As I settle down to pen this write-up, the incessant calls and messages on my phone serve as a poignant reminder of how our lives have been reshaped and defaced by the Covid-19 pandemic. In response, I offer what medical advice I can regarding Covid tests, treatment and follow-up, but can't oblige the requests of help with admissions in hospital beds, especially in the Intensive Care Units (ICUs). There are no vacancies anywhere, it seems. The increasing frequency of the news of deaths of near and dear ones is unnerving and unsettling. A year on, and we're back to square one. It has been a little more than a year since the first coronavirus cases were detected in Bangladesh, but the same, if not deeper, challenges and uncertainties remain.

"Building a fairer, healthier world" is the theme of World Health Day this year, which marks the 73rd founding anniversary of the World Health Organization (WHO). Before I dissect the aptly named theme in the context of the pandemic, I want to touch base first. Since the first coronavirus cases were detected on March 8 last year, Bangladesh's pandemic journey has been a predominantly unpredictable one so far. A total of 651,652 people have been infected and 9,384 people have sadly lost their lives thus far, amounting to a mortality rate of 1.44 percent. The morbid part of this statistic is that these numbers are ever rising. An indicator to that end is the record high, staggering test positivity rate (infection rate) of 23.40 percent recorded two days ago, and the country has been forced into a lockdown once again.

When the first wave of the pandemic hit home last year, it truly was a jolt to an already beleaguered health system grappling with inadequate financial allocation and unequal distribution of manpower and resources, coupled with a weak governance structure and undeniable mismanagement. The sudden surge in Covid-19 cases, Covid-19 related deaths and a dearth of hospital beds and ICUs at that time brutally exposed the gaping cracks of a health sector whose budget allocation for fiscal year 2021 stands at 5.14 percent, which is a meagre 0.9 percent of the country's GDP. A few months into the pandemic, despite a myriad of challenges and the initial shock to the system, the brave and selfless healthcare professionals of the country—doctors, nurses and other providers—were able to treat and manage patients better with improved outcomes, marked by better recovery rates and reduced mortality.

The wider scale effects of the pandemic, however, was a far reaching issue, adversely affecting people's lives and livelihoods throughout the country—culminating in severe ramifications on an economy which had otherwise seen robust growth over the past decade. In the midst of this gloom, further evidence of the stoic resilience of the Bangladeshi people came to the fore. As infection rates kept dropping and relative normalcy was restored, with resumption in activities of business and commerce, the economy gained some momentum towards the end of last year. As a result, projections made in a study in early 2021 by Standard Chartered Bank Bangladesh stated that Bangladesh was likely to recover faster than its Asian peers from the Covid-19 fallout thanks to improving exports, growth in domestic consumption and remittance inflow.

After a welcome drop in cases between August and September last year, health experts had predicted that the second wave would hit the country during winter. However, that second wave has now hit us in March this year with renewed vigour, once again exposing a fragile health system. Were adequate measures taken to prevent this second wave? Well, the answer is not a clear cut one. Compared to the time of the first wave, the Ministry of Health and Family Welfare have established guidelines on an overall management system with lessons learnt in preparation for the second wave, and there has also been a sharp rise in the testing facilities and daily testing capacity. In addition, Covid-19 dedicated hospitals, dedicated beds and ICU beds have also been increased a few fold. Unfortunately, however, these increments have not proven to be enough to counter the ruthless second wave thus far, as is evident by a shortage of available hospital beds and ICU beds. Also, the plan undertaken last year of setting up temporary Covid hospitals with high bed capacities to counter peaks of infection did not come to fruition.

Another glaring deficiency is the lack of adequate high flow oxygen delivery systems across hospitals in the country, a good one year into the pandemic. High flow oxygen therapy is a vital component in managing very sick Covid patients. There could certainly be a better, more widespread allocation in this regard. Moreover, there has been a shortage of some essential drugs such as remdesevir and tocilizumab in the management of this infection, and adequate stockpiles will need to be ensured for the coming weeks and possibly months. It is also of utmost importance to step up and sustain the public health awareness campaigns and messages of health directives and information on the importance of getting vaccinated, as well as addressing any myths and safety concerns around vaccination.

The global vaccine race has also once again highlighted the glaring disparity in healthcare globally, which is a deterrent in achieving a "fairer, healthier world" as envisioned in this year's World Health Day theme. In a world of vaccine inequity, a handful of rich nations like the US, Canada, UK, countries in the EU, China and the UAE, among a few others, have hoarded almost 65-70 percent of the world's doses, despite having only 16 percent of the global population. It is estimated that these rich nations are vaccinating one person every second while the majority of the poorest nations are yet to administer a single dose. These high income nations have stockpiled one million doses more than is needed for their populations and is an embodiment of "vaccine nationalism".

It is with keen interest that I keep tabs on the vaccination programme in the country since this is the only sustainable way of reducing the infection load. We have a commendable history of successful vaccination programmes, including the Expanded Programme on Immunisation and other drives. Keeping in line with that track record, the vaccination drive is going well so far. The Oxford-AstraZeneca vaccine has been administered to approximately five million people since the first dose was given on January 27 as a "dry/test run" and since the official vaccination programme began on February 7. This means that around 3.5 percent of the total population will be fully vaccinated (two doses) within June of this year. This is a good achievement on the balance of things.

However, uncertainties around the ability of Serum Institute of India (SII) supplying doses on time, according to the agreement, means that we will now have to scramble to find other sources of safe and effective vaccines. The single dose, easy-to-preserve Johnson & Johnson vaccine, with an estimated efficacy of 90 percent, would be a good choice, but Chinese and Russian alternatives should also be explored. As we fight through the second wave of this pandemic, it is imperative that we vaccinate a majority of the population in the quickest feasible time, and sourcing different types of vaccines is crucial to that end.

Dr Naveed Ahmed is research coordinator, PCP, Centre for Health Research and Implementation, Diabetic Association of Bangladesh, and senior medical officer, department of internal medicine, at BIRDEM General Hospital.