Vaccine procurement and a lack of transparency

Bangladesh's Covid-19 cases are on the rise again. On July 27, the country registered the highest number of daily Covid-related deaths so far: 258. At the time of writing this article, Bangladesh has crossed the grim landmark of 20,000 Covid deaths. The total caseload, on the other hand, is around 1.2 million. The situation at the district levels is worsening at the moment, with local hospitals grappling to provide medical care to the Covid-infected patients. And, after the Eid-related migration of people to their hometowns, the cases are expected to witness a further spike in the coming weeks. In the face of this crisis, our only defence is a robust and effective mass vaccination programme.

We understand that the government is trying to get as many vaccines as it can, from wherever it can. It is, therefore, very puzzling why the government seems to have ignored an opportunity when it presented itself.

On June 9, 2021, Gonoshasthaya Kendra (GK) had written an official letter, addressed to Foreign Minister AK Abdul Momen, offering the government the Russian-made Sputnik V vaccine at USD 8 per dose—below market price.

GK did it as a follow-up of a previous meeting held on June 6, where Gonoshasthaya Nagar Hospital—as the "exclusive distributor" of Sputnik V vaccine in Bangladesh, as appointed by LLC MEB TEX—submitted an initial proposal to the foreign minister. The foreign secretary and the DGHS DG were also present during the meeting. Later, however, DGHS DG denied knowledge of this, as reported by this daily.

Getting no follow-up response on the proposal from the foreign ministry, GK wrote a letter addressing the prime minister with the same offer on June 15—it again sent a reminder letter to the PM on June 22. On June 24, GK sent a letter to the Prime Minister's Office (PMO), this time addressing the prime minister's Principal Secretary Ahmad Kaikaus. In the letters, GK also offered to bring down the price further through negotiation. But there was no follow-up on the proposal, as disclosed to the media by GK.

The PM's principal secretary informed GK over email that "the government is directly negotiating with RDIF [Russian Direct Investment Fund] through our Ambassador in Moscow. We have already discussed and evaluated their supply ability. They are yet to provide us any confirmation of supply. Our Ambassador is constantly in touch with them." 

The proposal and the letters to the prime minister, her principal secretary, and the foreign minister had been officially received by PMO and the ministry of foreign affairs, as revealed by copies of the received letters and emails secured by this writer from GK.

However, prior to these offers made by GK, Bangladesh had shown considerable interest in Sputnik V vaccine. Earlier in May, Health Minister Zahid Maleque suggested that Bangladesh was interested to buy the Russian-made vaccine at USD 9.95 per dose—a higher rate compared to the GK offer.

Recently, on July 19, the foreign minister confirmed that such a meeting with GK did take place and that it was the health ministry that did not "go ahead" with the proposal, reported this newspaper. He further added that as per recent discussion with his Russian counterpart, Sergey Lavrov, the country, apart from exporting vaccine doses to Bangladesh, has also agreed to co-produce "bottling and finishing of the vaccine" as Russia will not share vaccine production technology till other countries do so, according to another local English newspaper. The foreign minister said: "Things are at final stage". Given the current Covid-19 situation in the country, one hopes that it is true.

Earlier on June 6, the foreign minister had also expressed similar confidence in procuring Sputnik V vaccine. "The agreements [with Russia] are in the final stage. Hopefully, they would be concluded soon," a local English newspaper had quoted the foreign minister as saying, following his meeting with the Russian ambassador. And then that was it.

One might remember that Bangladesh had initially authorised the emergency use of the Sputnik V vaccine in April 2021, with the expectation of receiving about four million doses by May. It was supposed to have been a government-to-government deal. There was also the possibility of Incepta Pharmaceuticals producing it locally, as DGHS was quoted by the local media. What happened to that deal?

Dr Mohib Ullah Khondoker of GK informed this writer that the company that appointed GK as the sole distributor in Bangladesh might already have committed some of the doses to other countries, who had been faster in their response to the offer. However, Bangladesh can still procure some doses if the government places the order now, Dr. Mohib added.

In the meantime, Bangladesh has received Pfizer, Moderna, and Sinopharm vaccines from the US, China and also under the COVAX arrangement. The country has also procured the Sinopharm vaccine from China. It is also expecting another 3.5 million more doses of Moderna vaccine as gift from the United States.

All this is good news. But we must keep in mind that Bangladesh is nowhere near achieving herd immunity. It needs about 250 million doses of vaccine to inoculate about 125 million people—around 70 percent of our total population of over 160 million—to reach herd immunity. But as reported by this newspaper, a total of 1.11 crore (or 11.1 million) people were vaccinated as of July 17, 2021. Of them, only about 43 lakh (or 4.3 million) people have received both doses.

The government aspires to inoculate 50 lakh people by the year-end, and is also looking at lowering the age bar to 18 for eligibility for inoculation. Currently, people aged 25 and above can get the vaccines. So far, the country has confirmed vaccine commitments from AstraZeneca though Japan (29 lakh doses), Moderna (30 lakh), Sinopharm (1.1 crore), and Johnson & Johnson (50 lakh). The commitment from Johnson & Johnson is under process. In addition to these, there has been another proposal of procuring an additional three crore doses of vaccine from Sinopharm.

However, in this recent development, there is no mention of the Sputnik V vaccine. According to media reports, Bangladesh is paying USD 10 for the Sinopharm vaccine. The price of Sputnik V, as quoted by GK, is lower.

Moreover, Sputnik V's efficacy against the brutal Delta Variant is almost 90 percent, as reported by the media citing a study by the vaccine's developer Gamaleya Institute. So, what is taking so long in procuring Sputnik V vaccines? If there is any concrete reason behind why despite authorising it in April the government has made no concrete headway in procuring Sputnik V, they should make it clear to the public.

Let us not forget that it is taxpayers' money that pays for these vaccines. The public deserves to know in detail what the plans are regarding mass inoculation. The government must also factor in the duration of the effectiveness of vaccines in designing such a plan. We do not know yet for how long these vaccines will provide us immunity from the virus, even for people who have received both the doses.

The government needs to ensure full transparency in the vaccine procurement process, including the prices, the standardised procedures that are being followed, and the third parties that are involved in these procurements: the third-party roles and why they are required in the process.

There is no alternative to mass immunisation within a certain period of time to achieve herd immunity and defeat the disease. Any delay in immunisation can lead to disastrous consequences. Partially immunised population in a setting where viral transmission rates are high are more likely to trigger the emergence of new variants, with greater transmissibility and deadliness, reported The Wall Street Journal citing scientists.

"That middle part, where you have a partially vaccinated population, or a partially immune population with lots of virus circulating, that's kind of your danger point," the publication quoted Emma Hodcroft, a molecular epidemiologist at the University of Bern. The situation in Bangladesh is headed in the same direction. "New variants could also reduce the effectiveness of Covid-19 vaccines and treatments and lead to reinfections among people who have already recovered from Covid-19, scientists say," added The Wall Street Journal report.

We cannot risk such a situation.

Transparent and timely procurement of vaccines, strategic and effective immunisation, among other parameters, will determine how effectively we can fight this virus. Hundreds and thousands of lives are at stake. The government must not fail them.

Tasneem Tayeb is a columnist for The Daily Star. Her Twitter handle is: @tasneem_tayeb