In Bangladesh, Plenty of Vaccines but Few Takers

A speedy vaccine rollout is Bangladesh’s shining victory during the pandemic, but there aren’t enough takers for the shots, says Taufique Joarder, MBBS, DrPH, MPH, executive director of the Public Health Foundation, Bangladesh. Even as the country negotiated quick access to vaccines, it didn’t prioritize distribution planning and communications.

The paradox is one of many for the country’s COVID-19 response, including a lockdown that was called a “general holiday” as well as doctors locked out of their apartments by fearful landlords.

Joarder, who lives in Dhaka, shares insights on Bangladesh’s surging case numbers and other issues for Global Health NOW’s COVID Countries series.

Bangladesh

• Cases: 611,295
• Deaths: 9,046

Source: Johns Hopkins (as of April 1, 2021)

The Big Picture
In the past couple of weeks, suddenly, the numbers increased. I guess a couple of weeks ago, we had perhaps 100 or so cases per day, but today [March 26] it was 3,587 cases and 34 deaths. We don’t have a very reliable data. In the absence of a way to really verify, we just rely on what the government says. It can be an artifact of increased testing.

I heard from people working in government, medical, primary health care centers and rural areas that whenever there was a surge in cases, they received informal government directives that said, don't send your patients for testing, give them some medications. Because when it is tested, it's kind of difficult to hide the numbers.

The Mood in Bangladesh
If you go outside, I mean, you won't see any difference with from the like, pre-COVID situation. People are all around everywhere.

There was no good information like what can happen, what you can do, what you cannot do. Nothing was there. As a result, we read news articles like children deserting their elderly parents who had coughing, for example. They just deserted them in a jungle so that they can't return home. That happened.

I heard from so many of my doctor colleagues, physician colleagues, that they were actually driven out of their homes and they did not have any place to go because their landlord said, “Oh, you will bring in the coronavirus in our apartment.”

Government Response
Bangladesh does not have a very effective public health system. So firstly, the response was very clinical centric, all hospital centric. There was no effective communication. Secondly, the response was very much administrative rather than scientific.

During Eid [the Muslim religious holiday], traditionally, the Eid prayer is held in open places. [The government] gave us another directive to say your prayer in a mosque rather than in open places. Their directive was totally opposed to the scientific knowledge we had at that time [May 2020]. We were surprised. The scientific leadership was not really there.

Lockdown
They started lockdown on 26th of March and said it would last for one week. They just kept on increasing the time of the lockdown every week. People were not prepared to stay home for a longer time. And as a result, there had never been an effective lockdown in Bangladesh.

The government also did not use the term “lockdown.” They used “general holiday.” Some of my acquaintances used this general holiday as an opportunity to go to vacations to tourist places. A few got married. And when there is a wedding ceremony in Bangladesh, you have like thousands of people coming. And that's what exactly happened.

Vaccine Situation
The one good thing is that Bangladesh procured the vaccine quite early. They started vaccination on January 27. And they started vaccinating people in a larger scale from 7  February.

Interestingly, instead of like government procurement or going to COVAX, the government engaged a private pharmaceutical company to procure it for them. And it did not follow any, any transparent procedures.

Nobody really knew how this vaccine is going to be distributed, who is going to get the vaccine, or anything like that. When they started rolling out, they found that there was not many recipients, and they decreased the age bar from 55 to 40 years. Enthusiasts rushed in, and government was happy to call it a success. But after a few weeks, vaccination centers became almost empty again. My wife went to get vaccine just 2 days ago. And she reported that nobody was there in the vaccine center.

Expatriate Workers
In the beginning, it was termed a disease of the expatriates. Bangladesh has a lot of expatriate workers working in Middle East and Southeast Asian countries, Europe. So, when they returned, [the government] should have actually arranged good quarantine facilities. Instead, the government raised a red flag over the houses of the people who came from abroad. This stigmatized them and their family.

Worst Time
I would say the worst time was actually the early days. We were all confused. The whole city was like a ghost city. Nobody knew what's happening. Nobody knew who is in charge. So it was actually a terrible time.

Positive Moment
A positive moment is actually the vaccination. That was the only time we praised the government for taking very rapid actions. I got the vaccine. My friends are living in different countries, most of them said they need to wait at least four or five months before they get the vaccine, but we got the vaccine.

What’s happening in your country? To be part of GHN’s COVID Countries series, email Brian at bsimpso1 [at] jhu.edu.

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