Health experts fear that the socio-political situation of the country might lead to the criminalisation of the distribution of Covid-19 vaccinations in Bangladesh.
Since deserving candidates and marginalised groups may be sidelined for the vaccination in favour of more privileged individuals, they proposed that the private sector be allowed to import the vaccines, with central oversight by the government.
They made the remarks Sunday at a webinar titled "Access to Covid-19 Vaccine in Bangladesh: Who, When and How?", jointly organised by the Citizen's Platform for SDGs, Bangladesh, and the Bangladesh Health Watch.
"Powerful people in the country will get the shots first. I believe vaccination distribution will be criminalised here," Professor Rashid-E-Mahbub, chairman of the National Committee on Health Rights Movement and also the former president of the Bangladesh Medical Association, said during the webinar.
AFM Ruhal Haque, former health minister and also the chairman of Parliamentary Standing Committee on Ministry of Science Technology, echoed Prof Rashid.
He said the government's inoculation plan might face challenges in vaccinating people aged above 60 years or those with comorbidities. "Here in Bangladesh, might is right. It will be difficult to control who will get vaccinated first," he noted.
Ruhal Haque pointed out that Bangladesh does not conduct antibody tests and the country's RT-PCR testing often produces flawed reports.
"You may not have done things right the first time. This does not mean that you will not course correct in future. We can immunize people later who have already developed antibodies for the virus," the former minister added.
Ruhal Haque is currently serving as a member of the Parliamentary Standing Committee on Ministry of Health and Family Welfare. Referring to child immunization under the health ministry, he said Covid vaccination and child immunization are completely different.
He emphasized on strengthening post-vaccination monitoring for Covid vaccinations, and also advocated for vaccine import by the private sector under government control.
He also said the existing cold storage capacity is being ramped up to accommodate the Covid-19 shots.
In the keynote paper, Mushtaque Raza Chowdhury, convener of the Bangladesh Health Watch and also the former vice-chairperson of Brac, marvelled at the fact that the world is all set to receive the shots within just ten months of the pandemic.
"But this also raises multiple questions, including how long the vaccine will protect us for, whether it will protect people of all ages, or whether the shots will protect us from new strains of the coronavirus," he stated.
Mushtaque Raza Chowdhury also pointed out a newly developed nationalism, leading to many wealthy nations racing to stockpile the shots.
He said this tendency could deprive many poor countries of access to vaccines, spurring Nobel Laureates, including Dr Muhammad Yunus, to step in with the "Vaccine-A global common good" message.
The keynote paper said that Bangladesh could gain herd immunity if 80% of the people are vaccinated. Upon receiving the shots from Oxford and Covax, the country will immunize 5 crore people during its first phase.
Mushtaque Raza Chowdhury said, "The country's vaccine plan is optimistic as the health minister has said that the vaccine will be available in the country by 15 January. But the Oxford vaccine has not yet been approved. The race over vaccinations can eliminate the elderly, poor or marginalized people."
Senior Scientist to the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Firdausi Qadri said though the first phase of the inoculation may show numerous side effects, people really do not have a choice.
"We have to be brave and take the shot," she said, adding that the vaccine development plan includes a close monitoring of the side effects.
Dr Bijon Kumar Sil, eminent vaccine expert, said: "Who will get the vaccine and who is eligible for it – these questions must be scientifically determined."
He suggested that those who have recovered from Covid-19 and those infected with Covid-19 should not be entitled to the jab.
"Only those who do not have antibodies to fight the coronavirus should be deemed eligible for the vaccine shot."
The health expert said it is not possible to argue about the merits and demerits of the vaccine within just 10 months of research. Such a determination will take at least five years.
Hamidul Islam, cold-chain specialist, UNICEF, said EPIA has enough cold chain vaccine boxes to store them at a temperature of 8-20°C. EPIA has also a system to store the five lakh Oxford vial vaccines.
The COVAX vaccine will be late, and if multiple vaccines arrive simultaneously, storing them all will be a challenge.
Dr Mohammad Sorowar Hossain, scientist and executive director, Biomedical Research Foundation, said the government should not only rely on COVAX, but should also place advance orders for the best vaccines.
The vaccine should be procured in bulk by the government, and domestic companies should bottle them.
Prof Rumana Huque, Department of Economics, University of Dhaka, said countries that participated in the vaccine trial could negotiate to receive the inoculations on a priority basis. The government, therefore, should join the trial with the vaccine companies.
Rumana fears that people may lose confidence in vaccines following their arrival in the country.
CPD Distinguished Fellow Rounaq Jahan said dissemination of information from the government to the people must be as transparent as possible.
She suggested that all the information about the vaccine plan should be uploaded onto the website, so people are fully informed, adding that frontline workers should receive the vaccine on a priority basis.
In addition to this, people in the garment sector and in slums should be prioritized for the vaccine shots, suggested the analyst.
Prof Md Habibe Millat, member, Parliamentary Standing Committee, Ministry of Foreign Affairs, said, "We have EPIA's solid reputation behind us and so there will be no problem in storing the vaccines, but lack of manpower is a challenge."
He said two-three pharmaceutical companies in the country have the capacity to produce vaccines.
"If we try harder, we will be able to produce the jabs on our own in a year or two, and we need to increase both the budget and capacity of the health sector."
CPD Distinguished Fellow Debapriya Bhattacharya, convener, Citizen's Platform for SDGs, presided over the event.
He said owing to the socio-economic and political situation in the country, many marginalised people find themselves deprived of their due rights.
"If there is any discrimination at play in vaccination distribution, a global campaign to regard the vaccine as a public good will be seen as plain hypocrisy."
The immunisation programme will be one of the most-talked-about issues of 2021 in Bangladesh.
"We need to make sure that marginalised people are not deprived of the vaccinations."
Debapriya said the government's sound policies are not always correctly implemented due to a number of socio-economic and political factors. Key issues are transparency and information flow, and everyone must take steps in this regard.
There must be administrative accountability on the part of the government, democratic accountability on the part of the people's representatives and social accountability on the part of the citizens, he said, adding that only then will a good plan be well-managed.