Sixty years of icddr,b: From oral saline to polio eradication - saving millions of lives globally

This year marks a major milestone in the history of icddr,b. Sixty years ago, at the onset of a major cholera pandemic, the then-SouthEast Asian Treaty Organization (SEATO) established a small laboratory in Dhaka named Cholera Research Laboratory  to be operated under National Institutes of Health (NIH), USA. 

Later in 1978, this became the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) through a Government Ordinance followed by a World Health Organization (WHO) meeting in Geneva in 1979, which was chaired by UNDP and attended by 50 participants of 26 developing and developed countries, and agencies. A memorandum of understanding was signed by eighteen of those countries and agencies endorsing the Centre as an international entity.

With funds from the Government of Bangladesh and others, icddr,b has produced some stunning breakthroughs in scientific innovation, treatment, patient management and disease prevention and helped save millions of lives globally.

Here are some of icddr,b's greatest scientific discoveries:

icddr,b hospitals maintain a motto of turning no patient away. Photo: Courtesy

Discovery of life-saving ORS

icddr,b developed and carried out the first successful trial of Oral Rehydration Therapy (ORT), now known as Oral Rehydration Solution (ORS), The results were published in The Lancet in 1968. Within a decade, WHO, UNICEF, UNDP and other INGOs promoted the use of ORS and delivered millions of ORS sachets every year across the world.

icddr,b also discovered Labon-Gur saline in 1978 which was subsequently scaled up across the country by health workers of BRAC and other NGOs. 

In Bangladesh, ORS helped reduce diarrhoeal disease mortality among children under-five from 15.1 per 1000 to 6.0 per 1000 live births between 1980-2015. Over the same period, similar reductions were observed in the burden of diarrhoeal diseases.

In 2007, Fontaine, Garner, and Bhan estimated that more than 50 million children have been saved by ORS between 1982 and 2007 – that is on an average two million lives a year. Based on the estimates, the number of children saved from 1982 until 2019 could be more than 70 million.

In June 2012, The Lancet recognised ORS as "the most important medical discovery of the 20^th century."

Local woman making Labon-gur (common salt and molasses) oral rehydration solution at home during 1979-80 in Matlab, Chandpur. Photo: Courtesy

Ending the discriminatory use of injectable cholera vaccine

In 1970, scientists found the only available and used whole-cell injectable cholera vaccine confers low protection. Subsequently, the 26^th World Health Assembly in 1973 abolished the right of countries to require travellers from developing countries travelling to developed countries a certificate of vaccination against cholera saving billions of dollars.

Reducing fertility in Bangladesh and beyond

In 1977, Maternal, Child Health and Family Planning interventions began in Matlab, Chandpur, Bangladesh which was soon scaled up by the Government of Bangladesh. It resulted in a remarkable drop in fertility from 6.3 in 1975 to 2.1 in 2016 in Bangladesh after the scale-up. 

The Matlab service model was later successfully replicated in Ghana and was subsequently disseminated from Ghana to neighbouring African countries.

In the sixties the lower deck of the barged was used for treatment of diarrhoeal patients, and the upper deck housed scientists and doctors. Photo: Courtesy

Maternal and neonatal tetanus elimination 

In 1980, scientists found that newborns of mothers who received a tetanus toxoid vaccine before pregnancy were 75% protected from neonatal tetanus. As a result of this finding, WHO, UNICEF and partners have immunised more than 154 million women in 53 countries and helped eliminate the disease from 47 countries.

The beginning of oral cholera vaccine (OCV)

In 1985, the first ever OCV trial was launched in Matlab, which eventually led to the development of easy-to-administer and affordable OCVs. This resulted in WHO stockpiling OCVs. More than 50 million doses of OCVs have been distributed in cholera endemic countries across the globe saving millions of lives. Icddr,b has also facilitated the knowledge transfer to Bangladesh and the country now has OCVs produced by a local company.

Photo: Courtesy

New Vibriocholerae O139 serogroup discovered

In 1993, New Vibrio cholerae O139 Bengal was identified and later characterised. The world was warned about the emergence of a new infectious pathogen allowing preventive measures in anticipation of its spread.

Guidelines for treating severe malnutrition

In 1999, an icddr,b protocol for 'Management of Severely Malnourished Children' saw a decrease in case fatality from 20% to less than 5%. This was later published in The Lancet and was endorsed by WHO in the South Asian region.

Zinc treatment for diarrhea

In 2002, scientists discovered that zinc treatment of diarrhea reduces overall mortality in young children. In 2004, zinc was recommended by WHO and UNICEF as the only treatment to be coupled with oral rehydration salts for the treatment of all diarrhea episodes. This has significantly helped many developing countries reduce child mortality.

Photo: Courtesy

Influenza vaccine significantly reduces illness in infants and mothers

Between 2008 and 2010, scientists found that if pregnant women were given influenza vaccine, it reduced illness by 63% in infants under six months and reduced respiratory infections among children and mothers by one third. It has also shown to increase newborns' birth weight. The findings resulted in WHO to recommend maternal immunisation during pregnancy with flu vaccine. The article on the findings received the "Bruce Squires Award" in 2012 from the Canadian Medical Association Journal.

Scientific breakthroughs that ramp up polio eradication effort

icddr,b scientists have proved different doses and intervals of polio vaccines (bOPV, mOPV1, mOPV2 and fIPV) to be more effective than initially thought. This has resulted in WHO to revise and accordingly undertake vaccination campaigns in Pakistan, Afghanistan, Syria, Laos, India, Sri Lanka, Nepal, Bangladesh and other polio endemic countries. These findings also helped to determine how to design the Global Polio Eradication Initiative to combat against type 2 poliovirus outbreaks. The articles published with these findings have received the Charles C. Shepard Science Award from CDC in 2016 and in 2019.

Photo: Courtesy

Ultra low-cost Continuous positive airway pressure (CPAP) device for severe pneumonia

In 2015, scientists invented an ultra low-cost bubble-CPAP for treatment of severe pneumonia in children, which has the potential to save thousands of infants from premature death. Large scale trials are underway in Bangladesh and in Ethiopia.

WHO has already endorsed bubble-CPAP oxygen therapy as one of the non-invasive ventilations for COVID-19 affected children with severe pneumonia and hypoxemia.

Microbes to combat malnutrition

The prestigious journal Science recognised icddr,b and the Washington University, USA's research on microbes to combat malnutrition as one of the ten biggest scientific breakthroughs of 2019. This work has the potential to revolutionise the treatment of malnutrition in children in the days to come. 

AKM Tariful Islam Khan is a Senior Manager, Communications at icddr,b

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.