Why the fight against Covid-19 is different in Bangladesh
The socio-economic and economic infrastructure of Bangladesh is different as compared to other well-developed countries. Due to its large population, poor health care system, poverty, illiteracy, lack of health awareness, social divisions, etc., fighting against coronavirus is much more challenging than in developed countries
The Covid-19 is continuing its killing rampage; it has claimed over 30 lakh lives in the last 15 months worldwide. Fighting against this unseen killing machine is not easy and therefore we have to be prepared for a long battle. The first and foremost task to fight the virus here in Bangladesh is to understand its core as well as to pinpoint our own constraints.
Coronavirus will not go away soon
Scientists cannot predict when the virus will be eliminated from the face of earth but there is no doubt that it will not go away anytime soon. As a natural process, this virus is genetically changing, giving rise to new varieties randomly which could be lethal or weaker than before.
Several versions are already available (UK version, Brazilian version, South African version). To eradicate coronavirus, most people in a country need to have antibodies against it. It can be achieved naturally through infection and vaccination. This condition is called hard immunity.
In order to create herd immunity through vaccination, about 65%-70% of the people in a country need to be vaccinated in a short period of time. The harsh reality is that in a populous country like Bangladesh, it is very difficult. Developed countries with strong health care systems, adequate health awareness, and low population density may be able to bring the whole country under the vaccine.
In Australia, for example, vaccinating about 17 million people can achieve the desired herd immunity. On the other hand, about 100+ million people need to be vaccinated in Bangladesh. Procuring so many doses of vaccines and managing vaccination at the field level is the biggest logistical challenge in where developing countries are struggling for sure.
Moreover, it is not yet known how long the vaccine will be effective. In a recent article in the world-renowned journal Nature, scientists speculated that if immunity against the coronavirus (vaccine or natural) lasts one year, it will pop up again and again until 2025. It can become seasonal or endemic like influenza. The point is, coronaviruses are not easy to eradicate and we need to learn to live with them and plan accordingly.
The weak healthcare system and lack of research culture- the biggest challenges
The health system of Bangladesh is very fragile, as was made crystal clear during this pandemic. It is sad but true that the per capita health expenditure is only USD 31 in Bangladesh and this is very insignificant compared to any developed country (for instance, per capita health expenditure for Australia is USD 6000).
With so little allocation, then a culture of inherent corruption has exacerbated the situation. Due to the established research culture in developed countries, information-based decisions are made. On the other hand, research culture is missing in our country. Therefore, the data quality of the related Covid-19 pandemic is also questionable. Bangladesh does not have the ability to achieve a positive outcome from lockdown what developed countries are achieving.
Why is country-wide lockdown a wrong concept?
The socio-economic and economic infrastructure of Bangladesh is different as compared to other well-developed countries. Due to its large population, poor health care system, poverty, illiteracy, lack of health awareness, social divisions, etc., fighting against coronavirus is much more challenging than in developed countries.
For example, Australia has so far succeeded in controlling the Covid-19 pandemic because every person is being compulsorily quarantined before entering the country. When a necessary lockdown is imposed area-wise for a few days for contract tracing and performing thousands of tests for suspected people, the government takes responsibility for those who are unable to support their families due to restrictions.
Considering all these factors, Bangladesh does not have that ability. So the Covid-19 control model of developed countries is not the appropriate one for Bangladesh. When these foreign models are applied, it usually backfires. In order to formulate our policy, we need to consider our socio-economic issues and good quality data.
Importantly, thus far, nearly four crore people of the country have gone below the poverty line due to the multiple lockdowns. This poverty figure is now 42% while it was around 21.7% before Covid-19. About 78% of the people in Dhaka lost their jobs. On the other hand, the citizens of developed countries are under the support system of the government.
Although there is no outbreak or not so many reported cases in many parts of the country (urban and rural areas), the lockdown has been imposed on the whole country.
In stark reality, this indiscriminate and unplanned lockdown can help to spread the virus in those relatively safe areas since low-income earners in Dhaka are forced to leave the city and return to their villages. Therefore, the spread of the virus cannot be controlled in a country like Bangladesh only through lockdown without other measures.
The purpose of the lockdown at the first wave was not successful. Infections have not decreased; rather increased. The purpose of the lockdown is to reduce the pressure on the hospital and to delay so that we can take more preparations (such as vaccinations, building treatment centers). The reality is that we haven't been ready for that in one year. Keep in mind that even if the infection is theoretically reduced for a short period of time with lockdown, it will return.
How much has Bangladesh achieved in the last one year?
The exact number of ICU beds for covid patients in Bangladesh is still unknown! Different types of information are surfacing in different news portals.
The oxygen distribution system has not been developed at the district level. Everything is basically Dhaka-centric. Most of the patients died due to multiple organ failures while they were being brought to Dhaka. Many patients could have been saved if only oxygen supply had been ensured at an early stage. In countries where oxygen supply cannot be guaranteed, reckless decisions like lockdowns come as a surprise.
What should be the Covid-19 control strategy for Bangladesh?
1. Public-private joint venture to establish treatment centres in every district
About 80% of the people in Bangladesh seek healthcare in private hospitals or clinics. In other words, the capacity of the private system, in particular, is higher than that of the government. On the other hand, government management is very weak and corruption is also a big problem.
So fighting a deadly Covid-19 pandemic, government alone will not succeed. To save lives, the government should take initiative to ensure treatment facilities (adequate high-flow-oxygen system, ICU beds) in a short period of time by collaborating with reputed private hospitals in every district.
Unused resources have to be used for the needs of the country. Moreover, it is time to motivate the big businessmen of each district to get involved in the needs of the country. A crisis like the current one can be avoided if treatment can be ensured at the district level.
2. Ensuring the procurement of vaccines
A vaccine is the most viable and effective tool for fighting this virus at the moment. In order to get more people vaccinated, pre-orders must be made to ensure enough doses.
3. Area-based Lockdown or restrictions
Area-based smart lockdown can be given instead of giving unnecessary lockdown to the whole country if the situation is more deplorable. Lockdown without adequate treatment will be a boomerang.
4. Engaging religious scholars to increase community-level awareness and participations
Research initiated by Georgetown University in collaboration with BRAC has shown that there is no way to deny the influence of religious leaders at the community level in Bangladesh. The report recommends involving local religious leaders in community development.
Everyone is a victim of the country's catastrophe. Therefore, the scholars should contribute sincerely. Just issuing a notification through the Islamic Foundation does not work at the community level. In order to penetrate at the community level (for vaccination and implementing safety protocols), it is important to involve the community leaders in the way that NGO leaders are given importance.
5. Reorganisation of the national advisory committee
In order to build trust among general people, eminent scientists (expatriates as well), trusted public figures, religious leaders, and sociologists should be included in the National Advisory Committee for policy making.
6. Taking the initiative to achieve political unity
The COVID-19 pandemic is a global problem. Even developed countries are struggling. The situation of our country is far worse. It is impossible to deal with any national crisis without the confidence of the people.
Therefore, it is important to reach a political agreement to restore confidence among the people at all levels. In this regard, the government has to take the initiative for political reconciliation to save the lives and livelihood of the people in the country.
Mohammad Sorowar Hossain, PhD is a Public Health Researcher. He is the executive director of the Biomedical Research Foundation of Bangladesh and an associate professor at the Independent University of Bangladesh.
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.