In many COVID-ravaged parts of Bangladesh, the difficult truth remains that people continue to fear the inaccessibility of health care facilities above and beyond the virus itself. This says a lot about a stark reality where the loss of livelihoods brings with it the loss of lives, and where lockdowns and restrictions are a double-edged sword.
Iftekhar Ali is an associate program officer at Research Initiatives, Bangladesh (RIB), where he works with small farmers, marginal communities, and youth on issues like agroecology, participatory action research, and climate change.
Vinod Koshti is a project manager at the Rosa Luxemburg Foundation’s South Asia Office in New Delhi. He works on agrarian crisis, sustainable agricultural practices, and climate change.
The authors express their sincere thanks to Neha Naqvi in helping draft this article.
People catch wind of the fact that vaccines are being made available in several parts of the world. They remain painfully aware however, that these very vaccines will remain well out of reach for many. It’s as if the country has internalized the fact that rich and developed parts of the world—where the giant corporations are based—will continue to have a monopoly over both production and access.
A crisis of our collective humanity is brutally playing out in which profit and vested interest dictates action—where saving lives across the board comes secondary. The health care situation in Bangladesh is aching for global solidarity as it reels from the pandemic and its aftermath. The testing centres, laboratories, vaccines, and intensive care facilities are ill-equipped to meet this moment. The skewed balance of forces warrants a collective, immediate response.
Inadequate and Inaccessible
In March 2020, as COVID-19 descended upon Bangladesh, the country had a single laboratory to conduct the rRT-PCR tests that detect unique sequences of the virus. As recently as July 2021 (despite support from the WHO and other agencies), Bangladesh had just 648 public and private laboratories across the country. This meant 132 rRT-PCR labs, 52 GeneXpert labs, and 464 Ag.RDT centres, mainly located in district headquarters, sub-district headquarters, and city municipalities.
A country with a population of over 169 million has merely 648 testing centres, meaning that each centre is responsible for more than 260,000 people. As of 15 July 2021, the total number of samples tested was approximately an abysmal 7.1 million.
A rapid telephone survey conducted by Research Initiatives, Bangladesh (RIB) with support from the Rosa Luxemburg Foundation in July 2021 in nine villages across three districts determined that these testing centres were an average distance of 16 kilometres from the villages Berakuthi, Sorkarpara, and Joychondi in Nilphamari district; 23 kilometres from the villages Noyapara, Baluartair, and Majhbari in Bogura district; and at 11 kilometres from Dhumghat and Patrakhola in Satkhira district. Bongshipur village in Satkhira district was the closest to a testing centre, at 5 kilometres.
The farmers surveyed were emphatic about it being too expensive for most rural persons to travel such great distances just to access testing centres (located at the district and sub-district levels alone). None of the 180 farmers contacted during the telephonic survey ever got tested for COVID-19.
According to Rashida Begum, a woman farmer from Sorkarpara village in Nilphamari district, people were essentially afraid. Were they to test positive they would have to be quarantined for 14 days, which would severely impact income-generating activities and agricultural work. Barely anyone thinks about getting tested. In her view, there is far too much at stake.
Apart from issues connected with accessibility, another crucial factor is affordability. An rRT-PCR test in a government centre costs 100 Taka (roughly 1 euro). Private centres charge 3,000 taka. Even the cost of an Ag. RDT (rapid antigen) tests cost 700 taka (7 euro). For people living with massive income losses or reductions in the number of days of employment, it is well beyond both their imaginations and financial means to spend such huge sums on testing alone.
According to the Bangladesh Development Update (BDU) released by the World Bank in April 2021, 56 percent of those who did not own their homes were reportedly unable to pay their rent in full in the prior month. Food insecurity (measured through self-assessments) was substantial. 54 percent of respondents expressed concerns that they would run out of food, 41 percent spoke of having to reduce consumption of their preferred food, and 32 percent mentioned running out of food or money in the weeks preceding the interview. In such a situation—with families struggling to get by from day to day—it comes as no surprise that testing would be the least of one’s worries.
The telephone survey further revealed that instead of testing in the event of illness, villagers preferred to buy over-the-counter medicines from a nearby pharmacy or utilize home remedies like lemon juice, ginger, and other herbs to ease symptoms. Younus Ali, a respondent from Joychondi village in Nilphamari, shared that most of the villagers in his vicinity considered and treated their illness as seasonal or common flu.
The general perception across several villages was that rural masses were somehow less vulnerable to COVID-19. Among other things, it flowed from the mistaken belief that living in harmony with nature, eating fresh food, and performing a lot of physical labour combined with exposure to the elements (sunlight, soil, and water) would automatically result in an indefatigable immune system. These misconceptions are further cluttered by the idea that the coronavirus mainly attacks city dwellers due to their high population density, pollution, and relatively sedentary lifestyles. Thus, in addition to inaccessibility and unaffordability, a significant role is played by misinformation.
Bangladesh definitely requires more testing centres and affordable testing kits. The fact that scientists from Bangladesh had once come within inches of developing one of the very first antigen kits is ironic, to say the least. Prof. Ahmad A. Azad, an expert on biotechnology, argues that local production of recombinant proteins for antigen kits should be actively encouraged and supported by the government.
The Struggle to Obtain Vaccines
Bangladesh is dependent on other countries to obtain sufficient doses of COVID-19 vaccines for its population. Bangladesh initially signed a contract with the Serum Institute of India (SII) to procure 30 million doses of Covishield, an Oxford-AstraZenaca vaccine. India sent 3.3 million doses as a gift. As early as February 2021, Bangladesh had received 7 million doses of vaccines.
But SII could not deliver on their promise of further doses when the second wave ended up decimating India’s health care system and claiming many lives. As a result, the government of Bangladesh was forced to stop administering first doses of Covishield on 25 April. Up until then, Bangladesh had administered over 10.1 million Oxford-AstraZeneca vaccines. Among them, 5.82 million people had received their first dose, while 4.28 million got their second. Over 1.4 million people are still waiting to get their second dose.
For almost a month, the government failed to obtain further vaccines for the population. In June, Foreign Minister A.K. Abdul Momen expressed scepticism about efficiently procuring vaccines, stating that “we have discovered, with shock and disappointment, that global politics and affluence-power nexus have overpowering dominance in the global society.” He further stated that COVID-19 vaccines should be made a public good and technology should be shared and made available to all countries so that they can produce them at affordable prices, in large quantities.
Eventually, the country approved emergency use of US-made Pfizer-BioNtech and Moderna, China’s Sinopharm and Sinvac, Russia’s Sputnik V, and Belgium’s Janssen vaccines. Bangladesh will procure 15 million doses of the Sinopharm vaccine. The US already gifted 2.5 million doses of Moderna, while China gifted 1.1 million doses of Sinopharm in May and June.
By July 2021, Bangladesh had procured 9 million doses of vaccines and another 7 million were received in gifts or aid. Over the next two months, another 5 million procured doses are expected to arrive, while another 9.5 million are expected in aid. According to the chairman of the parliamentary standing committee on the Foreign Ministry, Muhammad Faruk Khan, if the current import continues, the targeted 80 percent of the population will not be vaccinated before 2024.
According to local experts, to develop herd immunity and avert the development of new, dangerous variants, Bangladesh needs to vaccinate at least 120 million people within 12 months. Based on this calculation, Bangladesh requires close to 20 million vaccines every month. The existing number of committed vaccines is nowhere near this figure. By 31 July 2021, only 2.71 percent of Bangladesh’s population had received a first dose of the vaccine, whereas only 2.63 percent were fully vaccinated against COVID-19.
Therefore, the alternative is to produce effective and affordable vaccines within the country. A Bangladeshi pharmaceutical company developed an mRNA vaccine for COVID-19, but it is still awaiting permission to commence clinical trials. According to Azad, the pharmaceutical sector in Bangladesh has the capacity to produce recombinant subunit and viral vector vaccines. In his view, instead of depending on foreign countries alone, Bangladesh should actively start investing in and promoting more research on developing indigenous vaccines.
Health Must Become a Higher Priority
Bangladesh’s total COVID cases number more than 1.25 million, with around 20,685 reported deaths by 31 July 2021. They began rising sharply again in July, with 13,734 new cases and 234 reported dead on 31 July alone. The positivity rate had gone up to 60 percent in the districts of Khulna and Rajshahi in June.
For the country’s population of over 169 million, there are just 12,034 beds for COVID patients in 110 government and private hospitals, with 56 percent of the beds concentrated in the capital region around Dhaka. Out of these, intensive care unit (ICU) facilities are available in only 48 hospitals. Of the 64 districts in the country, 35 district government hospitals do not have any ICU facility. Out of 1195 ICU beds in government and private hospitals, 826 are in the capital city of Dhaka, with 442 in private hospitals. Chattogram, the second major city in Bangladesh, has only 59 ICU beds. There are merely 310 ICU beds in the rest of the country. Across 29 districts, there is no hospital with a centralized oxygen supply system whatsoever.
For the last twelve years, public spending on the health sector has remained below 1 percent of GDP. For this fiscal year, the government of Bangladesh announced a budget allocation of a meagre 0.95 percent to the health sector. There is no specific allocation for procuring vaccines. In this light, government’s claim to dedicate “as much funds as required” towards mass vaccination programmes rings hollow.
At this critical juncture, thousands are needlessly and cruelly dying from a blatant lack of health infrastructure. It should weigh heavy on the collective conscience that public spending on the health sector is not getting the government attention it deserves. The capacity to conduct COVID-19 tests, screening, isolation centres, centralized oxygen supply systems, COVID-19 hospitals, and ICU facilities all require urgent prioritization. In addition, public education, risk communication, and community mobilization is paramount.
Addressing this pandemic effectively requires counting every voice in. The several counts on which Bangladesh is being devastated by COVID-19 has repercussions for the entire global community. Immediate action is the need of the hour. The interconnectedness of our lives has never been more apparent than it is today.
 The WHO authorized the use of the GeneXpert platform for testing COVID-19 patients. It is a rapid test for COVID-19 with a processing time of around 45 minutes and less cost. Less expertise is required, and it can prove lifesaving in emergency situations, as interventions can be performed at even earlier.
 The antigen detection rapid diagnostic test (Ag-RDT) directly detects viral proteins or antigen of SARS-CoV-2, the virus that causes COVID-19. This test is less sensitive than rRT-PCR, but easy to use, and allows tests results to become available in less than 30 minutes.