Govt raises false cholera alarm
Cholera did not plague Bangladesh, at least officially, in the last decade, but the health minister has told a World Health Organisation (WHO) meeting that 'the disease is widespread' in the country.
A Bangladesh proposal was accepted by the executive board meeting in January this year in Geneva on 'Mechanism for Cholera Control and Prevention', aimed at emphasising cholera surveillance and oral cholera vaccine to prevent the water-borne disease.
The draft proposal will be discussed in the upcoming world health assembly in May this year. Once the issue is accepted, cholera surveillance will start in the country and the vaccine will find its way to the national vaccination programme.
Experts, however, smell a rat over the health ministry's move. They believe ICDDR,B has pushed the government to speak up about cholera, as they are conducting a feasibility test of oral cholera vaccine in Mirpur.
Health minister that it was a milestone for Bangladesh that or the first time that any resolution had been accepted by WHO.
In the board meeting, the minister also said Bangladesh saw cholera peaks twice a year – before and after monsoon. But did not find any record of cholera outbreaks in the Directorate General for Health Services (DGHS) records.
The latest health bulletin says diarrhoea is a highly prevalent communicable disease in Bangladesh. It also reports the number of diarrhoea incidence in the last seven years (2003 to 2009), but cholera finds no mention.
The diarrhoea control room of the government could also not speak of any cholera patient in 2010.
"Of course, we had cholera," the minister said.
"ICDDR,B finds cholera patients every year," he said and argued, "This is also our organisation". In fact, Bangladesh is the highest donor of the institute.
But surprisingly, even ICDDR,B also does not record any cholera patients.
A health rights activist Prof Rashid-e-Mahbub strongly criticised the government move.
"A vested interest was active for marketing cholera vaccines in Bangladesh," he said, adding that ICDDR,B was only pushing the agenda forward.
Former president of Bangladesh Medical Association Prof Mahbub said Bangladesh did not need cholera vaccines, as ensuring safe water alone could keep the bacterium at bay.
"And how it could be a problem when the government does not report any cholera cases in the country?" he wondered.
He also questioned the presence of ICDDR,B scientist in the executive board meeting in Geneva.
ICDDR,B's principal investigator for cholera vaccine project Dr Firdausi Qadri was with the government team in Geneva during the 127th session of WHO board meeting in May 22, 2010.
The health minister placed the proposal in that meeting, but due to delay in distributing the draft, only a brief discussion could take place, and the issue was deferred for January 2011 meeting.
"We took the opportunity as many South African countries are now facing cholera and WHO is looking for prevention mechanisms," the health minister told bdnews24.com.
Referring to ICDDR,B he said, "We have best experts. They want our support and we also want their success."
A health ministry official told bdnews24.com that it was an ICDDR,B's agenda to project Bangladesh as a 'cholera country', as they started a five-year project in Mirpur in November 2009 to see whether oral cholera vaccine decreased cholera and severe diarrhoea.
Besides, he said they (ICDDR,B) had sponsored some officials to Geneva, so that the government could place the cholera issue in the meeting.
Dr Qadri said they were working together with the government. "It's also a government project, as we are using staff and support from Expanded Programme on Immunisation (EPI)."
"We help government in many ways…one or two officials might have been sponsored by us," she added.
Moreover, though it is a feasibility study under which ICDDR,B had already fed oral vaccines to 160,000 people on trial basis, the project title is 'Introduction of Cholera Vaccine in Bangladesh', suggesting that it is already in the system.
To this, Dr Qadri said, "This name is to suggest that it would be incorporated in the country's vaccination programmes in future."
Manufactured by an Indian company Shantha Biotech, sister concern of Sanofi-Aventis, the vaccine 'Shanchol' was fed in two doses between February 17 and April 16 this year.
One of the project purposes is to assist in transferring the cholera vaccine technology to Bangladesh to make it more affordable, available and cost effective, according to Dr Qadri.
She said since there was no scope to improve water supply and sanitation, the vaccine would be the choice to prevent the disease.
A Sweden-based vaccine scientist Shahjahan Kabir, however, told bdnews24.com that he knew about the ICDDR,B's large-scale field trial of an oral cholera vaccine.
In 2006, the vaccine was tested in the slums of Kolkata in India.
"British medical journal The Lancet reported in 2009, the vaccine offered poor protection, as its one-year protective efficacy is only 45 percent."
He said it had been propagated as a cheap vaccine. But in India, the two-dose oral vaccine was being sold by the producer at a cost of INR 60O (12 USD). "It is absurd that a vaccine that costs 12 USD in India should be regarded as cheap."
Besides, he said, all vaccine trials should be monitored by impartial observers.
"If vaccine developers or their associates are involved in monitoring the trial, there is a strong possibility that false and fabricated claims on the vaccine trial will emerge as had happened in the 1985 oral cholera vaccine trial of ICDDR,B," he said.
"The institute tried another cholera vaccine 'Dukoral' without maintaining ethics," he said, adding that Dukoral was quite expensive now.
Public health expert Dr Mohammad Khairul Islam also criticised the proposal Bangladesh placed. "It does not match the factors that lowered child mortality in Bangladesh."
"The country had been awarded Millennium Development Goal (MDG) award for its outstanding performance in reducing child mortality.
"Diarrhoea or cholera is no more the major cause of children's deaths in Bangladesh," he said, adding that the health ministry might have served someone's interest through the proposal.
"It's may be any research organisation or vaccine producing company," he said.
The government had already taken steps with Tk 1,400crore Asian Development Bank's loan to change water pipes in the capital.
Besides, safe water for all by 2011 and improved sanitation by 2013 were also the ruling party's pre-election pledges.
"Once they could do it, diarrhoea will come down drastically in Bangladesh," Dr Islam, country representative of Water Aid, said.
A strong member of the WHO executive board, France also noted that prevention and control of cholera was closely linked to the achievement of MDG goals and safe management of drinking-water.
"Cholera control demanded inter-sectoral policies on water, health and education in order to ensure satisfactory sanitation, personal hygiene and access to drinking-water," the French representative told the May 2010 meeting.
He suggested that the Bangladesh proposal should highlight reduction of economic and social inequalities in health as they related to the subject of cholera.
However, in the revised proposal, Bangladesh has requested the WHO director general to explore the feasibility of providing oral cholera vaccines in low-income countries like Bangladesh.
The proposal also requests WHO chief to assess appropriate and cost-effective use of vaccine as part of broader vaccination efforts, and accordingly liaise with relevant international agencies for possible support.
