Can we be doing more to ensure vaccine equality in Bangladesh?
Bangla-desh is facing one of its worst weeks since the Covid-19 pandemic first hit the country in March last year. On Monday, we saw the highest daily death toll since the pandemic began (164 lives lost) and yesterday, we had the highest number of new Covid-19 infections detected over 24 hours (11,525 new cases). Yesterday was the third day in a row where the daily death toll went over 150. The positivity rate is currently at 31.46 percent.
Amidst this worsening situation, the only silver lining is that we finally have vaccines in store, ready to be distributed across the country. A consignment of 106,000 doses of the Pfizer vaccine under Covax, the global vaccine alliance, reached Dhaka on May 31, and 11 lakh doses of the Sinopharm vaccine were gifted by the Chinese government at around the same time. Early this month, 25 lakh Moderna vaccines provided by Covax and another 20 lakh shots of Sinopharm vaccines bought from China, also arrived. According to reports, Bangladesh will be purchasing seven crore Johnson & Johnson vaccines from Covax as well.
After the sudden vaccine drought faced by the country when Serum Institute of India failed to deliver its promised shipments to Dhaka, the resumption of the vaccination programme is a light at the end of what often feels like an endless tunnel. The government has recently announced that the vaccination registration process will be open to the general public from Thursday, with anyone from 35 years of age being able to register.
While this is good news indeed, we must remind ourselves that only a meagre 3.5 percent of the country's total population has been vaccinated so far. According to Prothom Alo, we have received 1.6 crore doses of vaccines since the pandemic began. To reach the government's target of vaccinating 80 percent of the population, we require over 25 crore doses. With limited resources and with the very real issue of global vaccine inequality still looming large—according to Our World in Data, only one percent of people in low-income countries have received at least one dose of the country, a situation that WHO Director-General termed as "vaccine apartheid"—what steps can be taken to make vaccine access more equitable within Bangladesh?
If we look at DGHS data on the vaccination campaign that began on February 7, before grinding to a halt on April 26, there already exist a few glaring disparities. The most obvious is the gender divide—out of the 58 lakh people who have received the first dose of the vaccine, only 38 percent were women.
It also comes as no surprise that the most vaccines have been administered in Dhaka division, where over 18 lakh have received at least one dose, and over 15 lakh received both. While this might have made sense in February, the current situation in other divisions gives us every reason to regret this lack of foresight. Barishal division, for example, is experiencing positivity rates up to 54 percent, but only 1.8 lakh people there have received both vaccine doses. This excessive centralisation of the public health system has not only affected people outside of Dhaka in terms of vaccine uptake, but in all aspects of the Covid-19 crisis. Already, there are growing concerns of limited oxygen supplies, a lack of ICUs in many district hospitals, as well as basic equipment such as high flow nasal cannulas—not to mention the dearth of Covid testing facilities (according to a recent report in this daily, Rangpur, Mymensingh and Barishal have only two RT-PCR labs in each division, compared to Dhaka division's 88).
While there is no specific data available on those who have received their first vaccine dose so far, it would not be unfair to assume that the digital registration process can create significant difficulties for the digitally illiterate, or for people on the wrong side of the digital divide. Even of the 46 million internet users in Bangladesh (which in itself is less than a third of the population), being online does not necessarily demonstrate digital literacy. A 2019 survey conducted by the BRAC Institute of Governance and Development (BIGD) on 6,500 rural households found that, of the 40 percent of respondents who had regular internet access, only about 13 percent were able to navigate the homepage of the Department of Immigration and Passports, where the information is clearly marked in Bangla, in order to retrieve information for passport applications. BIGD research associate Maria Matin, in an article in The Daily Star, detailed how it also took the respondents "two to three minutes per information, which should be a matter of seconds for anyone with some digital literacy."
In this context, how do we ensure that it is not just the urban, tech-savvy groups who continue to register for and receive vaccines? Last month, it was announced that migrant workers, medical students, residential students of government universities and law enforcers will receive vaccines on a priority basis. According to Prothom Alo, the government will also target farmers, industrial workers and transport workers, and the relevant ministries have been asked to prepare a list of recipients. Targeting workers in specific sectors is a commendable step, and one that must be taken urgently. I would request the authorities to also include the city corporations in this initiative, so that the sanitation workers, garbage collectors and cleaners who have silently kept our cities functioning throughout the pandemic are given adequate protections.
However, if previous experience (especially with disbursement of Covid-19 relief funds) is anything to go by, the preparation of such lists can be slow, laborious and often, flawed. Since anyone above the age of 35 will be able to register online for vaccines soon, the authorities can take some immediate steps to ensure elderly, rural and digitally illiterate populations are included in the vaccine uptake.
The most obvious one is a mass public awareness campaign, coupled with efforts to bridge the digital divide. After low vaccine registration rates in February, the government decided to engage community healthcare centres and union digital centres in helping people to register. What is stopping representatives from these centres from going to the more remote locations and registering people door-to-door? We are all familiar with the auto rickshaws/vans with loudspeakers that make an appearance during every election season. Can we not treat this awareness campaign with the same enthusiasm that manifests during election campaigns? Why not reach out to student leaders, NGOs and volunteer organisations from across the country, and engage them in helping members of their communities to register?
It must be mentioned here that urban areas do not have a version of community healthcare centres and union digital centres. So where can the urban poor go to receive assistance in registering for the vaccine? If there are any such centres, are its target groups aware of its existence? While the most recent announcements have prioritised formal workers, we are yet to see a similar push to vaccinate urban, informal workers who have been most affected by lockdowns and the resultant economic downturn. Door-to-door registration in urban slums, or setting up of centres to assist with registration in nearby areas, should be a priority for the authorities—whether done via government actors, or with the help of NGOs.
Finally, although we are seeing a push to vaccinate workers to keep the economy running, we must remember that the majority of Covid-19 deaths are happening in populations aged over 65. Since the Department of Social Services already has a list (though incomplete) of people receiving elderly and widow allowances, it would not be difficult for the authorities to reach out to them and ensure they are vaccinated. Including widows in the vaccine list would also be a step towards bridging the gender divide in vaccine uptake, as would the efforts to bring vaccine registration to the doorsteps of marginalised populations.
The attempts to take our education system online have already demonstrated the digital divide that exists in the country. When it comes to a major public health issue like mass vaccinations, we cannot allow this divide to create vaccine inequality in the country, where marginalised populations who are disproportionately affected by the pandemic end up falling through the cracks. Bangladesh's past successes with mass immunisation programmes show that we have the capacity to make the vaccine campaign more equitable—all we need now is effective planning and management to see it through.
Shuprova Tasneem is a member of the editorial team at The Daily Star. Her Twitter handle is @shuprovatasneem.