As the eighth most populated nation in the world and home to more than 165 million people, Bangladesh has run several successful immunization campaigns, including COVID vaccination to provide its citizens with universal health coverage in the last two decades.
When the COVID-19 pandemic hit Bangladesh, the country remained resilient and became a Covid-19 vaccine success story, as per UNICEF. According to the Nikkei’s Covid-19 Recovery Index, Bangladesh stands 5th among 121 countries in the world. As of June 24, 2023, Bangladesh had administered a total of 360,177,584 vaccine doses. So what lies behind Bangladesh’s successive successful vaccination programs, especially for the COVID-19 despite its resource-constraints as a developing nation?
Soon after Bangladesh detected its first case of COVID on March 8, 2020, the number of infected patients shot up. The Government of Bangladesh (GoB), under the leadership of Prime Minister Sheikh Hasina, promptly took the decision to start a nationwide lockdown in order to control the widespread infection.
Factors that contributed to ensuring maximum COVID Vaccination
In retrospect, non-exhaustively THREE factors were responsible for ensuring maximum coverage of COVID vaccinations among the citizens and fighting the pandemic.
As many governments across the world failed to take prompt actions and quick decisions to fight the pandemic, the Government of Bangladesh, spearheaded by Sheikh Hasina, gave COVID-19 the top priority across all the stages of the country’s government structure, from local government to national level. After the first patient with COVID-19 was identified, Sheikh Hasina directed all pertinent government organizations, departments and ministries to launch a concerted effort in developing ‘COVID-19 Protocols and Guidelines’ for the mass population.
Applauding Bangladesh’s success in COVID vaccination, UNICEF Representative to Bangladesh, Sheldon Yett said, “Bangladesh’s ability to absorb and roll out COVID-19 vaccines is a testament to what can be achieved when there is political commitment and an equitable supply of vaccines. The success in getting millions of vaccines quickly and safely into arms in every corner of the country has been nothing short of remarkable.”
By July 2020, the Ministry of Health and Family Welfare of Bangladesh had formulated a comprehensive national plan of action titled ‘Bangladesh Preparedness and Response Plan (BPRP) for COVID-19’, which outlined the planning, coordination and response strategies of the government, including surveillance and laboratory support, infection prevention and control, essential health, population and nutrition services (ESP) delivery, procurement logistics and supply management, and so on. It also delineated the responsibilities of the government officials from national to sub-district levels and defined the procedures for forming the sub-committees accordingly with the participation of representatives from UN organizations, development partners, and national as well as local NGOs.
In 2020, GoB’s health service agency, the Directorate General of Health Services, was directed to mandate the institutional regulations on COVID-19 testing. At first, some hospitals were taking payments for COVID testing, which restricted the low-income and underserved segments of the population from accessing the testing services. The government subsidized testing services and made all of them free so that no one was left behind.
Isolation centers were a must to contain the Coronavirus. In April 2020, the government set up isolation centers in all public hospitals in Bangladesh. An additional 601 institutional quarantine facilities were also established in April to accommodate the growing number of COVID patients. In 2020, the public sector alone facilitated isolation for 100,000 individuals and institutional quarantine for more than 600,000 people.
In April 2020, the government equipped the Institute of Epidemiology, Disease Control and Research (IEDCR) to provide health advice to the general public. The government also formed a national technical advisory committee of epidemiologists and other experts to strengthen the government’s efforts to deal with the crisis.
Health sector professionals were putting their lives in jeopardy to fight the pandemic. The government provided them with health insurance and other incentive packages to incentivize and protect them, especially from high-risk situations.
Providing citizens with updated information was a must to fight disinformation and growing public skepticism. To deal with such problems, GoB launched the web platform www.corona.gov.bd to keep the citizens up-to-date with the pandemic situation of the country. 3 dedicated mobile helplines were introduced by the government, which offered health advice to around 3 million people.
In 2020, at the directive of Sheikh Hasina, the GoB appointed 2,000 doctors and 5,000 nurses within 15 days. This massive recruitment usually takes more than a year . However, the government made it possible due to the government’s firm commitment to effectively managing the pandemic. In the same year, the government established 167 PCR laboratories across the country, which have the daily capacity to test up to 20,000 samples. 56 other institutions carried out quick antigen tests. The PCR method was used to test more than 3.4 million Bangladeshis, while rapid antigen tests were made available to another 3.5 million. 10,381 general beds and around 600 ICU beds were allocated to treat COVID patients across Bangladesh in 2020.
To further prioritize the COVID emergency, the government increased the annual fiscal allocation of the health sector in June, which amounted to 29% for FY 2020–21. Also, to deal with emergencies caused by the pandemic, a budgetary contingency fund of USD 1 billion was set aside.
Bangladesh’s nationwide immunization campaign started on February 7, 2021, with 7 million vaccine doses developed by Oxford and AstraZeneca. Despite being a resource-constrained developing nation, Bangladesh successfully managed to purchase over 10 million doses of Oxford-AstraZeneca COVID-19 vaccines from the Serum Institute of India (SII).
Even though at first the government provided vaccines to front-line combatants like health professionals and the elderly population, soon most people, including children, were inoculated. The vaccination campaign didn’t leave anyone behind, including transgender people (popularly known as Hijras). The third- gender people were vaccinated under special arrangements. Even transgender people who did not have a national identity card were also brought under the program through a line-listing system and an on-the-spot registration system.
The government digitalized the vaccine registration process by launching the national portal ‘Surokkha’ (www.surokkha.gov.bd) and subsequently a vaccination app of the same name. This digitalization has helped the government in two major ways:
First, it allowed the government to decrease bureaucratic red tape and corruption in the vaccine delivery chain and target different segments of the population effectively. Anyone could register and get a date for their doses at a nearby hospital or vaccination center where the vaccine will be administered.
Secondly, and more importantly, when it comes to immunization programs, calculating and estimating both the aggregate demand and supply for the doses is crucial. Since the portal kept track of how many first, second and booster doses were administered, who received which dose when and all the pertinent data, the government was able to adjust its procurement and diplomatic strategy accordingly. As a result, Bangladesh was successful in increasing the vaccination rate gradually while keeping the infection rate lower simultaneously.
The government also closely monitored the development of COVID-19 versions, acting even before they could do much damage.
After COVID-19 spread from Wuhan to all across the world, rich nations began the race to find the cure for the pandemic, which led to the nationalization of COVID vaccines. Rich countries started to buy more and more vaccines for their citizens and controlled the production and supply of the vaccines, leaving underdeveloped and developing nations worried about procuring an adequate amount of vaccine doses for their citizens. Thus, adopting “vaccine diplomacy” as the key strategy became imperative for a developing country like Bangladesh.
From the very beginning, the government was proactive in finding multiple sources – both bilateral and multilateral – to procure vaccines. The devastating consequence of relying on a single source is that when the exporting foreign country fails to supply a sufficient amount of vaccine, the immunization program has to be paused.
On the onset of the nationwide COVID immunization campaign, Bangladesh signed a tripartite agreement with the Serum Institute of India (SII) and Beximco Pharama on November 5, 2020. As per the agreement, the neighboring country will supply Bangladesh with 30 million doses of the Oxford-AstraZeneca vaccine – 5 million doses each month – from SII through Beximco, costing $4 per shot. Even though Bangladesh received 7 million doses in the first 2 months of 2021 and 3.2 million doses as a gift under the “Vaccine Maitri” (Vaccine Friendship) campaign of India, the supplies soon stopped as India had to impose a ban on vaccine exports due to the increasing infection rate in India. This supply side shock coerced Bangladesh to put a pause on its vaccination campaign on April 26, 2021.
The Government of Bangladesh (GoB), particularly the Ministry of Foreign Affairs, started a concentrated effort to find other alternative sources by reaching out to both bilateral and multilateral entities. Bangladesh reached out to the United States, China, Japan, Russia, the United Kingdom and other countries with a positive approach to secure vaccine supplies.
Soon after the shutdown of Indian supplies, Bangladesh struck two crucial bilateral deals with China and Russia, leveraging Bangladesh’s strategic relationship with these two countries. On April 22, 2021, Bangladesh signed an agreement with Russia to produce Sputnik V vaccine domestically. On April 29, 2021, Bangladesh authorized the emergency use of China’s Sinopharm BIBP vaccine. Bangladesh ordered 15 million doses of the Sinopharm BIBP vaccine and received 500,000 doses as a gift.
In mid-2021, Bangladesh experienced a massive COVID surge, for which a huge supply of vaccine doses was required to tackle the situation. By May 2022, the United States donated nearly US $140 million in COVID assistance and 68 million doses of vaccines to Bangladesh to tame the pandemic.
The G7 economic powerhouse, Japan, sent the first batch of 245,200 Astrazenece vaccine doses on July 24, 2021, and as of May 2022, Japan sent 4.6 million vaccine doses to Bangladesh under COVAX.
While purchasing vaccines from bilateral sources, Bangladesh also focused on multilateral sources to ensure a steady supply of vaccines for its citizens. With Bangladesh’s other South Asian neighbors, such as Nepal, Afghanistan, Pakistan and Sri Lanka, the country joined the China-South Asia Platform for Covid-19 Consultation, Cooperation, and Post-Pandemic – a multilateral China led initiative that provided a steady vaccine and oxygen supply. Meanwhile, Bangladesh joined COVAX, a global initiative co-led by the Coalition for Epidemic Preparedness Innovation, Gavi, the Vaccine Alliance, and the World Health Organization, with UNICEF as a key delivery partner. Bangladesh is the top recipient of doses under COVAX till this date. In a single year, UNICEF has supplied over 190 million doses through COVAX to Bangladesh.
Bangladesh required a huge amount of funding, not just to purchase vaccine doses but also to keep the economy stable. Through its diplomatic efforts, Bangladesh was able to ink 3 agreements with the World Bank, totaling US $1.04 billion. This funding from the World Bank allowed Bangladesh to bring around 54 million of its citizens into the COVID vaccination program. Additionally, the Asian Development Bank (ADB) authorized a US $940 million loan to Bangladesh for the acquisition of COVID-19 vaccines. Besides diversifying the vaccine supplier sources, securing multiple funding partners enabled Bangladesh to protect its citizens from the pandemic.
The major success of Bangladesh’s diplomatic efforts can be attributed to the country’s ability to balance among India, China, and the United States. GoB championed the country’s foreign policy mission statement, “Friendship to all, malice to none.” Even after India halted its vaccine supply and Bangladesh secured deals with China and Russia, Bangladesh did not withdraw from the agreement – a well-calculated move that paid Bangladesh well in the upcoming days. Bangladesh’s Foreign Ministry continued diplomatic correspondence with its neighbor in a positive manner. As a consequence, vaccine supplies resumed again in October 2021 with Bangladesh immediately receiving 1 million doses of the Oxford-AstraZeneca vaccine from India.
At the same time, Bangladesh secured supplies from the United States, China, Russia, and Japan. Bangladesh continued to approve vaccinations from different countries to showcase the country’s willingness to cooperate with all the relevant players. The Pfizer vaccine’s emergency use was authorized on May 27, 2021, by Bangladesh’s drug regulatory agency. The health authorities in Bangladesh authorized the use of CoronaVac, also known as Sinovac, a different Chinese vaccine, for emergency use on June 6. On June 15, 2021, the Directorate General of Drug Administration authorized the emergency use of the COVID-19 vaccine, known as “Jansen,” manufactured by Johnson & Johnson in Bangladesh. The American COVAX facility shipped 2.5 million doses of the Moderna COVID-19 vaccine to Bangladesh during the same month. In line with this, Bangladesh approved the Moderna vaccine on June 29, 2021, making it the ninth vaccination to receive authorization for emergency use in the nation.
The balanced approach in bilateral negotiations paid Bangladesh dividends, which ultimately led to the successful immunization of the country’s inhabitants.
While appealing to the international community, GoB adopted the soft power strategy as its core diplomatic guiding principle. From the very beginning, the Bangladesh government championed the cause of equitable and fair access to vaccine doses in all countries around the globe. In a pre-recorded video message at the 75th World Health Assembly’s High-Level Segment, the Premier of the country stated, “We believe that vaccines should be treated as global public goods. We cannot ensure sustainable recovery by leaving millions behind in our vaccination efforts.”
Bangladesh has a long established history of high success in rolling out other mass immunization campaigns – a strength that allowed Bangladesh to leverage its existing resources, capacity and infrastructure to administer COVID vaccine doses to the entire population. Sheikh Hasina received the second ever Vaccine Hero Award from Gavi due to the country’s great accomplishment of mass immunization during her rule. Bangladesh has been awarded the GAVI Alliance Award for child health immunization by the GAVI twice – in 2009 and 2012.
With the implementation support of the Expanded Programme on Immunization (EPI) of the World Health Organization (WHO), Bangladesh was able to ensure maximum vaccine coverage for its inhabitants. From a 2% vaccination coverage rate in 1985, Bangladesh has been able to achieve an 84% coverage rate in 2019. As of 2016, Bangladesh has achieved a 99% coverage rate for treating tuberculosis.
According to the WHO, the country has made significant advancements in the elimination and control of Vaccine Preventable Diseases (VPDs). Bangladesh has been polio free since the last case of wild poliovirus was identified in 2006. In 2008, the country successfully eradicated maternal and neonatal tetanus. The country also met its rubella control goal in 2018.
In the last decades, Bangladesh has introduced several new vaccines, including the HepB vaccine in 2003, Hib in 2009, Rubella in 2012, PCV and IPV in 2015, MR second dose in 2015, and fIPV in 2017.
The Government of Bangladesh aptly utilized the existing capacities for mass immunization drives to provide access to COVID vaccines to its people. The government banked on the existing vaccine cold chain facilities in the country for storing, transporting and distributing COVID vaccines. At the same time, the existing community clinics and vaccination centers worked as a relief for the government, as these facilities were extremely effective in providing jabs when combined with the new facilities.
Mass Vitamin-A Immunization Campaign During Pandemic
Even during the pandemic, while running the COVID vaccination program, the government carried out a two-week long national Vitamin-A Plus campaign. Each year, GoB arranges two national Vitamin-A Plus campaigns. However, due to the pandemic, the campaign in July 2020 was suspended. From October 4 to 17, 2020, a total of 20.8 million children (97% of the target) were covered by the mass immunization campaign to mitigate the risks of child malnutrition.
The cover photo is taken from UNICEF/UN0510588/Chakma.
About the Author
Shah Adaan Uzzaman is the Blog Administrator at The Confluence. A former Bangladesh Television Debate Champion and winner of several policy & debate competitions, he is currently a student of IBA, University of Dhaka.