The stunning results from Covid-19 vaccine trials by Pfizer-BioNTech and Moderna raised hopes across the world in the battle against the deadly virus, but experts find big challenges for Bangladesh to avail of benefits from the two vaccines due to its existing poor cold chain.

They said the mRNA technology-based vaccines developed by Moderna and Pfizer need to be stored at minus 70-80 degrees Celsius temperature, but the country has a cold chain having the capacity of preserving life-saving drugs and children’s vaccines at temperatures as low as minus 20 degrees Celsius under the Expanded Programme on Immunisation (EPI) framework.

The experts said Bangladesh is also unlikely to be able to enhance its existing capacity for storing, transporting and distributing mRNA vaccines overnight as it is a very expensive and time-consuming process and the required number of refrigerators will not be found within a short time.

Under the circumstances, they said, the country needs a prudent Covid-19 vaccine policy alongside keeping in touch with all other potential countries and originations that are conducting the phase-III trial of vaccine development so that a suitable vaccine can be procured and maintained using the existing cold chain capacity.

Contacted, Health Minister Zahid Maleque told UNB: "We’ll procure a suitable vaccine from the source where we’ll get it first. We’re in touch with all to have it.”

He said the government has recently signed a memorandum of understanding (MoU) with the Serum Institute of India (SII) and Bangladesh's Beximco Pharmaceuticals to get three crore doses of the vaccine developed by Oxford University.

“We’ll get this vaccine at the early stage and it’ll be preserved at Beximco's cold storage. So, we’ll be able to give this vaccine to our 1.5 crore population--two doses for each person,” he said.

Health Services Division Secretary Abdul Mannan said the government is not thinking about procuring the vaccines of Pfizer and Moderna as those are not suitable for Bangladesh due to temperature-related problems.

“Nine organisations in the world are in the final stage of producing Covid vaccines, and we’re in touch with six of them. we’ll buy any suitable vaccine from where we get it earlier,” he added.

Difficulties in preserving mRNA vaccines

Contacted, Dr Be-Nazir Ahmed, former director (disease control) of the DGHS, said it seems two mRNA technology-based corona vaccines will hit the market soon if they get approval from the different regulatory bodies, including the WHO.

“A significant number of people in the USA, and the European countries may get these vaccines by the next six months. But it’ll be difficult for Bangladesh to procure and preserve these two vaccines for various reasons. The two vaccines need a storage temperature of minus 70-80 degrees Celsius,” he said.

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The vaccine expert said there are also very few aircraft that can carry these vaccines maintaining the required temperature.

“So, first of all, it’ll be difficult to bring these vaccines to Dhaka from the USA. Secondly, if even we can manage such aircraft to carry the vaccines, we don’t have required transport to carry those from the airport. More importantly, we don’t have the cold chain for storing, transporting and distributing these vaccines.”

Dr Be-Nazir said Bangladesh should now focus on the vaccines those could be preserved using the existing cold chain network.

Who may get it first?

Assigned by the government, Dr Be-Nazir said the National Immunisation Technical Advisory Groups (NITAGs) has already set priorities for the distribution of vaccine doses once those will be found.

As per the outlines of NITAGs, he said, those who are working on the frontline in tackling the corona pandemic, including the health workers and law enforcers, will get the first priority.

Dr Be-Nazir, a member of NITAGs, said they suggested providing the media workers, elderly public representatives and elderly freedom fighters with the vaccine in the first phase.

In their outline, he said, they also recommended giving the vaccine on a priority basis to the people having comorbidities and the senior citizens. “We, however, didn’t suggest vaccinating the pregnant women and children at the initial stage as we don’t have any credible study to assess its reaction to them.”

He said they recommended providing the vaccine free of cost, but the government wants to take $4-$5 equivalent money for each dose of the vaccine.

Vaccine policy urgently needed

Dr Be-Nazir said Bangladesh may not get sufficient doses of any vaccine at the primary stage. “So, we need proper planning to successfully use whatever we get for controlling the pandemic.”

Former World Health Organisation (WHO) Regional Advisor Muzaherul Huq said the government should formulate a national Covid vaccine policy very soon for procurement, storage and distribution of a suitable vaccine.

“We also need to conduct a national-level serosurveillance survey to know the actual data about the exposure levels and the presence of antibodies in people. We need the rapid antibody test to see the level of immunity people have. It’ll help get an idea about the required doses of vaccine and set the priority for its justified distribution,” he observed.

Dr Muaher also said the government must procure any vaccine based on some principles such as efficiency and safety levels, availability and affordability. “We must consider all these things before signing any deal for the vaccine.”

He said Bangladesh should not procure any vaccine which it cannot afford in terms of money, preservation and distribution.

The expert also said Bangladesh should not ink any deal with any institution and country unless their vaccines get approval from the WHO and other regulatory body for marketing,

“We should keep in touch with all countries and companies that are developing the vaccines, but we should not make any deal hastily. The government should give the Directorate General of Drug Administration (DGDA) authority to find out the suitable vaccines for the country,” he suggested.

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