Bangladesh must move toward updating pneumonia vaccine to ensure stronger child protection: Health experts

Experts from leading health institutions gathered at International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) yesterday (16 October) for a roundtable discussion on introducing higher-valency pneumococcal conjugate vaccines (PCVs) in Bangladesh. 

The dialogue focused on optimising vaccine-induced protection against circulating pneumococcal serotypes and addressing the emerging challenge of serotype replacement, said a press release from icddr,b.

The session followed a pneumococcal surveillance study jointly conducted by icddr,b and the Institute of Epidemiology, Disease Control and Research (IEDCR), with support from the US Centers for Disease Control and Prevention (CDC). 

The study, presented by Dr Md Zakiul Hassan, associate scientist at icddr,b's Infectious Diseases Division and Principal Investigator, analysed data from four public tertiary-care hospitals to identify Streptococcus pneumoniae serotypes currently causing infections among young children.

Findings show that most pneumococcal serotypes now circulating in Bangladesh are not well covered by the existing PCV-10 vaccine, which has been successfully used in the national Expanded Programme on Immunization (EPI) since 2015. While PCV-10 has substantially reduced illness and deaths caused by targeted serotypes, the pattern of circulating serotypes has evolved over time, prompting the need to expand protection through newer-generation vaccines.

Dr Tahmeed Ahmed, executive director at icddr,b, delivered the welcome address and thanked participants for attending, noting that pneumonia remains the biggest infectious killer of children worldwide. He stressed the importance of prevention and evidence-based decision-making in guiding national immunisation strategies.

Dr Firdausi Qadri, senior scientist at icddr,b and Chair of the National Immunization Technical Advisory Group (NITAG), moderated the discussion and explained that many countries are now transitioning to higher-valency pneumococcal vaccines that provide broader protection.

Experts observed that the shift in pneumococcal serotypes is a natural outcome of a successful vaccination programme, as the serotypes targeted by the current vaccine have become much less common. While PCV-10 is currently used in 35 countries including Bangladesh, PCV-13 has been adopted in 130, and newer formulations such as PCV-15 and PCV-20 have been introduced in 16 and 9 countries respectively. Participants agreed that updating to a higher-valency vaccine would be a prudent, evidence-based step to sustain progress and ensure continued protection for Bangladeshi children.

Dr Tajul Islam A Bari, former programme manager of the EPI, noted that transitioning from PCV-10 to PCV-13 could even be cost-saving, as PCV-13 is slightly less expensive than the vaccine currently in use.

Professor Dr Md Farhad Hussain, director (Disease Control) at the Directorate General of Health Services, emphasised that with rising antimicrobial resistance, Bangladesh should update the vaccine to reduce antibiotic dependence through stronger prevention.

Dr Tahmina Shirin, director of IEDCR, highlighted the need for robust surveillance of vaccine-preventable diseases to guide timely updates, while Mohammad Shahariar Sajjad, deputy director of the EPI, reaffirmed the government's intention to review and update the vaccine in line with new evidence and global best practices.

Dr Nizam Uddin Ahmed, chair of the Gavi CSO Steering Committee and NITAG member, said that moving to the next generation of PCVs is both logical and necessary but must consider cost-effectiveness and system capacity. He proposed that the findings be presented at the upcoming NITAG meeting.

Professor Chowdhury Ali Kawser, former chair of NITAG, observed that this may be the first time a vaccine decision will be guided by local scientific evidence rather than external influence. He suggested forming a sub-committee to carry the recommendation forward.

Clinicians including Professor Dr Md Jahangir Alam of Bangladesh Shishu Hospital & Institute and Dr Sharmin Afroze of Dr MR Khan Shishu Hospital & Institute of Child Health shared their experience treating pneumonia and highlighted growing antibiotic resistance. They commended the research and underscored the need to update the vaccine to maintain progress.

Dr Zakaria Bin Amjad, senior assistant secretary (Global Health Ministry) at the Ministry of Foreign Affairs, noted that infectious diseases have political, economic, and diplomatic implications. "Health security and international relations are deeply intertwined, and updating our immunisation programmes based on robust evidence is not just important but essential," he said.

Dr Chiranjit Das, national professional officer (Immunization) at WHO and NITAG member, added that neighbouring countries have already introduced PCV-13, suggesting Bangladesh could consider updating as well.

Dr Shamsuzzaman, senior immunization consultant at UNICEF, stressed that ensuring the best possible protection for children must remain the top priority.

Professor Mohammod Shahidullah, president of the Bangladesh College of Physicians and Surgeons (BCPS), thanked icddr,b for organising the discussion. He recalled that icddr,b had played a pivotal role in the government's decision to introduce PCV-10 in 2015 by providing technical guidance and evidence. "Once again, icddr,b has brought together the experts and data needed to inform policy. We should move forward positively, ensuring that government capacity and partner support remain aligned," he said.

Mr Kazi Delwar Hossain, additional secretary (Planning) at the Ministry of Health and Family Welfare and chief guest of the discussion, concluded, "The evidence is clear, and we should move swiftly to a newer generation vaccine to ensure maximum protection for our children."

Data from the study indicate that a move to PCV-13, PCV-15, or PCV-20 could substantially enhance protection, covering approximately 17%, 19%, and 52% of currently circulating pneumococcal serotypes respectively. Experts agreed that this evolution in vaccination strategy reflects scientific progress and ensures that immunisation programmes remain responsive to changing disease patterns.