'Herd immunity cannot be an option for Bangladesh'

The Business Standard (TBS): What is your take on herd immunity? Britain chose selective herd immunity at the beginning and they retreated afterwards. Could herd immunity be an option for Bangladesh?

Taufique Joarder (TJ): The Imperial College London floated the ideas of two strategies in the fight against coronavirus – mitigation and suppression. Britain was walking on the route to mitigation initially, which led them to go for targeted herd immunity. But when the number of infected patients continued to surge, Britain retreaded from mitigation; explained to media that they didn't adopt mitigation as a policy rather one of their lead scientists used it just as a reference.

And henceforth, Britain adopted suppression as their strategy instead.

Most of the scientists are against the idea of herd immunity in terms of fighting coronavirus because the concept is generally used in relation to developing vaccines where there is no risk of death. But when immunity is sought to be acquired in a natural process, instead of vaccines – which means to allow people to get infected and build a sort of defense from further infections – the control is not in our hands, rather the virus itself has the control.
We know that different diseases have different case fatalities. These case fatalities in terms of Covid-19 are two to three percent. So, adopting herd immunity as our strategy to address Covid-19 means to allow a very large section of people to get infected and eventually die.  

In such a case, two things need to be considered; firstly, when tens of thousands of people will get infected, our health care system will collapse, the number of deaths will be enormous and a tremendous humanitarian disaster could ensue.

Secondly, enough research has not been conducted about the effectiveness of herd immunity in addressing Covid-19. We are not certain if this would rule out the possibilities of reinfection.

For the sake of argument, suppose we adopt herd immunity and allow a subsequent disaster in our health care system, damage our economy and let tens of thousands of people get infected and die only to find that people are getting re-infected. In such a scenario, we just lose everything.

So, herd immunity cannot be an option for Bangladesh. It just cannot be.

TBS: Around 35 companies are working to find a vaccine for Covid-19. The World Health Organization (WHO) claimed their Solidarity initiative would cut the time to find a vaccine by 80 percent. How long could it really take to find a cure?

TJ: The WHO's Solidarity will only ensure the funding and facilitate to ease the difficulties of various procedures which often take a lot of money. But WHO cannot cut the time which is necessary for research. Also, the time human body takes to develop an immune response cannot be cut short.

We have to remember that vaccines are not like medicines. When you give medicines to terminally ill person, he will take it anyway because he is desperately seeking to live. But vaccines, on the other hand, are applied to healthy people. So, it requires a lot of precautions.

There are many steps in the process to find vaccines, which take time. I cannot predict how much time it would take to develop a vaccine in an extraordinary condition like this, but we know in a regular time, it can take up to 18 months. I don't see any possibility that we would get a vaccine before this timeframe.

Moreover, cutting time short would be risky too. Cutting time means we are not scrutinizing enough. Vaccines are not applied to a few people – rather it is applied to millions. So cutting the time short could be a desperate measure but it would be a very risky measure too. So, we would have to wait at least a year for vaccines I believe.

TBS: Medicines like Hydroxychloroquine and some other drugs have become popular. Are they really working?

TJ: WHO has a standard treatment protocol – supportive and symptomatic – for respiratory diseases. But they have no treatment for Covid-19. The respiratory treatments that WHO has will not eliminate the SARS-CoV-2 germs.

So, as long as the SARS-CoV-2germs are not eliminated, we cannot claim success for any medicine. The much talked about treatments so far are experimental.

As long as we don't find a cure through a proper method and long-term research, we cannot be certain about any medications indeed.

TBS: As a public health expert, how do you evaluate Bangladesh's response in addressing coronavirus? Do you think we are in the right track?

TJ: There are some standard guidelines in addressing coronavirus. If we ask – are they following the guidelines? The answer is yes. The guidelines ask for quarantine. Are they doing so? Yes, they are. The guidelines ask for contact tracing. Are they doing so? The answer is again yes. They are following the guidelines.

But the problem is despite following the guidelines, things are not working out fine. There is lack of coordination in the execution level.

Moreover, there is nothing to hide in terms of number of tests we are doing. Bangladesh is one of those countries who are conducting lowest per million tests. There are a few countries like Nigeria, Zimbabwe, Haiti and etc. behind Bangladesh in terms of testing. These countries, however, should not be ideal example for comparison. Even Nepal is testing three times more than what Bangladesh is doing.

On average, Bangladesh is conducting three to four thousand tests every day. But the number of tests should actually be a minimum 20,000 per day.

TBS: Why are so many medical professionals being affected by the virus in Bangladesh? What are they lacking?

TJ: There are three reasons behind this.

Firstly, they are coming in touch of many people every day. Secondly, the equipment they are using may not be of proper standard. I personally have seen that many Personal Protective Equipment (PPE) that are incapable of proper protection.

Third and most importantly, lack of proper training. It is apparently taken for granted that the medical professional has all the know-hows of PPEs by default. This is wrong. All of them need proper training. The government is training many of them. But they need to ensure that each and every one of them are properly trained.

TBS: In the context of Bangladesh, what should be our exit strategy? What should be the government's strategy to improve the local level health system?

TJ: We have imposed lockdown to save ourselves from the virus. But we need to remember that the lockdown itself will not save us from coronavirus. All we are doing is only suppressing the spread of the virus.  So, as long as we don't get the vaccines, we need to continue suppression.

As long as we continue this suppression, we have to keep testing, a lot. When we find that the curve is dropping, we may ease the lockdown. But we cannot open up everything all at once. We will need to open gradually and ensure proper hygiene in every factory we open up.

We will continue to test even when we ease the lockdown. So, whenever we find that the curve is rising again, we will have to immediately retreat to lockdown. This will go on like a cycle as long as vaccines are not found.

I have heard that some factories have already been opened up earlier this week. Now such decisions should actually not be an administrative one. Any such move about opening up should come in coordination with the epidemiologists.

TBS: What would be the consequence of lifting lockdown early?

TJ: Lifting the lockdown will simply pave the way for spreading the virus again. It will render all our sacrifices, all our efforts over the last few weeks futile. Premature lifting of lockdown has been warned against by public health experts starting from China to USA. One needs to test a lot first to be confident enough about the transmission status, then, if confirmed by the public health experts, may withdraw it gradually, and keep testing to detect any resurgence.

TBS: Our industries have been shut for more than a month by now. People are losing jobs and companies are anxious they will go bankrupt. In a situation like this, what is your advice to tackle this crisis?

TJ: We have to prioritize the interest of peoples' health above everything. The garments owners may call for opening up the industries because this is their concern. But as a public health expert, I cannot but portray the real picture of dangerous outcomes if any such measures are taken. We have to remember that indiscriminate opening up cannot be a solution.

Not long ago a garment owner died too. These deaths will neither spare the garments owners nor the workers. Furthermore, if opened up, we will lose the trusts of the world for endangering the lives of our workers – which is bad for business too.

Now, people are losing jobs and they are legitimately worried that they would starve. To address this, it is to the government that we need to ask this question because the government is in charge of the social safety net of a country.

Amidst this global crisis, the whole world is in lockdown and people all across the world are worried how they will get their next meal. In such a time, it is the governments around the world that are supporting people in need. If they can, why can't we?

Dr Taufique Joarder, a public health expert, is executive director of Public Health Foundation, Bangladesh. Dr Joarder received his PhD in public health from Johns Hopkins University and now teaches at Johns Hopkins Bloomberg School of Public Health and some other distinguished universities. He also serves as research director of FHI 360.