Bangladeshi authorities and officials of an international cholera research center are at loggerheads over the proposed trial of an anti-cholera vaccine, health terminology and the actual prevalence of diarrheal diseases.
Senior government health officials on Tuesday argued that the government does not see any reason for a trial of the oral vaccine, as the mortality rate of diarrhea is less than 1 percent (0.6 percent). Instead, Health Services official Dr. Khondhaker Shefyetullah said the vaccine trial needs government's public policy, based on a detailed technical study and the opinion of stakeholders.
The vaccine trial was launched in 2009 and was limited to low-income people in the capital Dhaka, where incidents of diarrhea are common during peak monsoon seasons, which occur April through May and August through September. The trial, being conducted on children under the age of 5 by the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) is set to end in September.
The government for more than three decades has avoided using the terms vibrio cholerae or cholera to describe the disease breakout. They insist that hospital doctors and the media describe the outbreak as diarrheal disease and dysentery.
Bangladesh deliberately avoids using the word cholera to prevent a ban on the export of fresh vegetables and freshwater fish, which are sold in markets in Australasia, Europe and North America, Shefyetullah told a seminar on the introduction of cholera vaccine.
Steve Luby, a researcher with ICDDR,B echoed statements by government officials that an affordable vaccine would provide only partial protection from diarrheal diseases. He stressed that social behavioral change and dissemination of health information could prevent 30 to 50 percent of the prevalence of diarrheal diseases, which mostly occur among disadvantaged populations in both urban and rural areas.
The government also disputes the prevalence of the disease. Professor Mahmudur Rahman of the government Institute of Epidemiology, Disease Control and Research (IEDCR) sets the annual figure of cholera outbreak at 450,000. The international health research institution estimates the figure at 1.2 million cases in its research journal.
Government officials have urged ICDDR,B to review its estimate and said that the government stands by its figure, which it said had been documented after obtaining information from the field over the last several years.
ICDDR,B executives agreed to review their data. They also said they will wait for the government public policy on clinical trials of cholera vaccine to protect child mortality and morbidity.
Saleem Samad, an Ashoka Fellow is an award winning investigative journalist based in Bangladesh. He specializes in Jihad, forced migration, good governance and elective democracy. He has recently returned from exile after living in Canada for six years. He could be reached at saleemsamad@hotmail.com
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