Tracey Koehlmoos on fear and swine flu in Bangladesh

Tracey Koelhmoos They were waiting for me when I returned to Dhaka in late July. My office is not easily found, so the small group of older gentlemen must have been determined in their efforts. Without an appointment but bearing chocolate, the request was clear: surely I had access to the H1N1 vaccine and they wanted it for themselves. In July the vaccine was available only in trials in North America, Europe and Australia—not in South Asia. My attempts to provide the best information available on preventing illness through good respiratory hygiene and hand washing fell flat on these accomplished men. As one said, “I have COPD. If I get this disease, I will die.”

The fear of H1N1 is real in Bangladesh, as we look across the border to India where schools have been closed and re-opened, the situation is viewed as a true public health emergency. Within Bangladesh, enterprising yet nefarious agents were reportedly selling “swine flu vaccine” in the informal market. I wonder what they were shooting into people? Saline? Another real vaccine like Hib or measles? Something potentially dangerous? Fortunately, there were no reported deaths from the fake vaccines.

From June to September 2009, the number of identified H1N1 cases in Bangladesh was 604, and there were only three reported deaths. Further, most people without other risk factors will contract a mild form of the disease, and recover fully without the help of anti-viral treatment or medical care. In a country where more than 1000 children a day die of diarrheal disease and 83 children per day die of injuries, the panic itself seems disproportionate to the burden and risk of H1N1.

Bangladesh, we learnt recently, will receive a small amount of vaccine in early 2010. It will not be enough to immunize everyone at risk. How can we get the vaccine to those who need it most?
We prepared a policy brief and newspaper articles in English and Bangla to provide the best evidence from global sources such as the CDC, the WHO, and the NHS discussing which groups should have priority. Because of the low ratio of provider to population the first priority group is front-line healthcare workers followed by pregnant women, children 6 months to 5 years, adolescents, and lastly adults with high risk conditions such as COPD, asthma, diabetes, liver diseases, etc.

When the vaccine arrives I have no doubt that my former visitors will turn up elsewhere in town, bearing chocolate and asking to cut the priority queue. Doubtlessly, others who are powerful and sincerely concerned about themselves and their families but not high priority will have the same approach. Let’s hope that those providing vaccination will stand strong in the face of such pressure.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and ajunct professor at the James P. Grant School of Public Health, BRAC University.