In mid-March, when Bangladesh was grappling with an acute shortage of Covid-19 testing kits, Gonoshasthaya Kendra – the country’s foremost public health institution – came up with a seemingly practical solution: a $3 (Rs 225) rapid kit to detect the disease. The inventor said the kit is highly accurate, a claim doubted by other experts; gives the result within 15 minutes; and does not require expensive bio-safety laboratories unlike the gold standard RT-PCR tests.
At the time, Bangladesh had only 1,732 RT-PCR kits – all borrowed from international agencies – for a population of 160 million, suggest media reports . The country’s health system was poorly, if at all, prepared to deal with the impending pressure, according to a leaked internal United Nations memo.
Therefore, the idea of having a much cheaper, faster and indigenously producible kit should have sounded tempting to the government. Except, it did not.
Public health pioneer
The country’s health authorities had given a preliminary green signal for the kit to be mass produced but in hindsight, it wasn’t a genuine expression of interest. Moreover, the decision had much to do with the Zafrullah Chowdhury, a famous public health veteran who founded the Gonoshasthaya Kendra.
In 1971, when the country was waging its independence struggle against Pakistan, he gave up a lucrative career opportunity in the United Kingdom to join the movement and helped set up a 480-bed field hospital for guerrilla fighters and refugees. He then founded the Kendra to provide low-cost health solutions to the poor.
Chowdhury is widely credited with helping rewrite Bangladesh’s national drug policy, which helped keep drug prices low and resulted in a strong domestic pharmaceutical industry. Therefore, for many public health workers around the world, he is no less than a legendary figure.
However, in recent years, he has become a somewhat polarising figure in the country, owing to his association with the country’s opposition camp. Right before the 2018 general election, he was part of a delegate representing the opposition alliance, Jatiya Oikyo Front, in a dialogue with Prime Minister Sheikh Hasina.
In a country where an increasingly intolerant government has taken hold, there is a steep price to pay for being on the wrong end of the political spectrum. Many believe that this is what led authorities to initially reject the kit without any validation.
Red tapism
The government did have a strong case: in many countries, laboratory-based antibody-dependent rapid kits were found to be unreliable. Just days ago, India joined a group of countries that rejected or cancelled Chinese-made rapid test kits.
However, in Bangladesh’s case, the bureaucratic red tape was on abysmal display. The government first asked Gonoshasthaya Kendra to go through a lingering approval process, which many argued could have been relaxed and shortened. At one point, the government even absolved its responsibility and asked the agency to have the validity test conducted via a third party, which Chowdhury declined to do.
After days of stonewalling, the chief of the drug directorate came up with a more straightforward answer: the government would not accept the kit developed, ruling out scope for trials. He pinned the blame on the World Health Organisation, claiming that the global body did not approve rapid kits.
But if that was the case, many wondered on social media, why did the government allow the Gonoshasthaya Kendra to go ahead with mass production in the first place? Why did the health authorities even advise the organisation to validate its kits, albeit by a third-party organisation?
While it’s true that the World Health Organisation does not recommend the use of antibody-detecting rapid tests for disease detection, it does encourage the continuation of research to establish their efficacy. Why then, did Bangladesh, not want to assess the kit’s accuracy?
There’s also a double standard. The lack of a World Health Organisation recommendation did not stop the local authorities from recommending hydroxychloroquine for Covid-19 treatment. The United States Food and Drug Administration also recently warned of the drug’s “serious and potentially life-threatening heart rhythm” side effects. It shows that the local authorities can indeed make independent decisions.
Merit of antibody testing
The decision could have had something to do with the government’s overall Covid-19 strategy as well. Instead of administering as many tests as possible, Bangladesh was testing only seriously ill patients, as indicated by its unusually high closed case death rates. This was probably to prevent its hospitals being overwhelmed. Employing rapid test kits for diagnosis could complicate its limited-testing strategy.
Meanwhile, several rapid test kits developed in other countries are found to be effective. Just days ago, a new antibody test developed by Abbott was reported to be 99% accurate. While the kit has been developed mainly for serological studies – i.e. measuring the amount of antibodies in the blood – it could probably be used for disease diagnosis as well, since it appears to reduce the risks of false-negative cases.
Abbott’s molecular-based rapid test kits are widely used across the United States for diagnosis. Malaysia has reportedly decided to use a South Korean antigen kit, which showed a significant sensitivity level of 84.4%. Countries such as France are also reportedly relying on laboratory-based rapid testing for disease detection. Bangladesh will eventually have to start testing for antibodies when it wants to exit from the lockdown mode. At that stage, such a cheap kit, if effective, could be immensely useful.
Zafrullah has indicated that vested corporate interests were most likely to suffer if the Gonoshasthaya Kendra kit were to be approved. He even alleged that bribes were sought from him, presumably in exchange for the approval. Dr Bijon Kumar Sil, the scientist who invented the kit, however, played down the allegations.
On April 30, the government backtracked from its earlier position and permitted the kit to be assessed for its efficacy by either of two respected labs.
Many still have doubts about the fairness of the process and wonder whether it’s a new decoy. Nonetheless, anyone familiar with Bangladesh’s notorious bureaucratic hassle would know that regardless of the final outcome, Chowdhury did put up a good fight.
Nazmul Ahasan is a Bangladeshi commentator. The views expressed here are solely his personal.
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