Interview: Muzaherul Huq
'Coronavirus third wave won’t strike if we are alert'
We have learnt that advance preparation and planning is vital to tackle any calamity. That includes a strategic plan about how and in how many days will we be able to tackle the calamity
Muzaherul Huq studied legal medicine at London Hospital Medical College and also studied at Dundee University. He is the former director of the Institute of Public Health and Centre for Medical Education at Mohakhali. He is former Southeast regional advisor of the World Health Organisation. He received lifetime achievement recognition from the Southeast Asian Regional Association for Medical Education. In a recent interview with Prothom Alo, he talked about the decrease in coronavirus transmission and deaths and what is to be done in the days ahead.
The daily rate of coronavirus deaths has come down to single digits and the transmission rate has fallen below two per cent. Is this a matter of relief?
It certainly is a matter of relief. And we have to hold on to this. This cannot be allowed to increase. The transmission rate has to be brought down to one per cent. When it falls below one per cent, we can say that Bangladesh is more or less free of coronavirus.
We must keep in mind that coronavirus is a global pandemic. Until and unless coronavirus goes away from other countries, we cannot say we are free of risk. We must follow the health protocol for as long as coronavirus remains in the world. We must be on full alert so that coronavirus can’t enter from outside. The government must ensure that the people follow the health guidelines. Monitoring must be stepped up. This will require the involvement of persons from all sections of society – local people’s representatives, teachers, the imams of mosques and so on. They will have to carry out the responsibility from their respective positions. We cannot let down our guard.
Q :
The government leadership claims that they have been successful in tackling coronavirus. Is this true? How do you measure such success or failure?
Firstly, the government didn’t have the preparation required to tackle the coronavirus outbreak. The World Health Organisation (WHO) issued repeated warnings. The government, however, did not attach due importance to that. They depended on just a single lab. That was a wrong decision. We were not able to set up the required testing laboratories at the outset. We had no strategy about how to tackle the situation. We should have had a strategic plan in place. We delayed in detecting coronavirus cases. There were hardly any significant efforts to prevent the disease either.
Later the government did increase the number of labs. It increased ICU, ventilation, oxygen and such facilities. In short, we ran behind coronavirus. But the bottom line in health care is prevention and advance preparation. We should have, under government management, kept every patient in isolation and treated them. We should have identified those who had come into contact with the Covid patients. At the outset when people contracted coronavirus in Dhaka and died, we should have identified those who had been in contact with them and placed them in quarantine. Then there would not have been social transmission of the virus. We didn’t do that and so the virus spread around the entire country. The delta variant spread particularly fast.
Our healthcare system must be taken to such a level where our president and prime minister do not have to go abroad for medical treatment
Q :
What about the treatment of patients? Could we provide them with proper medical treatment? We read in the newspapers about patients being turned away from hospitals without proper treatment.
The weakest point of our healthcare system is that everything is centred on the big cities. We have not been able to introduce an effective referral system. The upazila health complexes lack in capacity. If this could have been increased, this chaos wouldn’t have ensued. It is not just about coronavirus. People are contracting all sorts of new diseases. Each and every upazila health complex must have a minimum capacity at least. If a patient cannot be treated there, they can send him to the district headquarters. If treatment is not possible there, then the patient can be sent to Bangabandhu Medical (Bangabandhu Sheikh Mujib Medical University) or a specialised hospital. This requires an effective referral system. No patient should come to the higher level without referral from the lower level. This will bring discipline to the healthcare system. Everyone won’t come crowding to the big cities.
Q :
Do you have any apprehension about a third wave of coronavirus?
A third wave of coronavirus won’t strike if we are alert. We have to be fully prepared. We must place emphasis on two factors in this regard. In keeping with the government commitment, 80 per cent of the people must be vaccinated so that herd immunity is created. This will not remain the same at all times. Immunity can lessen. There will then be need for booster doses. The fear of a third wave will arise if we are lax about following and enforcing the health protocol.
We have fallen behind in vaccination because the government failed to take the right decision at the right time. There was need for strategic planning here too
Q :
You place stress of the vaccine to prevent coronavirus. Where do we stand in vaccine procurement?
Bangladesh lags the furthest behind among South Asian countries in vaccine procurement. Herd immunity will only be created if we can strengthen our vaccine regime. As soon as possible, 80 per cent of the people must be vaccinated. That means 240 million (24 crore) vaccines will be required -- and another 120 million (12 crore) if the booster shot is to be given.
We need to set our priorities. Those involved in the health sector, that is, those coming into contact with the patients, need to receive the vaccine first. And the elderly and ailing must be given priority. The mass vaccination drive must be completed speedily. We have fallen behind in vaccination because the government failed to take the right decision at the right time. There was need for strategic planning here too.
The policymakers must specifically state within how many days the first dose and the second dose of the vaccine will be administered. I think the first dose should be completed by December and the second by January.
Q :
There are considerations of vaccinating the under-18 age group, that is, children.
There is global research being carried out in this regard and the World Health Organisation is monitoring this. They have not advised the jabs for children as yet. The US, though, has already decided to administer half dose to children. We should wait for advice from WHO.
Q :
What have we learnt from the coronavirus pandemic?
We have learnt that advance preparation and planning is vital to tackle any calamity. That includes a strategic plan about how and in how many days will we be able to tackle the calamity.
There were two aspects to tackling the Covid crisis. One was prevention. The other was treatment of the afflicted persons. At the outset we did not place stress on tests for detecting the patients. We have very limited infrastructure and RT-PCR machines for the tests. Secondly, medical treatment was inadequate. We did not have sufficient ICU, oxygen masks, ventilators or anything. We failed to ensure a supply of these at the upazila level, even at the district level. If we are to take lessons from this, then the health ministry’s capacity must be stepped up at every level. We must ensure a skilled workforce.
We see a lacking in management and efficiency everywhere. Let me give an example. In the past fiscal years, the ministry was unable to spend its budget allocations. Funds were sent back. Our healthcare system must be taken to such a level where our president and prime minister do not have to go abroad for medical treatment. Ministers and civil servants do not have to go overseas for medical treatment. India’s president and prime minister do not go abroad for treatment, nor does the prime minister of Pakistan. Even Nepal’s prime minister undergoes medical treatment in Nepal. So why do our ministers go abroad for medical treatment?
Q :
Many say that our health sector allocation is very low. Is there need to increase the allocation?
I won’t even cite the case of developed countries. We have the lowest health sector allocation among the countries of South Asia. But simply increasing the allocation is not enough. We have to increase the capacity to utilise the allocation. Corruption and waste must be stopped. There is a case against a driver in the health sector for misappropriating millions of taka. He has been sent to jail. But there needs to be thorough investigation against everyone in the health sector involved in corruption and misappropriation of funds.
Q :
Thank you
Thank you too
The interview, originally published in the print and online editions of Prothom Alo, has been rewritten for English edition by Ayesha Kabir