IVI and Bangladesh

 

Bangladeshi Leadership at IVI

 

Since October 2023, Bangladesh has been represented on the IVI Board of Trustees by Prof. Ehsanul Kabir, Managing Director and Chief Executive Officer of the Essential Drugs Company Ltd. 

 

Since October 2023, Bangladesh has been represented on the IVI Global Council by Mohammad Akhteruzzaman, the Additional Secretary (Public Health) of the Health Services Division in the Ministry of Health and Family Welfare. 

 

Member State Relations

 

On 28 October 1996, Permanent Representative of Bangladesh to the United Nations, H.E. Anworul Karim Chowdhury, signed the IVI Establishment Agreement. 

 

On 22 February 2021, the Cabinet of Bangladesh, under the leadership of the Honourable Prime Minister Sheikh Hasina, ratified the IVI Establishment Agreement. 

 

On April 5, 2021, the government of Bangladesh deposited an instrument of ratification to IVI Establishment Agreement with the United Nations, becoming IVI’s 19th State Party.  

 

On July 15, 2021, IVI hosted a ratification ceremony at IVI Headquarters to recognize and celebrate Bangladesh’s elevation to IVI State Party. 

 

Ongoing Collaboration

 

Global HPV Burden Study

In late 2022, the Bill & Melinda Gates Foundation granted $14.99 million USD to an IVI-proposed HPV global disease burden study with $1 million in cofounding from the Swedish government through IVI’s European Regional Office.

 

This harmonized, multi-country and multi-site study will estimate the prevalence of high-risk HPV genotype infections among representative samples of girls and women aged 9-50 years, and among specific sub-populations, to better understand the incidence of persistent HPV infection in girls and women in low- and lower middle-income countries in Asia and sub-Saharan Africa. Project host countries include Bangladesh, Nepal, Pakistan, the Democratic Republic of the Congo, Ghana, Sierre Leone, Tanzania, and Zambia. 

 

During the tenure of this program, 33 substudies of four types, including cross-sectional surveys in general populations, longitudinal studies, special population studies, and qualitative studies will be launched. 

 

Data will also be collected on girls’ and women’s knowledge, attitudes, and beliefs about HPV and vaccination, and on risk factors for HPV infection and explore barriers to prevention, screening and treatment access for girls and women. 

 

The results of this study will enable a more accurate understanding of the HPV disease burden as well as barriers to effective interventions at the country and global level, will better inform policymakers and health program designers, and encourage prioritization of research and development efforts towards those with the greatest potential public health impact.

 

In Bangladesh, this program is led by iccdr,b and enrollment was initiated in 2023. 

 

Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA)

The IVI-led CAPTURA project played a pivotal role in expanding historical and current datasets on AMR and antimicrobial usage through extensive data collection efforts across Southeast and South Asia. Building on its successes, CAPTURA II aims to further improve the quality, quantity, analysis, and dissemination of AMR data. This phase focuses on refining methodologies in data collection, stronger monitoring of how surveillance systems are performing, better data management practices, and supporting sustainable improvements in these surveillance systems.

 

The project runs from 2023 through 2025, directly informing national and regional initiatives to help:

1. Improve AMR surveillance
2. Promote antimicrobial stewardship
3. Shape evidence-based policy

 

Countries: Bangladesh, Bhutan, Indonesia, Laos, Nepal, Pakistan, Papua New Guinea, Sri Lanka, Viet Nam

 

Strengthening External Quality Assurance for AMR in Asia (EQAsia)

The Technical University of Denmark is leading a consortium with IVI and the Veterinary Faculty at Chulalongkorn University in Thailand with the Strengthening External Quality Assurance for AMR in Asia (EQAsia) project. During the first phase, the consortium identified and mapped coverage of external quality assurance programs on the continent, providing seven rounds of services and relevant trainings to National Reference Laboratories and Centers of Excellence across One Health sectors. In the next phase, launched in 2023, partners provide four additional rounds of external quality assurance to more than 80 laboratories and centers in Asia and support two countries in establishing national external quality assurance programs to build up their capacity to independently conduct One Health-focused external quality assurance.

 

Technical Assistance for Clinical Engagement – Asia (TACE Asia)

The TACE Asia project focuses on providing technical support to improve the use of laboratory services and generation of good quality and representative AMR and antimicrobial use data in the human health sector. This will be done through support for clinical engagement and training on the use of simplified protocols to generate AMR burden data in select Fleming Fund priority countries. Launched in 2024, the program is contributing to the use of data on clinical practice and decision-making, improving rational use of antimicrobials, promoting antimicrobial stewardship, and shaping evidence-based practice.

 

Countries: Bangladesh, Bhutan, Indonesia, Laos, Nepal, Pakistan, Papua New Guinea, Sri Lanka, Timor-Leste, Viet Nam

 

Technical Assistance for Data and Evidence Use (TADEU)

The TADEU project was launched to provide technical assistance to support data production and improve the use of AMR data and evidence, with a particular focus on the economic evaluations of AMR.

 

In 2024, the project:

1. Developed a micro-costing tool to help governments plan future AMR surveillance by informing financial implications, sustainability, and outcomes of AMR surveillance.
2. Developed protocols and tools to measure the impact of antimicrobial stewardship programs as well as the economic burden of AMR.
3. Completed literature reviews on existing methodologies and frameworks for econometric modeling and quantifications for AMR economic burden and impact measurements of stewardship programs.
4. Developed a technical guide for the Political Economy Analysis framework.

 

Countries: Bangladesh, Indonesia, Laos, Nepal, Pakistan, Papua New Guinea, Timor-Leste, Viet Nam 

 

Investigating the impact of Respiratory Syncytial Virus (RSV)

RSV causes significant morbidity globally, however, an affordable vaccine is not yet available for use in LMICs. 

 

In 2022, IVI received a grant from the Federal Government of Germany (via Robert Koch Institute) to investigate the clinical and genomic epidemiology of RSV infections in children from both urban and rural settings in Bangladesh. RSV cases will also be included in a health economics study that estimates the cost-of-illness of RSV.

 

In Bangladesh, this program is conducted in collaboration with the Child Health Research Foundation.

 

Previous Collaboration

 

Regional Antimicrobial resistance Data Analysis for Advocacy, Response, and Policy (RADAAR)

The RADAAR project aims to improve regional data-sharing and analysis for use in AMR planning, policy, and advocacy. IVI (lead grantee), Brigham and Women’s Hospital (WHONET), Big Data Institute (University of Oxford), and Public Health Surveillance Group, as well as the Evidence-Informed Policy Network (EVIPNet) of the WHO, have been collaborating across various activities since 2021.

 

Based on identified need and demand emerging from countries, RADAAR laid the groundwork and embarked on a strategic pathway to strengthen LMIC capacities in translating AMR knowledge (data/evidence) into effective policies. Towards this end, IVI’s Policy and Economic Research (PER) department has completed a series of training workshops and disseminated a codeveloped ‘step-by-step’ AMR Policy Advocacy country guide.

 

In addition, the IVI PER team conducted the RADAAR–EVIPNet country capacity strengthening pilot initiative on AMR knowledge translation, piloted in Bangladesh, Malawi, Nepal, and Uganda.

 

Cholera Vaccines: International Reference Standards and Reagents

Since 2019, IVI has been working to ensure that internationally recognized critical standards and reagents are available to manufacturers and developers of low-cost oral cholera vaccine for Gavi markets.

 

This project involves the development of reference reagents for the coating of microtiter plates, reference reagents for detection use, and the establishment of one reference cholera vaccine. 

 

Once completed, these reference materials will be released by the UK’s National Institute for Biological Standards and Control (NIBSC), and the project partners will organize a collaborative study to evaluate WHO-developed international standards.

 

In Bangladesh, this project is conducted in collaboration with icddr,b. 

 

This project is funded by the Bill & Melinda Gates Foundation.

 

Extended analysis of past datasets of cholera, typhoid, and rotavirus II (EAD II)

From 2021 to 2023, IVI worked alongside Dr. Firdausi Qadri at Bangladesh’s icddr,b to reexamine disease surveillance and vaccination data collected at field sites across Africa and Asia since the 1980s. Datasets from these previous studies have been cleaned, archived, documented, and are available for analysis in a digitized and curated format. 

 

As a result of EAD II’s efforts, the now digitalized datasets have yielded new research papers on cholera, typhoid, and rotavirus and demonstrated the usefulness of new methodological approaches, such the fried egg analysis of cluster randomized trials, novel uses of machine learning, and innovative uses of vaccine probe analysis. 

 

EAD II was a successor project to EAD I, which ran from 2017 to 2019. EAD I successfully published eight manuscripts and taught new methodologies to young researchers at icddr,b and IVI.

 

AMR Surveillance

From 2017 to 2022, IVI administered the TUNDRA program, a standardized, real-time disease surveillance of pathogens in febrile and respiratory infections from hospitalized children. The TUNDRA host countries were Bangladesh, Cambodia, and Viet Nam.

 

In Bangladesh, TUNDRA operated at the Dhaka Shishu Children’s Hospital and the Child Health Research Foundation (CHRF). With evidence generated in Bangladesh, Cambodia, and Vietnam, TUNDRA aimed to identify and track human disease-causing pathogens in real-time, with a focus on resistant pathogen strains. 

 

This data will enable medical professionals to generate genomic data that could be used for patient care, quickly identify genes conferring antibiotic resistance, rapidly identify and confirm hospital outbreaks, and build a local molecular analysis capacity using a hub and spoke model. 

 

In 2019, IVI launched the Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) consortium. CAPTURA worked to increase the volume of data available to improve spatiotemporal mapping of antimicrobial resistance (AMR) and use. The project helped identify gaps in data and areas for quality improvement that can be addressed in future initiatives to strengthen surveillance capacity. The information resource generated by the project will help improve awareness, advocacy, policy, and interventions needed to combat AMR and antimicrobial misuse.

 

Vaccine Technology Transfer: Oral Cholera Vaccine

In 2014, IVI transferred the technology for oral cholera vaccine (OCV) production and quality control methods to Incepta Vaccine Ltd. Both IVI and Incepta are committed to developing the vaccine for the public sector in Bangladesh where a high burden of cholera exists. As part of this transfer, IVI and icddr,b supported Incepta with a clinical trial that assessed vaccine safety and immunogenicity in 2,052 people in Dhaka. Work on the development of Incepta’s Cholvax vaccine is still ongoing.

 

Cholera Vaccine Development

In 2004, IVI and icddr,b conducted phase II clinical trials of the Peru-15 cholera vaccine in Matlab, Bangladesh. 74 infants aged 9-12 months received either the vaccine or a placebo at the same time as a measles vaccine. The studies associated with this trial continued through 2009 and showed the vaccine to be safe and highly immunogenic when tested in adults, toddlers, and infants. 

 

Economic studies of the trial found that the vaccination of preschoolers, school-aged children, and adults in Matlab was cost-effective. As a result of this trial, the government of Bangladesh reviewed introducing cholera vaccination in high-risk areas of the country. 

 

In 2011, IVI and icddr,b conducted a large scale vaccine demonstration campaign in Dhaka, providing approximately 141,000 people with the IVI-developed OCV. 

 

In 2013, IVI’s Policy and Economic Research team developed and published an investment case study for cholera vaccination in Bangladesh. Intended for policymakers, vaccine manufacturers, and donors, the report provides an estimate of the disease and economic burden, financing needs, likely challenges, and cost, impact and cost effectiveness estimates for several cholera vaccination strategies.

 

In 2014, IVI and icddr,b conducted one of IVI’s largest ever clinical studies, a randomized trial to demonstrate the effectiveness of a single dose of OCV. Over 200,000 people in Dhaka received the vaccine or placebo. The study found that a single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years.

 

Cholera Surveillance

From 2002 to 2007, IVI carried out cholera surveillance and disease burden studies in Matlab, Bangladesh. The study found that the average cost of cholera illness for hospitalized patients in Matlab, including lost wages due to missed work by the patient or caretakers, was $26-47USD. 

 

Japanese Encephalitis

From 2008 to 2011, in collaboration with the Bangladesh Institute of Child Health, and with funding from Goldwin Korea, IVI conducted a hospital-based JE surveillance study in 3 hospitals in Dhaka and Mirazapur. This study was requested by the government of Bangladesh to address the lack of JE incidence data in the country. The study was conducted jointly with a study of Hib meningitis, and enrolled children under 10 who showed symptoms of meningitis or encephalitis in the participating hospitals. 

 

Shigella Surveillance

From 2002 to 2005, IVI carried out its first global program, the Diseases of the Most Impoverished (DOMI) disease burden study. As part of DOMI, IVI investigated the disease burden of Shigella in Bangladesh, China, Indonesia, Pakistan, Thailand, and Viet Nam. A total of 605,331 individuals were under surveillance and 56,958 episodes of diarrhea were detected, 2,927 (5%) of which were shigellosis. 

 

In Bangladesh, IVI established a study site in Dhaka. The study uncovered high Shigella incidence rates in Bangladeshi children (46 per thousand children/year) and discovered that more that 20% of isolated Shigella in Bangladesh belonged to S. boydii species, which is not commonly observed in either developed or developing countries. 

 

An additional study on the effectiveness of an oral Shigella vaccine (live attenuated SC602 S. flexneri 2a) in Bangladesh showed poor colonization and immunogenicity in young children. This indicates that Shigella vaccines face substantial challenges for inducing good immune responses in Shigella-endemic populations where there may be subgroups that have high levels of preexisting natural immunity.

 

The results of the Shigella study in Bangladesh have major implications for the design of new vaccines and influenced the development of IVI’s Shigella vaccine.