IVI and Bangladesh:
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.
In 2017, IVI began its TUNDRA program, a standardized, real-time disease surveillance of
pathogens in febrile and respiratory infections from hospitalized children. In Bangladesh, TUNDRA operates at the Dhaka Shishu Children’s Hospital and the Child Health Research Foundation (CHRF). With evidence generated in Bangladesh, Cambodia, and Vietnam, TUNDRA aims to identify and track human disease-causing pathogens in real-time, with a focus on resistant pathogen strains. This 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 will increase the volume of data available to improve spatiotemporal mapping of antimicrobial resistance (AMR) and use. The project will help 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 improve awareness, advocacy, policy, and interventions needed to combat AMR and antimicrobial misuse. CAPTURA will begin operations in Bangladesh in the near future.
Tech 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.
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.
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.
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 Vietnam. 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.