Attribution: Fahmida Khatun, "Bangladesh's Covid-19 Vaccination Agenda: Increase Supply, Reduce Hesitation", ORF Special Report No. 168, November 2021, Observer Research Foundation.

Since Bangladesh recorded its first Covid-19 case on March 8, 2020, the pandemic has spread rapidly, and today, at the time of writing this report, the country has 1,573,214 active cases. [1] The severity of infections and deaths peaked in June 2020 and has declined since January 2021. Bangladesh experienced its worst wave in June 2021 as the delta variant of the virus spread rapidly. Prior to this, the second wave-mainly due to the spread of the African variant of the novel coronavirus-reached its peak in the first week of April 2021. Figures 1 and 2 provide a snapshot of the epidemic of cases and deaths in Bangladesh over the past 16 months. 

Figure 1: New cases every day [2]

As with any infectious disease outbreak, the current global priority is to control the spread of Covid-19 and reduce the number of deaths. The scientific community agrees that the key to this work is vaccination.

Bangladesh launched a vaccination program for frontline health workers on January 27, 2021, and launched a vaccination program for the public on February 7, 2021. As of November 11, 19% of the target population in the country has been fully vaccinated. [4] The vaccination target is 138,247,508 people, which is 80% of the country’s population. Need to speed up efforts. In fact, like many other developing countries, Bangladesh may take longer to contain the pandemic because the supply of vaccines and the speed of vaccination are slower compared with richer countries (see Table 1). This model is not unique to Bangladesh. In fact, the gap between developed and developing economies is huge. As of November 10, 2021, the proportion of people vaccinated in the United Kingdom (UK) was 67%, and that of the United States was 57%. [5] In South Asia, Sri Lanka has the highest coverage. As of November 11, 2021, almost 63% of the population has been vaccinated. Other South Asian countries have slightly higher vaccination rates than Bangladesh. In Southeast Asia, Singapore already covers 86% of its population. 

Table 1: Covid-19 vaccination status in South and Southeast Asia[6]

Between March 15 and April 15, 2020, an online survey of 1,520 respondents (911 rural and 609 urban) in Bangladesh found that compared with urban residents, people in rural areas are more susceptible to Covid- 19 The level of understanding of pandemic-related behavior is much lower. [7] People have obvious hesitations about vaccination, which is more obvious in people with less formal education. A study conducted before the vaccination campaign found that people in rural areas and slum families were hesitant. [8] The analysis found various reasons for the general mood, including low literacy rates and lack of confidence in the healthcare system. In fact, media reports indicate that the number of registered people in rural areas is much lower than in urban areas. [9] The same study was conducted among 3,646 respondents in eight regions of Bangladesh from December 12, 2020 to January 7, 2021, and found that more than 7 out of 10 people (74.6%) expressed their willingness Vaccination against Covid-19, if safe and effective vaccine is provided free of charge. Only 8.5% of respondents expressed reluctance.

Vaccine rejection rates vary by age, location, occupation, education level, and trust in the national health system. The elderly, rural, semi-urban and slum populations, farmers, temporary workers, housewives, people with less education, and people with low trust in the national health system are more hesitant to vaccination. [10] These numbers are not small. The population of slum families alone is about 4 million, most of which are in the capital Dhaka. [11] They are poor and lack of resources, and any information about the pandemic is difficult to reach their level of knowledge. [12]

Due to the lack of mobile phones that can connect to the Internet, slum families have low interest in vaccination. This means that they cannot use online platforms to register themselves and their families for vaccinations. This may be the reason for their negative attitude towards vaccines and their reluctance to accept vaccines.

When the government first launched the online vaccination app "Shurokkha", people's hesitation was reflected in the small number of registered people. [13] The government subsequently made a decision to reduce the injection dose: Initially, the plan was to provide the first dose to 6 million people in the first month (February 2021); the target was later reduced to 3.5 million doses. The eligible age for vaccination has also dropped from the previous 55 to 40; the key population is still front-line workers and people over 40. Eventually, in July 2021, the minimum age was changed to 30; later, it was further reduced to 25 on July 29, 2021, and to 18 in October 2021. [14]

There are significant gender differences in vaccination rates. As of November 10, 2021, 52% of men received the first dose of the vaccine and 48% of women. For the second dose, the proportion was 53% for men and 47% for women. [15]

After the initial registration lag, the numbers rebounded within a few days. The government allows "onsite registration" to help those who cannot register online. However, hospitals soon had to stop this practice because they were unable to cope with the surge in crowds. What worked in the end was that more people turned to the application "Shurokkha". The waiting time to receive notification varies by vaccination center. In the early days, it was about a few hours to 7 days. Nowadays, as the number of applicants increases, it usually takes up to two weeks for registrants to receive confirmation. 

In order to pay special attention to students who have already suffered huge losses in their studies due to suspension of classes and the inability to learn online, the government launched a vaccination program called "Univac" in September 2021. [16] Therefore, in the same month, the University Grants Committee launched a link to the college student vaccine registration network. [17] Starting from November 1, 2021, 8 schools in the capital Dhaka will begin to vaccinate primary, secondary and college students between 12 and 17 years old. A total of 3 million students in this cohort will be vaccinated. [18] However, despite the popularity of the initiative, this figure only accounts for 30% of the country's 12 to 17 year old students. [19] In addition, there is currently no clear plan to vaccinate other students in the country outside of Dhaka. 

So far, vaccines have been distributed mainly through tertiary medical institutions in Dhaka. Vaccines were also sent to regional hospitals and upazila (district) health facilities, but access to these hospitals is limited. The government started a walk-in vaccination campaign on August 7, 2021. Anyone over the age of 18 can bring a national ID card and wait in line at the vaccination center for vaccination. The response from these walk-in vaccination facilities was overwhelming; thousands of people gathered together. This is especially useful for people who cannot use a smartphone or internet connection and therefore cannot register online for vaccination.

However, at the same time, the walk-in vaccination system also faces its own challenges. On the one hand, it is essential to accurately track the people vaccinated in these walk-in vaccination facilities. For vaccinators, it is important to keep track of the people who received the first dose and catch them during the second dose; otherwise, their punch will be useless. It is also important to monitor people for any potential vaccine side effects.

Bangladesh purchases vaccines from multiple sources. Between January and April 2021, only the Oxford-AstraZeneca vaccine was authorized for vaccination drives. The country subsequently ordered a vaccine produced by the Serological Institute of India, called Covishield. However, as India experienced a devastating pandemic in March and April 2021 and had to stop providing vaccines to other countries, Bangladesh was forced to suspend its vaccination program from April 26, 2021. By the end of April, Bangladesh had approved three other emergency vaccines-Russian Sputnik V, China's BBIBP-CorV and Pfizer-BioNTech vaccines, which will be distributed as part of COVAX. The government later approved the Moderna vaccine on June 29, 2021.

Bangladesh has received doses from Pfizer, AstraZeneca and Moderna through COVAX. Many countries have donated vaccines to Bangladesh: China sent 600,000 doses of Sinopharm; the US government sent Moderna; and Japan, AstraZeneca.

On August 17, 2021, the government of Bangladesh, China National Pharmaceutical Group Co., Ltd. (or Sinopharm Group) and Bangladesh pharmaceutical company Incepta Pharmaceuticals Limited signed a tripartite memorandum of understanding (MoU). [20] According to the memorandum of understanding, the two parties agreed to produce 5 million doses of Sinopharm locally, developed by Sinopharm/Beijing Institute of Biological Products Co., Ltd. Incepta will provide materials for the vaccine and will be responsible for other parts of the production chain, such as bottling, labeling and finishing. The government will purchase these vaccines and vaccinate the people free of charge, because these vaccines are regarded as public goods in Bangladesh. However, the Memorandum of Understanding did not specify the issue of technology transfer from China. Nevertheless, the local production of Sinopharm is expected to help meet Bangladesh's vaccine demand. Such cooperation will also reduce the overall cost of vaccines.

In order to increase supply and reduce inequality on a global scale, it has been proposed to allow developing countries to produce their own generic version of the Covid-19 vaccine. This will require the abandonment of certain provisions of the Trade-Related Intellectual Property Agreement (TRIPS)-the proposal was originally submitted to the World Trade Organization (WTO) in October 2020 by India and South Africa. [21] The two countries requested temporary "exemptions from certain provisions of the Trade-Related Intellectual Property Agreement on the prevention, containment and treatment of COVID-19. They urged WTO members "to work together to ensure patents, industrial designs, and copyrights." Intellectual property rights, such as the protection of undisclosed information, will not be necessary for timely access to affordable medical products, including vaccines and drugs, or for the expansion of research, development, manufacturing, and supply of medical products necessary to fight COVID-19. "[22] On May 25, 2021, 62 co-sponsors including India, South Africa and Indonesia submitted an amendment proposal, requiring "to be related to health products and technologies, including diagnosis, treatment, vaccines, medical equipment, Personal protective equipment, their materials or components, and the methods and manufacturing methods they use to prevent, treat or contain COVID-19. "[twenty three]

However, the pharmaceutical companies argue that because they invest in vaccine research and development, they have exclusive rights to price these drugs. Many opponents of the exemption proposal have also raised questions about the quality and safety of vaccines produced in other countries. [twenty four]

The proposals of India and South Africa were supported by about 120 countries. The United States agreed to waive the patent rights, limited to the COVID-19 vaccine. Many countries including Australia, Japan, the European Union, the United Kingdom, Singapore, Brazil, and South Korea are unwilling to discuss the revised proposal. On June 9, 2021, WTO members agreed to start text-based negotiations on the proposal. It is expected that by the end of July 2021, WTO members will reach an agreed negotiation text. On October 13-14, 2021, at the TRIPS Council meeting, WTO members noted encouraging discussions and bilateral meetings. The Chairman of the TRIPS Council announced that he will continue to negotiate with members to reach a consensus before the 12th WTO Ministerial Conference to be held from November 30 to December 3, 2021. However, the TRIPS Council has not yet reached a consensus. [25] Reached an agreed position on specific resolutions.

Although the patent exemption is essential for the production of a universal and cheaper Covid-19 vaccine, this is only the first step. The most important thing is the transfer of knowledge and technology. Article 66.2 of the TRIPS Agreement mentions the promotion and encouragement of technology transfer from developed countries to least developed country members. The 2003 and 2005 decisions on TRIPS and public health emphasized the need for careful implementation of Article 66.2. However, developed countries and pharmaceutical companies are reluctant to share technology with LDCs.

Bangladesh is a low- and middle-income country and least developed country. It is very interested in the patent exemption proposals for Covid-19 vaccines and medicines. Compared with other least developed countries, Bangladesh has stronger pharmaceutical production capacity. It has many world-class pharmaceutical companies that have been providing low-cost medicines to other countries, especially the poor. As a least developed country, Bangladesh can export its medicines under a compulsory license. As technological capabilities improve, Bangladesh can increase its production capacity and manufacture Covid-19 vaccines to meet domestic and international demand. Therefore, it can lead the voices of developing countries to successfully negotiate patent exemptions in response to the ongoing Covid-19 crisis. 

Although Bangladesh faces challenges in procuring vaccines, the government has been proactive in obtaining doses from various sources. However, the requirements are still high. Given that pandemics like Covid-19 can only be controlled through herd immunity, which depends largely on a successful vaccination plan, countries around the world have already begun the race to purchase vaccines. As a least developed country, Bangladesh does not belong to this kind of competition that requires both money and influence. If 70% of the global population must receive two doses of vaccine per person, then the world needs approximately 11 billion doses of Covid-19 vaccine. As of November 12, 2021, 51.5% of the global population has received at least one dose of Covid-19 vaccine, but only 4.5% of people in low-income countries have received at least one dose.

A total of 7.41 billion doses have been injected globally. [26] However, the population of high-income and upper-middle-income countries accounted for only one-fifth of the world's population, and the population of low- and middle-income countries accounted for four-fifths of the world's population.

The inequality in access to the Covid-19 vaccine makes it difficult for countries such as Bangladesh to vaccinate their populations at the same rate as richer countries. However, if all eligible people are not vaccinated, the world will not be able to fully recover from the pandemic. Therefore, the rapid expansion of vaccine production and distribution scale is essential. The Bangladesh government’s goal is to vaccinate 80% of the population through an accelerated vaccination campaign by 2022. [27] Achieving this goal will depend on the timely supply of vaccines.

For a country like Bangladesh, two issues must be resolved at the same time. The country must increase vaccine procurement and quickly promote vaccines across the country. This will require better delivery capabilities and efficient distribution systems. Concerns about vaccine inequality are not only a global issue, but also a national issue. Faster and fairer vaccination will be the key to better recovery from the large-scale effects of the pandemic.

Dr. Fahmida Khatun is the Executive Director of the Bangladesh Policy Dialogue Center.

[1] Directorate General of Health Services, "Bangladesh's COVID-19 Dynamic Dashboard", DGHS.

[4] Our data world, "Coronavirus (COVID-19) Vaccination".

[5] Our data world, "Coronavirus (COVID-19) Vaccination".

[6] Our data world, "COVID-19 data", comes from the GitHub population of the Duke Global Health Center.

[7] Rahman et al., "The COVID-19 Epidemic among Rural and Urban Residents in Bangladesh: An Online Cross-sectional Survey of Knowledge, Attitudes, and Practices", Epidemiology 2, Issue 2. 1 (2021).

[8] Abedin et al., "The willingness of adults in Bangladesh to be vaccinated against COVID-19: Understanding strategies to optimize vaccination coverage", Public Science Library ONE 16, Issue 2. 4 (2021).

[9] "Ensure Rural Population Registration and Vaccination", "Daily Star", February 5, 2021.

[10] Abedin et al., "The willingness of Bangladeshi adults to be vaccinated against COVID-19"

[11] Ferdous et al., "Knowledge, Attitudes and Practices Regarding the COVID-19 Outbreak in Bangladesh: An Online Cross-sectional Study", Public Library of Science ONE 15, Issue 2. 10 (2020).

[12] Anwar et al., "COVID-19 and Bangladesh: Challenges and how to respond. Frontiers in Public Health", 8, 154 (2020).

[13] "Vaccine Registration", University Grants Committee.

[14] "Bangladesh lowered the age limit for Covid-19 vaccine to 18 years." Dhaka Tribune, October 20, 2020.

[15] "Bangladesh's COVID-19 vaccination dashboard", Government of Bangladesh.

[16] "Get vaccinated and return to your campus".

[17] "UGC Launches Vaccine Registration Network Link for College Students", Financial Express, September 23, 2021.

[18] "Dhaka begins Covid vaccination for children aged 12-17", "Dhaka Tribune", November 1, 2021.

[19] "Starting to vaccinate school children in Dhaka", "Daily Star", November 1, 2021,

[20] Lu Sirui, "Sinopharm and Bangladesh sign a cooperation to produce COVID-19 vaccine", CGTN, August 17, 2021.

[21] Oommen C Kurian, "Patent Waiver as the New Pandemic Normal: India's Key Role in a Emerging Global Consensus", expert lecture, Observer Research Foundation, May 9, 2021.

[22] World Trade Organization (WTO), "Exemption from certain provisions of the TRIPS Agreement on the Prevention, Containment and Treatment of COVID-19: Communications from India and South Africa (IP/C/W/669)", WTO, 2020 October 2nd.

[23] World Trade Organization (WTO), "Exemption from Certain Provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19", revised decision text, (IP/C/W/669/Rev.1), WTO, May 25, 2021.

[24] "Covid: The United States supports the abandonment of vaccine patents to increase supply", BBC News, May 6, 2021.

[25] World Trade Organization (WTO), "Members seek integration to respond to IP COVID-19", WTO, October 14, 2021.

[26] Our Data World, "Coronavirus Vaccination",

[27] "Bangladesh will complete Covid-19 vaccination before 2022, and the health authorities are confident", Financial Express, August 30, 2021.

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Fahmida Khatun is the executive director of the Bangladesh Policy Dialogue (CPD). Dr. Khatun’s areas of interest include macroeconomic policy and management, effectiveness of international aid, international trade and WTO issues, youth unemployment, social inclusion and poverty eradication, climate change, feminist economics, least interest >>

ORF was established in 1990 to guide and help policy thinking to build a strong and prosperous India in a fair and just world. It helps to discover and inform India’s options, and to bring Indian voices and ideas to forums that influence global debate. ORF provides non-partisan, independent analysis and input to different decision makers (government, business, academia, and civil society) on issues such as security, strategy, economy, development, energy, resources, and global governance. ORF's mission is to conduct in-depth research, provide an inclusive platform, and invest today in tomorrow's thought leaders.