Talking about the measles vaccine is diverting attention

Eminent physician and senior public health expert Abu Jamil Faisal was the president of the Bangladesh Public Health Association. He has worked as the country representative of the health non-governmental organisation EngenderHealth Bangladesh. In addition, he has contributed as an expert adviser to various important government policies and guidelines in the health sector. He is associated with Dhaka University, State University of Bangladesh, American International University and East West University as an adjunct faculty member (part-time teacher). Sadia Mahjabin Imam, Assistant Editor of Daily Daily Samakal took his interview on the burning issue of measles outbreak in Bangladesh.

Daily Samakal: Do so many children die from infectious diseases? Is the lack of vaccination the only reason for the death of more than 400 children?

Abu Jamil Faisal: The idea that children died of measles only because they could not be vaccinated is not correct. The real problem is being hidden. The major reason for the death of so many children is the shortcomings of our health management. From reluctance to receive healthcare on time to lack of coordination of work, malnutrition of children – all these reasons are important. In the sector of healthcare, some bureaucrats advised the interim government to delay the purchase of vaccines. It is not that the vaccines were at zero level. The major crisis has been caused by the weakness of planning and management. Apart from vaccination, the government has many other things to do, which are not being done.

Daily Samakal: How is the management deficiency?

Abu Jamil Faisal: Seeking medical attention late, before that, trying to cure the problem by visiting the pharmacy and using over-the-counter medicines. This makes the child’s condition more complicated. This mentality of having to go to a big doctor prolongs the treatment. We are very ignorant of the symptoms of the disease and are not able to understand the emergency situation. Behind these reasons is ignorance. And it is the responsibility of the government to make the people aware. Just as there is a shortage there, there is also a huge weakness in the government’s manpower management, training, and awareness creation in such an endemic situation. An even bigger problem is that the government is not admitting various minor weaknesses within itself. If these important issues for public health are not given importance, it is not possible to completely prevent the infection through vaccination alone.

Daily Samakal: What could the government have done or still needs to do other than vaccination?

Abu Jamil Faisal: Now, efforts are being made to manage the situation only with the staff of the Directorate General of Health Services (DGHS). There are at least 1,200 doctors under the Directorate General of Family Planning. What are they doing in this emergency situation? General practitioner doctors should also be involved in this service in areas where measles is prevalent. Training was very important for doctors and nurses at the district and upazila levels. Whenever a measles patient comes to them, they are afraid to send them from upazila to district, and from district to Dhaka. The sick child is getting sicker due to the stress of the road. If they received training, the doctors and nurses in remote areas would have gained confidence; the patient would also have received service. ICU is not needed only when the child has difficulty breathing. Oxygen is needed and this system is available up to the upazila level. If you see a picture of a child being given oxygen, you will know that his chances of survival are high.

Daily Samakal: Why is the government not declaring the measles outbreak an emergency or calling it an endemic?

Abu Jamil Faisal: Declaring an emergency will create panic and the government will not be able to control the situation. It will prove their failure. The World Health Organization (WHO) will then ask, why was your preparation so deficient? However, if an emergency were declared, all other ministries could have been involved in dealing with the situation. All ministries, including the local government ministry, social welfare, women and children, would have had to work together.

There are also many failures of the private sector behind creating this situation. If private hospitals had tried to manage the situation together, they could have played a bigger role than the government. Our children are dying every day. The number of more than four hundred of them that is being said; this is just the hospital’s record. We will not even know how many more children died at home without treatment. We do not know how many children got on the boat and died due to delay to reach the destination. No one can deny the responsibility for such a big failure.

Daily Samakal: As soon as the vaccine crisis was resolved, it was seen that the kit crisis had begun. Could the lack of kits make the situation even more risky?

Abu Jamil Faisal: This is the result of clear negligence and those responsible needs to be held accountable. If testing is stopped due to the kit crisis, the true picture of the infection will not be available. It will be difficult to take the right decision to deal with the situation. However, if symptoms of measles appear, experienced doctors can understand without testing. Putting too much importance to the kit crisis means diverting attention from the real problem.

Children with measles experience vomiting, diarrhoea, and shortness of breath. Why can’t patients get treatment for this disease at upazila hospitals? Why are all patients coming to Dhaka? The fact that patients cannot be treated at the upazila level is a mismanagement of healthcare. Although the government has been running the vaccination programme, there has been little inter-ministerial coordination, discussion in parliament, and efforts to involve the private sector. Even the vaccination that has started has major flaws. I am not worried about the kits at all. Emphasis should be placed on local vaccination management.

Daily Samakal: If you had clarified the issue of the shortcomings of the vaccination programme.

Abu Jamil Faisal: To say this flaw, you have to understand the microplanning of the EPI (Expanded Programme on Immunization) programme. Is there any publicity about the vaccination being given anywhere? Have you seen any posters, banners on television or heard miking; when and where will the vaccination be given? Many people in remote villages are still not aware or they are not used to getting information through technology. The health assistant of each union has a list – which age children are at which address, who needs to be vaccinated. Earlier, during the EPI programme, the list was taken from those health workers and awareness was made in the area by miking accordingly. This is not happening now. This microplanning of EPI is absent this time. As a result, vaccination is being given, but the government is not trying to bring all children under its control.

Many health workers (health assistants) have already retired. Many workers have not worked due to salary problems. That problem still exists. In that case, family planning field workers could have been an alternative. There is no coordination plan for this work. These are the small shortcomings of the vaccination programme.

Daily Samakal: During the Corona pandemic, many organisations and individuals outside the government did public awareness work. Why not this time?

Abu Jamil Faisal: We could not convince the government that everyone needs to be involved. It is not possible to reach the people there as easily as a local religious leader, local elder or social worker can by sitting at the centre. Private hospitals could have done public awareness work in this case. When a family comes to the hospital with a measles child, it is seen that there are two other healthy children with them. The hospital authorities need to raise awareness about keeping these children safe. Measles is contagious. Private hospitals have the opportunity to explain the importance of getting vaccinated and why in times of emergency, one should go to a doctor practising in the area instead of waiting for a senior doctor.

Daily Samakal: Every three to four years, an infectious disease epidemic is seen. Is there any other risk of such an infection in the future?

Abu Jamil Faisal: I hope that the loss of lives of children due to the measles outbreak ends here. But the reality is, it will not end here. More children will die. Things are still stuck only in the availability of vaccines, kits, and ICUs. I repeat that the problem has not been solved. These arrangements are very important to control any disease outbreak in the country. Dengue and chikungunya will start again in the future. There are reports of Hantavirus spreading from ships. We still cannot imagine where and how far this virus will spread.

Daily Samakal: What can be done to control measles at this time?

Abu Jamil Faisal: We are not able to provide proper healthcare to handle the current situation. Children are dying before receiving services. As a result, healthcare management is more important now than whether kits or vaccines are available or not. People need to be made aware; the government needs to involve people from all walks of life. This government is smart enough not to declare a state of emergency even in such a situation. Attention is only being drawn to the failure of the Yunus government to vaccinate. But the management is not taking into account the work that could have saved many children from death. Vaccination must be given. But look, children who are not old enough to be vaccinated are also getting infected. As a result, it is necessary to conduct awareness campaigns along with vaccination. We must conduct campaigns on advertisements, billboards, all media, hospital walls, and various roads. Everyone must be involved.

Daily Samakal: Thank you for your time.

Abu Jamil Faisal: Thank you too.