কোভিড-নাইন্টিন রোগ – দ্বিতীয় ঢেউ-এর প্রস্তুতি


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‘ঢেউ-এর পর ঢেউ’- ভাবতেই সাগরের ঢেউ বালুকাবেলায় আছড়ে পড়ার মনোমুগ্ধককর দৃশ্য মনে পড়ে। কিন্তু এপিডেমিওলোজী পরিভাষায় ঢেউ বা ওয়েভ-এর অর্থ সংক্রামক ব্যাধির প্রত্যাবর্তন, যা অনাকাঙ্খিত।

নীরব ঘাতক কোভিড-১৯ রোগ সংক্রমণ শুরু হয়েছিল গত বছরের ডিসেম্বরে চীনের ঊহানে; আর তা মাত্র কয়েক মাসে সারা বিশ্বে ছড়িয়ে পড়ে। এ রোগে এ যাবৎ আক্রান্ত হয়েছে ৩২ লক্ষাধিক মানবসন্তান, আর মাত্র কয়েক মাসে মৃত্যু হয়েছে প্রায় ২.৩ লক্ষাধিক। শিল্পোন্নত দেশ যুক্তরাষ্ট্রে মৃত্যু সংখ্যা সর্বাধিক, প্রায় ৬৩ সহস্র।  মৃত্যুর মিছিলে শত-সহস্র যোগ হচ্ছে প্রতিদিন। যেমন, বিগত ২৪ ঘন্টায় যুক্তরাষ্ট্রে প্রায় ২ সহস্র (শুধু নিউ ইয়র্কে ৩০৬), যুক্তরাজ্যে ৬৭৪, মেক্সিকোতে ১৬৩, ব্রাযিলে ৩৯০ আর বাংলাদেশে অন্ততঃ ৫ জনের মৃত্যু হয়েছে।  ইওরোপের বিভিন্ন দেশে শত-সহস্র সংক্রমণ ও মৃত্যু লক্ষণীয়। এরই মধ্যে আশার বাণী কিংবা গুঞ্জন শোনা যাচ্ছে- করোনাভাইরাস নাকি দূর্বল হয়ে গেছে। তারই ভিত্তিতে লকডাউন উপেক্ষা করার প্রবণতা বাড়ছে। যুক্তরাষ্ট্রের লকডাউন শিথিল এলাকার গাড়ি চলাচল বেড়েছে আর সী-বীচ, বোট ক্লাব আর পার্কগুলিতে বিপুল জনসমাগম হচ্ছে। লকডাউন প্রত্যাহারের দাবীতে জনসমাবেশ হয়েছে কয়েকটি শহরে। নতুন সংক্রমণ কিংবা মৃত্যুহারে সামান্য নিম্নগতি কিছুটা আশার সঞ্চার করলেও এ মুহূর্তে কোভিড-১৯ রোগ পরাস্ত কিংবা নিষ্ক্রমণের দাবী আর যাই হোক যুক্তিসঙ্গত নয়।

স্বাধীনতাহীন, গৃহবন্দী, অলস ও বেকার জীবন কেউ চায় না।  কিন্তু ঊহানে কোভিড-১৯ এর প্রাদূর্ভাব শুরু হলে বাধ্যতামূলক লকডাউন, পিপিই বা সুরক্ষা সামগ্রী ব্যবহার ও সামাজিক দূরত্ব রক্ষার মাধ্যমে আড়াই মাস পর শহরবাসী মহামারীর কালো থাবা থেকে রক্ষা পেয়েছিল। এখন তারা সুস্থ-স্বাভাবিক জীবনযাপন করছে এমন দাবী করলেও বাস্তবে তা ঘটেনি; প্রায় অর্ধেক ব্যবসা প্রতিষ্ঠান এখনও বন্ধ। ফলে অর্থনৈতিক মন্দা দৃশ্যমান। এছাড়া নতুন করে সহস্রাধিক রোগ সংক্রমন ছাড়াও গত সপ্তাহে সেখানে ১৯ জন উপসর্গহীন রোগী পাওয়া গেছে।

লকডাউন ও সামাজিক দূরত্ব রক্ষা করতে গিয়ে যুক্তরাষ্ট্রে গত ৬ সপ্তাহে বেকারত্ব তিন কোটি ছাড়িয়েছে। সারা বিশ্বের বহু দেশে এখনো লকডাউন মেনে চলতে বলা হলেও গৃহবন্দী-দশা ও অর্থনৈতিক বিপর্যয়ের কারণে যুক্তরাষ্ট্রসহ বিভিন্ন দেশে যে ব্যাপক তোড়জোড় শুরু হয়েছে তা মঙ্গলজনক কিনা বলা মুশকিল। ভয়কে জয় করতে সাহসের প্রয়োজন, কিন্তু শত্রুকে দূর্বল ভেবে দূ;সাহসীর পরাজয়ের ঘটনা ইতিহাসে বিরল নয়। সুইডেন ও নরওয়ে প্রতিবেশী দেশ হলেও নরওয়ের তুলনায় সুইডেনে (লকডাউনে গুরুত্ব না দেওয়ায় ) সংক্রমণ ও মৃত্যুহার বেশী।

মনে রাখা দরকার,  করোনাভাইরাস একটি আরএনএ-ভাইরাস যার সংক্রমণ ক্ষমতা ব্যতিক্রমী; এরা ভূখন্ড, ভাষা, জাতি, সতর্কবার্তা কিংবা ধর্মের বাছ-বিচার করে না।  রোগ উপসর্গের অনুপস্থিতি কিংবা লক্ষণ রোগভিত্তিক না হওয়ায় পরীক্ষা-নিরীক্ষা ছাড়া শ্বাসতন্ত্রের এ রোগ নিরূপণ করাও কঠিন। আবার অত্যাধুনিক প্রযুক্তি ব্যবহার করে পিসিআর- টেস্ট কিংবা সেরোলজিক্যাল টেস্ট থেকে গুণগত (অর্থাৎ, পযিটিভ বা নেগেটিভ) ফলাফল পাওয়া গেলেও এদের কার্যকারিতা শতভাগ নিশ্চিত নয়।  সেরোলজিক্যাল টেস্ট এর মাধ্যমে সাধারণতঃ করোনাভাইরাস অ্যান্টিবডি (প্রতিরোধী আমিষ) সনাক্ত করা হয়; টেস্ট পযিটিভ হলে সাধারণতঃ তা শুধুই সংক্রমণ ইঙ্গিত করে। অপরপক্ষে, করোনা ভাইরাস টেস্টের ফল নেগেটিভ হলে ব্যক্তি রোগমুক্ত কিংবা ঝূকিমুক্ত, এমন দাবী করাও অসঙ্গত। বরং উপসর্গহীন আক্রান্ত ব্যক্তি অথবা মিথ্যা-নেগেটিভ একজন বাহক মিথ্যা স্বস্তি নিয়ে অন্যদের সান্নিধ্যে এসে অজান্তেই কোভিড-১৯ রোগ বিস্তারে সহায়তা করতে পারেন। আবার, পর্যাপ্ত ইম্যুনিটি বা প্রতিরোধক্ষমতার অভাবে একবার সেরে উঠার পর কোন ব্যক্তি আবারও করোনাভাইরাসে আক্রান্ত হতে পারেন।

সার্বিক পরিস্থিতি নিয়ন্ত্রনে না এলেও এ সপ্তাহে যুক্তরাষ্ট্রের প্রায় দু-ডজন রাজ্যে লকডাউন শিথিল করে সতর্কভাবে পর্যায়ক্রমে ব্যবসা-কর্মস্থল খোলার প্রস্তুতি চলছে। তবে মধ্য-মে’র আগে  নিউ ইয়র্কের অফিস-ব্যবসা খোলার সম্ভাবনা কম। ওয়াশিংটন ডিসির একজন প্রশাসক বলেছেন তিনি স্বল্প পরিসরে লকডাউন শিথিল করতে আগ্রহী। তিনি মনে করেন, রাজধানী ডিসি স্বাভাবিক হতে তিন মাস পর্যন্ত লেগে যেতে পারে। যুক্তরাষ্ট্রের করোনা পরিস্থিতি অগ্রাহ্য করা হলে কোভিড-১৯ এর প্রভাব আগামী শরত এমনকি শীতকাল পর্যন্ত দীর্ঘায়িত হতে পারে, এমন আশংকাও আছে।

প্রসঙ্গতঃ উল্লেখ্য, সংকুচিত সময়সূচি মেনে নিউ ইয়র্কের পরিবহণ সংস্থা ‘এমটিএ’ সাবওয়ে ও বাস সার্ভিস চালু রেখেছে। কিন্ত হটস্পট নিউ ইয়র্কে কোভিড-১৯-এ উল্লেখযোগ্য সংখ্যক স্বাস্থ্যকর্মী ছাড়াও অন্ততঃ ৮০ জন এমটিএ-কর্মী মৃত্যুবরণ করেছেন। এপ্রিলের ৯ এবং ৩০ সন্ধ্যায় নিউ ইয়র্কের এম্পায়ার স্টেট বিল্ডিং-এ এই দুই প্রথম সারির যোদ্ধাদের সম্মানে নীল আলোকসজ্জা করা হয়েছে।

জনবহুল বাংলাদেশে অন্যান্য দেশের তুলনায় কম হলেও নতুন কোভিড-১৯ রোগী সনাক্তকরণ ও মৃত্যু অব্যাহত আছে। সম্প্রতি ময়মনসিংহ ও নারায়নগঞ্জে বহু স্বাস্থ্যকর্মী কোভিড-১৯ এ আক্রান্ত হয়েছেন। পেশাজীবীদের মধ্যে ডাক্তার, সাংবাদিক ও পুলিশ সদস্যের মৃত্যু ঘটেছে। এছাড়া চট্টগ্রামে দুইজন ব্যক্তি দ্বিতীয় বার সংক্রমিত হয়েছেন। এসব সংবাদ দূশ্চিন্তার উদ্রেক করে। সীমিত আকারে বলা হলেও সহসাই লকডাউন শিথিল করে বহু সংখ্যক গার্মেন্টস শিল্প-কারখানা ও পবিত্র রমযানের কারণে ইফতারি/খাবারের দোকান চালু হয়েছে। গার্মেন্টস কর্মীরা চাকুরি বাঁচাতে নিকট ও দুরের জেলা থেকে কর্মস্থলে এসেছেন, অথচ যানবাহন চলাচলে নিষেধাজ্ঞা থাকায় অস্বাস্থ্যকর অবস্থায় ভ্রমণ করেছেন। স্বাস্থ্যবিধি মেনে চলার কথা বলা হলেও এসব কর্মী এবং খাবার ক্রেতা-বিক্রেতারা ভিড় করতে বাধ্য হচ্ছেন। এমতাবস্থায় নতুন করে রোগ সংক্রমনের আশঙ্কা বাড়ছে।

যা-ই হোক, সরকারী-বেসরকারী সমন্বিত উদ্যোগে প্রশাসন ও জনসাধারণের সহযোগিতায় এ নিম্নমুখী অর্থনীতির এ পরিস্থিতি থেকে উত্তরণ সম্ভব। তবে সদিচ্ছা কথায় সীমাবদ্ধ রেখে বসে থাকলে চলবে না। অতএব, পরিস্থিতি যথাযথভাবে মুল্যায়ন করে কর্মপদ্ধতি স্থির করতে হবে। যেমনঃ

– বিশ্ব স্বাস্থ্য সংস্থার নির্দেশিত নীতিমালা অনুসরণ করতে হবে।

– কুয়ারেন্টিন, সামাজিক দুরত্ব রক্ষা, ভ্রমণ (গমণাগমন) কিংবা লকডাউন নির্দেশনা সঠিকভাবে মেনে চলতে হবে।

– পরিস্কার-পরিচ্ছন্নতা বব্জায় রেখে, পিপিই ব্যবহার করতে হবে। এতে ব্যবহারকারী ও অন্যেরাও কিছুটা সুরক্ষা পাবেন।

– কেউ আক্রান্ত হলে বা রোগীর সস্পর্শে এলে পৃথক করে ১৪ দিন পর্যন্ত পর্যবেক্ষণ করতে হবে।

– রোগনির্ণয় সুযোগ বাড়াতে হবে। টেস্ট-এর ফলাফল যাচাই করে চিকিৎসা ব্যবস্থা দিতে হবে।

– সঠিক তথ্য প্রচার ও প্রসারে উদ্যোগী হতে হবে।

বিশ্বব্যাপী নিম্নমুখী অর্থনীতিকে চাঙ্গা করতে স্বাভাবিক কর্ম-জীবনে ফিরে আসার বিকল্ল নেই, কিন্তু আগুন নিভে গেছে ভেবে অগ্নিযোদ্ধারা তড়িঘড়ি করে ফিরে গেলে ফল যেমন খারাপ হতে পারে, তেমনই সংক্রমণ ঝুঁকি উপেক্ষা করে বেপরোয়াভাবে স্বাভাবিক জীবনে ফিরে এলে নতুন করে কোভিড-১৯ এর বিস্তার অর্থাৎ দ্বিতীয় ঢেউ এর আগমন ঘটতে পারে।

জেনেটিক পরিবর্তনের ফলে করোনাভাইরাসের রোগসৃষ্টির ক্ষমতা কি কমছে?


Interview of Voice of America (VOA) with 

Dr Mustak Ibn Ayub, Department of Genetic Engineering and Biotechnology, University of Dhaka



CARES is committed to giving the society the right information about the COVD -19.  Only scientific discussions by practising scientists from Bangladesh and other places are in CARES website.  Here are some new insightful suggestions from Professor Dr Jeba Seraj, an active member of CARES and a life scientist at Dhaka University. At CARES we talk science.  Engage Science in your life.   –  Wali-ul-Maroof Matin, Chairman, CARES


 

The need for SARS-CoV-2 genome sequencing


Professor Sharif Akhteruzzaman, PhD, Department of Genetic Engineering and Biotechnology, University of Dhaka


The ongoing coronavirus pandemic has suddenly and drastically changed the way we lived in the world, only a few months ago. We have not seen such devastation in recent history since World War II. The virus has already killed more than 170,000 people worldwide and billions are at risk of getting infected. There is no drug yet with convincing scientific evidence that can cure the illness, neither is there any effective vaccine in sight. We really don’t know how the crisis is going to end. But we know for sure that the post-pandemic world is never going to be the same as before. Therefore, envisioning a comprehensive strategy to cope with post-pandemic challenges by exploring all scientific means and ways of the 21st century is crucial.

We all know by now that the causative agent of Covid-19 is a novel coronavirus called SARS-CoV-2. Biologically speaking, viruses are not true biological entities and therefore require a host to survive. All viruses carry their genetic information as either DNA or RNA. The SARS-CoV-2 genome is an RNA molecule of about 30,000 bases containing only 15 genes. The human genome, on the other hand, is a double helix DNA—about three billion bases in size and containing about 30,000 genes. RNA is less stable and more prone to mutation than DNA, so RNA viruses generally change and evolve faster. This sometimes allows RNA viruses to jump from one species to another.

Coronavirus did not just pop up very recently. There are hundreds of coronaviruses belonging to a large family of viruses called coronaviridae. They have been around us for a long time in many avian and mammal reservoirs including bats, migratory birds, camels, civets, pangolins, mice, dog and cats. The current trail of death and disease around the world is believed to have been created by at least eight strains of the novel coronavirus.

Since novel coronavirus is a new virus, mining its genome sequence is of crucial importance. Genome sequencing has now become a powerful tool for tracking diseases—this is called “genomic prediction”. Whole genome sequencing will help researchers identify genetic changes that occur in a virus when it spreads through the population. The changes in the genetic sequence of the viral genomes collected from several patients will allow the monitoring of the spread of the disease within the country and between populations over time. It will also provide us with answers to the following questions, which are not known to us at this moment with certainty.

These are—why are some countries suffering more from the virus when compared to other countries? Why do children seem to be less vulnerable than adults? Can the virus evolve into a more virulent strain, and what will happen then? How fast is the coronavirus mutating? How can a vaccine be developed, targeting a particular population? Where did the virus actually originate?

From the perspective of any specific country, including ours, the most important information from the viral genome sequence at this moment will be—identification of particular viral strain/s that are prevalent, identification of infection hotspots or super-spreaders (individuals who spread the infection to more than the expected number of people), and formulation of strategies for public health intervention. This will also help develop a vaccine targeting our own population.

Many countries have already started sequencing the viral genomes collected from patients. In India, three institutes (CSRI, CCMB and IGIB) have started working together on the whole genome sequencing of the novel coronavirus. The government of UK has announced a GBP 20 million investment for mapping the Covid-19 spread in UK through whole genome sequencing. The study will be conducted through a consortium comprised of several research organisations and numerous academic institutes. According to the National Centre for Biotechnology Information (NCBI), there are 818 entries of SARS-CoV-2 complete genome sequence from various countries around the world. Countries that have submitted complete genome sequence include USA, China, Spain, Tunisia, Turkey, Iran, South Africa, Taiwan, Thailand, Vietnam, Nepal and Nigeria, with the highest number of submissions from the US.

From our country, we need to take the initiative to sequence the whole genome of the virus samples collected from infected patients in order to understand more about the virus type, its origin, rate of mutation, what type of vaccine would suit our population and most importantly, how we could face the next wave of infection in case of its re-emergence. In Bangladesh, we have several universities and institutes capable of doing genome sequencing with the necessary expertise. What is important is that we act quickly, before it is too late.

Source:  https://www.thedailystar.net/opinion/news/the-need-sars-cov-2-genome-sequencing-1895359

What Can Antibody Testing Really Tell Us About COVID-19?


Compiled by Professor Dr Md. Mozammel Hoq


An immunology expert describes various tests for coronavirus, whether we’re immune to COVID-19 after infection, and more.

ABOUT

Such antibody testing has already started, but it can’t ramp up overnight. And first, scientists need to figure out exactly what to test for, and whether having these antibodies actually make someone immune and for how long, says Yvonne Maldonado, MD, a professor at the Stanford University School of Medicine.

“Right now, we’re trying to do some studies to understand exactly what having antibodies really means,” she says.

A virus-like the new coronavirus, officially called SARS-CoV2, enters cells and hijacks their machinery to make more copies of itself. The immune system then makes antibodies to track down and kill these clones, says Aneesh Mehta, MD, an infectious disease specialist at Emory University School of Medicine in Atlanta.

While diagnostic tests can tell if someone is currently infected, testing for antibodies reveals whether they’ve ever been infected — even if they never felt sick.

Experts say these antibody tests, in the short term, can answer personal questions, like, “Was I infected?” It will take much longer to answer questions such as, “How long will immunity last after infection?” and societal ones, such as, “How dangerous is COVID-19 really?”

And until we know the answer to those questions, we won’t really know the true value of having antibodies. While experts agree it doesn’t mean our lives will completely revert to the way they were before, the tests can help us get on that path.

Knowing how many people were actually exposed and developed antibodies will help officials understand how dangerous it truly is, says Michael Mina, MD, PhD, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health. While millions of people worldwide have been diagnosed with COVID-19, many more have probably had it and were unable to get tested or didn’t even notice the infection.

“It really changes our view of many, many things: First and foremost, how many people have been infected and [how many] remain susceptible to this infection,” he says. “But it also changes our view on the actual biology and pathogenicity of this virus. It will determine and change how we’re looking at this virus.”

Antibody tests will also be essential for getting us out of our houses and back to work, and for easing the fear that has paralyzed the country, says Marc Lipsitch, PhD, also an infectious disease epidemiologist at Harvard.

Policymakers will need to know how many people have the disease and how many have immunity against it, Lipsitch says, before deciding when it’s safe to loosen social distancing requirements and when they will need to tighten up again to cope with a new wave of infections.

Hopefully, having antibodies will protect someone from getting COVID-19 a second time. But since the virus has only been around since late last year, no one yet knows how long that protection will last.

With the common cold, a relative of the new coronavirus, immunity doesn’t last long. You can catch it again a few months later. On the other hand, people who contracted severe acute respiratory syndrome (SARS) — another related virus that caused a deadly outbreak in 2003-2004 — still carry protective antibodies more than 15 years later, Maldonado says.

Where this virus lies on that continuum could have a huge impact on the country’s ability to reopen and get people back to work, and also on the development of a vaccine, experts say.

If immunity lasts for years, those who have recovered can generally relax, resume their daily lives, and go back to hugging loved ones.

If immunity lasts for just a short time, then even people who were infected once could be vulnerable again soon — and it will be harder to develop a protective vaccine, says Matthew Sims, MD, PhD, director of infectious disease research at Beaumont Health.

Ramping Up Testing

Researchers are also still deciding which antibodies their tests should look for. Some antibodies are made early in an infection and go away, usually within a few weeks, while others can linger for months or years. Looking for antibodies called Immunoglobulin M, or IgM, can identify recent infections, says Harvard’s Mina.

Immunoglobulin G, or IgG, stays around longer, he says. “I would choose IgG for that effort to get a better understanding of how many people have gotten it,” he says, noting that tests for IgG usually yield information about IgM as well. So far, all of the announced tests look for IgG.

A third antibody, Immunoglobulin A, or IgA, plays a role in the immune function of mucous membranes, Sims says, and will be part of the test he is launching.

ABOUT

There are also different types of tests, Sims says. The commercial tests often use a finger-prick of blood and reveal a “yes/no” answer, like a pregnancy test. Cellex’s test, which takes about 15-20 minutes to yield results, is one of only three that the FDA has approved so far.

Abbott’s test, which is being rolled out on April 16, can be analyzed on any of 2,000 machines that are already in labs across the United States, says a company spokeswoman. Each machine can run 100-200 tests a day at a cost of about $6 each.

Sims says most of these commercial tests just say whether the person has ever been infected, while most of the tests used for research also look for the amounts of antibodies.

The amount would be useful for a few reasons, including finding out if a person’s blood is suitable for donating convalescent plasma, a blood product from someone who has recovered from COVID-19 that can be used to treat people who are fighting the infection and that has antibodies against the virus. For instance, Harvard President Lawrence Bacow, who recently recovered from a COVID-19 infection, donated blood this week in hopes of helping someone who is still fighting it off. In Kentucky, people who are tested for antibodies will be told if they have enough to become donors.

Antibody tests also vary in their reliability, sometimes returning false positives — identifying someone as having had the disease when they haven’t — and false negatives — missing people who have antibodies in their blood.

Maldonado says the test her team has developed at Stanford is reasonably reliable, correctly identifying blood samples with antibodies to the virus the vast majority of the time. Some commercial tests, she says, are not as specific and might find antibodies to the viruses that cause the common cold, for instance, which are similar to the new coronavirus.

Source:  WebMD Health News,  April 16, 2020

What to do if you develop Coronavirus (Covid-19) Symptoms

If you or your neighbour/relative has cough, fever, throat pain or running nose, please do the following things frequently & regularly. Even if you don’t have those symptoms, you can follow these for prevention:

  1. Worm water with salt gargle several times a day
  2. Hot steam/vapour inhalation through nose & mouth at least 2-3 times daily
  3. Drink hot water with lemon several times daily
  4. Take ginger tea more (green tea better)
  5. Take more orange & malta daily
  6. Take some black seeds (kali jira) 2-3 times daily
  7. Take rice or bread as less as possible, avoid meat, take well-cooked fish, egg & chicken (occasional), drink milk (skimmed or fat-free)
  8. Take any type of fruits more (after washing thoroughly). Preferable fruits: orange, banana (diabetics should take less), pomegranate (anar), apple, kiwi etc,
  9. Eat all sorts of well-cooked or boiled vegetables. Preferable vegetables: tomatoes, carrots, capsicum, cauliflower, broccoli, cabbage, spinach, beans, lentils, legumes etc.
  10. For fever & pain, take Paracetamol tablet only (after food). For running nose or nose-block, take antihistamine only (ceitrizine/loratidine). For dry cough, take natural cough syrup or antitussive syrup only. For productive cough with sputum, take spectorant/mucolytic syrup only. (for appropriate drug & dose, better to consult with a registered doctor), and finally
  11. If you develop any sort of breathing difficulty/respiratory distress with the above symptoms, please immediately call the local control centre of health or call an ambulance to take you to any of the designated/assigned hospitals. Please don’t delay in case of breathing difficulty with fever & cough.

Thank you all….Stay home, stay safe & stay healthy……May Almighty protect all of us.

Writer:  Dr Mohammad Dewan, Ministry of Health, Saudi Arabia (Madinah Munawara)

Channel 24 interview of Dr Ruhul Abid, MD, Principal Investigator, Global Health Initiative

Channel 24 interview of Dr Ruhul Abid, MD, Principal Investigator, Global Health Initiative and Assistant Professor in the Division of Cardiothoracic Surgery and Cardiovascular Research Center at Rhode Island Hospital and Brown University Alpert Medical School, USA regarding Coronavirus pandemic situation in the USA.

Affordable Biosimilar Medicine: A low-hanging fruit ready for picking


Prof Ahmed A Azad, PhD


The pharmaceutical sector in Bangladesh has huge potential and opportunities for producing affordable modern medicines for the ordinary citizens as well as the developing world. The vibrant pharmaceutical industry produces 98 percent of all medicines used domestically, and exports high-quality drugs to about 130 countries. Almost all medicines made locally are generic (exact copies of the original drugs) produced by repackaging (“fill-finishing”) of imported active chemical ingredients (ACI). At a recent seminar organised by the Dhaka Chamber of Commerce and Industry (DCCI), it was claimed that local production of ACI could substantially decrease the production cost of generic medicines and increase export earnings from the current USD 130 million to over USD 1 billion within five years (The Daily Star, November 3, 2019). The pharmaceutical industry and university researchers have till now failed to join forces to develop generic API in Bangladesh, even though the required expertise and technologies are available.

To move with the times, and for long-term viability, the local pharmaceutical industry needs to think beyond generic medicines. In the last two decades, largely as a consequence of lifestyle, climate and environmental changes, non-communicable diseases (NCDs) and chronic ailments (such as diabetes, hypertension, asthma and various cancers) have rapidly proliferated in both developed and developing countries. Chemically synthesised small-molecule drugs, and their generic copies, have not proved to be sufficiently effective against these NCDs and chronic diseases.

Attention has largely shifted to a new class of drugs, Biologics, which are genetically-engineered versions of naturally occurring bioactive proteins and peptides present in the human body. Cheaper copies of Biologics, which retain their biological and therapeutic properties, are known as “Biosimilars” as they are structurally similar but not identical to the originator Biologics. Biologics and Biosimilars are produced by recombinant DNA technology where microscopic bacteria, fungi or mammalian cells are converted into living factories for the large-scale production of rare and high-value foreign proteins.

In more recent times, a new class of Biologics has entered the market and it constitutes the bulk of novel drugs in the pipeline of major multinational drug companies. In these new Biologics, proteins or peptides of medical importance are linked to, and resemble, human monoclonal antibody (mAb) molecules. These new mAb Biologics are unusually potent in treating and managing previously untreatable forms of NCDs and chronic diseases. These new wonder drugs are extremely expensive, costing in excess of USD 50,000 per person every year, and clearly out of reach for the common man. There is, therefore, huge demand for cheaper mAb Biosimilars. Producing these in developed countries is not effective in making them more affordable to the citizens of poorer countries.

This has created a great opportunity for any developing country, with reasonable technological proficiency and low labour and production costs, to step in to produce the new class of Biosimilars. The global market for Biosimilars, and particularly the mAb Biosimilars, was USD 2 billion in 2013, and has now surpassed USD 30 billion, and is projected to reach up to USD 0.5 trillion in 2026. Even if Bangladesh could capture 5 percent of the global market for Biosimilars, it could amount to USD 50 billion and its export could become the largest, and most stable, foreign exchange earner for the country. Compared to generic medicines, the development of the new Biosimilars, particularly the mAb Biosimilars, is technologically and conceptually complex. Because they are biologically produced, Biosimilars are not exact copies of the original Biologics, and as such they are subjected to very extensive and costly regulatory procedures to ascertain safety and effectiveness, resulting in increased production costs.

The overriding rationale for undertaking this ambitious project would be to develop affordable mAb Biosimilars for the common man in Bangladesh and the developing world. This could be possible if these wonder drugs were locally produced from scratch, including the development of the molecular seed clones. This would also provide a mechanism for competing with—and keeping ahead of—potential rivals like Korea, China, India and Brazil by making use of the WTO’s exemption of Bangladesh from patent restrictions till 2033. While all developed and developing countries have to wait till patent expiry to copy a novel Biologic into its cheaper Biosimilar, Bangladesh is legally free to copy any new Biologic, irrespective of its patent status, thus gaining valuable time over potential rivals in developing, selling and exporting new Biosimilars. It would be a pity if the pharmaceutical sector in Bangladesh failed to make the best use of this competitive advantage.

Does Bangladesh possess the competencies required for developing and commercialising new Biosimilars from scratch? At least one local company has invested heavily in establishing world-class large-scale fermentation and downstream processing facilities (under GMP conditions) to produce recombinant protein APIs of a number of first-generation Biosimilars (such as Insulin and Erythropoietin) from molecular clones obtained from overseas sources. Some other local companies are also developing similar facilities which would be available for the production of new recombinant Biosimilars. The local pharmaceutical industry also has extensive experience in manufacturing and marketing of high-quality generic medicines, and their export to developing countries. This could ease the way for entry of Bangladeshi-made Biosimilars into established overseas markets.

The only missing competency is in upstream technologies needed for the development of molecular clones of targeted Biosimilars. This involves intricate design and construction of genetic vehicles for biological production of Biosimilar proteins. It could be the most complex biotechnology project undertaken in Bangladesh thus far, but fortunately, trained human resources with the required advanced molecular and cell biology skills are already present in Bangladesh and within the NRB scientific community. The immediate requirement, to get the ball rolling, is for some start-up funds and access to a semi-automatic clone selector to complete the proof of concept studies needed to demonstrate that it is, indeed, possible to develop the seed molecular clones in Bangladesh.

This ambitious project would work best as a tripartite partnership between the research community, the industry and government. While productive collaboration between academic researchers and the industry should be the biggest strength of the pharmaceutical sector, in reality, lack of substantive university-industry links remains one of its major weaknesses. To encourage academia-industry collaborations, researchers could be offered a share of profits from the sale of products they help develop, and the industry could be granted tax concessions for supporting R&D. Government agencies could play important enabling roles. The Directorate General of Drug Administration could streamline and simplify guidelines to speed up the regulatory process, and the Bangladesh Medical Research Council could establish Contract Research Organisations (CROs) to support and expedite preclinical animal studies and human clinical trials.

Bangladesh has the technical capability to produce the latest Biosimilar medicines. Can a nation that aspires to become an advanced nation by 2041 afford not to take advantage of this opportunity to use home-grown technology and local talent for producing the latest and most effective high-tech medicines at an affordable price for its own citizens and those in developing countries, and in the process also create wealth for the nation? This would also be an opportunity for early investors to stake a claim for big rewards in the future. Political will, self-belief and a need for all stakeholders to work together are critical for the successful production of the latest Biosimilars in Bangladesh.

Prof Ahmed A Azad, PhD, is a retired academic and biomedical researcher. After retirement, he has been working with resident and NRB scientists to help develop molecular biosciences research capacity in Bangladesh. Email: aaazad1945@gmail.com

Source: https://www.thedailystar.net/opinion/perspective/news/low-hanging-fruit-ready-picking-1846837

Photo source:  POWERUP/SHUTTERSTOCK.COM

Sir Fazle Hasan Abed

Sir Fazle Hasan Abed Passed Away

We deeply mourn the demise of Sir Fazle Hasan Abed KCMG the founder of the world’s largest non-government organization BRAC. Sir Abed passed away on Friday, 20 December 2019 at a hospital in Dhaka at 8:28 pm. He facilitated to raise people out of poverty, inspired and improved the lives of millions of people not in Bangladesh only, but around the world.

Our thoughts and prayers are with Sir Fazle Hasan Abed and his family. May the almighty and most compassionate Allah bless his departed soul and grant his eternal peace.

Saline water rice

Professor KMS Aziz talked about climate change and rice production in saline water

Professor Dr KM Sultanul Aziz, a founding member of CARES and a renowned scientist talked about climate change and rice production in saline water in an event organized by CARES on 23 September 2019 while he was summarizing the lecture provided by his student Professor Dr Muhammad Manjurul Karim, Department of Microbiology, University of Dhaka.

Biotechnology, Bio-economy

Biotechnology and Bioeconomy: Bangladesh Perspective

CARES has organized a public lecture series at EMK Center from 22-25 September 2019.  Professor Dr Md. Mozammel Hoq (Retd.), Department of Microbiology, University of Dhaka has given his lecture on the closing day 25 September 2019 on “Biotechnology and Bioeconomy: Bangladesh Perspective”.  Following is the summary video of his lecture.  If you want to see the full video of the lecture please visit >>https://youtu.be/OllDrjRghkQ.

You may want to see more videos in future from CARES, please Subscribe our YouTube channel “CARES BD” and click the bell for future notifications.  Thank you for your interest in CARES.