Cui bono is often a good starting point in an investigation. Literally meaning ‘who benefits?’ Whoever appears to have the most to gain from a ‘crime’ is probably the culprit. Stepping back from the ‘whodunnit’ nature of the drama that is playing out, we could be less dramatic and just look at the meaningfulness or advantages of carrying out an important function.
At this point in Bangladesh, as in many other countries, there are few things more important to do, than to detect whether or not one has been infected by the Covid-19 virus. For many, it could literally be a matter of life and death. It is beyond dispute that an efficient, accurate and affordable kit that could be made readily available would be of immense value to the country.
Zafrullah Chowdhury (born December 27, 1941) is a Bangladeshi public health activist. He is the founder of Gonoshasthaya Kendra (meaning the People's Health Center in Bengali), a rural healthcare organisation. Dr. Chowdhury is known more for his work in formulating the Bangladesh National Drug Policy in 1982. Photo: Shahidul Alam/Drik/Majority World
Let’s look at the actors in this play. Gonoshasthaya Kendra is the first health centre or field hospital in independent Bangladesh. The organisation earned the highest national award given by the Bangladesh government ‘The Independence Day Award’, 1977. Dr Zafrullah Chowdhury, the founder, besides being a freedom fighter, was also the architect of the Bangladesh National Drug Policy (NDP, 1982), ensuring that generic drugs be available cheaply. The previous attempt to establish an NDP had been in 1973, but with the assassination of Bangabandhu Sheikh Mujibur Rahman in 1975, that never went through. In 1985 Dr Zafrullah was awarded the Raymon Magsasay Award for ‘Community Leadership’ and in 1992, the Right Livelihood Award for his ‘…outstanding record of promotion of health and human development’.
The Eurasian Journal of Emergency Medicine describes Bangladesh’s NDP as ‘an epoch-making event in the history of Bangladesh. Before 1982, there was no NDP in Bangladesh.’ It goes on to say ‘The medicine market in Bangladesh was filled with unnecessary, harmful, and unsafe medicines before NDP 1982 and multinational companies were controlling the pharmaceutical markets of Bangladesh’.
Not everyone saw this as a good thing. Certainly not the multinational pharmaceutical companies, nor the health professionals on their payroll. There were others who lost out due to the NDP, the importers and dealers, sections of the government officials, and those who made a tidy profit from prescribing unnecessarily expensive drugs to unsuspecting patients who often spent their last savings to go to a reputed doctor.
I was interviewing Dr Zafrullah on March 19, 2020 in his chaotic but welcoming home in Dhanmondi, when a message came through that they had just received permission to import the ingredients necessary to test and develop their kit. His excitement was visible. There had already been a week’s delay by then. That and subsequent delays have been expensive for Bangladesh. Dr Zafrullah told me Iran was conducting one million tests per week using the same process and that India too, was proceeding along similar lines.
Valid questions have been raised about the nature of GK’s COVID-19 test, its accuracy, and whether it meets approved standards. These are the right questions and must be asked, but we must be wary of throwing away the baby with the bathwater. It is important to recognise the value of protocol and procedure, but let us remember that we are facing a pandemic where millions are already affected, not so much (by verified records) of the virus itself, but also of the hunger inflicted by the lockdowns and the conflicting and irresponsible decisions that have affected the lives of the poor and of garment workers in particular. Mistakes will be made, and sensible steps need to be taken to minimise them. But I am a believer in imperfect action over perfect inaction. More so, as suggested by Dr Zafrullah, when the inaction may be based on ulterior motives rather than public interest.
No test is 100 per cent accurate. No single test perfectly meets all criteria. We must strive towards as great a level of accuracy as can be reasonably obtained within the given parameters. It is also important to recognise that speed, affordability, availability and ease of use, are extremely significant factors in the equation that assesses the ‘best’ test.
I have no way of knowing whether GK’s kit is sufficiently accurate. What is known is that a credible organisation has claimed that a test can be made available, that it can be simply executed, that it is unbelievably cheap and that it can be produced in large numbers at a time when the lack of tests is our single biggest concern.
What I would expect, under these circumstances, is for the department of health to pull out all the stops to assist and indeed push GK into going through the necessary steps so the department can say it is safe (or not) to be certified, approved and released.
It is not as if the government is incapable of expediting things it considers to be important.
Captain Abdul Majed, the convicted killer of Bangabandhu Sheikh Mujibur Rahman was arrested on April 7, 2020. President Abdul Hamid rejected Majed’s petition for presidential clemency on April 8. He was hanged at 12:01 am on April 11 2020. The media was informed at 12:03 am. This efficient implementation of the rule of law would have been remarkable at normal times. At a time when the nation was in lockdown, the courts on vacation and physical movement at a near standstill, this was lightning speed.
All that I posit is that the danger of millions of people dying of a pandemic and due to starvation, is equally as important. The health ministry is right in insisting that GK’s kit be tested. All it needs to do, is to give the kit a fair trial, and to get off its backside and do all it possibly can to make it happen.
And who stands to gain? Not GK, not beyond the satisfaction of having provided an essential service at a time of great need, and a sense of national pride. One which we should all have for a home-grown success. GK’s partner organisation RNA Biotech, might well have a material interest, but then they might have gone for a patent, which they deliberately resisted. Neither did they choose to ‘settle’ with the intermediary, as is the norm in Bangladesh.
On the other hand, at least one of the top pharmaceutical companies in Bangladesh does have very close connections at the highest levels in the ruling party. Stalling GK could boost their business interests. The lead inventor of the kit, Dr. Bijon Kumar Sil, is not new to the game, but had previously fled the country after an attempted kidnapping when his research went against big pharma. The NDP saga seems to be playing out again. While the GK kit is being delayed, orders have been placed for importing over a million kits by the ministry. Ruling party high ups are reported to have brought in kits illegally. With kits from abroad costing between ten to fifty times that of GK’s local ones, every day delayed, is an extra day of potential earnings, for some.
Dr Zafrullah and Dr Sil are quick to point out that they have also had support from others in the government. The PM’s office, the foreign ministry and particularly customs have gone out of their way to be supportive, working long hours and over weekends when needed. That is exactly what one would hope for.
Millions of lives depend on it.