Battling COVID-19 in Bangladesh: A Conversation with Dr. John Clemens of icddr,b.

On April 13, 2020, a New York Times editorial (“The Global COVID-19Crisis isPoised toGetMuch,MuchWorse”) painted two sides of a planetary fault line. On one side were advanced economies girding themselves against COVID-19 and calculating how to weather the storm—on the other, poorer countries with far fewer tools tofight thepandemic.Thefinal impression?A world deeply divided between nations with first-world “agency” and those that were passive and weighed down with dread. The essay bared painful, obvious truths. Of course SARSCoV-2 could exact a terrible toll on “countries ravaged by conflict, through packed refugee camps and detention centers in places like Syria or Bangladesh, through teeming cities like Mumbai, Rio de Janeiro, or Monrovia, where social distancing is impossible and government is not trusted. . .” to quote its authors. And yet, I could not help but wince while reading the Times editors’ penultimate sentence, namely, “. . . the weakness of Washington should not prevent the brain trust of the developed world—the think tanks, news media, universities, and nongovernmentalorganizations—from focusingonastrategy for the next and possibly most brutal front in the struggle against the scourge of the COVID-19.” At first blush, who could disagree? At the same time, failing to acknowledge the skills and insights of other countries and entities seemed naive and paternalistic. This brings us toBangladesh. As adensely packed country of 161 million residents already burdened with natural and manmade challenges—infectious diseases, poor air quality, flooding, and refugees, for example, along with a “double epidemic” of diseases of poverty and development—the largely marshy delta crossedby700 rivers could suffer devastatingblows fromCOVID19.At thesame time,Bangladesh isanewlymiddle-incomenation which has achieved major gains in child survival, reproductive health, and adult life span over the last several decades. Much of this success reflects its energized leaders, engaged citizens, and cadres of health workers with the potential to conduct the kind of grassroots public health that advanced economies have not yet envisioned, much less implemented, during the new global crisis. Finally,Bangladesh ishometo icddr,b (formerly, the International Centre for Diarrhoeal DiseaseResearch, Bangladesh)—aoneof-a-kind, multinational institute now in its 60th year. The icddr,b’s current portfolio of research focused on improving the health of lowand middle-income countries spans bench to bedside and populations to health systems.What follows is an interview with Dr. John Clemens, who spent 5 years at icddr,b in the mid-1980s and returned there in 2013 as its executive director. For more highlights of Dr. Clemens’s career, please see the Addendum at the end of this piece.