The Value of Vaccines in Mitigating Antimicrobial Resistance in Bangladesh

Executive Summary

In 2019, the World Health Organization (WHO) declared antimicrobial resistance (AMR) a global emergency. AMR was estimated to have caused 1.14 million deaths globally in 2021; this death toll is only expected to rise to 10 million in 2050. AMR could cause over 39 million deaths worldwide between 2025 and 2050, and the annual cost of treating antibiotic-resistant infections could reach US$159 billion, according to recent reports. World Bank projections from 2017 suggest that by 2030, AMR could result in gross domestic product losses of US$1–3.4 trillion.This substantial economic impact reflects both mortality and medical management costs for hard-to-treat infections.

In 2021, 96,878 deaths in Bangladesh were associated with, and 23,454 deaths were directly attributable to AMR. To contain its spread, the Directorate General of Health Services, under the Ministry of Health and Family Welfare, had developed a National Action Plan (NAP) on Antimicrobial Resistance for 2021 – 2026, updating the earlier 2017 NAP, which aims to address surveillance gaps for human and animal health along with antimicrobial consumption trends, antimicrobial stewardship and infection control measures, and initiatives in community engagement.

Despite concerted efforts by numerous institutions along the One Health spectrum, significant barriers such as inadequate funding, insufficient evaluation, and monitoring continue to hinder the progress toward the goals set out in the NAP. Furthermore, there appears to be limited awareness among policymakers, healthcare providers, and the general public regarding the substantial health and economic burden posed by drug-resistant infections.

Preventive interventions such as vaccines have significant potential in the containment of AMR, because they prevent infectious disease and subsequent antimicrobial therapy. The National Immunization Program’s Expanded Programme on Immunization (EPI) has reduced the incidence of neonatal and childhood diseases for the past few decades through its wide-reaching vaccination programs. While the program provides a robust basic immunization schedule with substantial coverage, it would benefit immensely from including vaccines known to reduce AMR and antibiotic use, such as those against influenza and rotavirus, and continuing the typhoid vaccine.

Although global evidence shows that vaccines can reduce AMR, country-specific data are vital to inform Bangladesh’s national immunization and antimicrobial policies and guide effective interventions. In this context, research is needed to quantify the role of vaccines in reducing the burden in Bangladesh.The GARP-Bangladesh technical working group has presented the following key policy recommendations to advance the use of vaccines in AMR mitigation:

1. Expand the use of licensed vaccines to maximize their impact on AMR mitigation.

2. Ensure and sustain universal uptake of childhood vaccines.

3. Update existing immunization guidelines.

4. Develop regulatory and policy mechanisms to accelerate approval and use of new vaccines that can reduce AMR.

5. Enhance the body of evidence on AMR and vaccines in Bangladesh by increasing the collection and analysis of AMR-relevant data in vaccine studies.