How icddr,b turned a Cold War laboratory into a global lifesaving institution
What that laboratory eventually produced would go on to save tens of millions of lives and transform global public health. Almost nothing about that outcome was planned.
In 1960, the United States government helped establish a cholera research laboratory in Dhaka for reasons that had little to do with medicine.
The South-East Asia Treaty Organisation, a Cold War military alliance formed to check the spread of communism across Asia, wanted to protect American soldiers from the diseases endemic to the region. The Pakistan-SEATO Cholera Research Laboratory was the result – a facility built on geopolitical calculation, staffed by foreign scientists, operating in a city then known as Dacca in a country that did not yet exist.
What that laboratory eventually produced would go on to save tens of millions of lives and transform global public health. Almost nothing about that outcome was planned.
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From a Cold War tool to an international institution
When Bangladesh won independence in 1971, the laboratory passed through a period of severe disruption. Funding contracted, foreign staff departed, and the work continued at reduced scale under the name Cholera Research Laboratory. Recovery came gradually. In 1978, the centre was revived as icddr,b when it became an independent, international organisation in the newly created Bangladesh through a grant from the Ford Foundation.
Formal establishment followed through an Act of Parliament passed on 26 June 1979, chartering the centre as a non-profit organisation for research and training on diarrhoeal diseases and the related subjects of nutrition and fertility.
The institutional name International Centre for Diarrhoeal Disease Research, Bangladesh understated what the organisation had already become. By the time Parliament passed that act, icddr,b's researchers had already conducted what would prove to be among the most consequential clinical trials in the history of medicine.
The most important medical advance of the twentieth century
icddr,b developed and carried out the first successful trial of Oral Rehydration Therapy, now known as Oral Rehydration Solution (ORS). The results were published in The Lancet in 1968. The principle behind ORS is elementary: a precise mixture of water, glucose, and salts, administered orally, replaces the fluids lost during severe diarrhoea and prevents the dehydration that kills.
Its cost is negligible. Its logistics require no clinical infrastructure. Yet before it existed, diarrhoeal disease — cholera in particular — carried a case fatality rate that could reach 50 per cent. Over the following six decades, icddr,b helped reduce that cholera mortality rate from 50 per cent to less than three.
The research did not stop there. In 1999, an icddr,b protocol for the management of severely malnourished children reduced case fatality from 20 per cent to less than 5 per cent. In 2002, scientists discovered that zinc treatment of diarrhoea reduces overall mortality in young children. In 2004, zinc was recommended by WHO and UNICEF as the only treatment to be coupled with ORS for all diarrhoea episodes.
Dhaka Hospital and the Matlab surveillance system
The institution operates two hospitals and a field surveillance network that has no equivalent in the Global South. Dhaka Hospital, established in 1962 primarily for diarrhoeal disease, has grown into a nationally important centre treating more than 140,000 patients a year. The Matlab Hospital, located within the Health and Demographic Surveillance Site approximately 50 kilometres south of Dhaka, has 120 beds, provides free clinical care for diarrhoeal disease and maternal and child health services, and treats more than 30,000 people a year. The Health and Demographic Surveillance System at Matlab covers a population of approximately 225,000, tracking births, deaths, marriages, divorces, and migration every two months across 142 villages. It is the longest-running demographic surveillance site in the developing world.
A record of recognition
The awards icddr,b has accumulated reflect the scale of what it has produced. In 2001, it received the first Gates Award for Global Health in recognition of its development of ORS. In 2005, it received the Independence Day Award, Bangladesh's most prestigious national honour.
In 2017, icddr,b won the Conrad N. Hilton Humanitarian Prize worth $2 million in recognition of the institution's innovative approach to solving global health issues affecting the world's most impoverished communities. Most recently, the institution was placed on Time's Best Inventions list for a social impact innovation, and its executive director was included in the Time Health 100.
icddr,b is today supported by approximately 55 donor countries and organisations, including Sweden, Canada, the United Kingdom, the United States, and multiple UN agencies, governed by a 17-member multinational Board of Trustees. Its research portfolio has expanded to encompass nutrition, vaccine development, HIV surveillance, maternal and child health, antimicrobial resistance, and the health consequences of climate change.
