Tuberculosis, the forgotten pandemic relying on a 100-year-old vaccine

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Justin Denholm, Melbourne HealthBy some estimates, 2 billion people are now infected worldwide, and in 2019, around 1.4 million people died from it.

It’s a pandemic infection, spread through the air — but it’s not COVID. It’s tuberculosis (or TB). Yet we’re not in lockdown for it. And we’re not queuing up for a vaccine.

Some people call TB “the forgotten pandemic”. But our knowledge of one pandemic is helping us manage the other.

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Explainer: what is TB and am I at risk of getting it in Australia?

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They’re similar in some ways …

TB is caused by the bacterium Mycobacterium tuberculosis. And COVID is caused by SARS-CoV-2, a virus. They’re quite different microorganisms. But it’s easy for them to overlap in people’s minds.

Both TB and COVID are infectious diseases that generally affect the lungs. Both are passed between people mainly by aerosols, when infected people cough, sing or otherwise release them into the surrounding air.

TB is caused by Mycobacterium tuberculosis.
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So some of the things we’re used to doing for COVID-19 – like wearing masks and good ventilation – also work for preventing the spread of TB.

However, there are some important differences between them, which mean our public health responses can look quite different.

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… but not in others

We are all so familiar with COVID. So when I’m talking with people about TB, I’ve started highlighting three key differences between the infections.

1. TB is less infectious

TB is much less infectious. While COVID (especially strains like the Delta variant) may be transmitted after brief or “fleeting” contact, this is rare for TB.

As a rule of thumb, TB programs around the world often suggest you need to be in close contact with an infectious person for more than eight hours before that risk builds up to the point where you need to be tested for it.

This means people are more likely to spread the infection within their household or immediate family rather than at the shops.

2. TB symptoms take longer to show up

With TB, the “window” between being exposed and becoming unwell, known as the incubation period, is much longer.

Infections can stay dormant (or “latent”) in the body for many months or years before people become unwell. But almost everyone who becomes unwell with COVID has been infected within the past two weeks.

We don’t ask contacts of TB to isolate at home as we can’t predict when they might become unwell. It certainly wouldn’t be ethical or realistic to isolate people for months or years, just in case. Fortunately, people who have dormant TB cannot pass infection on to others in the meantime.

3. We have TB treatments to help curb the spread

As we’re uncertain about how long it takes between someone becoming infected and becoming unwell with TB, you’d think that would be a big problem.

But we have effective treatments to give people with dormant TB. These help prevent them developing active disease.

These treatments, particularly antibiotics such as isoniazid or rifampicin, can greatly reduce the risk of contacts becoming sick.

For COVID, we don’t yet have any treatments for people who are infected but who are not showing symptoms (known as post-exposure treatments) to minimise the chance of them spreading the virus.

Some have been tried, but so far none have convincingly been shown to be effective.

How about vaccines?

Perhaps the biggest difference in our response to these pandemics is we have a variety of effective vaccines against COVID.

For TB, we are relying on a 100-year-old vaccine, known as BCG (short for Bacille Calmette-Guerin), which is still one of the most widely used vaccines globally.

While it protects young children from the most severe forms of TB, the vaccine seems to give much less protection for adults.

The BCG vaccine, unlike COVID vaccines, is a live vaccine, meaning it contains live (but weakened) bacteria. So it can’t be given safely to people with immune suppressing conditions, like HIV, because they could get infected from it. This means its use is limited in some people who most need protection.

TB vaccine may protect against COVID

Perhaps the BCG vaccine and COVID will come full circle. The BRACE trial, launched from Melbourne’s Murdoch Children’s Research Institute, is studying whether the BCG vaccine might protect against COVID infection.

This investigation has been prompted by a long history of research showing the vaccine also improves our immune responses to other conditions such as viral infections.

We don’t know yet whether this will work, as the study is ongoing. Almost 7,000 health-care workers around the world at risk of COVID exposure have been recruited to the trial.

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Read more:
Could BCG, a 100-year-old vaccine for tuberculosis, protect against coronavirus?

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Whether or not BCG turns out to prevent COVID, there’s no question we need new and more effective vaccines for TB.

While we have an increasing number of potential vaccine candidates, right now there is still no alternative to our 100-year-old BCG.

The massive amount of activity globally in developing COVID vaccines has also stimulated calls for greater efforts and funding to develop new TB vaccines.

We hope these will lead to more effective and safer options, and be powerful tools for eliminating TB. Let’s hope we’re not left waiting another 100 years.

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Read more:
Tuberculosis kills as many people each year as COVID-19. It’s time we found a better vaccine

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Justin Denholm, Associate Professor, Melbourne Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Tuberculosis kills as many people each year as COVID-19. It’s time we found a better vaccine

Andreas Kupz, James Cook University

In July 1921, a French infant became the first person to receive an experimental vaccine against tuberculosis (TB), after the mother had died from the disease. The vaccine, known as Bacille Calmette-Guérin (BCG), is the same one still used today.

This first dose of BCG was the culmination of 13 years of research and development.

BCG remains the only licensed vaccine against TB and 2021 marks its 100th anniversary.

Today, all eyes are on the rollout of the COVID-19 vaccine. But while the number of people who died from COVID-19 in the last year is shocking, TB kills about the same number of people — about 1.5-2 million — each year, and has done so for many decades.

In fact, it’s estimated that over the last 200 years, more than 1 billion people have died from TB, far more than from any other infectious disease.

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COVID-19 isn’t the only infectious disease scientists are trying to find a vaccine for. Here are 3 others

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If we have a vaccine, why do so many people still die from TB?

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It’s transmitted when a person with active TB coughs up aerosol droplets, which are then inhaled by someone else.

There are about 10 million cases of active TB annually, and it’s estimated up to 2 billion people are what’s known as “latently infected”. That means they are not sick and do not transmit the disease, but in about 10% of these people the disease reactivates.

In most TB endemic regions of the world, BCG is given to infants shortly after birth. The vaccination prevents childhood versions of TB and saves thousands of children’s lives annually.

However, the efficacy of BCG wanes over time. In other words, it stops working. Protection against TB is often lost by adolescence or early adulthood.

Importantly, BCG doesn’t prevent active lung TB in adults, the most important driver of ongoing transmission and cause of death.

The World Health Organization has a goal of TB elimination. To do that, we need to find a TB vaccine that also works in adults.

Why hasn’t BCG been replaced with a more effective TB vaccine?

Over the last decades only about 15 new TB vaccine candidates have entered clinical trials (versus 63 for COVID-19 in one year).

Worryingly, many of the most advanced TB vaccine candidates work no better than BCG.

Because the current TB vaccine candidate pipeline is relatively small, these setbacks and trial “failures” mean BCG may remain the gold standard for many years to come.

Despite being 100 years old, exactly how BCG vaccine works is largely unknown. It’s unclear why BCG usually only confers protection against childhood versions of TB or why protection wanes in adolescence.

Given those uncertainties, we can count ourselves lucky the bureaucratic hurdles for vaccine development were significantly lower in the 1920s.

If BCG were developed today, it would probably never be used; the current complex regulatory framework for vaccine development and licensing would likely not allow the use of a vaccine for which nothing or little is known about how it works.

The reasons BCG hasn’t been replaced with a more effective TB vaccine include:

• the decline of TB in many Western countries in the 20th century

• limited interest from pharmaceutical companies to invest in TB vaccine development

• the fact TB research and pre-clinical vaccine development is logistically challenging and requires special biological containment facilities

• the short-term and fiercely competitive environment for government and philanthropic research funding makes it difficult for academics to commit to TB vaccine research as a career path.

Where there’s a will, there’s a way

The pace of COVID-19 vaccine development shows what’s possible when the political will, pharmaceutical interest and funding is there.

While TB is no longer widespread in Australia, it is an issue in remote Indigenous communities.

Papua New Guinea, Australia’s closest neighbour, has high rates of multi-drug resistant TB and low BCG coverage rates. TB has been introduced into Australia via the Torres Strait, with a high proportion of cross-border diagnoses in North Queensland and over-representation of Indigenous children.

Resistance to current TB treatments increases steadily. Treatment of multi drug-resistant TB is hugely expensive and can take up to two years, requiring multiple antibiotics and close monitoring.

Now is the time to put financial and political will into finding a more effective TB vaccine.

2020 taught us pathogens can cause enormous harm to societies and economies. Investment into infectious disease research and vaccine development represents a fraction of the economic cost of a pandemic.

Tuberculosis is a global threat and a public health concern on a scale similar to COVID-19. The development of a new and effective TB vaccine is crucial if TB is to be significantly reduced, let alone eradicated.

Although the anniversary of BCG is cause for celebration, it should also serve as a reminder more needs to be done to combat this deadly disease.

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Read more:
Just as in coronavirus, young people are key to stopping tuberculosis

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Andreas Kupz, Senior Research Fellow, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID-19 isn’t the only infectious disease scientists are trying to find a vaccine for. Here are 3 others

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Danielle Stanisic, Griffith University and Johnson Mak, Griffith University

More than 28 million people around the world have now contracted COVID-19, and more than 900,000 people have died.

Research groups across the globe are rightly racing to find a vaccine to protect against SARS-CoV-2, the virus that causes COVID-19.

While it’s not surprising all eyes are on this vaccine race, COVID-19 isn’t the only disease for which scientists are currently trying to find a vaccine.

Let’s look at three others.

The big three

We regard malaria, tuberculosis and HIV/AIDS as the “big three” infectious diseases. Together they’re responsible for about 2.7 million deaths a year around the world. They disproportionately affect low- and middle-income countries.

Deaths from these three diseases could almost double over the next year as a result of disruptions to health care in the face of COVID-19.

This is a clear example of the indirect effects of an uncontrollable infectious disease. It also reminds us of the importance of vaccine research for the many other infectious parasites, viruses and bacteria that can cause disease and death.

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Creating a COVID-19 vaccine is only the first step. It’ll take years to manufacture and distribute

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Malaria: the parasite

Malaria is a parasitic disease transmitted through the bite of an infected mosquito. Common symptoms are flu-like: fever, headache, muscle aches and fatigue. If not treated promptly, malaria can lead to severe disease and death.

In 2018, nearly half of the world’s population was at risk from malaria. There were roughly 228 million cases and 405,000 deaths from the disease, mainly in children under five in sub-Saharan Africa.

Anti-malarial drugs are routinely used to treat and prevent malaria infection. But Plasmodium falciparum, the deadliest of the malaria parasites that can infect humans, has developed resistance against all drugs currently used to treat and prevent malaria. So we urgently need an effective vaccine.

Development of a malaria vaccine is complicated by the diverse forms, or life-cycle stages, of the parasite in the human host. The immune responses required to kill the parasite differ between these different stages. So malaria vaccine candidates typically target just one parasite stage.

Malaria is a mosquito-borne disease.
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British multinational pharmaceutical company GSK has licensed the world’s first malaria vaccine, Mosquirix. It targets the stage the parasite is at when the mosquito injects it.

Although it’s the only malaria vaccine candidate to successfully complete phase 3 trials, Mosquirix has only moderate effectiveness (less than 40%) which drops off rapidly after the final dose. So we need a more effective vaccine capable of inducing long-lasting immunity.

There are 20 other malaria vaccine candidates in advanced pre-clinical or clinical evaluation.

At the forefront of these is Sanaria’s whole sporozoite vaccine (PfSPZ), which also targets the parasite stage injected by the mosquito. It’s currently being evaluated for effectiveness in Africa.

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Tuberculosis: the bacterium

Globally, tuberculosis is the leading cause of death by a single infectious agent. It’s caused by a bacterium that spreads from person to person through the air and mainly affects the lungs.

Tuberculosis was responsible for 1.5 million deaths in 2018. About one-quarter of the world’s population has latent tuberculosis, which has no symptoms and is not infectious. But 5-15% of these people will go onto develop active, infectious disease.

Generally, tuberculosis can be effectively treated with antimicrobial drugs. But the emergence of multi-drug resistant tuberculosis is a major cause of death and a serious public health concern.

We do have one licensed vaccine for tuberculosis. The BCG vaccine was first used in 1921 and is usually administered to infants in countries with high tuberculosis prevalence. But the degree and duration of protection this vaccine offers is not enough to control the disease.

Scientists are working to develop prophylactic vaccines (to prevent infection from the outset) and post-exposure vaccines (to prevent disease progression in people with latent tuberculosis).

At least 14 tuberculosis vaccine candidates are in clinical trials, with promising results giving hope we might be able to get the disease under better control in years to come.

HIV/AIDS: the virus

Since the discovery of human immunodeficiency virus (HIV) in the 1980s, the disease has caused 33 million deaths — roughly 770,000 in 2019. Some 38 million people have HIV/AIDS worldwide.

There’s currently no cure or protective vaccine. While antiviral therapeutics can effectively control HIV, around 20% (7.6 million) of HIV-infected patients don’t have access to them.

There’s no vaccine yet for HIV/AIDS.
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Researchers are aiming to develop a protective vaccine against HIV. A major focus is developing broadly neutralising antibodies (antibodies that can attack different HIV strains) in HIV-infected patients.

Notably, researchers identifying and developing COVID-19 therapeutics have used significant expertise from HIV vaccine development.

For example, defining the structural details of SAR-CoV-2’s spike protein as a target for a COVID-19 vaccine, and identifying broadly neutralising antibodies from convalescent plasma as a potential treatment, are similar to strategies scientists working on HIV have used.

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Could BCG, a 100-year-old vaccine for tuberculosis, protect against coronavirus?

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Time and commitment

Beyond COVID-19 and the big three, there are many more conditions for which scientists are working to develop vaccines.

The current pandemic highlights the need for governments, NGOs and philanthropists to support this work — and scientific research more broadly.

Research on one type of disease can often accelerate the development of treatments for others. We’re seeing this in the quest for a COVID-19 vaccine.

Ultimately, COVID-19 has raised public awareness of the type of scientific challenges researchers encounter every day. There’s neither a silver bullet nor a shortcut in the development of a safe and effective vaccine.

Danielle Stanisic, Associate Research Leader, Institute for Glycomics, Griffith University and Johnson Mak, Professor, Institute of Glycomics, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Could BCG, a 100-year-old vaccine for tuberculosis, protect against coronavirus?

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Kylie Quinn, RMIT University; Joanna Kirman, University of Otago; Katie Louise Flanagan, University of Tasmania, and Magdalena Plebanski, RMIT University

This week, the Bill and Melinda Gates Foundation announced it will donate A$10 million to help fund an Australian trial testing whether a very old vaccine, BCG, can be used against a new threat, COVID-19.

So what is the BCG vaccine and what might its place be in the fight against coronavirus?

The ABCs of BCG

The BCG vaccine has been used for nearly a century to protect against tuberculosis, a bacterial disease that affects the lungs. Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis.

BCG is short for Bacillus Calmette-Guérin, as it was created by Léon Charles Albert Calmette and Jean-Marie Camille Guérin in the early 1900s.

To make the vaccine, they used Mycobacterium bovis, a bacterium found in cows and closely related to Mycobacterium tuberculosis. They grew it on a nutrient-rich jelly in the lab for nearly 13 years. The bacterium adapted to this comfortable lifestyle by losing elements in its DNA it no longer needed, including elements that cause disease.

This process is called attenuation and it results in a live but weakened microbe that can be given to humans as a vaccine.

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BCG is offered to infants in some parts of the world where there are still high rates of tuberculosis. It protects 86% of the time against some rarer forms of tuberculosis more common in children.

But it only protects about 50% of the time in adults.

Scientists and clinicians generally feel we need a better vaccine for tuberculosis. However, epidemiologists have noticed children who received BCG had significantly better overall health, with fewer respiratory infections and fewer deaths.

Immunologists suspect this is caused by a type of immune response called “trained immunity”.

Trained immunity is distinct from how we traditionally think of immunity, or “immune memory”, because it engages different types of immune cells.

Immune memory vs trained immunity

There are two main types of cells within our immune system: innate cells, which respond rapidly to microbes that cause disease, and adaptive cells, which initially respond quite slowly.

Adaptive cells include B cells, which make antibodies to block infection, and T cells, which can kill infected cells. Importantly, adaptive cells can remember particular microbes for years, or even decades, after we first encounter them.

This phenomenon is called “immune memory”.

When adaptive immune cells encounter the same microbe a second or subsequent time, they respond much more quickly, and the immune system can effectively clear an infection before it causes disease. Immune memory is why often we don’t get infected with a specific microbe, like chickenpox, more than once.

Most of our current vaccines exploit immune memory to protect us from infection.

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For decades, scientists believed innate cells lacked the ability to remember previous encounters with microbes. However, we’ve recently learnt some innate cells, such as monocytes, can be “trained” during an encounter with a microbe. Training can program innate cells to activate more quickly when they next encounter a microbe – any microbe.

Some live attenuated vaccines, such as BCG, can trigger trained immunity, which can enhance early control of other infections. This raises the tantalising possibility that BCG could train innate cells to improve early control of the SARS-CoV-2 virus, to reduce COVID-19 disease or even prevent infection.

And as a bonus, BCG could potentially protect us against other pathogens too.

The BCG vaccine targets trained immunity, whereas most other vaccines target immune memory.
Kylie Quinn, Author provided

Could BCG protect against COVID-19?

We don’t know yet whether BCG will reduce the severity of COVID-19, but the vaccine has some interesting features.

First, BCG is a potent stimulator of the immune system. Currently, it’s used alongside other therapies to treat bladder cancer and melanoma, because it can stimulate immune cells to attack the tumour.

BCG also seems to benefit lung immunity. As we mentioned, children who have had the vaccine appear to get fewer respiratory infections.

There’s a study underway in Melbourne looking at whether BCG can reduce symptoms of asthma in children.

And finally, BCG has been shown to limit viral infection. In one study, human volunteers were given BCG or a placebo one month before being infected with a virus. Volunteers who received BCG had a modest reduction in the amount of virus produced during infection compared to those who received the placebo.

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Explainer: what is TB and am I at risk of getting it in Australia?

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However, BCG can cause side-effects to be mindful of. It usually causes a small raised blister on the skin at the vaccine site and it can cause painful swelling in the surrounding lymph nodes.

Importantly, because it’s a live bacterium, it can spread from the vaccine site and cause disease, called disseminated BCG, in people who are immunodeficient, like people with HIV. This means BCG can’t be given to everyone.

Current clinical trials

The ultimate test of BCG as a preventative measure for COVID-19 is to run randomised clinical trials, which are now underway.

Researchers across Australia and the Netherlands are preparing to give BCG to the people who have arguably the highest risk of COVID-19: frontline health-care workers.

These phase III trials will collect data on whether workers vaccinated with BCG have fewer or less severe COVID-19 infections.

If BCG is shown to be effective, we’ll face other challenges. For example, supply of the vaccine is currently limited. Further, there are many different strains of BCG and they might not all provide the same protection against COVID-19.

Protection would likely start to wane relatively quickly. When trained immunity was tracked in humans after BCG, it started waning from three to 12 months after vaccination.

Protection would also not be as strong as what we see with many traditional vaccines, such as the MMR vaccine which protects against measles 94.1% of the time.

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So BCG would be most helpful for people at high risk of exposure, but it wouldn’t replace a traditional vaccine based on immune memory.

These studies are important to give us options. We need a complete toolkit for control of COVID-19, consisting of anti-viral and anti-inflammatory drugs and vaccines. But an effective COVID-19 vaccine is likely still many months, even years, away.

By repurposing an old, well-characterised vaccine, we could bridge this gap and provide some protection to our health-care workers as they confront COVID-19.

Kylie Quinn, Vice-Chancellor’s Research Fellow, School of Health and Biomedical Sciences, RMIT University; Joanna Kirman, Associate Professor, University of Otago; Katie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of Tasmania, and Magdalena Plebanski, Professor of Immunology, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Christian Family in Bangladesh Attacked, Charged with Crime

Muslim neighbors fabricate attempted murder charge after beating them for their faith.

LOS ANGELES, October 27 (CDN) — Muslim neighbors of a Christian family in Bangladesh scheduled to be baptized last month beat them and filed a false charge of attempted murder against them and other Christians, the head of the family said.

Foyez Uddin, 62, told Compass that his neighbor Nazrul Islam and Islam’s relatives told him, his wife and his two adult children that as Christians they were “polluting” society and beat them on Sept. 17 in Joysen village in Rangpur district, some 300 kilometers (186 miles) north of Dhaka. Islam is a policeman.

Islam’s uncle, Abdul Mannan Miah, then filed false charges against Uddin, his family and three others, accusing them of trying to kill Miah’s niece, Uddin said by telephone after his release on bail on Oct. 8. The village is under Pirgacha police jurisdiction.

Uddin said his family was fishing at his pond on Sept. 17 when eight to 10 Muslim neighbors led by Islam appeared and began speaking abusively about their Christian faith.

“Nazrul told us, ‘You are polluting society by deviating from Islam. Come back to Islam, otherwise we will not allow any Christian to live here in this village,’” Uddin said.

He told them that his family would not return to Islam, Uddin said.

“I replied, ‘Invite Islamic scholars, and if they can satisfy us in light of the Quran, then we will go back to Islam. Otherwise nothing can affect our unshakeable faith in Christ,’” Uddin said. “They beat me, my wife and two sons for objecting to their proposal to come back to Islam.”

The angry neighbors then broke into his home and burned two Bibles, tore two others and ripped four hymnals, he said, and they also damaged some furniture and chairs. Their home serves as a worship venue, and Uddin said the villagers also hacked with a machete the sign board of their house church, Faith Bible Church of God.

The pastor of the church, Lavlu Sadik Lebio, told Compass that he went to a nearby police station to complain about the attack, but officers did not respond to him. He said he only went to inform police, not file a case, but even so officers were unresponsive.

“Intentionally burning Bibles was the most sacrilegious attack on our faith – how can a member of the police department do that?” Pastor Lebio said. “Those people should have kept in mind how an announcement of burning a copy of the Quran in the U.S. stirred up the anger, discontent and hatred of Muslims all over the world.”

Taken into police custody on Sept. 18, Uddin said he and his family were unable to be baptized as planned.

“We were planning to be baptized in the last week of September,” he said. “Somehow our neighbors came to know about the baptismal ceremony, and they became very rude to us. We have been living in faith in Christ, the mainspring of our life, but we were not baptized.”

 

Murder Charge

As part of the attack on Sept. 17, Miah, the uncle of police officer Islam, filed the charge of attempted murder against Uddin, his family and three others that day, the Christian said.

When handing Uddin over to court, police filed a report stating that he had collaborated with people within the Christian community and that he had made defamatory remarks about Islam, Uddin said.

“In the police report while handing me over to court, I was mentioned as a troublesome Christian, but in the case copy filed by my neighbor, nothing was mentioned about me as a Christian,” Uddin said. “I was hurt by the police role.”

The police report to the court said that area residents did not approve of his Christian activities, and that there was the possibility of a communal clash. On this basis police requested he remain in custody while the investigation was underway.

According to the case file obtained by Compass, Uddin and his companions allegedly attempted to kill Islam’s sister (Miah’s niece), Jahanara Begum, sexually harassed her, severely beat her and stole her gold jewelry worth 41,000 taka (US$570).

Uddin said that Begum – sister of police officer Islam and niece of Miah – had a boil on her head that her father lanced the day of the attack. When blood continued rushing out from the procedure, her father, Azizul Muhury, took her to a nearby clinic called Pirgacha Medical and admitted her there. Later her brother Islam filed the false case, saying one of the eight accused had hit her on the head in an attempt to kill her, Uddin said.

According to the case file, Uddin was fishing on Begum’s inundated land, though he says he was at his own pond. Furthermore, the case file states Uddin was on Begum’s land at 9:30 a.m. on Sept. 17, when according to Uddin he was worshipping at his house church. The service did not end until 10 a.m.

According to the police file, Begum objected to him catching fish on her flooded land, and after paying no attention to her he eventually became furious and allegedly beat her “in a pre-planned manner.”

Uddin’s companions were said to be hiding nearby with bamboo, knives and machetes to attack her, and at some point in a quarrel, they supposedly emerged and surrounded Begum. Nural Islam, 52 – known in the area as a recent convert to Christianity – allegedly struck her in the head with a machete on Foyez’s order, according to the case file. Uddin said Islam is a rickshaw driver who was working all day and was not present.

Uddin was then alleged to have hit her on the hand with bamboo, and when she supposedly fell down, according to the case file, his brother Iman Ali, 45, hit her with an iron rod on her back. Uddin said Ali could not have been present either, as he was suffering from tuberculosis and could not walk properly due to the debilitating illness.

Uddin’s son, Shahjahan Miah, 25, then allegedly snatched the 27,000-taka (US$375) gold chain from her neck, according to the case file, and 25-year-old Mohammad Sirajul Islam took her 14,000-taka (US$195) gold earring. Uddin said Mohammad Sirajul Islam – also known in the area as a recent convert to Christianity – had lost work due to his new faith and had been forced to relocate to Chittagong district, some 500 kilometers (310 miles) away from Rangpur district, and he was in Chittagong on that day.

His father, Mohammad Farid, 42, had also converted to Christianity, and the case file accuses him of trying to strangle Begum. Uddin said Farid also lives in Chittagong district and was there at the time. In the case file, Uddin’s wife, 47-year-old Mosammat Shahar Banu, is then accused of removing Begum’s clothes. Uddin’s other son, 28-year-old Shahdul Islam, then allegedly seriously wounded her by striking her with bamboo, according to the case file.

Thus the case file charges all members of Uddin’s family, as well as three people who were not present – two other recent converts to Christianity and Uddin’s brother, he said. Uddin said he has sent letters stating the falseness of the charges to the Rangpur district administrative chief, district police chief, sub-district administrative chief, home minister of Bangladesh, home secretary of Bangladesh, inspector general of police (Bangladesh police chief), president of the Rangpur district press club, member of parliament of that area, Rangpur divisional commissioner and commander of Bangladesh’s elite force (RAB-5), as well as to the Faith Bible Church of God chairman.

The case file mistakenly identifies Uddin as Foyez Ali, and also errs in listing his age as 50 rather than 62.

Since Uddin became a Christian in 2007, some of his neighbors have threatened to kill him or expel him from the village, he said.

“In threatening us, they have also said that the government will reward them if we Christians are beaten,” Uddin said.

The main weapon of Muslim villagers opposed to Christians is to withhold work from them, he said.

“Once I used to cultivate other people’s land for my livelihood,” he said. “When the local people came to know that we lead our life in Christ, then they stopped giving us their land for cultivation. Nobody talks with us, and we are outcasts here.”

Last Christmas, around 100 to 150 people went to Uddin’s house to protest their celebration of the birth of Christ.

“Police are deployed in all churches at Christmas,” he said. “Two police were deployed at our house to avoid any kind of unwanted situation. Those two police stopped the angry villagers.”

Report from Compass Direct News

Anti-Christian Sentiment Marks Journey for Bhutan’s Exiles

Forced from Buddhist homeland, dangers arise in Hindu-majority Nepal.

KATHMANDU, Nepal, February 23 (CDN) — Thrust from their homes in Bhutan after Buddhist rulers embarked on an ethnic and religious purge, Christian refugees in Nepal face hostilities from Hindus and others.

In Sunsari district in southeastern Nepal, a country that is more than 80 percent Hindu, residents from the uneducated segments of society are especially apt to attack Christians, said Purna Kumal, district coordinator for Awana Clubs International, which runs 41 clubs in refugee camps to educate girls about the Bible.

“In Itahari, Christians face serious trouble during burials,” Kumal told Compass. “Last month, a burial party was attacked by locals who dug up the grave and desecrated it.”

Earlier this month, he added, a family in the area expelled one of its members from their home because he became a Christian.

Bhutan began expelling almost one-eighth of its citizens for being of Nepali origin or practicing faiths other than Buddhism in the 1980s. The purge lasted into the 1990s.

“Christians, like Hindus and others, were told to leave either their faith or the country,” said Gopi Chandra Silwal, who pastors a tiny church for Bhutanese refugees in a refugee camp in Sanischare, a small village in eastern Nepal’s Morang district. “Many chose to leave their homeland.”

Persecution in Bhutan led to the spread of Christianity in refugee camps in Nepal. Though exact figures are not available, refugee Simon Gazmer estimates there are about 7,000-8,000 Christians in the camps – out of a total refugee population of about 85,000 – with many others having left for other countries. There are 18 churches of various faiths in the camps, he said.

“Faith-healing was an important factor in the spread of Christianity in the camps,” said Gazmer, who belongs to Believers’ Church and is awaiting his turn to follow five members of his family to Queensland, Australia. “A second reason is the high density in the camps.”

Each refugee family lives in a single-room hut, with one outdoor toilet for every two families. The Nepalese government forbids them to work for fear it will create unemployment for local residents.

Life was even harder for them before 2006, when Nepal was a Hindu kingdom where conversions were a punishable offence.

“When I began preaching in 2000, I had to do it secretly,” said Pastor Silwal of Morang district. “We could meet only surreptitiously in small groups. I used my hut as a make-shift church while many other groups were forced to rent out rooms outside the camp.”

A fact-finding mission in 2004 by Brussels-based Human Rights Without Frontiers found that police pulled down a church structure built by Pentecostal Christians in the Beldangi camp by orders of Nepal’s home ministry. The rights group also reported that Hindu refugees ostracized the Christians, who had proceeded to rent a room outside the camp to meet three times a week for worship services and Bible study.

When the Jesus Loves Gospel Ministries (JLGM) organization sent officials from India to the Pathri camp in Morang in 2006, they found that local residents resentful of the refugees had taken note of a baptism service at a pond in a nearby jungle.

“In August, we were planning another baptism program,” JLGM director Robert Singh reported. “But the villagers put deadly poisonous chemicals in the water … Some of the young people went to take a bath ahead of our next baptism program. They found some fish floating on the water and, being very hungry – the refugees only get a very small ration, barely enough to survive on – they took some of the fish and ate them. Three of them died instantly.”

Singh also stated that poisoned sweets were left on the premises of the refugee school in the camp. They were discovered in time to avert another tragedy.

Life for Christian refugees improved after Nepal saw a pro-democracy movement in 2006 that caused the army-backed government of Hindu king Gyanendra Bir Bikram Shah to collapse. The king was forced to reinstate parliament, and lawmakers sought to curb his powers by declaring Nepal a secular state.

Though Christian refugees are now allowed to run churches openly in the camps, ill will toward them has yet to end. When Pastor Silwal asked camp authorities to allow him to open a church in 2006, Hindu neighbors protested, saying it would cause disturbances. Camp authorities allowed him to open a tiny church in a separate room on the condition that its activities would not disturb neighbors.

Earlier in his life in Bhutan, said the 40-year-old Pastor Silwal, he had been a stern Hindu who rebuked his two sisters mercilessly for becoming Christians. He forbade them to visit their church, which gathered in secret due to the ban on non-Buddhist religions in place at the time. They were also forbidden to bring the Bible inside their house in Geylegphug, a district in southern Bhutan close to the Indian border.

“I became a believer in 1988 after a near-death experience,” Pastor Silwal told Compass. “I contracted malaria and was on the verge of death since no one could diagnose it. All the priests and shamans consulted by my Hindu family failed to cure me. One day, when I thought I was going to die I had a vision.”

The pastor said he saw a white-robed figure holding a Bible in one hand and beckoning to him with the other. “Have faith in me,” the figure told him. “I will cure you.”

When he woke from his trance, Silwal asked his sisters to fetch him a copy of the Bible. They were alarmed at first, thinking he was going to beat them. But at his insistence, they nervously fetched the book from the thatched roof of the cow shed where they had kept it hidden. Pastor Silwal said he tried to read the Bible but was blinded by his fever and lost consciousness.

When he awoke, to his amazement and joy, the fever that had racked him for nearly five months was gone.

Pastor Silwal lost his home in 1990 to the ethnic and religious purge that forced him to flee along with thousands of others. It wasn’t until 1998, he said, that he and his family formally converted to Christianity after seven years of grueling hardship in the refugee camp, where he saw “people dying like flies due to illness, lack of food and the cold.”

“My little son too fell ill and I thought he would die,” Silwal said. “But he was cured; we decided to embrace Christianity formally.”

Homeless

In 2001, Bhutan4Christ reported the number of Bhutanese Christians to be around 19,000, with the bulk of them – more than 10,500 – living in Nepal.

When persecution by the Bhutanese government began, frightened families raced towards towns in India across the border. Alarmed by the influx of Bhutanese refugees, Indian security forces packed them into trucks and dumped them in southern Nepal.

Later, when the homesick refugees tried to return home, Indian security forces blocked the way. There were several rounds of scuffles, resulting in police killing at least three refugees.

Simon Gazmer was seven when his family landed at the bank of the Mai river in Jhapa district in southeastern Nepal. Now 24, he still remembers the desolation that reigned in the barren land, where mists and chilly winds rose from the river, affecting the morale and health of the refugees. They lived in bamboo shacks with thin plastic sheets serving as roofs; they had little food or medicine.

“My uncle Padam Bahadur had tuberculosis, and we thought he would die,” said Gazmer, who lives in Beldangi II, the largest of seven refugee camps. “His recovery made us realize the grace of God, and our family became Christians.”

The plight of the refugees improved after the U.N. High Commissioner for Refugees (UNHCR) stepped in, receiving permission from the government of Nepal to run the refugee camps. According to the UNHCR, there were 111,631 registered refugees in seven camps run in the two districts of Jhapa and Morang.

Though Nepal held 15 rounds of bilateral talks with Bhutan for the repatriation of the refugees, the Buddhist government dragged its feet, eventually breaking off talks. Meantime, international donors assisting the refugee camps began to grow weary, resulting in the slashing of aid and food. Finally, seven western governments – Canada, Norway, Denmark, New Zealand, Australia, the United States and the Netherlands – persuaded Nepal to allow the refugees to resettle in third countries.

The exodus of the refugees started in 2007. Today, according to the UNHCR, more than 26,000 have left for other countries, mostly the United States. A substantial number of the nearly 85,000 people left in the camps are ready to follow suit.

Although they now have a new life to look forward to, many of Bhutan’s Christian refugees are saddened by the knowledge that their homeland still remains barred to them. So some are looking at the next best thing: a return to Nepal, now that it is secular, where they will feel more at home than in the West.

“I don’t have grand dreams,” said Pastor Silwal. “In Australia I want to enroll in a Bible college and become a qualified preacher. Then I want to return to Nepal to spread the word of God.”  

Report from Compass Direct News 

INDIA: PASTOR SHOT IN BOMB ATTACK ON CHURCH

Attacker said he aimed to stop Christian conversions; Hindu extremist connection suspected.

NEW DELHI, March 10 (Compass Direct News) – In an effort to stop conversions to Christianity in the eastern state of Bihar, a 25-year-old ailing man on Sunday (March 8) exploded a crude bomb in a church and shot the pastor.

Police Inspector Hari Krishna Mandal told Compass that the attacker, Rajesh Singh, had come fully prepared to kill the pastor, Vinod Kumar, in Baraw village in the Nasriganj area of Rohtas district, and then take his own life.

“However,” Mandal said, “believers caught him before he could do more damage or kill himself.”

The 35-year-old pastor was taken to a hospital in nearby Varanasi, in the neighboring state of Uttar Pradesh and at press time was out of danger of losing his life, according to a leader of Gospel Echoing Missionary Society (GEMS) who requested anonymity.

The church, Prarthana Bhawan (House of Prayer), belongs to GEMS. Around 30 people were in the church when the attack took place. Some women in the church sustained burns in the blast.

“Rajesh Singh threw a crude bomb from the window of the church, and the sound of the explosion created a chaos in the congregation,” said Inspector Mandal. As members of the church began to run out, he added, Singh came into the building and shot the pastor with a handmade pistol from point-blank range.

Singh had more bombs to explode and three more bullets in his pistol, but church members caught hold of him and handed him over to police, the inspector said.

“In his statement, Singh said he was personally against Christian conversions and wanted to kill the pastor to stop conversions,” Mandal said. “He wanted to take his own life after killing the pastor, and this is why he had more bullets in his pistol and an overdose of anesthesia in a syringe.”

Asked if Singh had any links with extremist Hindu nationalist groups, the inspector said no such organization was active in the area, though local Christians say Hindu extremist presence has increased recently. The GEMS source said people allegedly linked with a Hindu nationalist group had sent a threatening letter to the pastor, asking him to stop preaching in the area.

The source said the incident could have been fallout from conversions in nearby Mithnipur village, where a Hindu family had received Christ after being healed from a mental illness around six months ago. Singh also lives in Mithnipur.

“Pastor Kumar had not been visiting the village, fearing opposition from the villagers who were not happy with the conversion of this family,” the GEMS source said. “The same church’s cross had also been damaged about a year ago by unidentified people.”

The source said he believes that although Singh’s affiliation or linkage with a Hindu nationalist group has not been established, it is likely that he was instigated to kill the pastor by an extremist group. Pastor Kumar, married with three children, has been working in Rohtas district for the last 12 years.

Local Christians complain that the presence of the Hindu extremist Sangh Parivar (a family of organizations linked with the Rashtriya Swayamsevak Sangh or RSS, India’s chief Hindu nationalist group) has recently increased in the area. They say the Hindu nationalist conglomerate has been spewing hate against Christians for more than 10 years, accusing them of using monetary incentives and fraudulent means and foreign money to convert Hindus.

The attacker has an amputated hand and was said to be mentally disturbed since 1996, when he was diagnosed with cancer, Inspector Mandal said.

“According to the villagers,” he said, “Singh had been mentally disturbed ever since he was diagnosed with cancer, and later tuberculosis, although there is no medical report to substantiate this.”

The government of Bihar is ruled by a coalition of a regional party, the Janata Dal-United (JD-U) party, and the Hindu nationalist Bharatiya Janata Party (BJP). The JD-U is also part of the National Democratic Alliance, the main opposition coalition at the federal level led by the BJP. The JD-U, however, is not perceived as a supporter of Hindu nationalism.

Of the 82 million people, mostly Hindu, in Bihar, only 53,137 are Christian, according to the 2001 census.

Report from Compass Direct News