Bangladesh is battling a deadly measles outbreak that has exposed significant weaknesses in its childhood immunisation programme, raising concerns about declining vaccination coverage, inadequate emergency preparedness and unequal access to healthcare.
Since the outbreak began in mid-March, the South Asian country has recorded more than 202,000 suspected measles cases, including approximately 22,000 laboratory-confirmed infections, according to the World Health Organization (WHO). Data covering the period up to October 9 show that at least 1,147 people have died, with children under five accounting for about 94 per cent of reported fatalities.
The crisis has raised questions about how a country previously recognised for its progress in childhood immunisation became vulnerable to an outbreak of a vaccine-preventable disease on such a scale.
A review of WHO documents, meeting records and interviews with health professionals, scientists, government officials and affected families points to several contributing factors. These include declining vaccination coverage, unreliable population records, gaps in emergency planning and difficulties reaching children in remote communities.
“This is a real warning to every country,” said Mark Jit, a WHO vaccine adviser and professor at New York University’s School of Global Public Health.
Jit said routine immunisation was less expensive, safer and more effective than waiting until an outbreak had spread before attempting to control it. Although emergency vaccination campaigns can eventually curb transmission, preventable infections and deaths may occur before they take effect.
Ziauddin Hyder, a special assistant on health affairs to Prime Minister Tarique Rahman, previously told Reuters that the government was taking all possible measures to end the outbreak. The government did not provide further responses to questions submitted in October.
Behind the national figures are families whose children became ill or died in communities where access to vaccination and medical care remains limited.
In Sylhet, a northeastern region among the worst affected by the outbreak, two-year-old Arman Hossain died in July after contracting measles without having been vaccinated.
His family reportedly sold its three-wheeled auto-rickshaw to pay for his hospital treatment. Despite their efforts, Arman died about 24 hours after being admitted.
His four-year-old sister, who had also not received a measles vaccination, survived the illness.
Arman’s father, Amin Mia, 26, said health workers had failed to reach their remote village in time to vaccinate the children.
“They came only after I buried my son,” he said.
Another family in the town of Chhatak suffered a similar loss in June, when nine-month-old Labiba Akter died from measles.
Her father, Humayun Rashid, a 30-year-old carpenter, said his daughter had not been vaccinated despite an emergency campaign that lowered the eligible age for immunisation from nine months to six months.
According to Rashid, no health worker visited the family to inform them about the vaccination programme.
The deaths illustrate how gaps in healthcare delivery can leave children exposed even when vaccination campaigns are under way.
Measles is highly contagious and can cause serious complications, particularly among young children. The risk of severe illness and death increases in settings where malnutrition, delayed treatment and limited access to medical facilities make patients more vulnerable.
Bangladesh had previously made substantial progress in routine childhood immunisation.
Estimates from WHO and the United Nations Children’s Fund (UNICEF) indicated that 96 per cent of children received the first measles vaccine dose in 2024, while 93 per cent received the second.
The second dose is essential because some children do not develop sufficient immunity after their initial vaccination.
However, political unrest in 2024, which ended the 15-year rule of former Prime Minister Sheikh Hasina, disrupted public services, including healthcare delivery. Subsequent health worker strikes, delays in vaccine orders and interruptions to routine follow-up programmes further complicated immunisation efforts.
A joint WHO and UNICEF report published in July estimated that first-dose measles vaccination coverage fell to 90 per cent in 2025, while second-dose coverage dropped to 86 per cent.
Both figures were below the approximately 95 per cent coverage needed to interrupt measles transmission and prevent sustained outbreaks.
The report also raised concerns about the reliability of official vaccination statistics for measles and other diseases between 2023 and 2025.
Some preliminary records showed more children being reported as vaccinated than the estimated target population. Such discrepancies can indicate problems with counting administered doses, estimating eligible children or maintaining accurate population records.
These weaknesses make it harder for health authorities to identify unvaccinated children and direct resources towards communities at greatest risk.
As the outbreak intensified, Bangladesh launched an emergency vaccination campaign targeting children aged six months to five years.
Authorities reported that nearly 20 million children received vaccinations during April and May. Officials initially indicated that the campaign had reached every child in the designated age group.
Reported infections subsequently declined, raising hopes that the outbreak was coming under control.
However, cases began rising again in the following months, prompting questions about whether the campaign had reached all eligible children.
A comparison of government health programmes revealed a significant discrepancy in the number of children identified for vaccination. A separate routine health intervention conducted in June had a target list containing approximately four million more children than the measles campaign, despite covering the same age group.
The difference raised concerns about the accuracy of the emergency campaign’s target population and whether some vulnerable children had been overlooked.
Hyder acknowledged the discrepancy in September, suggesting that parental reluctance and childhood illnesses might have prevented some children from receiving vaccinations.
In May, Health Minister Sardar Md. Sakhawat Husain said the campaign had reduced infections in outbreak hotspots to almost zero and that the situation was under control.
However, Bangladesh recorded an average of 1,198 new measles cases daily in September, the highest daily average since May.
The resurgence highlighted the difficulty of containing measles when vaccination gaps persist and surveillance systems struggle to identify vulnerable populations.
Documents reviewed by Reuters, including records of meetings between the government, WHO and other health partners, revealed concerns about the preparation and implementation of the emergency vaccination campaign.
Minutes from an April 19 meeting indicated that authorities conducted only one round of preparedness assessments before launching the programme, citing time constraints. The process would typically involve four rounds of checks.
Such assessments help establish whether health facilities have adequate vaccine storage equipment, sufficient personnel and reliable estimates of the number of children requiring immunisation.
The single assessment suggested that most districts were prepared, although some had not met all the necessary requirements.
Mahmudur Rahman, an epidemiologist and chair of Bangladesh’s National Verification Committee for Measles and Rubella Elimination, warned that inadequate preparation could leave the poorest and most isolated children without protection.
Hyder said the emergency campaign had been organised within four weeks. However, Tajul Islam Abdul Bari, who led Bangladesh’s immunisation programme until 2017, said campaigns of this scale normally require several months of planning.
Further concerns emerged during an August meeting, when officials noted that the proportion of confirmed measles cases involving unvaccinated children had remained high after the campaign.
According to the meeting minutes, unvaccinated children accounted for 82 per cent of confirmed cases before the campaign and 85 per cent afterwards.
Although these figures do not, on their own, establish the campaign’s overall effectiveness, they highlight the continued vulnerability of children who had not received measles vaccines.
The WHO did not respond to specific questions about the meetings. However, its deputy representative in Bangladesh, Dr Rajesh Narwal, said the organisation remained committed to supporting the government in protecting children at risk.
He added that routine immunisation services needed to become more effective and resilient to prevent similar gaps in the future.
The scale of the challenge is particularly apparent in Sylhet, where official records indicate that 180 children have died during the outbreak.
Of the 16 families interviewed by Reuters in the region in September, eight said they had not seen health workers offering vaccinations. At least six families reported that medical teams visited their communities only after a child had died from measles.
The accounts point to continuing difficulties in reaching remote households and ensuring that families know when and where vaccines are available.
At the end of September, the government launched another vaccination campaign targeting approximately 3.4 million children who had been missed during earlier efforts.
Health Minister Sardar Md. Sakhawat Husain said authorities intended to mobilise communities across villages to ensure that no eligible child was overlooked.
However, longstanding weaknesses in population registration and healthcare staffing continue to complicate those efforts.
UNICEF and the Bangladesh Bureau of Statistics estimate that as many as 40 per cent of children are not registered, making it more difficult to maintain accurate records and identify those who need vaccinations.
Government figures also indicate that approximately one-third of health worker positions remain vacant.
Experts have called for vaccination efforts to be extended to children older than five, noting that this age group accounts for roughly one-third of measles cases, according to the WHO.
Researchers are also investigating why immunity appears to decline faster than expected among some infants aged up to around six months. Babies can receive temporary protection through antibodies passed from their mothers, but the level and duration of that protection vary.
While health authorities attempt to close vaccination gaps, hospitals are facing additional pressure from measles and a concurrent dengue epidemic.
During a September visit to Shahid Shamsuddin Ahmed Hospital in Sylhet, Reuters observed that the 100-bed facility appeared overwhelmed, with 178 patients admitted on the day of the visit.
The situation illustrates the strain placed on healthcare facilities when a large outbreak coincides with other public health emergencies.
Hospitals must treat children suffering from measles complications while health authorities expand vaccination coverage, improve disease surveillance and strengthen public confidence in routine immunisation.
The crisis also underscores the distinction between vaccine hesitancy and barriers to accessing vaccines. While misinformation and parental concerns can affect vaccination decisions, families in remote communities may remain unprotected because health workers, information and vaccination services do not reach them in time.
Addressing these challenges requires more than emergency campaigns. Reliable population records, adequate staffing, timely vaccine procurement and sustained outreach are essential to ensuring that children receive both recommended doses.
Bangladesh’s measles outbreak demonstrates how quickly progress against preventable diseases can be undermined when routine immunisation systems weaken.
The immediate priority is to contain transmission, treat infected children and reach those who have missed vaccination. Over the longer term, authorities must strengthen routine services, improve the accuracy of health records and ensure that remote and underserved communities receive consistent access to vaccines.
The experience also carries lessons for other countries. High vaccination coverage must be maintained even when outbreaks appear unlikely, while emergency campaigns need accurate population estimates, adequate preparation and effective monitoring.
For Bangladesh, the challenge is not simply to bring the current outbreak under control. It is to rebuild a system capable of protecting children before another preventable epidemic emerges.
Without sustained improvements in vaccination coverage and healthcare delivery, more children could remain vulnerable to measles and its potentially fatal complications.
Goodness Anunobi
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