Bangladesh measles crisis exposes deadly cost of vaccination gaps

DHAKA/SYLHET: Bangladesh’s struggle to contain a devastating measles outbreak is exposing how quickly progress against a vaccine-preventable disease can unravel when routine immunisation falters, health workers fail to reach vulnerable communities and public health programmes cannot reliably identify every child at risk.

The country reported 202,000 suspected measles cases, including 22,000 laboratory-confirmed infections, from the outbreak’s onset in mid-March through October 9, according to the World Health Organization (WHO), as reported in a Reuters investigation published on October 17. The figures represented more suspected cases than any other country had reported that year, according to the report.

The WHO figures also recorded 1,147 deaths, with children younger than five accounting for 94% of reported fatalities.

The outbreak has followed a decline in Bangladesh’s routine childhood vaccination coverage after years of progress. An investigation by Reuters, based on WHO documents, official meeting records and interviews with scientists, health workers and officials, found that political disruption, gaps in vaccination data, limited preparation and difficulties reaching parents had complicated the country’s response.

For public health authorities beyond Bangladesh, the crisis carries a broader warning: emergency vaccination drives cannot reliably compensate for years of missed doses if health systems do not know which children remain unprotected or cannot reach them in time.

Children in remote communities bear the heaviest burden

The consequences have been particularly severe in the northeastern Sylhet region, one of the country’s hardest-hit areas.

Two-year-old Arman Hossain died in July after being admitted to hospital for measles treatment. His family had sold its three-wheeled auto rickshaw to pay for his care. Arman had not been vaccinated, while his four-year-old sister, who was also unvaccinated, survived.

His father, 26-year-old Amin Mia, told Reuters that health workers had not visited their remote village to offer vaccinations before his son became ill.

“They came only after I buried my son,” Mia said.

In the town of Chhatak, also in Sylhet, nine-month-old Labiba Akter died of measles in June. Her father, 30-year-old carpenter Humayun Rashid, said his daughter had not received a vaccination and that no health worker had visited to inform the family.

Labiba could have been eligible for an inoculation during the emergency programme launched in April, when the vaccination age was lowered from nine months to six months.

The accounts highlight the difference between making vaccines available nationally and ensuring that children in remote or underserved communities actually receive them.

Measles is highly contagious and can cause fever, cough and a characteristic rash. The WHO says the disease typically kills two to three people per 1,000 cases, although mortality can be higher in settings where malnutrition and limited access to medical care increase the risk of severe illness.

For children who are not protected by vaccination, the consequences can be particularly serious.

Bangladesh’s vaccination success began to unravel

Until recently, Bangladesh had made substantial progress in routine childhood immunisation.

WHO and United Nations Children’s Fund (UNICEF) estimates placed the country’s coverage for the first dose of measles-containing vaccine at 96% in 2024, while coverage for the second dose stood at 93%.

The second dose is important because a small proportion of children do not develop sufficient immunity after their first vaccination.

The WHO recommends at least 95% vaccination coverage with two doses to help prevent measles outbreaks and interrupt transmission. Bangladesh’s earlier progress brought first-dose coverage close to that benchmark, but the country remained below it for the second dose.

The situation deteriorated in 2025.

In a report published in July 2026, WHO and UNICEF estimated that first-dose coverage had fallen to 90%, while second-dose coverage dropped to 86%. Both figures were below the level considered necessary to prevent outbreaks.

The decline followed major political upheaval in 2024, when protests ended the 15-year rule of former prime minister Sheikh Hasina. According to the Reuters investigation, the subsequent disruption affected the health system: health workers went on strike, vaccine orders were delayed and follow-up vaccinations linked to routine programmes were interrupted.

These disruptions left more children susceptible to infection and weakened the protection built through earlier immunisation efforts.

The WHO and UNICEF report also raised concerns about the reliability of official vaccination data for 2023 to 2025. Some preliminary figures suggested that the number of children vaccinated exceeded 100% of the target population, pointing to possible errors in counting doses or estimating the number of eligible children.

Such discrepancies matter because vaccination campaigns depend on accurate population estimates. If authorities underestimate the number of children who need immunisation, a campaign can appear successful while leaving substantial gaps in protection.

Emergency campaign reached millions but missed children

Bangladesh moved quickly after the outbreak emerged, launching an emergency vaccination programme that initially appeared to slow the spread of measles.

Nearly 20 million children received vaccinations during April and May. The government said the campaign had covered all children in the target age group of six months to five years.

However, subsequent evidence raised questions about the completeness of that effort.

A separate routine health intervention in June had a target list containing four million more children than the measles campaign, despite covering the same age group. The discrepancy suggested that the emergency programme may have failed to identify or reach millions of eligible children.

Ziauddin Hyder, special assistant on health affairs to Prime Minister Tarique Rahman, acknowledged a gap in the campaign in comments to Reuters on September 14. He attributed missed vaccinations partly to parental reluctance and children being ill when vaccination teams visited.

The emergency drive also faced challenges related to preparation.

Meeting minutes reviewed by Reuters showed that, at an April 19 meeting, authorities opted for one round of readiness checks before launching the campaign because of time constraints. Such checks would typically involve four rounds.

Readiness assessments help establish whether districts have adequate vaccine supplies, functioning refrigeration and cold-chain systems, trained personnel and reliable estimates of the children who need to be vaccinated.

The single round of checks suggested that most, but not all, districts were ready to begin the campaign.

The findings illustrate the difficulty of balancing the need for a rapid response against the preparation required to ensure that a large vaccination programme reaches its intended population.

Poorer families face barriers to vaccination

Professor Mahmudur Rahman, an epidemiologist and chair of Bangladesh’s National Verification Committee for Measles and Rubella Elimination, warned that inadequate preparation can leave the most vulnerable children behind.

He said children in the poorest and hardest-to-reach communities often pay the price when preparedness checks are not properly conducted.

Tajul Islam Abdul Bari, who led immunisation in Bangladesh until 2017, told Reuters that vaccination campaigns generally require months of planning, while Hyder said the April campaign had been launched within four weeks.

By August, programme reviews were still identifying substantial gaps.

According to meeting minutes cited by Reuters, the proportion of children with confirmed measles who had not been vaccinated was 82% before the emergency campaign and 85% afterwards. The figures suggested that the campaign had not sufficiently reduced the share of cases occurring among unvaccinated children.

The WHO did not respond to Reuters’ questions about the April and August meetings. However, Dr Rajesh Narwal, the organisation’s deputy representative in Bangladesh, said it remained committed to supporting the government in its effort to vaccinate every child at risk.

He stressed the importance of making routine immunisation more effective and resilient so that similar gaps did not develop again.

The challenge extends beyond vaccine availability. UNICEF and the Bangladesh Bureau of Statistics estimate that as many as 40% of children go unregistered, while government data indicate that approximately one-third of health worker posts are vacant.

Incomplete birth registration can make it harder to establish the size and location of the eligible population. Vacant health worker positions can further limit the capacity to visit communities, inform parents and deliver vaccines.

In Sylhet, official records cited in the Reuters investigation showed that 180 children had died. Of 16 families interviewed by Reuters in September, eight said they had not seen health workers offering vaccinations. At least six families reported that health workers visited only after a child in their community had died of measles.

A new campaign targets children missed earlier

At the end of September, the government launched another campaign intended to reach 3.4 million children who had been missed during earlier vaccination efforts.

Health Minister Sardar Md. Sakhawat Husain said the government would involve people across villages to ensure that no child was left out.

However, the scale of the remaining challenge is substantial.

Health experts have urged authorities to consider extending vaccination efforts to children older than five. According to the WHO figures cited by Reuters, this age group accounts for approximately one-third of measles cases.

Scientists in Bangladesh are also investigating why immunity appears to be waning faster than expected in some infants during their first months of life. Babies are generally afforded some early protection by maternal antibodies, although the level and duration of that protection vary.

The questions are important for determining whether vaccination schedules, outreach strategies or other elements of the immunisation programme need to be reviewed in response to the outbreak.

The government’s response is also taking place amid other health pressures, including a dengue epidemic that has added to the demands on healthcare services.

Hospitals struggle to accommodate patients

The outbreak has placed considerable pressure on facilities treating children with measles, particularly in Sylhet.

In September, every ward at the 100-bed Shahid Shamsuddin Ahmed Hospital in Sylhet appeared overwhelmed, according to Reuters. On the day its journalists visited, 178 patients were admitted, substantially exceeding the hospital’s stated bed capacity.

The situation highlights the importance of timely medical care alongside vaccination. Early assessment and appropriate treatment can be critical for children who develop severe illness, particularly where malnutrition or other health problems increase the risk of complications.

For Bangladesh, controlling transmission while providing care to large numbers of sick children presents a dual challenge: reaching those who remain unvaccinated and ensuring that hospitals can manage patients who have already contracted the disease.

A warning for countries beyond Bangladesh

Bangladesh’s outbreak comes amid wider concerns about declining immunisation coverage and growing vaccine scepticism in some countries. The Reuters report noted that vaccine hesitancy has become a concern in wealthier nations as well, including amid public debate surrounding US Health Secretary Robert F. Kennedy Jr.

However, the barriers in Bangladesh are different in important respects. Experts cited by Reuters said access to vaccination and awareness among families are more immediate challenges than hesitancy alone.

The outbreak also demonstrates why vaccination coverage figures need to be interpreted alongside the quality of the underlying data. National averages can obscure communities where children are repeatedly missed, while inaccurate population estimates can make campaigns appear more comprehensive than they are.

Mark Jit, a WHO vaccine adviser and professor at New York University’s School of Global Public Health, described Bangladesh’s experience as a warning to other countries.

He told Reuters that preventing an outbreak through vaccination was easier, cheaper and safer than responding after transmission had taken hold.

The warning is especially relevant to health systems that depend on routine immunisation to protect children against highly contagious diseases. Sustained coverage, accurate population data, well-prepared vaccination teams and reliable outreach are all necessary to identify and protect children who might otherwise be overlooked.

Government response and outstanding questions

Hyder told Reuters in September that the government was doing everything it could to end the outbreak. The government did not respond to further questions sent by Reuters in October for its investigation.

The report does not establish that any single factor caused the outbreak. Instead, it describes a combination of falling routine vaccination coverage, political and health-service disruption, data weaknesses, gaps in campaign preparation and difficulties reaching families.

The immediate priority is to close those gaps while providing timely care to children who are already ill. Longer term, the experience raises questions about how immunisation programmes can maintain continuity during political instability, identify unregistered children and ensure that emergency campaigns complement rather than replace routine vaccination services.

Bangladesh’s experience shows that the existence of a national vaccination programme is not enough on its own. Children must be identified, reached and protected before an outbreak takes hold.

For countries seeking to prevent similar crises, the lesson is clear: maintaining immunisation coverage and reaching the children most likely to be missed are essential parts of protecting public health.

Source note: This report is based on figures and findings published by Reuters on October 17, 2026, drawing on WHO data, WHO and UNICEF vaccination estimates, official meeting records and interviews with health experts, officials and affected families. Medical News Pakistan has independently structured and rewritten the report for its readers.

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