Bangladesh cholera vaccination: 82.6% coverage, 8.52 lakh miss first dose

Bangladesh’s first-round oral cholera vaccination (OCV) campaign reached 82.6 percent of its target population, with Narayanganj recording the lowest coverage.

A total of 40,47,018 people were vaccinated against a target of 48,99,440, leaving 8,52,422 people unvaccinated in the first round, according to data from the Directorate General of Health Services (DGHS).

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Cholera vaccination campaign launched

Narayanganj alone accounts for a large share of the gap. Of the 10,32,963 people targeted there, 6,72,287 received the vaccine, leaving more than 3,60,000 unvaccinated. That is roughly 42 percent of all those missed in the first round.

DGHS launched Bangladesh's first two-dose oral cholera vaccination campaign on August 22, covering areas under seven police stations in Dhaka and seven upazilas across four districts. The campaign targeted people aged one year and above, excluding pregnant women and those who were seriously ill. The first dose was administered from August 22 to September 21, while the second-dose campaign began on September 26 and will continue until October 25.

The campaign covers 14 cholera high-risk areas. In Dhaka city, these are areas under seven police stations: Lalbagh, Gandaria, Kadamtali, Kamrangirchar, Sher-e-Bangla Nagar, Khilkhet and Tejgaon.

Outside Dhaka, the areas are Sadar and Nabinagar in Brahmanbaria; Tarail, Karimganj and Hossainpur in Kishoreganj; Munshiganj Sadar; and Narayanganj Sadar.

Brahmanbaria was the best performer, with 98.4 percent coverage, followed by Kishoreganj at 94.8 percent and Munshiganj at 80.8 percent.

Coverage in Dhaka North City Corporation was 82.6 percent, while Dhaka South City Corporation recorded 77.4 percent.

Why coverage fell short

A DGHS official involved in the campaign said their expectation was to achieve 95 percent coverage, but they could not reach the target.

“But the coverage rate is not that bad,” he said.

He said the target population was large, making high coverage more difficult to achieve. Unlike routine immunisation and special campaign, which mainly involves children, the campaign covered a much broader population, he added.

Besides, many people in the target population were working, meaning they missed vaccination because of a mismatch between their working hours and the campaign schedule.

“In Dhaka city, we carried out evening sessions, enabling us to cover more people,” he said.

But this was not possible in Narayanganj.

The official also pointed to the scattered nature of the population in Narayanganj, which made outreach difficult. The number of people in the city corporation was the second highest among the campaign areas, while high population movement also contributed to people being missed, he said.

However, a delegation from Gavi, the Vaccine Alliance, which recently visited Bangladesh, was satisfied with the coverage, the official said, wishing not to be named. Gavi provided the vaccine free of cost.

Contacted, Prof Halimur Rashid, DGHS director for disease control, whose wing is handling the campaign, said they did not have any specific coverage target.

“This is a preventive vaccine, and whatever coverage we achieved, we reported it,” he told The Daily Star today.

He also said all people aged one year and above were included in the target population, and coverage in such campaigns generally remains relatively lower than in campaigns where children are the target population.

“We carried out publicity as much as possible,” he added.

Asked about the lower coverage in Narayanganj, Prof Halimur asked this reporter to contact the civil surgeon of Narayanganj.

Narayanganj Civil Surgeon SM Sakhawat Hossain said he had recently joined the post and was unaware of the reasons behind the lower coverage.

Upazila Health and Family Planning Officer of Narayanganj Sadar upazila Umme Farhana was recently transferred and could not be reached for comment.

Part of a five-year plan

A joint DGHS and icddr,b study conducted in 2022-23 identified 144 sites -- upazilas and city corporation police-station areas -- as cholera hotspots, another DGHS official told The Daily Star recently.

The government subsequently drew up a five-year plan to vaccinate people in these vulnerable areas, starting with the 14 considered most vulnerable. The vaccine used in the campaign is WHO-prequalified.

“We have a plan to gradually cover all the other sites, but everything depends on funding,” the DGHS official added.