Measles has exposed the cracks beneath Bangladesh's immunisation success

Bangladesh is living through a public health tragedy that should never have happened. According to the latest Directorate General of Health Services (DGHS) data, over 1.89 lakh people—mainly children—have fallen ill with measles or measles-like symptoms since March 15, 2026. At least 1.49 lakh have required hospitalisation as of September 11, and the reported death toll from confirmed and suspected measles has reached 1,012.

These figures need careful interpretation, particularly the distinction between confirmed and suspected cases and deaths. But the central fact must not be obscured: children are dying in extraordinary numbers from a disease that is highly preventable by vaccination. This is unacceptable.

Tap here to add The Daily Star as a trusted source

The outbreak cannot conveniently be blamed on one government, one official, parents who failed to bring children for vaccination, or health workers. What we are witnessing is the result of an accumulation of failures over several years. However, some failures were avoidable and must be acknowledged as such.

Bangladesh was once one of the developing world’s great immunisation success stories. When the Expanded Programme on Immunization (EPI) received renewed attention in the mid-1980s, vaccination coverage rose dramatically within a decade. Government provided leadership, NGOs helped mobilise communities and reach households, health workers carried vaccines into villages, and families came to regard childhood vaccination as normal and necessary. We demonstrated that even a poor country with weak health infrastructure could protect virtually all its children when political commitment, competent management and community participation came together. The history makes today’s situation especially painful.

Measles is extraordinarily contagious. WHO recommends achieving and sustaining at least 95 percent coverage with two doses of measles-containing vaccine to interrupt transmission. When vaccination gaps develop, susceptible children accumulate until the virus finds them.

Covid disrupted routine immunisation. Some children were never brought back into the system. Hard-to-reach populations, urban slums, migrants and other marginalised communities remained particularly vulnerable. Routine follow-up and identification of zero-dose children were inadequate. These weaknesses piled up.

Then came a more immediate and potentially avoidable problem: vaccine availability. WHO’s assessment of the Bangladesh outbreak identified vaccination gaps and vaccine-supply problems as important elements of the crisis. Questions have also been raised about procurement arrangements and delays. Whatever the administrative explanations, the public health consequence was simple: children who should have been protected were not.

This year’s emergency response was enormous. By the initial deadline, authorities reported vaccinating 1.84 crore children against a target of about 1.8 crore. Eventually, reported coverage rose to around 1.97 crore. This recognition-deserving achievement raised an uncomfortable question. A subsequent Vitamin A campaign reached 2.23 crore children in the same age group. In other words, nearly 39 lakh more children appeared in the Vitamin A denominator than accounted for in the emergency measles campaign. Authorities subsequently acknowledged that the measles target population had been underestimated. This is not a minor statistical discrepancy. If we do not know with reasonable accuracy how many children need vaccination, apparently impressive coverage percentages can give false reassurance. A campaign can report more than 100 percent coverage and still leave millions of susceptible children behind.

After declining in June and July, measles resurged in August. Therefore, which children did we miss, where are they, and why did we miss them? We must ask.

However, today’s evidence forces us to ask another uncomfortable question: Why are so many children dying due to infection? The latest The Daily Star investigation describes children being moved from one hospital to another, sometimes reaching specialised facilities only when critically ill. Public health expert Mushtuq Husain told this daily that the response has relied too heavily on tertiary and intensive care, while early detection, isolation, contact tracing and management at primary and secondary levels have been inadequate.

Vaccination is our best defence against measles, but once an outbreak is underway, preventing deaths also requires prompt diagnosis, appropriate clinical management, Vitamin A supplementation, infection prevention and control, functioning referral pathways and adequately prepared hospitals. These are also among the measures WHO has recommended for Bangladesh’s outbreak response.

There is one additional issue. Measles vaccine is heat-sensitive. WHO guidance states that exposure to higher temperatures can cause potency loss and that, after reconstitution, measles vaccine becomes particularly sensitive to heat and light. I have seen no evidence demonstrating that loss of vaccine potency contributed to the Bangladesh outbreak. Indeed, the available epidemiological evidence points much more strongly towards failure to vaccinate: most patients currently being treated are reportedly unvaccinated.

Nevertheless, given the extraordinary scale and persistence of the outbreak, vaccine potency and cold-chain integrity should be independently examined rather than assumed to be satisfactory. Cold-chain records, vaccine vial monitors, transport and storage arrangements, handling after reconstitution, and vaccine lots should be reviewed. We should also know how many confirmed cases occurred among children with documented vaccination and whether that proportion is consistent with expected vaccine effectiveness. This is how a serious public health system should investigate an extraordinary event.

The health minister has recently suggested that the unusual severity of the outbreak could signal a “new variant,” while acknowledging that none has been identified. Such possibilities should be investigated scientifically, not become a substitute explanation for failures. There is also a temptation to turn the outbreak into another political argument. These are legitimate questions, but political point-scoring will not vaccinate a single child.

What should happen now? The immediate priority is obvious: find and vaccinate every eligible unvaccinated and under-vaccinated child. The government plans another nationwide campaign beginning September 25, targeting newly eligible six-month-olds and previously missed children. This campaign cannot repeat the denominator and microplanning mistakes of the earlier one. We need household-level microplanning, with particular attention to urban slums, mobile populations, remote areas and communities where routine services repeatedly fail.

When supply-chain management fails, children die. Routine EPI must be rebuilt. Emergency campaigns can extinguish a fire; they cannot substitute for a functioning health and immunisation system. At the same time, primary and secondary facilities must be able to recognise, isolate, treat and appropriately refer measles cases before children become critically ill.

Finally, the government should revive the partnership that made Bangladesh’s immunisation programme successful in the first place. The government must lead, but NGOs, community organisations, local leaders and frontline workers can help find children whom the formal system does not reach. We already know how to vaccinate children at scale. We know how to mobilise communities.

We should call the situation what it is: a preventable public health failure. Broadly, a governance failure. The question now is whether we dare to find out exactly why it happened, and whether we have the determination to ensure that it never happens again.

Dr Ahmed Mushtaque Raza Chowdhury is convener of Bangladesh Health Watch and founding dean of the James P Grant School of Public Health at BRAC University.

Views expressed in this article are the author's own. 

Follow The Daily Star Opinion on Facebook for the latest opinions, commentaries, and analyses by experts and professionals. To contribute your article or letter to The Daily Star Opinion, see our guidelines for submission.