Why Bangladesh is struggling against measles epidemic despite 20m vaccines

Dhaka, Bangladesh – One-year-old Saif Hasan died wrong minutes of being taken into intensive attraction astatine Dhaka’s Infectious Diseases Hospital (IDH) connected August 27.

The kid from the confederate Bangladesh territory of Shariatpur had developed a fever and rashes days aft receiving his archetypal measles-rubella vaccine. His household wondered whether the vaccine had made him ill.

But Saif, who had been receiving attraction for a pre-existing respiratory illness, was apt infected with measles before the vaccine had clip to support him, Shrebash Paul, a inferior advisor astatine the hospital, said. “The corruption past aggravated his underlying condition.”

Saif’s decease points to the situation Bangladesh faces successful containing a measles epidemic that is present believed to person killed much than 1,000 radical since March 15 this year. Last year, Bangladesh recorded 132 measles cases successful total, with zero deaths.

The deaths travel contempt an exigency run that has administered astir 20 cardinal vaccine doses implicit this period.

By September 9, wellness authorities had recorded 1,009 deaths – 100 among laboratory-confirmed measles patients and 909 classified arsenic suspected measles deaths. Yet the aforesaid authoritative information shows 19.75 cardinal children vaccinated since the exigency run began successful April against the people of 18 million.

But nationalist wellness experts accidental that seemingly bonzer fig helps exposure 1 of the problems Bangladesh has faced successful controlling the epidemic: On the 1 hand, the archetypal estimation of the children needing vaccines was excessively low, portion connected the other, nationalist sum figures tin obscure pockets wherever ample numbers of susceptible children remain.

Mothers with their children hold successful a queue to person measles vaccinations amid an outbreak successful Dhaka, Bangladesh, April 12, 2026 [Mahmud Hossain Opu/AP Photo]

A people that underestimated the problem

Bangladesh’s vulnerability to measles did not look overnight.

The South Asian federation of astir 178 cardinal radical had been moving towards eliminating the illness earlier years of declining immunisation sum near a increasing fig of children susceptible.

Bangladesh’s 2023 Coverage Evaluation Survey recovered that first-dose measles-rubella sum had declined from 88.6 percent successful 2019 to 86 percent successful 2023, portion second-dose sum fell from 89 percent to 80.7 percent.

Routine immunisation was disrupted during the COVID-19 pandemic, portion UNICEF has besides cited misinformation and vaccine hesitancy among factors contributing to children missing vaccinations.

Besides, earlier this year’s effort, Bangladesh had not conducted a nationwide supplementary measles-rubella run since the past 1 ran from December 2020 to January 2021. Coverage truthful remained beneath the astir 95 percent level needed to interrupt measles transmission, allowing the fig of susceptible children to turn implicit successive years.

The occupation worsened amid governmental upheaval pursuing the July 2024 uprising, erstwhile then-Prime Minister Sheikh Hasina was ousted, and disruptions to the country’s immunisation programme.

The alteration successful authorities led to delays successful vaccine procurement, said Mushtuq Hussain, a erstwhile main technological serviceman astatine Bangladesh’s Institute of Epidemiology, Disease Control and Research (IEDCR). That, successful turn, led to vaccine shortages successful 2024 and 2025.

Cases began rising markedly successful January 2026 and surged done March, prompting Bangladesh to notify the World Health Organization (WHO) of a nationwide outbreak connected April 4. By mid-April, cases had been reported successful 58 of the country’s 64 districts.

When the existent outbreak accelerated, authorities launched exigency vaccination successful high-risk areas connected April 5, followed by a nationwide run aboriginal that month. Authorities acceptable a people of astir 18 cardinal children aged six months to nether 5 years erstwhile the measles-rubella vaccination run was launched connected April 20.

Yet, astir 2 months later, connected June 28, the government’s run to administer Vitamin A supplements targeted astir 24 cardinal children successful the aforesaid property radical – a quality of astir six million. That discrepancy helps explicate however Bangladesh tin present study vaccinating astir 20 cardinal children – exceeding its archetypal people – portion susceptible children proceed to beryllium found.

Hussain of the IEDCR questioned the colonisation estimates utilized to acceptable the vaccination target, saying they underestimated the fig of eligible children.

Nationwide averages tin besides disguise section gaps. “You person to support equity,” Hussain said, arguing that astatine slightest 95 percent sum indispensable beryllium achieved crossed communities, including among hard-to-reach and mobile populations.

A kid rests arsenic helium receives attraction for measles successful a infirmary successful Dhaka, September 8, 2026 [Mahmud Hossain Opu/AP Photo]

Numbers that tin hide

Measles is among the world’s astir contagious diseases, meaning adjacent comparatively tiny concentrations of unprotected radical tin prolong transmission.

Hussain said precocious nationalist mean sum rates could conceal immunity gaps successful idiosyncratic communities, allowing the microorganism to proceed circulating.

A 2nd epidemiologist with extended acquisition successful Bangladesh’s immunisation programme, who requested anonymity due to the fact that of the sensitivity of the issue, said authorities needed to analyse cases by age, vaccination past and determination and usage the findings to place susceptible populations.

Without targeted vaccination of those populations, the epidemiologist said, transmission was apt to proceed adjacent if wide lawsuit numbers declined. Doctors treating patients are seeing grounds of those gaps.

Paul, the doc astatine the IDH successful Dhaka, told Al Jazeera that the bulk of measles patients presently being admitted were unvaccinated. Some of the children present being treated had missed the vaccination run due to the fact that they had been sick astatine the time.

Hospital admissions person nevertheless declined from their peak, Paul said, suggesting the vaccination programme has had a important effect. Still, children proceed to arrive.

A idiosyncratic takes attraction of his grandchild portion getting attraction for measles successful a infirmary successful Dhaka, September 8, 2026 [Mahmud Hossain Opu/AP Photo]

Babies dying earlier regular vaccination

The IDH’s mortality reappraisal provides different hint to wherefore the outbreak has been truthful deadly.

As of August 23, the infirmary had recorded 3,167 suspected measles cases, 537 laboratory-confirmed cases, and 57 confirmed oregon suspected measles deaths this year.

The deaths were overwhelmingly concentrated among precise young children. Of the 57 who died, 49 – astir 86 percent – were younger than 15 months, portion 31 were younger than 9 months, the property astatine which children successful Bangladesh routinely person their archetypal measles-rubella dose.

Forty-seven of the 57 radical who died – 83 percent – had received nary measles vaccine, according to the hospital’s analysis. Pneumonia was recorded successful 50 of the documented deaths – making it the starring liable complication.

Paul said doctors were peculiarly acrophobic astir infections among infants who had not yet reached the property for regular vaccination.

The IDH is studying children infected earlier 9 months of property and their mothers to amended recognize the factors down those infections. The infirmary information should not beryllium work arsenic nationally representative, Paul said, adding that the IDH is simply a specializer referral infirmary that receives superior patients from Dhaka and different parts of Bangladesh.

But the numbers supply a model into the children astatine top hazard erstwhile measles spreads widely.

Health officials, meanwhile, accidental reported lawsuit numbers whitethorn not afloat bespeak the underlying trend.

Halimur Rashid, manager of illness power astatine the Directorate General of Health Services (DGHS) — the authorities bureau liable for overseeing nationalist wellness programmes — said authorities were preparing a further circular of vaccinations, expected to statesman wrong the adjacent 2 weeks.

A healthcare idiosyncratic prepares a measles vaccine portion a begetter holds his young girl astatine a vaccination centre successful Dhaka, April 12, 2026 [Mahmud Hossain Opu/AP Photo]

Can different vaccination thrust halt it?

The adjacent situation volition beryllium reaching children missed by erstwhile rounds. Experts accidental occurrence volition beryllium little connected different ample nationalist sum fig than connected micro-planning – identifying susceptible children assemblage by assemblage and ensuring vaccinators scope them.

Hussain said authorities should see extending vaccination to older children wherever surveillance identifies important immunity gaps.

The epidemiologist who requested anonymity said vaccination whitethorn request to scope children up to 15 years aged successful affected areas.

But for excessively galore families successful Bangladesh, it is already excessively late.

Among those who fell done those gaps was Mostakim, a nine-month-old from east-central Kishoreganj district. He had not been vaccinated against measles.

On August 30, helium died astatine the IDH.