But that same year, protests erupted, ending Prime Minister Sheikh Hasina’s 15-year rule. In the political turmoil that followed, health workers went on strike, vaccine orders were delayed, and follow-up vaccinations that usually accompany routine programs were halted.
In a report released in July this year, WHO and UNICEF estimated that first dose coverage in 2025 had fallen to 90%, while second dose coverage was 86%, several percentage points below the 95% needed for herd immunity.
The report also raises questions about the quality of official data on vaccinations against measles and other diseases for the years 2023 to 2025.
He said preliminary figures sometimes showed the number of people vaccinated exceeded 100% of those targeted, indicating errors in counting doses or the target number.
The emergency program missed millions
Yet when the measles outbreak broke out, Bangladesh reacted quickly and initially appeared to be winning the battle.
An emergency program was followed by an initial slowdown in new cases after nearly 20 million children were vaccinated in April and May. The government said it had covered all children in the target age group of 6 months to 5 years.
But in reality, the program fell short. This emerged when another routine health intervention in June aimed to reach 4 million more children than the measles campaign, although it covered the same age group.
“There is a gap,” Prime Minister Hyder’s adviser told Reuters on September 14, as measles cases rose again, blaming parental hesitancy to vaccinate or children’s illnesses for keeping children away.
Other challenges also emerged.
Documents detailing April and August meetings between the government, WHO and other health partners, reviewed by Reuters and not previously reported, show how efforts to act quickly may have led to shortcomings.
Minutes from the April 19 meeting describe how the government opted for just one round of readiness checks before launching its emergency vaccination program due to time constraints, instead of the usual four rounds. The checks cover everything from the availability of refrigerators to keep vaccines cold to determining how many children to vaccinate.
The one set of checks suggested that most districts — but not all — were ready, according to the minutes.
The poorest “pay the price”
“When readiness checks are not done properly, it is often the poorest and hardest-to-reach children who cannot be vaccinated and who pay the price,” said Professor Mahmudur Rahman, epidemiologist and chair of Bangladesh’s National Measles and Rubella Elimination Verification Committee.
Hyder said the April campaign was launched in four weeks. Still, Tajul Islam Abdul Bari, who led vaccination in Bangladesh until 2017, said campaigns typically require months of planning.
At the August meeting, gaps in the rollout were identified. The minutes noted that the proportion of children with confirmed measles cases who had not been vaccinated was “virtually unchanged between pre-campaign (82%) and post-campaign (85%)…highlighting persistent gaps in coverage.”
The WHO did not respond to questions about the April and August meetings. But WHO deputy representative in Bangladesh, Dr Rajesh Narwal, said the agency was committed to supporting the government in its goal of vaccinating all children at risk.
“Routine vaccination must become more effective and more resilient so that these gaps do not occur again,” he said.
In Sylhet, where official records show 180 child deaths, eight of 16 families interviewed by Reuters in September said they had not seen health workers offering vaccines. At least six families said health workers came to them only after a child died of measles in their community.
In late September, the government launched a new campaign aimed at targeting 3.4 million previously neglected children.
“We will involve residents of all villages so that no child is left behind,” the health minister said at a press conference.
Yet reaching every child remains a challenge. UNICEF and the Bangladesh Bureau of Statistics say up to 40% of children are unregistered, while government data shows about a third of health worker positions go unfilled.
Health experts are also pushing the government to extend the vaccination program to children over 5 years old. This age group represents a third of measles cases, according to the WHO.
In addition, scientists in Bangladesh are studying why immunity wanes faster than expected in babies younger than about 6 months. They are usually still protected by maternal antibodies, experts say.
Ensuring prompt medical care is vital, WHO says, posing another challenge for Bangladesh, which is also battling a dengue outbreak.
In September, all wards at Sylhet’s 100-bed Shahid Shamsuddin Ahmed Hospital, which treats measles, appeared overwhelmed. On the day of Reuters’ visit, 178 patients were admitted.
Gn Health
