400+ dead from measles in Bangladesh: How did we get here?

Back in the early 2000s and 2010s, posters for the Measles-Rubella Vaccination Campaign were displayed around almost every educational institution and government office. Schools were required to send children to vaccination campaigns, and the country's immunisation coverage was among the strongest in the region. Its control of vaccine-preventable diseases (VPDs) was held up as a model for other countries. It begs the question, then: how did a country with such a legacy find itself facing a measles epidemic of this magnitude?

Bangladesh's first measles campaign was introduced in 2004–05, followed by another in 2010. Following the massive success of its immunisation programme — with only 36 measles cases reported in 2018 — the country set a target to eliminate measles and rubella completely by 2020. However, this target was not achieved due to multiple factors, and the declining focus on immunisation ultimately contributed to the outbreak in 2026.

Since mid-March, the total number of confirmed and suspected measles deaths has risen to more than 400 (as of mid-May). Approximately 79% to 81% of all reported cases involve children under five years old. According to Save the Children, about 75% to 83% of confirmed cases involved children who were either completely unvaccinated or had received only a single dose.

One of the most alarming aspects of this outbreak is that one-third of those infected are infants under nine months old, too young to be eligible for the measles vaccine. These children's risk of exposure depends entirely on the immunity of those around them. When older children remain unvaccinated, the disease spreads through them and reaches these highly vulnerable infants. This is precisely why routine vaccination programmes cannot afford disruption, as even small gaps in coverage accumulate over time, leaving entire age groups exposed.

Several factors contributed to the disruption of routine vaccination campaigns. "Resurgences like the current one are typically the result of these accumulated gaps rather than a single factor," UNICEF noted in a statement. The key drivers behind this resurgence include delays caused by the COVID-19 pandemic, political unrest, administrative mismanagement, and funding shortages.

The Covid-19 disruption

Every four years, Bangladesh conducts special measles vaccination campaigns, known as Supplementary Immunisation Activities (SIAs), delivering vaccines to all targeted individuals regardless of their prior vaccination history. These campaigns operate on a larger scale than routine programmes, maximising vaccination coverage across the population.

The campaign scheduled for 2020 was postponed due to the Covid-19 pandemic, which similarly disrupted other mass immunisation efforts across the country, heavily affecting the procurement and distribution of measles vaccines. Between March and May 2020 alone, 3.2 million children in Bangladesh missed their scheduled vaccinations compared to 2019. This disruption created a growing backlog of unvaccinated children, quietly building towards a crisis.

Political unrest and administrative mismanagement

After Sheikh Hasina's ousting and the formation of the Interim Government in August 2024, a special measles vaccination campaign was scheduled for April 2025, but it did not take place due to political instability. Despite experts' warnings about declining stocks of measles and rubella vaccines, the Interim Government failed to take appropriate action.

In September 2025, the Interim Government decided to overhaul its vaccine procurement system, moving away from UNICEF to an open tender system that invited suppliers to bid for contracts. UNICEF strongly opposed the decision, warning that it would disrupt the immunisation system and risk triggering an outbreak. UNICEF Bangladesh Representative Rana Flowers reportedly recalled telling interim Health Minister Nurjahan Begum:

"For God's sake… don't do this."

Unfortunately, UNICEF's warning proved accurate, as bureaucratic delays in the open tender process ultimately led to vaccine supplies drying up, triggering a nationwide outbreak within just six months of the decision.

The government's lack of a proper tracking system for immunisation data from the private health sector also created significant blind spots in monitoring vaccination coverage nationwide.

Logistics and funding crisis

The timing could not have been worse. The supply crisis came immediately after the withdrawal of USAID funding. USAID had served as a critical strategic and financial partner to the Expanded Programme on Immunisation (EPI), providing technical assistance, cold-chain infrastructure, and vaccine management, while also acting as a major donor alongside WHO, UNICEF, and Gavi for procurement and supply chain management in Bangladesh.

USAID's withdrawal also led to mass layoffs across organisations working in the public health sector. According to one report, more than 45% of senior positions in the health sector were vacant in over half of the districts in 2025. The resulting shortage of workforce and administrative capacity further escalated the outbreak into a full-blown epidemic.

In April 2026, the government, alongside UNICEF, WHO, and Gavi, launched an emergency measles-rubella vaccination campaign aimed at protecting more than 1.2 million children nationwide. But this was a response rather than prevention — and a preventable crisis at that. The campaign came only after hundreds of children had already lost their lives.

The warning signs were obvious and apparent to anyone paying attention. Experts and organisations such as UNICEF had repeatedly alerted the authorities well in advance. Yet these warnings fell on deaf ears, as no concrete measures were taken by the authorities at the time. Had these failures been addressed earlier, they could have broken the chain of events that led to this deadly outbreak.

The current crisis should serve as a lesson to the government on the importance of properly regulating and maintaining immunisation programmes. Authorities must invest in building a more resilient framework for vaccination campaigns and crisis management — one that ensures these programmes continue uninterrupted, regardless of the political climate.

 Shuprio Shahi Teerno is an undergraduate student of Jahangirnagar University.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.