The ghost of measles: why a preventable disease is haunting Bangladesh

Decades of public health progress in Bangladesh are currently under siege as measles returns with a vengeance.

Recent official outbreak reports indicate rapidly expanding transmission across most of the country, with cases confirmed in over 50 districts and more than 19,000 suspected infections recorded within a single month. Besides, there were around 3,000 laboratory-confirmed cases, including over 500 reported deaths. The current outbreak is occurring largely among children under five in the majority of cases; however, infants too young to be vaccinated also make up a substantial proportion of infections, highlighting critical vulnerabilities in early-life protection. What is emerging is not a localised flare-up, but a nationwide public health emergency.

Measles is among the most infectious diseases known, with a single case able to infect as many as 18 others in a susceptible population, as the virus can remain airborne for up to two hours after an infected person leaves a space. It is a serious childhood disease that can lead to life-threatening complications, including death. There is currently no specific antiviral cure for measles. Vaccination before exposure remains the only reliable protection.

Bangladesh's Expanded Programme on Immunisation (EPI) has long been recognised as a global success, driving substantial declines in vaccine-preventable diseases. However, measles demands exceptionally high coverage — around 95% of the population — to maintain herd immunity and prevent sustained transmission. In several areas, coverage is now suspected to have slipped below this level, leaving hotspots where outbreaks can occur and spread quickly.

According to WHO outbreak assessments, recent declines in MR1 and MR2 coverage due to a nationwide stockout of the MR vaccine between 2024–25, combined with routine immunisation gaps and the absence of regular nationwide supplementary measles-rubella campaigns since 2020, have increased the number of susceptible children and contributed to the current outbreak.

Beyond coverage gaps, delays in detection and response are also shaping the outbreak. Early symptoms of measles often resemble other childhood infections, leading to delayed recognition. Many families first seek care from private or informal providers, which are not always fully integrated into surveillance systems. As a result, cases are often detected late, after transmission has already occurred within households and communities. Laboratory confirmation and reporting can also take time, particularly outside major urban centres, slowing outbreak response. This mismatch between rapid viral transmission and slower health system detection is allowing the outbreak to spread across divisions.

The persistence of measles also reflects gaps in awareness and delayed care-seeking. Measles typically begins with fever, cough, and a runny nose — symptoms easily mistaken for common illnesses — before the characteristic rash appears. By that stage, transmission may already have occurred. Infants under nine months, who are not yet eligible for routine vaccination, are increasingly affected when exposed within households or communities with immunity gaps. At the same time, misinformation continues to promote 'vaccine hesitancy', particularly during periods of crisis. Previous vaccine campaigns in Bangladesh and the region have shown how rumours can circulate quickly, affecting uptake even among otherwise willing families.

Urban environments are further amplifying transmission. High population density, informal settlements, and overcrowded housing in a city like Dhaka create ideal conditions for rapid spread, where a single infection can move quickly through households and communities. Mobility between rural and urban areas further complicates vaccination continuity, as children may miss scheduled doses when families move frequently for work or housing. Fragmentation across public, private, and non-governmental service providers also makes it difficult to maintain immunisation records, particularly for mobile populations. Importantly, measles is not affecting populations randomly. It is disproportionately impacting children who are already vulnerable — those who are undernourished, living in crowded conditions, or lacking consistent access to primary healthcare. In this sense, measles is not only an infectious disease but also a marker of inequality and system failure.

Controlling the outbreak will require urgent, coordinated, and sustained action. The Expanded Programme on Immunisation network, community clinics, and frontline health workers provide an extensive delivery platform. Catch-up immunisation campaigns must reach beyond fixed facilities into underserved and mobile populations. Surveillance systems must be strengthened to enable faster detection, real-time reporting, and rapid response, including stronger integration of private providers into national systems. Urban strategies must also become more adaptive, reflecting population density and mobility rather than relying solely on fixed-site delivery models. Equally important is rebuilding trust and improving community awareness so that early symptoms are recognised and care is sought without delay.

It is also important to acknowledge that disruptions to health services and vaccine supply chains in recent years have contributed to missed immunisations in some areas, widening existing coverage gaps and increasing vulnerability to outbreaks.

Measles is entirely preventable. The tools to eliminate it already exist. The current resurgence is not a failure of science or a shortage of vaccines — it is the result of gaps in protection that have been allowed to accumulate. Closing those gaps is now an urgent public health priority if Bangladesh is to protect the gains achieved over decades.

Dr Sabiha M Khan is a Research Fellow in the BRAC James P Grant School of Public Health, BRAC University. Dr Tanvir Ahmed is a Research Associate in the BRAC James P Grant School of Public Health, BRAC University. Dr Sadia Parvin is a Senior Research Assistant in the BRAC James P Grant School of Public Health, BRAC University.

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