Measles outbreak: The writing was on the wall 

Nearly 66% of children infected with measles had not received even a single dose of the vaccine, according to a report by the Expanded Programme on Immunization (EPI), as measles deaths this year reached a record-high in almost a decade.

The report found that over 47% of children classified as suspected measles cases had also received no vaccination.

Between 15 March and 16 April, 206 deaths linked to suspected and confirmed measles cases were reported across the country. Of those, 34 children died from confirmed measles infections and 172 from suspected measles.

So far this year, data from the Directorate General of Health Services show 3,065 laboratory-confirmed measles cases between 15 March and 16 April, alongside 20,352 suspected cases and 10,496 recoveries nationwide.

The previous highest number of measles deaths was recorded in 2017, when 10 people died.

The warning signs for this year's massive outbreak had been building for years, as routine immunisation faltered due to pandemic disruptions, suspension of operational plans, delays in vaccine procurement, and repeated work stoppages by field-level health workers.

With no large-scale measles campaign conducted since 2020 and approval delays for external support, a growing number of children were left unvaccinated, steadily eroding herd immunity and setting the stage for an outbreak.

Public health experts said the failure to ensure that children received both doses of the measles vaccine, preventing the development of herd immunity.

Dr Be-Nazir Ahmed, a former director (Disease Control) at DGHS, said inadequate vaccination coverage was the principal reason behind the growing outbreak.

"Measles spreads easily because herd immunity against the disease has not been established," he told TBS.

According to EPI data, 85% of confirmed measles cases involved children under the age of five. Among those children, 65.7% had received no vaccine, while 21% had been only partially vaccinated.

An analysis of confirmed and suspected measles cases showed that 21% of confirmed patients and 25.5% of suspected patients had received one dose of measles vaccine. Two doses had been administered to 13.3% of confirmed cases and 27.2% of suspected cases.

According to Be-Nazir Ahmed, at least 95% vaccination coverage is required to build herd immunity against measles. Although isolated infections continued to occur every year, no major outbreak had been seen since the launch of the national immunisation programme in 1989, when higher coverage gradually improved protection.

He said routine immunisation had been disrupted during the Covid-19 pandemic, leaving a large number of children outside the vaccination system.

The EPI attributed the decline in vaccination coverage to the suspension of operational plans during the interim government period, which created structural problems in the immunisation programme.

According to EPI officials, delays in approving alternative plans, weak decisions on vaccine procurement and distribution, and severe shortages of vaccines disrupted routine immunisation.

They also said that three rounds of work stoppages by field-level health workers in 2025 left many children without vaccination.

The EPI further noted that no large-scale campaign had been conducted since 2020, increasing the risk of a measles outbreak. Although Bangladesh applied to Gavi, the Vaccine Alliance in 2023 for support for a measles-rubella campaign, approval was not granted until 2025, delaying preparations and implementation.

Dr Be-Nazir described the decision to suspend the operational plan as "rash," warning that ending public health programmes without an alternative created long-term risks.

He also cautioned that the weakening of the immunisation programme was affecting not only measles control, but also efforts to contain other diseases, including diphtheria, whooping cough, rabies, kala-azar, and malaria.

Speaking at a workshop on the measles vaccination programme held yesterday at the National Institute of Mass Communication in Dhaka with support from Unicef, Dr Riad Mahmud, health manager (immunisation) of Unicef, said the effectiveness of the measles vaccine was around 85% after one dose and rose to about 95% after two doses.

According to the latest 2023 Coverage Evaluation Survey, first-dose coverage of the measles-rubella vaccine stands at 86.1%, while second-dose coverage is 80.7%, leaving a significant number of children unprotected.

Dr Riad said that unvaccinated children accumulate over four to five years, increasing the likelihood of an outbreak. To reduce the number of unprotected children and strengthen herd immunity, he said a measles-rubella campaign should be conducted every four years.

To address the current outbreak, the government launched a measles-rubella vaccination campaign on 5 April in 30 upazilas and 13 municipalities, targeting about 12 lakh children.

The campaign was extended on 12 April to four city corporations – Dhaka South City Corporation, Dhaka North City Corporation, Mymensingh City Corporation and Barishal City Corporation – with a target of vaccinating 9,76,838 children.

Dr Riad said vaccine supplies are now available in all city corporation areas.

A nationwide measles-rubella vaccination campaign is scheduled to begin on 20 April (Monday) and aims to vaccinate 1,78,40,536 children aged between six months and 59 months.

In the initial phase, the campaign targets 21,80,105 children in 30 upazilas, 13 municipalities across 18 districts and four city corporations.

As of 15 April, 11,31,128 children aged between six months and five years had been vaccinated, representing 52% of the target.

Dr Riad said that, for the first time, children under nine months of age would be included in the campaign. Children aged between six months and under five years are eligible, although those who are currently ill should be vaccinated after recovery.