For a nation that modelled vaccination to the world, letting measles kill children is a disgrace 

There is something deeply painful and paradoxical about the ongoing measles epidemic across Bangladesh in recent months.

Children, some barely six months old, are dying of measles in hospital wards in Dhaka, Rajshahi, Chattogram and beyond.

As of the end of April 2026, more than 19,000 suspected measles cases had been reported across 58 of Bangladesh's 64 districts. At least 166 children had died, and the toll continued to climb.

In Dhaka, infections have been concentrated in densely populated informal settlements such as Demra, Jatrabari, Kamrangirchar, Mirpur and Tejgaon, where poverty and overcrowding already place children at greater risk.

Most deaths have occurred among unvaccinated children under the age of two. The World Health Organization (WHO) has classified the national risk level as "high."

Yet this is the same country once described globally as a miracle of immunisation — a nation that transformed child survival through political commitment, community mobilisation and public health innovation.

To understand the full weight of this tragedy, it is important to understand what Bangladesh had achieved.

When the Expanded Programme on Immunization (EPI) was launched in the late 1970s, fewer than 2% of Bangladeshi children aged between 12 and 23 months had received basic vaccinations.

Diseases such as measles, diphtheria, polio and whooping cough claimed children's lives with alarming regularity. One estimate suggested that 2.5 million children were dying each year from vaccine-preventable diseases before the EPI began.

What followed was decades of sustained effort.

Outreach centres were established in every union, cold-chain infrastructure was built across the country and tens of thousands of frontline health workers travelled through remote rural areas to reach children.

By 1993, immunisation coverage had climbed to 74%. By the 2010s, it exceeded 80% for most vaccines.

At its peak, measles-rubella vaccine coverage reached 118% for the first dose, reflecting not only political commitment but also public trust in the health system.

International recognition followed.

Bangladesh received the GAVI Best Performance Award in 2009 and 2012. The country was declared polio-free in 2014, while rubella was brought under control by 2018.

Over the decades, the EPI vaccinated more than 50 million children, prevented an estimated 94,000 child deaths annually and contributed to an over 80% reduction in under-five mortality — an achievement matched by only a handful of countries worldwide.

Experts described it as a "miracle," while foreign governments and UN agencies highlighted Bangladesh as a global model.

By almost any measure, Bangladesh's EPI became one of the most successful public health programmes of the late twentieth and early twenty-first centuries.

That is why the current outbreak is not merely a health crisis. It is also a collapse of a hard-earned legacy.

The vaccine supply chain must be professionalised and insulated from political disruption. No change in government, budgetary delay or procurement failure should ever again leave vaccine storage facilities empty during a critical immunisation period. Supplementary measles-rubella campaigns must return as a regular and non-negotiable part of the national immunisation calendar. Surveillance systems must be strengthened so immunity gaps are identified and addressed long before they erupt into outbreaks.

The causes behind the outbreak are known.

A nationwide stockout of measles-rubella vaccines between 2024 and 2025 left many children unprotected during a critical period.

Routine immunisation services had already weakened, while no nationwide supplementary measles-rubella campaign had been conducted since 2020. That five-year gap allowed vulnerability to accumulate silently across the population.

A nationwide vaccination drive was also disrupted by the political upheaval that toppled the government in 2024.

Political transitions are difficult. But allowing vaccine stocks to run dry and vaccination campaigns to lapse represents a failure of public health governance, regardless of who is in power.

Funds had reportedly been allocated for vaccine procurement, yet authorities failed to procure vaccines on time because of inefficiency or negligence.

Measles remains one of the most contagious viruses known to science.

It attacks the respiratory system, suppresses immunity and leaves children vulnerable to secondary infections for months.

The virus can cause encephalitis, blindness, pneumonia and death. Once infection occurs, there is no specific treatment.

Vaccination remains the only effective defence, and it must be widespread.

The WHO recommends at least 95% coverage with two doses to achieve herd immunity and prevent outbreaks.

Bangladesh once approached that threshold.

But by 2023, first-dose measles-rubella coverage had already fallen to 86%.

That decline, combined with vaccine shortages and the absence of supplementary campaigns, was enough to trigger an outbreak of this scale.

Bangladesh's EPI was built on a simple principle: no child should remain unprotected from a vaccine-preventable disease.

That principle requires not only a strong routine programme but also constant vigilance, because population immunity can erode quickly when even one part of the system fails.

The absence of supplementary campaigns for five years, combined with stockouts and declining coverage, created what epidemiologists describe as an "immunity gap."

For years, the gap remained invisible. It became terrifyingly visible the moment the measles virus spread.

The government has since launched emergency response measures.A nationwide measles-rubella vaccination campaign targeting children aged six to 59 months has begun. Rapid Response Teams have also been activated.

But emergency responses alone are not enough.

When a country with Bangladesh's immunisation history experiences an outbreak of this magnitude, accountability and structural reform become unavoidable.

Three urgent priorities must now follow.

First, the vaccine supply chain must be professionalised and insulated from political disruption. No change in government, budgetary delay or procurement failure should ever again leave vaccine storage facilities empty during a critical immunisation period.

Independent oversight of vaccine procurement and inventory management is not a luxury. It is essential.

Second, supplementary measles-rubella campaigns must return as a regular and non-negotiable part of the national immunisation calendar.

Third, surveillance systems must be strengthened so immunity gaps are identified and addressed long before they erupt into outbreaks.

Bangladesh spent decades earning recognition as a global immunisation success story.

That achievement was built not only by governments but also by millions of mothers who brought their children to vaccination centres, by health workers travelling door to door during monsoon rains and by communities that trusted the system with the lives of their children.

Allowing measles to return and kill hundreds of children is a betrayal of that trust.

Bangladesh now owes it to every child lost in recent months — and to every child who should never face such a preventable tragedy again — to ensure that this outbreak becomes a turning point rather than a recurring warning.

The EPI success story is not over yet.

But preserving it will require an honest reckoning with the failures that allowed this crisis to happen.

Nazmul Alam is a public health researcher and faculty member at Prairie View A&M University, Texas, USA (naalam@pvamu.edu).

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.