When more than 570 children die, transparency cannot wait

More than 570 children have reportedly died from measles-related illness in Bangladesh. Behind every number is a child whose life ended too soon, a mother whose arms are now empty, a father carrying a grief that words cannot adequately describe, and a family whose future has been altered forever. For these families, this is not a debate about policies, programmes, budgets, institutions, or politics. It is a deeply personal tragedy.

The scale of this reported loss demands not only sympathy and condolences but also transparency, accountability, and a commitment to learning from what happened. Yet despite the magnitude of the crisis, there has been no widely publicized independent fact-finding inquiry to determine why the outbreak reached such proportions, whether preventable weaknesses existed, and what measures are necessary to prevent similar tragedies in the future.

The purpose of such an inquiry should not be to assign political blame, identify scapegoats, or settle partisan scores. Public health demands a higher standard. The objective must be to establish facts, identify weaknesses, understand failures if any occurred, and recommend corrective actions. Every major public health crisis deserves an evidence-based and transparent review, particularly when children have lost their lives.

Bangladesh has long been recognized internationally for the remarkable achievements of its Expanded Programme on Immunization (EPI). Through the dedication of health workers, programme managers, development partners, and policymakers, the country dramatically reduced the burden of vaccine-preventable diseases and achieved immunization coverage levels that earned global recognition. These achievements are a source of national pride and have saved countless lives over the past decades.

It is equally important to acknowledge that the government, health authorities, development partners, and frontline health workers have undertaken substantial efforts to prevent and control measles through routine immunization services, supplementary vaccination campaigns, surveillance activities, outbreak response measures, and public awareness programmes. Thousands of physicians, nurses, vaccinators, health assistants, family welfare assistants, programme managers, and development partners have worked tirelessly, often under difficult circumstances, to protect children from vaccine-preventable diseases. Their dedication deserves the nation's gratitude and respect.

Yet even the most successful public health programmes can encounter unexpected challenges. A call for an independent fact-finding inquiry should therefore not be interpreted as criticism of the government or frontline health workers. Rather, it is a responsible public health response aimed at understanding what happened, identifying systemic weaknesses, and strengthening the country's immunization programme for the future.

Strong institutions do not fear scrutiny; they welcome it.

Transparency strengthens public confidence, reinforces accountability, and ultimately makes programmes more effective. Silence and uncertainty, by contrast, create confusion, speculation, and mistrust.

Important questions have already emerged regarding immunization coverage, surveillance systems, vaccine procurement, financing mechanisms, cold-chain management, logistics, field-level supervision, outbreak response, clinical management, and programme implementation.

Concerns have also been raised regarding the transition from the long-standing Health, Nutrition and Population Sector Programme (HNPSP) to a Development Project Proposal (DPP)-based financing and management arrangement.

Some experts have questioned whether adequate safeguards were in place to ensure uninterrupted delivery of immunization services and outreach activities during this transition. These concerns deserve objective investigation rather than political debate.

If there were disruptions in financing, vaccine supply chains, transportation, supervision, community outreach, disease surveillance, or service delivery, the nation deserves to know. If there were no such disruptions, an independent inquiry would help establish that fact and reassure the public. Either way, transparency serves the public interest.

The tragedy also raises broader questions about health-sector governance and reform. The Health Sector Reform Commission submitted a comprehensive set of recommendations aimed at strengthening primary healthcare, improving accountability, modernizing public health administration, enhancing emergency preparedness, and building a more resilient health system. Many health professionals and policy observers believe these recommendations deserve urgent attention and implementation.

Unfortunately, progress in translating many of these recommendations into concrete action appears limited. Public health emergencies should encourage greater urgency in pursuing reforms that strengthen service delivery, disease surveillance, governance, financing, and accountability. Delayed reforms often carry costs that are ultimately borne by ordinary citizens, particularly the most vulnerable members of society.

In light of the growing public concern and the reported death toll exceeding 570 children, the government should establish a High-Powered Independent Fact-Finding and Response Committee. To ensure credibility, public confidence, and professional independence, the Committee should be chaired by a respected and independent public health expert and include representatives from the Ministry of Health and Family Welfare, the Directorate General of Health Services, the Directorate General of Drug Administration, ICDDR,B, WHO, UNICEF, epidemiologists, paediatricians, public health experts, health economists, development partners, civil society, and other relevant stakeholders.

The committee should establish three specialised subcommittees.

First, a Fact-Finding and Root Cause Analysis Subcommittee to investigate the outbreak, review immunization coverage, surveillance systems, financing mechanisms, vaccine supply chains, programme implementation, and the circumstances surrounding reported deaths.

Second, a Current Response and Recovery Subcommittee to recommend immediate actions for reducing mortality, strengthening outbreak containment, identifying high-risk districts, ensuring uninterrupted vaccine delivery, and improving community engagement.

Third, a Clinical Management and National Guidelines Subcommittee to develop or update national measles management guidelines, standardized treatment protocols, strengthen referral systems, and enhance training for physicians and frontline health workers.

The findings of the Committee should be made public and followed by a time-bound national action plan with clear accountability mechanisms.

Transparency is not a threat to the government; it is one of the strongest tools available to strengthen public confidence, improve programme performance, and protect future generations.

Equally important is the need for constructive dialogue among all stakeholders. Health challenges cannot be solved through political polarization, institutional distance, or mutual distrust. Whether one belongs to the government, opposition, civil society, academia, professional associations, or development organizations, the responsibility to protect children remains the same. Diseases do not distinguish between political affiliations.

This is why decisive national leadership is now required.

The magnitude of this tragedy demands intervention at the highest political level. The Honourable Prime Minister and Mr. Tarique Rahman should support the establishment of an independent national fact-finding committee and ensure that its recommendations are implemented without delay.

Protecting the lives of children must rise above political divisions and partisan considerations.

At a time when more than 570 children have reportedly lost their lives from a vaccine-preventable disease, the nation expects cooperation rather than confrontation, dialogue rather than denial, and solutions rather than blame. A united commitment from political leadership would send a powerful message that every child's life matters and that Bangladesh is prepared to learn from this tragedy and emerge stronger.

The children who died cannot be brought back. Nothing can erase the grief endured by their families. But their deaths must not become merely another statistic in an annual report.

Their memory should compel us to ask difficult questions, confront uncomfortable realities, strengthen institutions, and improve the systems entrusted with protecting the nation's children.

As a nation, we owe these families more than condolences. We owe them answers. We owe them transparency. We owe them accountability. Most importantly, we owe them the assurance that every possible lesson will be learned and every reasonable step will be taken to prevent such a tragedy from recurring.

An independent fact-finding committee would be an important first step—not for blame, but for truth; not for politics, but for prevention; and not for the past alone, but for the future of Bangladesh's children.

Prof Dr Syed Md Akram Hussain FCPS, MPH, PhD; Founding Chairman Clinical Oncology Department BMU; Former Member, Health Sector Reform Commission, Bangladesh; Former Publicity Secretary, Bangladesh Medical Association