Bangladesh’s Measles Crisis Exposes Gaps in Routine Vaccination

The outbreak demonstrates why vaccination programmes must remain consistent even when disease levels appear low. A period of reduced transmission does not mean the population is permanently protected. When enough susceptible children accumulate, a highly contagious disease can spread rapidly.

Emergency vaccination reaches millions, but gaps remain

Bangladesh launched an emergency measles-rubella vaccination campaign in April with support from WHO, UNICEF and Gavi, the Vaccine Alliance.

The initial effort focused on children aged six months to under five years, beginning in high-risk areas before expanding nationwide. According to the authorities, nearly 20 million children received vaccinations during the emergency campaign and subsequent efforts.

However, the scale of the outbreak showed that reaching large numbers of children was not the same as reaching every eligible child.

On September 26, Bangladesh began another nationwide catch-up campaign targeting approximately 3.4 million children who had either missed earlier vaccinations or had not received the required doses. The campaign was scheduled to continue through October 31, according to Bangladesh Sangbad Sangstha, the national news agency.

The renewed effort includes identifying children outside existing vaccination lists and checking vaccination status through household visits.

That approach matters because children can be missed for several reasons. Families may live in remote communities, lack information about vaccination schedules or face practical barriers to reaching health facilities. In other cases, incomplete registration and weak recordkeeping can make it difficult for health workers to identify who still needs protection.

The poorest and hardest-to-reach communities can face the greatest consequences when these gaps persist.

Why emergency campaigns cannot replace routine care

Mass vaccination campaigns can help contain an outbreak quickly, but they are not a substitute for a reliable routine immunisation system.

Routine services allow children to receive vaccines at the appropriate ages, help health workers identify missed doses and provide opportunities to detect emerging health risks. When these services weaken, the number of unprotected children can grow even if a country has previously achieved high vaccination coverage.

WHO recommends maintaining at least 95% coverage with both recommended doses of measles-containing vaccine to help prevent outbreaks. Coverage also needs to be sufficiently consistent across communities. A strong national average can conceal local areas where too many children remain unvaccinated.

Bangladesh’s experience highlights the importance of accurate vaccination records, dependable vaccine supplies, trained health workers and effective communication with parents.

It also shows why outbreak preparedness matters. WHO’s April assessment identified weaknesses in readiness checks and surveillance as concerns during the response. Better planning, reliable local data and adequate staffing can help health authorities identify vulnerable populations before transmission becomes widespread.

An independent review of Bangladesh’s immunisation programme and vaccine-preventable disease surveillance began in October, with WHO and other partners supporting the assessment. According to WHO, the review is examining programme management, financing, vaccine supply, service delivery, data quality and outbreak preparedness. Findings and recommendations are expected to inform further improvements.

A warning beyond Bangladesh

The crisis has implications beyond the country’s borders.

Measles outbreaks can spread when infected people travel between communities and countries, particularly where vaccination coverage is uneven. WHO has identified regional transmission risks linked to population movement across South Asia, where health authorities continue to face challenges in reaching vulnerable groups.

Bangladesh’s experience is relevant to countries that depend on vaccination programmes to protect children against preventable diseases. Even well-established systems can become vulnerable when vaccine supplies are interrupted, health services lose capacity or public confidence weakens.

The lesson is not that emergency campaigns are ineffective. Rather, emergency action works best when it is supported by strong routine services, dependable surveillance and the ability to identify children who have been overlooked.

For Bangladesh, the immediate priority is to contain transmission, reach children missed by earlier campaigns and ensure that families can access appropriate vaccination and medical care. Health authorities also need reliable data to measure progress and identify communities where protection remains inadequate.

The longer-term challenge is to prevent the next outbreak. That requires sustained investment in routine immunisation, stronger local health services and systems that can reach children regardless of where they live or how easily their families can access care.

Bangladesh has demonstrated that large-scale vaccination campaigns can reach millions of children. The current crisis shows why the next measure of success must be whether those still at risk are reached before another outbreak begins.

Source: WHO, UNICEF, Reuters, BSS