Bangladesh’s measles epidemic has killed more than 1,000 people since March despite an emergency vaccination campaign that has delivered nearly 20 million doses, exposing gaps in both the country’s immunisation estimates and coverage.
Health authorities had recorded 1,009 deaths by September 9, including 100 among laboratory-confirmed measles patients and 909 classified as suspected measles deaths. Official figures show that 19.75 million children have been vaccinated since the campaign began in April, exceeding the original target of 18 million.
Public health experts say the apparently successful total masks a more complex problem: the initial estimate of eligible children was likely too low, while national coverage figures can conceal communities where many children remain unprotected.
The consequences have been seen at Dhaka’s Infectious Diseases Hospital, where one-year-old Saif Hasan died within minutes of being admitted to intensive care on August 27.
Saif, from Shariatpur district, developed a fever and rashes days after receiving his first measles-rubella vaccine. His family questioned whether the injection had made him ill, but doctors said he was likely already infected before the vaccine could take effect.
Shrebash Paul, a junior consultant at the hospital, said the infection had aggravated a pre-existing respiratory illness. Saif died despite having been treated for that condition.
Bangladesh’s measles epidemic exposes immunity gaps
Bangladesh had been moving towards eliminating measles, but routine immunisation coverage declined over several years. The first-dose measles-rubella rate fell from 88.6 per cent in 2019 to 86 per cent in 2023, while second-dose coverage dropped from 89 per cent to 80.7 per cent.
Immunisation services were disrupted during the Covid-19 pandemic, while misinformation and vaccine hesitancy were also identified as factors behind missed vaccinations. The country had not held a nationwide supplementary measles-rubella campaign since one conducted between December 2020 and January 2021.
Coverage remained below the roughly 95 per cent level considered necessary to interrupt transmission, allowing the number of susceptible children to build up over successive years. Political upheaval after the July 2024 uprising further disrupted the immunisation programme.
Mushtuq Hussain, a former principal scientific officer at Bangladesh’s Institute of Epidemiology, Disease Control and Research, said the change in government delayed vaccine procurement and contributed to shortages in 2024 and 2025.
Cases began rising sharply in January 2026 and surged through March. Bangladesh notified the World Health Organisation of a nationwide outbreak on April 4, with cases reported in 58 of the country’s 64 districts by the middle of that month.
Emergency vaccination began in high-risk areas on April 5, followed by a nationwide campaign later in April for children aged six months to under five years. But the campaign’s target of about 18 million children was considerably lower than the approximately 24 million children in the same age group targeted for Vitamin A supplements on June 28.
Hussain questioned whether the population estimates used to set the vaccination target had understated the number of eligible children. He also warned that national averages could hide localised shortfalls.
“You have to maintain equity,” he said, arguing that at least 95 per cent coverage was needed across communities, including among hard-to-reach and mobile populations.
Infants among those most at risk
Measles is highly contagious, meaning relatively small pockets of unvaccinated people can allow transmission to continue. A second epidemiologist with extensive experience in Bangladesh’s immunisation programme said authorities needed to analyse cases by age, vaccination history and location to identify susceptible groups.
Doctors at the Infectious Diseases Hospital said most of the measles patients currently being admitted had not been vaccinated. Some children had missed the emergency campaign because they were ill when vaccinators visited.
Admissions have fallen from their peak, suggesting the vaccination programme has had a substantial effect, Dr Paul said. However, children continue to arrive at the hospital.
Hospital records also show the particular danger faced by babies too young for routine vaccination. By August 23, the hospital had recorded 3,167 suspected measles cases, 537 laboratory-confirmed cases and 57 confirmed or suspected measles deaths.
Forty-nine of those who died were under 15 months old, while 31 were younger than nine months, the age at which children in Bangladesh routinely receive their first measles-rubella dose. Forty-seven had received no measles vaccine, and pneumonia was recorded in 50 of the deaths.
Halimur Rashid, director of disease control at the Directorate General of Health Services, said officials were preparing another round of vaccinations expected to begin within two weeks.
Experts say the next campaign will depend on identifying unprotected children community by community rather than relying solely on another national coverage figure. They said vaccination might need to be extended to older children in areas where surveillance finds significant immunity gaps, with one epidemiologist suggesting it could be necessary to reach children up to 15 years old.
Among those missed by previous efforts was Mostakim, a nine-month-old from Kishoreganj district who had not been vaccinated against measles. He died at the Infectious Diseases Hospital on August 30.
