The government is set to launch the nationwide Vitamin A Plus Campaign today, targeting 24 million children aged between six months and under five years with Vitamin A capsules.
However, this target population is 5.8 million higher than that of the nationwide Measles-Rubella (MR) vaccination campaign conducted just two months ago, which aimed to vaccinate 18.2 million children in the same age group.
The significant gap has raised concerns among public health experts over the accuracy of the government's child population estimates.
The MR vaccination campaign, carried out in phases during April and May this year, initially targeted 18.2 million children. The Directorate General of Health Services (DGHS) later reported that it had achieved 103% of its target.
Experts, however, say such a sharp increase in the estimated number of eligible children within a short period points to weaknesses in data collection and programme planning. They argue that the discrepancy raises questions about the reliability of population estimates, as well as the effectiveness of national public health interventions and their evaluation.
They also note that despite claims of exceeding the vaccination target, around 1,000 new measles cases are still being detected daily, indicating a mismatch between reported coverage and the epidemiological situation.
Speaking at a press briefing at the Secretariat on June 25, State Minister for Health and Family Welfare Dr M A Muhit said Vitamin A capsules would be distributed from 8am to 4pm at around 120,000 centres nationwide. In addition, nearly 500 mobile centres will operate at bus terminals, railway stations and river ports.
He said a four-day special follow-up campaign would be conducted in 58 remote upazilas to identify and reach children who miss the main programme. A second round of the campaign is also scheduled for December.
The Vitamin A Plus Campaign, generally held twice a year, was last conducted in March 2025. It remained suspended for an extended period due to funding shortages and procurement-related complications.
According to experts, prolonged interruptions in such programmes can increase the risk of child malnutrition, weaken immunity and exacerbate the impact of infectious diseases such as measles.
<Wide gap in coverage targets>
Following an unusual surge in measles cases, the government first launched emergency MR vaccination drives in 30 high-risk upazilas, followed by four city corporations, before eventually expanding the campaign nationwide.
The campaign targeted 18.2 million children aged between six months and under five years. According to official data, 18.3 million children had been vaccinated by May 20, representing 102% of the target.
Despite this, authorities acknowledged that some children remained outside the vaccination net. In contrast, the upcoming Vitamin A Plus Campaign has set a target of 24 million children in the same age group.
Mohammad Yunus Ali, director of the Institute of Public Health Nutrition (IPHN), which is implementing the campaign, said the revised target was based on updated data collected from civil surgeons' offices and city corporations.
Asked why the number of children targeted under the Vitamin A programme is significantly higher than that of the MR campaign, he said: "I do not know how the Expanded Programme on Immunization (EPI) collected its data. We prepared our child listings using our own methodology."
Public health expert Dr Mushtaq Hossain said the MR vaccination campaign was launched under emergency circumstances, leaving insufficient time for proper micro-planning.
"The Vitamin A campaign target may not be perfectly accurate either, but it appears more realistic than the previous estimate. My assumption is that the new figures were developed using information and experience gained during the MR campaign," he said.
According to him, national campaigns typically require at least three months of field-level micro-planning. However, the urgent need to contain the measles outbreak made that process difficult.
He suggested that rather than focusing solely on claims of achieving targets, authorities should use the Vitamin A campaign to identify children who missed the measles vaccination and bring them under immunization coverage.
"Authorities should acknowledge the shortcomings in field-level planning and take corrective measures," he added.
Dr Mushtaq further noted that the continued detection of more than 1,000 suspected measles cases a day indicates that the vaccination drive has yet to achieve its intended results.
Public health expert Prof Benazir Ahmed said at least 95% vaccination coverage is required to effectively control measles transmission within a community.
Commenting on the government's claim of exceeding 100% coverage, he said: "If coverage had genuinely surpassed 100%, measles transmission should have declined substantially by now. The current situation suggests there are still gaps in coverage."
Public health and immunization specialist Dr Tajul Islam A Bari said the target population for the MR campaign had likely been underestimated and that the child population estimate used for the Vitamin A Plus Campaign is closer to reality.
Based on the revised estimate, he said the actual MR vaccination coverage would be around 76.66%.
"Achieving herd immunity against measles requires at least 95% coverage. Bangladesh remains nearly 18 percentage points short of that threshold, which is why transmission continues. Identifying and vaccinating children who remain outside the programme should now be the priority," he added.
Health Services Division Secretary Md Kamruzzaman Chowdhury said one possible reason for the discrepancy is that measles vaccination activities had already been conducted in some areas with support from the World Health Organization (WHO).
He said major errors in vaccination coverage estimates are unlikely because international agencies, including WHO, assist in determining target populations. However, he added that the issue would be reviewed and reassessed.