In its graduation from the United Nations’ least developed country (LDC) category to developing category, Bangladesh is approaching a major milestone in its development journey in 2026. Alongside this, the country is also moving through an accelerated transition in vaccine financing, where external support is gradually reduced and domestic responsibility rises. These shifts reflect progress but they also come with new vulnerabilities.
One of the most overlooked risks during this transition is antimicrobial resistance (AMR). While policy discussions around vaccine financing often focus narrowly on procurement costs, vaccines are not merely a child health investment. They are also among the most powerful upstream tools available to reduce antibiotic use, prevent drug-resistant infections, and slow the spread of resistance.
Bangladesh’s AMR burden is already substantial
In 2021, an estimated 96,878 deaths were associated with AMR, and 23,454 deaths were directly attributable to it, a scale that places AMR among the most serious health threats facing the country today.
At the same time, antibiotic misuse remains widespread. Evidence suggests that around half of antibiotics are purchased without a prescription, and Bangladesh’s antibiotic consumption is heavily skewed toward drugs in the WHO “Watch” and “Reserve” categories -- antibiotics that should ideally be used sparingly to preserve their effectiveness.
This is precisely why Bangladesh cannot afford to treat immunization as a discretionary line item during fiscal tightening.
Vaccines reduce infections and antibiotic demand
The relationship between vaccines and AMR is straightforward -- when vaccines prevent infections, they reduce the need for antibiotics. This prevents unnecessary prescriptions, reduces hospitalizations, and lowers the volume of antimicrobial exposure that drives resistance.
Bangladesh’s Expanded Program on Immunization (EPI) has long been one of the country’s strongest public health successes. It has contributed to the elimination of neonatal tetanus (2008), polio (2014), and major reductions in childhood mortality.
But today, vaccines must also be recognized as a pillar of AMR prevention, particularly in settings where antibiotic access is poorly regulated and diagnostics remain uneven.
The evidence is increasingly clear that several vaccine-preventable infections in Bangladesh overlap strongly with antibiotic consumption patterns.
Pneumococcal disease and childhood diarrhoea are two major examples. Estimates suggest that among every 100 children aged 24-59 months in Bangladesh, there are about 20 cases of invasive pneumococcal disease and 28 cases of acute otitis media treated with antibiotics, and direct effects of the pneumococcal conjugate vaccine (PCV) could prevent a significantly large share of these cases.
Similarly, rotavirus, which is still not included in Bangladesh’s routine immunization schedule, is estimated to cause over 13 antibiotic-treated diarrhoeal cases per 100 children under two, with vaccination potentially preventing roughly two-thirds of these.
These are not abstract benefits. Every infection prevented is a course of antibiotics avoided, and every avoided antibiotic course is a small but meaningful step in slowing resistance.
Typhoid vaccination is a test case
Bangladesh’s recent nationwide introduction of typhoid conjugate vaccine (TCV) is especially important in this context. The campaign launched in October 2025, targeting children and adolescents aged 9 months to under 15 years, with an ambition to reach at least 95% coverage.
Typhoid is not only a disease of poverty and poor sanitation, it is also one of the most antibiotic-dependent infections in South Asia.
Rising resistance makes treatment increasingly expensive and uncertain. This shows that vaccination against typhoid is not simply a preventive health measure, it is also a strategic AMR intervention.
Modelling suggests that sustained infant vaccination with TCV over a decade could avert millions of cases of resistant typhoid, alongside substantial mortality and DALY reductions.
But campaigns alone are not enough. The long-term AMR value of typhoid vaccination depends on sustained routine coverage, which in turn, depends on stable financing.
Transition risks
Bangladesh’s vaccine financing transition is not going to be a sudden collapse. It is a gradual shift in the mathematics of immunization, which can involve rising co-financing obligations, reduced eligibility for new health system strengthening grants, and a larger domestic vaccine bill to absorb over time.
While some mechanisms may reduce the risk of a price shock (such as continued access to negotiated pricing tiers) the fiscal pressure is still real.
The greatest risk is not that Bangladesh will stop buying vaccines altogether, but that ‘invisible’ parts of immunization could become vulnerable, including cold-chain maintenance, outreach services, health worker capacity, and the last-mile delivery systems needed to reach slums, remote districts, and underserved communities.
These are the areas where backsliding can quietly occur, and where AMR can rise quietly with it in a country already significantly burdened with it.
A policy window Bangladesh can seize
This moment should be treated as an opportunity. Bangladesh’s LDC graduation should not coincide with reduced immunization ambition. Instead, it should mark a shift toward a more strategic and health security-oriented approach to vaccines.
A recent policy brief by the Global Antibiotic Resistance Partnership (GARP) Bangladesh technical working group, led by experts from icddr,b, DGHS, IEDCR, WHO, Unicef, and others, outlines a set of practical directions that policymakers can take to strengthen vaccines as an AMR mitigation tool.
We are including here some of the most urgent steps.
First, Bangladesh should prioritize sustaining universal uptake of routine childhood vaccines, ensuring that co-financing pressures do not translate into coverage gaps.
Second, Bangladesh should accelerate inclusion and rollout of vaccines that reduce antibiotic-treated illness, such as rotavirus and influenza vaccines, alongside sustaining high-impact vaccines like PCV and TCV.
Third, regulatory and policy pathways should be strengthened to enable faster approval and uptake of new vaccines with AMR relevance, and immunization guidelines should be regularly updated to reflect evolving evidence.
Finally, Bangladesh should expand its evidence base by systematically collecting AMR-relevant data within vaccine studies, so that vaccines are not only justified through general global evidence, but through Bangladesh-specific impact.
As Bangladesh moves through this transition, the most important message is simple -- vaccines are not just about preventing disease. They are also about preventing a (very likely) future in which antibiotics stop working.
In a country already carrying tens of thousands of AMR-related deaths each year, immunization is not merely a health program to be sustained, it is a national AMR defense strategy to be protected.
Rishiraj Bhagawati is Senior Research Analyst, One Health Trust. Email: rbhagawati@onehealthtrust.org. Dr Wasif Ali Khan is Emeritus Scientist, Infectious Diseases Division, at icddr,b. Email: wakhan@icddrb.org.