Measles is a well-understood disease with an effective prevention method that has been known for decades. The vaccine remains safe, inexpensive, and easily accessible.
Currently, when children succumb to measles, it is seldom due to medical issues; instead, it highlights systemic failures.
The return of measles in Bangladesh should alarm not just health authorities but also policy-makers, political leaders, and development partners.
This is not merely a medical problem but also a governance challenge.
Bangladesh has been recognized for its achievements in immunization over the years. Since launching its Expanded Program on Immunization in 1979, the country has steadily increased vaccine coverage, including in remote areas.
By the mid-2010s, over 92% of children received the initial measles vaccine dose, with second-dose coverage surpassing 80%. Nationwide measles-rubella campaigns played a vital role in closing immunity gaps and saving countless lives.
The results were remarkable. Under-five mortality declined rapidly over three decades, demonstrating that political will, community involvement, and steady policies can prevail despite limited resources. Bangladesh proved what could be achieved.
Bangladesh’s well-known immunization success is largely due to its measles-rubella (MR) vaccination strategy. The government carried out nationwide MR campaigns (especially in 2014–2015) that vaccinated over 50 million children, significantly lowering measles cases and advancing rubella control.
This extensive effort was backed by strong community health networks and international partners, exemplifying Bangladesh’s ability to manage complex mass immunization efforts.
Consequently, the country’s high routine immunization coverage and successful MR campaigns contributed to its global recognition, including the 2019 Vaccine Hero Award.
The MR program highlighted how focused disease-control efforts could enhance Bangladesh’s overall vaccination success and international reputation.
That is why the current reversal is so concerning.
Measles is highly infectious and difficult to control. To prevent outbreaks, at least 95% of children need two doses of the vaccine. Bangladesh remained near this threshold for years, never fully reaching it but staying close enough to keep the disease under control.
Then, slowly, the ground began to shift.
Immunization systems do not collapse overnight. They weaken gradually. Outreach becomes irregular. Vaccination campaigns are delayed. Coverage slips by a few percentage points.
For a while, everything still looks stable -- until suddenly it isn’t.
The warning signs were there. Before 2020, routine services functioned well. During the Covid-19 pandemic, vaccination outreach stalled, supervision weakened, and thousands of children missed their scheduled doses, especially the second one.
In the following years, services resumed partially. Coverage stabilized at lower levels, and the system could not fully recover.
In 2024, a nationwide measles-rubella catch-up campaign could have closed them. It did not happen.
Reportedly, the interim government's inaction, the halt in funding to procure vaccines, administrative disruption, and political instability directly undermined preventive measures when they were most needed.
In a densely populated country like Bangladesh, delaying and disrupting prevention efforts is a recipe for disaster.
By 2025, the impacts became undeniable. Vaccination rates fell further, supply chains broke down, and health workers were overwhelmed.
Without a major effort to address the years of missed vaccines, measles outbreaks increased. Hospitals became overcrowded, and child mortality started to climb, even among infants too young for vaccination.
When infants die of measles, it sends a chilling warning: Herd immunity has fallen apart.
Recent newspaper editorials noted that measles vaccination in Bangladesh has been “hobbled by neglect.” That assessment aligns with the data -- and the lived reality.
It's tempting to blame this crisis on external shocks like the pandemic, political transitions, or financial constraints.
However, that overlooks the core issue.
Bangladesh has the necessary tools and expertise to operate a high-performing immunization program. The real problem was a lack of continuity.
Routine services overlooked children, with preventive campaigns experiencing delays or cancellations, and coordination becoming weaker during the era of the interim government.
Immunization was no longer seen as an untouchable core service. These problems are not due to scientific faults but governance issues.
Relying on emergency responses instead of strengthening routine systems will lead to repeated outbreaks. Increasing second-dose coverage above 90% will reduce outbreaks, and if Bangladesh maintains 95% coverage, measles transmission can be entirely eliminated.
The difference between the outcomes is political, not technical.
Every measles death is preventable. Every outbreak signals a failure earlier in the chain.
Bangladesh’s current situation is the product of delayed decisions and missed opportunities -- but it is still reversible.
Rebuilding involves returning to fundamental strategies: Safeguarding routine immunization against disruptions, addressing second-dose gaps through targeted outreach, restoring frontline capacity and public trust, and taking early action rather than waiting for crises.
These are not new ideas; they are the same principles that previously made Bangladesh a global example.
Measles does not wait for political stability or follow administrative schedules. It takes advantage of gaps -- swiftly and persistently -- and those gaps are now clear.
The real question isn't whether warning signs existed -- because they did. Instead, the question is whether these signs will finally be addressed.
Dr Ezaz Mamun is a freelance contributor from Australia.