Bangladesh is facing a heart-breaking tragedy that should have never happened. We are fast approaching 800 infant deaths since March 15 from a disease the country pledged to eliminate more than a decade ago.
Measles is very much preventable, detectable, and controllable. A safe and effective vaccine has existed for nearly 60 years averting an estimated 59 million deaths from measles globally between 2000 and 2023. This crisis, therefore, demands a harder question: What went wrong? Why did our public health system fail to act before we lost so many children?
Weak governance let measles spread
Diseases do not occur in a vacuum. Gaps in immune protection, failure of the system to anticipate threats, and delays in response may see any pathogen to spread and transmit diseases amongst the vulnerable populations.
Reports have emerged that many children missed routine immunization, including measles vaccination, in 2025 owing to a possible change in government procurement policy resulting in vaccine stockouts.
The outcome of this stockout was tragic. Our children paid the price with their lives. Amid blame and counter-blame, the deep faultlines in Bangladesh’s public health system have been brutally exposed.
A measles vaccine stockout should have triggered immediate public health concern. The failure to anticipate its consequences was a governance failure.
Bangladesh notified WHO on April 4 of a nationwide surge in measles cases. By then, according to the government’s own data, the outbreak had spread to 61 of 65 districts in the country.
It is unclear when the outbreak began though the government’s official source is reporting on measles cases and death counts since March 15. It is plausible that the delay in detection of the outbreak, delay in notification, and delay in instituting any control measure have allowed the outbreak to spread unabated. This was another sign that our systems fail to act in a timely manner.
Equally troubling are reports that laboratory confirmation is centralized in Dhaka, creating backlogs and reporting delays. This is indefensible. Measles elimination requires standardized, case-based surveillance for every suspected case, backed by a national laboratory network capable of testing for measles, rubella, and mumps.
Bangladesh began its journey for measles elimination in 2010 and committed to eliminate it by 2030. But even by 2026, the country did not build any laboratory infrastructure for testing of measles.
During Covid-19, the country reportedly established over 100 molecular diagnostic laboratories across many districts. These are the same laboratory testing facilities that could be used for testing of measles.
Though molecular testing (using Real time RT-PCR) remains the gold standard, measles confirmation often relies on serology (detecting measles specific antibodies) which can be performed in any healthcare facility with basic laboratory capacity. It is difficult therefore to justify why measles confirmation would remain so centralized during a nationwide outbreak.
Measles outbreaks are predictable
Good quality data is the foundation of any effective public health system, transforming information into actionable strategies. Most measles outbreaks are predictable using statistical models on vaccine coverage, seasonality, and past transmission patterns.
Bangladesh never achieved 95% coverage for both the first and second doses of measles-containing vaccine -- the threshold needed to prevent outbreaks. Unconfirmed reports suggest that the measles vaccine coverage dropped to nearly 57% in 2025.
Data on the government’s administrative coverage have always shown such coverage above 100% but the WHO-Unicef’s estimate for Bangladesh’s measles vaccine coverage remained between 93% to 96% since 2010. Such discrepancies were warning signs which we failed to anticipate.
This shows Bangladesh still struggles to count the number of children eligible for receiving vaccines accurately. An Electronic Immunization Registry which Bangladesh has not implemented fully, could have identified every eligible child by geographic location, tracked those who missed their immunization cycle, and detect “zero-dose” children in real-time triggering urgent follow-up actions.
Integrated response is the key
Vaccination is essential, but it cannot interrupt transmission if other foundations of outbreak control measures such as active surveillance, laboratory confirmation, case management, risk communication, and community engagement are weak and not integrated.
Measles cases and deaths continue to be reported in July, months since the nationwide mass vaccination campaign ended. This suggests that susceptible children remained unreached and that transmission chains were not fully interrupted.
We still do not know the full characteristics of this outbreak. The government’s data shows a total of 114,164 measles cases reported since March but the real size of the outbreak could be much bigger. If there are no active case findings currently ongoing and community transmission is continuing, the outbreak cannot be stopped.
Measles is a highly contagious infection. One case can infect up to 18 others in closed settings. Therefore, the country’s health system plausibly missed and continues to miss many mild infections which are propagating overt transmission in the community.
Deaths among very young children demand urgent investigation. Anecdotal reports suggest that many children dying from secondary complications are under nine months old -- too young for their first measles vaccine dose. A national line list of cases and deaths, including demographic, vaccination history, laboratory test results including genomic sequencing data, and treatment history, would help experts identify risk factors and guide necessary action.
If delayed care-seeking is contributing to deaths, Bangladesh needs immediate, trusted public communication campaigns informing families when and where to seek help. In outbreak control, trust saves lives. Silence costs lives.
Accountability must be restored
This outbreak should be treated as an emergency which resulted from a series of governance failures. Childhood vaccination coverage has suffered not only for measles but for all vaccine-preventable diseases.
If Bangladesh continues the familiar cycle of panic during crisis, neglect after headlines fade, and apathy between outbreaks, our inactions may result in the return of other preventable diseases -- notably diphtheria and pertussis (whooping cough).
We recommend establishing an emergency task force of multidisciplinary experts to review the response, close data gaps, strengthen laboratory networks, expand active surveillance, improve real-time reporting, and rebuild confidence in routine immunization.
Measles is a tracer for vaccine inequity and system failure. The lesson is painful but clear. More accountability and improved governance are needed to prevent another avoidable tragedy.
Dr Sk Md Mamunur Rahman Malik is a senior public health specialist who worked with the World Health Organization (WHO) for over 22 years holding various senior leadership positions in the areas of control of emerging infectious diseases, including outbreak control and health systems strengthening. Email: [email protected]. Dr SM Moazzem Hossain is Director of the Centre for Health and Population Development at Independent University, Bangladesh, and formerly the Principal Advisor of Health and Chief of Sections in Unicef across countries in Asia and Northern Africa. Email: [email protected].
