Bangladesh is struggling to contain the world's worst measles outbreak, a crisis exacerbated by weak data, inadequate awareness efforts and vaccination gaps, which experts say constitutes a warning to other countries of the deadly danger of declining immunization rates, according to Reuters.
The World Health Organization said that Bangladesh, whose routine vaccination program has faltered in 2025, has reported 202,000 suspected cases of measles, 22,000 of which were confirmed in laboratories, since the outbreak began in mid-March until October 9. This represents the largest number of suspected cases in any country this year.
The organization said that 1,147 people have died so far from this highly contagious disease, with children under five making up 94 percent of the recorded deaths.
Bangladesh's experience shows the difficulty of containing an outbreak when vaccination coverage falls below 95 percent, the level the World Health Organization says is necessary to prevent outbreaks. Bangladesh has been close to reaching this level in the past few years, but coverage will decline in 2025.
A Reuters review of WHO documents, along with interviews with more than a dozen scientists, health workers and officials, found that Bangladesh's emergency response was also hampered by data that left out millions of children, a lack of preparedness, and a failure to reach enough parents.
“This is a real warning for every country,” said Mark Jett, a vaccine advisor at the World Health Organization and a professor at the School of Global Public Health at New York University.
He added that preventing an outbreak with vaccinations is easier, less expensive and safer than responding to an emergency.
He continued: “The response will eventually stop the outbreak, but in the meantime many will become infected with measles and some will die.”
Ziauddin Haider, Special Assistant to Prime Minister Tariq Rahman for Health Affairs, told Reuters in September that the government was doing everything in its power to end the outbreak. The government did not respond to additional questions sent in October to prepare this report.
“They did not come until after I buried my son.”
In the northeastern region of Sylhet, one of the most affected areas in the country with a population of 178 million people, two-year-old Armaan Hussain died in July, without receiving a vaccination, 24 hours after he was admitted to the hospital to receive treatment that his family members funded by selling the three-wheeled rickshaw they owned. His 4-year-old sister, who was also not vaccinated, survived.
His father, 26-year-old Amin Mia, said that no health workers had visited their remote village in Sylhet to provide vaccinations in a timely manner. He added: “They did not come until after I buried my son.”
The World Health Organization says that measles usually kills two or three people out of every thousand cases, but the disease may be more deadly in poor countries due to factors such as malnutrition.
In the town of Chatak, which is also located in the Sylhet region, the daughter of carpenter Humayun Rashid, 30 years old, died in June, at the age of 9 months, without receiving the vaccination. Labiba Akhtar could have received a vaccination dose in April, when an emergency program lowered the vaccination age to 6 months instead of 9.
“No health worker came to tell us,” her father said.
Health Minister Sardar Muhammad Sakhawat Hussain said in May that the emergency campaign had reduced cases in outbreak hotspots to “nearly zero,” and that the outbreak was under control.
But in September, Bangladesh reported a daily average of 1,198 new cases of measles, which causes fever, cough and rash. That was the highest total since May.
The outbreak of the disease in Bangladesh comes at a time of increasing hesitation regarding vaccines, especially in wealthier countries, amid skepticism promoted by people such as the US Secretary of Health.
Experts said access to and awareness of vaccinations are two major hurdles in Bangladesh.
Until recently, Bangladesh was a vaccination success story. Estimates of the World Health Organization and the United Nations Children's Fund (UNICEF) indicated that coverage of the first dose of the vaccine reached 96 percent in 2024, and 93 percent for the second dose, which is given to accommodate the small percentage of children who do not acquire immunity after a single dose.
But in the same year, protests broke out that ended 15 years of Prime Minister Sheikh Hasina's rule. In the political turmoil that followed, health workers went on strike, vaccine orders were delayed, and the follow-up doses that normally accompany routine programs were disrupted.
Estimates of the World Health Organization and UNICEF concluded, in a report published in July, that coverage of the first dose decreased to 90 percent in 2025, while coverage of the second dose reached 86 percent. That is, several percentage points lower than the 95 percent needed to achieve what is known as herd immunity.
The report also raised questions about the quality of official data on vaccinations against measles and other diseases for the years 2023 to 2025.
He said that preliminary numbers sometimes showed that the numbers of those vaccinated exceeded 100 percent of those targeted, which indicates errors in calculating doses or target numbers.
The emergency program left out millions
However, when the measles outbreak broke out, Bangladesh responded quickly and initially appeared to be winning the battle.
The emergency program was followed by an initial slowdown in new cases after nearly 20 million children received the vaccine in April and May. The government said it covered every child in the target age group between 6 months and 5 years.
But the program did not actually achieve its goal. This became clear when another routine health intervention in June included a target list of 4 million more children than the measles campaign, even though it covered the same age group.
“There is a gap,” Haider told Reuters on September 14, as measles cases rose again. He attributed the lack of children’s access to vaccination to the hesitation of parents, or the children contracting diseases.
Other challenges also emerged.
Documents seen by Reuters, which have not been previously published, show details of meetings held in April and August between the government, the World Health Organization and other health partners, and how the effort to act quickly may have led to shortcomings.
Minutes of a meeting held on April 19 indicated that the government chose to conduct only one round of so-called readiness checks before launching the emergency vaccination program due to time constraints, instead of the usual four rounds. The tests include everything; From ensuring that refrigerators are available to keep vaccines cold to determining the number of children who should be vaccinated.
The minutes stated that one round of examinations concluded that most, but not all, areas were ready.
The poor “pay the price”
“When preparedness checks are not done properly, it is often the poorest and hardest-to-reach children who miss out on vaccination and pay the price,” said Professor Mahmudur Rahman, an epidemiologist and head of the National Verification Committee for Measles and Rubella Elimination in Bangladesh.
Haider said that the April campaign was launched within 4 weeks. But Tajul Islam Abdul Bari, who led Bangladesh's immunization program until 2017, said campaigns usually require months of planning.
By the August meeting, shortcomings in implementation had been identified. The minutes indicated that the percentage of children who had confirmed measles cases and did not receive vaccination remained “significantly unchanged between before the campaign (82 percent) and after it (85 percent)... which confirms the persistence of coverage gaps.”
The World Health Organization did not respond to questions about the April and August meetings. But the organization's deputy representative in Bangladesh, Dr. Rajesh Narwal, said that the organization is determined to support the government in its goal of vaccinating every child at risk.
He added: “Routine immunization must become more effective and resilient, so that these gaps do not reoccur.”
In Sylhet, where official records show 180 children have died, 8 of 16 families interviewed by Reuters in September said they had not seen health workers administering vaccinations. At least six families said that health workers did not visit the area until after a child died of measles in their area.
At the end of September, the government launched a new campaign targeting 3.4 million children who had missed previous campaigns.
The Minister of Health said in a press conference: “We will involve people in all villages so that no child is left behind.”
But reaching every child remains a challenge. UNICEF and the Bangladesh Bureau of Statistics say that up to 40 percent of children are not registered, while government data showed that about a third of health worker positions are vacant.
