Addressing the measles situation requires a multifaceted strategy in which governments, international organisations, and local communities work together by prioritising emergency vaccination campaigns focused on the most vulnerable groups, especially children who have not received even a single dose; strengthening public health campaigns to counter misinformation and build trust in vaccines and healthcare; ensuring long-term investments in healthcare infrastructure, particularly in rural and underserved areas, to guarantee equitable access to immunisation and essential services; and securing financial and logistical support from international partners to help Bangladesh effectively combat this preventable disease, writes Md Alamgir Hossain.
A preventable disease is once again testing Bangladesh’s public health system. Measles – long kept at bay through sustained vaccination drives – is quietly resurging, exposing cracks in immunisation coverage, health infrastructure, and crisis preparedness.
A report published on April 2 in the BMJ paints a worrying picture: at least 38 children have died, and 684 cases have been confirmed in Bangladesh so far in 2026. What began on January 4 in the crowded Rohingya refugee camps has since spread beyond, with infections accelerating sharply in March.
Globally, the disease remains a silent killer. According to the World Health Organization (WHO), around 95,000 children died from measles in 2024 –underscoring that even in an age of advanced medicine, gaps in vaccination can quickly turn deadly.
A slipping shield of immunity
For years, Bangladesh’s immunisation programme was considered a public health success story. Data from the Expanded Programme on Immunization (EPI), published in Prothom Alo, shows that measles vaccination coverage among 12-month-old children remained above 89 per cent between 2017 and 2023.
But that protective shield has weakened. Coverage fell to 86.6 per cent in 2024 and then dropped sharply to just 59.6 per cent in 2025.
For a disease as contagious as measles, that decline is more than just a statistic – it is a red flag. Public health experts warn that herd immunity requires at least 95 per cent coverage with two doses. Once it slips toward 70 per cent, outbreaks become almost inevitable.
The anatomy of a resurgence
The current outbreak did not emerge overnight. It is the result of layered vulnerabilities that have built up over time.
One of the most persistent challenges has been the failure to consistently achieve the WHO-recommended 95 per cent two-dose coverage. Even when first-dose vaccination rates were relatively high, dropout rates – especially in densely populated or underserved areas – remained significant.
The COVID-19 pandemic further disrupted routine immunisation. Lockdowns, strained healthcare systems, and diverted resources interrupted vaccination campaigns and weakened supply chains, leaving many children unprotected.
Then came the humanitarian dimension. The Rohingya refugee camps – densely populated and resource-constrained – have long struggled with low vaccination coverage. These conditions created a fertile ground for the virus to spread, eventually spilling into wider communities.
Another overlooked factor is the long gap between nationwide measles vaccination campaigns. Without regular, targeted drives, immunity gaps accumulate quietly until they reach a tipping point.
Compounding these challenges is the financial structure of the immunisation programme itself. Bangladesh’s EPI remains heavily dependent on donor funding, with the government covering only about 30 per cent of costs – raising questions about long-term sustainability.
Why does measles spread so fast
Measles is not just contagious – it is one of the most infectious diseases known. The World Health Organization explains that the virus spreads through the air, lingering even after an infected person has left a space.
An infected individual can transmit the virus from four days before to four days after the characteristic rash appears. Anyone unvaccinated is at risk, but young children and pregnant women are particularly vulnerable.
The real danger lies in complications. Measles can lead to blindness, brain inflammation (encephalitis), severe diarrhoea, ear infections, and pneumonia. In many cases, it is these complications – not the virus itself – that prove fatal.
A race against time
Public health experts say the current situation demands urgent, coordinated action.
Emergency vaccination drives targeting unvaccinated children – especially those who have not received even a single dose – are critical to halting transmission. At the same time, rebuilding public trust through clear, science-based communication is essential in countering misinformation around vaccines.
But short-term responses alone will not be enough. The resurgence has exposed deeper structural issues: uneven access to healthcare, gaps in rural and underserved areas, and overreliance on external funding.
A sustainable solution will require long-term investment in healthcare infrastructure, stronger routine immunisation systems, and closer collaboration between the government, international partners, and local communities.
A preventable crisis
Perhaps the most sobering reality is that measles is entirely preventable. The vaccine is safe, effective, and widely available. Yet, as Bangladesh’s recent experience shows, even a temporary lapse in coverage can undo years of progress.
The current outbreak is more than a health alert – it is a reminder. In the fight against infectious diseases, complacency can be costly, and prevention must remain constant.
The writer is a research officer at the icddr,b