But that same year, protests erupted that ended 15 years of rule by Prime Minister Sheikh Hasina. In the ensuing political turmoil, health workers went on strike, vaccine orders were delayed and follow-up vaccinations that usually accompany routine programs were disrupted.In a report published in July this year, WHO and UNICEF estimated that first-dose coverage in 2025 had fallen to 90%, while second-dose coverage was 86%, several percentage points below the 95% needed for herd immunity.The report also raised questions about the quality of official data on vaccinations for measles and other diseases for the years 2023 to 2025.It said preliminary figures sometimes showed numbers of those inoculated exceeded 100% of those targeted, indicating mistakes in counting doses or target numbers.Emergency program missed millionsStill, when the measles outbreak erupted, Bangladesh responded swiftly and initially seemed to be winning the battle.An emergency program was followed by an initial slowdown in new cases after almost 20 million children received vaccinations in April and May. The government said it had covered every child in the target age group of 6 months to 5 years.But in reality, the program fell short. This emerged when another routine health intervention in June had a target list with 4 million more children than the measles campaign despite covering the same age group.“There is a gap,” prime ministerial adviser Hyder told Reuters on Sept. 14, as measles cases rose again, blaming vaccine hesitancy by parents or child illnesses for keeping children away.Other challenges have also emerged.Documents detailing meetings in April and August between the government, the WHO and other health partners, reviewed by Reuters and not previously reported, show how efforts to act fast may have led to shortcomings.Minutes from the April 19 meeting outlined how the government opted for just one round of so-called readiness checks before launching its emergency vaccination program due to time constraints, instead of the typical four rounds. Checks cover everything from ensuring fridges are available for keeping vaccines cool to determining how many children should be vaccinated.The single round of checks suggested that most — but not all — districts were ready, according to the minutes.The poorest ‘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 chair of Bangladesh’s National Verification Committee for Measles and Rubella Elimination.Hyder said the April campaign was launched in four weeks. Yet Tajul Islam Abdul Bari, who led immunization in Bangladesh until 2017, said campaigns usually demand months of planning.By the August meeting, shortcomings in the rollout were identified. Minutes noted the proportion of children with confirmed measles cases who had not been vaccinated was “virtually unchanged between pre-campaign (82%) and post-campaign (85%) … underscoring persistent coverage gaps.”The WHO did not respond to questions about the April and August meetings. But the deputy WHO representative to Bangladesh, Dr. Rajesh Narwal, said the agency was determined to support the government in its goal of vaccinating every child at risk.“Routine immunization must become more effective and resilient so that these gaps do not develop again,” he said.In Sylhet, where official records show 180 children have died, eight of 16 families Reuters interviewed in September said they had not seen health workers offering vaccinations. At least six families said health workers visited only after a child had died from measles in their community.At the end of September, the government launched a new campaign to target 3.4 million children previously missed.“We will involve people across villages so that no child is left behind,” the health minister told a news conference.Yet reaching every child remains a challenge. UNICEF and the Bangladesh Bureau of Statistics say as many as 40% of children go unregistered, while government data showed that about a third of health worker posts are unfilled.Health experts are also pushing the government to expand the program to vaccinate children over 5. That age group represents a third of measles cases, the WHO says.A child patient at the Infectious Diseases Hospital in Dhaka in March.Abdul Goni / Drik via GettyIn addition, scientists in Bangladesh are studying why immunity is waning faster than expected in babies up to 6 months or so. They are usually still protected by maternal antibodies, experts say.Ensuring prompt medical care is vital, the WHO says, another challenge for Bangladesh as it also fights a dengue epidemic.In September, every ward in Sylhet’s 100-bed Shahid Shamsuddin Ahmed Hospital, which is treating measles, appeared overwhelmed. On the day Reuters visited, 178 patients were admitted.
