Bangladesh is struggling to contain the world’s largest measles outbreak this year, with more than 1,100 deaths exposing serious gaps in vaccination coverage, emergency planning and efforts to reach vulnerable children.
The country reported 202,000 suspected measles cases, including 22,000 laboratory-confirmed infections, between mid-March and Oct. 9, according to the World Health Organization. Of the 1,147 reported deaths, 94% were children younger than 5.
The outbreak follows a decline in routine immunization coverage in 2025, reversing years of progress against a highly contagious disease that vaccines can prevent. Experts say unreliable data, inadequate preparation and failures to reach parents have further weakened the response.
A Reuters review of WHO documents, combined with interviews with more than a dozen scientists, health workers and officials, found that millions of children may have been missed by an emergency vaccination campaign launched in April.
The crisis offers a warning to other countries about the consequences of declining vaccination rates and underprepared health systems.
“This is a real warning to every country,” said Mark Jit, a WHO vaccine adviser and professor at New York University’s School of Global Public Health.
Preventing an outbreak through vaccination is easier, cheaper and safer than responding after infections spread, Jit said.
“The response will stop the outbreak eventually, but in the meantime, many will have had measles, and some will have died,” he said.
Ziauddin Hyder, special assistant on health affairs to Prime Minister Tarique Rahman, told Reuters in September that the government was doing everything possible to end the outbreak. The government did not respond to further questions sent in October.
Children left behind
In northeastern Sylhet, one of the hardest-hit regions of the country of 178 million people, families say they received no timely warning or access to vaccination services.
Two-year-old Arman Hossain died in July, about 24 hours after being admitted to a hospital for measles treatment. His family sold its three-wheeled auto rickshaw to pay for his care. Arman had not been vaccinated, although his unvaccinated 4-year-old sister survived.
His father, Amin Mia, 26, said health workers had not visited their remote village to offer vaccinations before his son became ill.
“They came only after I buried my son,” he said.
In Chhatak, also in Sylhet, 9-month-old Labiba Akter died of measles in June. Her father, Humayun Rashid, a 30-year-old carpenter, said no health worker had informed the family about the vaccination campaign.
Labiba could have received a dose in April, when an emergency drive lowered the minimum vaccination age from 9 months to 6 months.
“No health worker came to tell us,” Rashid said.
Measles typically kills two or three people for every 1,000 infections, according to the WHO, but the risk can be higher in poorer countries, where malnutrition and limited access to medical care worsen outcomes.
In May, Health Minister Sardar Md. Sakhawat Husain said cases in the worst-affected areas had fallen “almost to zero.” But the decline did not last. Bangladesh recorded an average of 1,198 new cases a day in September, its highest daily average since May.
Falling coverage
Bangladesh was once considered a vaccination success story.
The WHO and UNICEF estimated that 96% of eligible children received their first measles vaccine dose in 2024, while 93% received the second. The second dose protects children who do not develop sufficient immunity after the first.
The WHO recommends coverage of at least 95% to prevent measles outbreaks. Bangladesh had approached that threshold before immunization rates fell.
Political turmoil following the 2024 protests that ended Prime Minister Sheikh Hasina’s 15-year rule disrupted health services. Health workers went on strike, vaccine orders were delayed and follow-up vaccinations were interrupted.
A WHO and UNICEF report published in July estimated that first-dose coverage fell to 90% in 2025, while second-dose coverage dropped to 86%.
The report also questioned the reliability of official vaccination figures from 2023 to 2025. Preliminary data sometimes suggested that the number of children vaccinated exceeded 100% of the target population, pointing to possible errors in counting doses or estimating the number of eligible children.
Those weaknesses made it harder to identify communities being missed and determine where additional resources were needed.
In Bangladesh, experts said, access to vaccines and a lack of awareness have been greater obstacles than vaccine hesitancy, which has gained attention in wealthier countries amid skepticism promoted by figures including U.S. Health Secretary Robert F. Kennedy Jr.
A flawed campaign
Bangladesh initially appeared to be making progress after launching an emergency vaccination campaign in April. Nearly 20 million children received vaccinations in April and May, and new infections slowed.
The government said it had reached every child in the target group, covering those aged 6 months to 5 years.
But a comparison with another health intervention in June raised questions about that claim. The June program, which targeted the same age group, had a list of eligible children containing 4 million more names than the measles campaign.
The discrepancy suggested the emergency drive had failed to reach a substantial number of children.
“There is a gap,” Hyder told Reuters on Sept. 14, as cases rose again. He attributed missed vaccinations partly to parental reluctance and children being ill when vaccination teams visited.
Documents reviewed by Reuters also revealed concerns about preparation. Minutes from an April 19 meeting between the government, the WHO and other health partners showed that officials conducted only one round of readiness checks before launching the campaign, citing time constraints. Such campaigns typically involve four rounds.
The checks cover vaccine refrigeration, staffing and estimates of how many children need immunization. The minutes indicated that most, but not all, districts appeared ready.
Hyder said the campaign was organized within four weeks. Tajul Islam Abdul Bari, who led Bangladesh’s immunization program until 2017, said vaccination drives normally require months of preparation.
“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 Mahmudur Rahman, an epidemiologist and chair of Bangladesh’s National Verification Committee for Measles and Rubella Elimination.
By August, officials were confronting evidence that the campaign had failed to close major gaps. Meeting minutes showed that the share of children with confirmed measles who had not been vaccinated stood at 82% before the campaign and 85% afterward.
The figures suggested that the campaign had done little to reduce the proportion of unvaccinated children among confirmed cases.
The WHO did not respond to questions about the April and August meetings. Its deputy representative in Bangladesh, Rajesh Narwal, said the organization remained committed to helping the government vaccinate every child at risk.
“Routine immunisation must become more effective and resilient so that these gaps do not develop again,” he said.
Reaching every child
In Sylhet, official records show 180 children have died. Of the 16 families Reuters interviewed in September, eight said they had not seen health workers offering vaccinations. At least six said vaccination teams arrived only after a child in their community had died of measles.
The government launched another campaign at the end of September, targeting 3.4 million children who had previously been missed.
“We will involve people across villages so that no child is left behind,” the health minister said at a news conference.
Reaching every child remains difficult. UNICEF and the Bangladesh Bureau of Statistics estimate that as many as 40% of children are not registered, complicating efforts to identify eligible recipients and track vaccination coverage. Government data also show that about one-third of health worker positions are vacant.
Experts have urged the government to extend vaccination efforts to children older than 5, who account for about one-third of measles cases, according to the WHO.
Scientists in Bangladesh are also investigating why immunity appears to be waning faster than expected in babies up to around 6 months old. Infants in that age group are generally expected to retain some protection from antibodies passed on by their mothers.
Prompt diagnosis and treatment are also essential to reducing deaths, the WHO says. But Bangladesh is simultaneously fighting a dengue epidemic that is putting additional pressure on its health services.
In September, Shahid Shamsuddin Ahmed Hospital in Sylhet, a 100-bed facility treating measles patients, appeared overwhelmed in every ward during a Reuters visit. The hospital had 178 patients admitted that day.