Closing the immunity gap: The only way to end the measles outbreak

Bangladesh is facing one of its most serious measles outbreaks in recent decades.

Almost 80000 children have been infected, 590 of lives have been lost and hospitals have become overwhelmed.

The resurgence of this vaccine-preventable disease is a stark reminder that public health gains can be quickly reversed when immunization coverage declines.

Measles is among the most contagious viral diseases known to humanity.

A single infected person can transmit the virus to up to 90 percent of susceptible individuals who come into close contact.

Although an effective and safe vaccine has been available for decades, measles continues to cause illness and death whenever vaccination coverage falls below the level required for herd immunity.

For many years, Bangladesh was considered a global success story in immunization.

Through the Expanded Programme on Immunization (EPI), the country achieved remarkable progress in protecting children from vaccine-preventable diseases.

The country made massive strides in controlling the disease.

First-dose (MR1) coverage increased from 89% in 2000 to over 96% by 2015.

Measles cases declined significantly, and Bangladesh was on track to eliminate measles and rubella.

However, recent disruptions in routine immunization services, vaccine supply challenges, missed vaccination campaigns, and gaps in healthcare delivery have created a growing pool of susceptible children.

A recent Vaccine Coverage Evaluation Survey indicates that approximately 10 million children have a first-dose gap, and 20 million have a second-dose gap, leaving them susceptible to the disease.

The current outbreak is not simply the result of a virus spreading through communities; it is the consequence of an expanding immunity gap.

As these unprotected children accumulated over several years, conditions became ideal for widespread transmission.

The impact has been particularly severe among children under five years of age. Many affected children were either completely unvaccinated or only partially vaccinated.

Infants too young to receive their first vaccine dose have also suffered because community immunity was insufficient to protect them.

In densely populated urban settlements, refugee camps, and underserved rural areas, the disease has spread rapidly, exposing weaknesses in surveillance and immunization systems.

Closing the immunity gap must therefore become Bangladesh’s foremost public health priority.

The first step is to ensure that every eligible child receives two doses of the measles-rubella vaccine.

Emergency vaccination campaigns should be strengthened and extended to reach missed children in urban slums, remote villages, migrant communities, and refugee settlements.

Special outreach programs are needed to identify zero-dose children who have never received any routine vaccines.

Starting April 5, 2026, the government initiated targeted drives in 30 high-risk upazilas across 18 districts, which was rapidly scaled to include city corporations and all 64 districts.

The campaign prioritizes children aged 6 months to 5 years, with an emphasis on catching up on routine immunizations and expanding coverage to children up to 10 years in certain high-burden areas. Authorities set a goal to vaccinate over 18 million children.

By late May, over 18.3 million children had received their shots, bringing the coverage beyond initial targets in many regions.

Equally important is restoring confidence in routine immunization services.

Vaccination should not be viewed merely as a campaign activity but as a continuous and reliable public health service.

Parents must be informed about vaccine schedules, safety, and effectiveness through community engagement, schools, religious leaders, and mass media.

Combating misinformation and vaccine hesitancy is essential to sustaining high coverage.

A robust surveillance system is another critical component of outbreak control.

Early detection of cases, rapid reporting, contact tracing, and prompt outbreak response can prevent local outbreaks from becoming nationwide emergencies.

Healthcare facilities should be equipped to diagnose, isolate, and manage measles cases while preventing hospital-based transmission.

The outbreak has also highlighted the need for stronger health system preparedness.

Adequate vaccine stocks, trained healthcare workers, reliable cold-chain systems, and sufficient funding are fundamental requirements.

Immunization services must remain uninterrupted regardless of political transitions, economic challenges, or administrative changes.

The lessons from the current crisis are clear. Measles outbreaks do not occur because vaccines fail; they occur because vaccination coverage fails.

Closing the immunity gap is not only the key to ending the present outbreak but also the foundation for preventing future epidemics.

Every missed child represents a vulnerability, and every vaccinated child brings Bangladesh one step closer to a healthier and safer future.

The path forward is straightforward: identify the unvaccinated, strengthen routine immunization, maintain high vaccine coverage, and build resilient health systems.

By doing so, Bangladesh can overcome the current measles crisis and renew its commitment to safeguarding the health and well-being of every child.

(The writer is public health & hyperbaric medicine specialist and Director, Medical Services,
BRB Hospital).