Cholera drive misses 8.5 lakh
Bangladesh’s first nationwide two-dose oral cholera vaccination campaign has reached 82.6 percent of its target population in the first round, with more than 8.5 lakh people missing the vaccine and Narayanganj recording the lowest coverage among the 14 high-risk areas.
According to Directorate General of Health Services (DGHS) data, 40,47,018 people received the oral cholera vaccine (OCV) against a target of 48,99,440 in the first round, leaving 8,52,422 people unvaccinated.
Narayanganj accounts for a significant portion of the gap. Of 10,32,963 people targeted there, 6,72,287 received the vaccine, leaving more than 3.6 lakh without the first dose.
The shortfall in Narayanganj alone represents roughly 42 percent of the total number of people missed across all campaign areas.
The DGHS launched the country’s first two-dose OCV campaign on August 22, targeting people aged one year and above in 14 cholera high-risk areas. Pregnant women and people who were seriously ill were excluded from the campaign.
The first-round vaccination continued until September 21, while administration of the second dose began on September 26 and will continue until October 25.
The campaign covers areas under seven police stations in Dhaka and seven upazilas across four districts. In Dhaka city, the areas are Lalbagh, Gandaria, Kadamtali, Kamrangirchar, Sher-e-Bangla Nagar, Khilkhet and Tejgaon.
Outside Dhaka, the campaign covers Sadar and Nabinagar in Brahmanbaria; Tarail, Karimganj and Hossainpur in Kishoreganj; Munshiganj Sadar; and Narayanganj Sadar.
Brahmanbaria recorkded the highest coverage at 98.4 percent, followed by Kishoreganj at 94.8 percent and Munshiganj at 80.8 percent.
Dhaka North City Corporation achieved 82.6 percent coverage, while Dhaka South City Corporation recorded 77.4 percent.
Why coverage fell short
A DGHS official involved in the campaign said the authorities had expected coverage of around 95 percent but could not reach that level.
“But the coverage rate is not that bad,” he said.
The official said achieving high coverage was more challenging because the campaign targeted a much broader population than routine immunisation or child-focused special vaccination drives.
“Unlike routine immunisation and special campaign, which mainly involves children, the campaign covered a much broader population,” he said.
Many people within the target group were also at work during vaccination hours, resulting in lower uptake because of a mismatch between working hours and the campaign schedule.
“In Dhaka city, we carried out evening sessions, enabling us to cover more people,” he said, adding that a similar arrangement was not possible in Narayanganj.
The official also cited the scattered nature of the population in Narayanganj as another challenge.
The area had the second-highest target population among the campaign locations, while high population mobility also contributed to people being missed.
A delegation from Gavi, the Vaccine Alliance, which recently visited Bangladesh, was satisfied with the coverage, the official said, requesting anonymity. Gavi provided the vaccine free of charge.
Prof Halimur Rashid, DGHS director for disease control, whose wing is implementing the campaign, said there was no specific coverage target.
“This is a preventive vaccine, and whatever coverage we achieved, we reported it,” he told the media.
He said all people aged one year and above were included in the target population and that coverage was generally lower in campaigns targeting the broader population than in child-focused vaccination drives.
“We carried out publicity as much as possible,” he added.
Asked about the relatively low coverage in Narayanganj, Prof Halimur referred the matter to the district’s civil surgeon.
Narayanganj Civil Surgeon SM Sakhawat Hossain said he had only recently joined the post and was unaware of the reasons for the lower coverage.
The upazila health and family planning officer of Narayanganj Sadar Upazila, who could have provided further information, was recently transferred and could not be reached for comment.
Five-year vaccination plan
The current campaign is part of a broader government plan to expand cholera vaccination to other vulnerable areas.
A joint DGHS and icddr,b study conducted in 2022-23 identified 144 sites, including upazilas and city corporation police-station areas, as cholera hotspots, another DGHS official informed the media.
The government subsequently prepared a five-year plan to vaccinate people in these vulnerable locations, beginning with the 14 areas considered the most vulnerable.
The vaccine being used in the campaign is prequalified by the World Health Organisation (WHO).
“We have a plan to gradually cover all the other sites, but everything depends on funding,” the DGHS official said.
The first-round coverage, while falling short of the level initially expected by some officials, provides the basis for the ongoing second-dose campaign and highlights the logistical challenge of reaching highly mobile and working-age populations in densely populated urban areas.
