Negligence in procurement, now no syringes to administer vaccines

Some decisions taken during the previous interim government have caused delays in the procurement of all types of vaccines. Recently, the Expanded Programme on Immunisation (EPI) received measles-rubella vaccines.

However, EPI officials said that while vaccines for the national measles-rubella campaign have arrived, syringes have not. It may take another one and a half to two months to launch the nationwide campaign.

Instead of ensuring routine immunisation for children, the Ministry of Health, the Directorate General of Health Services, the Office of the Comptroller and Auditor General, the Cabinet Division, and donor agencies spent time debating the procurement process—whether the government would purchase vaccines directly or through UNICEF, and what the financial implications would be.

As a result, vaccine stocks were depleted and the national campaign had to be delayed. Public health experts say this clearly amounts to negligence in vaccine procurement.

A measles outbreak has already been reported in the country. According to the Directorate General of Health Services, the disease has spread widely in Dhaka, Chattogram, Rajshahi, Chapainawabganj, Pabna, Barishal, and Mymensingh.

More than 700 people have been infected, and over 50 have died. Meanwhile, EPI officials confirmed that at least 21 people have also been infected with rubella.

Public health experts warn that the government must act quickly without further delay. If not addressed urgently, there is a high risk of widespread transmission, as one infected person can spread measles to 16 to 18 others.

In Bangladesh, measles vaccines are administered to children in two ways. Routine immunisation is carried out through around 120,000 vaccination centres across the country.

In rural areas, government field-level health workers administer vaccines, while in city corporation areas and urban centres, vaccines are provided by city corporation vaccinators and NGO workers.

In addition, nationwide campaigns are conducted every few years to vaccinate all children within a few days.

Under the routine schedule, the first dose is given at nine months of age and the second dose at 15 months.

During national campaigns, all children aged between nine months and 10 years are vaccinated. The last such campaign was held in December 2020.

To understand the overall vaccine situation, this correspondent spoke on Tuesday with several officials and experts, including former health adviser of the interim government Nurjahan Begum, special assistant to the former chief adviser Professor Md Sayedur Rahman, former health secretary Md Saidur Rahman, former Director General of Health Services Professor Abu Jafar, EPI Deputy Director Mohammad Shahriar Sajjad, officials from UN agencies, and public health experts. Some declined to comment, while others spoke on condition of anonymity.

The country’s major health sector programme was the Health, Population and Nutrition Sector Programme (HPNSP). This five-year initiative, supported by donor agencies, began in 1998 and was widely known as the “sector programme.”

It was implemented through Operational Plans (OPs). The fourth phase (2017–22) was originally scheduled to end in 2022 but was later extended until June 2024.

Alongside this development programme, activities under the government’s revenue budget were also in place.

Under the maternal and child health operational plan of the sector programme, the Expanded Programme on Immunization (EPI) was carried out.

With financial support from Gavi, vaccines were procured through UNICEF. The same system was followed during the covid-19 period, and the process was comparatively faster and less complicated.

Around 2017, even before the fourth sector programme began, discussions emerged that Bangladesh’s financial capacity was improving and dependence on donors was decreasing.

Therefore, it was suggested that the sector programme might no longer be necessary and that activities should gradually shift to the revenue budget. However, that discussion did not progress.

Before the fall of the Awami League government in 2024, work had already begun on preparing various operational plans for a fifth sector programme.

After taking office, the interim government decided to cancel the sector programme. Following several meetings, the programme was formally scrapped on 6 March 2025, which also ended vaccine procurement through OPs.

At one point, the ministry decided to exclude UNICEF and procure vaccines directly.

However, the Finance Ministry raised several questions, prompting the ministry to reverse its decision and re-engage UNICEF. This back-and-forth process consumed several months.

According to one official, the Cabinet Division was informed that procuring vaccines through UNICEF involved a 17.5 per cent charge (12 per cent for transportation and 5.5 per cent service fees), and that direct procurement could save money.

However, when the ministry attempted to proceed with direct procurement, the Finance Ministry objected, stating that prior approval was required.

Before that approval could be finalised, the Office of the Comptroller and Auditor General pointed out unresolved financial issues from the 2022–23 and 2023–24 fiscal years.

Eventually, the decision reverted to procuring vaccines through UNICEF, but by then significant time had already been lost. Such complications persisted for a long time.

There are now also signs of inadequate preparation. The interim government had planned to launch the national vaccination campaign in April, but it has since been postponed.

When contacted, former health adviser Nurjahan Begum declined to comment, saying, “Media reports are not presenting accurate information and journalists should have consulted me or my special assistant.”

Former special assistant Md Sayedur Rahman also declined to comment, while former health secretary Md Saidur Rahman said, “We have given due importance to vaccine issues and that there was no reason for any delay.”

There is also some confusion about which vaccines are available. According to EPI data released on Sunday, there are no stocks of vaccines that protect against 10 diseases, including measles. These include BCG, Pentavalent, bOPV, PCV, MR, and Td vaccines.

However, EPI Deputy Director Mohammad Shahriar Sajjad said that vaccines for the campaign are available.

A source added that although procurement was delayed, vaccines are now arriving through UNICEF, and around 20 million doses are currently in stock—enough to conduct a campaign.

A recent meeting of the National Technical Advisory Group on Immunisation (NTAG) decided that the national measles vaccination campaign would be held by June.

In 58 districts, all children aged between 6 months and 5 years will be vaccinated, while in six districts—Faridpur, Madaripur, Shariatpur, Chandpur, Patuakhali, and Bagerhat—children up to 10 years of age will be covered due to lower vaccination rates.

When asked why the campaign would still be delayed despite having vaccines, Mohammad Shahriar Sajjad explained that funding for syringes and logistics comes from Gavi, and that funding has not yet been received.

Plans are in place to procure 7.2 million syringes in May, 8 million in June, and 5.6 million in July. A letter has already been sent to Gavi requesting urgent assistance to expedite procurement.

He added that several preparatory steps are required before launching a national campaign, including inter-ministerial coordination and awareness campaigns. The upcoming SSC examinations are also being considered before finalising the schedule.

Information gathered from various hospitals over the past week shows that 56 children died from measles across the country in March alone.

The government has yet to provide an official explanation for the outbreak or the deaths. However, public health experts say that a large number of children remain outside the vaccination coverage.

Public health expert and former chief scientific officer of the Institute of Epidemiology, Disease Control and Research (IEDCR), Mushtuq Husain said that experts had warned about these risks earlier, but the authorities failed to respond and showed negligence.

He stressed that infected and critically ill patients must receive proper treatment, vaccination efforts must be accelerated, contact tracing must be carried out to identify new cases, and those exposed to infected children must be isolated and treated. Otherwise, the spread of infection may worsen.