How deadly negligence allowed measles to spiral out of control

Farzana Islam became a mother 11 years after her marriage—and that, too, at immense expense through IVF (In Vitro Fertilisation).

She named her child Faiyaz Hasan Tajim. On her Facebook profile, she set her profile name as ‘Tajim’s Ammu’ (Tajim’s Mother).

After suffering from measles, Tajim passed away on 22 April. He was just eight months and 18 days old. Between 15 March and yesterday (11 August), 880 patients like Tajim have died from measles and measles-related complications—almost all of them are children.

For many years, measles remained well under control in Bangladesh; news of child deaths from measles was rare. Prothom Alo conducted a three-month investigation to uncover why a disaster unfolded this year and who bears the responsibility.

An examination and analysis of government records, alongside interviews with various stakeholders, reveal that the situation spiralled out of control due to sheer negligence.

The crisis developed gradually through a failure to prioritise measles risk, repeated postponements of the Measles-Rubella (MR) campaign in favour of typhoid vaccination, the procurement of fewer vaccines than required over several years, and a failure to analyse risk data on time.

The blame for this failure does not rest with a single government or institution. A combination of a lack of coordination, misguided priorities, and administrative bottlenecks across the highest levels of government policy-making, the Ministry of Health, the Directorate General of Health Services (DGHS), the Expanded Programme on Immunisation (EPI), as well as the World Health Organization (WHO) and UNICEF, pushed the situation towards disaster.

Although a national MR vaccination campaign was conducted later, the outbreak was not fully contained due to understated target figures and weak management.

At one stage of the investigation into measles, measles outbreaks, and vaccines, the EPI, the DGHS, and the Ministry of Health refused to provide information. Later, an application was submitted under the Right to Information (RTI) Act, yet complete information was still withheld. The Information Officer of the Ministry of Health provided no data.

Requests for information sent to several members of various expert committees also yielded no results. Members refused to share the minutes of meetings from two committees. Furthermore, after initially providing information, WHO and UNICEF refused to disclose further details during the second phase.

However, various information and documents were obtained from sources within the Ministry of Health, UNICEF, and Gavi—the Vaccine Alliance. An analysis of these documents and data highlights five primary causes behind the current measles outbreak:

1. The Measles-Rubella (MR) vaccination campaign scheduled for September 2025 was repeatedly deferred and only commenced in April 2026. This meant that the campaign intended to administer measles vaccines to all eligible children across the country was delayed by seven months. The previous campaign was held in 2020.

The primary reason for failing to conduct the campaign on time was the low priority given to measles, coupled with an excessive focus on typhoid vaccination. The DGHS itself admitted that the MR campaign was delayed because the typhoid vaccination programme was prioritised.

2. Between 2023 and 2025, 42 per cent fewer MR vaccines were procured for routine immunisation than were required.

3. There was clear data indicating an increasing number of unvaccinated children, a real vaccination coverage rate lower than official estimates, and a surge in lab-confirmed measles cases. However, the EPI, the DGHS, national-level expert committees, and international partner organisations failed to identify the outbreak risk from this data and issue warnings to policy-makers.

4.  The interim government introduced changes in health administration and management, experimented with vaccine procurement methods, and created friction between the Ministry of Health and UNICEF, leading to delays in purchasing vaccines. Additionally, in 2025, healthcare workers went on work stoppages and strikes on multiple occasions over various demands, disrupting routine immunisation and delaying the vaccination campaign.

5. Even when the national campaign was eventually held in April this year after the outbreak had begun, there was a major shortfall in setting targets. A massive number of children were left unaccounted for from the outset.

The ultimate consequence of all this was child mortality. During a WHO South-East Asia regional meeting held in Sri Lanka last June regarding the status of measles elimination, it was stated that 92 per cent of the children who died in Bangladesh had not received a single dose of the measles vaccine.

Five epidemiologists, vaccine specialists, virologists, paediatric health experts, and scientists told Prothom Alo that had the national MR campaign been completed six months earlier or prior to that, the outbreak might not have occurred at all—or, if it had, it would not have been so widespread.

Professor Be-Nazir Ahmed, former Director of the Disease Control Line Directorates at the DGHS, also believes that had 95 per cent or all children in the country been brought under vaccination coverage through a national campaign around last September, the measles outbreak would not have happened.

Speaking to Prothom Alo, he further said that if all children had received the vaccine, the infection would not have spread nationwide.

Measles vaccination for children under the EPI was launched in 1979. The MR vaccine was introduced on 12 September 2012. Under routine immunisation, the first dose of the MR vaccine is given to infants at nine months of age, and the second dose at 15 months. National campaigns are conducted to reach children missed by routine vaccination.

Speaking about this, vaccine expert and former EPI Deputy Director Tajul Islam Bari told Prothom Alo that Bangladesh purchases a portion of its routine vaccines using its own funds and receives others at a subsidised rate, with Gavi providing the subsidy. Bangladesh buys its measles vaccines with its own money, whereas Gavi bears the full cost of vaccines for any national campaign.

According to the DGHS, MR vaccine campaigns began in Bangladesh in 2006, followed by campaigns in 2010, 2014, and 2020 (which started in December of that year and concluded in January the following year). The latest campaign took place from 20 April to 20 May this year, although it was originally scheduled for September 2025.

Decisions regarding when a national vaccine campaign will take place in the country are made by the Inter-Agency Coordination Committee (ICC). Chaired by the secretary of the Health Services Division, this committee includes officials from the Ministry of Health and the DGHS, as well as representatives from the EPI, WHO, UNICEF, and national immunisation technical advisory groups.

Following a decision by the ICC, the MR campaign was pushed back from September 2025 to April 2026.

An analysis by Prothom Alo of the minutes of 11 out of 13 ICC meetings held between 2022 and 2026 reveals that while typhoid vaccination campaigns consistently received priority, there was no discussion regarding forecasts or warnings about a potential measles outbreak. Although decisions regarding the MR campaign were taken, it was repeatedly deferred.

Discussions on a national typhoid vaccine campaign began during the Awami League government. At the 61st ICC meeting held on 18 May 2022, EPI officials recommended a typhoid vaccination campaign. The meeting was chaired by Lokman Hossain Miah, the then Senior Secretary of the Health Services Division.

The National Immunisation Technical Advisory Group (NITAG)—the highest technical advisory committee on vaccines—had recommended integrating the typhoid vaccine into the national routine immunisation schedule. The typhoid campaign was also discussed at the 62nd ICC meeting on 8 September 2022, chaired by the then Health Secretary Anwar Hossain Howlader.

Later, at the 67th ICC meeting held on 16 April 2024, it was decided that the national MR campaign would take place in September 2025. That meeting was chaired by the then Secretary of the Health Services Division, Md. Jahangir Alam.

Following the mass uprising in July, the Awami League government was ousted on 5 August 2024. After the interim government assumed office, the first ICC meeting was held on 29 September that year. In that meeting, it was decided to administer typhoid vaccines to all children aged between nine months and 15 years in April–May 2025.

The same meeting maintained the decision to run the nationwide MR campaign in September 2025. The meeting was chaired by the new Health Secretary, MA Akmall Hossain Azad.

The next meeting was held nine months later—on 24 June 2025—chaired by Health Services Division Secretary Md. Saidur Rahman, where changes were made to the timelines for both the typhoid and measles vaccination campaigns.

Minutes of that meeting show a decision to push back the typhoid campaign to September 2025, grounded on the rationale that a delay in vaccine supplies from Gavi necessitated the postponement.

A decision was also made at that meeting to defer the MR campaign, with the revised schedule set for 20 December 2025 to 20 January 2026. It was noted that since the typhoid campaign was scheduled for September and there were delays in procuring MR vaccines from Gavi, the MR campaign would have to be delayed.

The meeting minutes indicate that ICC Chairman and then Health Services Secretary Md. Saidur Rahman expressed an opinion in favour of running both the typhoid and measles campaigns concurrently. However, UNICEF representative Md. Zahid Hossain and WHO representative Jayanta Niagene argued that running both campaigns simultaneously was not feasible. Meanwhile, EPI official Shafiqul Islam stated that at least two months of preparation time would be needed following the typhoid campaign before undertaking the measles campaign.

However, the typhoid campaign did not begin on 1 September 2025 as planned. The reasons become clear from the minutes of the 70th ICC meeting held on 14 August that year, which record that preparations for the typhoid campaign could not be completed due to a nationwide strike by health assistants. Consequently, the campaign was rescheduled to 12 October. Although postponing the MR campaign was discussed at the meeting, no definitive date was set.

The typhoid campaign concluded in October 2025. Subsequently, dates for the MR campaign were set during an ICC meeting held on 23 December 2025, where it was decided that the nationwide MR campaign would take place from 19 April to 19 May 2026. It was reported that MR vaccines had arrived at the EPI headquarters. The BNP government later pushed the campaign back by one day, running it from 20 April to 20 May.

In response to Prothom Alo’s query on whether the MR programme was delayed because of the typhoid campaign, the DGHS stated in writing that the national measles campaign was indeed delayed due to the typhoid vaccination campaign.

When contacted via email at Gavi’s Geneva office, Gavi also noted that the MR campaign was postponed due to multiple operational readiness factors. These included national leadership transitions, competing vaccine priorities (such as the introduction of the typhoid vaccine), and the need for additional time to ensure effective planning.

The minutes of the ICC meetings, written statements from the DGHS, and feedback from Gavi clearly indicate that the measles vaccination campaign was repeatedly delayed to accommodate the typhoid campaign.

Former Health Secretary Md. Saidur Rahman, who served during the interim government, told Prothom Alo on 22 June, “UNICEF and WHO have worked with the EPI for many years. In the Ministry, we rely on the EPI, UNICEF, and WHO.”

The former secretary claimed that he had never heard any warnings about measles risks from these three bodies in any meeting. He asserted that representatives from these institutions never presented the MR campaign as a top priority during meetings, nor did they ever suggest holding the measles campaign before the typhoid campaign.

According to the Global Burden of Disease Study 2023, a global epidemiological surveillance study conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, approximately 430,000 people contract typhoid in Bangladesh every year, resulting in just over 6,000 deaths.

Recently, researchers have observed that typhoid bacteria are becoming resistant to antibiotics. Preventing typhoid through vaccination could help avoid severe complications, leading some scientists and researchers to advocate for the typhoid vaccine to policy-makers for several years.

However, a scientist researching typhoid, speaking to Prothom Alo on 10 July on condition of anonymity, noted, “There is no sudden risk of thousands of people contracting typhoid simultaneously. That risk exists for measles. Based on priority, vaccination for a disease carrying an immediate outbreak risk should be carried out first.”

The rationale for prioritising the administration of the typhoid vaccine to the population of Bangladesh, and the basis on which the decision for a typhoid campaign was taken, remain unclear. The MR campaign could easily have been conducted first, with the typhoid campaign following afterwards.

A prime example of the EPI and international agencies failing to discharge their duties responsibly is the huge gap between vaccine demand and supply.

UNICEF and WHO assist the EPI in preparing procurement documents, organising meetings, and drafting meeting minutes. Despite knowing for years that fewer vaccines were arriving in the country than required, neither organisation raised the issue. The topic was never discussed at ICC meetings.

An investigation by Prothom Alo reveals that Bangladesh has been procuring fewer vaccines than required for several years. Two EPI officials and a UNICEF official independently confirmed to Prothom Alo that the routine immunisation programme requires an average of 215,000 vials of the MR vaccine per month—totaling 2.58 million vials annually. With five doses per vial, this amounts to 12.9 million doses per year.

From 2023 to 2025, the total vaccine requirement stood at 38.7 million doses. However, only 22.49 million doses arrived, meaning Bangladesh procured 42 per cent fewer vaccines than needed over those three years.

The DGHS acknowledged this vaccine deficit in a written response to Prothom Alo on 21 June, confirming that there were shortages of the measles vaccine at the central warehouse in Dhaka in 2024, 2025, and 2026. On various occasions, there was an insufficient supply of MR vaccines to send to field units. However, the DGHS could not provide data on whether vaccines were completely out of stock at the field level.

Regarding this issue, Health Minister Sardar Sakhawat Hossain told Prothom Alo on 3 August that following 2020, the Awami League government showed reluctance to procure adequate vaccines, while during the interim government, the health adviser attempted to procure vaccines through alternative channels. The vaccine crisis, therefore, persisted throughout.

Shortages of the measles vaccine at the field level first came to light in early 2024. In January of that year, journalist Rashed Ahmed visited a vaccination centre in Jashore to vaccinate his 9-month-old child. Despite visiting several times over two weeks, he was unable to obtain the vaccine. On 10 February 2024, he published a front-page report in the English daily New Age detailing vaccine shortages across several districts.

On 21 May 2025, DGHS Director Afrin Mahmud sent a letter to the Chief of Health at UNICEF, underscoring the severity of the shortage. The letter stated that by 30 June 2025, stock for four vaccines—including measles—would be completely exhausted.

She requested UNICEF to supply these vaccines in advance to last until August. Following the letter, UNICEF supplied four types of vaccines, including measles.

Compounding the vaccine shortage, work stoppages and strikes by field-level staff severely disrupted regular immunisation. Under the Interim Government in 2025, health assistants embarked on work stoppages twice and went on a month-long strike once to press home various demands. The DGHS admitted in writing to Prothom Alo that routine immunisation activities were severely disrupted by these actions.

Under normal circumstances, not all targeted children receive vaccinations, and 2025 was no exception. However, the number of unvaccinated children that year was exceptionally high. The EPI dashboard initially showed that only 57.1 per cent of children received the measles vaccine in 2025. This figure remained on the EPI website until 31 March 2026 before being taken down.

On 10 August, the EPI authorities told Prothom Alo that 92.73 per cent of 9-month-old children and 90.78 per cent of 15-month-old children received the MR vaccine in 2025.

These statistics are questionable, as the actual number of vaccinated children is consistently lower than the EPI claims. The true picture emerges in evaluation reports. For instance, while EPI records claimed a 93 per cent measles vaccination coverage rate in 2023, an evaluation report revealed that actual coverage was only 81 per cent—meaning 19 per cent of eligible children were left out.

In certain districts, this exclusion rate was even higher. Year after year, significant numbers of children fall through the cracks of routine immunisation schedules. Notably, no evaluation report has been published since 2023.

In a written explanation to Prothom Alo, WHO noted that a measles outbreak can occur whenever vaccination coverage in every community is not sufficiently high, or when pockets of unvaccinated children accumulate.

WHO’s assessment is that the current outbreak stemmed from an ‘immunity gap’ caused by a combination of factors, including missed routine doses, uneven coverage across regions and demographics, and recent service disruptions.

Prothom Alo’s investigation reveals that the EPI failed to communicate data or issue warnings to WHO, UNICEF, the DGHS, or the Ministry of Health regarding missed children or the cumulative risk of an impending outbreak. There is no record of the issue ever being discussed at any ICC meeting.

Furthermore, the 2023 evaluation report was never officially released, nor were its key findings shared with policy-makers.

However, during a press conference on 20 May this year, UNICEF Representative Rana Flowers claimed that UNICEF had repeatedly warned the Interim Government about a potential outbreak due to vaccine shortages. At least five letters sent to the Ministry of Health highlighted potential supply crises, and UNICEF officials raised the issue in 10 separate meetings with government representatives.

On the same day, Professor MA Sayedur Rahman, Special Assistant to the Chief Adviser of the Interim Government, told Prothom Alo that none of the communications from UNICEF mentioned a risk of a measles outbreak.

Statements from both Rana Flowers and Professor MA Sayedur Rahman were published in Prothom Alo on 21 May.

Meanwhile, instances of EPI officials withholding information have recently come to light. The National Polio and Measles-Rubella Laboratory at the Institute of Public Health regularly sends measles test results to the EPI. A rise in measles cases was detected in lab tests as early as December 2025 and reported to the EPI. By January 2026, confirmed measles cases had doubled, and those results were also forwarded to the EPI. Yet, the EPI failed to escalate this data to higher authorities.

The National immunisation Technical Advisory Group (NITAG), which advises the government on technical aspects of vaccination, also failed to issue early warnings.

Speaking on condition of anonymity on 10 August, a NITAG member stated that they issued an alert regarding the measles outbreak on 3 March. By that time the outbreak was already well under way.

Similarly, no early warning was issued by the National Verification Committee (NVC) for Measles and Rubella Elimination. Professor Mahmudur Rahman, who has chaired the committee since 2017, told Prothom Alo on 10 August that during a June 2024 meeting with the Health Secretary, he briefed him on areas with low vaccination coverage and discussed measures required to eliminate measles.

However, he confirmed that no specific warning regarding an imminent outbreak risk was conveyed.

The Interim Government assumed office on 8 August 2024. During its tenure, major discussions on health rarely touched upon measles or vaccination issues. The then Health Adviser, Nurjahan Begum, told Prothom Alo that medical treatment and rehabilitation for July uprising victims were their top priorities.

However, the Interim Government did push forward changes to the vaccine procurement process—a move that ultimately delayed the acquisition of measles vaccines.

Since 1998, the Health, Population, and Nutrition Sector Programme (HPNSP)—commonly known as the sector programme—had been the Ministry of Health’s largest initiative. Primarily donor-dependent, this development programme was implemented through operational plans (OPs) ranging from 10 to 32 over time.

As development and revenue programmes operated side by side, it created administrative overlaps, compounded by declining donor funds and Bangladesh’s economic growth. Consequently, the government sought to transition away from the sector programme framework.

The EPI was operated under the Maternal, Neonatal, Child, and Adolescent Health Operational Plan. During the Awami League government, an ICC meeting on 8 September 2022 decided that funding for all routine EPI vaccines would be transferred from the development budget to the revenue budget.

Upon taking power, the Interim Government attempted to dismantle the sector programme entirely and bring almost everything under the revenue budget. To facilitate this shift, the Ministry of Health held seven stakeholder meetings in early 2025. A final decision to scrap the sector programme was taken at a meeting on 6 March that year.

Minutes of that meeting show a decision to build internal procurement capacity—an initiative aimed at reducing reliance on WHO and UNICEF for vaccine purchases.

While buying vaccines through UNICEF is convenient, it carries higher costs. UNICEF charges service fees, including a 4 per cent handling fee, 4–7 per cent for freight and insurance, and 6 per cent for a contingency buffer—at times adding up to 17 per cent above the base cost of the vaccines.

Reducing donor dependency requires prior preparation. However, there are allegations that the Interim Government abolished the sector programme without adequate preparation.

As with many other areas, this severely impacted the EPI. Under the old system, vaccines could be procured quickly without open tenders. Conversely, the new revenue-budget framework required full public tender procedures, significantly lengthening procurement timelines.

The dismantling of the old system also triggered field-level disruptions. Salaries for 1,326 porters responsible for delivering vaccines to vaccination centres—previously funded through Operational Plans (OPs)—were halted. They went unpaid for an entire year, causing many to become irregular in performing their duties.

Meanwhile, the government relied on an Asian Development Bank (ADB) loan for a portion of the vaccine funding (Tk 6.09 billion). Processing this loan took five months.

Analysts argue that had vaccination been prioritised, the government could have allocated these funds from its own reserves. A committee was set up during a Health Ministry meeting on 15 September 2025 to investigate why government funds were not prioritised for vaccine procurement.

UNICEF eventually received the procurement funds (around Tk 10 billion) in April.

Debate over whether to purchase vaccines through open tendering or the Direct Procurement Method (DPM) existed during the Awami League administration and persisted under the Interim Government.

It was reported that Professor MA Sayedur Rahman, Special Assistant to the Chief Adviser of the Interim Government, favoured open tendering. Conversely, most DGHS officials favoured direct procurement.

In a letter to the Secretary of the Health Services Division on 30 October 2025, DGHS Director (Administration) ABM Abu Hanif outlined the complexities of open tendering and highlighted the advantages of direct procurement through UNICEF.

He noted that UNICEF offers pre-financing options, allowing vaccines to be delivered on credit with payments deferred.

In a letter on 30 December 2025 to Professor Sayedur Rahman, UNICEF Acting Representative Farookh A. Doomun warned that tender-based procurement takes eight to 11 months, whereas direct procurement via UNICEF takes only two to four months.

The Special Assistant to the Chief Adviser also explored alternative procurement channels. On 23 September 2025, UNOPS (the United Nations Office for Project Services, which assists with humanitarian and development projects) delivered a presentation showing that procuring vaccines through UNOPS instead of UNICEF could yield a 16 per cent cost savings.

As these alternative options and disagreements stalled procurement, vaccine reserves dwindled. On 21 May 2025, DGHS Director Afrin Mahmud wrote to UNICEF’s Health Chief, warning that stocks for four vaccines—including measles—would be completely depleted by 30 June.

She urged UNICEF to supply these five vaccines in advance to cover needs through August.

UNICEF delivered four vaccines, including measles, on credit (pre-financing) across various dates in August, temporarily averting an acute shortfall. Consequently, in mid-November 2025, the Interim Government decided to procure vaccines directly through UNICEF. The work order was formally issued to UNICEF in the first week of February 2026.

The BNP-led government took oath on 17 February. Funds for the vaccine purchase were released in March, and the first shipment arrived in May 2026. By then, it was too late—the measles outbreak was already under way.

Both former Health Adviser Nurjahan Begum and Special Assistant to the Chief Adviser Professor Sayedur Rahman declined to comment on these matters.

Following the arrival of the vaccines, the health department initiated vaccinations on 5 April, with the national campaign running from 20 April to 20 May. Many observe that the BNP government also failed to demonstrate adequate efficiency in managing the crisis. They revised the age eligibility for children, lowering the minimum age from nine months to six months; however, publicity and awareness campaigns regarding this change were minimal.

Errors were also made in estimating the number of eligible children. The vaccination target omitted an estimated 4.6 million children from the initial counts.

On the final day of the National MR Campaign (20 May 2026), UNICEF’s Rana Flowers stated at a press conference that the measles outbreak had been brought under control. Two and a half months have passed since that press conference, yet measles remains uncontained.

Farzana Islam, the mother of Faiyaz Hasan Tajim mentioned at the start of this report, wrote on Facebook in May, “Innocent children are dying, and no one takes responsibility. Nobody admits failure. It’s always blamed on the mother and child.”

When contacted over the phone on 10 August, Farzana told Prothom Alo that she wants a full investigation and justice for why measles was allowed to spread.

“They don’t feel the pain. Only a mother whose arms have been left empty knows the agony of losing a child!” she stated.