Bangladesh aspires to become a developed country. The country’s per capita income and life expectancy have increased. Families now have one or two children. Yet those very one or two children are dying from measles. The state cannot ignore this “family tragedy.” In this day and age, the deaths of 500 children in this man-made epidemic are unacceptable by any standard.
A target had been set to eliminate measles within this year. But by a cruel twist of fate, we are now drowning in a measles crisis. Various international and domestic data and evidence indicate that the interim government’s health sector incompetence, bureaucratic complexities, the unnecessary complication of an established vaccination management system, failure to carry out the measles campaign on schedule, and several other factors have caught the country off guard.
After news emerged of child deaths from measles in Rajshahi, the current health minister wanted to “hang” the director of that hospital. But following such a reaction from the minister, the kind of comprehensive measures that should have been taken were never implemented.
Attempts were made to dismiss public health experts’ recommendations to declare measles an epidemic. This amounts to gradually avoiding a major problem. When the highest levels of the Health Ministry say things like, “I also had measles,” or try to trivialise the matter, it creates a lax attitude among officials in the ministry and the directorate.
The health minister has announced the cancellation of leave for physicians in charge of measles treatment during Eid. Such a declaration itself indicates that the situation is not normal. The minister and secretary are visiting hospitals to see children undergoing measles treatment. Yet the government has still not declared the measles situation an epidemic.
From the experience of the Covid pandemic, I can say that if measles had been declared an epidemic, everyone’s attention would have remained focused on it. The government could have assigned special responsibility to someone to control the spread and reduce deaths.
Special funding for measles treatment could have been allocated. Instead, because no special allocation exists, hospitals and institutions are facing various obstacles in providing treatment.
Children from low-income families are being admitted to hospitals across the country. Relatives are being asked to buy oxygen and various medicines themselves. Many families simply cannot afford them. With special funding, hospitals could have ensured uninterrupted care.
If the measles situation had been declared an epidemic, children would have received standardised treatment at every level—from upazilas to district hospitals and beyond. As a result, families would not have had to travel all the way to Dhaka.
There would also have been an emergency action plan and clear programmes for implementation. None of this exists. Consequently, the stream of measles admissions and deaths in hospitals continues unabated.
We also lack a national guideline for dealing with the measles situation. If physicians and nurses had been trained under such guidelines, complications and deaths from measles could have been reduced.
The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has developed Bubble CPAP technology. But it has not been distributed to hospitals across the country. Had that been done, the oxygen shortages among children would not have become so severe.
Children have now been vaccinated, and it is being said that the outbreak will decline. However, children who have long been hospitalised with post-measles complications also remain at risk. During Eid, people will travel to villages. Families with small children who have fever, cough, or any other symptoms should refrain from Eid travel. If measles symptoms appear while visiting relatives, receiving treatment in rural areas during Eid will become even more difficult.
* Professor Be-Nazir Ahmed is former Director of the government’s disease control branch, the CDC.