Lessons for Immunisation Policy and Practice From the Deadly Measles Resurgence in Bangladesh

ABSTRACT

Bangladesh is experiencing one of the deadliest outbreaks of measles in 2026, with at least 472 suspected child deaths and over 67,079 suspected cases as of 27 May 2026. It has happened primarily following a fall in measles vaccination coverage in 2025, largely due to the cancellation of a planned 2024 Measles–Rubella vaccination Campaign and major political unrest. This editorial, based on available surveillance data, disease transmission modelling and lower vaccination coverage, argues that the 2026 measles outbreak was predictable, preventable and needed prompt action and management. We urge attention to addressing the issues related to structural and programmatic barriers, political and financial gaps in the planning, challenges related to Supplementary Immunisation Activity (SIA) scheduling and recommended—to protect vulnerable high‐risk communities.

1. Introduction

Measles remains one of the most contagious airborne viral diseases and continues to pose a significant threat to child health and survival worldwide [1]. Measles can affect the various systems of the body including skin, gut, eyes and respiratory system causing diarrhoea, pneumonia, otitis media and conjunctivitis [2]. Patients may suffer from immune amnesia for up to 1 year resulting in susceptibility to secondary infection [3, 4, 5]. Despite the availability of safe and cost‐effective vaccines, periodic outbreaks continue to occur, and 2024 alone is causing 95,000 deaths globally, mostly among unvaccinated or under vaccinated children [6]. In 2026, Bangladesh has experienced an uncontrolled resurgence of measles cases, raising concerns about gaps in population immunity and the sustainability of previous achievements in disease control [7].

At least 95% of the population is required to receive two doses of measles containing vaccine (MCV) to achieve the herd immunity threshold necessary to interrupt the transmission [8, 9, 10]. When coverage falls below this level, susceptible individuals accumulate in communities and outbreaks become inevitable [11]. The 2026 crisis in Bangladesh was not an unforeseeable public health emergency event; it was the foreseeable consequence of the gaps in immunisation programming, financing and governance that eroded decades of hard‐won progress.

1.1. Previous Progress in Measles Control in Bangladesh

Over the past decades, Bangladesh has achieved substantial progress in reducing the burden of measles and associated healthcare costs through its national Expanded Programme on Immunisation (EPI) [12]. Coverage of the first dose of the measles‐containing vaccine (MCV1), administered at 9 months of age, increased from 74% in 2000 to 97% in 2015. The second dose (MCV2), introduced in 2012, also demonstrated rapid uptake, rising from 41% in 2012 to 90% by 2016 [13]. According to the Coverage Evaluation Survey 2023, MCV1 coverage decreased somewhat to 86% from 88.6% in 2019. The decline in MCV2 coverage is particularly alarming, having fallen from 89% in 2019 to 80.7% in 2023 [14].

The 2005 measles outbreak (Figure 1) marked a critical turning point in the country's immunisation efforts. According to World Health Organisation (WHO) data, 25,934 suspected cases were reported that year, representing one of the highest recorded burdens at the time. This outbreak exposed significant gaps in population immunity, particularly due to incomplete coverage and reliance on a single‐dose vaccination strategy. In response, Bangladesh implemented large‐scale catch‐up campaigns during 2005–2006, targeting children aged 9 months to 10 years. The outbreak also underscored the limitations of a single‐dose regimen, as evidence indicated that a substantial proportion of children required more than one dose to achieve adequate immunity, thereby supporting the subsequent introduction of a two‐dose schedule [16].

FIGURE 1.

Measles reported cases and incidence by year in Bangladesh (2000–2026) [13, 15]. *Data as of May 27 2026. The incidence rate for 2026 refers to the annualised incidence of measles cases, confirmed either through laboratory testing or epidemiological investigation; expressed per one million population. For Bangladesh, the mid‐year population in 2026 is estimated at 177,818,044 people, and this figure is used as the denominator in calculating the rate.

Building on these efforts, Bangladesh continued to implement periodic supplementary immunisation activities. Notably, the nationwide measles‐rubella (MR) campaign in 2014 targeted children aged 9 months to 14 years, vaccinating ~53 million children, followed by another campaign in 2020 that reached around 34 million children aged 9 months to 10 years [8, 17, 18]. Sustained government commitment, combined with support from international partners, enabled consistently high vaccine coverage across much of the country.

As a result of these combined interventions, measles incidence and related mortality declined markedly and Bangladesh made significant progress towards regional elimination targets. Since 2006, measles incidence has remained substantially below the global average (Figure 1), decreasing from 179.2 cases per million population in 2005 to 1.5 in 2015 (compared with 29.2 globally), and further to 1.2 in 2021 (compared with 16.4 globally) [13]. However, sustaining such low incidence requires not only high vaccination coverage but also robust surveillance systems to ensure early detection and rapid response to outbreaks [11].

1.2. Emergence of the 2026 Outbreak

The 2026 outbreak began in late January, with cases accumulating rapidly through March and concentrated in densely populated urban areas including Dhaka, Mymensingh, Chapainawabganj, Pabna, Natore and Rajshahi [19]. Bangladesh is currently experiencing a nationwide surge in measles cases, with significant sharp spikes documented in February and March 2026. Based on the press release on measles from Directorate General of Health Services (DGHS), updated on 27 May 2026, 67,079 suspected cases, including 8834 laboratory‐confirmed cases (Figure 2) [15, 20]. Surveillance data were updated during manuscript revision to include cases reported up to 27 May 2026; corresponding analyses and figures were revised accordingly. Figure 2 was created from DGHS press releases at different dates [21, 22, 23, 24, 25, 26, 27, 28, 29]. This has been a very sharp increase from 2025, when only 132 cases were recorded in the whole year [7, 13]. The number of deaths from measles was unusually high in 2026 outbreak, highest in the past two decades. As of 27 May 2026, a total of 472 measles‐related deaths were documented, corresponding to a case fatality rate of 0.7%. This represents the highest recorded mortality burden from measles in Bangladesh to date. In comparison, the previous peak was observed in 2017, when 10 measles‐related deaths were reported [15, 30]. Among the infected individuals, about one third were under 9 months old [7, 31], and the most vulnerable group is unvaccinated children under 5 years and also unvaccinated adults over the age of 30 [32].

FIGURE 2.

Reported measles cases and deaths in Bangladesh by DGHS.

1.3. Contributing Factors

Several interrelated factors likely contributed to the resurgence of measles in Bangladesh. Political instability in 2025, coupled with repeated strikes by vaccinators and health assistants, substantially disrupted routine immunisation services and reduced coverage [7, 9]. In addition, delays in vaccine procurement associated with the change to an interim government interrupted timely supply, increasing the number of children, particularly those under nine months of age who missed scheduled doses of the measles‐containing vaccine (MCV1 and MCV2) [33]. The cancellation of the planned 2024 MR campaign due to political unrest and vaccine shortage further exacerbated this gap by removing a key mechanism for reaching unvaccinated and under‐vaccinated populations [33, 34].

A compartmental modelling study by Kuddus et al. estimated the basic reproduction number (R₀) for measles in Bangladesh at ~1.44 in 2021 under the existing two‐dose vaccination programme, indicating continued endemic transmission rather than progression towards elimination. This suggests that any decline in vaccination coverage would increase the effective R₀ beyond the epidemic threshold, facilitating sustained transmission and rendering large outbreaks highly probable [35]. The combined effects of service disruption, supply delays and campaign cancellation plausibly contributed to such a shift.

Although Bangladesh has historically maintained high routine immunisation coverage (approximately 90%–92%), even modest coverage gaps can accumulate over time. With over three million births annually, the remaining 8%–10% of unvaccinated children constitutes a substantial and steadily growing susceptible population each year [33]. Periodic supplementary immunisation activities, such as MR campaigns, are therefore critical for addressing these accumulated immunity gaps; their disruption markedly elevates the risk of outbreak resurgence.

1.4. Public Health Implications

The persistence and periodic resurgence of measles outbreaks highlight critical gaps in population immunity, particularly among hard‐to‐reach, urban slum and migrant populations [36]. These immunity gaps are often exacerbated by inequities in access to routine immunisation services, vaccine hesitancy and disruptions caused by public health emergencies [36, 37].

The high transmissibility of measles, one of the most contagious human infections (R₀: 12–18) poses a substantial risk of rapid outbreak propagation, particularly in densely populated urban settings where close contact facilitates transmission [38]. This places considerable strain on an already burdened healthcare system, diverting resources from other essential health services. Furthermore, measles‐related complications including pneumonia, diarrhoea, malnutrition and encephalitis contribute significantly to morbidity and mortality among children under 5 years of age [6, 38].

From a health systems perspective, recurring outbreaks underscore the need to strengthen routine immunisation programmes, ensure high two‐dose vaccine coverage, and improve surveillance systems for early detection and rapid response. SIAs remain essential but should not substitute for robust routine services. Strengthening cold chain infrastructure, healthcare workforce capacity and community engagement strategies is critical to sustaining measles elimination efforts [39].

At a broader level, measles outbreaks serve as a sensitive indicator of health system performance and equity. Addressing the social determinants of health such as poverty, overcrowding, low maternal education and limited healthcare access is essential to achieving sustainable control.

1.5. Strengthening the Response

Addressing the current outbreak requires immediate and well‐coordinated public health action. The Government of Bangladesh has initiated an emergency measles‐rubella (MR) vaccination campaign targeting more than 1.2 million children aged 6 months to 5 years, with support from key global partners such as UNICEF, WHO and Gavi, the Vaccine Alliance [40]. Building on this response, intensified vaccination strategies should prioritise the identification and immunisation of children who have missed routine doses, particularly within high‐risk and underserved populations.

Equally critical is the mobilisation of domestic governance and communication structures. Government entities, including local administrative bodies such as Union Parishad, Paurashava and City Corporation, can play a central role in microplanning, community mobilisation and frontline service delivery at the community level. The Press Information Department is similarly pivotal for disseminating timely and accurate information, as well as for countering misinformation through coordinated risk communication strategies.

Civil society engagement constitutes another essential pillar of the response. Local elites, religious and political leaders, art and cultural organisations and social media influencers exert considerable influence on public perceptions and health‐related behaviours. Their active involvement can strengthen public trust, mitigate vaccine hesitancy and foster community ownership of immunisation programmes. The use of culturally appropriate communication channels and trusted community figures is particularly important for reaching marginalised or hesitant populations.

In addition, a wide range of non‐governmental and regional platforms can provide complementary technical, logistical and operational support. At the national and community levels, organisations such as the Bangladesh Red Crescent, alongside volunteer‐based groups including Rover Scouts and Bangladesh National Cadet Corps, can support outreach, logistics and risk communication, particularly in hard‐to‐reach or crisis‐affected settings.

Strengthening surveillance systems remains essential to ensure early detection and rapid response to outbreaks. This includes enhancing laboratory confirmation capacity, improving case‐based reporting mechanisms and ensuring timely data analysis to inform decision‐making. Finally, robust public health communication strategies must underpin all interventions. The dissemination of clear, accurate and culturally sensitive information through both formal government channels and trusted community networks will be critical for countering misinformation, building confidence in vaccines and improving immunisation uptake.

2. Conclusion

The measles outbreak in Bangladesh in 2026 shows that progress in controlling diseases that can be prevented by vaccines is always at risk and needs to be protected through constant vigilance, strong health systems, training for vaccine providers and uninterrupted immunisation services. The recent rise in cases shows how quickly immunity gaps can appear when services are interrupted, campaigns are delayed and uptake drops. According to recent data, this pattern is not exclusive to Bangladesh. Recent outbreaks in affluent regions, such as the United States and New Zealand, illustrate that the resurgence of measles is a global issue, affecting even nations with well‐established health systems [41, 42, 43, 44]. In these instances, outbreaks have been associated with decreasing vaccination rates, vaccine hesitancy and disruptions related to the COVID‐19 pandemic. This example shows that having a high standard of coverage is not enough to protect everyone. To keep everyone protected, there needs to be ongoing acceptance of vaccine, trust in the programmes and close surveillance at all times.

In Bangladesh, the resurgence highlights the compounded effects of structural disruptions and the potential emergence of behavioural factors, including vaccine reluctance following the COVID‐19 pandemic [45, 46]. There is a critical need for in‐depth, population‐level investigations to better understand the determinants of missed vaccination, including access barriers, misinformation and shifting risk perceptions. Such evidence is essential for designing targeted, context‐specific interventions to restore confidence in immunisation programmes.

In the future, it will be important to improve surveillance systems, boost routine immunisations, keep extra campaigns going and use evidence‐based communication methods to deal with low coverage and limited acceptance. To stop future outbreaks and keep making progress towards the elimination of measles in Bangladesh and beyond, we need a broad and adaptive method based on both epidemiological evidence and community involvement.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available in Directorate General of Health Services (DGHS), Bangladesh at https://dghs.gov.bd/pages/press-releases. These data were derived from the following resources available in the public domain: DGHS, https://dghs.gov.bd/pages/press-releases—WHO, https://immunizationdata.who.int/compare?CODE=BGD&COMPARISON=type1__WIISE/MT_AD_INC_LONG+type2__WIISE/MT_AD_COV_LONG+option1__MEASLES_cases+option2__MCV_coverage&YEAR=.