Why Bangladesh has lost 1,000 lives to measles despite record vaccine drive

The nation has administered 20mn vaccines since April, but past slipups have led to a mounting death toll, say analysts

Patients receive treatment during a measles outbreak as family members sit beside them in an overcrowded hospital in Dhaka, Bangladesh, September 8, 2026 [Mahmud Hossain Opu/AP Photo]

Dhaka, Bangladesh – One-year-old Saif Hasan died within minutes of being taken into intensive care at Dhaka’s Infectious Diseases Hospital (IDH) on August 27.

The child from the southern Bangladesh district of Shariatpur had developed a fever and rashes days after receiving his first measles-rubella vaccine. His family wondered whether the vaccine had made him ill.

But Saif, who had been receiving treatment for a pre-existing respiratory illness, was likely infected with measles before the vaccine had time to protect him, Shrebash Paul, a junior consultant at the hospital, said. “The infection then aggravated his underlying condition.”

Saif’s death points to the challenge Bangladesh faces in containing a measles epidemic that is now believed to have killed more than 1,000 people since March 15 this year. Last year, Bangladesh recorded 132 measles cases in total, with zero deaths.

The deaths come despite an emergency campaign that has administered nearly 20 million vaccine doses over this period.

By September 9, health authorities had recorded 1,009 deaths – 100 among laboratory-confirmed measles patients and 909 classified as suspected measles deaths. Yet the same official data shows 19.75 million children vaccinated since the emergency campaign began in April against the target of 18 million.

But public health experts say that apparently extraordinary figure helps expose one of the problems Bangladesh has faced in controlling the epidemic: On the one hand, the original estimate of the children needing vaccines was too low, while on the other, national coverage figures can obscure pockets where large numbers of susceptible children remain.

Mothers with their children wait in a queue to receive measles vaccinations amid an outbreak in Dhaka, Bangladesh, April 12, 2026 [Mahmud Hossain Opu/AP Photo]

A target that underestimated the problem

Bangladesh’s vulnerability to measles did not emerge overnight.

The South Asian nation of about 178 million people had been moving towards eliminating the disease before years of declining immunisation coverage left a growing number of children susceptible.

Bangladesh’s 2023 Coverage Evaluation Survey found that first-dose measles-rubella coverage had declined from 88.6 percent in 2019 to 86 percent in 2023, while second-dose coverage fell from 89 percent to 80.7 percent.

Routine immunisation was disrupted during the COVID-19 pandemic, while UNICEF has also cited misinformation and vaccine hesitancy among factors contributing to children missing vaccinations.

Besides, before this year’s effort, Bangladesh had not conducted a nationwide supplementary measles-rubella campaign since the last one ran from December 2020 to January 2021. Coverage therefore remained below the approximately 95 percent level needed to interrupt measles transmission, allowing the number of susceptible children to grow over successive years.

The problem worsened amid political upheaval following the July 2024 uprising, when then-Prime Minister Sheikh Hasina was ousted, and disruptions to the country’s immunisation programme.

The change in government led to delays in vaccine procurement, said Mushtuq Hussain, a former principal scientific officer at Bangladesh’s Institute of Epidemiology, Disease Control and Research (IEDCR). That, in turn, led to vaccine shortages in 2024 and 2025.

Cases began rising markedly in January 2026 and surged through March, prompting Bangladesh to notify the World Health Organization (WHO) of a nationwide outbreak on April 4. By mid-April, cases had been reported in 58 of the country’s 64 districts.

When the current outbreak accelerated, authorities launched emergency vaccination in high-risk areas on April 5, followed by a nationwide campaign later that month. Authorities set a target of about 18 million children aged six months to under five years when the measles-rubella vaccination campaign was launched on April 20.

Yet, about two months later, on June 28, the government’s campaign to administer Vitamin A supplements targeted about 24 million children in the same age group – a difference of nearly six million. That discrepancy helps explain how Bangladesh can now report vaccinating almost 20 million children – exceeding its original target – while susceptible children continue to be found.

Hussain of the IEDCR questioned the population estimates used to set the vaccination target, saying they underestimated the number of eligible children.

Nationwide averages can also mask local gaps. “You have to maintain equity,” Hussain said, arguing that at least 95 percent coverage must be achieved across communities, including among hard-to-reach and mobile populations.

A child rests as he receives treatment for measles in a hospital in Dhaka, September 8, 2026 [Mahmud Hossain Opu/AP Photo]

Numbers that can hide

Measles is among the world’s most contagious diseases, meaning even relatively small concentrations of unprotected people can sustain transmission.

Hussain said high national average coverage rates could conceal immunity gaps in individual communities, allowing the virus to continue circulating.

A second epidemiologist with extensive experience in Bangladesh’s immunisation programme, who requested anonymity because of the sensitivity of the issue, said authorities needed to analyse cases by age, vaccination history and location and use the findings to identify susceptible populations.

Without targeted vaccination of those populations, the epidemiologist said, transmission was likely to continue even if overall case numbers declined. Doctors treating patients are seeing evidence of those gaps.

Paul, the doctor at the IDH in Dhaka, told Al Jazeera that the majority of measles patients currently being admitted were unvaccinated. Some of the children now being treated had missed the vaccination campaign because they had been ill at the time.

Hospital admissions have nevertheless declined from their peak, Paul said, suggesting the vaccination programme has had a substantial effect. Still, children continue to arrive.

A person takes care of his grandchild while getting treatment for measles in a hospital in Dhaka, September 8, 2026 [Mahmud Hossain Opu/AP Photo]

Babies dying before routine vaccination

The IDH’s mortality review provides another clue to why the outbreak has been so deadly.

As of August 23, the hospital had recorded 3,167 suspected measles cases, 537 laboratory-confirmed cases, and 57 confirmed or suspected measles deaths this year.

The deaths were overwhelmingly concentrated among very young children. Of the 57 who died, 49 – about 86 percent – were younger than 15 months, while 31 were younger than nine months, the age at which children in Bangladesh routinely receive their first measles-rubella dose.

Forty-seven of the 57 people who died – 83 percent – had received no measles vaccine, according to the hospital’s analysis. Pneumonia was recorded in 50 of the documented deaths – making it the leading responsible complication.

Paul said doctors were particularly concerned about infections among infants who had not yet reached the age for routine vaccination.

The IDH is studying children infected before nine months of age and their mothers to better understand the factors behind those infections. The hospital data should not be read as nationally representative, Paul said, adding that the IDH is a specialist referral hospital that receives serious patients from Dhaka and other parts of Bangladesh.

But the numbers provide a window into the children at greatest risk once measles spreads widely.

Health officials, meanwhile, say reported case numbers may not fully reflect the underlying trend.

Halimur Rashid, director of disease control at the Directorate General of Health Services (DGHS) — the government agency responsible for overseeing public health programmes — said authorities were preparing a further round of vaccinations, expected to begin within the next two weeks.

A healthcare worker prepares a measles vaccine while a father holds his young daughter at a vaccination centre in Dhaka, April 12, 2026 [Mahmud Hossain Opu/AP Photo]

Can another vaccination drive stop it?

The next challenge will be reaching children missed by previous rounds. Experts say success will depend less on another large national coverage figure than on micro-planning – identifying susceptible children community by community and ensuring vaccinators reach them.

Hussain said authorities should consider extending vaccination to older children where surveillance identifies significant immunity gaps.

The epidemiologist who requested anonymity said vaccination may need to reach children up to 15 years old in affected areas.

But for too many families in Bangladesh, it is already too late.

Among those who fell through those gaps was Mostakim, a nine-month-old from east-central Kishoreganj district. He had not been vaccinated against measles.

On August 30, he died at the IDH.

分析人士称，自4月份以来，该国已接种了2000万剂疫苗，但过去的失误导致死亡人数不断攀升。

2026年9月8日，在孟加拉国达卡一家拥挤的医院里，麻疹疫情爆发期间，患者正在接受治疗，家属坐在他们身边。[Mahmud Hossain Opu/AP Photo]

孟加拉国达卡——8月27日，一岁的赛义夫·哈桑被送入达卡传染病医院（IDH）的重症监护室后几分钟内便去世了。

这名来自孟加拉国南部沙里亚特布尔地区的儿童在接种第一剂麻疹-风疹疫苗几天后出现发烧和皮疹。他的家人怀疑是否是疫苗让他生病的。

但医院初级顾问什雷巴什·保罗表示，赛义夫此前就患有呼吸道疾病，正在接受治疗，很可能在疫苗发挥作用之前就感染了麻疹。“感染加重了他的原有病情。”

赛义夫的死凸显了孟加拉国在控制麻疹疫情方面面临的挑战。据信，自今年3月15日以来，麻疹已造成超过1000人死亡。去年，孟加拉国共记录了132例麻疹病例，无死亡病例。

尽管在此期间开展了紧急疫苗接种运动，接种剂量接近2000万剂，但仍出现了死亡病例。

截至9月9日，卫生部门记录了1009例死亡病例——其中100例为实验室确诊的麻疹患者，909例为疑似麻疹死亡病例。然而，同样的官方数据显示，自4月份启动紧急疫苗接种运动以来，已有1975万名儿童接种了疫苗，而目标接种人数为1800万。

但公共卫生专家表示，这个看似非同寻常的数字有助于揭示孟加拉国在控制疫情方面面临的一个问题：一方面，最初对需要接种疫苗的儿童人数的估计过低；另一方面，全国覆盖率数据可能会掩盖仍然有大量易感儿童的地区。

2026年4月12日，孟加拉国达卡爆发麻疹疫情，母亲们带着孩子排队等待接种麻疹疫苗。[Mahmud Hossain Opu/AP Photo]

目标低估了问题

孟加拉国易受麻疹侵袭的状况并非一朝一夕形成的。

这个拥有约 1.78 亿人口的南亚国家原本正朝着消除这种疾病的方向努力，但多年来免疫接种覆盖率的下降导致越来越多的儿童易感。

孟加拉国 2023 年疫苗接种覆盖率评估调查发现，第一剂麻疹-风疹疫苗的接种覆盖率从 2019 年的 88.6% 下降到 2023 年的 86%，而第二剂疫苗的接种覆盖率从 89% 下降到 80.7%。

COVID-19 大流行期间，常规免疫接种工作受到干扰，而联合国儿童基金会也指出，错误信息和对疫苗的犹豫态度是导致儿童错过疫苗接种的因素之一。

此外，在今年的努力之前，孟加拉国自 2020 年 12 月至 2021 年 1 月以来，一直没有开展过全国范围的麻疹-风疹补充疫苗接种运动。因此，疫苗覆盖率仍然低于阻断麻疹传播所需的约 95% 的水平，导致易感儿童的数量逐年增加。

2024 年 7 月起义后，政治动荡加剧了这一问题，当时的总理谢赫·哈西娜被罢黜，该国的免疫接种计划也受到干扰。

孟加拉国流行病学、疾病控制和研究所（IEDCR）前首席科学官穆什图克·侯赛因表示，政府更迭导致疫苗采购延误，进而导致2024年和2025年疫苗短缺。

2026 年 1 月，病例开始显著增加，并在 3 月份激增，促使孟加拉国于 4 月 4 日向世界卫生组织 (WHO) 通报了全国范围内的疫情爆发。到 4 月中旬，该国 64 个地区中有 58 个地区报告了病例。

随着疫情加速蔓延，当局于4月5日在高风险地区启动紧急疫苗接种，随后于当月晚些时候开展了全国范围的疫苗接种活动。4月20日，麻疹-风疹疫苗接种活动正式启动，当局设定了为约1800万名6个月至5岁以下儿童接种疫苗的目标。

然而，大约两个月后，6月28日，政府开展的维生素A补充剂接种活动针对的是同一年龄段的约2400万儿童——与最初计划的接种人数相差近600万。这一差异有助于解释为何孟加拉国目前能够报告已为近2000万儿童接种疫苗——超过了其最初目标——同时仍不断发现易感儿童。

IEDCR 的 Hussain 对用于设定疫苗接种目标的人口估计数提出了质疑，称这些估计数低估了符合接种条件的儿童人数。

全国平均水平也可能掩盖局部差距。“必须保持公平，”侯赛因说，他认为，社区覆盖率至少要达到95%，包括难以触及的地区和流动人口。

2026年9月8日，一名儿童在达卡一家医院接受麻疹治疗时休息。[Mahmud Hossain Opu/AP Photo]

可以隐藏的数字

麻疹是世界上最具传染性的疾病之一，这意味着即使相对较少的未受保护人群也能持续传播。

侯赛因表示，全国平均较高的疫苗接种率可能会掩盖各个社区的免疫力缺口，从而使病毒继续传播。

另一位在孟加拉国免疫规划方面拥有丰富经验的流行病学家（由于问题的敏感性，他要求匿名）表示，当局需要按年龄、疫苗接种史和地点分析病例，并利用这些发现来确定易感人群。

这位流行病学家表示，如果不针对特定人群接种疫苗，即使总体病例数下降，病毒传播也可能继续。治疗患者的医生们也看到了这些疫苗接种缺口的迹象。

达卡传染病医院的保罗医生告诉半岛电视台，目前收治的麻疹患者中，绝大多数都没有接种过疫苗。一些正在接受治疗的儿童因为当时生病而错过了疫苗接种活动。

保罗表示，尽管如此，住院人数已从峰值回落，这表明疫苗接种计划已取得显著成效。然而，仍有儿童不断入院。

2026年9月8日，一名男子在达卡一家医院接受麻疹治疗期间照顾他的孙子。[Mahmud Hossain Opu/AP Photo]

婴儿在常规疫苗接种前死亡

IDH 的死亡率审查为解释此次疫情为何如此致命提供了另一个线索。

截至 8 月 23 日，该医院今年已记录了 3167 例疑似麻疹病例、537 例实验室确诊病例和 57 例确诊或疑似麻疹死亡病例。

死亡病例绝大多数集中在幼儿群体中。在57名死者中，49名（约占86%）年龄小于15个月，31名年龄小于9个月，而9个月正是孟加拉国儿童通常接种第一剂麻疹-风疹疫苗的年龄。

根据医院的分析，57名死者中有47人（占83%）未接种过麻疹疫苗。在记录在案的死亡病例中，有50例死于肺炎，肺炎是导致死亡的主要原因。

保罗说，医生们尤其担心尚未达到常规疫苗接种年龄的婴儿的感染情况。

IDH正在研究9个月大之前感染的婴儿及其母亲，以更好地了解这些感染背后的因素。保罗表示，医院的数据不应被视为具有全国代表性，并补充说，IDH是一家专科转诊医院，接收来自达卡和孟加拉国其他地区的重症患者。

但这些数字让我们得以了解，一旦麻疹广泛传播，哪些儿童面临的风险最大。

与此同时，卫生官员表示，报告的病例数可能无法完全反映潜在趋势。

负责监督公共卫生项目的政府机构——卫生服务总局 (DGHS) 的疾病控制主任哈利穆尔·拉希德表示，当局正在准备新一轮疫苗接种，预计将在未来两周内开始。

2026年4月12日，在达卡的一个疫苗接种中心，一名医护人员正在准备麻疹疫苗，一位父亲抱着他的小女儿。[Mahmud Hossain Opu/AP Photo]

再发起一次疫苗接种运动能阻止疫情蔓延吗？

下一个挑战是如何覆盖到之前几轮接种中遗漏的儿童。专家表示，成功与否与其说是取决于再次实现全国范围内的大规模覆盖，不如说是取决于细致的规划——逐个社区地识别易感儿童，并确保疫苗接种人员能够接触到他们。

侯赛因表示，如果监测发现存在明显的免疫缺口，当局应考虑将疫苗接种范围扩大到年龄较大的儿童。

要求匿名的流行病学家表示，受影响地区的疫苗接种可能需要覆盖到 15 岁以下的儿童。

但对于孟加拉国的许多家庭来说，一切都太迟了。

在这些被遗漏的人群中，有一位名叫莫斯塔基姆的九个月大的男婴，他来自中东部的基肖尔甘杰县。他没有接种过麻疹疫苗。

8月30日，他在IDH去世。