Professor Dr. Safi Bhuiyan, Public Health Expert, Academic and Researcher, University of Toronto, Canada
In an unstable geopolitical reality, governments change, leadership shifts, policies alter, and even political priorities evolve. However, the risk of infectious diseases never stops. Even a minor vulnerability in the public health system can sometimes snowball into a massive national crisis.
Recently, during a postgraduate Community Assessment class at my university, I engaged in a discussion with students regarding Bangladesh's measles vaccine crisis, vaccine shortages, and the subsequent risks to child health. Here, I briefly highlight some of the realistic observations, public health concerns, and potential solutions that emerged from that discussion.
1. A One-Time Success Story Now Faces Challenges
Bangladesh's Expanded Programme on Immunization (EPI) was once considered one of the world's most successful examples of public health initiatives. Bangladesh has achieved international recognition for reducing child mortality and controlling vaccine-preventable diseases through immunization. However, over time, certain structural weaknesses, manpower shortages, planning inconsistencies, and ground-level realities have pushed this success toward new challenges.
2. Accurate Count of the Actual Child Population: The Fundamental Planning Challenge
The foundation of vaccine planning relies on determining the exact number of children. However, in many cases, birth registration is performed in multiple locations (such as the paternal grandfather's house, maternal grandmother's house, or the father's current residence), creating a risk of data duplication or discrepancy. Consequently, this can lead to confusion in determining actual vaccine demand, supply chain planning, and procurement management.
The time has come to establish an integrated connection (interoperability) between birth registration, national identity-based digital health data, and the EPI database.
3. Vaccine Procurement and Rapid Purchase System: Time is of the Essence
Vaccine procurement is an extremely time-sensitive matter. In many instances, the Direct Procurement method provides the opportunity for rapid decision-making, whereas a bureaucratic and lengthy procurement process can elevate public health risks.
While the Open Tender Method is theoretically crucial for transparency, delays in emergency immunization situations can cause severe public health damage. This is because—a child's age does not wait, and infectious diseases do not wait either.
4. Manpower Shortage: The Silent Weakness of the EPI System
Health Assistants and frontline healthcare workers are the core strength of field-level immunization activities. However, due to a prolonged lack of adequate recruitment and subsequent retirements, a workforce deficit has emerged in many areas. Where a Health Assistant is supposed to handle 114 specific scopes of work, vacancies are forcing them to effectively carry double the responsibility.
As a result, existing workers are overburdened with additional duties, which include routine EPI activities, COVID-19 vaccination, and Typhoid and HPV campaigns, among other public health initiatives. An effective immunization system does not rely on vaccines alone; it depends equally on a trained, adequate, and motivated workforce.
5. Cold-Chain Management: A Prerequisite for Ensuring Efficacy
The measles vaccine remains effective by maintaining a specific temperature range (2–8°C). Maintaining temperature control during long immunization sessions in the field is a major challenge. In many instances, temperatures rise up to 25°C, risking a reduction in the vaccine's efficacy.
Furthermore, the practice of "returned vials" at the field level raises questions if an unused vial from one EPI session is utilized in a subsequent session. If the efficacy of that vaccine has deteriorated, will the children receiving it develop adequate immunity?
For this reason, it is critical to strengthen cold-chain monitoring, real-time temperature tracking, and quality control at the field level. It is not enough for the vaccine to just be available—its efficacy must also be guaranteed.
6. A 20 Percent Shortage Means a Risk for the Future
If national immunization coverage is estimated at 80 percent, a significant portion of children is left out of vaccination every year. Over a span of a few years, this susceptible population accumulates, eventually creating the risk of a large-scale outbreak. If vaccines arrive late, the child’s age does not wait, and the disease does not wait.
This is precisely why many countries conduct Measles-Rubella (MR) campaigns at specific intervals. In Bangladesh, regular risk assessments, catch-up campaigns, and the identification of unvaccinated populations are urgently required.
7. Protecting Future Generations Must Be Considered
The unvaccinated or partially protected children of today are the parents of tomorrow. From a public health science perspective, it is known that a child's initial immunity during early infancy comes from antibodies received from the mother's body.
Therefore, if a population suffers from weak long-term immunization coverage, it can negatively impact the immune systems of future generations—representing a major public health concern.
8. Coordination of Responsibility and Accountability is Required
Although immunization activities in municipal and city corporation areas are managed under local government frameworks, disease management and hospital services rely heavily on the Health Department.
Given this reality, the question arises—where is the integrated leadership to ensure demand assessment, coverage, storage, efficacy, and accountability? The time has come to build a robust, coordinated monitoring and accountability framework.
9. Now is the Time to Strengthen Preventive Measures
Child nutrition, Vitamin A Supplementation, routine immunization, surveillance systems, cold-chain strengthening, and field-level healthcare worker recruitment—all need to be part of a well-coordinated plan.
Today, our biggest question should be: Is Bangladesh heading toward the risk of a resurgence of Polio, Diphtheria, or Tetanus, or will we strengthen preventive measures right now?
Time is running out quickly, because the children of today are the Bangladesh of tomorrow. Therefore, the current measles situation should not be viewed merely as an isolated crisis—it must be treated as a critical warning sign for the national immunization system, manpower, surveillance, and public health preparedness.
The time for coordinated, data-driven, and swift action is now. Investing in public health is not an expense—it is the ultimate safeguard for the security of future generations, human resource development, and the sustainable progress of the nation.
