- More than 100 children died in Bangladesh due to a severe measles outbreak
- Bangladesh launched an emergency campaign to vaccinate over 1.2 million children
- India's measles vaccine coverage rose from 83% in 2013 to 93% in 2023
More than 100 children have died in Bangladesh in one of the worst measles outbreaks in recent years. Health authorities, along with partners such as the World Health Organization (WHO) and UNICEF, have launched an emergency measles rubella campaign to protect over 1.2 million children. The scale of loss underlines a basic fact. Even small gaps in immunisation can quickly escalate into a public health crisis.
This is a regional warning. India has made steady gains in immunisation, but if a similar outbreak emerges, how prepared is the system to respond quickly and at scale.
A Preventable Disease Still Turning Fatal
Measles remains one of the most contagious diseases. It is also preventable. Vaccines are central to child survival. When coverage drops, the consequences are immediate, especially for younger children.
Public health guidance is clear. At least 95% coverage with two doses is needed to achieve herd immunity. South Asia is still below this threshold. Coverage stands at around 93 percent for the first dose and 88 percent for the second dose, according to regional updates from WHO in 2025. This gap leaves enough room for outbreaks to persist.
India's Progress Is Significant But Incomplete
India's immunisation programme has expanded steadily over the past decade. Mission Indradhanush, launched in 2014, has focused on reaching children and pregnant women who were earlier missed. According to government figures, the vaccination drive has reached 5.46 crore children and 1.32 crore pregnant women.
Coverage has improved over time. Measles vaccination has gone up from 83 percent in 2013 to 93 percent in 2023. The dropout rate between the first and third doses of DTP vaccines has also come down, from 7 percent to 2 percent in the same period.
The reduction in zero dose children is another important marker. Estimates from WHO and UNICEF WUENIC 2024 report show that India reduced its zero-dose population from 1.6 million in 2023 to 0.9 million in 2024, a 43% decline. As a share of the population, this dropped from 0.11% to 0.06%.
These are strong outcomes. They reflect sustained policy focus and system capacity. But they do not remove risk.
Absolute Vulnerability Remains High
Even after progress, close to one million children remain completely unvaccinated. This is a large vulnerable population.
The distribution is uneven. Higher concentrations are seen in states such as Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan and Assam. Urban clusters with large migrant or informal populations in Maharashtra, Karnataka and Gujarat also show persistent gaps. Evidence from longitudinal and geospatial analysis published in The Lancet Global Health highlights how these pockets have remained difficult to reach over time. Outbreaks do not spread evenly. They take hold in precisely these areas where immunity is weakest.
The Gap Is In Delivery, Not Supply
India has vaccine supply, cold chain systems and established delivery platforms. National Immunisation Days, along with Sub National campaigns and Village Health and Nutrition Days, offer a structure for these outreach initiatives.
The deficiencies manifest in the final stages of delivery, surveillance capabilities, and preparedness for response. Certain regions persist in experiencing missed opportunities for child coverage, attributable to mobility constraints, access impediments, or underlying social determinants. Furthermore, surveillance systems often lack the sensitivity needed to quickly identify new clusters of concern. Hospitals, particularly those in busy cities, can face difficulties when there's a sudden increase in patients.
A strong policy framework requires better implementation. India already has several existing programs.
Intensified Mission Indradhanush focuses on districts where coverage is still low. The Zero Dose Implementation Plan 2024 is targeting 143 districts across 11 states with a high number of unvaccinated children. There are also task forces at the state, district and block levels that are meant to keep the system accountable and running. The UWIN platform has been introduced to record vaccinations and track who is still being missed.
The policy framework is comprehensive. The challenge is consistent execution at the local level. A single approach does not work in a country like India. The effectiveness of an intervention can vary significantly across different locales. Remote rural areas, crowded urban slums, and transient migrant communities each encounter distinct obstacles. The extent to which a program is embraced depends on local conditions. These conditions include trust in the healthcare system, existing cultural norms, and the practical aspects of accessing services.
Preparedness Depends On Speed And Trust
Outbreak control depends on early detection and rapid response. It also depends on public trust. The situation in Bangladesh shows how quickly measles can turn fatal when immunity gaps persist. Delayed detection or slow response amplifies the impact.
Surveillance needs to be tighter and quicker. Data systems have to talk to each other, not sit in silos. Frontline health workers need support on the ground, not just targets on paper. Communication has to come from within communities and feel credible. Vaccine hesitancy will not shift with generic messaging.
Focus Must Shift To The Hardest To Reach
India's immunisation journey has moved from expansion to precision. The next phase requires identifying and reaching every missed child. This means identifying zero dose children more precisely, strengthening urban health systems and making sure migrant populations are not left out of routine services. It also means preparing hospitals to handle sudden spikes in cases. Even with progress, millions of children are still unvaccinated or under vaccinated. Each missed child keeps the risk of an outbreak alive.
The outbreak in Bangladesh shows how quickly measles returns when coverage drops. The gaps may look small in percentage terms, but in real numbers they leave thousands of children exposed.
India has the systems and experience to prevent a similar crisis. The focus now must be on closing the last gaps, strengthening surveillance and ensuring rapid response capacity. Preparedness is not defined by past success. It is defined by the ability to prevent the next outbreak.
(By Dr. Sabine Kapasi, CEO, Enira Consulting Pvt. Ltd. | Founder, ROPAN Healthcare | UN Advisor)
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