The numbers are stark. Over 400 children have died from measles in Bangladesh since November, according to the latest data from the country's Institute of Epidemiology, Disease Control and Research. That is a conservative estimate. The true toll is likely higher, given the collapse of routine immunisation during the pandemic and the strain on a health system already grappling with climate-driven disasters.
Measles is a disease of poverty and broken supply chains. It is also a disease we know how to prevent. The vaccine requires two doses: the first at nine months, the second at 15 to 18 months. Global coverage of the first dose has stagnated at 86% since 2020, far below the 95% threshold needed to stop outbreaks. In Bangladesh, routine coverage dropped from 96% in 2019 to 74% in 2021. That is a 22 percentage point gap. In epidemiological terms, that is a chasm.
The outbreak is now the largest in a decade. It has hit the Rohingya refugee camps in Cox's Bazar particularly hard. Overcrowding, malnutrition and poor sanitation create a perfect storm. The UK, historically a major donor to the Gavi vaccine alliance, has cut its aid budget from 0.7% to 0.5% of GNI. The result: a £250 million reduction in the 2021-2025 period for immunisation programmes. The mechanics are simple: fewer vaccines in the pipeline, more children unprotected.
The UK government has redirected some funds to the COVAX facility for Covid-19 vaccines. That is necessary but not sufficient. Measles does not respect Covid priorities. It is far more infectious. A single case can infect 12 to 18 others in an unvaccinated population. Compare that to 2 or 3 for the original SARS-CoV-2 strain. The virus spreads through respiratory droplets and remains airborne for up to two hours. In a camp with 600,000 people, it is like lighting a match in a gas field.
Treatment is supportive: hydration, vitamin A, antibiotics for secondary infections. There is no cure. The only bulwark is herd immunity. That bulwark is crumbling.
The mortality rate for measles in children under five is 3% in the worst outbreaks. For malnourished children, it can exceed 10%. In Bangladesh, 28% of children under five are stunted. That is a biological amplifier. The virus attacks immune memory cells, wiping out protection against other diseases. A child who survives measles is more vulnerable to pneumonia, diarrhoea and tuberculosis for years afterwards. The damage is cumulative.
What is to be done? First, a mass vaccination campaign. Bangladesh has applied for 10 million doses from the International Coordinating Group on Vaccine Provision, but supply is tight due to global demand. Second, nutritional support. Vitamin A supplements reduce measles mortality by 50%. Third, sustainable funding. The UK aid cut has been criticised by the All Party Parliamentary Group on Global Health as 'short-sighted'. Their language is diplomatic.
There is a larger pattern here. As the planet warms, vector-borne and vaccine-preventable diseases are expanding their ranges. The World Health Organization reported a 79% increase in global measles cases in 2022 compared to 2021. Climate displacement, flooding and Cyclone Sitrang last year have worsened the situation in Bangladesh. The health system, already fragile, is being asked to do more with less.
The science is clear. The virus is not the only thing that is scalable. So is our response. But that requires political commitment. When we cut budgets, we cut lives. The arithmetic is not complicated.
