How Measles Came Roaring Back
project-syndicate.org
Bangladesh is facing a sharp rise in measles cases. This outbreak is not the result of one single mistake. It is the result of years of slow weakening in the public health system. Keeping a population safe from highly contagious viruses requires constant attention. It requires a steady supply of vaccines. It also requires public trust and strong social foundations. When these elements erode, outbreaks become inevitable.
Measles was once close to being eliminated in many parts of the world. However, the disease has made a troubling comeback globally. In 2023, there were approximately 10.3 million cases. This number was 20 percent higher than in 2022. Outbreaks have been concentrated in Africa, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. High-income countries are also seeing a resurgence. The United States reported 1,983 confirmed cases in 2024 alone. These events show a painful truth about public health. Even the most successful vaccination programs are vulnerable to failure.
Nowhere is this vulnerability more clear than in Bangladesh. For many years, experts praised Bangladesh as a model for low-income countries. They showed how such nations could achieve great improvements in human development. This praise was well deserved. Despite limited money and weak infrastructure, Bangladesh massively expanded its childhood vaccination program. Coverage rose from barely 2 percent in 1986 to over 80 percent by the mid-2000s. The country used community-based delivery systems and worked closely with non-governmental organizations. This "immunization miracle" helped eliminate diseases like polio and neonatal tetanus. It also caused the death rate for children under five to drop by more than 80 percent.
But the system that delivered these gains is now failing. In 2025 and 2026, Bangladesh reported more than 62,000 suspected measles cases. These cases led to more than 500 deaths. Most of the victims were children under the age of five.