Measles Outbreak in Bangladesh: Public Health Failures as a Violation of the Right to Life

I. EXECUTIVE SUMMARY

As of 12 May 2026, the Directorate General of Health Services (DGHS) of Bangladesh recorded 424 deaths (68 confirmed, 356 suspected), alongside 51,567 total cases (7,024 confirmed) since the outbreak commenced in January 2026. This report analyses the 2026 measles outbreak in Bangladesh through the prism of constitutional law, statutory governance obligations, and international human rights standards.

The outbreak represents a reversal of Bangladesh’s previous progress towards measles elimination, attributable to suboptimal population immunity resulting from nationwide stockouts of the measles-rubella (MR) vaccine between 2024 and 2025, combined with routine immunisation gaps and the absence of completed nationwide supplementary campaigns since 2014.

The analysis presented herein establishes that the State’s failure to maintain a continuous, adequately funded, and institutionally sound vaccination programme constitutes a breach of Articles 15(a), 18(1), and 32 of the Constitution of the People’s Republic of Bangladesh, and of obligations under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). This report calls for immediate structural reforms grounded in constitutional duty, administrative law, and international best practice.

II. BACKGROUND AND CONSTITUTIONAL/STATUTORY CONTEXT

A. Constitutional Framework

The Constitution of the People’s Republic of Bangladesh imposes clear and graduated obligations on the State with respect to public health. Article 15(a) makes it a fundamental responsibility of the State to secure the provision of medical care for its citizens, while Article 18(1) provides that the State shall regard the raising of the level of nutrition and the improvement of public health as among its primary duties, and shall adopt effective measures to that end.

Crucially, Article 32 guarantees the right to life as a fundamental right. The Appellate Division of the Supreme Court, in the landmark case of Dr Mohiuddin Farooque v Bangladesh, extended the interpretation of this article to include the protection of health and normal longevity of an ordinary human being from man-made hazards. This judicial precedent renders the right to life inseparable from the State’s positive obligation to protect citizens from preventable disease mortality.

Although Articles 15(a) and 18(1) are classified as Fundamental Principles of State Policy and are thus not directly justiciable under Article 8, their operative significance is elevated when read conjunctively with Article 32. Collectively, they establish a non-derogable duty on the State to sustain systems of preventive healthcare, of which routine immunisation is the most foundational component.

B. Statutory and International Framework

Bangladesh ratified the ICESCR in 1998. Article 18(1) of the Constitution mirrors the language of Article 12 of the ICESCR, and the UN Committee on Economic, Social and Cultural Rights, in General Comment No 14 (2000), has underlined that States must at a minimum adopt a national strategy to ensure the enjoyment of the right to health based on human rights principles. The Convention on the Rights of the Child (CRC), ratified by Bangladesh in 1990, further mandates under Article 24 that States shall take appropriate measures to combat disease and malnutrition, including through the provision of primary healthcare. Failure to procure and administer vaccines against a well-known, vaccine-preventable disease such as measles falls squarely within the category of retrogressive measures proscribed under ICESCR General Comment 14.

III. ANALYSIS OF FACTS AND IMPLICATIONS

A. Causal Chain of the Outbreak

The proximate and structural causes of this outbreak are documentable and largely administrative in origin. Bangladesh routinely administered two doses of the measles-rubella vaccine at nine months and fifteen months of age, supplemented by nationwide campaigns every four years to reach the 95 percent coverage threshold required to prevent outbreaks. Bangladesh had progressively graduated from Gavi’s full support by 2022, transitioning to self-financing its EPI vaccines through the national revenue budget, with UNICEF continuing to act as the primary procurement agent.

In September 2025, the then-interim government halted vaccine procurement through UNICEF and moved to an open tender system. UNICEF strongly opposed the change, and its representative in Bangladesh repeatedly warned health officials of the risk of disruption.¹ The tender process became caught in bureaucratic delays, causing vaccine supplies to run out and routine immunisation to stall. A supplemental MR campaign, postponed from 2024 to 2025 because of unrest, was eventually cancelled.

MR1 coverage fell from 100.1 percent² in 2023 to 92.73 percent in 2025, while MR2 coverage fell from 98.1 percent in 2023 to 90.78 percent in 2025. Experts have noted the actual figures are likely lower, as some evidence suggests vaccinations were falsely reported from the field when health workers were on strikes three times in 2025.³

By late March 2026, vaccine coverage stood at only 59 percent, far below the 95 percent needed for herd immunity. The outbreak began in January 2026 in Rohingya refugee camps near the Myanmar border before spreading rapidly across Bangladesh.⁴ Children under five years accounted for 61 percent of laboratory-confirmed cases (while WHO data indicates 79 percent across all reported cases), including 22 percent among infants younger than nine months.

Malnutrition compounded the crisis: approximately 28 percent of children under five are stunted and 10 percent suffer from wasting, increasing the rate of severe disease and death. Bangladesh had also missed three biannual vitamin A distribution campaigns since 2024, further weakening children’s immune defences.

US bilateral funding for Bangladesh’s health programmes was also cut by 97 percent, falling from nearly USD 80 million in 2024 to just USD 2 million in 2025, making Bangladesh the country with the largest percentage programme cut.⁵

B. Comparison with International and Regional Best Practices

India (Mission Indradhanush): India adopted a National Strategic Plan for Achieving and Sustaining Measles and Rubella Elimination and vaccinated over 324 million children between 2017 and 2020 through the MR vaccination campaign. Despite the challenges caused by the COVID-19 pandemic, India made remarkable progress in MR elimination by extending surveillance and expanding the MR laboratory network. India’s Mission Indradhanush model, which targets districts with poor vaccination coverage through periodic intensification, demonstrates that supplementary immunisation activities (SIAs) are a cost-effective and proven instrument for closing immunity gaps. Bangladesh, by contrast, has conducted no completed nationwide SIA since 2014, with the planned 2020 campaign cancelled.

Philippines (2018-2019 Outbreak as a Cautionary Precedent): The Philippines experienced over 630 measles deaths in the 2018-2019 outbreak following the collapse of its vaccination programme,⁶ and Madagascar recorded over 900 deaths across its 2018-2019 outbreak.⁷ Both events arose from systemic disruptions to established immunisation programmes and offer direct precedent for the kind of catastrophic and foreseeable harm that follows vaccination system breakdown.

Sri Lanka (Sustained Elimination Model): Sri Lanka has maintained measles elimination status in the WHO South-East Asia Region through consistent two-dose coverage exceeding 95 percent, robust case-based surveillance, and the absence of procurement disruptions. The Sri Lankan model illustrates that sustained elimination demands not only a procurement framework but an institutionalised surveillance and response architecture insulated from political transitions.

IV. IDENTIFICATION OF GAPS AND COMPLIANCE DEFICIENCIES

Gap 1: Procurement System Fragility. The interim government’s decision to explore alternative procurement processes for vaccines from the national revenue budget, despite UNICEF expressing concerns that this would delay the overall procurement process by up to 12 months, demonstrates a fundamental absence of risk assessment protocols in health procurement decision-making.

Gap 2: Absence of SIA Implementation. No nationwide supplementary immunisation activity has been completed since 2014, a direct contravention of the established four-year cycle required to sustain herd immunity.

Gap 3: Surveillance and Reporting Deficiencies. The actual number of measles deaths is likely higher than the official central tally, as data from two divisional offices of the health directorate showed at least 34 more suspected deaths than reported in the official figures. This mismatch between central and divisional data reflects structural weaknesses in the disease surveillance and reporting system.

Gap 4: Health System Infrastructure Deficit. Poorly funded clinics and hospitals became overwhelmed, with Dhaka’s Infectious Disease Hospital running out of beds, and patients being treated on the floor. The absence of paediatric intensive care capacity at key infectious disease facilities is a systemic failure.

Gap 5: Accountability Deficit. The removal from the government website of data showing only 59 percent coverage in 2025, after it had been publicly available, raises serious concerns regarding transparency and access to information, both of which are prerequisites for democratic accountability.

Gap 6: Malnutrition-Immunisation Policy Disconnection. No integrated policy framework links child nutrition supplementation with immunisation scheduling. The missed vitamin A campaigns since 2024 directly worsened measles case fatality rates.

V. RECOMMENDATIONS FOR REFORM

Recommendation 1: Legislate Vaccine Supply Continuity as a Statutory Obligation. Parliament should enact a Vaccine Supply Security Act requiring the government to maintain a minimum three-month buffer stock of all vaccines in the Expanded Programme on Immunisation (EPI) schedule. Any change to a vaccine procurement mechanism must be subjected to a mandatory public health impact assessment prior to implementation.

Recommendation 2: Insulate Vaccine Procurement from Political Transition. An independent National Immunisation Procurement Authority, operating under statutory authority and governed by a multi-stakeholder board including WHO, UNICEF, and civil society, should be established to manage procurement continuity across political transitions.

Recommendation 3: Mandate Quadrennial Supplementary Immunisation Activities. The SIA cycle should be codified in law or subordinate legislation, with funding ring-fenced in the annual budget. Cancellation or postponement of any SIA must require parliamentary approval and a written public health risk assessment submitted to the legislature.

Recommendation 4: Establish an Independent Disease Surveillance and Transparency Authority. All case and mortality data from the DGHS must be published daily on a publicly accessible, tamper-evident digital platform. Removal or alteration of epidemiological data without audit should constitute a statutory offence. Divisional and central data reconciliation must occur within 24 hours of recording.

Recommendation 5: Integrate Nutrition and Immunisation Policy. The government should adopt an integrated Child Health Security Framework that links biannual vitamin A distribution, routine immunisation, and nutritional supplementation under a single operational plan, with a unified disbursement mechanism to prevent programmatic disruptions.

Recommendation 6: Conduct an Independent Judicial Inquiry. In light of the scale of preventable child mortality and the concerns raised by the complaint filed with the Anti-Corruption Commission by a civil society coalition on 12 April 2026,⁸ the government should appoint a commission of inquiry under the Commissions of Inquiry Act 1956 to determine administrative responsibility for procurement failures and to make binding recommendations.

Recommendation 7: Reinforce the Justiciability of Health Rights Through Constitutional Amendment. Constitution Watchdog recommends that Parliament consider an amendment to render Article 18(1) justiciable in cases of demonstrable and gross State neglect causing mass preventable mortality, thereby enabling aggrieved citizens and civil society organisations to seek judicial enforcement of the State’s primary duty to protect public health.

VI. REFERENCE LIST

Legislation and Treaties

Constitution of the People’s Republic of Bangladesh 1972.

Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) 1577 UNTS 3.

International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 993 UNTS 3.

Cases

Dr Mohiuddin Farooque v Bangladesh (1997) 49 DLR (AD) 1 (SCB).

Official Documents and Reports

Directorate General of Health Services (DGHS), Bangladesh, ‘Daily Measles Situation Report’ (12 May 2026).

International Federation of Red Cross and Red Crescent Societies, ‘Madagascar: Measles Outbreak Emergency Plan of Action Final Report’ (IFRC, 4 September 2020).

UN Committee on Economic, Social and Cultural Rights, ‘General Comment No 14: The Right to the Highest Attainable Standard of Health’ (11 August 2000) UN Doc E/C.12/2000/4.

World Health Organisation, ‘Disease Outbreak News: Measles in Bangladesh’ (23 April 2026) DON598.

World Health Organisation, ‘Disease Outbreak News: Measles – Western Pacific Region’ (7 May 2019).

World Health Organisation India, ‘Moving Towards the Measles and Rubella Elimination Goal in India’ (March 2022).

Journal Articles and Secondary Sources

NI Chowdhury, ‘Right to Health in Bangladesh in the Situation of Post Natural Calamities’ (2022) SSRN 4261146.

P Dhalaria and others, ‘Exploring Landscape of Measles Vaccination Coverage: A Step Towards Measles Elimination Goal in India’ (2024) 42(17) Vaccine 3637.

V Iannelli, ‘Update on the Measles Outbreak in Bangladesh’ Vaxopedia (12 May 2026).

A Krugman, ‘One Year Post-USAID, Global Health Funding Stuck in Limbo’ (Think Global Health, 15 January 2026).

A Rahman, ‘Measles Explodes in Bangladesh after Vaccination Breakdown, Killing Hundreds of Children’ Science (30 April 2026).

News Media

‘Child Deaths Mount from Bangladesh Measles Outbreak’ The Express Tribune (8 May 2026).

‘Health Workers Strike Over Pay Arrears, Field Data Under Scrutiny’ The Daily Star (Dhaka, 15 November 2025).

‘Interim Govt’s Missteps Behind Measles Crisis’ The Daily Star (Dhaka, 12 May 2026).

Stanley Gwavuya (UNICEF Acting Representative), Interview with Prothom Alo (Dhaka, May 2026).

VII. DATA TABLE: KEY INDICATORS OF THE 2026 BANGLADESH MEASLES OUTBREAK

Table 1 Key indicators of the 2026 Bangladesh measles outbreak and systemic context (as of 14 May 2026)

Sources: DGHS Bangladesh Daily Situation Reports; WHO DON598 (23 April 2026); A Rahman, Science (30 April 2026); The Daily Star; Dhaka Tribune; UNICEF Bangladesh; Vaxopedia (12 May 2026).