FROM PAGE 1

THE TRIGGER

The health ministry has been implementing the Health, Population, and Nutrition Sector Programme (HPNSP) since 1998, popularly known as Operation Plans (OPs), to provide a range of health, nutrition, vaccination, and family planning services.

The fourth HPNSP had ended in June 2024 and the then Awami League government had proposed a fifth edition of the OPs worth Tk 1.061 trillion for another five years.

Documents show that a project evaluation committee sat for 60 meetings at the planning commission between July and November, 2024, concluding that this fifth edition would be the final one. The committee asked the health ministry to prepare an exit plan.

But instead, the ministry scrapped the HPNSP altogether in March 2025 and decided to integrate the OPs into regular government programmes. This was done to improve coordination and strengthen infrastructure, officials said.

The ministry had also decided to adopt several “bridging projects” to complete unfinished tasks under the fourth HPNSP and continue the supply of medicines, vaccines, and other essential items.

However, approvals took time. It was not until November 2025 that the projects were given a green light. Then, it took several more months to appoint project directors to run the projects.

Consequently, disrupted procurement led to a suspension of services. It was not just vaccines, but OPs discontinuation meant that over 14,000 community clinics across the country saw their medicine supplies dwindle, leaving thousands to suffer. The 450 NCD corners, dedicated points at Upazila Health Complexes (UHCs) that provide free medicines for hypertension and diabetes, were also deprived of supplies.

Many UHCs could not operate ambulances due to a funding crisis, as fuel costs and drivers’ salaries were covered under the programme. Two crucial national campaigns, deworming tablets and Vitamin A Plus capsules, have remained suspended for over a year, a disruption experts say may have worsened the measles outbreak.

Although the interim government made some allocations for medicines, these were insufficient and the shortage still persists.

Prof Be-Nazir Ahmed, a health expert and former director of disease control at the health directorate, said the programme, a proven mechanism, should not have been “discontinued whimsically”.

He said that even if there had been allegations of corruption, the interim government could have addressed them instead of abruptly stopping it.

“Besides, where was the exit plan? Had there been an exit plan and had it been implemented properly, the situation might not have evolved like this,” he told The Daily Star on May 2.

Epidemiologist Prof Mahmudur Rahman, also chair of the National Verification Committee for Measles and Rubella Elimination, said just as the OPs were suspended so were the services of line directors and programme managers.

As a result, there was a vacuum in manpower, and at one point only three officials remained at headquarters. “This was a major reason behind the problem.”

He added that with no OPs in place, the associated funding had also ceased. “Various issues have arisen as authorities moved to a new system using funds from the revenue budget.”

Prof Sayedur Rahman, special assistant to the chief adviser of the interim government for the health ministry, said as the sector had long relied on the OPs, the transition required extensive inter-departmental coordination, which took more time which they had not foreseen.

He said in a written interview that the delays were primarily because the officials were not accustomed to the new system and “bureaucratic inertia regarding the new initiative”.

DELAYED PROCUREMENT

With the OPs scrapped and the bridging projects yet to be approved, Tk 842 crore was finally allocated in August 2025. Bangladesh used to procure vaccines through Unicef under the Direct Procurement Method (DPM). However, in September, the Cabinet Committee on Economic Affairs decided to directly procure half through Unicef, and the other half through an open tender.

The committee also directed the health ministry to negotiate vaccine prices with Unicef.

“All these decisions caused complications, and we have not received a single vaccine through any of the methods to date,” an EPI official told The Daily Star in early April, seeking anonymity.

Unicef strongly opposed the change, reported Science.org on April 30.

“It was very frustrating,” Unicef Representative to Bangladesh, Rana Flowers told Science.org, a scientific research, technology and medical news site of the eponymous journal. “For God’s sake … don’t do this,” Flowers recalled telling the interim government’s health adviser Nurjahan Begum, reads the Science.org article.

Another health directorate official, wishing not to be named, said under the OPs, the line director was authorised to place vaccine orders with Unicef simply with one approval from the finance ministry. “But the latest funds, allocated from the revenue budget, require approval from two cabinet committees, apart from other issues, which could take two to three months.”

On the other hand, current officials have little experience in procuring vaccines through an open tender, which requires separate tenders for each type of vaccine, which takes even longer.

He said the interim government procured vaccines worth about Tk 200 crore late in 2025 from Unicef on credit when reports of shortage began to trickle in. “But it was not enough.”

Stocks of six types of vaccines, including measles, were exhausted by March 2026. But, he said, there used to be a three-month buffer under the previous programme.

Prof Be-Nazir Ahmed said the fact remains that delayed procurement meant vaccination coverage was not properly maintained, resulting in the outbreak. “If responsibility is to be assigned, it falls on the interim government. Their failure to ensure proper vaccination meant herd immunity or collective protection was not achieved.”

Prof Sayedur in a Facebook post on Friday said it was important for the government to build its own capacity and reduce dependence on external sources for a long‑running vaccination programme. “So, the interim government tried to procure vaccines at competitive prices.”

He told this newspaper that the Unicef warning had only reached him on December 30, 2025, when there was little time to review the process which was already in its last stages.

NO SPECIAL CAMPAIGN

According to the World Health Organisation (WHO) risk assessment report on April 23, the current outbreak is occurring in the context of “suboptimal population immunity”.

Bangladesh had made substantial progress in eliminating measles, with first dose coverage rising significantly between 2000 and 2016 and, later, with the second dose coverage between 2012 and 2024. Confirmed cases declined sharply during this period.

The crude vaccination (both valid and invalid vaccinations) of MR 1 was 100.1 percent in 2023, which fell to 92.73 percent in 2025, while MR 2 fell to 90.78 percent in 2025 from 98.1 percent in 2023.

But experts say the actual figure is likely lower, as some evidence suggests vaccinations were falsely reported from the field when health workers were on strikes three times in 2025.

Prof Mahmudur Rahman said that on several occasions, they informed senior officials of the health ministry about the decline but did not see any action.

Another health directorate official requesting anonymity said, even though half the vaccines had arrived following arrangements with Gavi in September 2025, the measles campaign was scheduled in April 2026. “This suggests a lack of understanding of the urgency.”

Prof Sayedur, appointed in November 2024, said that the interim government was grappling with the treatment and services of wounded July warriors for the first six months.

Sayedur further prevaricated that there was no alert, warning, or red flag from any national or international authority indicating an urgent need to conduct the special campaign immediately.

When asked to respond to the public sentiment that the ministry’s glaring lapses contributed to the tragic child fatalities, Prof Sayedur evaded responsibility and said, “We are all deeply saddened by the loss of these children. These tragedies touch every one of us.”

He equivocated further that the ministry had provided timely approvals “according to established procedures” for vaccine procurement.

As much as 74 percent of the confirmed measles patients did not receive either of the two doses of the vaccine, while 14 percent received only one dose, government data show.