The COVID-19 pandemic has had far-reaching impacts on health systems globally, and Bangladesh is no exception. A recent study assessing the disruption of immunisation services across the country revealed significant regional disparities in vaccination coverage, highlighting the challenges faced by various divisions, especially in the early months of the pandemic.

Bangladesh, a densely populated South Asian country with approximately 165 million people, is divided into eight administrative divisions. Among these, Dhaka, Chattogram, and Sylhet were most severely impacted by the pandemic’s disruption of routine vaccination services. The study found that vaccination rates in Bangladesh plummeted in the early months of 2020, particularly in April and May, with a notable reduction in the administration of vaccines like BCG and measles.

Sylhet, which historically reported lower vaccination rates, was one of the hardest-hit regions. The study recorded a 70% decrease in BCG vaccine administration in April 2020 and a 65% drop in measles vaccination by January 2021. These findings are consistent with prior studies showing that Sylhet’s health system struggled with lower vaccine coverage even before the pandemic. Factors such as limited public awareness, geographical challenges, and a high population living in slums, compounded by the pandemic, exacerbated the decline in vaccination rates.

Chattogram also faced significant challenges. The region saw a sustained reduction in vaccine administration, particularly as the Rohingya refugee crisis further strained an already fragile health system. The influx of refugees into overcrowded camps with limited access to essential services, coupled with the higher COVID-19 infection rates in urban areas, likely discouraged families from seeking vaccinations due to fear of contracting the virus. Furthermore, economic disparities and limited access to health services in slum areas further hindered vaccine uptake.

Dhaka, the capital, also experienced a sharp drop in measles vaccination in the early stages of the pandemic. As the epicenter of COVID-19 infections in Bangladesh, Dhaka faced severe lockdown measures, movement restrictions, and social distancing protocols that disrupted routine health services. The reallocation of health workers to pandemic response efforts and the challenges of maintaining physical distancing in densely populated slums further impeded vaccination delivery.

Despite the initial setbacks, vaccination rates began to recover in the latter half of 2020. The easing of lockdown measures and the resumption of routine health services led to a rebound in vaccine administration. However, the study noted another decline in early 2021, attributed to a strike by health workers demanding better pay, which delayed national vaccination campaigns.

The regional disparities in vaccination coverage highlight the urgent need for tailored, region-specific interventions. Factors such as economic inequality, public health awareness, geographic barriers, and healthcare system weaknesses must be addressed to ensure equitable access to immunisation services. Targeted strategies such as improving health infrastructure, enhancing public awareness campaigns, and addressing resource allocation issues are crucial in mitigating the effects of future health crises.

While Bangladesh’s health system showed resilience in recovering from the early impacts of COVID-19, the pandemic exposed deep regional disparities in immunisation coverage. Addressing these gaps will require comprehensive, region-specific solutions to ensure that all children have access to life-saving vaccines, regardless of where they live. 

Reference: 

Akter E, Sayeed A, Siddique AB, Ahamed B, Manna RM, Hossain L, et al. Unveiling the dimension of regional disparities: Assessing the disruption of immunisation services by COVID-19 in Bangladesh. J Glob Health [Internet]. 2024;14:05028. Available from: http://dx.doi.org/10.7189/jogh.14.05028