The prevalence of zero dose  and under-immunisation among children in Bangladesh has decreased over the years. According to the WHO-UNICEF estimates, the proportion of children who did not receive any vaccinations decreased from 5.5% in 2010 to 1.5% in 2020 [1]. However, the prevalence of zero dose and under-immunisation varies significantly across different regions of the country, with the highest rates found in remote and hard-to-reach areas and communities. The country still faces challenges in achieving universal vaccination coverage, and the prevalence of zero dose and under-immunisation remains a concern.

Various factors contribute to the prevalence of zero dose and under-immunisation in Bangladesh. These include poverty, lack of awareness about vaccines, limited access to healthcare services, and inadequate vaccine supply and distribution systems. Furthermore, vaccine hesitancy, fueled by misinformation and distrust of the healthcare system, is also a growing concern in the country. The COVID-19 pandemic has also affected routine immunisation services, leading to disruptions in vaccine delivery and uptake [2].

The Government of Bangladesh (GoB) has implemented various measures to improve vaccination coverage and reduce the prevalence of zero dose and under-immunisation. These include the development of a comprehensive national immunisation program, the establishment of cold chain facilities for vaccine storage and transportation, and the deployment of mobile vaccination teams to reach remote and underserved areas. Furthermore, NGOs and community-based organisations have been involved in delivering immunisation services, particularly in hard-to-reach areas [5]. Furthermore, the private sector has supported the government’s efforts to strengthen the vaccine supply and distribution systems, by investing in the development of cold chain infrastructure and vaccine logistics.

Despite the progress made in expanding immunisation coverage, significant challenges remain. One of the major challenges is the uneven distribution of vaccine coverage across the country, with disparities observed between urban and rural areas. Furthermore, vaccine hesitancy and misinformation continue to be significant barriers to achieving universal immunisation coverage. The COVID-19 pandemic has also highlighted the need for strengthened health systems and resilient vaccine supply chains [4].

To address these challenges, the GoB needs to continue investing in  development of a robust and sustainable immunisation program. This includes strengthening the vaccine supply and distribution systems, addressing vaccine hesitancy through targeted communication and community engagement efforts, and ensuring that all communities have access to quality healthcare services. The private sector can also play a critical role in supporting the government’s efforts to improve immunisation coverage and reduce the prevalence of zero dose and under-immunisation.

References

1)   Ministry of Health and Family Welfare, Bangladesh. EPI Coverage Evaluation Survey (CES) 2019. Directorate General of Health Services, 2019, old.dghs.gov.bd/images/docs/vpr/Coverage_Evaluation_Survey_2019.pdf. Accessed 6 Mar. 2023.

2)   Rahman M, Obaida-Nasrin S. Factors affecting acceptance of complete immunisation coverage of children under five years in rural Bangladesh. Salud Publica Mex [Internet]. 2010 [cited 2023 Apr 15];52(2):134–40. Available from: https://www.scielosp.org/pdf/spm/2010.v52n2/134-140/en

3)   Equity in immunization [Internet]. Who.int. [cited 2023 Apr 15]. Available from: http://www.who.int/europe/news-room/fact-sheets/item/equity-in-immunization

4)   Overcoming challenges in the immunisation programme with vaccine heroes [Internet]. Who.int. [cited 2023 Apr 15]. Available from: https://www.who.int/philippines/news/feature-stories/detail/overcoming-challenges-in-the-immunization-programme-with-vaccine-heroes

5)   Alexander S. 5 vaccination challenges you need to know [Internet]. ONE. 2020 [cited 2023 Apr 15]. Available from: http://www.one.org/international/blog/5-vaccination-challenges