According to the EPI Coverage Evaluation Survey (CES) 2019, more than 95% of urban and rural children receive immunisation in Bangladesh [1]. Even after such a stellar success rate, zero-dose children or children who did not receive a single dose of the Pentavalent vaccine exist in rural and urban settings. This article examines a comparative analysis between Bangladesh and other countries, identifies the reasons for children not receiving any vaccination, analyses the reasons relevant to Bangladesh and recommends governance solutions to stakeholders and policymakers.

Cata-Preta et al (2021) explored the immunisation pattern and the dynamics of zero-dose children in 92 countries. According to their research study, 7.7% of children in the 92 countries were in the zero-dose population. A certain relation between the first and all vaccination doses can be traced in their research. 76.8% of children who received the first vaccine received all the types of vaccine doses. According to their analysis, the zero-dose rate was 9.0% in rural and 5.2% in urban settings [2]. The research suggested that children vaccinated with the initial vaccine tend to receive several vaccines and that poorer children are likely to be zero dose [3]. Two other factors discovered by researchers in India that led to zero-dose children were less than 10 years of schooling among mothers and living in a nuclear family [4]. Another group of researchers in India claimed that the pandemic could be a barrier to immunisation progress globally [5].

The comparative analysis shows certain reasons for the existence of zero dose around the globe. The aim is to understand the implications of the reasons relevant to Bangladesh. Income level and education level are two reasons that can be valid in the case of Bangladesh. Although EPI vaccines are free of cost in Bangladesh, most NGOs who provide vaccines in urban settings ask for service charges, which puts the marginalised population in a difficult financial position. Furthermore, marginalised populations often need to be informed about vaccination programmes and their needs.

It is evident that the issue of zero dose requires the necessary initiative from the Government of Bangladesh (GoB) and all relevant stakeholders to be resolved. The government can conduct various awareness campaigns to educate caregivers on the importance of vaccination through the National Committee for Immunisation Practice (NCIP). The private sector should also come up with effective initiatives to support the government’s efforts to improve immunisation coverage.


  1. Ministry of Health and Family Welfare, Bangladesh. “EPI Coverage Evaluation Survey (CES) 2019.” Directorate General of Health Services, 2019, [cited 2023 Apr 15]. Available from:
  2. Cata-Preta BO, Santos TM, Mengistu T, Hogan DR, Barros AJD, Victora CG. Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low and middle-income countries. Vaccine [Internet]. 2021;39(32):4564–70. Available from:
  3. Joy TM, George S, Paul N, Renjini BA, Rakesh PS, Sreedevi A. Assessment of vaccine coverage and associated factors among children in urban agglomerations of Kochi, Kerala, India. J Family Med Prim Care [Internet]. 2019;8(1):91–6. Available from:
  4. Restrepo-Méndez MC, Barros AJD, Wong KLM, Johnson HL, Pariyo G, França GVA, et al. Inequalities in full immunisation coverage: trends in low- and middle-income countries. Bull World Health Organ [Internet]. 2016 [cited 2023 Apr 15];94(11):794-805A. Available from:
  5. Taneja G, Datta E, Sapru M, Johri M, Singh K, Jandu HS, et al. An equity analysis of zero-dose children in India using the National Family Health Survey data: Status, challenges, and next steps. Cureus [Internet]. 2023;15(2):e35404. Available from:

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