Review flags vaccine storage risks and weak urban oversight.
Representational image. Photo: Collected
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Representational image. Photo: Collected
Bangladesh’s Expanded Programme on Immunisation (EPI) is facing a severe staff shortage, with 40% of sanctioned vaccinator posts vacant. The shortage is creating challenges for a programme once recognised as a model of success in South Asia.
The findings emerged in a recent report by a Joint Independent Review Team comprising local and international experts, which identified shortages in staffing, vaccine storage, service coverage, and management.
To sustain the programme’s achievements, the team recommended quickly filling vacant posts, creating new positions where needed, improving vaccine storage facilities, and allocating adequate funds for field-level services.
According to the report, 53% of cold-chain technician posts, 34% of field-level positions including health assistants and health inspectors, and 45% of posts at the EPI headquarters are vacant. In urban areas, 90% of vaccinators are employed by non-governmental organisations (NGOs), with weak oversight of their activities.
Vaccination activities were also disrupted by a seven-month work stoppage by vaccinators in 2025. The suspension of payments to volunteers further affected field-level operations.
Infograph: TBS
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Infograph: TBS
The Joint Independent Review Team was formed with representatives from the World Health Organisation (WHO), Unicef, Gavi, the Vaccine Alliance, the health ministry, EPI officials and public health experts to assess the causes of measles and other infectious disease outbreaks, the vaccination situation and EPI activities.
The 70-member team, divided into nine groups, began work on 3 October and submitted its report to the government on 14 October. Alongside a national team, eight divisional teams collected field-level information.
Each divisional team collected information from two upazilas in two districts.
The teams visited vaccination centres, schools and madrasas and spoke to mothers who had returned from vaccination centres without receiving services, new mothers, and mothers and daughters from different households.
State Minister for Health and Family Welfare MA Muhit also acknowledged the staff shortage.
He told The Business Standard that the government would recruit the necessary personnel to address the shortage and work to implement the experts’ recommendations.
Population grows, but staffing remains unchanged
According to the review report, Bangladesh’s EPI, launched in 1979, once earned international recognition for vaccinating a large population with limited resources. However, staffing has not expanded in line with population growth, urbanisation, and the expansion of vaccination services.
More than 1,20,000 vaccination centres and related facilities have been mapped using geographic information system (GIS) technology and population data. However, their distribution remains uneven, with remote and high-risk areas having fewer centres than required.
Under the Urban Immunisation Strategy 2019 and EPI Microplan 2024, six vaccinators are recommended for every 50,000 people in urban areas, or approximately one per 8,300 people. However, this requirement has not been met.
In rural areas, health assistants provide vaccination services, while local government bodies and NGOs operate fixed and temporary vaccination centres in urban areas.
Under the plan, each ward is supposed to conduct eight vaccination sessions per month and each union 24 outreach sessions. However, staff and funding shortages have made it difficult to maintain regular services and quality.
Concerns over vaccine storage
Public health specialist and vaccinologist Dr Tajul Islam A Bari, a member of the review team, told The Business Standard that shortcomings were found in maintaining proper temperatures and storage conditions for vaccines at the field level, creating risks to vaccine quality.
“There was also insufficient funding to transport vaccines from district to upazila level,” he said.
Alongside recruiting personnel, proper temperature control, improved storage facilities and adequate funding for field workers’ travel must be ensured, he added.
The report warned that staff shortages in cold-chain management could put vaccine storage and distribution at risk.
Maintaining prescribed temperatures and storage conditions throughout production, supply, transportation and administration is essential to preserving vaccine effectiveness, it said.
Review after eight years, govt promises action
State Minister MA Muhit said Bangladesh’s national immunisation programme was once recognised globally for vaccinating large populations with limited resources, supported by effective systems, adequate personnel and strong monitoring.
However, the monitoring system had broken down over the past eight to 10 years, he said.
The state minister said the EPI programme was generally reviewed by international experts every four to five years to identify weaknesses and recommend corrective measures.
“However, no such review had been conducted in the past eight years. Neither the previous government nor the interim government undertook the exercise,” he said.
Muhit said the recent review involved experts visiting all eight divisions, inspecting vaccination activities and speaking to vaccinators to identify shortcomings.
The recommendations had already been discussed with civil surgeons from all 64 districts and health directors from the eight divisions, and steps were being taken to address the gaps, he added.
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