Two crucial national campaigns — distribution of deworming tablets and Vitamin A Plus capsules — have remained suspended for over a year, a disruption experts say may have worsened the measles outbreak.
These campaigns aim to improve children’s immunity and nutritional status, and lapses are likely to increase malnutrition and weaken immunity, making measles more severe, they added.
Although both campaigns were scheduled twice a year, the National Deworming Campaign has not been held since May 2024, and the last National Vitamin A Plus campaign took place in March last year, officials said.
They blamed the cancellation of the sectoral programme, under which the campaigns were funded, without renewed funding by the interim government, as well as complications in the tendering process to procure capsules.
The matter comes to light as the country faces a measles outbreak on a scale unprecedented in the past two decades.
The Directorate General of Health Services (DGHS) reported 23 confirmed measles deaths yesterday. With the latest report, the number of suspected measles deaths since March 15 has risen to 143. Besides, over 12,000 suspected cases have been reported nationwide during this time.
Experts link the crisis to disruptions in routine measles vaccinations, last year’s health workers’ strikes, and the prolonged gap in special campaigns for children who missed the routine programmes.
Epidemiologist Prof Mahmudur Rahman said, “Vitamin A strengthens immunity, so when children with deficiency are infected with measles, they suffer more severe complications.”
“If deworming is not carried out, children cannot fully utilise the food they consume, leading to malnutrition and comorbidities,” Prof Mahmudur, a former director of the Institute of Epidemiology, Disease Control and Research (IEDCR), also told The Daily Star yesterday.
Prof Mushtaq Husain, a public health expert, noted that children from marginalised communities are especially vulnerable, as malnutrition and lack of supplements heighten complications.
“Vitamin A capsules make a big difference. Anyone can be infected with measles, but the lower the immunity, the higher the risk of complications,” he told The Daily Star yesterday.
Prof Husain also said worms prevent absorption of nutrients from food. “This is why there is a direct link between measles casualties and the absence of the two campaigns,” he added.
The last Vitamin A Plus campaign, in March 2025, targeted 2.26 crore children aged six to 59 months.
Prof Anjuman Ara Sultana, the former line director of National Nutrition Services, said that although the tenure of the 4th Health, Population and Nutrition Sector Programme (HPNSP) ended in June 2024, there was enough capsule in stock to carry out the March 2025 campaign.
Since 1998, four HPNSPs have been implemented, with the latest ending in June 2024. The interim government scrapped the proposed fifth programme in March 2025, opting instead to integrate sectoral programmes into regular ones.
Several projects were later approved to continue unfinished tasks and ensure the supply of medicines and vaccines, but approvals were significantly delayed — some until November last year — causing funding shortages for vaccines, medicines and even the salaries of many health workers, health officials said.
After the expiry of the sector programme, the Institute of Public Health Nutrition (IPHN) was supposed to carry out the Vitamin A Plus campaign.
Contacted, Mohammed Eunus Ali, director of IPHN, said they had planned to distribute Vitamin A capsules in November or December last year but did not receive the supply.
He said that in the absence of an operational plan, a fund was arranged from the DGHS to procure capsules through Central Medical Stores Depot (CMSD).
But CMSD had to cancel two bidding processes because the bidders quoted unusually high rates, he told this correspondent early last week, adding that the third bidding process is now awaiting administrative approval.
Asked when the campaign could be carried out, he said, “Once the tender process is completed, the campaign schedule can be announced.”
Back in 2005, the government launched the soil-transmitted helminth (STH) control programme after stool tests showed 80 percent of children had worms, a DGHS official said.
Since then, the national deworming campaign has been carried out under the Communicable Disease Control (CDC) programme, providing deworming tablets twice a year to school-going children aged 5 to 16, he said, requesting anonymity.
The stool positivity rate fell to below eight percent in 2018–19, he said, adding that the last campaign was held in May 2024, with coverage reaching around 96 to 98 percent.
He said the campaign cost is relatively low, as the tablets are supplied free of cost through the World Health Organization, yet the campaign has not been held in the past two years.
Contacted, Prof Halimur Rashid, DGHS director (Disease Control) and the last line director of the CDC programme, said the campaign could not be held in the absence of an operational plan.
However, they have supplied around four crore deworming tablets to hospitals.
When asked how all school-going children would receive the tablets from hospitals, since medical facilities usually provide them only to those who come for treatment, Prof Halimur Rashid did not respond.
Replying to another question, he said the campaign would be carried out again if the operation plan is revived or the government decides to do so. “The matter is not that urgent at the moment,” he added.
