Where the road ends, vaccination begins: Bangladesh’s MR campaign on the Jamuna’s shifting islands

Down winding backroads through palm-fringed rice fields, then a three-hour shallow-boat journey up the Jamuna River, WHO Surveillance Immunization Medical Officer (SIMO) Dr Tarik Md Reza and Health Inspector in-Charge, Sariakandi Upazila, Mst Serajum Monira, arrive at Hatbari Primary School, Bogura District, converted for the day into a measles–rubella (MR) vaccination centre.

Their mission: to ensure every child in Bangladesh aged 6 months to under 5 years, wherever they live, is protected from measles.

“Every child deserves the same protection,” says Dr Tarik, one of 61 WHO SIMOs funded by Gavi, the Vaccine Alliance, supporting the Government-led emergency campaign. “Distance, terrain, access – these cannot decide who is protected and who is not.”

^{Before setting out for the day, WHO SIMO Dr Tarik observes the quality of key vaccination processes at Sariakandi Upazila Health Complex, which is coordinating the campaign across the upazila.}

Since mid-March, a rapidly spreading measles outbreak has reached 59 of the country’s 64 districts. As of 5 May, almost 43 000 suspected measles cases and 263 suspected deaths have been reported, with children under 5 disproportionately affected.

Launched on 5 April in 30 high-risk upazilas across 18 districts, the emergency campaign was expanded nationwide on 20 April, targeting about 18 million children. Dr Tarik and Mst Serajum’s monitoring visit is part of ongoing, country-wide efforts to ensure safe, high-quality vaccination for every child.   

At the vaccination site, Mst Serajum moves between the table and the register, watching closely how vaccines are handled, how injections are given and how each child is recorded.

“I cover more than 250 vaccination centres, including very remote ‘char’ areas,” she says, checking a child’s vaccination card. “I am proud to support these communities.”

Hatbari is one of many river islands, known locally as chars, that form and shift along the Jamuna. These low-lying sandbars expand, erode and are often partly submerged during the monsoon, making access to health services difficult and unpredictable for the communities who live there.  

_{Mst Shabbana, 18, waits with her 14-month-old daughter Sadika at the temporary vaccination site in Hatbari char, Bogura District.}

For Mst Shabbana, 18, who lives in Hatbari, the campaign provides a critical point of access for her 14-month-old daughter.

“This is the first time Sadika is getting the measles vaccine,” she says, waiting in line as children dart between the classrooms and a nearby haystack. “I brought her so she can be healthy and safe.”

Twenty-year-old Savina says she was unaware of the outbreak itself, only the call to vaccinate.

“I didn’t know about the measles deaths,” she says, standing beside her 4-year-old daughter, Marium. “There is no television or news here. I heard the announcements and came to vaccinate my daughter.”

Delivering protection, one char at a time

With monitoring in Hatbari complete, Dr Tarik and Mst Serajum return to the shallow boat for a half-hour journey to the next stop – a nearby char known locally as Dalika.

There, Md Aminul Islam, a Health Assistant with 16 years of experience, works through the mid-afternoon heat, deployed from his post in Chaluabari, about 10 kilometres south, to support the effort.

^{Redeployed from Chaluabari, Health Assistant Md Aminul Islam prepares an MR vaccine dose on Dalika char, Bogura District.}

“The first thing I did this morning was clean and decorate the centre to reduce children’s fear,” he tells the monitoring team. “Then I prepared the vaccination cards and started work.”

To reach families, he used the mosque’s loudspeaker, calling people to the site across the char. Turnout, he says, has been strong, with children continuing to line up throughout the afternoon.

“In this ward, there are 452 children to be vaccinated,” he says, checking the register. “I will vaccinate all of them today and tomorrow.”

If necessary, he says, he’ll speak directly with parents, persuading them of the life-saving benefits of vaccination.     

As the afternoon heat subsides, Dr Tarik and Mst Serajum make their way back to the boat, past sheets of drying corn and peanuts spread across the sand, with livestock grazing nearby.

^{For Dr Tarik and Mst Serajum, the campaign’s success depends on building protection, one char at a time, for every child across Bangladesh.}

The boat pulls away, tracing the shifting routes between islands.

“Out here, you cannot wait for people to come to services. You have to take services to the people,” says Dr Tarik, before pausing.

“That is how you stop an outbreak. That is how you build protection – and access – for the future.”