A community outreach immunisation session during the EPI review in Bangladesh.

Bangladesh EPI review highlights priorities for strengthening immunisation workforce and surveillance systems

NCIRS Head of Global Health joins WHO-led review of Bangladesh’s immunisation program

Between 4 and 14 October 2026, the World Health Organization South-East Asia Regional Office (WHO SEARO), in partnership with the Government of Bangladesh and international technical partners, conducted an independent external review of Bangladesh’s Essential Programme on Immunization (EPI) and vaccine preventable disease (VPD) surveillance system. 

The review was commissioned at the request of the Government of Bangladesh following concerns about immunity gaps identified during the 2026 measles outbreak. It included an assessment of the country’s outbreak response and an evaluation of recent vaccine introduction efforts, including human papillomavirus vaccination.

The review examined program performance across the country’s 8 divisions, assessing immunisation coverage, service delivery, disease surveillance, workforce capacity, vaccine supply systems and outbreak preparedness.

Among the international experts invited to participate was Professor Gulam Khandaker, NCIRS Associate Director and Head of Global Health, who served as an independent reviewer alongside WHO specialists, national experts and development partners.
 

A strong program facing new challenges 

For more than 4 decades, Bangladesh has been recognised as one of the world’s immunisation success stories. Since the establishment of the EPI in 1979, its achievements have included maintaining a polio-free status, eliminating maternal and neonatal tetanus, controlling rubella and successfully introducing new vaccines to protect children and communities. 

The review found that Bangladesh continues to benefit from a mature immunisation program supported by an extensive national delivery network, experienced frontline health workers, strong government commitment and established disease surveillance systems. The country retains a nationwide platform capable of delivering vaccines through both fixed and outreach services, supported by government agencies, non-government organisations and development partners.

The assessment also identified significant workforce challenges, with implications for the program’s long-term sustainability and its ability to maintain high immunisation coverage.

A key finding was the growing shortage of frontline immunisation personnel, particularly among community-based vaccinators and supervisory staff, including Health Assistants, Assistant Health Inspectors and Health Inspectors. The review also identified significant shortages in specialist logistics and cold-chain personnel responsible for maintaining vaccine storage equipment and managing vaccine supplies.

The review noted that many frontline workers are carrying increasingly complex responsibilities – including vaccination, surveillance, data reporting, outbreak response, household registration and community engagement – while operating in an environment of staffing shortfalls and expanding program demands.
 

Lessons from the measles outbreak

The 2026 measles outbreak highlighted the risks that emerge when immunity gaps develop within communities. The review found that maintaining high national coverage alone is insufficient if certain populations, geographic areas or groups experiencing barriers to vaccination remain under-immunised.

Review teams examined outbreak detection and response systems to identify lessons that could strengthen preparedness for future public health threats. A major conclusion was the need to further strengthen surveillance systems, workforce capacity and local program management to enable earlier identification of and response to emerging risks.

The review also recognised that new vaccines, expanding digital reporting requirements and growing urban populations are increasing demands on the immunisation workforce.
 

Priorities for further strengthening

The review identified several priority actions to help Bangladesh strengthen its immunisation program.
Immediate recommendations include: 

• accelerating recruitment to fill critical workforce gaps, particularly among frontline vaccinators, supervisors, medical officers, cold-chain technicians and logistics personnel
• establishing a dedicated recruitment and deployment taskforce to fast-track appointments and monitor progress
• strengthening medical leadership at district and subnational levels 
• improving oversight of immunisation services, disease surveillance, outbreak preparedness and adverse event monitoring through dedicated public health and disease-control positions.

Longer-term recommendations focus on modernising workforce planning, strengthening urban immunisation programs, investing in staff training and competency development, improving accountability mechanisms and developing a sustainable financing model as Bangladesh transitions towards greater domestic financing.

The review also recommended the development of a comprehensive national workforce database and dashboard to improve planning, deployment and monitoring of immunisation personnel across government and partner-supported services.
 

Shared learning across the region

For NCIRS, participation in the review provided an important opportunity to contribute technical expertise while learning from one of the world’s largest immunisation programs.

Professor Khandaker’s involvement contributed Australian and international experience in immunisation program strengthening, VPD surveillance and outbreak response to the review process. The findings will also help inform the NCIRS Global team’s ongoing work to support immunisation programs across the Asia-Pacific region.