Immunisation Programme in Severe Staffing Crisis: 40% of Posts Vacant, Over Half of Cold-Chain Technician Posts Empty, Joint Review Finds
A staffing crisis has become acute in the country's Expanded Programme on Immunization (EPI). Forty percent of the approved vaccinator posts are vacant. For want of the necessary manpower, Bangladesh's national immunisation programme — once an exemplary success in South Asia — now faces a range of challenges.
A report by a Joint Independent Review Team, formed recently with domestic and foreign experts, has laid out these shortcomings in the EPI's manpower, vaccine storage, service coverage and management. The team was formed with representatives of the World Health Organization (WHO), UNICEF, Gavi — the global alliance working on vaccine supply and delivery — the health ministry, EPI officials and public health experts, to assess the causes of outbreaks of measles and other infectious diseases, the vaccine situation and the EPI's activities.
The 70-member team, divided into nine sub-teams, began work on October 3 and submitted its report to the government on October 14. Alongside a national team, eight divisional teams collected information at field level. Each divisional team visited two upazilas in two districts. During the visits they inspected vaccination centres, schools and madrasas, and spoke with mothers who had come for vaccination and been turned away, new mothers, and mothers and daughters from various families.
According to the review report, 53 percent of the EPI's cold-chain technician posts are vacant. In addition, 34 percent of posts of field-level health assistants, health inspectors and related staff, and 45 percent of posts at the EPI's central office, are vacant. In urban areas, 90 percent of vaccinators are staff of non-governmental organisations (NGOs), and oversight of their work is weak.
In addition, a seven-month work stoppage by vaccinators in 2025 disrupted immunisation activities. The suspension of volunteers' honorariums has also affected field-level work.
To sustain the programme's achievements, the team recommended filling the vacant posts quickly, creating new posts as needed, strengthening the vaccine storage system and allocating sufficient funds to run services at field level.
State Minister for Health and Family Welfare Dr M A Muhit also acknowledged the staffing crisis, saying the government will recruit the necessary manpower to fill the gaps and will work to implement the experts' recommendations. The state minister said a review of the EPI programme with international experts is normally carried out every four to five years, identifying weaknesses and recommending remedies; but no such review had taken place in the past eight years — neither the previous government nor the interim government did this important work. He said that after eight years a review of the EPI programme had recently been conducted with domestic and foreign experts, with expert teams sent to all eight divisions; they inspected the programme in person and identified various shortcomings by speaking with vaccinators, and the government will work to implement their specific recommendations. Dr Muhit said the recommendations have already been discussed with the civil surgeons of all 64 districts and the divisional health directors of the eight divisions, and necessary initiatives are being taken to fill the identified gaps.
State Minister Dr Muhit said Bangladesh's national immunisation programme once achieved success that was exemplary in the world, vaccinating a huge population with limited resources. The foundation of that success was effective management, manpower suited to delivering services at the grassroots and a strong surveillance system. But over the past eight to ten years, he remarked, that surveillance system has broken down.
The evaluation report says Bangladesh's EPI, begun in 1979, once earned international recognition for vaccinating a large population with limited resources. But although population growth, urbanisation and the expansion of immunisation activities increased the programme's scope, its staffing structure was not expanded accordingly.
According to the report, more than 120,000 vaccination centres and related facilities in the country have been identified through Geographic Information System (GIS) technology along with population data. However, considering population density and risk, there is inequality in the distribution of vaccination centres; in remote and high-risk areas there are fewer centres than needed.
Under the Urban Immunisation Strategy 2019 and the EPI Microplan 2024, six vaccinators are needed for every 50,000 people. The urban immunisation strategy also sets a standard of one vaccinator for every 8,300 people. But these manpower requirements have not been met. Services are provided through health assistants in rural areas and through local government and NGOs in urban areas, at permanent and temporary vaccination centres. Under the plan, eight vaccination sessions are to be held in each ward every month and 24 outreach sessions in each union every month. But for want of the necessary staff and funds, running these activities regularly and to standard has become difficult.
Dr Tajul Islam A Bari, a public health expert and vaccinologist who is a member of the evaluation team, said shortcomings were found at field level in maintaining the correct temperature of vaccines and storing them according to the prescribed rules, creating a risk that vaccine quality will be damaged. He said that alongside recruiting manpower, the correct maintenance of vaccine temperature, improvement of the storage system and funding for field workers' travel must be ensured; there is not even enough money to transport vaccines from district to upazila level. The report says the staffing crisis in cold-chain management can put vaccine storage and distribution activities at risk; to preserve vaccine effectiveness, the prescribed temperature and storage rules must be followed from production and supply through to administration at field level.
