Beyond immunity gaps: health-system constraints and measles mortality in Bangladesh.

Bangladesh is experiencing its largest measles outbreak in two decades, with mortality that appears disproportionate to the reported case burden. While declining vaccination coverage has received considerable attention, health-system factors contributing to mortality remain underexplored. Government data show that nearly half of confirmed measles deaths occurred among infants too young for routine vaccination. A review of 34 media-profiled pediatric deaths identified recurrent barriers, including limited pediatric intensive care capacity, multiple facility transfers, referral delays, financial hardship, and geographic inequities in access to critical care. Reducing measles mortality requires strengthening both immunization coverage and health-system capacity, particularly pediatric critical care, oxygen therapy, and equitable access to emergency services.