As neighbouring Bangladesh battles an ongoing measles outbreak that began in mid-March and has killed over 500 children, Nepal has reported outbreaks in seven districts since January. But emergency vaccination drives in Nepal have been limited to select areas due to vaccine shortages.

According to the Immunisation Section at the Family Welfare Division, measles outbreaks occurred in Sarlahi, Baglung, Mahottari, Kalikot, Dailekh, Achham and Siraha districts. But officials say response vaccination drives were limited—ring vaccinations were conducted only in the Sarlahi district and Dhorpatan Municipality of Baglung district.

No deaths have been recorded, but outbreaks since January have infected over 300 children, including more than 200 in Baglung district alone.

Officials say every child in the outbreak areas should ideally be vaccinated as part of the response, but they could not do so due to vaccine shortages.

The Health Ministry recently received 200,000 doses of measles vaccine from an aid agency, several months after requesting emergency supplies.

“We are now considering where to administer these vaccine doses, as the quantity is not sufficient to cover all outbreak-affected areas,” Dr Abhiyan Gautam, chief of the Immunisation Section, told the Post.

Measles is a highly contagious disease that spreads through respiratory droplets from the nose and mouth of an infected person. It can be fatal, especially for unvaccinated people.

Citing Bangladesh, India and other South and South-East Asian countries, including Myanmar, they say Nepal could face a major measles outbreak at any time, as continued government neglect of the risks and weak preparedness leave the country vulnerable.

They say countries with stronger immunisation systems have managed to limit deaths and large-scale outbreaks. But Bangladesh has witnessed a far worse situation, which experts link to disruptions in routine immunisation following the political upheaval in 2024.

According to media reports, the interim government that took charge in August 2024 halted vaccine procurement through the United Nations Children’s Fund, and this resulted in depleted stocks, delays in routine immunisation and a surge in measles cases.

An official at Nepal’s Department of Health Services, speaking on condition of anonymity, said contract health workers and vaccinators have been removed by the new government of the Rastriya Swatantra Party. “We are also veering towards a Bangladesh-like scenario,” the official said, adding that health worker positions have been cut and vaccine procurement have not been given priority despite repeated outbreaks.

Health officials say Nepal currently has neither vaccine buffer stocks for outbreak response nor dedicated budget for emergencies. They added that assistance from aid agencies have also become slower and less reliable.

“If aid agencies do not respond on time or take too long to provide vaccine doses, it is the responsibility of the government to protect its population,” said Dr Shyam Raj Upreti, former director general at the Department of Health Services. “The government cannot escape its prime responsibility of saving children’s lives.”

Low vaccination coverage, a floating population, lack of public awareness of the importance of vaccines, and apathy among government agencies in plugging loopholes are some reasons behind the regular outbreaks of measles in various parts of the country.

Experts urge stronger focus on pockets of poor and marginalised communities, where immunisation coverage is very low. They also urge authorities to allocate dedicated funds for outbreak response and maintain buffer stocks of life-saving vaccines.

Measles can be prevented with a two-dose vaccine, administered at 9 months and 15 months of age. The government provides measles vaccines free of charge from health facilities across the country.

Nepal had aimed to eliminate measles by 2026, as there had been no outbreak since June 2023. However, recent outbreaks have hindered the country’s progress towards that goal.

The country earlier missed the 2023 and 2019 deadlines. A massive measles outbreak occurred in 2022 and 2023.

To declare measles eliminated, the number of cases should be fewer than five per 1,000,000 people per year. The country must verify progress through foreign, independent verification. For independent verification, there should be no new outbreaks for three consecutive years, officials say.

Doctors say people of all age groups are vulnerable to the disease. Underage children, pregnant women, elderly people and those with weak immunity, such as HIV-infected people, are at higher risk

Early symptoms, which usually appear 10-12 days after infection, include high fever, runny nose, bloodshot eyes and white, tiny spots inside the mouth. Several days later, rashes develop on the face, upper neck and other parts of the body.

Some patients develop severe complications such as pneumonia and encephalitis, which can be fatal.

Measles was once endemic in Nepal, and an average of 90,000 cases were recorded every year between 1994 and 2004. Routine measles vaccination began in the country in 1979, starting with three districts. The campaign was made nationwide after 10 years.