A Knock on the Front Door

In the mid 70s, I lived in a one storey house near Bangla Motor. Thereafter, every year there was a knock on the front door. A female health worker would come and vaccinate my two young boys, the servants and me against measles and small pox.  A health worker could easily track every child in her neighbourhood. Measles, while always a threat, was frequently cornered because the human chain of transmission was interrupted by open spaces. It was an era of one to two storey houses, open space and flow of air. 

But gradually the population exploded without any population policy. While China, a vast country, had a policy of, “One family one child”, we in Bangladesh, failed to implement a stringent population control policy. Consequently, after decades, there was a massive population explosion creating immense problems of housing, employment, unemployed youths, diseases and related problems. The door to door health visits were stopped due to population boom and the government established 575 health clinics. For measles, Bangladesh launched its ‘Expanded Programme on Immunization’ (EPI) in 1979. By 1982, the measles vaccination was effectively at 1% to 2%. The next few decades Bangladesh produced a world class vaccination framework ultimately driving coverage up to 96%to 97%.

Unfortunately measles epidemic is widely viewed by experts as direct governance and procurement failure. The Interim Government under Prof Yunus declared that the old procurement mechanism �" which relied primarily on UNICEF and Gavi �" was operating under emergency provisions. The goal of introducing an open tender system in September 2025 was to establish a more competitive ‘rule based’ and transparent domestic procurement process that would allow private suppliers to bid for contracts. 

Reports published in major scientific journals like ‘Science’ and Health Ministry evaluation highlight that the policy did not achieve its intended success and instead led to severe consequences.
 
The Bureaucratic Deadlock: The open tender system became entangled in administrative delays, paperwork and slow fund approvals prevented timely shipments.

Widespread Measles Epidemic:  Despite warnings from UNICEF before the roll out, the resulting supply gaps left millions of children under-immunized.  By early 2026 Bangladesh suffered a major measles outbreak, reporting tens of thousands of infections and hundreds of child deaths. 

Another lethal disease is Dengue. It is a disease that shifted from ‘Dacca fever’ to Urban Crisis.

The reason we did not hear of dengue in the late 70s and early 80s is because the virus did not exist in epidemic form and the population was manageable.

Timeline: The first severe nationwide epidemic of Dengue Hemorrhagic Fever did not strike until the year 2000 when the population exploded and construction boom took place.

Why is it an Emergency Now?: Dengue’s explosion is less about a lack of specific vaccine safety net and more about unmanaged urbanization, lack of hygiene,  failed civic planning and climate shifts. Unchecked real estate construction, limited open space, inadequate municipal waste management and warming monsoon season have created a paradise for the Aedes albopictus mosquito. The policy failure rests with Municipal Corporations’ inability to transition from reactive ‘monsoon spraying’ to year- round vector surveillance and strict enforcement of environmental building code to allow open spaces for free flow of air and retain parks.

With the advent of Ready Made Garments (RMG) many people got employment and many have become wealthy. Suddenly, families owning quiet, low-rise bungalows found themselves sitting on goldmines. Professional developers stepped in with joint-venture models: they demolished the traditional homes, built towering multi-story apartment blocks, and split the flats. Almost overnight, Dhaka went aggressively vertical, transforming into a dense, grey labyrinth of asphalt and cement with poor water management.   

The highest proportion of Adeas larvae (35.23%) was discovered in modern multi-storey buildings while single storey buildings accounted for 27%. Rapidly developing neighbourhoods like Mirpur, Mohammadpur and Uttara with numerous building constructions have 17.44% of all active breeding grounds due to unmanaged water-logging. 

A total of 198 people died of dengue till date and there are 65,499 recorded hospital admission of dengue patients at the same time. 


Some of the areas of highest prevalence of dengue in Dhaka city are the following:

Dhaka North City Corporation (DNCC) Areas in Mirpur 2, Kazipara, Shewara-para. Mohammedpur,   Shamoyli,  Rayerbaza,  Kochukhet, Ibrahimpur, Baunia, Mohakhali and  Uttara. In Dhaka South City Corporation high risk wards are 28 wards which span Dhanmondi, Kalabagan, Khilgaon, Basabo, Mugda, Lalbagh, Azimpur and Jatrabari.
    
Clean Stagnant Water: Calm unmoving water in areas where water is scarce and stored in drums and buckets are places for dengue larvae. Adeas mosquitoes. They do not lay eggs directly on top of the water. They glue them to the wet inner walls of the container just above the water line..These eggs can survive for several months. The moment the container fills with clean water the eggs hatch almost instantly. The dengue mosquitoes are active during the day. They fly low to the ground and tend to bite humans around the ankles and elbows. 

Multi-Storey and Single Storey Buildings: The highest proportion of Adeas larvae (35.23%) was discovered in modern multi-storey buildings while single storey buildings accounted for 27%. Rapidly developing neighbourhoods like Mirpur, Mohammadpur and Uttara with numerous building constructions have 17.44% of all active breeding grounds due to unmanaged water-logging.

Domestic Water Storing Habits:  In areas with irregular water supply, residents are forced to store water and a survey discovered larvae breeding directly inside households with stagnant water in drums, buckets and plastic containers.

The Direct Result of Dengue Bite

An infected person feels normal while the virus multiples in the immune cells. The symptoms strike suddenly with high fever (104degrees), intense headache, nausea and flat red rash. As the fever drops patients suffer from a threatening internal bleeding or shock.
 
Hydration is the priority:  Dengue patients lose water from fever and vomiting. So a patient needs oral saline or fluid with electrolytes. Only paracetamol can be used to control high fever and body aches.
 
A vaccination Odenga by WHO is for children living in areas with exceptionally high dengue transmission rates is useful.
  
How to Safely Store Water to Prevent Dengue

Follow the "3C" method:

* Cover tightly: Seal all water storage vessels with airtight lids or heavy plastic sheets.

* Clean weekly: Scrub the inside walls of your water containers with detergent and a brush at least once a week.
 
* Consume quickly: Use stored water within 3 to 5 days. Empty, wash, and dry the containers before refilling them.

Key Dengue Prevention Guidelines for Your Household

* Larviciding: (an insecticide) Apply eco-friendly larvicide or bleaching powder to permanent water sources that cannot be easily drained or covered.

* Personal protection: Install mosquito nets over beds and keep windows closed or screened. 

A tragic case of proliferation of disease is also the commercial transformation of numerous parks in Dhaka which were leased by city corporations to private individuals leading to unclean illegal buildings and commercial stalls with pools of stagnant water. There is hardly an open space for free flow of air.

The current crisis of measles and dengue is immense.  But there is hope. We have risen from the ashes of history time and again, proving to the world that when this nation coordinates its collective will even the most deeply entrenched crisis can be dismantled. As the Emergency gates open let us not just deploy medicine, let us deploy our collective determination. Let us show the world that when we choose to protect our children and citizens, there is no boundary we cannot cross and no disease we cannot defeat.