Maternal vaccination can close the immunity gap for newborns

Despite remarkable progress in child survival, newborn deaths remain a major challenge in Bangladesh. According to recent estimates, about 60,000 newborns die each year in the country, with nearly three-quarters of these deaths occurring in the first week of life. Many of these deaths are caused by infections that strike before infants are old enough to receive routine vaccines. While Bangladesh expanded childhood immunisation and maternal health services over the past decades, protecting babies in the earliest days of life requires additional strategies. Maternal vaccination, which allows mothers to pass protective antibodies to their babies during pregnancy, offers a promising opportunity to reduce these preventable deaths and strengthen newborn survival. Yet, despite this potential, maternal immunisation remains absent from routine pregnancy care in Bangladesh, reflecting a collaboration gap between antenatal care services and the national immunisation programme.

The recent measles outbreaks in Bangladesh, where around 50 children have died and hundreds of cases have been reported this year, serve as a reminder of the risks posed by immunity gaps and the consequences of delayed or incomplete protection against infectious diseases. While measles primarily affects older infants and children, it reflects broader vulnerabilities in maintaining population immunity and protecting those who are too young to be vaccinated. This underscores the importance of complementary strategies such as maternal vaccination, which can provide early protection to newborns and help bridge the critical window before routine vaccination.

Maternal vaccination falls between two health platforms. Vaccine delivery is managed through the Expanded Programme on Immunization (EPI), while pregnancy care is provided through antenatal services. Because these systems often operate in parallel, vaccination is not routinely integrated into antenatal visits, and opportunities to counsel or vaccinate pregnant women may be missed. Bridging this gap will be essential to expand maternal immunisation and prepare for new vaccines that protect mothers and newborns.

Encouragingly, public trust in vaccines remains one of Bangladesh’s greatest strengths. Decades of successful childhood immunisation have built strong confidence among communities, families, and frontline health workers. National immunisation coverage for many childhood vaccines remains above 90 percent, and vaccination has become widely accepted as a normal part of protecting children’s health. Many women, therefore, view vaccination as an important step in safeguarding their own and their babies’ health. In community discussions, participants frequently expressed willingness to accept vaccines when they understand their benefits. As one pregnant woman mentioned during our qualitative fieldwork, “If the doctors or healthcare providers explain that this will help the child and prevent illnesses, of course I will say yes. Why would I want harm?” This deep-rooted trust creates a favourable environment for introducing new maternal vaccines, provided that pregnant women receive clear information and guidance from trusted health providers.

Antenatal care offers one of the most promising platforms for strengthening maternal immunisation in Bangladesh. According to the Bangladesh Demographic and Health Survey 2022, more than 85 percent of women receive at least one antenatal care visit during pregnancy. These contacts provide crucial opportunities to counsel women about vaccination and deliver vaccines at the right time. Timing is particularly critical for maternal vaccines, as they are most effective when administered during specific stages of pregnancy. Accurate assessment of gestational age is therefore essential. Ultrasound examinations, used by 94 percent of women who sought antenatal care during their pregnancies, can help determine gestational age and support the appropriate timing of maternal vaccination. However, a significant proportion, around 70 percent of antenatal care in Bangladesh is delivered through the private sector, where vaccination services are not always systematically integrated with the national immunisation programme. Strengthening coordination among immunisation programmes, public antenatal care services, and private providers could transform routine pregnancy visits into effective opportunities for maternal vaccination.

At the same time, the global maternal immunisation landscape is evolving rapidly. Tetanus toxoid-containing vaccines have long been administered during pregnancy to prevent maternal and neonatal tetanus, and some countries have introduced pertussis vaccination for pregnant women to protect newborns from severe respiratory infection. More recently, maternal vaccines against respiratory syncytial virus (RSV) have emerged as a promising tool to reduce severe illness in early infancy, while vaccines against Group B Streptococcus (GBS) are under development. Importantly, these vaccines are also considered highly cost-effective public health strategies because a single dose given during pregnancy can protect newborns during their most vulnerable months and reduce hospitalisations and healthcare costs. For Bangladesh, these innovations present both opportunities and challenges. While maternal vaccines could significantly strengthen newborn protection, their successful introduction will require preparedness across the health system. Without clear delivery strategies, provider training, and coordination across health services, new vaccines may face delays or low uptake. Planning must begin well before the vaccines arrive.

Research and evidence will play a critical role in guiding this process. The Maternal Immunisation Readiness Network in Africa and Asia (MIRNA), funded by the Gates Foundation, is a nine-country consortium working to strengthen the evidence base for maternal vaccination in low and middle-income countries, including Bangladesh. Through collaborative research, the network aims to understand maternal vaccine demand, acceptance, and implementation challenges across health systems to help policymakers address key questions before introducing new maternal vaccines.

Protecting newborns begins before birth. As maternal vaccines such as those for respiratory syncytial virus (RSV) and Group B Streptococcus (GBS) approach introduction, Bangladesh has an opportunity to prepare its health system now. Recent measles outbreaks point to the need for stronger efforts to close immunity gaps early in life, through routine immunisation, including vaccination during pregnancy. Strengthening coordination across immunisation and maternal health services, engaging both public and private providers, and building on the country’s strong trust in vaccines can make maternal vaccination routine part of pregnancy care and help protect newborns in their most vulnerable early days. 

Aniqa Tasnim Hossain is associate scientist at icddr,b.
Dr Ridwana Maher Manna is study physician at icddr,b.
Dr Shams El Arifeen is senior scientist at icddr,b. 

Views expressed in this article are the author's own. 

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