Bangladesh’s Border Health Defenses Fall Short of Global Pandemic Rules, Study Finds

When a new pathogen emerges anywhere in the world, the first line of defense is often not a hospital or a laboratory but an airport terminal, a seaport gate, or a crowded land crossing. These are the places where infected travelers can be detected, isolated, and stopped before they carry disease across borders. A new qualitative study from Bangladesh, published in BMC Public Health, reveals just how fragile that first line of defense can be in a low- and middle-income country, even after the hard lessons of the COVID-19 pandemic. Researchers from icddr,b and the Directorate General of Health Services examined how the International Health Regulations of 2005, the binding legal framework that the World Health Organization uses to coordinate global responses to public health emergencies, are actually put into practice at four designated Points of Entry in Bangladesh. What they found was a system struggling with gaps in knowledge, staffing, equipment, and cooperation.

The International Health Regulations, revised in 2005 after earlier versions proved inadequate, require all 196 signatory states to develop core capacities for detecting, reporting, and responding to public health events at their borders. Under the framework, countries must designate Points of Entry, including international airports, seaports, and major ground crossings, where routine health screening, emergency medical services, and communication systems must be available around the clock. When an event rises to the level of a Public Health Emergency of International Concern, as COVID-19 did in January 2020, these entry points become critical nodes in a worldwide surveillance and containment network. Yet the regulations have long been implemented unevenly, particularly in resource-constrained settings, and the new study set out to document precisely where those implementation gaps lie in Bangladesh.

The research team conducted an exploratory qualitative study between October 2022 and June 2023, in the aftermath of the pandemic’s acute phase. They selected four designated Points of Entry: Hazrat Shahjalal International Airport, the country’s busiest international air gateway; Shah Amanat International Airport in Chattogram; Chittagong Seaport, one of the largest maritime hubs in South Asia; and Benapole Ground Crossing, the principal land border crossing between Bangladesh and India. Data collection involved 30 interviews in total, comprising 20 in-depth interviews with frontline service providers and port users, and 10 key informant interviews with decision-makers and experienced service providers. All interviews were transcribed, coded, and subjected to thematic analysis using ATLAS.ti software, version 7.5.10, allowing the researchers to identify recurring patterns in how officials and travelers experience border health operations.

The central finding is stark: the study revealed more challenges than enablers on both the regulatory and public sides of IHR-2005 implementation. Among the most fundamental problems was a lack of understanding of the regulations themselves and their role in global infectious disease prevention and control. This is not a trivial administrative detail. If the officers stationed at an entry point do not grasp what the framework requires of them, or why it matters, the entire architecture of border health security weakens at its foundation. The researchers also identified inadequate training on IHR-2005 as a persistent barrier, compounding the knowledge deficit and leaving staff ill-prepared to execute the screening, reporting, and coordination duties the regulations demand.

Human resources emerged as another severe constraint. The study documented a critical shortage of personnel at the entry points, a problem familiar across many low- and middle-income countries where health workforces are stretched thin and border health posts compete with hospitals and clinics for scarce staff. Screening travelers for symptoms, managing health declarations, and responding to suspected cases all require trained people on the ground, and without them even well-designed protocols exist only on paper. The shortage interacts with the training gap in a damaging cycle: too few staff means those who are present cannot be spared for training, while untrained staff cannot build the institutional competence that would justify expanding the workforce.

Practical logistics added further friction. The researchers found limited availability of ambulances for transporting ill travelers, meaning that even when a potentially infectious passenger was identified, moving that person safely to a treatment facility could be difficult or delayed. Health offices were often inaccessible or not conveniently located at every Point of Entry, fragmenting the chain of command and slowing communication between border staff and the health authorities who must authorize and support public health actions. On the public side of the counter, the study recorded uncooperative behavior from travelers, a challenge that frontline screeners worldwide have encountered but which carries particular weight in crowded, high-throughput crossings where delays provoke frustration and evasion.

Not all entry points fared equally. The study found that Benapole Ground Crossing encountered the most significant obstacles in ensuring effective implementation of the regulations, and that the overall environment there was suboptimal. This finding matters because Benapole is one of the busiest land crossings in South Asia, handling enormous daily flows of passengers and goods between Bangladesh and India. Land crossings are inherently harder to manage than airports: passenger processing is less structured, infrastructure is often older, and the sheer volume of movement makes comprehensive screening difficult. By contrast, the other designated Points of Entry, including the two international airports and Chittagong Seaport, demonstrated good communication and coordination capacities, available medical and technical services, and a generally good environment, suggesting that implementation success in Bangladesh is less a uniform national failure than a uneven landscape in which some sites have achieved functional capacity while others lag far behind.

The methodological contribution of the study is also notable. According to the authors, no qualitative research on IHR-2005 implementation at designated Points of Entry in Bangladesh had been conducted before, making this the first in-depth account of how the framework operates, or fails to operate, at the country’s borders. Qualitative approaches of this kind capture dimensions that quantitative audits miss: the lived experience of officers who lack clear guidance, the frustrations of port users navigating health checks, and the informal workarounds that develop when formal systems fall short. The study received ethical approval from the Institutional Review Board of icddr,b under research protocol number PR-22149, with informed written consent obtained from all participants and transcripts anonymized and stored in password-protected databases. The work was funded by the Disease Control program of the Directorate General of Health Services, with core support from the governments of Bangladesh and Canada.

The findings carry implications well beyond Bangladesh’s borders. The COVID-19 pandemic demonstrated that a pathogen detected in one country can circle the globe within days, and that the strength of the weakest border health system can determine the speed of international spread. The World Health Organization has repeatedly emphasized that global health security depends on every country meeting the core capacity requirements of the regulations, and independent assessments have consistently shown that many low- and middle-income countries remain short of those benchmarks. Bangladesh’s experience illustrates the specific mechanisms by which the gap opens: knowledge deficits among staff, inadequate training pipelines, chronic understaffing, missing transport and infrastructure, and public non-cooperation. Each of these is addressable, but only with sustained investment and political attention rather than emergency-time improvisation.

The researchers conclude that the implementation of IHR-2005 at designated Points of Entry in Bangladesh faces significant challenges that hinder its effectiveness, and that addressing these barriers is essential to strengthen enforcement of the regulations and enhance the country’s ability to prevent and control the spread of infectious diseases at its key entry points. Their evidence suggests a clear agenda: systematic training on the regulations for all border health staff, recruitment to close the human resource gap, guaranteed ambulance and transport capacity for ill travelers, and health offices physically present and accessible at every designated entry point, with particular urgency at Benapole Ground Crossing. As the world prepares for future pandemics that experts consider inevitable rather than hypothetical, studies like this one provide the granular, ground-level evidence that turns abstract international commitments into workable practice. The borders of Bangladesh, like those of many countries, are only as secure against infectious disease as the people, training, and equipment stationed there, and this study shows exactly where those defenses need reinforcement.

Subject of Research: Implementation of the International Health Regulations 2005 for infectious disease control at designated Points of Entry in Bangladesh

Article Title: Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh

Article References: Dutta, G. K., Hasan, M. K., Sanin, K. I., Roy, B. R., Ali, M. S., Islam, M. N., Islam, M. S., Khan, M. N. A., Mahmud, M., Nadia, N., Noushin, F., & Tofail, F. (2026). Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh. BMC Public Health. https://doi.org/10.1186/s12889-026-29658-2

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29658-2

Keywords: IHR-2005, Points of Entry, Bangladesh, global health security, infectious disease control, border health, COVID-19, public health emergency, qualitative research, LMICs, Benapole Ground Crossing, WHO