Report on Declining Vaccination Uptake and its Implications for Sustainable Development Goals

An analysis of public correspondence reveals significant concerns regarding the decline in vaccination rates and the subsequent impact on public health. The issues raised directly correlate with several United Nations Sustainable Development Goals (SDGs), highlighting the need for robust and equitable healthcare systems.

Analysis of Vaccination Delivery Systems and Public Health Outcomes

Evidence from past public health initiatives indicates a direct link between the method of vaccine delivery and the rate of uptake. The choice of delivery system has profound implications for achieving universal health coverage, a cornerstone of SDG 3 (Good Health and Well-being).

Historical Success of School-Based Vaccination Programs

A school-based vaccination model implemented in the 1980s demonstrated exceptional efficacy. Key features of this successful program included:

• Centralised administration within the school setting.
• Direct communication with parents via letters, with follow-ups conducted by school staff.
• Logistical ease, with children vaccinated in class groups.

This system achieved a 98% uptake rate, effectively creating herd immunity within the community and contributing to SDG 3 by preventing communicable diseases. It also supported SDG 4 (Quality Education) by ensuring children remained healthy and able to attend school.

Impact of Shifting to GP-Led Vaccinations

A subsequent policy change, which discontinued the school-based service and required parents to schedule vaccinations at local GP surgeries, led to a drastic decline in uptake to below 40%. This institutional decision inadvertently created significant barriers, undermining public health objectives.

The identified barriers directly conflict with the principles of SDG 10 (Reduced Inequalities):

1. Logistical Hurdles: Parents reported practical difficulties, such as children not delivering consent letters or parents losing them.
2. Socio-Economic Disadvantage: A significant barrier was the inability of working parents to take time off to accompany their children to a GP surgery, creating an inequality of access to essential healthcare.

This failure to maintain high vaccination rates represents a challenge to SDG 16 (Peace, Justice and Strong Institutions), as the responsible health authority’s decision led to a negative public health outcome without apparent corrective action.

Consequences of Low Vaccination Rates and SDG Alignment

The repercussions of declining vaccination coverage are severe, manifesting as preventable diseases and long-term disabilities that compromise multiple SDGs.

SDG 3: Good Health and Well-being

Personal testimonies underscore the devastating health consequences of vaccine-preventable diseases. These accounts serve as critical reminders of the importance of vaccination in achieving SDG 3.

• Congenital Rubella Syndrome: A case was reported of an infant born with severe disabilities, including bilateral cataracts and total deafness, after the mother was exposed to rubella during pregnancy.
• Measles Complications: A personal account detailed contracting measles before vaccines were available, leading to burst eardrums, recurrent infections, and eventual deafness with complications in later life.

These outcomes represent a direct failure to protect individuals and promote well-being for all ages.

SDG 4: Quality Education

The health consequences of vaccine-preventable diseases have a direct impact on educational opportunities. The potential re-emergence of specialised schools for children deafened by diseases like rubella or measles highlights a regression in public health that places new burdens on the education system, working against the inclusive aims of SDG 4.

Recommendations for Achieving Sustainable Development Health Targets

Based on the evidence presented, several strategic interventions are proposed to restore high vaccination uptake and align with SDG commitments.

Proposed Systemic Improvements

1. Reinstate School-Based Programs: Re-establishing efficient, low-barrier vaccination programs in schools is critical to improving access and equity, directly addressing SDG 3 and SDG 10.
2. Strengthen Primary Healthcare Outreach: The role of health visitors in advising and encouraging new mothers on vaccination schedules should be reinforced as a key component of universal health coverage.
3. Review Vaccination Policies: Consideration should be given to making preschool vaccinations compulsory before school admission, a policy adopted by many other countries to ensure community-wide protection and uphold the principles of SDG 3.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The entire article focuses on public health, specifically the importance of vaccination to prevent communicable diseases like measles and rubella. It discusses the consequences of low vaccine uptake, such as a “measles surge” and severe health complications (“bilateral cataracts and was totally deaf,” “serious ear infections, burst eardrums”). This directly aligns with the goal of ensuring healthy lives and promoting well-being for all at all ages.

• SDG 4: Quality Education

  The article connects health to education in two ways. Firstly, it describes a highly effective school-based vaccination program. Secondly, it warns that a failure to vaccinate could lead to a rise in preventable disabilities, necessitating the return of specialized “Schools for deaf children.” This implies that poor public health outcomes directly impact the educational system and the needs of the student population.

• SDG 10: Reduced Inequalities

  The article highlights how a change in policy created a significant disparity in healthcare access and outcomes. The shift from a school-based system to a GP-based one caused vaccine uptake to plummet, partly because some parents were “unable to take time off to take their child to the surgery.” This points to an economic barrier that creates inequality in access to essential health services, leading to unequal health outcomes for children from different socioeconomic backgrounds.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

     The article directly discusses the accessibility of vaccination services. The school-based program provided broad access, resulting in “98% uptake,” while the GP-based system created barriers for parents “unable to take time off,” leading to access issues and a drop in uptake to “less than 40%.” This illustrates the challenge of ensuring universal access to vaccines.

   • Target 3.3: By 2030, end the epidemics of… and other communicable diseases.

     The article is a direct response to a “measles surge,” which is a communicable disease outbreak. The personal accounts of suffering from measles and rubella underscore the importance of vaccination in preventing and ultimately ending the spread of such diseases.

   • Target 3.b: Support the research and development of vaccines… provide access to affordable essential medicines and vaccines…

     While the article doesn’t discuss R&D, it is fundamentally about providing access to existing essential vaccines for diseases like measles and rubella. The core argument is that systemic failures are preventing the widespread use of these crucial public health tools.

2. SDG 4: Quality Education

   • Target 4.a: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all.

     The article implies a connection to this target by warning that low vaccination rates could increase the number of children with preventable disabilities, such as deafness from measles or rubella. This would necessitate a return of specialized “Schools for deaf children,” highlighting how public health failures can create new challenges for providing inclusive and appropriate educational environments.

3. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome…

     The article provides a clear example of a policy change that led to an inequality of outcome. The previous school-based system had a near-equal outcome of 98% uptake. The new system, which required parents to take time off work, created a barrier that resulted in a drastically unequal outcome, with uptake plummeting to “less than 40%.” The author’s call for mandatory vaccination is a proposal to restore a more equal outcome in public health.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator 3.b.1: Proportion of the population covered by essential vaccines.

  The article provides explicit quantitative data for this indicator. It states there was a “98% uptake of vaccines in the school setting,” which dropped to “less than 40% of eligible children” when the service was moved to GP surgeries. These figures are direct measurements of vaccine coverage under different delivery systems.

• Incidence of communicable diseases.

  The article refers to a “measles surge,” which is an implied indicator of rising disease incidence. The personal stories of contracting measles and rubella, and the resulting complications (deafness, cataracts), serve as qualitative indicators of the human cost when vaccination rates are low and disease incidence is high.

• Disparity in health service uptake based on delivery model.

  The dramatic difference between the 98% and

4. Create a table with three columns titled ‘SDGs, Targets and Indicators’ to present the findings from analyzing the article.

Source: theguardian.com