Report on Declining Vaccination Rates in England and Implications for Sustainable Development Goals
Introduction: Measles Resurgence and Public Health System Deficiencies
A significant public health crisis is unfolding in England, marked by over 500 confirmed measles cases and at least one child fatality this year. In response, early years education settings are reintroducing emergency infection control protocols reminiscent of the COVID-19 pandemic. This situation highlights critical failures in the public health system and poses a direct threat to the United Kingdom’s progress towards achieving key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being).
Analysis of Declining Immunisation and its Impact on SDG 3 (Good Health and Well-being)
The current measles outbreak is a direct consequence of declining vaccination coverage. The failure to maintain herd immunity undermines global and national health objectives. This decline is not isolated to the MMR vaccine; it represents a broader trend that jeopardises long-term public health and the achievement of SDG 3.
- Failure to Meet Global Targets: The UK is currently failing to meet the World Health Organization’s 95% coverage target for any routine childhood immunisations, directly impeding progress on SDG Target 3.3, which aims to end the epidemics of communicable diseases.
- Low MMR Uptake: Approximately one in six children aged five and under are not fully vaccinated with the MMR jab, leaving a significant portion of the population vulnerable to a preventable and life-threatening disease.
- Broader Vaccine Complacency: Immunisation rates for other critical vaccines have also fallen. The number of NHS staff receiving the flu jab has hit a decade low, while HPV vaccination rates among pupils have dropped by 17 percentage points since before the pandemic, threatening England’s goal to eradicate cervical cancer by 2040.
- Access to Vaccines: These trends represent a failure to uphold SDG Target 3.8, which calls for universal access to safe, effective, and affordable essential medicines and vaccines for all.
Socioeconomic Barriers and the Impact on SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities)
The decline in vaccination uptake is not solely due to hesitancy but is significantly driven by systemic barriers that exacerbate social and economic disparities. These challenges directly contravene the principles of SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities) by preventing equitable access to essential healthcare.
- Economic Hardship: Many low-income parents cannot afford to take time off work or pay for transport to attend vaccination appointments.
- Healthcare System Strain: A lack of available GP appointments creates a primary obstacle to accessing timely immunisations.
- Marginalisation: Vulnerable groups, including asylum seekers, may be reluctant to engage with official health services, leaving them unprotected and further marginalised.
These factors demonstrate how health outcomes are intrinsically linked to socioeconomic status, creating a cycle of inequality where the most vulnerable are left at the greatest risk.
Institutional Weaknesses and Threats to SDG 16 (Peace, Justice and Strong Institutions)
The public health response has been hampered by institutional challenges, including a decline in public trust and a failure to sustain effective strategies. This erosion of confidence and institutional capacity undermines SDG 16, which focuses on building effective, accountable, and inclusive institutions.
- Erosion of Trust: A post-pandemic rise in “vaccine fatigue,” coupled with misinformation and distrust of authorities, has weakened the effectiveness of public health mandates.
- Failure to Sustain Investment: Successful pandemic-era outreach initiatives, such as the use of community engagement and translators, have not been maintained.
- Impending Budget Cuts: Proposed plans to slash operational costs for integrated care boards by up to 50% threaten to dismantle the very infrastructure needed to recover vaccine coverage and respond to future health crises.
Recommendations for Aligning Public Health Strategy with Sustainable Development Goals
To address the current crisis and build a resilient public health system, a renewed strategy aligned with the Sustainable Development Goals is imperative. The following actions are recommended:
- Strengthen Public Health Infrastructure (SDG 3, SDG 16): Reinvest in and sustain funding for local public health outreach teams, ensuring they have the resources for community-based engagement, as learned from the COVID-19 response.
- Ensure Equitable Access (SDG 1, SDG 10): Actively remove socioeconomic barriers by expanding vaccination programmes into community settings, making it easier for low-income and marginalised families to access immunisations.
- Promote Collective Responsibility (SDG 3, SDG 4): Launch a sustained national public health campaign to rebuild trust, counter misinformation, and clearly communicate the importance of herd immunity for protecting the entire community, including immunocompromised individuals, and ensuring educational settings (SDG 4) remain safe and open.
- Foster Institutional Commitment (SDG 16, SDG 17): Secure long-term political and financial commitment to public health, strengthening partnerships between the NHS, local authorities, and community organisations to create an inclusive and effective health system for all.
Analysis of SDGs, Targets, and Indicators
1. Which SDGs are addressed or connected to the issues highlighted in the article?
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SDG 3: Good Health and Well-being
This is the most prominent SDG in the article. The entire text revolves around a public health crisis, specifically the measles outbreak in England. It discusses the importance of vaccines (MMR, flu, HPV), the consequences of low vaccination rates such as disease spread and death (“more than 500 confirmed cases… one child in Liverpool having died”), and the role of the public health system (NHS) in managing communicable diseases.
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SDG 10: Reduced Inequalities
The article directly addresses inequalities in access to healthcare. It points out that vaccine uptake is not just about hesitancy but also about systemic barriers affecting vulnerable populations. It states, “Many low-income parents are unable to take time off work to get their child vaccinated, or can’t afford the transport to get there.” It also mentions that “aslyum seekers and other marginalised groups can be reluctant to engage with official health services,” highlighting how social and economic status creates unequal health outcomes.
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SDG 16: Peace, Justice and Strong Institutions
The article critiques the effectiveness and responsiveness of public institutions. It discusses the failure to learn lessons from the COVID-19 pandemic, the decline in public trust (“distrust of ‘elites'”), and the impact of funding cuts on public health outreach. The statement that “plans for integrated care boards to slash their operational costs by as much as 50% will only place further obstacles to vaccine coverage recovery” points to institutional weaknesses that undermine public health goals.
2. What specific targets under those SDGs can be identified based on the article’s content?
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SDG 3: Good Health and Well-being
- Target 3.2: End preventable deaths of newborns and children under 5 years of age. The article’s mention of a child dying from measles (“one child in Liverpool having died this month”) directly relates to this target, as measles is a vaccine-preventable disease.
- Target 3.3: End the epidemics of… communicable diseases. The focus on the “rise in measles cases” and the need to control the outbreak aligns with the goal of ending epidemics of communicable diseases.
- Target 3.8: Achieve universal health coverage, including access to… safe, effective, quality and affordable essential medicines and vaccines for all. The article’s central theme is the challenge of achieving sufficient vaccination coverage, highlighting barriers like cost, time off work, and lack of appointments, which prevent universal access.
- Target 3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks. The article critiques the current response to the measles outbreak by comparing it to the COVID-19 pandemic, noting that “infection control methods we learned during Covid… have not been continued,” indicating a failure in managing national health risks.
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SDG 10: Reduced Inequalities
- Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status. The article identifies specific groups, such as “low-income parents,” “aslyum seekers and other marginalised groups,” who are excluded from equal access to essential health services like vaccination.
- Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The article explains how structural issues like the inability to afford transport or a “lack of GP appointments” lead to unequal health outcomes, where some children are vaccinated and protected while others are not.
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SDG 16: Peace, Justice and Strong Institutions
- Target 16.6: Develop effective, accountable and transparent institutions at all levels. The article questions the effectiveness of public health institutions by stating, “we failed to learn from Covid about the investment needed for NHS teams and local authorities to do outreach.” The planned budget cuts (“slash their operational costs by as much as 50%”) further challenge the capacity of these institutions.
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
Yes, the article provides several specific quantitative and qualitative indicators:
- Morbidity and Mortality Rates: The article provides data points that can be used as direct indicators for Target 3.2 and 3.3.
- Number of measles cases: “more than 500 confirmed cases… in England so far this year.”
- Child mortality from measles: “one child in Liverpool having died this month.”
- Vaccination Coverage Rates: These are key indicators for Target 3.8. The article provides several examples of declining rates.
- MMR vaccine coverage: “about one in six children aged five and under – have not had one or both doses.”
- Failure to meet WHO target: The UK is “failing to meet the World Health Organization’s target of 95% coverage for herd immunity for any routine childhood jabs.”
- NHS staff flu jab uptake: “crashed to its lowest level since 2010 (37.5%).”
- HPV vaccination rate: “dropped by 17 percentage points since before the pandemic.”
- Barriers to Access (Qualitative Indicators): For Target 10.3, the article implies indicators by describing the reasons for unequal access.
- Inability for low-income parents to take time off work.
- Inability to afford transport to clinics.
- Lack of available GP appointments.
- Reluctance of marginalized groups to engage with official health services.
- Institutional Funding and Capacity: As an indicator for Target 16.6, the article points to financial decisions affecting public health capacity.
- Planned budget cuts for integrated care boards: “to slash their operational costs by as much as 50%.”
4. Summary of Findings
SDGs | Targets | Indicators Identified in the Article |
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SDG 3: Good Health and Well-being |
3.2: End preventable deaths of children under 5.
3.3: End epidemics of communicable diseases. 3.8: Achieve universal health coverage and access to vaccines for all. |
– Number of child deaths from measles (1 reported). – Number of confirmed measles cases (500+). – MMR vaccination coverage rate (1 in 6 children not fully vaccinated). – National vaccination coverage relative to WHO 95% target (failing to meet). – HPV vaccination rate (down 17 percentage points). – Flu vaccination rate for NHS staff (down to 37.5%). |
SDG 10: Reduced Inequalities |
10.2: Promote social and economic inclusion of all.
10.3: Ensure equal opportunity and reduce inequalities of outcome. |
– Barriers to vaccine access for low-income parents (time off work, transport costs). – Reluctance of marginalized groups (e.g., asylum seekers) to engage with health services. – Lack of GP appointments as a barrier to equal access. |
SDG 16: Peace, Justice and Strong Institutions | 16.6: Develop effective and accountable institutions. |
– Failure to maintain effective pandemic-era outreach programs. – Planned budget cuts for integrated care boards (up to 50%). – Public distrust of “elites” and public health diktats. |
Source: theguardian.com