The fight to keep measles out of nurseries raises issues of freedom and responsibility | Letter – The Guardian

 

Report on Public Health Measures and Vaccination Policies in the Context of Sustainable Development Goals

Introduction: Measles Outbreak and Institutional Response

An increase in measles cases in England has prompted responses in early childhood education settings, raising questions about efficacy and alignment with broader developmental goals. The implementation of certain public health measures and the ongoing debate surrounding vaccination choice have significant implications for achieving the Sustainable Development Goals (SDGs).

• Nursery staff have been observed using Personal Protective Equipment (PPE), such as aprons and gloves, to prevent measles transmission.
• The effectiveness of this specific PPE is questionable, as measles is an airborne virus spread through respiratory droplets. This suggests that respiratory protection, such as masks, may be a more appropriate intervention.
• The use of extensive PPE by caregivers raises concerns regarding its potential negative impact on the emotional and social development of young children, a key component of SDG 4 (Quality Education), specifically Target 4.2 concerning early childhood development.

Analysis of Vaccination Policies and SDG 3 (Good Health and Well-being)

The core of the public health challenge lies in the tension between individual parental choice regarding the Measles, Mumps, and Rubella (MMR) vaccine and the collective responsibility to ensure community health. This directly impacts the achievement of SDG 3 (Good Health and Well-being).

• The framing of non-vaccination as a “personal choice” fails to account for its public health consequences, undermining the principle of herd immunity necessary to protect the entire community.
• Achieving SDG Target 3.3, which aims to end the epidemics of communicable diseases by 2030, is contingent on high vaccination coverage.
• The “personal choice” of some individuals directly endangers vulnerable populations who cannot be vaccinated for medical reasons.

The groups at highest risk from this public health gap include:

1. Infants who are too young to receive the MMR vaccine.
2. Children with compromised immune systems who are medically ineligible for vaccination.
3. These vulnerable children face a disproportionately high risk of severe complications from measles, including permanent brain damage and death.
4. Protecting these individuals relies entirely on ensuring high immunisation rates among their contacts, a principle central to universal health access as outlined in SDG Target 3.8.

Socio-Economic Implications and Alignment with SDGs 4, 10, and 16

The debate over vaccination and disease containment extends beyond immediate health outcomes, touching on fundamental issues of equity, education, and social justice.

• SDG 4 (Quality Education): Policy decisions regarding the exclusion of children from nurseries during outbreaks have direct consequences for access to early childhood education (Target 4.2). Often, the medically vulnerable child who cannot be immunised is excluded, disrupting their education and development to accommodate the choices of others.
• SDG 10 (Reduced Inequalities): Current practices can exacerbate health inequalities by placing the burden of risk and social exclusion on medically vulnerable children, while the children of parents who opt out of vaccination face no such consequence. An equitable policy would seek to reverse this imbalance.
• SDG 16 (Peace, Justice and Strong Institutions): The issue highlights a conflict between individual freedom and collective social responsibility. A just society, supported by strong institutions, must establish policies that balance rights with responsibilities to protect its most vulnerable members.

Policy Recommendations and Conclusion

To better align with the principles of the Sustainable Development Goals, a re-evaluation of current public health strategies is required. Policy should be guided by scientific evidence and a commitment to equity.

• It is proposed that during a measles outbreak, consideration be given to the temporary exclusion of healthy but unvaccinated children from nursery settings.
• This policy shifts the responsibility to those making a choice rather than penalising those with no choice, thereby upholding the principles of SDG 10.
• Such a measure would protect the health of medically vulnerable children and ensure their continued access to education, in line with SDG 3 and SDG 4.
• Ultimately, public health policy must reinforce that individual freedoms are accompanied by a responsibility to protect the wider community, a foundational concept for building the just and healthy societies envisioned by the SDGs.

Analysis of the Article in Relation to Sustainable Development Goals

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

SDG 3: Good Health and Well-being

• The article’s primary focus is on public health, specifically the outbreak of measles, a preventable communicable disease. It discusses the importance of the “safe and effective MMR vaccine” in preventing serious health outcomes for children, including “brain damage and death.” The entire debate revolves around promoting health and preventing disease within a community.

SDG 4: Quality Education

• The article directly refers to the “nursery” setting, which is a form of early childhood education and care. It raises concerns about how to manage the measles outbreak in this environment, including the potential “exclusion” of children from the nursery. Furthermore, it questions the impact of staff wearing PPE on the “emotional development” of young children, which is a critical aspect of quality early childhood development.

SDG 10: Reduced Inequalities

• The article highlights a significant inequality. It points out that the “personal choice” of some parents not to vaccinate puts vulnerable children at risk. These children are “unimmunised – not through a parent’s decision, but because the child is not eligible” due to being too young or having a compromised immune system. The article questions the fairness of a situation where the vulnerable child who “cannot be immunised is excluded,” thereby facing unequal access to education and social interaction due to the choices of others.

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

SDG 3: Good Health and Well-being

1. Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age. The article directly relates to this by discussing measles, a vaccine-preventable disease that can lead to “serious complications, including brain damage and death” in young children.
2. Target 3.3: By 2030, end the epidemics of… communicable diseases. Measles is a highly communicable disease, and the article discusses its spread (“spread by coughing, sneezing”) and the rise in cases, which constitutes an epidemic risk.
3. Target 3.8: Achieve universal health coverage, including access to… safe, effective, quality and affordable essential… vaccines for all. The article’s core argument is about the use of the “safe and effective MMR vaccine” to protect the entire community, which is a fundamental component of universal health coverage.

SDG 4: Quality Education

1. Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education. The article discusses the “nursery” setting and the potential for children to be “excluded,” which directly impacts access. It also touches on the quality of care by questioning the effect of staff in PPE on a child’s “emotional development.”

SDG 10: Reduced Inequalities

1. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome… The article questions the practice where “the child who cannot be immunised is excluded.” This scenario represents an inequality of outcome and opportunity, where a child’s access to education is denied due to a health vulnerability that is exacerbated by the actions of others.

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

Indicators for SDG 3

• Incidence of measles: The article explicitly mentions “confirmed cases of measles in England” and provides a specific statistic: “Two-thirds of cases of measles this year have been in children aged 10 years or younger.” This is a direct measure of the burden of a communicable disease (relevant to Target 3.3).
• Vaccination coverage rate: The discussion about parents making a “personal choice” not to use the “MMR vaccine” directly implies that the proportion of the population vaccinated is a critical indicator. Low coverage rates lead to the loss of herd immunity and outbreaks (relevant to Target 3.8).
• Child mortality rate from preventable diseases: The article states that measles can lead to “death” in children. Therefore, the number or rate of child deaths caused by measles is a key indicator of failure or success in preventing it (relevant to Target 3.2).

Indicators for SDG 4

• Participation rate in early childhood education: The suggestion that “children who are not immunised should be excluded from nursery” or that the vulnerable child is excluded points to the participation/exclusion rate in pre-primary education as a relevant indicator (relevant to Target 4.2).

Indicators for SDG 10

• Policies on social inclusion for vulnerable groups: While not a quantitative number, the article implies a qualitative indicator: the existence of policies or common practices that lead to the exclusion of medically vulnerable children from educational settings. The question “Is that right?” calls for an assessment of the fairness and equality of such practices (relevant to Target 10.3).

4. Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators Identified in Article
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, including access to vaccines.	– Child mortality rate from measles (implied by the risk of “death”). – Incidence of measles (explicitly mentioned as “confirmed cases of measles”). – MMR vaccination coverage rate (implied by the discussion of “personal choice” not to vaccinate).
SDG 4: Quality Education	4.2: Ensure access to quality early childhood development, care and pre-primary education.	– Participation/exclusion rate in nursery/pre-primary education (implied by the discussion of excluding children). – Quality of child’s emotional development in care settings (mentioned as a concern).
SDG 10: Reduced Inequalities	10.3: Ensure equal opportunity and reduce inequalities of outcome.	– Exclusion of medically vulnerable children from education (highlighted as an unfair outcome and inequality of opportunity).

Source: theguardian.com