US on the brink of major public health failure – Australian Broadcasting Corporation

 

Report on the United States Public Health Crisis and Setbacks to Sustainable Development Goals

Executive Summary

A significant public health crisis is unfolding in the United States, characterized by a widespread measles outbreak that directly threatens the nation’s progress toward Sustainable Development Goal 3 (SDG 3): Good Health and Well-being. This report details the outbreak’s scale, the governmental response under Health Secretary Robert F. Kennedy Jr., and the subsequent erosion of public health institutions and policies. These developments represent a substantial regression from key SDG targets, particularly those concerning the control of communicable diseases (Target 3.3), access to vaccines (Target 3.8), and the maintenance of effective, accountable institutions (Target 16.6).

Analysis of the Measles Outbreak and its Impact on SDG 3

Current Status and Threat to SDG Target 3.3

The ongoing measles outbreak constitutes a direct challenge to SDG Target 3.3, which calls for an end to epidemics of communicable diseases. The situation is characterized by the following:

• Over 1,300 confirmed cases have been reported across 40 states.
• The outbreak has resulted in three confirmed fatalities.
• The initial spread began in a community with demonstrably low vaccine uptake, highlighting vulnerabilities in public health coverage.
• Dr. Noel Brewer, an expert involved in determining the nation’s measles elimination status, described the situation as a “full crisis” and a “meltdown around measles.”

Risk to Measles Elimination Status and Child Health

The United States is at imminent risk of losing its measles elimination status, a designation signifying that the disease is no longer endemic. This potential failure in public health management has severe implications for SDG 3.

• Dr. Brewer stated, “We’re fully on track for losing our elimination status,” calling such an event a “complete and utter failure of public health.”
• According to the Centers for Disease Control and Prevention (CDC), one to three of every 1,000 children infected with measles will die from complications, underscoring the grave risk to child well-being.
• Epidemiologist Dr. Zack Moore noted that measles is a “major killer of children” globally and that under-reporting is likely, particularly in communities hesitant to seek medical care.
• Of those infected, 92% are either unvaccinated or have an unknown vaccination status, demonstrating a critical gap in achieving universal access to essential vaccines as outlined in SDG Target 3.8.

Governmental Response and Implications for Sustainable Development

Inconsistent Messaging and its Effect on SDG Target 3.8

The public health response has been undermined by inconsistent messaging from the Health Secretary, creating confusion and eroding confidence in vaccination programs essential for achieving SDG Target 3.8 (universal access to safe and effective vaccines).

• Secretary Kennedy has publicly endorsed the measles, mumps, and rubella (MMR) vaccine while simultaneously calling it a “leaky vaccine” and falsely claiming it has not been “safety tested.”
• Alternative treatments such as Vitamin A and cod liver oil have been promoted, which, while having some application in specific contexts, are presented in a manner that equates them with vaccination as a primary prevention strategy.
• Dr. Cameron Wolfe, an infectious disease expert, warned that this approach “undermines vaccines indirectly, which is a little more insidious.”

Overhaul of Public Health Institutions and Threats to SDG 16.6

Significant structural changes to key public health bodies threaten the integrity and effectiveness of national health institutions, contravening the principles of SDG 16.6 (effective, accountable, and transparent institutions).

• Seventeen members of the Advisory Committee on Immunization Practices (ACIP), the expert panel that develops vaccine recommendations, were abruptly fired by Secretary Kennedy.
• The board was subsequently reduced in size and repopulated with hand-picked appointees, some known for vaccine skepticism.
• Dr. Yvonne Maldonado, a former ACIP member, stated the move “demonstrates a lack of understanding of what the process is” and eliminates crucial “institutional memory.”
• This overhaul compromises the evidence-based, participatory, and representative decision-making required for strong public health governance (SDG 16.7).

Specific Policy Changes and Challenges to Scientific Integrity

The Thimerosal Debate and Evidence-Based Policy

The administration has revisited scientifically settled debates, diverting resources and undermining evidence-based policymaking.

• The new ACIP recommended, and the Secretary adopted, the removal of the mercury-based preservative thimerosal from flu vaccines.
• This decision was justified by the Secretary with claims of protecting vulnerable populations from “unnecessary mercury exposure,” despite long-standing findings from the CDC and FDA that the low doses of thimerosal in vaccines are safe and cause no harm beyond minor local reactions.
• The FDA notes the amount of mercury in a vaccine is comparable to that in an 85-gram can of tuna fish.
• Dr. Brewer criticized the move, stating, “We’ve already established that [thimerosal is] safe … We need to not be rehashing all this old stuff and replacing it with misinformation and lies.”

Dissemination of Discredited Theories

The continued promotion of disproven theories by public officials erodes public trust and misdirects health priorities, hindering progress toward SDG 3.

• Secretary Kennedy has repeatedly promoted the debunked claim linking vaccines to autism, a theory based on a fraudulent 1998 paper that was retracted in 2010.
• Dr. Wolfe described the persistence of this claim from a high-level official as “abhorrent” and “factually incorrect.”
• The Secretary’s pledge to fund research into a vaccine-autism link was criticized by Dr. Brewer as “stealing from that community” by diverting funds from research into genuine causes and support for individuals with autism.

Broader Implications for National Health Strategy

Systemic Changes to the Department of Health and Human Services (HHS)

Under Secretary Kennedy’s leadership, the HHS has undergone radical changes that weaken its capacity to manage national and global health risks, affecting its ability to contribute to SDG Target 3.d.

1. The department’s workforce has been reduced by 20,000 people.
2. Nearly $500 million in contracts for mRNA vaccine development have been cancelled, with the Secretary stating funds will go to “safer, broader vaccine platforms.”
3. A personal directive was issued to no longer recommend COVID-19 vaccines for healthy children and pregnant women.

Former Surgeon-General Jerome Adams called the funding cuts “dangerous,” stating, “We should be doubling down on what works — not defunding it.”

Erosion of Transparency and Policy Coherence

Despite promises of “radical transparency,” experts report a decline in the clarity and accessibility of public health information, undermining SDG 16.6 (accountable and transparent institutions) and SDG 17.14 (policy coherence).

• Dr. Wolfe noted it is “less clear that the data and where it’s sourced from on public websites is as accurate and complete as it once was.”
• The politicization of public health has made the work of clinicians more difficult and threatens to dismantle the national public health infrastructure.
• Dr. Brewer concluded, “We need vaccines to be boring again … we need it to not be part of the political process.” This sentiment reflects a call to return to evidence-based, non-partisan public health management to restore progress toward national health objectives and the Sustainable Development Goals.

Analysis of Sustainable Development Goals in the Article

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

The article primarily addresses issues related to SDG 3: Good Health and Well-being. It also touches upon aspects of SDG 16: Peace, Justice and Strong Institutions.

• SDG 3: Good Health and Well-being

  This is the most relevant SDG as the article’s central theme is a public health crisis. It discusses the outbreak of a vaccine-preventable disease (measles), the importance of vaccination, child mortality resulting from the disease, and the overall failure of the public health system to contain the spread. The narrative revolves around ensuring healthy lives and promoting well-being, which is the core of SDG 3.

• SDG 16: Peace, Justice and Strong Institutions

  This SDG is relevant due to the article’s focus on the governance and institutional integrity of the US public health system. It details the overhaul of the Advisory Committee on Immunization Practices (ACIP), the abrupt firing of scientific experts, and the appointment of new members with a history of vaccine skepticism. These actions raise questions about the effectiveness, accountability, and transparency of public health institutions, which are key components of SDG 16.

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

Several specific targets under SDG 3 and SDG 16 are clearly identifiable from the article’s content.

1. SDG 3: Good Health and Well-being

   • Target 3.2: “By 2030, end preventable deaths of newborns and children under 5 years of age…”
     
     Explanation: The article directly connects to this target by highlighting that measles is a “major killer of children” and providing a specific mortality rate: “one to three out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications”. The mention of “three confirmed deaths” underscores the failure to prevent deaths from a vaccine-preventable disease.
   • Target 3.3: “By 2030, end the epidemics of… communicable diseases.”
     
     Explanation: The article is centered on a measles outbreak, a communicable disease. The statement, “We’re fully on track for losing our elimination status,” signifies a major setback in controlling an epidemic. The spread of “more than 1,300 cases in 40 states” is a clear example of a failure to meet this target.
   • Target 3.b: “Support the research and development of vaccines and medicines… provide access to affordable essential medicines and vaccines…”
     
     Explanation: The article discusses the importance of vaccines (specifically the MMR vaccine) and the public’s access to them. The low vaccine uptake (“Ninety-two per cent of those who have been infected in the US are unvaccinated”) and the government’s mixed messaging and cancellation of vaccine development contracts (“he revoked a nearly $US600 million contract to develop an mRNA bird flu vaccine”) are directly related to this target.

2. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.6: “Develop effective, accountable and transparent institutions at all levels.”
     
     Explanation: The article describes actions that undermine the effectiveness and accountability of the ACIP. The firing of 17 experts, the halving of the board, and the appointment of “vaccine sceptical” members are detailed. Dr. Brewer calls the situation a “complete and utter failure of public health,” and Dr. Maldonado notes that removing the committee leaves “no institutional memory,” directly questioning the institution’s effectiveness.
   • Target 16.10: “Ensure public access to information…”
     
     Explanation: This target is relevant because the article highlights the spread of misinformation and a lack of transparency from public officials. Dr. Wolfe notes, “It’s less clear that the data and where it’s sourced from on public websites is as accurate and complete as it once was.” The Health Secretary’s promotion of debunked claims (e.g., linking vaccines to autism) undermines public access to accurate, evidence-based information.

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 contains several explicit and implicit indicators that can be used to measure progress.

1. Indicators for SDG 3 Targets

   • Incidence of measles (Indicator for Target 3.3): The article explicitly states there have been “more than 1,300 cases in 40 states.” This number serves as a direct measure of the scale of the measles epidemic.
   • Child mortality rate from measles (Indicator for Target 3.2): The CDC statistic that “one to three out of every 1,000 children who become infected with measles will die” is a specific mortality rate indicator. The report of “three confirmed deaths” is a direct measure of mortality.
   • Vaccination coverage (Indicator for Target 3.b): The statistic that “Ninety-two per cent of those who have been infected in the US are unvaccinated or their vaccination status is unknown” is a strong indicator of low vaccination coverage in the affected populations. The mention of the outbreak starting in a community with “low vaccine uptake” also serves as a qualitative indicator.
   • Disease elimination status (Indicator for Target 3.3): The potential loss of the US’s “elimination status” for measles is a critical, high-level indicator of the country’s ability to control a communicable disease.

2. Indicators for SDG 16 Targets

   • Perception of institutional integrity (Indicator for Target 16.6): The quotes from experts like Dr. Brewer (“They’re tearing the entire edifice down”) and Dr. Maldonado (“To say that it’s a rubber stamp really demonstrates a lack of understanding”) serve as qualitative indicators of the perceived decline in the effectiveness and integrity of public health institutions.
   • Public access to reliable information (Indicator for Target 16.10): Dr. Wolfe’s statement that it is “less clear that the data and where it’s sourced from on public websites is as accurate and complete as it once was” acts as an indicator of deteriorating public access to reliable information.
   • Evidence-based policymaking (Indicator for Target 16.6): The decision to remove thimerosal from vaccines despite the CDC and FDA stating “there is no evidence of harm” and the move being described as “not evidence-based” is an indicator of a shift away from scientific evidence in policy decisions.

4. Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators Identified in the Article
SDG 3: Good Health and Well-being	3.2 End preventable deaths of newborns and children under 5 years of age.	Mortality rate from measles: “one to three out of every 1,000 children who become infected with measles will die”. Number of deaths from the outbreak: “three confirmed deaths across the country”.
SDG 3: Good Health and Well-being	3.3 End the epidemics of communicable diseases.	Incidence of measles: “more than 1,300 cases in 40 states”. National disease control status: “fully on track for losing our elimination status”.
SDG 3: Good Health and Well-being	3.b Support R&D and provide access to affordable essential vaccines.	Vaccination coverage among infected individuals: “Ninety-two per cent of those who have been infected… are unvaccinated”. Funding for vaccine development: Cancellation of nearly “$US500 million worth of mRNA vaccine contracts”.
SDG 16: Peace, Justice and Strong Institutions	16.6 Develop effective, accountable and transparent institutions.	Dismissal of scientific experts from advisory committee: “he and 16 others were abruptly fired by RFK Jr”. Expert perception of institutional failure: “a complete and utter failure of public health”. Loss of institutional knowledge: “you’ve left no institutional memory, no institutional history”.
SDG 16: Peace, Justice and Strong Institutions	16.10 Ensure public access to information.	Perceived accuracy of public health data: “less clear that the data and where it’s sourced from on public websites is as accurate and complete as it once was”. Spread of misinformation by officials: Promotion of “debunked claim that vaccines could cause autism”.

Source: abc.net.au