From an immunological perspective, most vaccines are very effective. But the contribution they make to the health of the world’s children depends on how immunisation programmes are organized, on access to them, and on commitment to making them work. The book argues that public health is now marked by a growing obsession with targets, by an over-emphasis on technology, and by the taken-for-grantedness of a global perspective. Targets and goals – in terms of coverage to be achieved, new vaccines to be introduced - are formulated at the global level. The expectation is that national health author ... More

From an immunological perspective, most vaccines are very effective. But the contribution they make to the health of the world’s children depends on how immunisation programmes are organized, on access to them, and on commitment to making them work. The book argues that public health is now marked by a growing obsession with targets, by an over-emphasis on technology, and by the taken-for-grantedness of a global perspective. Targets and goals – in terms of coverage to be achieved, new vaccines to be introduced - are formulated at the global level. The expectation is that national health authorities and their agents, down to the community health worker, will comply with global objectives. Incentives, both financial and normative, encourage them to do so. Nevertheless, health systems and their governance vary widely. And so, therefore, do the ways in which immunisation programmes are organised, integrated with other health and welfare services, and supplied with the resources they need. Immunisation is conceptualized here in terms of a ‘chain’, linking the global level, the national level, down to the individual parent and child. Drawing on relevant literature from the social sciences as well as public health, and on the results of original research, we discuss what actually happens at the interfaces between these various levels. The book argues that current emphasis on meeting global targets, justified in terms of the mobilisation of resources, creates distortions and may undermine trust. Children’s health would be better served if the governments of poor countries were encouraged to collect reliable data, informed by knowledge of local realties, and to develop policies based on them.