Are Australia’s immunisation rates really falling?

Our childhood immunisation rates have been climbing. Between April 2012 and March 2013 COAG reported an overall increase in Aboriginal and Torres Strait Islander children, children in certain low coverage regions, and four year olds. The report showed an increase in 25 of the 30 subgroups across all states and territories and five where there were slight reductions. It also reported on vaccine leakage or wastage – a story in itself but not discussed here.

I have put the COAG report figures into some graphs below. It gives  a snapshot of the main findings. I also discuss what can be done in the subgroups where immunisation rates are lower compared with other groups.

Aboriginal and Torres Strait Islander children

The good news is that immunisation rates in Aboriginal and Torres Strait Islander children have mostly increased. Three different age groups in each state or territory were reported. Of 24 groups, 21 had increased, with the largest increase among four year olds in South Australia jumping from just 67.1% to 85.7% – an increase of 18.6%. Just three of the 24 groups had reduced vaccination rates and these were Victoria (down by 1.5%) and WA (down by 2.2%) for the two year olds and Tasmania for the 12 months olds (down by 0.9%).

The following graph shows the overall coverage changes from baseline in this period with red arrows where coverage dropped.

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Four year olds

There has been an impressive increase in coverage for four year old children. This is probably related to the previous government’s decision to link receipt of Family Tax Benefit Part A with on-time immunisation. Queensland remained worryingly low and it is not clear why this is the case.

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Low coverage areas

Some states or territories have named certain regions within them as ‘low coverage’ areas. For the 12-15 month old age group, this included NSW, WA and Tasmania.

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NSW reported a 0.3% reduction, a finding that the Daily Telegraph picked up on this week with the headline “COAG Reform Council Shows Vaccination Rates Fall Further In Some Areas“.  Immunisation rates do jump around slightly, but to me this newspaper missed the overall story in their pursuit of a more dramatic angle.

The idea that Australia’s immunisation rates are falling generally has been propagated widely in Australia this year in the media. But it is simply wrong, as seen in the graph below produced by the National Centre for Immunisation Research and Surveillance. Our national coverage is stable and has in fact increased in the four year old age group nationally. It seems irresponsible to propagate this idea of falling national coverage and shows an implicit disregard for the evidence. It has also spurred newspaper editors, professionals and politicians to seek quick and poorly thought out policy solutions.

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While vaccination rates are not declining nationally, averages can mask significant variations in regions and sub-groups. Mostly where rates are lower, it’s about timeliness. A four year old may have had all her baby vaccines but if she is more than three months late four year old vaccines, she will be in that group counted as not fully immunised. Reminders and recalls that help prompt parents when a vaccine is due or overdue, can certainly increase vaccination rates. NSW has produced an app that does this. But parents who tend not to vaccinate on time also tend not to opt-in for such things. For them, Australia could invite all parents postnatally to be enrolled into an SMS reminder system linked to the Australian Childhood Immunisation Register.

Helping motivated parents to access timely vaccination can be done with the right strategies. But parents and whole communities who are less motivated to vaccinate present a much bigger challenge. For many years we have put them in the ‘too hard basket’ and for years, the rates of vaccine refusal in such communities have stagnated. But with lower coverage, they are more vulnerable to disease outbreaks, it is time to ‘brave the discontent’.  Our research group is now starting a series of studies that will build a situational analysis of such communities. By working with a range of partners, we hope to develop some promising approaches that respectfully help parents and communities to make the best quality choices about vaccination.

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The figure above shows how parents who decline vaccination and register their conscientious objection cluster in certain regions of Australia.

Source: NCIRS http://www.ncirs.edu.au/immunisation/coverage/maps/index.php

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