The need to Improve Vaccination Coverage in Australia Using the Provision of Services or Information Instrument

Australia records high average rates of children immunization according to the Australian Government of Health (2015), whereby over 90% of the children are fully vaccinated at 12 months, 24 months and 60 months. Conversely, the Australian Childhood Immunization Register (ACIR) shows a slight increase in the percentage of fully immunized children, as indicated in table 1. The rate increased by 0.1%, among children aged 60 months, with no significant change in immunization coverage between 2015 until March 2016 (Australian Government Department of Health, 2016). However, data documented by the National Health Performance Authority’s (NHPA’s, 2014) shows that most children remain partially or not vaccinated, and the trend spreads unevenly across the country. For example, Byron Bay records low immunization coverage, around 67%, for children aged five, compared to the region of Illawarra, which records high immunization coverage, estimated at 98%. Further, the Childhood Immunization Register (ACIR, 2013) shows an increase in the number of unvaccinated children owing to the decision of their parents or guardian not to immunize them. The above rate increased from 0.23% in 1999 to 1.44% in 2012, further increasing the possibility of outbreak, increasing the risk of diseases outbreak. Measles requires the highest vaccine coverage rate to achieve the target coverage of 95% as set by the Department of health (Mulholland, 2013). The paper discusses how legislative instruments can be applied to enhance vaccination coverage in Australia from the epidemiological perspective.

Currently, the definition of fully immunized state, for measuring the coverage rates, incorporates an individual’s vaccination status against measles, diphtheria, hepatitis B, Varicella, Meningococcal C., Pneumococcal, and Pertussis, among other diseases (Australian Government Department of Health, 2016).

Table1. Annual report on childhood immunisation coverage for the June 2015, September 2015 and March 2016 (Australian Government Department of Health, 2016)
% Fully immunised % MMR %polio %DTP Age Group State
93.66 94.25 94.25 94.84 60-<63 Months ACT 93.21 93.75 93.81 94.53 60-<63 Months NSW 93.09 93.69 93.66 94.46 60-<63 Months VIC 92.52 93.03 93.09 93.79 60-<63 Months QLD 91.73 92.37 92.39 93.17 60-<63 Months SA 91.22 91.94 91.86 92.83 60-<63 Months WA 93.72 94.37 94.34 95.20 60-<63 Months TAS 92.15 93.27 93.12 94.15 60-<63 Months NT 92.73 93.31 93.33 94.10 60-<63 Months AUS Key: MMR (Measles, Mumps, and Rubella), DTP (Diphtheria, Tetanus and Pertussis) The Vaccination Issue The recent measles outbreak in the Melbourne Suburb of Brunswick has been blamed on anti-vaccination campaigners. In total, a number of 14 cases have been reported, whereas the health department has been notified of 5 additional patients, including two primary school children (Lauder & Stayner, 2016). Consequently, some teachers and students, who are not fully immunized, have been requested to stay at home to avoid contracting measles. The Victorian health authorities have blamed the outbreak on anti-vaccination campaigners. The dropping immunity, as evident in the rapid spread of the measles incidents, is blamed on decreasing percentage of the number of fully immunized people in the population as affirmed by a vaccination advocate. Estimates by the National Health Performance also show that one in every ten Australian children is not fully immunized. The immunization rate in Brunswick for children aged five is 90%, 89% for those aged two, and 94% for those aged one year old. At the moment, the Australian nation aims to attain an immunization rate of 95% (Lauder & Stayner, 2016). The range of potential policy instruments that can be used to tackle Anti-Vaccination incorporate measures aimed at increasing vaccination rates and minimizing the spread of preventable diseases (Diekema, 2012). One of the most outstanding policy instrument in addressing anti-vaccination is the “No vaccine no pay for child welfare policy.” The policy restrains financial assistance for parents who do not take their children for vaccination. There is need for the Australian government to offer vaccination programs for all, which incorporates extra doses for extra protection and increased funding to improve immunization coverage rates (Commonwealth of Australia, 2016). How the Provision of Services or Information Instrument can Improve Vaccination A range of policy instruments can be implemented to address the issue such as regulatory instrument through legislation. A good example would be imposing mandatory vaccination and voluntary consensus with parents and guardians to immunize their children, once they are well informed about the procedure, as well as the potential risks and benefits. Besides, the provision of information instrument is important in increasing awareness and understanding of the National Immunisation Program to facilitate addressing parents’ and guardian’s concerns regarding vaccination (Hambidge, 2009). Legislative Instrument Application to Address the Issue of Vaccination The current policies involve: NO Jab, NO Pay – new immunisation requirements for family assistance payments Provision of incentives to immunisation providers to complete ‘catch up’ vaccination Broader immunisation data capture to assist immunisation providers boost coverage rates No Jab, No Pay: New Immunization Requirements for Family Assistance Payments One of the most effective policy instruments to boost the vaccination rate in Australia is through restricting parent and child welfare benefits for conscientious objectors of vaccination. However, the benefits will be retained for individuals who are exempted from immunization on medical grounds. From the perspective of causal mechanism, the measure is one of the rules that the government will need to enforce to boost vaccination rates, by requiring that children have the required vaccinations administered so that their parents are eligible to receive welfare payments and children subsidies (Luntz, 2015). In the current legislation, children must be vaccinated so that their families benefit from tax benefits and other rebates to cater for childcare costs. In this regard, exemptions for vaccination should only be based on medical and religious grounds, so that the legislation is effectively implemented. Anti-vaccination based on personal objections should be exempted to achieve higher vaccination rates (Brown et al., 2010). From the epidemiological perspective, the policy should be assessed on the basis of the magnitude of effectiveness, causal mechanism, and harm with focus on prevention versus treatment and evidence (Woo, Labadie & Braun, 2014). By implementing the policy, Australia will effectively address outbreaks of contagious illnesses such as measles. These diseases had been eliminated completely, and the outbreaks are linked to the increasing number of parents opting not to vaccinate their children (Salmon, MacIntyre & Omer, 2015). The decision by some parents not to vaccinate their kids is neither backed by medical research nor state policy; hence, it should be discouraged. Although the proposal is largely backed by health agencies and parental lobby groups, it has been opposed by human rights lobby groups as exercising a form of hostility against such parents and their children. The magnitude of effectiveness of the “no jab, no pay” policy is likely to be very high. Critics argue that the conscientious objection clause will only target 2% of parents, failing to account for another 6% of children who have not been vaccinated for other reasons linked to lack of oversight, rather than through deliberate parental decision (Luntz, 2015). The policy is, however, expected to have sufficient impact in addressing outbreaks because those families choosing not to vaccinate their children seem to be concentrated in particular regions. In effect, this is creating suitable grounds for the outbreak and spread of infectious diseases such as measles (Watson & Cresswell, 2015). With regard to prevention versus treatment and evidence, a collective approach will be implemented to create public awareness and influence the communities to embrace immunization based on proven evidence that vaccination is vital in averting outbreaks (Luthy et al., 2013). As such, the new policy is expected to increase vaccination rates to an extent whereby the herd immunity will be sufficient to avert further outbreaks. Provision of Incentives to Immunisation Providers to Complete ‘Catch Up’ Vaccination Making incentive payment to doctors, nurses, and other immunization providers when they identify a child overdue for vaccination is an important intervention in improving vaccination coverage among Australians. From the epidemiological perspective on causal mechanism, the incentives provided to immunization providers are aimed at motivating them to follow up on children overdue for vaccination to administer vaccination (Allen, Georgousakis & Macartney, 2015). The magnitude of policy effectiveness is likely to be high because immunization providers, including doctors, will receive incentive payment each time they detect a child under their care who is overdue for vaccination, and consult with their parents to catch up on their vaccines (Commonwealth of Australia, 2016). The approach will ensure that immunization providers are rewarded for their effort to improve the vaccination coverage rates, especially in low coverage regions, where the vaccination rate is low. The provision of ‘catch up vaccination’ is also justified from the context of causal mechanism, because the percentage of the herd is increased and an outbreak will be less severe. From the epidemiological perspective, the magnitude of effectiveness of the policy is likely to be high, since medical professionals will receive financial rewards for identifying children overdue for vaccination, in addition to the vaccination notification payments that providers currently receive. The provision of incentives to medical professionals is likely to significantly improve coverage rates, increasing the “herd immunity,” and protecting the population in case of outbreaks (Chaix-Couturier et al., 2000). From the viewpoint of harm with focus on prevention versus treatment and evidence, the communication approach is will increase awareness on the importance of vaccination, in a renewed effort to boost the coverage rates. The Australian government will need to invest in extensive awareness campaigns among communities to promote immunization (Nowak et al., 2015). The awareness campaign will incorporate a wide array of initiatives based on comprehensive communities’ research regarding the factors that contribute to low vaccination coverage. The focus of the campaign will be to increase awareness of the vaccination program, and address the resulting parents’ concerns about immunization, as well as dispel the common myths about vaccination. The awareness program will also be supported by improved investment in information materials for medical providers to assist them to have a substantial discussion with parents on the need to immunize their children. The approach will enable parents to make informed decisions regarding immunization, in addition to the ‘no jab, no pay’ measure (Beard et al., 2016). Broader Immunisation Data Capture to Assist Immunisation Providers Boost Coverage Rates Broader immunization data capture helps the providers in enhancing the coverage rates. In most jurisdictions, the approach has been applied as a mechanism towards high vaccination coverage rates. The approach incorporates the provision of funding up to $26.4 million over a period of four years to boost the national coverage rates (Australian Government Department of Health, 2016). The intervention seeks to benefit the whole Australian community by reducing the occurrence of vaccine preventable illnesses (Sadaf et al., 2013). Whereas the vaccination coverage in Australia remains high, the percentage of coverage is still low, and this puts the communities at risk. From the epidemiological perspective, the magnitude of effectiveness of the approach is likely to be high because the program incorporates activities aimed at improving the community’s understanding and awareness of the National Immunisation program as well as broadening and improving data capture to assist immunization providers increase the coverage rates (Australian Government Department of Health, 2015). The initial step in enhancing immunization rates among adolescents and adults is to analyse the current vaccine coverage of these groups. At the present, there lacks comprehensive national data for these vaccines’ coverage, except for the Human papillomavirus (HPV) (Australian Government Department of Health, 2016). The approach could be highly effective if the existing National HPV Vaccine Register could be expanded and adopted as the ‘Australian School Vaccination Register.’ The approach will facilitate capture of all adolescent vaccines that have been administered via school-based programs (Moss et al., 2014). The intervention will avail the tools needed, for instance, recall and reminder systems, to enhance adolescent immunization coverage rates (King et al., 2006). The approach will be preventing harm to the population in cases of an outbreak because of an increased coverage (Mah et al., 2010). This is because vaccination will be delivered nationally via learning institutions. As part of the National Immunisation Program, the vaccination will facilitate the capture of a new register with vaccinations for diphtheria, tetanus, whooping cough HPV, and chicken pox. The register is expected to be operational in 2017 school year. In effect, families will be able to access immunization data for all National Immunisation Programs administered at school (Australian Government Department of Health, 2016). Conclusion To avert the outbreak of diseases such as measles, there is a need to increase the vaccination coverage rates through the provision of information instruments and provision of services. In this regard, the information instruments and provision of services have been proposed for implementation in Australia in the form of policies. The recommended policies include and the ‘no jab, no pay’ regulation, which restricts the reimbursement of welfare funds to parents who have not immunized their children, as well as the Broader immunisation data capture to assist immunisation providers boost coverage rates. The provision of incentives to medical providers is aimed at motivating them to seek out children who are not immunized and ensure that they are vaccinated. A communication model should also be implemented to dispel common myths regarding vaccination and create community awareness on the importance of vaccination to protect the people in case of an outbreak of infectious diseases. The provision of safe immunization compels medical providers to enforce best practices in the administration of vaccines to win the trust and confidence of the public regarding the practice, and in turn, increase the coverage rates. The anti-vaccination crusade can be effectively addressed if the Australian Health Department enforces the above-recommended policies to increase coverage rates. References Allen, T. J., Georgousakis, M. M., & Macartney, K. K. (2015). Childhood immunisation in Australia: 2015 update. Australian Childhood Immunisation Register (2013). (ACIR) data relating to children with no vaccinations recorded and parents registered as conscientious objectors. FOI Disclosure Log. Department of Health. 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