News

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Access barriers drive low kids’ vaccination for third year

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For the third consecutive year, Australian childhood vaccination rates continue to drop for all standard age assessment milestones.
 
The National Centre for Immunisation Research and Surveillance (NCIRS) has released its Annual Immunisation Coverage Report 2023, revealing less-than-ideal coverage rates for the past year and setting a reminder to ‘not be complacent’. 
 
In 2023, fully vaccinated coverage rates for children overall decreased at all three standard age assessment milestones:

• 12 months – decreased to 92.8%, from 93.3% in 2022 and 94.8% in 2020
• 24 months – decreased to 90.8%, from 91.0% in 2022 and 92.1% in 2020
• 60 months – decreased to 93.3%, from 93.4% in 2022 and 94.8% in 2020

These figures follow the 2022 report displaying that coverage also fell for each of the age milestones from 2021 to 2022.
 
This ongoing decreasing trend comes after eight years of steadily increasing coverage prior to the onset of the COVID-19 pandemic.
 
Dr Tim Jones is a Tasmanian GP and Chair of RACGP Specific Interest Child and Young Person’s Health. He told newsGP access and inequity remain the biggest challenges for vaccination coverage.
 
‘The number of people I’m seeing who just can’t get into a GP is still significant,’ he said.
 
‘We need to be looking within general practice at what we can do to try and prioritise getting kids in in the first year of life, and getting these lifesaving treatments into them, that’s very important.’
 
With vaccinations part of GPs’ bread and butter, Dr Jones said there is also a role for audits of populations within general practices to ‘look at who is slipping through the net’.
 
‘There’s a number of people who have come in to see me as a GP where they’ve just been busy and stressed as a family and a [vaccination] reminder hasn’t been adequately placed in a way they could recognise it,’ he said.
 
‘And so it wasn’t until they got a note from Centrelink to say that childcare subsidies were ending that they knew something had been missed.’
 
For the report, Australian Immunisation Register data as of 4 February 2024 was analysed – predominantly for vaccines funded under the National Immunisation Program (NIP) for children, adolescents and adults, with a focus on changes in vaccination coverage since the previous report.
 
Decreases in full vaccination coverage were slightly more in children overall than among Aboriginal and Torres Strait Islander children, with decreases in coverage greater in the latter cohort of children since the onset of the pandemic:

• 12 months – 89.7% compared to 90% in 2022
• 24 months – 87.8% compared to 87.9% in 2022

However, coverage at 60 months of age remains higher in Aboriginal and Torres Strait Islander children (95.0%) than in children overall (93.3%).
 
Overall, fully vaccinated coverage in Australian children was 0.1–0.5 of a percentage point lower than in the 2022 report at all three age assessment milestones.
 
This follows the 1.1–1.5 percentage points decrease at these three milestones between the 2020 and 2022 reports, which came after approximately eight years of generally increasing coverage
 
NCIRS Associate Director, Associate Professor Frank Beard, said while ‘relatively modest’, the decline in vaccination rates is concerning.
 
While the report notes that factors contributing to these declines include a combination of acceptance and access issues, it states that a ‘deeper understanding is needed of the reasons for partial and under-vaccination’ in Australia.
 
‘Regular monitoring of vaccination coverage is important, but it doesn’t tell us why vaccination uptake is low or declining’, Associate Professor Beard said.
 
‘It is therefore critical to identify the barriers to vaccination uptake and implement evidence-based approaches to address them.’
Dr Jones added that vaccine hesitancy – once a significant challenge in the wake of the pandemic –has reduced.
 
‘If we look at something like RSV, and preventive immunisation, there’s a tremendous level of interest in our community about that, and these are new vaccines as well too,’ he said.
 
‘So I don’t see that hesitancy as a problem anymore. I see it purely as an access challenge.’
 
A nationwide, fully funded meningococcal B vaccine for all infants aged under two is also something Dr Jones is calling for, with the vaccine only currently funded by the NIP for those who meet certain criteria and in some states.
 
‘We do really need to see that happen,’ Dr Jones said.
 
‘It remains the best example of vaccine inequity in our community that we’ve got so many families who need it, so many families who want it, but cost is a barrier, and we know that we would save money to our health system if we immunised everyone just to prevent the hospitalisations from that disease.’
 
Also released earlier this month is the Australia-first National Vaccination Insights project, revealing insights on vaccination barriers and drivers to inform future strategies to drive uptake.
 
It confirms that cost and a lack of appointment availability are key barriers to accessing vaccinations, rather than hesitancy or scepticism.
 
Dr Jones finds this ‘very challenging’ as a GP, and says while his practice bulk bills all vaccination appointments, he understands not all are in the same position.
 
‘It’s important for practices to do what they have to do, but I think we also need to consider that this is universal primary and preventive care, and that if families can’t access it for reasons of cost, we need to look at any and all strategies that improve the equity of access for those families,’ he said.
 
‘At a practice level, we can look at what percentage of our population is in these key vaccine age ranges and have a look at our data to see who’s missing out.
 
‘And we’ve got a tremendous resource in our practice, nurses who I know do so much of the lifting work for our clinics to achieve this.’

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access barriers childhood immunisation children’s health vaccination vaccine inequity vaccines

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