‘Alarming’ shortfall in aged care COVID vaccination

Only around one in four eligible aged care residents (24.7%) has had a 2023 COVID-19 vaccine booster, according to the latest figures supplied by the Department of Health and Aged Care (DoH).
 
When taking into account residents who were infected in the past six months, the DoH estimates those with existing immunity sat at 70,713 (39.6%) as of 3 May. Last month, the Older Persons Advocacy Network described take-up in aged care as ‘alarmingly low’.
 
While the figures show some sign of recent improvement, having moved from a take-up of 11% on 6 April, GPs are being asked to help increase rates ahead of winter.
 
In the most recent COVID-19 response update for primary care webinar, the acting Chief Medical Officer Professor Michael Kidd noted 391 current outbreaks in aged care facilities around the country, with slightly fewer than 2000 active cases.
 
He suggested a recent rise in cases may have reached a plateau, with figures remaining reasonably consistent in the aged care sector week on week, but said that co-administering COVID-19 and influenza vaccinations will have an impact on addressing the current levels of uptake.
 
‘A really important reminder to please do what you can to get those flu vaccines and COVID-19 vaccines into your eligible patients,’ Professor Kidd said.
 
‘Of course, as we all know, you can give both on the same day, separate arms, without causing any problems.’
 
A total of 5387 deaths have been reported among residents of aged care facilities since the pandemic began according to the latest national snapshot of the sector, including 79 in the most recent week.
 
That is more than one in four of the 20,400 reported deaths from COVID-19 that have been recorded during the pandemic in Australia so far.
 
According to Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, co-administering vaccines is ‘an excellent suggestion’, although he has experienced barriers first-hand in making that happen.
 
‘Anecdotally, I have had a lot of pushback, particularly from families concerned about co-administration,’ he told newsGP.
 
‘Besides the Australian Immunisation Handbook, there is not a lot of consumer-friendly material available to explain the risks versus benefits in co-administering vaccines.’
 
Dr Marinucci described obtaining informed consent as the ‘biggest impediment’ to vaccination.
 
‘This is a very time-consuming process requiring phone calls often to next of kin, especially when there are residents [who] do not have the capacity to consent, ie those people living with dementia,’ he said.
 
‘I have been advocating for multidisciplinary support in this particular area and worked closely with all my facilities with the registered nurses and care managers to help in this informed consent process.
 
‘This has certainly helped me increase vaccination rates in my facilities, not only for COVID but also for influenza and pneumococcal disease.’
 
He also believes that after more than three years of pandemic, shifting attitudes are making the task harder.
 
‘What I’ve noticed is something I like to call vaccination fatigue,’ Dr Marinucci said.
 
‘I have certainly seen a decreased demand, or concern, from people.
 
‘After they have had four vaccinations against COVID, again there is lack of consumer-friendly material explaining the benefits of further boosters.’
 
The same factor was recently mentioned by Professor Julie Leask, a social scientist specialising in immunisation at the University of Sydney's School of Nursing and Midwifery, in an interview with Nine Newspapers about uptake concerns last month.
 
‘I think it reflects the fact that there’s a lot of vaccine fatigue out there, and very likely in aged care facilities as well,’ she said.
 
‘People are wanting to move on from COVID, but we can’t move on from the importance of having boosters for those who really need them.’
 
A recent review of 40 studies investigating vaccine-derived immunity indicates effectiveness against both laboratory-confirmed Omicron infection and symptomatic disease reduces to less than 20% six months after the primary vaccination cycle.
 
It also found boosters restore vaccine effectiveness to levels similar to those recorded after the primary doses, before effectiveness again wanes to approximately 30% nine months later.
 
In the latest primary care webinar, Dave McNally, a First Assistant Secretary for the DoH’s National COVID-19 Vaccine Program, acknowledged that there is ‘further work to be done’ to improve vaccination rates in the sector.
 
He said the DoH is developing communications material for residential aged care facilities aimed at improving uptake among the cohort.
 
‘There’s no minimum number of patients for providers to need to go and visit as part of those in-reach services into residential aged care homes, or disability settings,’ he said.
 
‘Whether it’s one or 10, we encourage providers to go in and vaccinate those people that are eligible and wanting to receive the vaccine.’
 
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