Booster take-up disparities widen

Jolyon Attwooll

18/03/2022 5:04:55 PM

Striking contrasts in booster coverage are emerging in different local government areas. What can be done to address the inequities?

Person receiving COVID booster
Mandates appear to have made a major contribution to Western Australia’s nation-leading booster coverage. (Image: AAP)

Significant geographical gaps are emerging in the proportion of eligible people to have received a booster dose, according to official Federal Government statistics.
Vaccine rollout figures released by the Department of Health have included local government area (LGA) level statistics on the booster rollout since the end of February.
They show that while some areas have high levels of coverage, others are lagging significantly.
The lowest coverage rate that is not flagged for problematic data issues is that of Yarrabah in northern Queensland (45.3%), followed by Cumberland in western Sydney (46.5%).
They contrast with the Perth suburbs of Nedlands and Cambridge at the other end of the spectrum, where more than 90% of eligible people have already had a third dose.
The figures, which were current as of 14 March, represent a trend that is broadly in line with the pattern of the vaccine rollout in the early stages when primary doses were the main focus.
As highlighted by newsGP at the time, affluent areas tended to have a more rapid vaccine uptake, which again is largely being reflected with a disproportionately high level of boosters administered.
A notable and obvious exception to the pattern of the early rollout is playing out in Western Australia, where vaccination rates had lagged much of the rest of the country in the initial stages of the rollout.
Chair of RACGP Western Australia Dr Ramya Raman said GPs had played a major part in rolling out the vaccine and reaching out to patients to ensure they were well protected.
‘The population of Western Australia have done very well in understanding the role boosters play to protect themselves as well as their loved ones,’ Dr Raman told newsGP.
‘Western Australia has had time to adapt while watching the other states, to reduce the risk of experiencing severe COVID symptoms.’
Now, the vast majority of the state’s local government areas (LGAs) have already recorded booster uptake rates in excess of 80% – a mark most LGAs in other states and territories have struggled to reach.
Strikingly, 49 of the 50 highest LGA booster uptake rates can be found in Western Australia, with the only location outside that state being Queenscliffe in Victoria (its 84.2% coverage rate puts it at 49th highest overall).
The effect of mandates
The West Australian Government imposed stricter vaccine mandates than elsewhere in the country ahead of the reopening of its borders last month, with a reported 75% of the state’s workforce subject to vaccine mandates for primary doses.
This year the mandate has since been extended to booster coverage.  
The ABC has contrasted the spread and impact of the virus between Western Australia and South Australia. Both states were both pursuing aggressive virus suppression tactics, but the ABC reports hospitalisation and ICU admission rates have been substantially lower in Western Australia since they opened up their respective borders.
According to the latest vaccine rollout figures, 70% of the eligible population have received a booster in South Australia compared to 84.6% in Western Australia.

RACGP WA Chair Dr Ramya Raman says GPs have played a crucial role in helping people in the state understand the benefit of booster doses. 

Professor Julie Leask, a social scientist at the School of Nursing and Midwifery at the University of Sydney, acknowledges the impact of mandates.
‘Requirements for third doses are in place in many occupational settings [in Western Australia] and that would probably account for the high coverage,’ Professor Leask told newsGP.
‘Around the time boosters were being offered to a lot of the population, they were going to get COVID circulating in the state in an endemic way for the first time.’
However, Professor Leask is wary about other states and territories adopting similarly wide-ranging policies.
‘The problem is mandates produce very significant downsides and we have been made aware of those as we’ve seen them play out across the nation in different formats,’ she said.
‘That’s why we are going to have to increasingly rely on measures other than public health orders and requirements to get people to behave in COVID-safe ways, including wearing masks and having vaccines.
‘You can get high coverage without having mandates, but it takes time and it takes a consistent effort from government and professionals.’
Targeting the vulnerable
Access for people who speak a language other than English and engaging with communities to build trust are important aspects of this push, Professor Leask says.
‘That’s resource-intensive, but it can reduce the inequities as well,’ she said.
‘The other thing when you are looking at boosters is not to look at overall coverage but to focus in on population groups that have greater risk of severe disease such as older people, or First Nations people.
‘You have to think about the efficiency in the way you target this problem.
‘Understanding why, talking to the community leaders or people in that age group, and getting a picture of what’s happening with them and why they are not vaccinating and then engaging with them on solutions.’
It is a point echoed by infectious diseases expert Professor Peter Collignon of the Australian National University.
‘We do need to get more selective, particularly for those aged over 50,’ he told newsGP.
‘If there are socio-economic groups in different LGAs [not being reached] these need to be targeted to find out why they are not getting boosted.  
‘GPs in the area as well as pharmacy nurses and community leaders will have big part to play in that.’
Reminders including information about when to vaccinate after illness are effective, as well as incentives if applied carefully, Professor Leask believes.
She suggests care also needs to be taken about describing those who have had two primary vaccine doses and may also have been infected as ‘complacent’ if they have not had the booster.
‘It’s not complacency, these are people who have been vaccinated who are making their decisions appraising all the different risks amidst busy lives,’ Professor Leask said.
‘There has been a lot of confusion about the recommendations about when you should take your booster dose. Let’s not blame the individual.’
With no public figures released so far indicating the detailed take-up among many vulnerable groups – there are currently no public federal figures on take-up in different age groups for example – Professor Leask believes more could be revealed on strategies to address inequities.
‘We need to have a close look at the coverage in groups of people where disadvantage might compound – for example an older person who speaks a language other than English at home, who lives in an LGA where there is more COVID,’ she said.
‘Those three things put them at much greater risk of COVID and severe disease.
‘It would be useful to see how the government is using that information to improve coverage. They absolutely are, but we often don’t get a lot of visibility at the federal or state level.
‘We also need to look at how the primary health networks are being tasked to support primary care in relation to vaccination, or how local public health units are, and how they can improve that level of support, because it can be quite variable.’
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Dr Jennifer Gael Bromberger   19/03/2022 8:44:49 AM

At this stage of the COVID pandemic, where many people have had COVID- and this has been proven over and over to prevent SERIOUS second infection, and with the approval of effective early treatment, I do not understand why we are so focused on vaccines anyway. Many countries in Europe have completely dropped all vaccine requirements and are not chasing booster statistics. Data from UK, South Africa and Denmark is not showing booster efficacy. I think we should be changing our focus .