How do we raise child COVID-19 vaccination rates?

By Wednesday 16 March, just over 51% of eligible 5–11-year-olds had received their first dose of a COVID-19 vaccination, according to Department of Health (DoH) statistics.
 
Fast forward seven days and how much difference did a week made?
 
The answer: not much at all.
 
As of 23 March, the overall first dose vaccination rate still hovers at just over half the eligible population – 51.83% to be precise – with the 10,942 extra doses representing a rise of just 0.48%.
 
Those official figures represent a pattern familiar to many general practices and other vaccination centres around the country.
 
The rollout began with high demand reported across the country.
 
According to a document published this week on the National Centre for Immunisation Research and Surveillance (NCIRS), during the initial stages of the rollout only New Zealand and Singapore had reported higher daily increases in vaccine coverage among younger children.
 
GP Dr Joe Garra says his vaccination clinic in the Wyndham local government area in south-west Melbourne initially struggled to keep pace.
 
‘When the vaccines first came out, we were getting booked out and [vaccinating] lots of kids,’ he told newsGP.
 
‘That was back in January, it was amazing. But it could be that everybody [who] wanted to be done was done. And then we’re left with the stragglers now, which is tricky.’
 
Why have children stopped coming forward?
Dr Garra says his best guess at the declining rate is the widespread presence of COVID-19 in the community. While children are returning to complete their vaccine course – the rise in second doses over the past week is a healthier 9% increase – he still reports a high level of cancellations.  
 
‘The suspicion is lots of the kids have caught it,’ he said. ‘That’s our suspicion, but we don’t know.
 
‘I’ve got lots of questions but no real answers.’
 
Despite the plateau, Associate Professor Margie Danchin – the Group Leader for Vaccine Acceptance, Uptake and Policy at Murdoch Children’s Research Institute (MCRI) – says that Australia is still among the leading countries for vaccine coverage in primary school children.
 
She describes the reasons behind the slowing rate – which is happening despite sufficient supply – as ‘a complex mix of access and acceptance barriers for parents.’
 
‘It is certainly not all hesitancy would be the first thing I would say,’ Associate Professor Danchin told newsGP. ‘Making access as easy as possible for parents to get their children vaccinated is really important.
 
‘There are so many reasons why people are feeling worn out and, and they’re sick of hearing about vaccines. And that’s not just for primary kids, so I think that’s an issue.’
 
A recent newsGP weekly poll would appear to agree with Associate Professor Danchin’s suggestion, with nearly two-thirds of all respondents recommending in-reach clinics at primary schools and other pop-up clinics at convenient times and places as the best way to boost numbers.
 
In the meantime, more than a million children around the country are yet to receive a first dose, and Dr Garra says he is persisting with reminders.
 
‘[I’m telling parents] children should get it. The odds of getting a rare complication from the vaccine is much less than getting a rare complication from COVID,’ he said.


Associate Professor Margie Danchin says vaccine hesitancy is not the only factor contributing to the lack of uptake. 

Vaccine monitoring conducted by the Therapeutic Goods Administration and AusVaxSafety also indicates that COVID vaccines have been better tolerated among 5–11-year-olds than older populations.

In contrast, Associate Professor Danchin says it is important to challenge the messaging that COVID is always ‘mild’ in this cohort.
 
‘One of the biggest barriers is low perception of need – “if [children] did have COVID, it was probably mild”. And if they haven’t had COVID, their parent expects it to be mild,’ she said.
 
‘We really [need] more messaging around the fact that we are still seeing severe disease in children, and they do need admission to hospital.
 
‘[For example], there is multi-system inflammatory syndrome in children, while we also need to vaccinate kids against chickenpox, which is a lot less severe in children than COVID.’
 
Uncertainty about the impact of long COVID, the impact of the infection on a developing brain, and the possibility of new variants should be powerful motivators, Associate Professor Danchin says.
 
‘We don’t want kids to get COVID,’ she said. ‘Even though it is a reasonably mild infection in the majority of children.’
 
Both Dr Garra and Associate Professor Danchin believe the messaging about the safety of the vaccine for children – with significantly fewer side effects in the age group than for adults – could be stronger.
 
‘We know that myocarditis occurs at a 10th the rate in primary kids [compared to] secondary school kids,’ said Associate Professor Danchin. ‘We need to reassure [parents] about this.’
 
She also points to state-run vaccination hubs in Victoria as good examples of being well set up to manage needle anxiety among children and says these could be promoted by other vaccine providers where necessary.
 
Addressing inequities
As well as trying to address a slowing of the booster take-up, the Federal Government this week announced plans for a school holiday vaccination blitz.
 
Just as with local government figures, significant differences in vaccine take-up between states and socio-economic groups is now emerging. The ACT, for example, has first dose vaccination rate for 5–11-year-olds is around 80%, while Queensland is much lower at 43%.
 
Continuing evening clinics, pop-up clinics and text message reminders are among the other methods Associate Professor Danchin believes will help boost the rates, with co-promoting COVID-19 vaccination alongside flu vaccines another potential means of increasing coverage.
 
The report published this week on the NCIRS website also highlights the relevance of improving timely data, which Dr Garra says he would welcome.
 
‘Governments must fund and involve researchers to provide timely and useful data on why parents are not willing or able to vaccinate,’ the publication on the NCIRS website reads.
 
‘Vaccination programs must integrate data into planning at the outset and there should be enhanced capacity to rapidly and iteratively use both quantitative data that tell us who is under-vaccinated and qualitative insights that explore why they are under-vaccinated.’
 
For Associate Professor Danchin, the key to improving rates is likely to come at a granular level.
 
‘It’s not just about a fancy communication campaign on telly,’ she said.
 
‘It’s communication actually tailored for the specific groups, understanding barriers and more importantly, engaging with community and leaders in different communities to promote the vaccine.’
 
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