‘Practical barriers’ central to low childhood immunisation rates

The declining rate of childhood vaccination in Australia could have more to do with cost barriers and a lack of appointment availability than vaccine hesitancy or scepticism, according to early findings from the groundbreaking National Vaccination Insights project.
 
The collaborative Commonwealth-funded initiative, run between the National Centre for Immunisation Research and Surveillance (NCIRS), the University of Sydney and the Murdoch Children’s Research Institute, is working to establish the first systematic national surveillance of drivers of under-vaccination in Australia.
 
In its early findings, from a survey of 2000 Australian parents of children under five, the data shows that 11% said they could not afford the costs associated with vaccination and a further 9.3% said they could not easily get an appointment.
 
Additionally, 8.2% said they did not prioritise vaccination appointments, while 6% thought vaccines were not safe and 5.3% did not believe vaccines were effective.
 
Dr Katarzyna Bolsewicz is one of several lead researchers on the project and told newsGP the initial findings will be followed by qualitative research and in-depths interviews to try and determine the main causes of the access barriers.
 
‘Immunisation for children is free of charge under the NIP (National Immunisation Program), but consultation costs sometimes are not and there are other costs also related to parents needing to take time off work and transportation-related costs, especially for parents and carers in more regional and rural areas,’ she said.
 
‘The exact understanding of those cost-related barriers and why it’s not easy for parents to get to the appointment, we will know only after we have conducted the interviews.
 
‘This type of data is absolutely important, but it needs to be supplemented with the social and behavioural insights which give us a story of why.’
 
RACGP Specific Interests Poverty and Health Chair Dr Tim Senior said the findings released so far are interesting and could also offer solutions.
 
‘As GPs, vaccine scepticism can be frustrating, particularly vaccine hesitancy because there’s so much different information, but if people are willing to have discussions about vaccination, then GPs are very happy to have those discussions,’ he told newsGP.
 
‘It’s actually really useful to know that it’s those practical reasons so, rather than focusing on vaccine scepticism or convincing people, we can concentrate on practical barriers and then we’ll actually have a good deal of success.’
 
Dr Bolsewicz said the findings so far do not indicate that ‘vaccine hesitancy is a major contributing factor to partial vaccination’.
 
Instead, she says there are practical issues at play that need to be looked at.
 
‘I think GPs and nurses working with GPs play an incredibly important role and, we have numerous studies indicating how important it is for people to have their trusted providers,’ she said.
 
‘We know that even when people are initially hesitant, having a good conversation with their trusted provider can really sway the decision into deciding to vaccinate.
 
‘But our data suggests that the barriers are beyond having a good conversation, the barriers are practical in nature.’
 
This first glimpse at the research comes as Australian Immunisation Register figures continue to show a steady decline in childhood immunisation, which has continued to drop since the COVID-19 pandemic into mid-2024.
 
Out-of-pocket costs for patients are also increasing, with data from the latest RACGP Health of the Nation report finding one in four GPs are bulk billing more consults.
 
Dr Senior says GPs are doing their best to encourage vaccination, sometimes at their own cost.
 
‘GPs are really aware of the importance of vaccination and for children, many of them would bulk bill with a triple bulk-billing incentive, but it’s really hard, because GPs do try to absorb costs,’ he said.
 
‘They can bulk bill, but they’re all going to make a decision as to how far they can discount their services in order to encourage vaccination.’
 
He says he hopes the findings will further push funding for preventive care.
 
‘Relying on GPs just to bulk bill and discount actually won’t solve the problem, because there’s only so far that will go, for vaccination rates to be high, primary care needs to be funded,’ he said.
 
Dr Bolsewicz said the next steps of the research will be completed over the coming months, with more findings to be revealed soon.
 
‘These are bigger issues that we’re seeing, and we need to support GPs and practice nurses in doing their job,’ she said.
 
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