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Committee Name:

Select Committee on Immunisation & Vaccination Rates in Children


Legislative Council
Report Type:Report


Report of the Select Committee on Immunisation and Vaccination Rates in Children
Report No:1
No of Pages:315
Physical Location:Legislative Council Committee Office

Presentation Date:


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Hide details for Executive SummaryExecutive Summary

        The two public health interventions that have been attributed as having the greatest impact on the world's health are clean water and vaccines. Immunisation is often referred to as the most cost-beneficial of all prevention strategies, resulting in huge savings to society and to health-care systems. It has been said that "... the value of immunisation has been established beyond reasonable debate and one takes its benefits for granted". World Health Organisation
        The ultimate triumph of vaccines is disease eradication. In the mid-1970s smallpox vaccine deployed following special epidemiological strategies succeeded in eradicating the disease that Edward Jenner attempted to prevent in the 1790s. The debate now is whether the 191 member countries of the World Health Organisation vote to destroy the remaining known samples of the deadly smallpox virus. Only the United States and Russia have admitted to holding samples of the smallpox virus. Polio has been eradicated from the western hemisphere, and worldwide eradication is now a realistic goal
        During the past decade the percentage of the world's infants who receive the basic vaccines of the World Health Organisation’s expanded programme (BCG, DPT, oral polio, and measles) has risen from about 40% to over 80%. The introduction of this program is estimated to save over three million lives annually. This is the greatest tribute to Edward Jenner, who started it all 200 years ago.
        Vaccines have proved to be robust and efficient, and continue to be the workhorses of global immunisation programmes. Across the world, in both industrialised and developing countries, more vaccines of different types are being administered to increasingly larger segments of the population. They have dramatically reduced the burden of death and disease from many infections, and have given credibility to the entire preventive health movement.
        It has been said that immunisation is "...not only the right thing to do but an obligation for society. It is unacceptable to have the capacity to save lives and not to use it." Carol Bellamy, Executive Director of UNICEF International
        The terms of reference for this report examine the rates of vaccination in Western Australia and seek to determine whether vaccination rates of children in Western Australia are lower than rates elsewhere in Australia, to identify factors which may contribute to the low coverage rates of vaccination and to identify ways of rectifying this.
          Raising the profile of immunisation
        • The Committee considers that there is an important need to raise the profile of immunisation as a useful population-health strategy. We therefore recommend that the profile of immunisation be increased by actively publicising the number of deaths prevented, diseases avoided, and costs saved by the prevention of diseases through the use of mass campaigns of immunisation.
        • An important adjunct to the above recommendation is the need for a comprehensive, ongoing immunisation education program for parents, children and immunisation providers.
        • Such an initiative could be led by the Commonwealth Department of Health and Aged Care.
          An annual report to provide a national overview
        • The Committee recommends that the Commonwealth Department of Health and Aged Care produce an annual report on immunisation achievements in Australia providing an overview of immunisation nationally and highlighting important issues from a national perspective.
        • Included within the national annual report on immunisation achievements would be scorecards on the performance of each State and Territory. Western Australia would be measured on its ability to achieve nationally targeted levels of immunisation.
        • There would also be greater transparency of the delivery of vaccines by the various immunisation providers in the State allowing for the development of "joined up thinking" to co-ordinate the activities of each category of immunisation provider.
        • The report can be used as a tool to help policy makers, health-care workers, and the public measure Australia’s progress in reducing the incidence of vaccine-preventable diseases, and to identify actions that can be taken to improve immunisation programs.
          Evaluation mechanism
        • While the Committee commends the Federal Government’s initiative in introducing the Australian Childhood Immunisation Charter ("Charter"), the Committee notes that general goals have been set but targets to the means of achieving these remains unclear.
        • On current estimates, Western Australia, and indeed Australia, is unlikely to meet the goals for immunisation coverage by the year 2000 set out in the Charter.
        • The Committee considers that in addition to the setting of goals, a plan is required to be mapped out by each State and Territory detailing how they plan to achieve the goals. Setting goals without setting out the means for their attainment may create artificially high expectations of the immunisation program and immunisation providers.
          Effective immunisation tracking system
        • The Committee considers that an effective immunisation tracking system is urgently needed in Australia to identify children due or overdue immunisation, to notify parents, to make appointments, to provide a database for health-care providers to monitor the immunisation of patients at each encounter regardless of where the vaccine was administered, to assist in planning and identifying populations at risk for delayed immunisation, to target interventions appropriately, and to evaluate the success of the program.
        • The Australian Childhood Immunisation Register ("AICR") has the potential to be this tracking system once it is fully established but a considerable amount of work needs still remains to be done before its full potential can be realised.
          A national program of immunisation
        • There is a lack of a nationally consistent methodology in measuring immunisation coverage making comparisons between studies of immunisation coverage difficult. This represents a major shortcoming in attempts to quantify coverage throughout Australia. There also appears to be a lack of consistency across Australia in reporting adverse events associated with the administration of vaccines.
        • Given the importance of an effective tracking-system to the maintenance of high rates of immunisation coverage, the time has arrived for consideration of a clearing- house of current State and Territory procedures to decide on standards and core information to be collected, and to ensure further compatibility of reporting systems.
        • At present, there is the potential for the national records of immunisation coverage collected by the AICR, and adverse event reporting notifications collected by the National Adverse Events Reporting Scheme, to be distorted and incomplete due to the different methods of recording and reporting data which each State and Territory currently operates under.
          A single co-ordinating body in Western Australia
        • We recommend that a single body in Western Australia be designated with the responsibility to co-ordinate the programs of the various immunisation providers (community health, local government and GPs) and that this body is held accountable for the attainment of national immunisation goals.
        • This body would draw together the various immunisation providers in the State, and be given the responsibility of co-ordinating immunisation programs in this State The Western Australian Immunisation and Primary Care Strategy, while seeking a collaborative approach, is funded by the Commonwealth and is targeted exclusively at immunisation programs involving GP’s. It appears to ignore the very important contribution made in this State by Community Health Nurses and others to vaccination programs.
          Training and Further Information
        • The Committee recommends that more training is given to health-care providers. Parents want to be informed and involved. The Committee notes the excellent publications of the joint Commonwealth/ State initiative, "Immunise Australia", but considers that more is required to be done to inform the public as to the benefits and risks of immunisation. Consideration should be given to the presentation of materials in more novel ways, e.g., using video or audio tape and better use could be made of Internet resources and immunisation information telephone help lines.
          Compensation for adverse events following immunisation
        • The Committee recommends that urgent consideration be given to the introduction of a limited compensation scheme without proof of fault.
          Types of vaccine
        • The Committee recommends that agreement is sought between the Commonwealth and all States and Territories as to the type of vaccine to be provided and available funding level for all routine childhood vaccinations. To maintain public confidence in routine childhood immunisation it is important that the best available vaccines are included in the schedule.
        • The replacement on the schedule of the whole-cell pertussis vaccine for the less reactogenic and more efficacious, new generation acellular pertussis is to be commended.
        • However, the damaging public debate which engulfed the withdrawal of the acellular pertussis vaccine shortly after its introduction dented public confidence in the childhood immunisation program and must not be repeated.
          The need to identify target groups with low levels of immunisation
        • The Committee recommends that further research is undertaken to identify target groups which require special attention with respect to vaccination education and service provision. For example, research indicates that children of parents with very high or very low education levels are more at risk of not being fully immunised.
        • Aboriginal children in rural areas are more likely to be fully immunised whereas aboriginal children in urban areas are at great risk of not being fully immunised.
        • Early intervention programs, assisted by Community Health Nurses are recommended for those groups in the community identified as being at high risk of not being fully immunised.
          Information at child care entry, enrolment at kindergarten, pre-primary and year 1
        • In line with legislation already in existence in New South Wales, Victoria and the Australian Capital Territory, the Committee recommends that support be given for legislation requiring information on immunisation status at child care entry and school enrolment. This is not to be interpreted to imply compulsory immunisation.
          Funding of all current providers to be continued
        • The Committee recommends that the State continues to adequately fund and support non-GP provided immunisation services including Local Government Authorities, Community Health Nurses and Health Department immunisation clinics.
        • Despite current national strategies aimed at increasing immunisation coverage through the payment of financial incentives to general practitioners it is vital in a State of this size with isolated pockets of population, that a viable range of alternative immunisation service providers continue to operate alongside GPs.
          Monitoring of immunisation coverage of new Australians
        • As the level of immunisation coverage in Australia increases and the risk of outbreaks of vaccine-preventable diseases decrease, the immunisation status of new Australians will become increasingly important.
        • For new arrivals, inadequate or non-existent immunisation records, partial immunisation and cultural or linguistic misunderstandings are common problems. The health care system and health care providers are often ill-informed about the pertinent issues.
        • Special considerations are needed for areas with high immigrant populations and outreach programs implemented designed to address cultural and linguistic needs.