Why childhood vaccination is dropping and what we can do about it
An alarming decline in childhood vaccination rates is a "wake-up call" for all levels of Australian government and the health sector, according to the peak body for doctors.
President of the Australian Medical Association (AMA), Dr Danielle McMullen, said new figures released this week show we urgently "need to do more" to address the issue.
"Perhaps as a country we've become complacent in trusting our really excellent vaccination rates," Dr McMullen said.
Tasmanian GP Tim Jones said he was talking to hesitant patients about vaccination every day.
"I'm having four to five conversations a day with families about vaccinations particularly as it applies to their children."
He said some were skeptical about both the safety of vaccinations and whether the diseases they protect against are, in fact, dangerous, while others felt apathetic and burnt out in the wake of the pandemic.
"They're fearful, they're worried about harm, they don't want to hurt the people they love."
Dr Jones has been a GP for almost ten years and said vaccine hesitancy was much higher now than it was when he first started working as a doctor.
Dr Jones is also the chair of child and young person's health at the Royal Australian College of General Practitioners.
He said it's really important to listen to people's fear and hesitancy about vaccines, so they feel safe.
"As a GP working in 2025, I did not think I would be seeing kids in the developed world die of measles and yet this is the situation we're now facing"
Dr Jones said fear and hesitancy were the main issues he's seeing in Hobart, but there are also significant economic and cultural barriers with some people struggling to access affordable, convenient care.
New data from the National Centre for Immunisation Research and Surveillance (NCIRS) shows a widespread decline in childhood vaccinations for a range of diseases over the past five years.
The proportion of children who are up-to-date with their immunisations by the age of 12 months fell from 94.8 per cent in 2020 to 91.6 per cent last year.
The percentage of those fully vaccinated by age two was down from 92.1 per cent to 89.4 per cent in the same time frame.
For highly contagious diseases like measles, approximately 95 per cent vaccination coverage is needed to maintain herd immunity.
Source: Department of Health
Dr McMullen from the AMA said a review of Australia's public health vaccination campaigns was needed to "refocus" the messaging and target misinformation.
"Most people are getting the message that vaccinations are a really critical part of our health system.
"Just blasting them with more and more information may not change the dial.
"What we've really got to do is be targeted and work out for people who aren't being vaccinated, what are the barriers they're facing and how do we address those?"
There are practical and ideological reasons why some parents aren't vaccinating their children, either fully or partially.
In practical terms, cost and access to care can be barriers.
Although childhood immunisations are free, sometimes GPs will charge for the appointment, especially in regional or remote areas.
And even if the appointment is free, there may be the cost of taking time off work or transport to the doctor.
Even getting an appointment can be a battle too.
"Childhood vaccinations are due every few weeks so sometimes a GP is really busy and you can't get an appointment every six weeks when it's due," said Jessica Kaufman, a lead researcher on the Vaccine Uptake Group at the Murdoch Children's Research Institute.
"Then before you know it you've fallen behind."
The other reasons for reluctance are linked to emotions and social influence.
Dr Kaufman is part of the National Vaccination Insights Project which surveyed 2,000 parents about childhood vaccination last year.
About 50 per cent of parents with unvaccinated children said they didn't believe vaccines were safe and around 40 per cent didn't think vaccines were effective at preventing disease.
But the most common barrier for all surveyed parents (including those who did vaccinate their children) was "feeling distressed when thinking about vaccinating their child".
"A lot of parents worry about seeing their kids in pain, or worry they are making the right decision or may just have a needle phobia themselves," Dr Kaufman said.
This data was collected last April so Dr Kaufman said it does not reflect the rise in vaccine misinformation that we've seen since the Trump administration was re-elected in the US.
US Secretary of Health Robert F. Kennedy is a well-known vaccine skeptic who has revived the debunked claim that vaccines cause autism and promoted treatments for measles that have no grounding in scientific evidence, such as vitamin A.
"What's happening in the US means things that used to be fringe beliefs are becoming mainstream and anecdotally I'm hearing from nurses that people are coming into clinic with questions about things like vitamin A supplementation," Dr Kaufman said.
Dr Kaufman said employing more practice nurses who can give vaccines at GP clinics, establishing walk-in vaccine clinics and allowing pharmacists to give childhood immunisations could all help reverse the trend.
Creating a positive and supportive environment at the clinics where the vaccinations are administered is also crucial to ease distress.
"Distraction techniques can help or allowing the mother to breastfeed while the baby gets vaccinated," Dr Kaufman said.
"Another idea would be to have a Medicare item that incentivises vaccination conversations so there's time to have good conversations that can be bulk billed."
Julie Leask is a social scientist who is involved in the National Vaccination Insights Project, specifically looking at influenza vaccination uptake. She said the simple act of sending reminders needed to be revitalised.
"Reminders work but they are quite ad hoc right now and it's up to the GP practice. I'm not aware of any jurisdictions using reminders systematically."
Getting through to parents who don't believe vaccines are safe or effective is a lot more challenging but fear campaigns are not effective, Dr Kaufman said.
"Research has shown this can overwhelm people as they might already be scared of the vaccine and potential side effects and then they are shown scary images of people with the disease … this can put them into a kind of analysis paralysis so they do nothing."
She said the most effective way to get through to people with doubts is through community outreach, which was used a lot at the height of the COVID-19 pandemic.
This involves people who are already trusted by a community getting trained in how to have conversations about vaccination within their cultural, religious, political or social network.
"This is a lot more useful than something like the 'arm yourself' campaign we saw during COVID."
Health Minister Mark Butler said the decline in childhood vaccination was "alarming" and the government was currently finalising its National Immunisation Strategy for 2025 to 2030 which will outline how to improve uptake.
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