Indigenous Australians’ vaccination rates too low and not improving

We need urgent action to reverse declining targeted flu and pneumococcal vaccination rates among adult Indigenous Australians, according to a new UNSW study.

The study – published today in the Australian and New Zealand Journal of Public Health – found that adult Indigenous Australians’ vaccination coverage for the flu and invasive pneumococcal disease (IPD) remained “unacceptably low” between 2004–05 and 2012–13.

Lead author Fleur Webster, a PhD candidate at UNSW Medicine, said the findings shocked the study’s authors and should make the Government and policy makers “sit up and take notice”.

After adding younger adult Indigenous Australians to the list of groups eligible for free vaccine in 2010, coverage improved from only 23 per cent to 29 per cent.

“We knew that compared to the general adult population for Australia, the coverage rates are substantially lower for Indigenous Australians for influenza and pneumococcal vaccines, and despite the passing of eight years between national surveys the rates were still so low,” Ms Webster said.

“We were alarmed that the coverage rates actually declined in many instances – similar to 2004-05, the majority of eligible adult Indigenous Australians did not receive targeted vaccinations – which is crucial for service providers, researchers, the Government and policy makers to be aware of.

“It’s been eight years with no progress. The goal is for Indigenous Australians’ targeted vaccination coverage to be equal to or above the general adult population rates for Australia.”

Targeted vaccination coverage declining

The paper compared targeted vaccination coverage for the flu and IPD between two national surveys of adult Indigenous Australians’ health from 2004–05 and 2012–13. Each survey involved almost 6000 participants. 

Between 2004–05 and 2012–13, pneumococcal vaccination coverage declined across all age groups 18 years and above. And, despite national funding of the flu vaccine in 2010, there was no increase in influenza coverage, except for the 18 to 49-year-old age group.

Targeted vaccines are those vaccines where the National Immunisation Program (NIP) recommends a different age group for Indigenous Australians compared to the general population.

Influenza and pneumococcal vaccines – the latter is to guard against diseases such as pneumonia – are recommended for a broader age range of Indigenous Australians because of their far higher rates of chronic disease leading to debilitating illness and death.

Poor information leads to poor outcomes

Ms Webster said a key issue in the disparity of targeted vaccination rates between Indigenous Australians and the general population was the “unacceptable” lack of regular and reliable information.

“In order to have good vaccination programs in place, you need to know what the data is telling you, and frequently, but we don’t have regular or frequent coverage data for adult Indigenous Australians,” she said.

“We know vaccination coverage among adult Indigenous Australians is very low, so a national survey of where it’s at every eight years is inadequate. Without data it’s very hard to create effective vaccination programs that will lead to substantial improvements.

“Much more frequent surveying will facilitate close monitoring and help targeted program delivery efforts – we know urban areas have much lower vaccination rates – so programs need to be customised by age group and location and must be culturally appropriate with input from indigenous stakeholders.” 

Innovative, targeted strategies are the solution

Ms Webster said the situation was critical and the Government’s urgent attention was needed to reverse declining targeted vaccination rates among adult Indigenous Australians.

“We need targeted, innovative strategies because what we are doing is not working and is not enough to make substantial improvements – small, incremental improvements are insufficient,” she said.

“We are in 2019 and the next survey of adult Indigenous Australians’ health is in progress, but seven years is still a long time between data points, even if things are tracking well.

“It is very important that immunisation providers know who their Indigenous clients are, so that they can offer them targeted services like this.”