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The Ministry of Health has released it’s 2013 Immunisation Health Report.[1] As you would expect overall we’re a nation of vaccinators. Looked at more closely, though, we could do better.

The report, done in partnership with The Meningitis Foundation Aotearoa New Zealand and Pfizer New Zealand[2] surveyed 1500 people, most of who were parents. Here are some of the results:

  • Overall, 87% fully vaccinated their children.
  • 96% at least partly vaccinated their children. (“4% of parents surveyed told us they do not immunise their children at all.”)
  • 78% vaccinated their children on time. (Furthermore, “Of those parents who do fully vaccinate their children, 19% do not adhere, or were unsure they adhered, to the age appropriate schedule and this rises to 50% among parents who only partially vaccinate.”)
  • Younger parents were slightly less likely to fully vaccinate their children. 80% of parents aged 18 to 24 fully vaccinated their children compared to 89% of older parents, aged 25 to 44.
  • 90% of those surveyed believed vaccines are safe.

The Ministry of Health has set targets for vaccination of under 8-month olds. They aim to have 85% of these children vaccinated by July 2013, 90% by July 2014 and 95% by December 2014. (This will tie in with levels needed for effective herd immunity.)

As part of that aim there is also a survey by the New Zealand Immunisation Advisory Centre Litmus research [see comments] looking at the views of that delay vaccination of their children, titled Audience Research: Delayers of Infant Immunisation (PDF file, released late February) – more on this later in this article.

The MoH 2013 Immunisation Health Report includes general information as well as some example stories,[3] such as Alijah William’s tetanus and Letitia Gallagher’s meningococcal meningitis. Towards the end is a page with suggested sources of further information for parents.

There is a focus on infant immunisation, as noted in Tony Ryall’s foreword,

In some cases this first visit didn’t occur until well after the 6 week timeframe for baby’s first immunisation.

Results show there was some demand for more information,

Around 1 in 10 parents do not feel well informed about vaccines and would like access to more information. The parents who said they were not well informed were most likely to be aged under 25 or living in rural areas and towns.

It is suggested that some of the lower vaccination in rural areas in particular may be access issues, e.g. transport to a doctor’s clinic (and presumably the time involved) consistent with a 2011/2012 New Zealand Health Survey that found “About 3.2% of children were unable to see a GP because of transport problems.”

Similarly, there was some demand for information about vaccines that are not funded by the government,

The research also shows that 86% of adults want healthcare providers to inform them of vaccines that provide extra coverage against diseases, even if these are not funded through the National Immunisation Schedule. This includes 80% of adults earning less than $30,000 per year, and 92% of Maori adults who want to be informed about non- funded vaccines.

[Citations omitted for clarity.]

They also asked how people thought those that chose not to vaccinate should be treated,

We asked whether families should lose some of their family tax benefit (as part of Working for Families) if they do not have their children immunised. Opinion was divided – 49% of respondents did not agree with financial penalties; 40% were in favour, and 11% did not know.

We also asked whether children who have not been vaccinated should be accepted into early childhood centres such as day care. Opinion was again divided. While 45% of respondents would not exclude non-vaccinated children, 42% were in favour of exclusion, and a further 13% were unable to answer or did not respond.

[Citations omitted for clarity.]

On this note, the New Zealand Medical Association chairman, Dr Paul Ockelford, has publicly stated they will not punish parents who choose not to vaccinate their children.[4]

The aims of the separate survey of Delayers of Infant Immunisation (PDF file on this page) published in late February are two-fold: to explore “parents’ decisions and reasons for delaying the primary course of immunisations” and to test what “messages to encourage and support parents to immunise their infants on time” might be effective.

The executive summary runs to six pages, so I won’t reproduce it here![5] (The full document is 37 pages.) A key value of this report, to an initial skim reading, are the accounts of what concern parents – raising suggestions of what might be done to met those concerns.[6]

The study involved,

Focus groups and individual interviews were conducted with 68 parents of infants aged eight to 12 months for whom one or more primary immunisations were not administered on time. Fieldwork was conducted in seven district health boards between July and August 2012.

From the study they draw three ‘typologies’ of parents who delay vaccination (their summary quoted here):

  • The Compromised – support immunisation but face significant individual, family/whānau and/or environmental barriers to immunising their infant(s) on time.
  • The Considered – support immunisation but are concerned with the timeliness of the schedule. They therefore immunise at times that they feel are more appropriate for their child.
  • The Conflicted – have concerns about immunisation and immunise their infants when they feel there is a heightened risk of disease, or through a sense of pressure from their partner, family/whānau and/or health provider.

They assessed a range of messages, how they assisted parents in deciding to vaccinate.

It’s a topic worth exploring and it’s good to see this studied, finding out what the concerns are and what might assist rather than presuming to know or taking a particular stance.

It is difficult to summary this work fairly in a few words. If readers feel there is interest I may try examine this in a later post. In the meantime, these two conclusions, while only part of what they examine, might give some of the flavour:

One of the MoH concerns is getting infants vaccinated on time. The conclusions had this to say on “Motivations and enablers for parents to immunise their infants, on time, as scheduled”,

Parents who have delayed one of more of their infant’s primary courses of immunisation have a strong desire to protect them from serious illness and disease and keep them healthy and well throughout their lives. Parents believe their infants are vulnerable to disease when they start socialising with other children and adults outside of their home, and immunisation provides them with a ‘protective blanket’ from serious disease. The tipping point for immunising their infants and children is around socialisation.

Similarly, within “Key messages that might encourage or enable timely immunisation uptake amongst parents of infants” the conclusions offered,

Recommendations for practice to improve the immunisation experience include supportive and accurate information about immunisation at all stages (such as calling ahead to seek advice about whether to delay appointment if their child is unwell), and a more supportive environment (such as a more comfortable waiting area after immunisation is administered, where they can settle their infant, breastfeed, and/or have other children with them during the required waiting time). In addition, having practice staff who acknowledge that it is a distressing event and take steps to reduce anxiety and answer questions would also work to empower parents.

Footnotes

1. A low-resolution copy of the report is available in a nzdoctors.co.nz article. I’ve had no luck locating a MoH source for the document, nor a report with the “raw” data yet – I will update this post if/when I find these.

2. The data seem to be derived from Curia research for Pfizer New Zealand (see references footnotes of the 2013 Immunisation Health Report).

3. I’ve written elsewhere that I feel medical issues like vaccination are perhaps best presented with some examples in addition to facts. It strikes me that this is approach they’ve taken in the report.

4. I question medical staff—e.g. nurses—choosing not to vaccinate, however, as their decision affects people under their care who are not their family members. I feel this belongs in a different discussion than this article, however, as it’s about professional responsibilities rather than ‘just’ personal decisions.

5. I have to admit I think their executive summary is too long. My instincts are that the bullet points in the summary should have been presented without the accompanying explanatory text, tempting as it must be to include it, with the explanation deferred to a more in-depth overview.

6. This survey reminds me of the few other social science reports I’ve read: less quantitative than someone from the ‘hard’ sciences (like myself) is used to, with a fair bit of the value in simply carefully gathering statements that help illuminate the spectrum of views observed.


Other articles at Code for life:

Vaccination – why learn the hard way?

The Panic Virus

Thoughts on, and for, those trying to choose to vaccinate or not

Fact or fallacy, a survey of immunisation statements in the print media

Immunisation, then and now