Dropping the ball on vaccination

Cases have been rising. In early November nearly 100 NSW aged care facilities had a COVID outbreak, more than three times the number just a month earlier.

It’s the wrong time to drop the ball on vaccination but that’s what we’re doing.

Less than four in 10 aged care residents in NSW have been vaccinated in the past six months. The problem goes beyond NSW and beyond aged care. Among all Australians over 75, less than three in 10 have had a recent vaccination.

It’s easy to see why. Some people are sick of thinking about vaccinations or confused by constantly changing rules. Others think the threat from COVID is over or have been swayed by misinformation. But COVID remains dangerous, vaccines are very safe for people who are recommended to get one and regular boosters are crucial to maintain protection.

And the vaccination problem goes well beyond COVID.

Just half of Australians in their 70s have had their recommended shingles vaccinations and only one in five are vaccinated for pneumococcal disease. Most years, at least a third of older people aren’t vaccinated for flu.

These averages are bad enough, but a new Grattan Institute report shows that the problem gets worse when you zoom in. Whether you get vaccinated depends a lot on things like where you live, where you were born, and what language you speak.

Even within Sydney, the differences in COVID vaccination are stark. At the start of winter, more than half of older people in North Sydney and Mosman had been vaccinated in the previous six months. But in Fairfield the rate was just 17 per cent.

Across Australia, high-risk people who don’t speak English at home were half as likely to be recently vaccinated. The vaccination rates for some language groups are extremely low, in some cases just a fifth of the average.

Poorer neighbourhoods, Indigenous people, and people living in regional and remote areas are all more likely to miss out.

All these groups are more likely to get seriously sick from infectious disease, so the gaps in vaccination are in the worst possible places.

Fortunately, many building blocks for higher and fairer levels of adult vaccination are in place.

Governments did a lot of work during the pandemic to stock up on vaccines, improve data, expand pharmacy vaccination, and increase uptake in the most vulnerable communities. GP clinics and pharmacies worked hard too, giving tens of millions COVID vaccinations, and reaching almost all high-risk people.

Australia can build on these strengths, but there’s no time to lose. Trust in vaccination is declining due to misinformation and COVID fatigue. Even before the pandemic, adult vaccination was too low. With uptake of some vaccines falling further, it’s time for governments to lead a vaccination reset.

First, Australia should set clear goals. About 25 years ago, we set targets for child vaccination, with goals for the whole population and for areas that lag behind. Child vaccination soared to hit many targets and surpass some.

We should set goals for adult vaccination to help repeat this success.

Second, vaccination must get easier. There should be vaccination surges in the lead-up to winter, to reduce the burden on hospitals. At those times, people at high risk should be eligible even if they’ve had a recent injection or infection.

Surges should be accompanied by advertising that explains vaccination and makes the benefits clear. And everyone at high risk should get an SMS reminder.

But that won’t work for everyone, including people in some cultural groups that are missing out. Almost all of them see a GP, and many visit a pharmacy, so there is a good way to reach them. GP clinics and pharmacies should get more support to explain and encourage vaccination, overcome language barriers, and dispel misinformation.

Even these changes won’t remove the most complex barriers. For people in poverty, or who deeply distrust the health system, a different approach is needed. During the pandemic, we saw what worked. ‘Vaccine champions’ spread the word in their own community and language, vaccination vans visited homeless people, and vaccination tents were set up outside places of worship. These programs should continue, with secure funding and monitoring to make sure they get results.

All these policies should be enshrined in a new national deal that provides funding and clarifies muddled federal and state responsibilities.

COVID vaccines saved tens of thousands of lives in Australia during the pandemic. Like the other vaccines recommended by experts, they have low risks, protect people from serious illness, and take pressure off the health system.

Our governments should put Australia back on the front foot by making vaccination easier for everyone, and reaching out to those who need it most.