For decades, Australia has been a global leader in child immunization efforts.
Vaccination has protected millions of children from preventable diseases like diphtheria, measles and whooping cough. But after child vaccination rates peaked in 2020 at around 95%, we’re now seeing an alarming decline.
In this podcast, health policy experts Peter Breadon and Wendy Hu discuss these concerning trends and what governments can do to boost vaccination rates in Australia. Hosted by Kat Clay.
Relevant research
- Child vaccination in Australia is falling – The Conversation
- Falling vaccination rates endanger us all – The Sydney Morning Herald
Transcript
Kat Clay: For decades, Australia has been a global leader in child immunization efforts.
Vaccination has protected millions of children from preventable diseases like diphtheria, measles and whooping cough. But after child vaccination rates peaked in 2020 at around 95%, we’re now seeing an alarming decline. What’s causing this and what should governments do to turn things around? That’s the question for today’s podcast, and joining me are Grattan Institute health policy experts, Peter Breadon and Wendy Hu, who have been researching this issue very closely.
So, Wendy, let’s start with the big picture. What has made Australia such a success story in terms of child vaccination?
Wendy Hu: One of Australia’s biggest health success stories has been the introduction of the National Immunisation Program in 1997, and this was a systematic effort by government to vaccinate children against common diseases. In 1995, we saw that the percentage of one-year olds who were fully vaccinated was only 52%.
But by 2020, this had risen to the government target of 95%.
Kat Clay: And Wendy, I mean, that high coverage made a real difference to children’s health, didn’t it?
Wendy Hu: That’s right, years of healthy lives lost due to vaccine preventable diseases in children under five fell by nearly 40 percent in the decade to 2015. And some diseases were even eliminated, such as polio and measles.
Importantly, gaps between communities fell too. The gap between the Northern Territory, which had the lowest vaccination rate and the national average, had disappeared by 2020, and the gap between First Nations children and other children also narrowed considerably.
Kat Clay: It’s important to remember that a lot of those diseases have been nearly eliminated thanks to vaccination. But those gains that we’ve seen are now slipping away. Wendy, what’s happened since 2020?
Wendy Hu: Yeah, it’s quite concerning. So, since 2020, child vaccination rates have fallen every year. And last year, only 92 percent of one-year olds were fully vaccinated. We see that coverage is lower in 2024 for every single vaccine across every age group compared to 2020, and that this is a nationwide issue.
Every state and territory, except for the ACT, has areas where more than 10 percent of one-year olds are not fully vaccinated. And while coverage has remained quite steady in high coverage areas, we’ve seen that vaccination rates in our lowest coverage areas decline quite dramatically. And these are areas like Noosa, the Gold Coast hinterland, and now even areas like Manjimup in Western Australia and Tasmania’s southeast coast.
Peter Breadon: That’s right. The parts of Australia where more than one in 10 one-year olds were unvaccinated back in 2018, there were only 10 of those places across Australia.
But when you got to last year, we’d seen a fivefold increase. So now we’ve got 50 parts of Australia where you’ve got really far too many one-year-olds that don’t have all their vaccinations.
Kat Clay: So, Peter, in context, I mean, 92 percent sounds fine to me. Why isn’t that okay? And what does this mean in terms of infections and protection from illnesses for children?
Peter Breadon: I agree, Kat. On the face of it, 92 percent sounds like a great result, but there’s a couple of issues here. The first is, we’ve just talked about how some areas are well below that level, but also that target that we had at a national level set back 25 years ago of 95%, it was set for a reason.
And that’s because among these vaccine preventable diseases, the most infectious ones, you really only start to get herd immunity around that level of 95%. And that’s when you really hope to stop transmission of the disease in the community in its tracks. At that point, you start to give protection also to those minority of children who aren’t vaccinated.
So that’s a great aspiration to get to that 95%. And we’ve just been slipping further and further away from it.
Kat Clay: Yeah, and I mean, it’s important to remember that we’re talking about little children who are getting sick from preventable diseases. So, while we’re talking about percentages, we’re also talking about preventing little children from getting sick. And I mean, we’ve recently had two cases of measles in Lismore, and that is very serious.
Are we at risk of seeing more cases of preventable diseases cropping up in Australia?
Peter Breadon: We are Kat. It’s so easy to be complacent and think these kinds of conditions sound a bit like something that happens in the last century. They’re not a concern today. But as you said, we’ve just seen two measles cases reported really in the last couple of weeks in Lismore. Someone who came back from overseas, they infected a member of their family, and you might think, oh, the protection’s fine.
That won’t spread too far. But we’ve seen over in Texas in a rural county, a massive measles outbreak. It’s put well over a dozen children in hospital, and you know, you might think that’s Texas, they’ve got other kinds of problems, but there are parts of Australia with lower measles vaccination levels than that rural Texas county where they’re having such struggles against this outbreak.
And some of those areas are close to Lismore.
Kat Clay: And there are really serious complications as part of these diseases, aren’t there?
Peter Breadon: Yes. Well, measles is a really scary disease. A few children will actually die in every thousand cases of measles, and there are really long-term effects for many people who are infected in terms of their immune system and other complications and conditions that can arise, so it’s really one we have to stop in its tracks.
And, you know, we’ve done it before, but, you know, as we might discuss. These trends need probably some new approaches to turn them around.
Kat Clay: Wendy, what’s causing this fall in vaccination rates? You mentioned that they’ve been falling since 2020. Is COVID part of the explanation?
Wendy Hu: There’s no single cause, but the timing of this decline in child vaccination rates certainly suggests that things changed or at least accelerated during COVID.
So, one factor is vaccine hesitancy. We’ve seen a growing threat of this, which has been filled by COVID misinformation. And another factor is cost of living pressures and a high inflationary environment post COVID. In a recent survey by the National Centre for Immunization Research and Surveillance, it found that more than 1 in 10 parents said that cost and trying to get an appointment were barriers to vaccinating their children.
Kat Clay: So, it sounds like parents have their concerns and they’re also struggling to get appointments. And I mean, you know, this is a problem we’ve discussed on the podcast previously, but Peter, if we want to lift these vaccination rates, what should governments be doing?
Peter Breadon: It’s really important, Kat, that governments acknowledge the world has changed. Unfortunately, as Wendy was going through, it seems to have gotten harder to get people vaccinated. Vaccine fatigue, suspicion, misinformation just the knowledge of vaccines and how, you know, things keep changing and maybe people can’t keep up.
As Wendy mentioned, we need a strategy that really addresses all of those barriers. We’ve seen with this huge triumph of child vaccination that happened in the first 20 years of this century, that one thing that can really help are clear goals. And that goal of 95 percent for one-year olds and five-year-olds, you know, we finally reached it in 2020. So, we need to maintain that target, but we also need tougher targets for those communities that keep falling behind.
Today, under the national agreement on immunization, state’s target for helping areas that are falling behind is they’ve got to choose out of the 10 areas within their boundaries with the very lowest vaccination rate, they’ve got to pick four and increase the level in those areas.
So, they don’t have to address all the low vaccination areas. They don’t have a target to reach. They just have to make any incremental improvement. And as Wendy mentioned before, the falls we’re seeing a really biggest in those low vaccination areas and vaccination matters locally because it’s about transmission within a local community.
So, we’ve got to set tougher targets for the low vaccination areas, not just for the national average.
The next thing governments need to do is really push that information out into the community. There’s been a little bit of hesitancy, I think about really advertising vaccinations since the COVID vaccinations and some of the mandates that were involved and people kind of wanting to put the pandemic behind them, we need to get over that and really have strong public advertising campaigns that explain the benefits of vaccination, what is needed at every stage of childhood and older life, and then also that really combats the misinformation that is seems to be taking roots in parts of our community.
And then the other thing that we need to do is I’ve said, you know, set targets for those places that are falling behind.
You need to really put resources into those communities too. During the pandemic, we saw some great models where people work with local communities to really understand what’s going on here. Is it a misunderstanding? Is it misinformation? And set up programs that might go out to people’s homes to, to make vaccination more convenient.
It might work with local community champions to really have a trusted voice in that community, explain the benefits of vaccination. But for those communities, the barriers are all different. You really need those intensive tailored local efforts to turn things around.
So along with those targets for areas falling behind, we should have targeted resources so that we can make changes in local communities. So, it is time for a big vaccination reset. The good news is there’s a new strategy in the works, a new 5-year vaccination strategy. We just have to make sure it’s got those ambitious goals, those new resources, and it’s backed up by a strong argument to the community about why vaccination is so important.
The slide in child vaccination we’ve talked about today is really alarming. But if governments take action now and are serious about it, we can turn it around and we can get Australia back to setting records for child vaccination.
Kat Clay: Thank you so much, Peter and Wendy. If you would like to read more about their research, I’m going to include a link to their article in the show notes below. Please do look further at our research and consider donating to Grattan at grattan.edu.au. As always, please do take care and thanks so much for listening.