Vaccines save lives. Yet the likelihood an older Australian is vaccinated varies hugely by GP.
For some GPs, 90 per cent of older patients are vaccinated for flu. For others, only 40 per cent are vaccinated. For COVID, shingles and pneumococcal, the gap is even bigger.
In this podcast, Peter Breadon, Health Program Director, and Anika Stobart, the Senior Associate, discuss their new report, Patchy protection: How to boost GPs’ patient vaccination rates. Hosted by Kat Clay.
Transcript
Kat Clay: It’s that time of the year when everything seems to be going around. COVID, flu, and other diseases have well and truly hit. But vaccines have the capacity to reduce the impact of these illnesses. Each year they save thousands of lives, yet the likelihood an older Australian is vaccinated varies hugely by GP. For some GPs, 90 per cent of older patients are vaccinated for flu. For others, only 40 per cent are vaccinated. For COVID, shingles and pneumococcal, the gap is even bigger. In this podcast, we’re going to delve into why that is the case and what governments can do to raise adult vaccination rates. I’m Kat Clay, and today I’ll be talking to Peter Breadon, Health Program Director, and Anika Stobart, the Senior Associate, about their new report, Patchy Protection, How to Boost GPs’ Patient Vaccination Rates.
This work follows on from a 2023 report, A fair shot: How to close the vaccination gap, which looked at the inequities in vaccination rates in older Australians. Welcome to you both.
Anika Stobart: Thanks, Kat.
Peter Breadon: Thanks, Kat.
Kat Clay: So, Peter, you looked at adult vaccination last year. We’re now in winter of course, when flu and COVID rates are spiking. How are the vaccination rates going?
Peter Breadon: Well, Kat, you mentioned that everyone seems to be sick at the moment, but despite that, we are dropping the ball a bit on vaccination. So, for COVID, for people who are over 75, who are currently recommended to get the vaccine every six months, the COVID vaccination rate has fallen. So, only just a little over a third of those older adults are up to date with their COVID vaccine.
And flu has also fallen off. Currently the flu rate is at 57 per cent for people who are aged over 65. That’s below what we’ve achieved in previous years. It was 61 per cent at this time last year. And these vaccines are very important.
So, the other two adult vaccines are pneumococcal and shingles. And each of these vaccines are recommended for almost everyone in these older age groups. The age band is narrower for shingles and for pneumococcal, but these vaccines are important because they protect from severe disease, from hospitalization and even from death.
And as I mentioned, you know, the medical advice is it’s really important to get it. Now, I’ve already mentioned that we’re not doing that well overall, but when you dig deeper, it gets even worse because many of the groups that need vaccination the most are those who have even lower rates of vaccination.
So, for example, for COVID, the rate is just over a quarter, 26 per cent for Aboriginal Australians. And for people not proficient in English, the COVID vaccination rate is now down at 11 per cent. That’s about the lowest it’s ever been.
And although we’ve seen a bit of an uptick as we’ve gone into winter, people not proficient in English haven’t seen that increase. So, we’re seeing gaps, in fact, get worse. People who are disadvantaged, people who are from different cultural backgrounds and rural areas, many of the gaps are growing.
So not only do we have too little vaccination, many groups that are at greater risk of serious illness are even more likely to be missing out.
Kat Clay: So, Anika, just give us a refresher. What did last year’s report recommend?
Anika Stobart: The report recommended a whole suite of policies that are required at the national, state and local level to boost vaccination rates amongst older people and really close some of these gaps that Peter was just talking about. And this requires policy response at three different levels to address the three levels of challenges that people face to get vaccinated. Firstly, we need universal measures for everyone to remind them to get vaccinated, including SMS reminders, national targets and equity targets and advertising campaigns. The next level down, we need more targeted measures focused on people who face some barriers to vaccination. And this requires action from primary health networks to work with GPs. pharmacists and community health workers to boost vaccination rates at the more local level. And then we also need state governments to really use tailored measures at some communities who face very complex barriers to vaccination.
And this requires identifying, for example, community champions to encourage people to get vaccinated.
Kat Clay: So, in this new report, you looked at how vaccination rates differ between different GPs. What did you find?
Anika Stobart: This report really focuses on the targeted measures I was just talking about that really leverage the role of GPs in boosting vaccinations and closing these gaps. And this is because GPs play such an important role in preventative healthcare and are responsible for promoting vaccinations to their patients.
So, we got access to data from the ABS that combines data on people’s vaccination status, as well the demographic information from the census, and also looks at their interactions system through Medicare, and we were able to determine what a GP’s pool of patients’ vaccination rates looks like.
This was looking at only the older people that are recommended to be vaccinated. And it also doesn’t matter where the patient got vaccinated. So, if they got vaccinated in a pharmacy, that counts too. And what we found was there were these really big differences in rates between GPs, with some having very low rates and some having very high rates.
So, for example, for flu, GPs at the top end had about 90 per cent of their older patients recommended to be vaccinated for flu vaccinated, but on the other end some GPs only had 40 per cent of their patients up to date and you saw this pattern play out across all the four vaccines that we looked at.
So, for shingles, there was a fourfold difference between GPs with the lowest rates and the highest rates. For COVID it was a fivefold difference and for pneumococcal, it was a whopping 13-fold difference. So, while some variation in vaccination rates is inevitable, we think these differences are unacceptably large.
Kat Clay: Does the difference here mean that GPs with low vaccination rates are doing a bad job?
Anika Stobart: It’s very unfair to assume that and our analysis shows why, because we know that looking more deeply at the kind of patient demographics of these different GPs, some GPs, particularly those with lower rates, tended to see more patients who had these higher barriers to vaccinations. So, for example, GPs with lower COVID vaccination rates had 25 per cent of patients who were not proficient in English compared to GPs with higher rates, only having one per cent of patients not proficient in English. We also saw GPs with lowest vaccination rates, more likely to be located in disadvantaged areas and GPs with lower rates more likely to have patients who visit GPs frequently but not regularly, meaning their visits were likely to be bunched up together or separated by long gaps, suggesting their care might be more sporadic, unplanned and involve less of that preventative care, where vaccinations can be discussed and promoted.
And we also did this analysis to then look at to what extent these barriers explain the difference in rates we see between GPs. So, we took account of all these barriers to vaccination. So, things like, you know, age, health status, the demographic profile of a patient, such as their level of disadvantage, cultural background, and their access to GP care. And so, what we found was that while all of these things do play a role in driving some of this variation between GPs, it doesn’t explain all of the difference. There was still variation in GP rates for GPs who had similar patients. So, this suggests that some GPs are beating the odds and vaccinating or have a lot of patients that are vaccinated, and other GPs could be doing more.
Kat Clay: So last year you saw that kind of difference in, between communities and now you’ve dug a little bit more into that GP specific data, and I’m very interested to hear a bit more about this, how you’ve niched down into this.
Could you tell us a little bit more, explain it out for us? How did the rates differ between GPs in similar neighbourhoods?
Anika Stobart: So, our data analysis enabled us to dig into. What the variation in GP vaccination rates look like at a smaller geographic level. So, we found that there were some communities that had a huge variation in GP vaccination rates, even within their neighbourhoods, where you would expect patients to have a fairly similar profile. For example, in Bankstown in Sydney, some GPs had only 33 per cent of their patients vaccinated against flu, whereas others had 80 per cent of their patients vaccinated. And we see this pattern play out in other parts of the of the country too. For example, in Wyndham, on the outskirts of Melbourne, some GPs had an 11 times higher vaccination rate compared to others.
So, our analysis doesn’t enable us to pinpoint exactly why or what is going on here contributing to this variation in GP rates. But we know that some GPs have less resources, have a lot of short consultations where they’re dealing with people’s immediate health issues and don’t have the time to focus on preventative care and talk about vaccinations.
And we also know that, you know, some GPs might not focus as much on vaccination because they don’t have, a nurse on site to support vaccination or a broader team in the clinic to support them.
Kat Clay: Peter, what can governments do to increase these vaccination rates?
Peter Breadon: Anika has talked us through results that tell two big stories about Australia’s healthcare system. The first one is GPs are not on a level playing field. So, we found in our analysis, those GPs with the lowest vaccination rates, most of them also had the patients that faced the biggest challenges. Struggling with English, disadvantage you know, having a chaotic pattern of accessing care. And so, we can’t necessarily blame these GPs when they’re also getting the least funding from the system.
They get less money from those patients. And so, the system forces them to churn through as fast as they can and try and get through these patients to meet the growing demand for care and all the people who are on their waiting list. So, we need a new funding model that’s much fairer, and this report just strengthens the case for GPs getting a flexible patient budget, along with the fees they get for the different services they provide, and that that flexible budget should grow with the complexity and needs of the patient.
And that will give these clinics that see the patients with the biggest challenges more time to spend and with the patient, to explain the benefits and risks of vaccination, to combat, misinformation and to provide care in a culturally safe and appropriate way. So that’s the big change.
Number one, make funding fairer. Cause we see those GPs with low rates, getting less money, and having a bigger lift they need to do for their particular patients.
Kat Clay: Peter, is it just a matter of funding or are there other things that governments can do?
Peter Breadon: It’s not all about the money. So, we also need a healthcare system that uses data to find the problems, investigate them, and then put the solutions where they’re needed most.
Our other big recommendation here is that we need to get this benchmarking data so that GPs can see how they compare. Are they one of the clinics that is only vaccinating 6 per cent of relevant patients for pneumococcal? And that should spur improvement if GPs routinely get this data that tells them how they’re performing compared to similar clinics with similar patients.
The other way we can use data is as a system. And say, okay, who, which GP clinics are doing better than expected. Let’s go in there, find out the best practices and spread them. Which clinics are doing worse than expected. Let’s go in there and talk to the GPs, talk to the patients, understand the barriers, and then provide the support that is needed.
Do they need an extra nurse to provide vaccinations? Do they need better connections to the pharmacy to get appointments for their patients to get vaccinated there? Are there language barriers? Are there cultural issues in how care is being delivered? There’s so many things it could be.
We have these great data now that can give so many insights about who is missing out and where, and really allow the system to lean in and provide the support that is needed. These kind of stark variations in who’s getting high quality care have existed forever. Now we have the data that lets us investigate and solve the problem.
So, it’s a really exciting approach and we’re hopeful that government will take us up on the recommendations to really have a much more focused and targeted approach to addressing these big and enduring gaps in vaccination.
Kat Clay: So, I mean, we’re talking about vaccination rates in older Australians. So, it is important that we do talk about the aged care setting as well. You also found that vaccination rates in aged care are particularly low.
Do governments need to do more there, Peter?
Peter Breadon: That’s right, Kat. Australia needs to do much better in vaccinating residents in aged care. In mid-June, less than four in ten aged care residents were up to date with their COVID vaccinations. This is well under half of the most, potentially the most vulnerable people in our community. They’re older, sicker, more likely to be frail, and they live in these communal facilities where there are greater risk of infection in the first place.
And yet we’re really failing to vaccinate them enough. In a really positive sign, the government took up our recommendation from our last report, which was to report publicly the vaccination rates of individual aged care facilities and so residents and their family and carers and friends can know the kind of protection that is in those facilities in terms of vaccination rates, of course, with that low rate overall, it’s not surprising that we see, you know, really terrible underperformance in some aged care facilities.
So, 100 aged care facilities in Australia have less than 10 per cent of their residents vaccinated against COVID in the past year. Now bear in mind the recommendation is to be vaccinated in the last six months. So, the real rate of optimum protection is even lower than ten per cent. And flu is a very well-established vaccination, really important for older people.
And yet even for flu, aged care services are not providing enough protection to their residents. In June this year, there were 110 facilities with less than 10 per cent of their residents up to date with flu vaccinations. And it’s worth noting also that we’re doing worse than some other countries.
At the end of last winter, we were at about 55 per cent of aged care residents up to date with COVID, which compares very poorly to rates of around 9 in 10 age care residents being up to date in England and in Ireland, our rates are way down, around the level seen in America, which is really never a good benchmark for how you’re performing in public health. This is very bad. It’s good to see this new transparency. We’d love to see that continue with regular updates to these rates expanding the reporting out to the other adult vaccinations of shingles and pneumococcal. And there was also a good budget measure in the last budget, which paid pharmacists to go into aged care settings to provide vaccinations.
So, we need to keep this going, but we also need to set some targets here to show, you know, what is the overall vaccination rate we expect in aged care. And we think, primary health networks should be given accountability to reach those targets. in, two years or less because we really need a sense of urgency about this.
It’s unacceptable to have some of the most vulnerable Australians missing out on vaccinations that could keep them out of hospital and keep them alive longer.
Kat Clay: Thank you so much, Peter and Anika. If you’d like to read that report or any of the other work that we’ve mentioned in this podcast, I’ll put links to them in the show notes for today. We are a not-for-profit organization.
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As always, please do take care and thanks so much for listening.