How vaccination policies could be improved

An investigation into the management of adverse effects associated with influenza vaccinination of children (with the Panvax and Fluvax products)  was released yesterday. The report, by the Australian Government’s former chief medical officer, Professor John Horvath, is dated March 10.

It coincides with a special theme issue on vaccination from the journal Nature.

Dr Julie Leask, Senior Lecturer in the Sydney Medical School at the University of Sydney, who contributed to the Nature series, identifies a number of areas for some systematic policy action.

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A systems-based approach is needed

Julie Leask writes:

As vaccines continue to achieve their success, we increasingly see their risks take centre stage and many are concerned about an erosion of public confidence.

This week’s edition of Nature unpacks the topic of vaccination from a global perspective. I provide an overview of acceptance of childhood vaccines in industrialised nations.

Heidi Larson and Isaac Ghinai focus on polio eradication.

There are special features on vaccine safety, measles and HIV vaccination.

When we think of vaccines it’s often in terms of the highly polarised debates over their safety. The problems with vaccine uptake are spoken of in terms of what people think and do, rather than how health systems and policies support people.

Addressing the latter has much more of an impact on vaccination than trying to change what individuals think.

A minority actively refuse vaccination – about 3% in Australia but rising to as much as 35% in towns where alternative lifestyles predominate. The problem here is that herd immunity is lost giving the diseases a foothold.

To achieve change in these communities would require a creative and resource-intensive approach. Learning from across the disciplinary boundaries might help. So might listening and public engagement.

We must not forget the other half who face barriers experienced by families in social isolation or poverty. There’s a will, but less of a way.

Here the solutions centre on ensuring vaccines are easy to have with more upstream solutions like incentives, reminder systems and flexible clinic times. These are things governments can address more readily.

For most parents, vaccinating a child is an automatic process.

But a few – up to 20% want to consider things a bit beforehand. They tend to have tertiary education and usually vaccinate but might delay or refuse a stigmatised vaccine. This questioning group should be the focus of attention when vaccines scares take off. Social sciences research needs to better understand them and their influences and develop and test strategies.

We already know one of the secret ingredients in strategies to prevent unwarranted vaccine safety concerns take hold: health professionals.

My article sets out the ways they can be supported. Health authorities also need to be in the practice of listening to public and health professional concerns about vaccination. Heidi Larson’s article highlights how this has played out with efforts to eradicate polio.

Meanwhile, we continue to see some vaccine opponent groups like the Australian Vaccination Network hijack debates with their radical claims and eclipse the opportunity for a legitimate public discussion about improving vaccination programs.

In reality, vaccines can sometimes cause rare but serious side effects. Governments should be able to reassure the public that there is a robust and efficient system for detecting and responding to signals.

The findings handed down by former Chief Medical Officer, John Horvath, call for a more timely and coordinated approach to vaccine safety surveillance systems in Australia.

They arise out of the events surrounding the suspension of the seasonal influenza vaccines for children aged 5 years and under in April 2010 which resulted from an increase in febrile convulsions after administration of what later turned out to be one brand’s vaccine.

The criticisms largely revolved around the timing and flow of communication between the governments and agencies involved but also communication with public and health professionals. But while Horvath calls for a more efficient system, he stresses its existing ability to ultimately detect a problem and act on it.

The Horvath review is a positive step towards improving things.

However, the need for improvements in timeliness and communication have been recognised for some time.

Hopefully, the recent events will provide the impetus to put recommendations into action. Then we can tackle the complex question of how Australia compensates the very, very small number who have been seriously affected by a vaccine.

Certainly many in the immunisation community support the call for such a system.

Vaccine safety is an important issue but the benefits of vaccines should not be forgotten.

They have helped rid the world of smallpox and eliminated polio and measles from a number of regions. We have seen a profound impact on rates of diseases like polio, measles, diphtheria, whooping cough, tetanus, mumps, rubella, hepatitis B, rotavirus and Hib disease along with a number of other diseases.

However, the safest and most effective vaccines are of little use if the public don’t take them up. So countries should invest in the research and actions that help maintain high uptake of vaccine programs.

• You can also hear Julie Leask in this Nature podcast interview