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Carlson SJ, Tomkinson S, Hannah A, Attwell K. What happens at two? Immunisation stakeholders' perspectives on factors influencing sub-optimal childhood vaccine uptake for toddlers in regional and remote Western Australia. BMC Health Serv Res 2024; 24:968. [PMID: 39175040 PMCID: PMC11340031 DOI: 10.1186/s12913-024-11371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND In Western Australia (WA), children aged 24 months living regionally or remotely (non-urban) have suboptimal vaccine uptake. As there has not yet been a systematic approach to understanding the facilitators and barriers to childhood vaccination in regional and remote WA, this study aimed to understand the views of key immunisation stakeholders regarding barriers and solutions. METHODS Drawing on the World Health Organization's "Tailoring Immunization Programmes" approach, we undertook a qualitative study with three forms of data collection: (1) semi-structured interviews with immunisation experts within Australia's immunisation system, (2) a semi-structured focus group with immunisation coordinators and health workers working in regional or remote WA, and (3) member checking with senior staff from WA Health. Data from the interviews and focus group was deductively analysed using the Capability-Opportunity-Motivation-Behaviour (COM-B) model on NVivo 20. RESULTS There was no clear consensus on the typical under-vaccinated child in country WA. A range of barriers were identified: lack of awareness of the vaccine schedule, difficult access to vaccination services, a shortage in a workforce able to have meaningful conversations with vaccine hesitant parents, ineffective reminder systems, and the rapid spread of misinformation. Participants described previous efforts used to improve vaccine uptake, and felt the following would improve uptake: better access to vaccine clinics, building capacity of Aboriginal Health Workers, and vaccine reminders. CONCLUSION This is the first time the facilitators and barriers to routine childhood vaccine uptake in country WA has been explored. Addressing some of these barriers may see an increase in uptake.
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Affiliation(s)
- Samantha J Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Perth, 6009, WA, Australia.
- School of Social Sciences, The University of Western Australia, Perth, WA, Australia.
| | - Sian Tomkinson
- School of Social Sciences, The University of Western Australia, Perth, WA, Australia
| | - Adam Hannah
- School of Social Sciences, The University of Western Australia, Perth, WA, Australia
- School of Political Science and International Studies, The University of Queensland, Queensland, Australia
| | - Katie Attwell
- School of Social Sciences, The University of Western Australia, Perth, WA, Australia
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Matthews R, Menzel K. Vaccine Mandates and Cultural Safety. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:719-730. [PMID: 38165556 DOI: 10.1007/s11673-023-10319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/04/2024]
Abstract
The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety-not state compulsion-must remain the first principles of any engagement-including vaccination-with First Nations Peoples, families, and communities.
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Affiliation(s)
- R Matthews
- Bond University, 14 University Drive, Robina, Queensland, 4226, Australia.
| | - K Menzel
- Southern Cross University, Military Road, Lismore, New South Wales, 2480, Australia
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Burns S, Bhoyroo R, Leavy JE, Portsmouth L, Millar L, Jancey J, Hendriks J, Saltis H, Tohotoa J, Pollard C. The Impact of the No Jab No Play and No Jab No Pay Legislation in Australia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6219. [PMID: 37444067 PMCID: PMC10341108 DOI: 10.3390/ijerph20136219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Australia has a long history of population-based immunisation programs including legislations. This paper reports on a review of evaluations of the impact of the federal No Jab No Pay (NJNPay) and state implemented No Jab No Play (NJNPlay) legislations on childhood immunisation coverage and related parental attitudes. Five databases were searched for peer-review papers (Medline (Ovid); Scopus; PsycInfo; ProQuest; and CINAHL). Additional searches were conducted in Google Scholar and Informit (Australian databases) for grey literature. Studies were included if they evaluated the impact of the Australian NJNPay and/or NJNPlay legislations. Ten evaluations were included: nine peer-review studies and one government report. Two studies specifically evaluated NJNPlay, five evaluated NJNPay, and three evaluated both legislations. Findings show small but gradual and significant increases in full coverage and increases in catch-up vaccination after the implementation of the legislations. Full coverage was lowest for lower and higher socio-economic groups. Mandates are influential in encouraging vaccination; however, inequities may exist for lower income families who are reliant on financial incentives and the need to enrol their children in early childhood centres. Vaccine refusal and hesitancy was more evident among higher income parents while practical barriers were more likely to impact lower income families. Interventions to address access and vaccine hesitancy will support these legislations.
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Affiliation(s)
- Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Ranila Bhoyroo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Justine E. Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Linda Portsmouth
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Lynne Millar
- Telethon Kids Institute, Perth, WA 6102, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Hanna Saltis
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Jenny Tohotoa
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Christina Pollard
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
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4
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Toll M, Li A. Vaccine mandates on childcare entry without conscientious objection exemptions: A quasi-experimental panel study. Vaccine 2022; 40:7440-7450. [PMID: 35501181 DOI: 10.1016/j.vaccine.2022.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage. STUDY DESIGN Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses. RESULTS Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI-0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas. CONCLUSION Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns.
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Affiliation(s)
- Mathew Toll
- Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Ang Li
- Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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Thomas S, Bolsewicz K, Leask J, Clark K, Ennis S, Durrheim DN. Structural and social inequities contribute to pockets of low childhood immunisation in New South Wales, Australia. Vaccine X 2022; 12:100200. [PMID: 35991158 PMCID: PMC9386109 DOI: 10.1016/j.jvacx.2022.100200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/31/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022] Open
Abstract
The TIP approach was used in 5 Australian communities to identify barriers to childhood immunisation. A lensed approach to analysis focused on s social determinants and structural barriers. Socio-economic hardship and service access barriers contributed to under vaccination. Public health interventions need to address structural barriers to childhood vaccination.
Introduction Material and Methods Results Discussion Conclusions
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Neufeind J, Schmid-Küpke N, Rehfuess E, Betsch C, Wichmann O. How a generally well-accepted measles vaccine mandate may lead to inequities and decreased vaccine uptake: a preregistered survey study in Germany. BMC Public Health 2022; 22:1846. [PMID: 36192739 PMCID: PMC9527387 DOI: 10.1186/s12889-022-14075-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background In Germany, a measles vaccine mandate came into effect in March 2020, requiring proof of measles immunization for children attending kindergarten or school and for staff in a variety of facilities. Mandates can be successful if implemented with care and in a context-sensitive manner. They may, however, also lead to inequities and decreased uptake of other vaccines. The aim of this study was to investigate the acceptance and potential unintended consequences of the measles vaccine mandate in Germany. Methods As part of a larger evaluation project on the new mandate, we conducted an online survey among parents in August/September 2020. We assessed differences in knowledge about the mandate and the measles vaccine by socio-economic status. We used linear and logistic regression to estimate how reactance to the mandate was associated with vaccination status and vaccination intention against other diseases. We used mediation analysis to measure how trust in institutions had an impact on the attitude towards the mandate, mediated by level of reactance. Results In total, 4,863 parents participated in the study (64.2% female, mean age = 36.8 years). Of these, 74.1% endorsed a measles vaccine mandate for children. Parents with lower socio-economic status had less knowledge about the mandate and the measles vaccine. The higher parents’ levels of reactance, the lower the vaccination intentions and the likelihood for the child to be vaccinated against other diseases. Furthermore, higher institutional trust decreased the level of reactance and increased positive attitudes towards the mandate (partial mediation). Conclusions The new measles vaccine mandate in Germany, though well accepted by many, might have unintended consequences. Parents with lower socio-economic status, who know less about the mandate and vaccine, might be less likely to comply with it. The mandate may also lead to some parents omitting other childhood vaccines, as a way to restore their freedom. This could decrease vaccination coverage of other vaccines. Any potential loss of trust might provoke more reactance and lower acceptance of mandates. Policymakers should now expand communication activities on the mandate, monitor trends in vaccination coverage carefully and take measures to strengthen trust. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14075-y.
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Affiliation(s)
- Julia Neufeind
- Immunization Unit, Robert Koch-Institute, Berlin, Germany.
| | | | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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Attwell K, Drislane S. Australia's 'No Jab No Play' policies: history, design and rationales. Aust N Z J Public Health 2022; 46:640-646. [PMID: 35980171 DOI: 10.1111/1753-6405.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Since 2014, five Australian states have enacted 'No Jab, No Play' policies requiring children to be fully vaccinated to attend childcare and early education services. We review the five policies and their implications for implementers - including healthcare and childcare service providers - and analyse factors that shaped the design of state policies. METHODS We employed documentary analysis and analysed key informant interviews in NVivo 12. RESULTS Our findings reveal similarities and differences between state provisions regarding exemptions, grace periods, responsibilities of service providers and sanctions for non-compliance. We elaborate on five factors of influence that have shaped No Jab, No Play policies: i) impetus for change; ii) policy normalisation, growing concurrence and stringency; iii) increased co-optation of childcare providers into vaccination governance; iv) policy influence and lessons; and v) partisan politics and the development of party ideologies over time. CONCLUSION A range of factors contribute to how and why Australia's NJNPlay policies have taken their current forms. IMPLICATIONS FOR PUBLIC HEALTH NJNPlay policies impact families and healthcare providers as part of the broader policy ecosystem concerned with maintaining high immunisation rates in Australia. Increased coercion of parents over time has been tempered by partisan positions on exemptions for disadvantage.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia
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8
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Yap N, Buttery J, Crawford NW, Omer S, Heininger U. The Impact of Australian Childhood Vaccination Mandates on Immunization Specialists and Their Interactions With Families. Pediatr Infect Dis J 2022; 41:e188-e193. [PMID: 35333843 DOI: 10.1097/inf.0000000000003490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent global outbreaks of vaccine-preventable diseases, both before and since the coronavirus disease 2019 pandemic, have led to the introduction or strengthening of vaccine mandate policies to target vaccine refusal. Globally, there is wide variation in how governments and jurisdictions implement and enforce mandatory vaccination as well as the financial and educational consequences to those who fail to comply. We explored the impact of mandate vaccination policies on Australian Immunization Specialists who work in Specialist Immunization Clinics (SIC) for approving vaccine exemptions outside of the mandated criteria. In particular, their interactions with patients and families. METHODS A national, prospective, mixed methods, survey-based study conducted with members of the Australian Adverse Event Following Immunisation Clinical Assessment Network between February 2020 and June 2020. RESULTS Sixteen Immunization physicians and nurse practitioner specialists working in a SIC completed the survey. All sixteen respondents had been requested by parents to provide a Medical Exemptions at least once. 88% of respondents felt pressure to provide an exemption that was not medically justified according to legislation. Seventy-five percent of SIC consultants felt that the "No Jab" policies created a moderate or extreme amount of stress to both themselves and parents. All respondents reported experiencing hostility from parents with three respondents having received threats of violence. CONCLUSIONS Mandatory vaccination policies are associated with increased vaccination coverage but can result in widened financial and social inequity, and may harm families' relationships with health care providers. Countries considering the implementation of vaccination mandates should use the least restrictive health policies to ensure a balance between the public health and individual benefit whilst minimizing burdens on health care professionals, children and their parents.
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Affiliation(s)
- Natalie Yap
- From the Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Jim Buttery
- From the Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics, The Melbourne Children's Campus, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- SAEFVIC, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Victorian Department of Health, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Saad Omer
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine
- Yale Institute for Global Health
- Yale School of Nursing
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Ulrich Heininger
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital
- Faculty of Medicine, University of Basel, Basel, Switzerland
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9
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Cordingley TJ, Wilson MAG, Weston KM. The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:353-359. [PMID: 33970550 DOI: 10.1111/hsc.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.
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Affiliation(s)
- Timothy J Cordingley
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Mark A G Wilson
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kathryn M Weston
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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10
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Wiley KE, Leask J, Attwell K, Helps C, Barclay L, Ward PR, Carter SM. Stigmatized for standing up for my child: A qualitative study of non-vaccinating parents in Australia. SSM Popul Health 2021; 16:100926. [PMID: 34604497 PMCID: PMC8473775 DOI: 10.1016/j.ssmph.2021.100926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaccine refusal is highly polarizing in Australia, producing a challenging social landscape for non-vaccinating parents. We sought to understand the lived experience of non-vaccinating parents in contemporary Australia. METHODS We recruited a national sample of non-vaccinating parents of children <18 yrs, advertising on national radio, in playgrounds in low vaccination areas, and using snowballing. Grounded Theory methodology guided data collection (via semi-structured interviews). Inductive analysis identified stigmatization as a central concept; stigma theory was adopted as an analytical lens. RESULTS Twenty-one parents from regional and urban locations in five states were interviewed. Parent's described experiences point to systematic stigmatization which can be characterized using Link & Phelan's five-step process. Parents experienced (1) labelling and (2) stereotyping, with many not identifying with the "anti-vaxxers" portrayed in the media and describing frustration at being labelled as such, believing they were defending their child from harm. Participants described (3) social "othering", leading to relationship loss and social isolation, and (4) status loss and discrimination, feeling "brushed off" as incompetent parents and discriminated against by medical professionals and other parents. Finally, (5) legislative changes exerted power over their circumstances, rendering them unable to provide their children with the same financial and educational opportunities as vaccinated children, often increasing their steadfastness in refusing vaccination. CONCLUSION Non-vaccinating Australian parents feel stigmatized for defending their child from perceived risk of harm, reporting a range of social and psychological effects, as well as financial effects from policies which disadvantaged their children through differential financial treatment, and diminished early childhood educational opportunities. While it might be argued that social stigma and exclusionary policies directed a small minority for the greater good are justified, other more nuanced approaches based on better understandings of vaccine rejection could achieve comparable public health outcomes without the detrimental effect on unvaccinated families.
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Affiliation(s)
- Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
| | - Julie Leask
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Katie Attwell
- School of Social Sciences, Faculty of Arts, Business, Law and Education, University of Western Australia, Australia
| | - Catherine Helps
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Lesley Barclay
- University Centre for Rural Health, Sydney School of Public Health, University of Sydney, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Stacy M. Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), University of Wollongong, Australia
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11
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Court J, Carter SM, Attwell K, Leask J, Wiley K. Labels matter: Use and non-use of 'anti-vax' framing in Australian media discourse 2008-2018. Soc Sci Med 2021; 291:114502. [PMID: 34715625 DOI: 10.1016/j.socscimed.2021.114502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Childhood vaccine refusal is a globally contentious topic, with some jurisdictions addressing it with punitive policies. Media discourse influences how solutions are framed by implying blame - a process known as framing. We examined Australian media discourse on vaccine rejection over a period in which mandatory childhood vaccination policies were discussed and introduced, focusing on the common Australian pejorative term 'anti-vaxxer'. We mapped frequency of use from January 2008 to December 2018. We then searched Factiva for print media articles on childhood vaccination and parents published in that period, searching separately for articles using and not using 'anti-vaxxer' and variants. We constructed a set of 85 articles that did, and 85 articles date-matched that did not use the term to make comparisons and conducted a frame analysis of each set. 'Anti-vaxxer' was absent in Australian media discourse 2008-2010, rising to a peak of 247 articles using the term at the height of legislative change in 2017. Parents were framed as: 1) deviant "others"; 2) ignorant and in need of informing; 3) vulnerable and in need of protection from anti-vaccination activists; 4) thoughtful, critical, informed, and in need of agency and respect; 5) entitled, privileged and selfish; and finally, 6) lacking access to vaccination, rather than being unwilling. Articles using 'anti-vax' terms were more likely to negatively characterise non-vaccinating parents, while articles not including this language were more likely to frame them as thoughtful or lacking access. This study clearly demonstrates strategic use of pejoratives in the Australian mass media around a time of pressure for legislative change and conflation of anti-vaccination activists with non-vaccinating parents. We suggest fundamental changes to how non-vaccination is framed and dealt with in the media to curb polarization and fostering more respectful dialogue, and better social and public health outcomes.
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Affiliation(s)
- Jay Court
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Australia
| | - Katie Attwell
- Faculty of Arts, Business, Law and Education, School of Social Sciences, University of Western, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; School of Public Health, University of Sydney, Australia
| | - Kerrie Wiley
- School of Public Health, University of Sydney, Australia.
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Tran C, Chiu C, Cheng AC, Crawford NW, Giles ML, Macartney KK, Blyth CC. ATAGI 2021 annual statement on immunisation Last updated: 19 September 2021. COMMUNICABLE DISEASES INTELLIGENCE (2018) 2021; 45. [PMID: 34711147 DOI: 10.33321/cdi.2021.45.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Australian Technical Advisory Group on Immunisation (ATAGI) 2021 Annual Statement on Immunisation is the first publication in this series. It highlights the key successes, trends and challenges in the use of vaccines and control of vaccine preventable diseases (VPDs) in Australia in 2020. It also signals ATAGI’s priority actions for addressing key issues for 2021 and beyond.
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Affiliation(s)
- Catherine Tran
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Allen C Cheng
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
- Infection and Immunity, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia
| | - Michelle L Giles
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Kristine K Macartney
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital and PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
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13
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Duch R, Roope LSJ, Violato M, Fuentes Becerra M, Robinson TS, Bonnefon JF, Friedman J, Loewen PJ, Mamidi P, Melegaro A, Blanco M, Vargas J, Seither J, Candio P, Gibertoni Cruz A, Hua X, Barnett A, Clarke PM. Citizens from 13 countries share similar preferences for COVID-19 vaccine allocation priorities. Proc Natl Acad Sci U S A 2021; 118:2026382118. [PMID: 34526400 DOI: 10.1101/2021.01.31.21250866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 05/26/2023] Open
Abstract
How does the public want a COVID-19 vaccine to be allocated? We conducted a conjoint experiment asking 15,536 adults in 13 countries to evaluate 248,576 profiles of potential vaccine recipients who varied randomly on five attributes. Our sample includes diverse countries from all continents. The results suggest that in addition to giving priority to health workers and to those at high risk, the public favors giving priority to a broad range of key workers and to those with lower income. These preferences are similar across respondents of different education levels, incomes, and political ideologies, as well as across most surveyed countries. The public favored COVID-19 vaccines being allocated solely via government programs but were highly polarized in some developed countries on whether taking a vaccine should be mandatory. There is a consensus among the public on many aspects of COVID-19 vaccination, which needs to be taken into account when developing and communicating rollout strategies.
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Affiliation(s)
- Raymond Duch
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom;
| | - Laurence S J Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | | | - Thomas S Robinson
- School of Government and International Affairs, Durham University, Durham DH1 3TU, United Kingdom
| | - Jean-Francois Bonnefon
- Toulouse School of Economics, CNRS, Université Toulouse Capitole, 31000 Toulouse, France
| | - Jorge Friedman
- Facultad de Administracion y Economia, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Peter John Loewen
- Department of Political Science, Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON M5S1A4, Canada
| | - Pavan Mamidi
- Center for Social and Behavioral Change, Ashoka University, Sonipat, Haryana 131029, India
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policies, Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
| | - Mariana Blanco
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Juan Vargas
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Julia Seither
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Paolo Candio
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ana Gibertoni Cruz
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Xinyang Hua
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
| | - Adrian Barnett
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
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14
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Duch R, Roope LSJ, Violato M, Fuentes Becerra M, Robinson TS, Bonnefon JF, Friedman J, Loewen PJ, Mamidi P, Melegaro A, Blanco M, Vargas J, Seither J, Candio P, Gibertoni Cruz A, Hua X, Barnett A, Clarke PM. Citizens from 13 countries share similar preferences for COVID-19 vaccine allocation priorities. Proc Natl Acad Sci U S A 2021; 118:e2026382118. [PMID: 34526400 PMCID: PMC8463843 DOI: 10.1073/pnas.2026382118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/21/2022] Open
Abstract
How does the public want a COVID-19 vaccine to be allocated? We conducted a conjoint experiment asking 15,536 adults in 13 countries to evaluate 248,576 profiles of potential vaccine recipients who varied randomly on five attributes. Our sample includes diverse countries from all continents. The results suggest that in addition to giving priority to health workers and to those at high risk, the public favors giving priority to a broad range of key workers and to those with lower income. These preferences are similar across respondents of different education levels, incomes, and political ideologies, as well as across most surveyed countries. The public favored COVID-19 vaccines being allocated solely via government programs but were highly polarized in some developed countries on whether taking a vaccine should be mandatory. There is a consensus among the public on many aspects of COVID-19 vaccination, which needs to be taken into account when developing and communicating rollout strategies.
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Affiliation(s)
- Raymond Duch
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom;
| | - Laurence S J Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | | | - Thomas S Robinson
- School of Government and International Affairs, Durham University, Durham DH1 3TU, United Kingdom
| | - Jean-Francois Bonnefon
- Toulouse School of Economics, CNRS, Université Toulouse Capitole, 31000 Toulouse, France
| | - Jorge Friedman
- Facultad de Administracion y Economia, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Peter John Loewen
- Department of Political Science, Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON M5S1A4, Canada
| | - Pavan Mamidi
- Center for Social and Behavioral Change, Ashoka University, Sonipat, Haryana 131029, India
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policies, Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
| | - Mariana Blanco
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Juan Vargas
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Julia Seither
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Paolo Candio
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ana Gibertoni Cruz
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Xinyang Hua
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
| | - Adrian Barnett
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
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15
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Leask J, Seale H, Williams JH, Kaufman J, Wiley K, Mahimbo A, Clark KK, Danchin MH, Attwell K. Policy considerations for mandatory COVID-19 vaccination from the Collaboration on Social Science and Immunisation. Med J Aust 2021; 215:499-503. [PMID: 34510461 PMCID: PMC8661777 DOI: 10.5694/mja2.51269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW
| | | | | | - Kerrie Wiley
- School of Public Health, University of Sydney, Sydney, NSW
| | - Abela Mahimbo
- School of Public Health, University of Technology Sydney, Sydney, NSW
| | - Katrina K Clark
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
| | - Margie H Danchin
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | - Katie Attwell
- School of Social Sciences, University of Western Australia, Perth, WA
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16
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Epstein D, Enticott J, Larson H, Barton C. Pragmatic cluster randomised control trial using Vaxcards as an age-appropriate tool to incentivise and educate school students about vaccination. BMJ Open 2021; 11:e049562. [PMID: 34475171 PMCID: PMC8413930 DOI: 10.1136/bmjopen-2021-049562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This trial aimed to determine if return rates of consent forms for vaccination could be improved when Vaxcards were offered as an incentive to school children. SETTING Nineteen schools in South East Melbourne participated. INTERVENTIONS Students in the experimental arm received a pack of Vaxcards when they returned their government consent form. OUTCOME MEASURES Return of 'yes' consent forms for vaccination as part of a local government council vaccine programme was the primary outcome of this trial. Return rates were compared between the intervention and control schools and with historical return rates. RESULTS Secondary school students (N=3087) from 19 schools participated. Compared with historical returns, a small global reduction in 'yes' responses to consent forms of -4.21% in human papilloma virus consent 'yes' responses and -4.69% for diphtheria, tetanus and pertussis was observed across all schools. No difference between the experimental and control groups was observed. CONCLUSIONS Low 'yes' consent rates and reduction in consent rates between 2018 and 2019 for all groups are concerning. This finding highlights the need for behaviour change interventions across all groups to increase vaccine confidence. Lack of effect of incentivisation with Vaxcards in this study may have been due to the timing of receiving the cards (after the decision to vaccinate had been made, not before) and the limited intensity of the intervention. Optimising the timing and the intensity of exposure to Vaxcards could improve the outcome. TRIAL REGISTRATION NUMBER ACTRN12618001753246.
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Affiliation(s)
- Daniel Epstein
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Southern Synergy, Victoria, Australia
| | - Heidi Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Barton
- Department of General Practice, Monash University, Clayton, Victoria, Australia
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17
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Arat A, Moore HC, Goldfeld S, Östberg V, Sheppeard V, Gidding HF. Childhood vaccination coverage in Australia: an equity perspective. BMC Public Health 2021; 21:1337. [PMID: 34229652 PMCID: PMC8261950 DOI: 10.1186/s12889-021-11345-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states. RESULTS Vaccination coverage was 3-4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively). CONCLUSION Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.
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Affiliation(s)
- Arzu Arat
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sharon Goldfeld
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Viveca Östberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, North Sydney, NSW, Australia
| | - Heather F Gidding
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
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18
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Millar MR, Gourtsoyannis Y, Jayakumar A. Ethics of vaccination: Should capability measures be used to inform SARS-CoV-2 vaccination strategies? Br J Clin Pharmacol 2021; 88:47-55. [PMID: 33891340 PMCID: PMC8250988 DOI: 10.1111/bcp.14875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/02/2023] Open
Abstract
Proposals for SARS-CoV-2 virus vaccination priorities in the UK and in many other countries are heavily influenced by epidemiological models, which use outcome measures such as deaths or hospitalisation. Limiting the values under consideration to those attributable to the direct effects of infection has the advantage of simplifying the models and the process of decision-making. However, the consequences of the pandemic extend beyond outcomes directly attributable to SARS-CoV-2 infection, and include restrictions on educational and work opportunities, access to services, recreational activities, affiliations and relationships with others, freedom of movement (including escaping abusive relationships), and other determinants of human experience. Capability theory gives emphasis to the freedoms that individuals have to express themselves (in doings and beings). Restrictions on freedoms restrict our capabilities. Capability theory has been used to provide a framework for the evaluation and comparison of international development approaches and in the evaluation of public health policy. There is a clustering of disadvantages associated with this pandemic that adds to pre-existing inequalities. Much of the disadvantage engendered in the SARS-CoV-2 pandemic is left out when public health policy is based on a limited range of metrics. Acknowledging the impact of policy across the range of human freedoms at both a national and international level has the potential to improve policy, facilitate the mitigation of direct and indirect adverse consequences, and improve public confidence and the effectiveness of vaccine deployment strategies.
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19
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Removing conscientious objection: The impact of 'No Jab No Pay' and 'No Jab No Play' vaccine policies in Australia. Prev Med 2021; 145:106406. [PMID: 33388333 DOI: 10.1016/j.ypmed.2020.106406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.
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20
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Talley NJ. A New Year, the top research articles, and a call to deliver a "net zero" Australian health care system by 2040. Med J Aust 2021; 214:17-19. [PMID: 33454973 DOI: 10.5694/mja2.50896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022]
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21
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Navin MC, Danchin M. Vaccine mandates in the US and Australia: balancing benefits and burdens for children and physicians. Vaccine 2020; 38:8075-8077. [PMID: 33183856 DOI: 10.1016/j.vaccine.2020.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, MI, United States; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States.
| | - Margie Danchin
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of General Medicine, Royal Childrens Hospital, Australia
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22
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Attwell K, Seth R, Beard F, Hendry A, Lawrence D. Financial Interventions to Increase Vaccine Coverage. Pediatrics 2020; 146:peds.2020-0724. [PMID: 33199467 DOI: 10.1542/peds.2020-0724] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent vaccine mandates in Australia, as in other high income settings, have sought to change the behavior of parents, including those who would otherwise access nonmedical exemptions. Since 2014, Australian state governments have introduced and progressively tightened policies restricting the access of unvaccinated children to early education and child care. In 2016, the Federal Government removed financial entitlements and subsidies from nonvaccinating families. We sought to ascertain the impact of these policies on vaccine coverage rates by state, and also to consider their impact on communities with high numbers of registered refusers. METHODS Interrupted time series models were fitted by using the Autoregressive Integrated Moving Average framework to test for changes in trend in vaccination rates following implementation of government policies. RESULTS Australian vaccine coverage rates were rising before the vaccine mandates and continued to do so subsequently, with no statistically significant changes to coverage rates associated with the interventions. The exception was New South Wales, where vaccine coverage rates were static before the policy intervention, but were increasing at an annual rate of 1.25% after (P < .001). The impact of the policies was indistinguishable between communities with high, medium and low numbers of registered vaccine refusers. CONCLUSIONS In our study, we show that childhood vaccine coverage continued on its positive trajectory without any conclusive evidence of impact of mandatory policies. Overseas policymakers looking to increase coverage rates would be well-advised to examine the contribution of pre-existing and parallel nonmandatory interventions employed by Australian governments to the country's enhanced coverage.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, The University of Western Australia, Perth, Australia; .,Wesfarmers School of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Rebecca Seth
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; and.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Alexandra Hendry
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; and
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
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23
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Nolan TM. "No jab, no pay" pays off. Med J Aust 2020; 213:356-357. [PMID: 32996182 DOI: 10.5694/mja2.50796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Terence M Nolan
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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