No Jab, No Pay and vaccine refusal in Australia: the jury is out
May 2017 - News
In a recent article in the Medical Journal of Australia, NCIRS experts have argued that, as Australian policies requiring documented receipt of all National Immunisation Program (NIP) vaccines to qualify for benefits (No Jab No Pay – federal) and to attend childcare or pre-school (No Jab No Play – state) are unique internationally, it is important to fully evaluate their impact.
Australian national childhood immunisation rates have remained at or over 90% for more than 15 years, and currently sit at 93%. Achieving an immunisation rate as close as possible to 100% is an important goal, and will maximise the benefits of vaccines to individuals and the community. However, parents actively refusing vaccines (refusers) are less numerous among the “last 7%” than families having difficulty accessing healthcare services, and it is important to realise even 100% child immunisation won’t prevent all cases, especially for whooping cough, write Professor Peter McIntyre and co-authors Dr Frank Beard and Associate Professor Julie Leask, of NCIRS and University of Sydney.
In the article titled 'No Jab, No Pay and vaccine refusal in Australia: the jury is out', Professor McIntyre and co-authors say "evaluation should focus on identifying differential effects on vaccine uptake, as well as any unintended adverse consequences" for children (such as children of vaccine-refusing parents) and parents affected by access or logistic issues. They go on to say the Victorian No Jab, No Play legislation, for example, requires full immunisation for attendance at childcare centres, unless the child has an approved medical exemption or is on a recognised catch-up schedule. The likely unintended adverse impacts of this highly restrictive Victorian legislation include reduced access to important early childhood education.
The authors argue that Australia’s vaccination rates are “relatively high and at least comparable with similar developed countries” and vaccine objection in 2013 was about 3% – the same as in 2001. They go on to say “Vaccine refusal is only one of a range of factors relevant to further improvements in vaccine coverage and disease control. The greatest yield is likely to come from first implementing measures already shown to be effective in improving accessibility and minimising logistic barriers to vaccination, and second, from well structured research and evaluation of new interventions [such as No Jab, No Pay, and No Jab, No Play] to overcome vaccine refusal and hesitancy.”
NSW Doctor Article - Advances in vaccination safety
May 2017 - News
Australia’s landmark system to monitor adverse reactions is increasing patients’ confidence in the safety of vaccines
Click here to read the article
AusVaxSafety, which actively monitors the safety of vaccines using SMS-feedback and email from recently vaccinated children and adults, is helping to ensure public confidence in taking up vaccination.
AusVaxSafety is a collaborative initiative led by the National Centre for Immunisation Research & Surveillance (NCIRS) and funded by the Australian Government Department of Health.
Currently established in 130 sentinel immunisation providers across all States and Territories, AusVaxSafety will expand to more than 200 sites in 2017. General practices, hospital and community-based clinics, and Aboriginal Medical Services are participant partners.
The idea for the monitoring system was sparked in 2010, after a number of children suffered fever and febrile convulsions after receiving one brand of the flu vaccine (Fluvax and Fluvax Junior). There have been no safety concerns with the use of other brands of flu vaccine in children.
Despite withdrawing that brand of vaccine, many parents lost confidence in the flu vaccination. Research conducted by Professor Christopher Blyth of the Telethon Kids Institute revealed that in WA, vaccine uptake was substantially reduced in the following two years.
These reactions prompted different groups across the country to develop a way to monitor adverse reactions to vaccinations, particularly in children.
Traditionally, it’s been left up to parents (or patients themselves) to report adverse reactions to a vaccination to their GP. This passive reporting system then relied on GPs to make a report to the Therapeutic Goods Administration (TGA).
In light of the events of 2010, several medical professionals identified the need for a more proactive reporting system that recorded how vaccination was performing across the population in real-time.
Dr Alan Leeb, a GP in Western Australia, set up a system called SmartVax that uses text messaging and clinical data extracted from existing medical practice management software to actively contact patients who have received a vaccination, to enquire whether they had experienced any adverse reactions.
Meanwhile Professor Mike Gold set up another active monitoring system in South Australia, and a similar system called Vaxtracker was established in NSW by Professor David Durrheim.
Recognising the value in monitoring vaccine safety, the Australian Government called for tenders to conduct surveillance of influenza vaccination in children aged under five for the next three years.
NCIRS won the tender. Now, using SmartVax as the main data collection tool in general practice, AusVaxSafety receives and analyses de-identified data from all States and Territories and reports this to the Department of Health and TGA. AusVaxSafety currently monitors the safety of influenza vaccine in all ages (during the influenza season), pertussis vaccines in toddlers and young children, and zoster vaccine in adults.
SmartVax is a software program, designed to actively monitor the safety of all vaccines given in general practice and vaccination clinics via SMS and smartphone technology. When a practice uses SmartVax, an automated text message is sent to patients three days after their vaccination asking whether they experienced a reaction. Patients who respond ‘yes’ are sent a question about the severity of the reaction, and a survey. Many States and Territories offer specialist vaccine adverse events clinics for patients who experience a reaction. Patients who experience a significant reaction can be referred by their GP to specialist vaccine adverse events clinics. For more information, contact the NSW Immunisation Specialist Service (NSWISS) on 1800 679 477.
SmartVax is completely free for practices. It is fully automated, and integrates with existing patient management systems. To get your practice involved, contact SmartVax via the website or by emailing firstname.lastname@example.org.
According to the NCIRS, “Patients respond extremely well to SmartVax and participation rates are high. As well as informing national vaccine safety monitoring, the use of SmartVax in practices helps GPs with their duty of care following vaccination.”
NCIRS provides reports regularly to the Department of Health, TGA and vaccine safety experts and clinicians throughout Australia. Any safety concerns are reviewed by the NCIRS Expert Leadership Group, and there are mechanisms in place to follow-up safety concerns through more detailed data analysis and clinical follow-up of patients.
Dealing with requests for vaccination exemption
May 2017 - News
There are few valid reasons to sign an Immunisation Medical Exemption form. It is important that general practitioners (GPs) understand what these are, and how to manage common vaccine concerns that may contribute to exemption requests.
'To sign or not to sign: dealing with requests for vaccination exemption' written by Dr Frank Beard and Dr Nicholas Wood of NCIRS and published in Medicine Today (April 2017) is a guide for GPs on what the true medical contraindications are and what constitutes adequate evidence of natural immunity. It is also offers practice points on how to recognise and manage common concerns, including those about adverse events after vaccination, that may contribute to parents’ requests for completion of exemption forms.
ADVAC Advanced Course of Vaccinology, organised by Fondation Mérieux and Université de Genève, - Les Pensières, France
May 2017 - News
Dr Frank Beard from NCIRS attended the 2017 Advanced Course of Vaccinology (ADVAC) held in Annecy, France. ADVAC is an intensive and comprehensive 2-week training program across all fields related to vaccines and vaccination. Topics covered over the 2 weeks included new vaccines, vaccine trials, ethical issues related to vaccine trials, vaccination strategy and policy, and communication. Disease-specific vaccine issues were also covered in detail, including polio, measles, meningococcal and pneumococcal diseases, influenza, malaria, HIV and AIDS, tuberculosis, human papillomavirus, rotavirus, dengue and Japanese encephalitis, cytomegalovirus, and rabies. The ADVAC faculty includes Stanley Plotkin and over 60 other top-level lecturers who are all international experts in vaccinology.
May 2017 - Newsletter
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Updated NCIRS meningococcal disease fact sheet
Apr 2017 - News
Thanks to all those who attended the Controlling Meningococcal Disease in 2017 symposium last Friday (7 April 2017). It was fantastic to be able to hear from so many leading clinicians, researchers and public health authorities about meningococcal disease and vaccination programs in Australia, New Zealand and the United Kingdom.
Following our meningococcal symposium, we've updated our meningococcal disease fact sheet, Meningococcal vaccines for Australians: Information for immunisation providers.
The full list of NCIRS fact sheets can be viewed on our fact sheets page.
Controlling meningococcal disease in 2017 - evidence from Australia, NZ and the UK - Friday 7 April 2017
Apr 2017 - Events
This one-day symposium organised by the National Centre for Immunisation Research and Surveillance, in partnership with the National Neisseria Network and the Communicable Diseases Network Australia was held on Friday 7 April 2017.
Meningococcal disease in Australia has increased from a nadir of 149 cases in 2013 to 253 cases in 2016, however this remains less than half the 688 cases notified in 2002. This increase has been driven by serogroups W and Y, which now account for >50% of cases. This workshop brought together national and international experts on meningococcal disease and heard the latest data from meningococcal B and ACWY vaccine programs in the United Kingdom. The workshop aimed to distill the best evidence to inform Australia’s response to meningococcal disease in 2017.
Resources from the Symposium
NB: Not all speakers were able to offer their presentation publicly as unpublished data was presented
PDFs of selected presentations are available from the following links. Please note files are large and may take a couple of minutes to download.
Trends in case numbers, age and serogroup specific incidence and mortality of invasive meningococcal disease in Australia 2001 - 2016 - Dr Jennie Hood
International context - Prof. Peter McIntyre
Impact of meningococcal vaccines in UK 2001- 2016 - Dr Shamez Ladhani
New Zealand’s experience with starting and stopping meningococcal vaccine programs - Dr Amanda Kvalsvig
WA outbreak– lessons learned - Dr Paul Armstrong
Congratulations to NCIRS Public Health Physician, Dr Anastasia Phillips, recipient of the 2016 Australasian Faculty of Public Health Medicine (AFPHM) Sue Morey Medal
Apr 2017 - News
NCIRS would like to congratulate Dr Anastasia Phillips, recipient of the 2016 Australasian Faculty of Public Health Medicine (AFPHM) Sue Morey Medal. The AFPHM Sue Morey Medal is awarded to the trainee who has achieved the highest mark in the AFPHM Oral Examination.
Dr Phillips completed the AFPHM Public Health Medicine Advanced Training Program in 2016 while working at NCIRS. She continues to work at the Centre, predominantly in vaccine safety surveillance, and is a PhD Candidate with the University of Sydney. Dr Phillips also holds an academic appointment as Clinical Associate Lecturer with the School of Public Health, University of Sydney.
Is there a test your child can take before getting vaccinated, as Pauline Hanson said?
Mar 2017 - News
In this article published in The Conversation, Associate Professor Kristine Macartney (NCIRS), Associate Professor Nicholas Wood (NCIRS) and Associate Professor Julie Leask (University of Sydney) address the comments made by Senator Hanson in a recent interview on Insiders. Senator Hanson commented that people should have a test to see if they have a reaction to a vaccine before they are vaccinated. These experts in infectious diseases and immunisation state "Immunisation programs prevent millions of deaths worldwide each year. Vaccine safety monitoring – what experts call vaccine pharmacovigilance – as well as many other checks and balances before and after vaccines registration, ensure that vaccines have a minimal risk of causing harm. There is no blood test to see if vaccines shouldn’t be given. In fact, the best 'test' for deciding if a vaccine is appropriate is taking a good old medical history."
ATAGI 2017 Influenza Statement and updated Influenza Chapter of the Handbook published online
Mar 2017 - News
The following two items have been published on the Immunise Australia website:
These two publications are designed to complement each other.
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