How can we get more people to vaccinate?
People may say they never get the flu so they don't need the vaccine, but you can pass on the virus without knowing you have it, writes Associate Professor Julie Leask and Samantha Carlson.
Flu (influenza) has traditionally been the underdog of vaccine-preventable diseases. People tend not to worry about the flu too much, and there are various myths about its听听and the听. It鈥檚 true most people experience flu as a mild disease, but many don鈥檛 recognise it can be more severe.
Each year flu is听听to kill at least 3,000 Australians aged over 50 years alone. It took more听听than any other vaccine preventable disease in Australia between 2005-2014, and is the most common vaccine preventable disease that sends Australian children to听.
The tragic death of eight-year-old Rosie Andersen from flu this week has followed the recent outbreaks in aged care facilities and subsequent deaths of residents in听,听听补苍诲听. A听听died earlier this month due to complications from the flu, and now听, who was infected late in her pregnancy, remains in a coma, unaware her baby was safely delivered six weeks ago.
This year鈥檚 flu season has been a听. And it鈥檚 not over yet.
听have shown the flu vaccine can usually reduce the risk of flu in those who are vaccinated by 40-50%, and by 50-60% for听.听听are showing the effectiveness of this year鈥檚 flu vaccine may be lower.
Experts are calling for a听, which is needed. But even a more effective vaccine won鈥檛 address all the barriers to uptake.
Who鈥檚 most at-risk?
Annual flu vaccination is听听for any person six months of age or older who wishes to reduce the likelihood of becoming ill with flu. It鈥檚听听at higher risk of the severe effects of the disease including:
鈥� people over 65 (听are vaccinated)
鈥� Aboriginal and Torres Strait Islander people from six months to five years (听are vaccinated)
鈥� Aboriginal and Torres Strait Islander people over 15 (听are vaccinated)
鈥� pregnant women (听are vaccinated)
鈥� people aged six months and over with medical conditions such as severe asthma, lung or heart disease, low immunity or diabetes (听are vaccinated, and听).
Why don鈥檛 they vaccinate?
Researchers have looked at why many people in these groups don鈥檛 have their yearly flu vaccine. A common theme emerges - health professionals are not recommending it enough, people aren鈥檛 aware they need it, they鈥檙e not sufficiently motivated, or they don鈥檛 have easy access.
These themes come out in studies with听听of young children,听听,听,听, and听.
听is now looking at the children who end up in hospital with severe flu. We鈥檙e trying to better understand the barriers to flu vaccination, along with vaccine efficacy issues.
We鈥檝e heard that not only are health care workers not recommending it enough, some doctors are even recommending against it, as they don鈥檛 believe the child is at risk. This is even though over听听of children hospitalised from the flu are those without medical risk factors. Other times it鈥檚 simple awareness - parents didn鈥檛 know their child can receive a flu vaccine if they鈥檙e over the age of six months.
Busy lives can mean making time to go to the clinic for a vaccine falls down the list of priorities. A four-year-old in our study was hospitalised only three days before a visit to the clinic had been booked.
Some of the children in our study were not theoretically at high risk of flu and so not in the group where the vaccine is free. This was a major barrier, as it has been in other studies in听听补苍诲听. Parents report to us that their child is up-to-date with their scheduled vaccines, but annual flu vaccination is not being ticked off as it鈥檚 not on the schedule.
The challenge with flu vaccine is it鈥檚 given yearly.听听it鈥檚 recommended and funded for all children of primary school age using a school-based delivery program and currently between 53-58% of children have it. When this many children are vaccinated there can be听听of others who are not vaccinated because the virus is not able to spread from person to person as easily.
Misconceptions about the flu vaccine
听about flu vaccine are also a barrier: that it causes flu, that it鈥檚 not effective, that it鈥檚 not needed. People might say they never get the flu, not realising symptoms can be mild or not noticed and they can pass it on to the vulnerable. Others reported their belief was that the flu was not a serious disease. Some believed contracting flu 鈥渘aturally鈥� was likely to provide greater immunity.
Some parents also have concerns about the safety of the flu vaccine. Australians were spooked by a听听when there was a temporary听听of flu vaccine for children under five after reports of an increase in the rate of convulsions in children.
The one vaccine found to be the cause (BioCSL/Sequiris Fluvax鈩�) is no longer听听for use in children younger than five, but there are听听seasonal flu vaccines children can have. But public and professional confidence is听, despite having听.
Western Australia has had a free child vaccine program for years which was achieving relatively听, but this dramatically declined after 2010, and coverage languishes at around 15% today. In other words, mud sticks.
How to improve uptake
To improve uptake we first need timely and accurate coverage figures. We now have the capacity to get coverage estimates from the expanded听听but these are not yet available.
The vaccine needs to be recommended more often, available more readily,听听and recommended as part of the schedule, and myths addressed听.
We need to motivate and support health care workers to implement the recommendations, such as with automated reminders,听. Systems need to ensure people can get the vaccine easily - from the GP or other health clinic, the specialist clinic, the antenatal care clinic, or from an Aboriginal or Torres Strait Islander health worker.
Promoting flu vaccine to everyone is important, as is providing ease of access, awareness and opportunity. Although the flu vaccine isn鈥檛 perfect, it鈥檚 far better than no protection at all.
This article was written by 听and Samantha Carlson and first published on
