'Concerning decline' in childhood vaccination as Australian Government seeks input on new immunisation strategy

Submissions close 19 June 2024

After steady increases in vaccination rates over the past 25 years, Australia is now experiencing “concerning declines in childhood vaccination coverage,” which the government is seeking to reverse with a new national immunisation strategy.

A discussion paper informing the new strategy states that “downward trends in childhood coverage have persisted since June 2021.” From a high of 95% coverage for children aged one-to-five in 2020, coverage declined to 93% of one-year-olds, 91% of two-year-olds, and 94% of five-year-olds as at December 2023. There have been “even steeper declines in First Nations children.”

Underlying the decline in childhood vaccination coverage is a shift in community sentiment that appears to have been exacerbated by Covid, according to research commissioned by the Department of Health (2022).

The report, by research and strategy agency Snapcracker, states that “support for childhood vaccination has dropped significantly among all parents, regardless of the age of their children.” This is “largely due to an increase in negative perceptions and concerns about childhood vaccination which seem to stem from enhanced levels of engagement and understanding of the topic, mainly due to COVID.”

The Australian Government is now seeking to rebuild lost confidence as it forms the National Immunisation Strategy (NIS) for 2025-2030, the core mission of which is to, “Improve vaccine uptake and reduce the impact of vaccine-preventable diseases in Australia.”

According to the strategy discussion paper, this mission will be achieved with investment in disease surveillance, communications and community engagement, and vaccine research, manufacture and distribution. There is a strong focus on diversity and equity, especially for First Nations Peoples (FNP).

The Department of Health is currently undertaking open public consultation, with stakeholders and the public invited to complete a survey to give feedback on the “vision, mission, priority areas, and opportunities for action for the next Strategy.”

Survey TLDR:  “How much do you agree that the government should do more things to find more diseases, create, manufacture and distribute more vaccines to treat them, monitor uptake better, rush out vaccines faster, and make more people want to take them more of the time? #equity #diversity

What’s in the strategy discussion paper and survey

A word cloud generated from the discussion paper,  Towards a National Immunisation Strategy 2025-2030

Proposed priority areas:

1. Improve immunisation coverage through universal and equitable access to vaccination, with a focus on First Nations people.

2. Strengthen community engagement, awareness and acceptance of immunisation.

3. Strengthen program governance, how we manage programs and account to the public.

4. Use data and evidence to target and monitor programs, build confidence, and improve outcomes.

5. Strengthen a diverse immunisation workforce to work with Australia’s diverse populations.

6. Prepare for emerging infectious diseases and emergencies requiring rapid and/or targeted vaccination.

Overall, the survey seems designed to affirm the government’s strategic goals, with Likert scales restricting respondents to simply agreeing with or ranking the importance of predetermined strategies and actions.

There are numerous unsupported assumptions baked into the survey questions, such as:

• The notion that all diseases addressed by the National Immunisation Program (NIP) are vaccine-preventable

• The Covid vaccine rollout was successful for health outcomes

• FNP have the same health profile and needs as non-FNP

• FNP share the same mission as the Australian Government when it comes to vaccination coverage

These baked-in assumptions make it hard to answer the Likert scale questions in any way other than giving the NIS a thumbs up.

For example, when the survey asks respondents how important it is for the NIS to prioritise partnership and shared decision-making with FNP in delivering immunisation services, do they mean they’ll partner with FNP to tailor immunisation policies to their communities? Or do they mean they’ll partner with FNP to force vaccination rates up against the will of the communities, like they did during Covid?

People who support the former proposition may answer ‘very important’, but in fact may simply be affirming more of the same treatment of Indigenous communities that Warlpiri man, Professor Wanta Pawu, speaks of below:

“When Covid came, police came and they knew how to scare the Warlpiri people. Many doctors came. They knew that if they could get my father, the senior elder, to get the needle, then everyone else would get the needle too.

“And that is what happened; it worked. Some younger people were scaring the living daylights out of people saying that if you did not get the needle, then you would not be allowed to go out, buy food or eat. Emergency rations were given out to make the whole thing seem like a serious emergency.

“A well-known doctor put in place strategies, along with the police, to scare the people. The roads were blocked. Those of us who wanted to go to our outstation to get away from the danger were threatened with a $10,000 fine. The place was like it was invaded by an army made up of doctors and police.

“People were lined up like a prisoner-of-war camp. If you were found to be Covid-19 positive, then you were taken away from the community and put in a quarantine camp in Howard Springs (over 800 kilometres away) near Darwin for two weeks…

“…The whole thing was on purpose and was a deception. The community was frightened by evil ways that were disguised as a health thing. The government deceived us, using the medical profession and the police. These evil people need to be stopped. They frightened the community into something so much so that we feel there is no hope for us now. Our only hope is the Christian gospel. The Covid-19 government response and injection roll-out was very cruel to our young people.”

Prof Wanta Pawu’s testimony was included in the Canberra Declaration’s submission to the COVID-19 Royal Commission Terms of Reference Inquiry. However, the committee chose not to publish the submission to the public inquiry page, leading the Canberra Declaration to claim that the testimonies of FNPs within the submission had been “censored.”

The discussion paper and survey indicate a preoccupation with measuring things - vaccination rates, spread of coverage, speed of rollouts and other bureaucratic markers, but not whether the various vaccination programs actually work to achieve the desired outcomes.

Therefore, where the survey references evidence-informed targets or improving record-keeping and data linkage, I’m not confident they’re thinking in terms of measuring health outcomes. If the federal government fails to link immunisation data with state and territory health outcome data to measure whether any of the vaccination programs work, then these databases will remain as useless as they proved to be during Covid.

The survey discusses enhancing vaccine safety surveillance. But if the Therapeutic Goods Administration is going to handwave away historically unprecedented levels of injury reports, as it has done during Covid, then this too will be fairly useless. Improvement of vaccine safety surveillance has to be an end-to-end solution - not just collating reports, but following up, analysing and taking action (even if not in the interests of the TGA’s sponsors). I see nothing in the discussion paper to acknowledge this.

In an effort to improve community confidence, the new NIS will consider expansion of the no-fault compensation scheme from covering just Covid vaccination, to all state-funded vaccines.

A no-fault compensation scheme is long overdue. However, lessons should be learned from the failures of the Covid vaccination compensation scheme, which has long processing times, unreasonably strict qualifying parameters, and frequently offers amounts too low to cover medical expenses.

There is a whole section dedicated to disease surveillance and scale-up preparation, keeping the NIS in step with the World Health Organisation’s (WHO) recent obsession with disease hunting and pandemic preparedness.

There is also talk of “new vaccine platforms such as mRNA technology and vaccine adjuvants offer the potential to protect against more serious and complex diseases,” with Moderna’s partnership with the Australian and Victorian Governments projected to produce 100 million vaccine doses per year. There will also be “new delivery technologies, such as nasal spray or skin patches,” which “may emerge and expand program options.”

Finally, the survey asks respondents to select which of the predetermined strategic goals is the most important to them.

What’s not in the strategy discussion paper or survey

• Plans to improve research into, and diagnosis and treatment of vaccine injuries

• Application of a human rights framework to end medical segregation and restore the conditions for informed consent.¹

• Plans for research to determine the success of various immunisation programs. eg: For the Covid pandemic, Australia has produced no empirical evidence to show the effect of the vaccination program on hospitalisations and deaths. The data exist in disparate databases, but have not linked or analysed.

• Discussion of legitimate concerns contributing to vaccine hesitancy, including:

  • Breaching public trust by going too hard on Covid vaccine mandates

  • Mixed public health messaging (eg: using the term ‘vaccine-preventable’ for diseases that are not vaccine-preventable)

  • Poor efficacy of newer vaccines compared to older, sterilising vaccines

  • The re-emergence of almost eradicated illnesses due to vaccines (particularly in South Asia)

  • Failure of authorities to ensure robust vaccine safety and, when Australians have been injured, to acknowledge and quickly compensate for injuries

  • The fact that the National Immunisation Program Schedule has blown out to 42 doses of vaccines (in 28 shots) before the age of five

Australian National Immunisation Program Schedule ages 0-5

How to do the survey

CLICK HERE to take the survey. It takes about 15-20 minutes to complete. The page states that all responses will be anonymous.

The survey will close at 11:59 pm AEST on Wednesday, 19 June 2024

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1. Under Australia’s No Jab, No Pay policy, family assistance payments are withheld from parents of children who are not vaccinated according to the NIP schedule. Additionally, in most states and territories, unvaccinated children cannot attend early education or care services.