Australia's childhood vaccination rates have been gradually declining since the start of the COVID-19 pandemic — and researchers have now uncovered some of the possible reasons why.
The National Vaccination Insights project — a nationally representative study released this week — looked at attitudes and practical barriers, and their association with parents' decisions to partially vaccinate children or not have them vaccinated at all.
The researchers divided barriers to vaccination into access barriers, such as an inability to travel for appointments or cost of vaccination and acceptance barriers, such as not trusting information about vaccines from doctors or nurses or having people close who do not support vaccination.
While decisions to partially vaccinate children were associated with access and acceptance barriers, the choice to not vaccinate children at all was significantly associated with acceptance barriers.
The full report, which will include proposed policy and other actions, will be released next year.
The team — from the National Centre for Immunisation Research and Surveillance (NCIRS), Murdoch Children's Research Institute (MCRI) and the University of Sydney — surveyed 2,000 parents across Australia to understand the barriers to uptake of National Immunisation Program (NIP) vaccines among children under five years old.
The government's NIP provides free vaccines to eligible people to help reduce diseases that can be prevented by vaccination.
"We have national coverage data, data broken down by area, by postcode ... but we can't really learn why coverage is low based on that data alone," Dr Jessica Kaufman, a senior research fellow and team leader in MCRI's vaccine uptake group, told SBS News.
"That has been an ongoing challenge, and it's really a priority now that we have seen ongoing declines in coverage since the pandemic."
What do we know about childhood vaccination rates in Australia?
According to the NCIRS' latest annual immunisation coverage update, published in October, vaccination rates among children have declined by 1 to 2 percentage points for the third consecutive year.
In 2023, fully vaccinated coverage rates decreased at all three standard age milestones: 12 months (to 92.8 per cent, from 93.3 per cent in 2022 and 94.8 per cent in 2020), 24 months (to 90.8 per cent, from 91 per cent in 2022 and 92.1 per cent in 2020) and 60 months (to 93.3 per cent, from 93.4 per cent in 2022, and 94.8 per cent in 2020).
This follows eight years of "generally increasing coverage" before the onset of the pandemic, the report says.
The majority of children in Australia are still being vaccinated.
However, Kaufman said the gradual decline is a concern.
"It is a gradual decline. It's not a huge drop. We've seen much bigger drops in other countries than we've seen here. However, it's also the first time we've seen a steady decline in coverage rates in many years in Australia," she said.
"Even though the magnitude of the decline is not enormous, the fact that it's consistent and ongoing since the pandemic conditions have eased is really a concern, and I think a canary in the coal mine."
Speaking in October following Health Minister Mark Butler also referred to a 7 or 8 percentage point drop in whooping cough and measles vaccine program uptake for under fives.
In October, Health Minister Mark Butler highlighted a 7 or 8 percentage point drop in vaccine uptake for whooping cough and measles among children under five. Source: AAP / Lukas Coch
"The erosion of trust has had very significant impacts on the community," he said.
The most common vaccination barriers
The National Vaccination Insights researchers looked at vaccination barriers across three parent groups: those of partially vaccinated children, unvaccinated children and children who had received all vaccines recommended for their age.
They explored associations between these barriers and a child's vaccination status. Financial stress and where parents lived were also considered.
According to the research, the most commonly reported barrier was the distress parents experienced when thinking about vaccinating their children (60.2 per cent).
However, Kaufman stressed this was not necessarily a barrier that was driving under-vaccination.
"What that tells us is maybe that many, many parents feel distressed, but at the moment, it's not affecting their decision about vaccinating," she said.
Kaufman said distress around vaccination can be associated with phobias or concern about pain, which can be alleviated in clinical settings.
Other common barriers included parents reporting they could not afford the costs associated with vaccinating their child (11 per cent) and having difficulty in getting an appointment when their child's vaccination is due (9.3 per cent).
Barriers associated with partial vaccination
Kaufman said a number of barriers were found to be significantly associated with children being partially vaccinated — and several were related to access.
These included not prioritising their children's vaccination appointments over other things (23.9 per cent of parents of partially vaccinated children compared to 6.9 per cent of parents of up-to-date children) and not finding it easy to get an appointment (24.8 per cent and 8.5 per cent, respectively).
The survey found some barriers were also related to acceptance. Among these was a belief that vaccines are not safe for their child (17.7 per cent of parents of partially vaccinated children compared to 4.8 per cent of parents of up-to-date children).
Referring to the safety of childhood vaccines, the Department of Health says on its website that "all vaccines go through rigorous testing to ensure they are safe and effective before approval in Australia by the Therapeutic Goods Administration (TGA)".
Also among the barriers to vaccination was a belief that vaccines are ineffective for preventing diseases (14.3 per cent of parents of partially vaccinated children compared to 4.4 per cent of parents with up-to-date children).
"When a child gets a vaccine, their body produces an immune response in the same way it would after exposure to a disease. If the child comes in contact with that disease in the future, their immune system remembers it and responds quickly, preventing the disease from developing," the health department says.
"Vaccines give protection without causing disease. They are safer than getting the disease itself."
Kaufman said understanding the differing associations of access and acceptance barriers is important.
"It's interesting to see some of those access issues are keeping people from people vaccinated on time or completing a vaccination," she said.
Barriers associated with not vaccinating
According to the findings, barriers that were significantly associated with not vaccinating were mostly related to acceptance.
"What that tells us is that people are more ideologically opposed, or the acceptance barrier is really keeping them from wanting to vaccinate — not access," Kaufman said.
Kaufman also acknowledged that parents experiencing financial stress were more likely to report multiple barriers, including associated costs of vaccines.
"I think that's a bigger group than we realise given cost of living challenges, so I think it's an important group to keep in mind."
Barriers for multicultural communities
Dr Ikram Abdi is a research fellow at the University of Sydney whose PhD research focused on improving vaccine uptake in Australian refugee and migrant populations.
While she was not directly involved in the National Vaccination Insights project, Abdi told SBS News previous studies have highlighted several barriers for these communities, including language and communication and issues around "catch-up immunisation".
"Many newly-arrived refugee and migrant communities also face competing priorities, from securing stable employment to navigating the complexities of settling into a new environment," she said.
"In these circumstances, accessing vaccination services can often feel like a low priority."
LISTEN TO
Understanding vaccination rules for children in Australia
SBS English
14/10/202410:06
Abdi said having accessible, community-based services can offer flexibility and reduce barriers and adapting vaccine information to fit community needs is also important.
"Sometimes, resources don’t quite capture cultural nuances. It’s not just about translating materials into different languages — it’s also about delivering them in formats that truly resonate with communities."
When it comes to vaccine acceptance and uptake, Abdi said engaging healthcare workers is crucial.
"In our previous research, healthcare workers told us they were confident in communicating but would benefit from more training to strengthen their skills in communication."
