Immunization, as a public health issue, was traditionally the responsibility of Australian states and territories, in line with the federal system. The role of the Australian states and territories was to increase the availability of vaccines to the general public. Australia has reported few incidences of disabilities and deaths of once the most common infectious diseases since the country formulated and implemented routine immunization programs and policies since 1950s. The low incidence of disabilities and deaths related to the once-common infectious diseases demonstrates the effectiveness of the countries routine immunization programs and policies.
Today, some of the outcomes of NIP in Australia include control of vaccine-preventable diseases, high immunization coverage rates, and increased general public access to all vaccines recommended by World Health Organization. Moreover, all levels of government in collaboration with healthcare providers, researchers, and administrators developed a new National Immunization Strategy for Australia in 2019 to expand and improve on the success of the previous 5-year National Immunization Program (2013-2018). The current Australian National Immunization Program comprises of eight strategic areas that the federal and state systems prioritize to expand and enhance the success of the previous five-year immunization program. The strategies prioritize improving immunization coverage, ensure NIP’s effective governance, improve the vaccine safety monitoring systems, and ensure effective supply and efficient use of all WHO-recommended vaccines in the program. This paper explores the existing knowledge related to immunization as a public health issue and modern immunization policies and programs, such as the National Immunization Program and analyzes the implications of the NIP program in Australia.
Summary of Existing Knowledge
The article “Immunization and Ethics: Beneficence, Coercion, Public Health, and the State” extensively explores immunization as a health policy. In the article, Colgrove argues that one of the most beneficial and cost-effective activities in the fight against most infectious diseases is immunization (3).For more than 200 years, vaccines have helped to decrease disability and death incidences related to infectious diseases thus improve health status and well-being of many people across the world. Colgrove asserts that vaccines directly benefit the person who receives it. Indirectly, vaccines help other members of society because it creates herd immunity. Despite the benefits, immunization also carries a risk of adverse events, just like any other medical intervention (3). For instance, the oral polio vaccine can trigger paralysis. However, these adverse effects are rare and they are worth the risk because the potential impacts of failure to be vaccinated are catastrophic. Therefore, civic education on relevant immunization programs should be done by governments to ensure that people are fully informed of the benefits and possible risks of getting immunized.
Policies and programs related to immunization are highlighted by numerous research articles. For example, Garcia and O’Leary explore children’s vacation policies. The two authors argue that child vaccination is one of the greatest achievements of the 20th and 21st centuries. However, parents have been questioning the efficiency and safety of immunizations, such as the oral polio vaccine, leading to increased rates of vaccine delay and refusal (6). The reluctance and failure to vaccinate children has resulted in the increase of the prevalence of vaccine-preventable diseases in many nations, such as the United States. Garcia and O’Leary argue that physicians across the U.S struggle with how to respond to families that refuse vaccines, as there are a few ways to convince them to let their children be vaccinated against infectious diseases. Another research article that focuses on policies related to immunization is “Increasing HPV vaccination through policy for public health benefit,” which explores the benefit of human papilloma virus (HPV) vaccination in improving the general public’s health. Brandt, Pierce and Crary, the authors of the article, enumerate that the vaccination has been met with unacceptance by a section of the global population as many people have questioned its safety and concerns about the vaccination’s side effects (1). They also argue that unawareness of the need for vaccination amongst the general public and lack of healthcare provider recommendation are the other reasons the uptake of HPV vaccine is lower than optimal for public health benefit. Therefore, the WHO reiterated support for HPV to be included in national immunization programs to improve the general public’s health status.
Immunization is among the most beneficial and cost-effective strategies in the fight against the outbreak of infectious diseases around the world. However, the strategy faces resistance in its implementation process. Many federal governments have formulated and implemented child vaccination policies that require parents to take their children for immunization. However, child vaccination has been met with great resistance by many parents who constantly question the efficiency and safety of all WHO-recommended vaccines (7). The HPV vaccine has also been met with strong national criticism from Australian parents because of various reasons, such as concerns related to its side effects, safety concern, and lack of awareness about the vaccination amongst the public. Despite this vaccine unacceptance, WHO has continued to advocate for the HPV vaccine in National Immunization Programs to improve the public’s well-being.
The practices that have been adopted to encourage the uptake of immunization include the exclusion of parents who delay or refuse vaccines from immunization activities and incorporation of HPV into National Immunization Programs. Physicians across the Australia have adopted the practice of excluding parents who refuse to vaccinate their children from immunization activities to reduce cases of infectious diseases that can be prevented. Indeed, ignoring vaccination has led to an increased rate of outbreaks of infectious diseases such as measles. For instance, in the case of measles, the Australian National Health and Medical Research Institute reported that 118 cases of measles were reported in 24 states across the country. The Australian National Health and Medical Research Institute estimates that 89 percent of the cases were due to parents failing to have their children vaccinated (2). The exclusion of parents who delay or refuse vaccines has so far helped in the reduction of the risk of an outbreak of infectious diseases across the country. Another recent practice for encouraging immunization is the incorporation of HPV policies into National Immunization Programs. WHO supported the need for integration of HPV into NIP to help reduce the global burden of preventable cancers such as cervical cancers and other HPV-associated cancers (4). The implementation of the program in Australia has shown a reduction in the number of HPV-associated diseases across the country.
Current research on disease immunization focus on two issues: finding more vaccines and tackling vaccine refusal. WHO together with other national research centers, such as the CDC in America, and the Australian National Health and Medical Research Institute are conducting studies aimed at discovering new vaccines for new diseases. The Australian National Health and Medical Research Institute also conducts studies aimed at finding vaccines for new diseases and virus that currently lack treatment interventions (5). On the other hand, vaccine refusal research focuses on studying what influences apathy towards immunization and how to tackle it. Such research is mostly done to ensure greater compliance with government regulations on disease immunization. Indeed, both of these measures work together to prevent diseases that can be prevented by immunization.
Analysis of Policy Implications
The National Immunization Strategy for Australia 2019 provides an effective legal and operational framework for healthcare immunization in Australia. The framework provided by the Australian National Immunization Strategy 2019 covers various social issues that impact health and disease immunization in the country. However, the immunization framework does not tackle health disparity, which is a critical social issue affecting health care provision in Australia. The provision of health care services in Australia is negatively impacted by health disparities more so among the poor and individuals hailing from minority communities in Australia (3). The National Immunization Strategy for Australia 2019 covers this critical issue of health disparities by guaranteeing the equitable and equal provision of immunization programs in Australia.
On the negative side, the immunization framework does not clearly state the steps that should be followed during the dissemination of the immunization to ensure that health disparities are eliminated in the country. The lack of necessary procedural steps to prevent health disparities in the immunization policy weakens effective actualization of the policy. The National Immunization Strategy for Australia 2019 does not tackle the issue of vaccine refusal which is an integral aspect of every immunization strategy in the contemporary world. The huge challenge that 9 out of 10 immunization programs face in the world is immunization refusal (4). The fact that the National Immunization Strategy for Australia 2019 does not provide mechanisms and strategies of tackling vaccine refusal completely renders immunization strategy inefficient. With the Australian National Immunization Strategy lacking policies related to vaccine refusal, the actualization and roll out of the national immunization program will be hard to implement.
The merits of the National Immunization Strategy for Australia 2019 are related to each strategic priory highlighted in the policy. For example, the policy works towards achieving a 95 percent immunization coverage for children aged 1, 2, and 3 amongst the aboriginal and non-aboriginal population to reduce the rate of infections of diseases that immunization can prevent (10). The mentioned populations are usually at higher risk of being affected by infectious diseases thus the program prioritizes them. The policy also intends to facilitate access to immunization services for every individual residing in Australia regardless of ethnicity, economic status, religion, among other forms of diversity. Ensuring NIP’s effective governance is another area of priority for the strategic policy. The strategy aims at ensuring that vaccination within the country is clearly defined, reliable, efficient, and secure for all individuals. Another area of priority for the National Immunization Strategy for Australia 2019 is to promote secure supply and efficient use of vaccines by the general public. In this area of priority, the strategy aims at preventing wastage of vaccines and ensuring that the National Vaccine Storage Guidelines support NIP’s objectives. Another key objective of the program is to improve vaccine safety-monitoring systems that align with World Health Organization’s guidelines of best practice such as effective monitoring, surveillance, and quick responsiveness towards issues associated with once most common infectious diseases across the country. In this area of priority, National Immunization Strategy for Australia 2019 aims at educating the general public about the vaccine monitoring system to increase confidence in the system.
Maintaining effective communication strategies and ensuring that the community has confidence in the immunization programs and policies is another objective of the National Immunization Program for Australia 2019. The mentioned objective is meant to be achieved by identifying and implementing various ways of communication to educate individuals on particular groups with low or delayed immunization coverage of the importance of the activity. National Immunization Strategy for Australia 2019 works towards strengthening the monitoring and evaluation of the National Immunization Program. It identifies the trends and patterns of vaccine-preventable diseases using effective monitoring and surveillance systems. Promoting effective training for immunization providers is another issue that the National Immunization Program for Australia 2019 prioritizes to ensure the adequately skilled workforce. The strategy supports immunization providers by engaging them in communication, education, and training programs to enhance their skills. NIS also ensures that Australia maintains to be an active participant in the WHO expanded program on immunization to help prevent increased outbreaks of infectious diseases around the world.
The immunization program faces a lot of challenges. For example, many people usually refuse vaccines because they have safety concerns over the vaccines, which have side effects on health. Moreover, the National Immunization Strategy for Australia 2019 has not managed to address this issue. For example, it has not taken measures against those who refuse vaccines. The implication for the policy not addressing vaccine refusal is an increased number of unvaccinated people across the country (8). Indeed, if a lot of people are not vaccinated, the rise of cases of infectious that can be prevented by vaccination could occur.
The National Immunization Strategy for Australia 2019 has been criticized for its failure to address the issue of vaccine refusal. For instance, Gianfredi, Moretti, and Lopalco criticize the policy and provide an approach to deal with the issue of vaccine refusal by particular individuals. The article suggests that incorporating the use of information technology systems in vaccination programs could help to increase people’s confidence in vaccines and trust in both health care workers and decision-makers
Immunization, a public health issue, is the responsibility of the state, federal, and local governments in Australia, in line with the federal government. Australia introduced National Immunization Programs and policies in the 1950s to fight against the outbreak of infectious diseases across the country and curb their adverse effects of the infections. The National Immunization Programs have been continuously revised, and one of the current amendments is the National Immunization Strategy for Australia 2019. The National Immunization Strategy for Australia 2019 addresses various areas of concern, such as improving immunization coverage and continuing to enhance the vaccine monitoring system. However, the strategic policy has failed to adopt effective measures to resolve vaccine refusal, which is common across the world. The implication for the failure of the strategic policy to address such concerns is the increased numbers of unvaccinated people across the country and the prevalence of infections that can be prevented.
- Brandt HM, Pierce JY, Crary A. Increasing HPV vaccination through policy for public health benefit. Human Vaccines & Immunotherapeutics. 2015;12(6):1623–5. Available from: https://www.tandfonline.com/doi/full/10.1080/21645515.2015.1122145 DOI: 10.1080/21645515.2015.1122145
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- Colgrove J. Immunization and Ethics: Beneficence, Coercion, Public Health, and the State. The Oxford Handbook of Public Health Ethics. New York, NY: Oxford University Press; 2019 Jul 23:435.
- Chow EP, Danielewski JA, Murray GL, Fehler G, Chen MY, Bradshaw CS, et al. Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne, Australia. Vaccine. 2019;37(43):6271–5. Available from https://www.sciencedirect.com/science/article/pii/S0264410X19311429DOI: 10.1016/j.vaccine.2019.08.066
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- Garcia TB, O’Leary ST. Dismissal policies for vaccine refusal among US physicians: a literature review. Human Vaccines & Immunotherapeutics. 2020;:1–5. Available from: https://www.tandfonline.com/doi/abs/10.1080/21645515.2020.1724742DOI 10.1080/21645515.2020.1724742
- Gianfredi V, Moretti M, Lopalco PL. Countering vaccine hesitancy through immunization information systems, a narrative review. Human Vaccines & Immunotherapeutics. 2019;15(11):2508–26. Available from: https://www.tandfonline.com/doi/full/10.1080/21645515.2019.1599675 DOI: 10.1080/21645515.2019.1599675
- Omer SB, Salmon DA, Orenstein WA, Dehart MP, Halsey N. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases. New England Journal of Medicine. 2009Jul;360(19):1981–8.Available from: https://www.nejm.org/doi/pdf/10.1056/NEJMsa0806477 DOI: 10.1056/nejmsa0806477
- Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States. Jama. 2016;315(11):1149.Available from: https://jamanetwork.com/journals/jama/article-abstract/2503179 DOI 10.1001/jama.2016.1353
- Raj SM, Chughtai AA, Sharma A, Tan TC, Macintyre CR. Cost-benefit analysis of a national influenza vaccination program in preventing hospitalisation costs in Australian adults aged 50–64 years old. Vaccine. 2019;37(40):5979–85. Available from: https://www.sciencedirect.com/science/article/pii/S0264410X19310928 DOI: 10.1016/j.vaccine.2019.08.028