January 10th, 2018
Barriers to Immunisation Initiatives in Australia
Funding to specific groups and settings
The strict application of funding to specific subgroups and settings is one of the challenges to immunisation efforts by the Australian government. In last decade, funding for immunisation in Australia has been gradually introduced to communities to enhance public health outcomes, but most of such funding has been applied strictly to certain subgroups or settings in the community (Page, Earnest & Birden 2008). Although such initiatives could alleviate diseases when targeted to highly susceptible sections, the strict application has led to the exclusion of some individuals who need such vaccines, from vaccination programs. For instance, immunisation initiatives targeted to areas such as the urban regions have proved insufficient in providing adequate coverage to the indigenous populations (McIntyre & Menzies 2005). Such populations are often under-identified in non-remote areas thus resulting in their inadequate coverage by the vaccination drives. When this occurs, the unvaccinated population is likely to re-introduce the diseases targeted to the rest of the population, thus defeating the purpose of the vaccination interventions (Page, Earnest & Birden 2008).
Statistics available indicate that the under-identification of target group for immunisation poses severe public health challenges. Although, the vaccine-preventable diseases have significantly reduced compared to the period before the introduction of funding, occasional cases of disease outbreaks have been documented due to poorly identified subgroups of indigenous populations. For instance, McIntyre and Menzies (2005), note that the vaccination coverage of Indigenous population is consistently lower in the non-remote areas. Despite there being targeted programs to regions predominantly occupied by the Indigenous Australians, lack of appropriate strategies to identify such populations in urban areas could result in the re-introduction of the disease in these urban centres (McIntyre and Menzies 2005). Such under identification does not only increase the burden of disease in Indigenous population, but also continues to make the population more vulnerable. Additionally, the under-identification makes the uncovered subgroup to become a potential reservoir from which the vaccine-preventable diseases spread to other populations in non-remote areas.
Geographical location that limits coverage for vaccination programs
A second aspect that presents a barrier for coverage of vaccination programs, especially for indigenous populations, is their living in geographically isolated regions. This can present a barrier in two ways. Firstly, where the vaccines are produced in centralized locations, usually in urban centres, transportation of such vaccines to the remote areas where the indigenous people are located may prove challenging. For instance, Page, Earnest and Birden note that maintaining the cold chain during storage and transport of vaccines is critical to maintaining the potency of vaccines. As such, transportation of vaccines from their cold storage facilities in centralized locations to remote areas inhabited by the indigenous people could expose them to elevated temperatures that make such vaccines non-potent (Fernando 2004). The breach of the cold chain required for vaccines to maintain potency may thus mean that the indigenous population in distant areas may receive ineffective vaccination.
Secondly, living in geographically isolated areas may present challenges for coverage during vaccination drives. For instance, even with targeted programs, personnel conducting the vaccination procedures may not achieve full coverage in the widely distributed indigenous populations (Page, Earnest & Birden 2008). This is for instance evident in the study by McIntyre and Menzies (2005), where children identified as indigenous were noted to receive vaccination at delayed ages. For instance, comparing the vaccination coverage for the indigenous and non-indigenous children at 12 months and 2 years, McIntyre and Menzies (2005) noted that such coverage was lower for the indigenous children at 12 months but not at 2 years. Such suggested that vaccination programs targeted to indigenous population was only becoming effective after some periods. In this respect, indigenous children could fail to receive critical vaccination at the age they need such vaccination most. Failure of full coverage presents a risk of reintroduction of the targeted disease among the immunised population as earlier noted. This is because such unimmunised individuals could serve as reservoirs of the disease thus spreading it to the immunised group who might not have built full immunity against the disease.
Go to part three here.