Abstract
Rather than concentrating primarily on children and adolescents, there has been a shift in the discourse around immunisation to encompass a whole-of-life approach. Despite this acknowledgement and ongoing high burdens of vaccine preventable diseases in adults, coverage for some adult risk groups remains sub-optimal. This study aimed to explore key informant's and stakeholder's perceptions of factors impacting provision of immunisation programs for Australian adults and to identify strategies to promote acceptance and uptake. Semi-structured telephone interviews were undertaken with people involved in adult immunisation program delivery, advocacy, policy or research between September 2020 and June 2021. Transcripts were inductively analysed, with the resulting themes categorised into the five influences on vaccination gaps that have informed program planning in other countries: Access, Affordability, Awareness, Acceptance and Activation. Participants spoke of improvements in the provision of vaccines to adults, however, ongoing challenges persisted. Participants agreed that the focus or emphasis of policies and the promotion/communication strategies has been on childhood vaccination in Australia, however there is a sense that the “pendulum has swung.” These included understanding of eligibility amongst the Australian population and the reluctance of some health providers to dedicate time to exploring immunisation needs with adult patients. In comparison to the childhood vaccination program, there has been a lack of data available on coverage for adult vaccines on the national immunisation program. This has contributed to the ongoing challenges of identifying and promoting certain vaccines. At a government level, questions were raised about why the Australian government has never set an aspirational target for adult vaccination (i.e., influenza or pneumococcal) coverage. While significant improvements have been made in adult immunisation uptake, there are still gaps across the program. While the system remains under stress because of the COVID-19 pandemic, it is not appropriate to implement any additional programs. There needs to be strong commitment to establish the value of adult vaccination in the eyes of community members, policy makers and healthcare professionals. Having a national adult immunisation strategic plan would help advance action.
Highlights
Complete and timely data has only just started to become available on adult vaccination as an outcome of the expansion of the Australian Immunisation Register (AIR)
There was a level of consensus amongst participants that the focus or emphasis to date has been on childhood vaccination in Australia, or on adults aged 65 years and above (“tiny tots and older adults”)
Whilst vaccine coverage data for adults will become more reliable soon, an issue remains with the usefulness of the system for tracking coverage in at-risk groups
Summary
Complete and timely data has only just started to become available on adult vaccination as an outcome of the expansion of the Australian Immunisation Register (AIR). While influenza vaccination coverage estimates for adults aged ≥ 65 years have been 70% or greater, coverage for adults with certain medical conditions, such as severe asthma, lung or heart disease and diabetes is as low as 45% [4] This is despite influenza vaccination being free for these target groups and improving vaccination coverage in high-risk groups being a national strategic priority. 23 months following commencement of the national zoster immunisation program, cumulative vaccine uptake was 31.2% for adults aged 70–79 years old, with a slightly higher vaccination uptake documented for Indigenous adults (37%) [5] This number is likely an underestimation of the true zoster vaccine uptake, as another study (based on primary care data) has documented the vaccine coverage as being between 41and 46% [6]. A systematic review of Australian studies from 1992 to 2013 estimated that pneumococcal vaccination coverage for people ≥65 years ranged from 50.3 to 72.8% after the introduction of the vaccine onto the national program [7]
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