Five-year study finds Northland has twice national rate of vax refusal for babies Monday, 18 July 2016

Source: New Zealand Doctor, 18 July 2016

Northland has double the national rate of unimmunised children with 7 per cent of babies not vaccinated at six weeks.

Northland medical officer of health Juliet Rumball-Smith led a study that tracked almost all babies born in Northland from 2009 to 2013 - totalling nearly 12,000. Results were published today in the latest issue of the  New Zealand Medical Journal.

Northland medical officer of health Juliet Rumball-SmithUsing National Immunisation Register data, researchers found parents and caregivers who refused vaccines at six weeks were likely to continue down that path, having made the decision not to vaccinate before their babies were born.

A third of practices not following up vax refusers

The authors also found general practices played a role, with a third of 38 practices in Northland not adopting the recommended guideline of following up parents who decline at six weeks. 

The Immunisation Advisory Centre recommends follow-up at three months and five months but a third of practices had an "informal" policy of delaying re-engagement until the 15-month immunisation round.

But Dr Rumball-Smith told  New Zealand Doctor  today, this was unlikely to have made a substantial impact on parents' decision-making.

"I think it was good to identify a factor that was maybe contributing that we can work on," Dr Rumball-Smith says.

More than 40 per cent living in marked deprivation

With 41.6 per cent of the cohort of 11,972 living in "marked socio-economic deprivation" - quintile five - their health outlook would be worsened by exposure to vaccine-preventable illness, the study says.

The authors found of the 40 known Northland primary care providers, the proportion of vaccine refusers varied from 2.2 per cent to 14.6 per cent with a mean of 8.6 per cent. One small urban clinic had a refusal rate of 63 per cent.

Around 40 per cent of babies not receiving the vaccine were Maori and 52 per cent were New Zealand European.

While some vaccine-refusers were opposed to all vaccines, for some access was difficult.

According to other studies Northland Maori were more likely to report transport as a barrier to getting GP services but were also less likely to have full trust and confidence in their GP.

Reaching the limit 

Northland has had consistently low immunisation rates, but the level has climbed a little in recent years.

"It is possible that we have reached the limit of what we can achieve within our present regulatory framework," the authors say.

Aside from making the vaccination process more patient-friendly at the primary care level and providing pregnant mothers with information, Dr Rumball-Smith says the next step would be national initiatives such as using incentives or quasi-mandatory strategies.

She says in the US, children are required to be fully immunised by the time they start school but parents can apply for exemptions on medical, religious or personal grounds.

Rules for exemptions differ between states but the amount of effort required to apply for exemptions has a direct impact on how many children are exempt, she says.