How do Indigenous Australians fare when it comes to vaccination?

Paramate (Marvin) Siriya

In Australia, you don’t have to look too far past our backyard to see some pretty major health inequalities. Disease rates for hepatitis B in Aboriginal and Torres Strait Islander people (Indigenous Australians) are 3.1 times higher than in non-Indigenous Australians and even 13 times higher for Haemophilus influenzae type B infections. (1) Many of these inequalities in disease incidences are vaccine preventable and so the question that begs to be asked is ‘how do Indigenous Australians fare when it comes to vaccination?’ This post focuses particularly on the vaccination of Indigenous children.

Vaccination coverage

On average, vaccination coverage amongst Indigenous Australians is generally lower than non-Indigenous Australians. 86% of Indigenous children are fully vaccinated for the standard vaccines at 12 months (6% less than non-Indigenous children), 91% at 2 years (same as non-Indigenous children) and 85% at 5 years (4% less than non-Indigenous children). (1) It can be seen that there is some disparity between Indigenous and non-Indigenous children when it comes to vaccine coverage, however the majority of Indigenous children do get immunised for the standard vaccines. Some vaccines (hepatitis A and pneumococcal polysaccharide vaccines) are specifically scheduled for Indigenous children, however vaccine coverage data does not exist for these vaccines. (2)

Sticking to the schedule

Timeliness of vaccination is a major issue in the vaccination of Indigenous children. Indigenous children often fall behind the recommended vaccination schedule with only 45% of pneumococcal polysaccharide vaccines and less than 30% of hepatitis A vaccines administered within 6 months of the due date. (2) Delayed vaccination contributes to the disparities seen in vaccination coverage and consequently vaccine preventable disease incidences between Indigenous and non-Indigenous people.

Fighting a different battle

Indigenous Australians have a much lower rate of vaccine refusal (0.37%) compared to non-Indigenous Australians (1.65%). (1) Therefore, strategies to increase vaccination coverage amongst Indigenous people are geared around increasing access to vaccination through Aboriginal community controlled health services and culturally appropriate health services. (3) This is in contrast to the non-Indigenous population who have excellent access to vaccination services but have a higher proportion of vaccine refusers.

The power of vaccination; a success story of Indigenous vaccination

Positive success stories of vaccination programs serve as a powerful reminder that vaccines save lives and that we should be vaccinating everybody. Despite the health inequalities apparent between Indigenous and non-Indigenous people, good things are happening and we should celebrate successes when we have them. In 2005, a hepatitis A vaccination program was commenced in Indigenous communities with high incidences of hepatitis A. (1) Prior to the introduction of the hepatitis A vaccination program, Indigenous children under five years of age had 24 times the disease rate of hepatitis A compared to their non-indigenous counterparts. Since the program (2006-2010), there have been no new cases of hepatitis A in Indigenous children under five years of age. In all other age groups (older than 5 years of age), hepatitis A disease rates were similar between Indigenous and non-Indigenous Australians prior to the program. Since the program, hepatitis A disease rates for Indigenous people in all other age groups are now less than their non-Indigenous counterparts, who are not ordinarily vaccinated against hepatitis A.

This example highlights the incredible power of vaccines and why vaccination is so important to keeping our communities healthy. Within a matter of three years, the major health inequality of Hepatitis A within Indigenous people has done a backflip and now the inequality lies with the non-Indigenous people who are not vaccinated.

Where to from here? A community approach to vaccination

It has been well established that timeliness and access to vaccination services are the main issues that we need contend with in order to improve health equality for Indigenous Australians with regard to vaccines. We need to increase access to vaccination services for Indigenous people and this should be achieved primarily through increasing access to culturally appropriate care such at Aboriginal community controlled health organisations, schools and other community settings. (3) We also need to actively encourage the timely vaccination of Indigenous children (4) and again this must take place on the community level. Indigenous culture is based upon community and improving the health outcomes of Indigenous people requires a community approach. This requires all people involved in the community at all levels, from the community leaders to health workers, parents, teachers and friends to take an active role in making sure that a) Indigenous people are vaccinated and that b) it is done on time. Vaccination and health care of Indigenous people has to begin at the community so that it doesn’t end at the hospital!

1. Naidu L, Chiu C, Habig A, Lowbridge C, Jayasinghe S, Wang H, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006-2010. Communicable diseases intelligence quarterly report. 2013;37 Suppl:S1-95.

2. Menzies R, Andrews R. Immunisation issues for Indigenous Australian children. Journal of paediatrics and child health. 2011.

3. McIntyre PB, Menzies RI. Immunisation: reducing health inequality for Indigenous Australians. The Medical journal of Australia. 2005;182(5):207-8.

4. O'Grady KA, Krause V, Andrews R. Immunisation coverage in Australian Indigenous children: Time to move the goal posts. Vaccine. 2009;27(2):307-12.

#aboriginal #vaccinationrates #australia #hepatitisa #community