• Internal Code :
  • Subject Code : MBA621
  • University : Kaplan University
  • Subject Name : healthcare system

Immunisation program for children

Executive summary

Golden chapter in the history of the evolution of medical science is the influence of vaccines on the extension of the life span of humans and improvement in the quality of life. It has been almost 300 years since the first vaccine was discovered. It is noted globally that the uptake rate of vaccines especially in infants and children are not enough for adequate coverage, that is, as stated by the World Health Organization (WHO) there should be complete, that is, 100% universal coverage. The National Immunisation Programe (NIP) of Australia is successful; it is a program where the governments at all levels, health care providers, administrators, and researchers work collaboratively to provide Immunisation to the population of Australia. This academic paper aims to describe, critically evaluate with respect to the ethical implication, risk, and safety measure of the Immunisation program for children in Australia.

Contents

Description of the program 

Ethical considerations 

Risk identification and management 

Quality and safety of vaccines 

Conclusion 

References 

Description of the program

Immunisation of children is included in the NIP of Australia and is renowned worldwide for its excellence (Ruff et al. 2012). Disparity in reaching people, monetary issues between different regions in Australia reflected on the coverage, and the survey conducted in 1980 reported that only 53% of the children were vaccinated (Commonwealth of Australia, 2018). In 1993 the first national Immunisation strategy was formed and led to the establishment of the Australian Childhood Immunisation Register in 1994 followed by the introduction of the immunize Australia program that came to be known as the National Immunisation Policy in 1997 (Ruff et al. 2012). At present, this program affects the health of people living in Australia at some point or the other in their lives- either directly or indirectly through vaccination or reduction in transmission, respectively. 

The national Immunisation strategy takes lesson from the feat of the last 5-year strategy of 2013-2018 and aims to develop and progress the National Immunisation Policy, this strategy is in accordance with the WHO’s Global Vaccination Action Plan. It follows the Australian government's health reform to improve the health of people by focusing on health rather than the illness that is, covering the WHO’s definition of health. The aim is the prevention of disease and an unadorned result of the illness by ensuring maximum coverage of people by the Immunisation program. The strategies recognized to aid the National Immunisation Policy are: to advance vaccination coverage, guarantee operative supremacy, safe supply of vaccines and their efficient use, and monitor their safety, better communication to improve the confidence of the community, monitoring and evaluation of the National Immunisation Policy by the scrutiny of vaccine-preventable illness, guarantee facilitation of accomplished personnel and maintain the contribution of Australia. 

The National Immunisation Policy is providing vaccines for 17 vaccine-preventable diseases, including those for the children. The action plan for the strategies discussed above- for improvement in the coverage: attainment of 95% coverage for children between the age of 1-5 years with specific attention to Aboriginal and Torres Strait Islander children between the ages of 1-5 years which is consistent with the WHO’s prescribed target (WHO 2015). In 2018, the childhood coverage was 90% and it required to maintain and improve in the future to keep vaccine-preventable diseases under control. Compliance plays a major role in the attainment of this and research conducted by Hull (Commonwealth of Australia 2018) showed that 3% of parents delay timely immunisation. The National Immunisation Policy is planned out for the next five years from 2019-2024.

The resources of the National Immunisation Policy are included in the planning of Australian Technical Advisory Group on Immunisation (ATAGI) which is the think tank and is in action since 1994 which takes responsibility of resources, time frame, development and testing of vaccines, implementation and evaluation of the National Immunisation Policy (Commonwealth of Australia 2019).

Ethical considerations

Ethical implications are present in Immunisation programs as they frequently encompass a large part of the community bearing the benefit of the community in mind not that of the individual. This is more important in the case of children as they are too young to decide for themselves. Various factors like age, prevalence of illness, autonomy govern the risks and benefits. For example- some parents exercise their autonomy to decide against the Immunisation of their children of school age, while, parents World Health Organisation immunize their children strongly oppose this. Verweij and Dawson (as cited in Isaacs 2012) bordered seven ethical principles for joint vaccination programs and they are- benefits, risks, effectiveness, equity and justice, autonomy, reciprocity, and trust. As the global need for a reduction of communicable diseases increased there was an increased need for vaccine uptake, there was a resurgence of new vaccines (MacDonald et al. 2018).

The benefit should outweigh the risk is important, that is, narrow risk-benefit ratio.  This worked fine with older vaccines, but the introduction of new vaccines makes parents skeptical about the risk involved. Historically, it was seen with the polio vaccine which led to the elimination of the disease from various countries (Leask, Braunack‐Mayer and Kerridge 2011). The purpose of Immunisation is to benefit the community along with an individual. Few diseases can be controlled if the transmission is controlled and is important in mass Immunisation and is called herd immunity. Few people do not get immunized either due to the fact that they presume that the manufacturing is not safe, will cause more harm, is not helpful, pharmacological companies do this only to benefit themselves and sometimes they do not get the vaccines due to the thinking of getting free-ride because of herd immunity (Clarke, Giubilini and Walker 2017).

The vaccination program should be effective not only clinically but also should be cost-effective. Literature evidence of the cost-effectiveness of vaccines or the immunisation policy is not available but as a general rule the effectiveness should be more than the cost and in healthcare, it is measured as disability-adjusted life-years saved. Australian Immunisation policy has high immunisation rates without compulsion, as it reduces the autonomy of a person and it is realized that voluntary Immunisation policy in benign and operative (Isaacs 2012). The Australian Technical Advisory Group on Immunisation is the advisory committee that reflects upon the efficacy of vaccines, prediction of herd immunity and practicability of the program; it keeps the prices down so it is more accessible to more vulnerable groups (Isaacs 2012).

Risk identification and management

Risk identification is important so the vulnerable areas can be addressed. Earlier, the school of thought was children with familial history illness like whooping cough had a predilection to development of central nervous events, hence, it was declared a contraindication to vaccination. Reanalysis of the at a later time showed that the risk of damage was close to zero. There has been evidence to state the development of encephalopathy within a week of immunisation and anaphylaxis can occur and are adverse reactions to vaccination (Wilyman 2015). The implementation of Immunisation policy should be done keeping risk factors and risk areas into consideration, and identification of those factors is important as they have to be effectively managed for the achievement of the immunisation program. 

In Australia, the vaccine utilization has been relatively stable around 91-92% which is below the WHO’s global Immunisation target and some areas and social groups are inaccessible to herd immunity as well (Department of Health 2014). The parents refusing immunisation can be classified into two broad categories. First, are conscientious objectors they tend to be hesitant towards acceptance of vaccines to do their perceptions and concerns, they are more prosperous and sophisticated (National Health Performance Authority 2014; Leask et al. 2012; Dubé et al. 2013). The second is people World Health Organisation may have physical and social barriers (Pearce et al. 2015). Identification of this is important as the ways to manage this will also conform to the same. The success of the National Immunisation Policy in Australia is commendable hence, there is no compulsory Immunisation. 

With compulsory Immunisation adoption, there is always a risk for unwanted consequences. In order to manage this government of Australia has implemented No Jab No Pay bill released in 2015 where non-medical exemptions have been removed immunisation requirements (Leask and Danchin 2017). This amount accounted for approximately 15000 AUD per annum. Few states also passed No Jab No Play policy that affected the acceptance of children in the daycare center leading to full exclusion. Other initiatives included were reminder system, incentive for indigenous groups, campaigns, etc. as a result of this by 2018, the immune coverage increased from 92- 94% (MacDonald et al. 2018).

Quality and safety of vaccines

Vaccines and medicines are controlled by the Therapeutic Goods Administration in Australia, any new vaccine introduced the manufacturing company is mandated to apply with data pertaining to quality, safety, efficacy, and its intended use is further evaluated by the Therapeutic Goods Administration. This quality check is done for vaccines in each batch to maintain the quality as mentioned in the description of the vaccine and it accounts for purity, potency while maintaining the efficacy of the vaccine. In order to import a particular vaccine to Australia, the review prior to marketing quality checks and references are given by the World Health Organisation is submitted to Therapeutic Goods Administration which then performs a batch testing program for all the aspects of the vaccine. Even after all the quality checks, a vaccine has a chance of producing adverse events in some people hence post-marketing safety surveillance is of utmost importance. It involves effective placement of a system that identifies, reports and evaluates any adverse events as maintenance of confidence between the government and community is important for the continued Immunisation. 

Post licensure surveillance can be either active reporting or passive surveillance. For proper reporting requires an understanding of the Adverse Events Following Immunisation so it can be identified. Adverse Events Following Immunisation can be any negative reaction that following vaccination, can be local, systemic, allergic or anaphylaxis though it is rare. AusVaxSafety is a nationwide government-funded active vaccine surveillance initiative led by National Centre for Immunisation Research and Surveillance (NCIRS) and it monitors vaccine safety by Adverse Events Following Immunisation-clinical assessment network and National Prescribing Service (NPS) MedicineInsight Data. Paediatric Active Enhanced Disease Surveillance (PAEDS) also led by NCIRS which collects data from hospitals if the children are hospice due to any probable Adverse Events Following Immunisation and the information available is unique. PAEDS aims to improve the health outcomes of children by aiding in the betterment of the immunisation policy and practice. Therapeutic Goods Administration monitors Adverse Events Following Immunisation through national passive surveillance, that is, by reporting and this can be done by anyone like health care providers, vaccine producers, parents of children and others.

To summarize, it can be said that the past is easier to foretell than the future, but vaccine development in the present is much clearer. The National Immunisation Program in Australia has been a tremendous success. It is because of the meticulous understanding of the deficient areas and utilizing the known information for the betterment of the vaccine utilization by the people of Australia.

Conclusion

In conclusion, there are various ethical considerations to be taken care of while taking immunisation of children into consideration. It is vital to identify the risk and barriers to vaccine utilization. Apparent health contraindications, dearth of access, socio-cultural barriers, psychosomatic barriers, childcare expenses, and location are few things that prove as a barrier to proper immunisation. Hesitancy towards vaccination is an increasing concept in Australia and is an interesting research avenue due to which there are many propositions to be included in the policy implementation to increase vaccine utilization. Few of the improvements have been increasing transparency, making the public aware, more meticulous post-marketing surveillance for the identification and timely management of any adverse event following immunisation. Additional emphasis should be placed upon perceiving the grievances of the public and including the suggested changes to maximize the effect. Provision of immunisation to children is not regulated by a single aspect of the government, whereas, it is multidimensional and in order to provide appropriate care it is important that all the stakeholders are completely dedicated to the task only then WHO’s of 95% target can be achieved.

References

Clarke, S., Giubilini, A. and Walker, M.J., 2017. Conscientious objection to vaccination. Bioethics, 31(3), pp.155-161. doi: 10.1111/bioe.12326.

Commonwealth of Australia. 2018. National Immunisation Strategy for Australia 2019–2024. Retrieved from: https://www.health.gov.au/sites/default/files/national-immunisation-strategy-for-australia-2019-2024_0.pdf.  

Commonwealth of Australia. 2019. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Government, Department of Health. Retrieved from: https://www.health.gov.au/committees-and-groups/australian-technical-advisory-group-on-immunisation-atagi.

Department of Health. 2014. ACIR – Annual Coverage Historical Data. Retrieved from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/acir-ann-cov-hist-data.htm.

Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R. and Bettinger, J.A., 2013. Vaccine hesitancy: An overview. Human vaccines & immunotherapeutics, 9(8), pp.1763-1773. doi: 10.4161/hv.24657.

Isaacs, D., 2012. An ethical framework for public health immunisation programs. New South Wales public health bulletin, 23(6), pp.111-115. doi: 10.1071/NB11045.

Leask, J. and Danchin, M., 2017. Imposing penalties for vaccine rejection requires strong scrutiny. Journal of paediatrics and child health, 53(5), pp.439-444. doi: 10.1111/jpc.13472.

Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H. and Rowles, G., 2012. Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics, 12(1), p.154. doi: 10.1186/1471-2431-12-154.

Leask, J., Braunack‐Mayer, A. and Kerridge, I., 2011. Consent and public engagement in an era of expanded childhood immunisation. Journal of paediatrics and child health, 47(9), pp.603-607. doi: 10.1111/j.1440-1754.2011.02160.x.

MacDonald, N.E., Harmon, S., Dube, E., Steenbeek, A., Crowcroft, N., Opel, D.J., Faour, D., Leask, J. and Butler, R., 2018. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine, 36(39), pp.5811-5818. doi: 10.1016/j.vaccine.2018.08.042

National Health Performance Authority. 2014. Healthy Communities: Immunisation Rates for Children in 2012–13. Sydney: National Health PerformanceAuthority. Retrieved from: https://www.aihw.gov.au/reports-data/indicators/healthy-community-indicators.

Pearce, A., Marshall, H., Bedford, H. and Lynch, J., 2015. Barriers to childhood immunisation: Findings from the Longitudinal Study of Australian Children. Vaccine, 33(29), pp.3377-3383. doi: 10.1016/j.vaccine.2015.04.089.

Ruff, T.A., Taylor, K. and Nolan, T., 2012. Australia's contribution to global immunisation. Australian and New Zealand journal of public health, 36(6), pp.564-569. doi: 10.1111/j.1753-6405.2012.00956.x.

WHO, 2015. Regional framework for implementation of the global vaccine action plan in the Western Pacific. Retrieved from: https://iris.wpro.who.int/bitstream/handle/10665.1/10921/9789290617099_eng.pdf.

Wilyman, J., 2015. A critical analysis of the Australian government’s rationale for its vaccination policy. Ph.D. diss., University of Wollongong, Australia. Retrieved from: https://ro.uow.edu.au/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=5550&context=theses.



 

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