Vaccine refusal stays largely unchanged

Research published today in the Medical Journal of Australia has found that the overall level of vaccination objection (registered and unregistered) has remained largely unchanged since 2001.

Dr Frank Beard and colleagues from the National Centre for Immunisation Research and
Surveillance at The Children’s Hospital at Westmead and the University of Sydney examined the trends in registered vaccination objection and estimated the contribution of unregistered objection to incomplete vaccination among children in Australia.

They found that registered vaccination objection affecting children aged one to six years had increased from 1.1% in 2002 to 2.0% in 2013.

However, in this period the proportion of children who were incompletely vaccinated, but for whom no objection was recorded, declined.

“Most areas with high levels of recorded objection were in regional zones, with marked clustering in northern New South Wales and south-east Queensland,” the authors found.

Further, more than half (52%) of the 2.4% of children with no vaccinations and no recorded objection were born overseas. The authors suggest, however, that most are likely to have been vaccinated, but this had not been recorded on the Australian Childhood Immunisation Register.

“We recommend that primary care clinicians pay close attention to ensuring that the vaccination history of overseas-born children is correctly recorded in the ACIR,” the authors said.

Extrapolating their data, the authors estimated that 1.3% of children were incompletely vaccinated because of unregistered parental vaccination objection, so that an estimated total of 3.3% of children in Australia aged one to six years were affected by a registered or unregistered objection.

As a 2001 survey had found that 2.5–3.0% of children were affected by parents who had
registered an objection or had significant concerns about vaccination, this suggests “that there has been little change in the overall impact of vaccination objection since 2001”, contrary to claims in the media that parental refusal was increasing.

Beard and his colleagues advised clinicians to be “on the alert for appropriate catch-up
opportunities for partially vaccinated children, as in most cases they are probably not up to date for reasons other than parental objection.”

Professor Paul Van Buynder, public health physician and a director of the Influenza Specialist Group, commented on the research saying that vaccine hesitancy was a greater concern than outright vaccine refusal.

He told MJA InSight that he had “given up on the true vaccination objectors”.

“They are not going to be converted by a discussion about science,” he says. “They are lost to the vaccination program.

“By trying to convince these people, we’re spending less time talking to those who are worried about vaccinations, and these are the patients who are much more likely to respond to a conversation about the science.”

Prof Van Buynder says that he is noticing “worrying pockets” in the community where vaccination schedules were not being followed.

“There is also a trend of ‘designer schedules’, where parents pick out which vaccinations they will give their child, and skip others.”

He says it is vital that the medical and science community become more active and vocal on social media to get the vaccination message across.

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