Vaccination

Objectives To identify drivers of routine vaccination for Aboriginal and Torres Strait Islander children, from a health service provider perspective, to increase and maintain uptake.DesignThis qualitative study was designed, analysed and guided by Indigenous data sovereignty and governance principles. Data were analysed using inductive content analysis. Subcategories were refined using Miro (Miro Inc), an online collaboration platform. Aboriginal and Torres Strait Islander worldviews were privileged, with Aboriginal researchers leading data analysis in New South Wales (NSW) and contributing to analysis in the Northern Territory (NT).SettingThe study was conducted in NSW and the NT, Australia, with health service providers from urban, rural and remote settings.ParticipantsIndividual and group interviews were undertaken in person or online between 2 May and 28 August 2024, with 18 health service provider participants in the Hunter New England Local Health District in NSW and 17 health service provider participants in the NT.ResultsWe identified six key themes addressing drivers of vaccination for Aboriginal and Torres Strait Islander children for families (knowledge, attitudes and information sources; decision-making), health staff (workforce roles, responsibilities and relationships) and health services (improving access; health service operations; data for decision-making). Providers recommended strategies to improve uptake.ConclusionsHealth service providers in urban, rural and remote locations in Australia can provide valuable insights to inform tailored strategies to improve declining vaccine coverage for Aboriginal and Torres Strait Islander children, aligned with the priorities of the National Immunisation Strategy 2025–2030.

Bianca F. Middleton, Kristy Crooks, Kylie Taylor, Elizabeth Harwood, Katrina K. Clark, Caitlin Kent, Kelly McCrory, Marita Hefler, Jessica Kaufman, David N. Durrheim, Margie H. Danchin

Australia has been at the forefront of innovation and implementation of cervical cancer control and is predicted to eliminate cervical cancer by 2035, the first country to achieve elimination using active measures. This is a result of Australia being an early adopter of universal human papillomavirus (HPV) vaccination and early transition to a primary HPV-based cervical screening program. However, to ensure timely and equitable elimination, disparities in coverage among underserved populations must be addressed, and recent declines in vaccination and screening uptake must be reversed. Improved routine data linkages are required to ensure gaps in participation in subpopulations can be identified. Primary health providers have an important role in checking vaccination and screening status and offering vaccination catch-up or screening as appropriate. A universal option of self-collection of an HPV sample for all screen-eligible people has increased acceptability overall, but further innovative and flexible models of service delivery are required to ensure equitable access for all. Australia has also played an important role in cervical cancer control globally and was a co-sponsor of the 2020 World Health Assembly resolution to accelerate the global elimination of cervical cancer as a public health problem. In the Indo-Pacific region, regional frameworks have been developed to advance strategic actions to progress implementation of the global strategy. The Elimination Partnership in the Indo-Pacific for Cervical Cancer (EPICC), a major initiative supported by the Australian Government and the Minderoo Foundation, provides tailored support to countries, considering local needs and priorities.

Susan Yuill, Carol Naidu, Megan Smith, Deborah Bateson, Marion Saville, Boniface Damutalau, Karen Canfell

Regular vaccine boosting saves lives, particularly of older Australians, who are at greatest risk of death from COVID-19

Bette Liu · Anish Scaria · Sandrine Stepien · Kristine Macartney

The policy has been effective, albeit with modest closure of coverage gaps, and without substantial backlash

Terence M Nolan

A narrative review published in the Medical Journal of Australia examines the current landscape and future directions of respiratory syncytial virus (RSV) preventives in Australia. RSV is a major cause of acute lower respiratory tract infections, and disproportionally impacts children under the age of 4, who represent 50% of RSV hospitalisations. In November 2023, the long-acting monoclonal antibody nirsevimab was registered with the Therapeutic Goods Administration (TGA) for prevention of RSV-related infections in children under two years of age. Shortly after, in March 2024, a maternal RSV vaccine, Abrysvo, was registered with the TGA for prevention of RSV-related infections in infants under 6 months of age. The narrative review authors describe the availability of these vaccines as “an era defining advancement in RSV prevention.” “Both nirsevimab and Abrysvo have demonstrated substantial potential in reducing hospitalisation rates and mitigating long term health care costs associated with RSV infections in infants,” Sam Barnett of Monash University and co-authors wrote. Western Australia leading the charge at home Western Australia was the first Australian jurisdiction to announce a state-wide immunisation program, rolling out a government funded all-infant RSV immunisation program with nirsevimab in April 2024. A research letter published in the Medical Journal of Australia has examined the impact that the immunisation program had on the WA health care system. “From 2 April 2024, all WA infants born during 1 October 2023 – 30 September 2024 were eligible to receive nirsevimab in primary care services and birthing hospitals, as were Aboriginal children and children with conditions associated with severe RSV disease born during 1 October 2022 – 30 September 2023,” Dr Lauren Bloomfield and co-authors wrote. “With 71% of nirsevimab-eligible infants receiving RSV prophylaxis during April–September 2024, the number of RSV-associated hospitalisations in WA was 57% lower than expected during May–December 2024, equivalent to one hospitalisation averted per 43 infants immunised.” “Further, a contemporary case–control study found that nirsevimab was 86.4% effective in averting RSV-associated hospitalisations of infants in WA. As the cost of an infant RSV hospital admission is estimated to be $12 346 to $13 695, averting 505 admissions is likely to have saved $6.2–6.9 million in hospital costs.” The future of RSV prevention In 2025, Australia has a national RSV prevention program with free maternal vaccination with Abrysvo and targeted infant protection with nirsevimab. Analysing the data from this national program will be pivotal in evaluating and refining the national RSV prevention response going forward. “Program monitoring and evaluation, including cost-effectiveness modelling, from the 2025 RSV [Mother and Infant Protection Program] MIPPs will help guide future decisions regarding the optimal combination of maternal vaccination and nirsevimab,” Barnett and co-authors wrote in their narrative review. “These studies, which will incorporate Australian-specific data, will evaluate factors such as cost-effectiveness, timing, geographic variability and logistical considerations in relation to administration.” Successful implementation of RSV prevention programs will depend on maintaining cost effectiveness, addressing parental acceptance and uptake of the vaccines, and ensuring accessibility for groups at increased risk, such as First Nations children. “An evidence-based approach will be essential to ensure appropriate allocation of resources, tailoring programs to the specific needs of higher risk populations while maximising the economic and health benefits across Australia,” Barnett and co-authors wrote. Read the narrative review in the Medical Journal of Australia. Read the research letter in the Medical Journal of Australia.

Annika Howells