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
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
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
A third of practices not following up vax
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
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
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
More than 40 per cent living in marked
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
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
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
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
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.