Western Australian Immunisation Strategy

Immunisation is well recognised as one of the most effective measures a society can undertake to protect the health of the population. According to the World Health Organization (WHO), vaccination is second only to clean water as the public health intervention with the greatest global impact. Vaccination is also highly cost-effective; for every $1 spent on routine childhood vaccinations an estimated $5 in direct medical costs are saved, with another $11 saved in indirect costs (e.g. for time off work, loss of productivity).

Read more from the Minister for Health.

Immunisation is frequently cited as one of the greatest medical breakthroughs in human history. Research has shown vaccinations to be the most effective medical intervention for reducing morbidity and mortality from infectious diseases, surpassing even the notable contribution of antibiotics.

Despite the overall success of immunisations and ready availability of safe and effective vaccines, many vaccine-preventable diseases (VPDs) still occur in Australia. The consequences of this include increased doctor visits, absence from work and school, hospitalisation, permanent disability and premature death. Influenza alone is estimated to be responsible for 1,500 deaths, 18,000 hospitalisations, and 300,000 GP consultations in Australia each year.

Childhood immunisation coverage has, historically, been somewhat lower in Western Australia (WA) than other jurisdictions in Australia – but is improving – a reflection of the improved proactive collaboration occurring among WA stakeholders. In other areas, for example, vaccine safety surveillance and maternal vaccinations, WA is in the forefront of national efforts to improve services. A report of progress made under the 2013–2015 Strategy is included in this document.

The Western Australian Immunisation Strategy 2016–2023 provides a vision for building on improvements in immunisation services realised under the previous strategy. The current Strategy articulates 10 ‘Objectives’, which encompass a comprehensive framework for enhancing all aspects of immunisation program service delivery in WA. The specific objectives are:

• increase vaccination coverage for young children
• increase vaccination coverage for Aboriginal people
• increase vaccination coverage for adolescents
• increase vaccination coverage for adults
• improve support for immunisation providers
• increase immunisation workforce capacity
• improve vaccine preventable diseases surveillance and outbreak response
• improve vaccine safety monitoring
• improve communication with stakeholders and the community
• encourage and support applied immunisation research.

It is WA Health’s aim that the 2016–2023 Strategy will serve as comprehensive road map to strengthen programs and partnerships that improve our capacity to protect the health of our communities through immunisation.

Purpose

The purpose of the Western Australian Immunisation Strategy 2016–2023 (the Strategy) is to provide clear direction for immunisation stakeholders in Western Australia on how to optimise immunisation service delivery across the State, within the context of national and state policy.

Goal and aims

The goal of the Western Australian Immunisation Strategy 2016–2023 is to protect individuals and populations from vaccine-preventable diseases (VPDs). The overarching aims of the Strategy are to:

• achieve or sustain high levels of immunisation coverage across WA, with equity in access to vaccines and immunisation services, including communities that have special needs because of remote location or socio-cultural or economic factors
• provide safe, high-quality immunisation services that instil public confidence and adherence to vaccine recommendations
• ensure cost-effective use of vaccines and efficient immunisation services
• have timely and effective monitoring of immunisation coverage and surveillance of VPDs and the occurrence of adverse events following immunisation (AEFI)
• have clear communication with the public and providers about VPDs, vaccines and AEFI.

Objectives

In order to achieve the aims listed above, 10 Objectives have been established, with a set of strategies around each. The objectives are:

1. Increase vaccination coverage for young children
   
2. Increase vaccination coverage for Aboriginal people
3. Increase vaccination coverage for adolescents
4. Increase vaccination coverage for adults
5. Improve support for immunisation providers
6. Increase immunisation workforce capacity
7. Improve vaccine preventable diseases surveillance and outbreak response
8. Improve vaccine safety monitoring
9. Improve communication with stakeholders and the community
10. Encourage and support applied immunisation research.

The WA Immunisation Strategy 2013–2015 contained seven key performance indicators for assessing success in meeting the objectives of the strategy. How well WA performed against each of these indicators is summarised below.

Key performance indicators

1. Vaccination coverage rates in WA children 12–15 months old consistently >90%
2. Vaccination coverage rates in WA children 24–27 months old consistently >90%
3. Vaccination coverage rates in WA children 60–63 months old consistently >90%
4. Influenza vaccination coverage in persons 65 and older >70%
5. Vaccination coverage rates among Aboriginal children equal to those of other children
6. Vaccine wastage and leakage in WA less than 10 per cent
7. Maintaining or increasing coverage in agreed areas of low immunisation coverage
8. Other significant achievements

Despite recent success in many areas, substantial challenges to delivering comprehensive high-quality vaccination services remain.

WA is a large, diverse and unevenly populated area, and this contributes to the complexity of delivering equitable immunisation services statewide. Providers in the public and private sectors deliver varying sets of service. Robust immunisation services necessitate a coordinated effort and resources from many stakeholders. Ambiguity about the role of these parties may inadvertently lead to gaps in service and sub-optimal vaccination coverage. A better understanding of how responsibility for keeping children fully up to date with their vaccinations should be apportioned among parents, providers and health departments at local, state and national level is required.

The recent, relatively rapid transition from immunisation activities supported by GP Divisions, first to Medicare Locals, and now to the Primary Health Networks has added to the uncertainty about roles and responsibilities for improving immunisation services in WA. GPs provide the majority of vaccinations administered in WA, so robust collaboration with the private primary healthcare sector is essential for improving and sustaining quality immunisation services. The new WA Primary Health Alliance, representing the Primary Health Networks in WA, intends to build a robust and responsive patient-centred primary healthcare system through innovative and meaningful partnerships at the local and statewide level. Specifics on how immunisation initiatives undertaken by WA Primary Health Alliance will interface with those provided by Child and Adolescent Health Service (CAHS), WA Country Health Service (WACHS), and local Public/Population Health Units are currently being finalised.

Accountability for improving immunisation services is arguably the most challenging to articulate for metropolitan Perth. This is most likely because of the organisational structure of the department, resulting in CAHS having responsibility for delivering immunisation services to children (predominantly) and the public health units in the two metropolitan Area Health Services having responsibility for supporting immunisation services and improving uptake.

Last, legislation controlling the prescribing and administration of medicines has, historically, not allowed certain health professional groups autonomy to vaccinate without the direct supervision of a medical practitioner. Under newly passed legislation, however, efforts are underway to permit nurses and other trained and competent health professionals to independently administer vaccinations in the routine WA Immunisation Schedule using special prescribing arrangements.  It is anticipated the work required to accomplish this will be completed in 2016.

Beginning in mid-2015, DOH immunisation program staff conducted an internal review of how the Department and its partners performed in achieving the objectives of the 2013–2015 Strategy.

This assessment was shared with the WA Immunisation Strategy Implementation Steering Committee (WAISISC). Initially convened in July 2013, implementation of the WA Immunisation Strategy is overseen by WAISISC. WAISISC discussed potential changes to the WA Immunisation Strategy (WAIS) at a special session held in August 2015. Based on input from the committee, a draft version of the WAIS was circulated to wide range of stakeholders for comment. The key objectives contained in the WAIS 2016–2023 incorporate input from key stakeholders, following review by WAISISC.

Throughout this process there was general consensus that substantial progress has been made in improving immunisation coverage and services in WA under the 2013–2015 Strategy. The majority of the Key Objectives identified in the previous Strategy were considered appropriate, as evidence by WA’s overall success in meeting performance indicators during 2013–2015. Hence, many of the objectives have been retained in the WAIS for 2016–2023.

Key performance indicators for implementation of the Western Australian Immunisation Strategy 2016–2023 are: