Immunisation

Introduction

Vaccines, along with improvements in sanitation and hygiene, have been instrumental in reducing the global burden of infectious diseases worldwide, underpinning global security and important to strategies addressing antimicrobial resistance.¹ There are now vaccines to protect against more than 20 potentially fatal diseases, and estimates suggest vaccines save up to 5 million lives each year.¹ This section provides an overview of the uptake of the most common vaccines administered through Australia’s National Immunisation Program (NIP).

Vaccine coverage

When a sufficient number of people are immunised, disease transmission can be prevented or minimised, a benefit known as herd immunity. The level of coverage varies depending on the type of vaccine. For childhood vaccines, the goal is to have 95% of children, age appropriately vaccinated and vaccinated on time. Targeted immunisation strategies are also used to protect particularly vulnerable groups and during disease outbreaks.

Australia has one of the best immunisation programs in the world and vaccine acceptance remains high by world standards. However, maintaining public confidence in the efficacy, effectiveness and safety of vaccines:

• remains challenging in many parts of the world including Australia
• is vital to sustaining gains in reducing vaccine-preventable disease morbidity and mortality.²

The COVID-19 pandemic highlighted the issues surrounding vaccine hesitancy and refusal,³ largely driven by misinformation about immunisation circulating in the community, creating confusion and concern. Queensland responded to these challenges by developing:

• regional and statewide immunisation programs to improve uptake of recommended vaccines
• online immunisation courses for vaccine service providers to build capacity
• statewide social media campaigns to reinforce the importance of vaccination.

Immunisation programs

The National Immunisation Program (NIP) provides government-funded vaccines for population cohorts at greatest risk of severe outcomes from vaccine preventable diseases.⁴ Vaccines included under the NIP are decided and funded by the Australian Government following recommendations from the Pharmaceutical Benefits Advisory Committee.

Currently funded NIP vaccines include those against measles, mumps, rubella, polio, diphtheria, tetanus, pertussis (whooping cough), varicella (chickenpox), herpes-zoster (shingles), hepatitis A and B, Haemophilus influenzae type b (Hib), meningococcal ACWY, influenza, human papillomavirus (HPV) and pneumococcal and rotaviral diseases (see Additional information).⁵

Queensland Health distributes NIP vaccines through the Immunisation Program to over 1,800 immunisation providers across Queensland. The Queensland Health Immunisation Program provides other vaccines for diseases that are prevalent in some areas of Queensland or at certain times, such as Japanese encephalitis, rabies and, more recently, monkeypox. The Queensland Specialist Immunisation Services provides immunisation services for children and adults with complex vaccination needs and the School Immunisation Program (SIP) offers free vaccinations within the school setting to all Year 7 and Year 10 students in Queensland schools.

Immunisation coverage by target group

Early childhood immunisation

The Queensland childhood vaccination target is 95% at age 1, 2 and 5 years.⁶ Queensland maintains high childhood immunisation rates, with coverage approaching 95% at each age milestone.

In 2022, coverage amongst Queensland children was:

• 93.1% for 1-year-olds
• 91.6% for 2-year-olds
• 93.5% for 5-year-olds.⁷

Since 2012, coverage has been steadily increasing for 1-year-olds and 5-year-olds in Queensland and Australia overall, although a small decline was noted in 2022 (Figure 1). Changes in the definition of fully immunised for 2-year-olds in December 2014 is thought responsible for the 2015 decline in coverage in that age group.⁷

Adolescents

Vaccine uptake through the SIP in 2021 was:

• 61.1% of Year 7 students completed the two-dose course of HPV vaccine
• 73.3% of Year 7 students received a dose of diphtheria-tetanus-pertussis (dTpa) vaccine
• 65.6% of Year 10 students received a dose of meningococcal ACWY vaccine.

SIP uptake underestimates adolescent vaccination coverage because only those administered in the school setting are included. Students receiving vaccination from GPs or other community immunisation providers are not included.

In 2021:

• 76.4% of Queensland girls and 73.3% of Queensland boys were fully vaccinated against HPV by the age of 15 years
• 84.5% of Queensland adolescents were vaccinated against dTpa by 15 years of age
• 73.7% of Queensland adolescents were vaccinated against meningococcal ACWY.⁵

Adults

Adults with risk factors that make them susceptible to certain infectious diseases can receive some vaccines at no cost under the NIP. This includes:

• older persons
• people with high-risk medical conditions
• pregnant women
• First Nations peoples.

Funded vaccines include pertussis, influenza, herpes zoster (shingles) and pneumococcal vaccines. In Queensland, measles-mumps-rubella (MMR) vaccine is also funded for anyone born during or since 1966 without documented evidence of having received two doses of a measles-containing vaccine.

Free shingles (Varicella zoster) vaccination is offered through the NIP to people 70 to less than 71-year-olds, with a five-year catch-up program for adults 71 to 79 years until 31 October 2023. In 2021, Queensland had the highest zoster vaccination coverage rate in Australia for 70-years-olds (40.9% compared to the national average of 30.6%).⁵ For adults 71 to 79 years, corresponding percentages were 55.3% for Queensland and 46.7% nationally.

Pneumococcal vaccines are available under the NIP for:

• First Nations peoples from age 50 years
• other adults from age 70 years
• those with specific medical conditions.

Nationally in 2021, coverage for the 13-valent pneumococcal conjugate vaccine (13vPCV) was 17.2% (70-year-olds), 20.1% (71 to 79 years) and 1.0% (50 to 69 years) (Queensland result not reported).⁵

Vaccines in pregnancy

Pregnancy is a period of increased susceptibility to infection that can lead to adverse pregnancy outcomes.⁸ Further, young infants are at increased risk of severe disease due to several bacteria and viruses and there is strong evidence that maternal antibodies provide early protection until the infant is old enough to be vaccinated.⁹

Currently, three vaccines are recommended in pregnancy to protect the mother and/or infant:

• influenza
• pertussis (whooping cough)
• COVID-19.

Concerted efforts have been made globally to increase acceptance of, and access to, vaccination in pregnancy. Queensland’s perinatal data collection began recording influenza and pertussis vaccines in pregnancy in July 2015. Substantial advances have been made in Queensland since that time.

Uptake of both influenza and pertussis vaccines in pregnancy in Queensland climbed steadily from 2016 to 2020, along with improvements in the completeness of records (Figure 2). There was however a decline of 18.4% for influenza vaccine and a smaller decline of 3.5% for pertussis vaccine in 2021. The reasons for the decline in influenza vaccinations are not clear, however may be related to the substantial decline in circulating influenza virus that was observed during the COVID-19 pandemic.^10,11

Information is currently limited for uptake of COVID-19 vaccines in pregnancy in Queensland and Australia. A systematic review of the international literature that included published studies up to 23 March 2022 (11 studies and 703,004 pregnant women) reported 27.5% (95%CI 18.8–37.0%) of pregnant women were vaccinated;¹² there were no Australian studies in this that review. Government mistrust, a diagnosis of COVID-19 during pregnancy, and concerns about the safety of COVID-19 vaccines were reasons for declining vaccination.¹² A small study of 287 pregnant women attending antenatal clinics in two Sydney hospitals between 15 September and 22 October 2021 reported 73% of the 212 women who responded to the question had received a COVID-19 vaccine.¹³ In a Western Australia study survey of 218 women, 96 (44%) had been vaccinated.¹⁴

Selected vaccines

COVID-19 vaccination

The first COVID-19 vaccine was granted provisional registration by the Therapeutic Goods Administration (TGA) in late January 2021 in Australia.¹⁵ The first vaccine was administered in Queensland on 22 February 2021 at the Gold Coast University Hospital.¹⁶

COVID-19 vaccination is recommended for all people 5-years and older and for young children 6-months to under 5 years at risk of severe COVID-19. In February 2023, the Australian Technical Advisory Group on Immunisation (ATAGI) recommended 2023 booster doses for adults in specific groups if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was six months ago or longer, regardless of the number of prior doses received.¹⁷ This recommendation does not apply to children and adolescents who do not have risk factors for severe COVID-19.

As of 1 March 2023, more than 12.25 million COVID-19 vaccinations had been administered in Queensland and 93.5% of Queenslanders had received at least one dose, 92.1% had received two, 65.5% of those eligible had received three and 47.6% of those eligible had received four doses.¹⁸ For children 5 to 15 years, 51% had received at least one dose and 43.1% had received two.¹⁸

Influenza vaccination

NIP-funded influenza vaccine is provided for people in specific cohorts of the Australian population who are at greatest risk of severe outcomes:

• First Nations peoples age 6 months and older
• Children 6 months up to 5-years-old
• Pregnant women at any stage of pregnancy
• Adults 65 years and older
• People 6 months and older with medical conditions putting them at higher risk of getting serious disease.

Influenza vaccine is purchased privately by people that do not meet NIP criteria.

In 2022, Queensland experienced an early and severe start to the influenza season following the lifting of international travel restrictions during the COVID-19 pandemic. Queenslanders over age 6-months were offered a free influenza vaccine from GPs or pharmacies from 24 May 2022 to 17 July 2022.

Figure 3 presents influenza vaccine coverage by age group from 1 March to 31 August 2022.¹⁹ Queenslanders 65 years and over were most likely to be vaccinated against influenza, with 68.4% receiving their vaccination by 31 August 2022.¹⁹

In 2022, two programs to improve influenza vaccine uptake were trialled to provide:

• NIP influenza vaccines for people 65 years and older in regional community pharmacies
• state-funded influenza vaccines to those experiencing homelessness in collaboration with a local not-for-profit organisation.

Additional information

Data and statistics

Visit the National Centre for Immunisation Research and Surveillance

• Immunisation reports
• Interactive immunisation coverage data

Visit the Department of Health and Aged Care for the latest COVID-19 vaccination numbers and statistics.

Strategies and information

More information is available at Vaccination Matters from the Queensland government.

Section technical notes

Vaccinations received by individuals are recorded on Australian Immunisation Register (AIR), a national, whole-of-life register managed by Services Australia. Individuals appear on the AIR when they register with Medicare or their immunisation provider reports a vaccination encounter; only a recognised vaccination provider can update the AIR. The AIR includes vaccines given under the NIP, through school programs or those received privately such as travel vaccines. For details of the methods used to calculate coverage, refer to the National Centre for Immunisation Research and Surveillance annual coverage reports.

References

1. World Health Organization. 2023. Vaccines and immunization. Accessed: 24 February 2023.
2. Nuwarda R.F., Ramzan I., Weekes L. & Kayser V. 2022. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines. 10(10): 1595. doi: 10.3390/vaccines10101595.
3. Fajar J.K., Sallam M., Soegiarto G., Sugiri Y.J., Anshory M., Wulandari L., Kosasih S.A.P., Ilmawan M., Kusnaeni K., Fikri M., Putri F., Hamdi B., Pranatasari I.D., Aina L., Maghfiroh L., Ikhriandanti F.S., Endiaverni W.O., Nugraha K.W., Wiranudirja O., Edinov S., Hamdani U., Rosyidah L., Lubaba H., Ariwibowo R., Andistyani R., Fitriani R., Hasanah M., Nafis F.A.D., Tamara F., Latamu F.O., Kusuma H.I., Rabaan A.A., Alhumaid S., Mutair A.A., Garout M., Halwani M.A., Alfaresi M., Al Azmi R., Alasiri N.A., Alshukairi A.N., Dhama K. & Harapan H. 2022. Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis. Vaccines. 10(8): 1356. doi: 10.3390/vaccines10081356.
4. Department of Health and Aged Care. 2022. National Immunisation Program. Accessed: 19 February 2023.
5. Annual immunisation coverage report 2021. 2022. Canberra: NCIRS.
6. Queensland Health. 2017. Immunisation Strategy 2017–2022. Brisbane: Queensland Government.
7. Department of Health and Aged Care. 2022. Historical coverage data tables for all children. Accessed: 23 February 2023.
8. Kourtis A.P., Read J.S. & Jamieson D.J. 2014. Pregnancy and Infection. New England Journal of Medicine. 370(23): 2211–2218. doi: 10.1056/NEJMra1213566.
9. Edwards K.M. 2019. Maternal immunisation in pregnancy to protect newborn infants. Archives of Disease in Childhood. 104(4): 316–319. doi: 10.1136/archdischild-2017-313530.
10. Sullivan S.G., Carlson S., Cheng A.C., Chilver M.B., Dwyer D.E., Irwin M., Kok J., Macartney K., MacLachlan J., Minney-Smith C., Smith D., Stocks N., Taylor J. & Barr I.G. 2020. Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Eurosurveillance. 25(47). doi: 10.2807/1560-7917.ES.2020.25.47.2001847.
11. Olsen S.J., Azziz-Baumgartner E., Budd A.P., Brammer L., Sullivan S., Pineda R.F., Cohen C. & Fry A.M. 2020. Decreased influenza activity during the COVID-19 pandemic — United States, Australia, Chile, and South Africa, 2020. MMWR. Morbidity and Mortality Weekly Report. 69(37): 1305–1309. doi: 10.15585/mmwr.mm6937a6.
12. Galanis P., Vraka I., Siskou O., Konstantakopoulou O., Katsiroumpa A. & Kaitelidou D. 2022. Uptake of COVID-19 vaccines among pregnant women: a systematic review and meta-analysis. Vaccines. 10(5): 766. doi: 10.3390/vaccines10050766.
13. Rikard‐Bell M., Elhindi J., Lam J., Seeho S., Black K., Melov S., Jenkins G., McNab J., Wiley K. & Pasupathy D. 2022. COVID‐19 vaccine acceptance among pregnant women and the reasons for hesitancy: a multi‐centre cross‐sectional survey. Australian and New Zealand Journal of Obstetrics and Gynaecology. ajo.13622. doi: 10.1111/ajo.13622.
14. Ward C., Megaw L., White S. & Bradfield Z. 2022. COVID‐19 vaccination rates in an antenatal population: a survey of women’s perceptions, factors influencing vaccine uptake and potential contributors to vaccine hesitancy. Australian and New Zealand Journal of Obstetrics and Gynaecology. 62(5): 695–700. doi: 10.1111/ajo.13532.
15. Department of Health and Aged Care: Therapeutic Goods Administration. n.d. COVID-19 vaccine: provisional registrations. Accessed: 6 March 2023.
16. Queensland Government. 2021. First shot in Queensland’s COVID fight. Accessed: 7 March 2023.
17. Department of Health and Aged Care. 2023. ATAGI 2023 booster advice. Accessed: 3 July 2023.
18. Department of Health and Aged Care. 2023. Vaccination numbers and statistics. Accessed: 24 February 2023.
19. National Centre for Immunisation Research and Surveillance. 2022. Influenza vaccination and coverage data. Accessed: 24 February 2023.