Child Immunisation in New Zealand: Concluding thoughts…

It seems that immunisation is generally considered the best method of protecting children against preventable diseases, especially considering that the reactions caused by the wild form of a virus are far worse than those caused by a vaccine.  It is also apparent that the media is largely used as a tool, to influence public opinion in favour of immunisation.  As a response to disease outbreaks and poor immunisation rates, the Government is currently actively assessing and addressing the issues that inhibit immunisation growth in New Zealand.  It will be interesting to follow their progress and the results of future generation’s choices.
The information throughout this blog, for me, has confirmed my initial beliefs.  I am pro-immunisation as evidence proves that, overall, the benefits of immunisation outweigh the risk of not being immunised (getting a worse case from the wild form of a virus).  However, I can now also appreciate why some parents may choose not to immunise and I feel that I can now support those parents better, with a greater understanding.  Lastly, this blog has highlighted the need to be aware of potential threats early childhood teachers pose as potential virus carriers within early childhood settings; this need is yet to be addressed.

Helen Richardson (third year student)

Eastern Institute of Technology

Bachelor of Teaching Early Childhood Education

Immunisation: Responsibilities of Early Childhood Education Settings

As a requirement of the Education Review Office (ERO), early childhood education (ECE) settings are required to keep a copy of every enrolled child’s immunisation record (Section D: Health Safety and Environment PDF (Vol 1)).  It is the professional responsibility of teachers to ensure parents are fully informed about immunisation and to respect their decisions made for their child regarding immunisation.  However, being immunised is not an enrolment prerequisite (see Responsibilities, para. 1); therefore, a centre’s staff must be aware of any children in their care who are not immunised, and realise the associated health risk this poses.  I found this information quite interesting, and wonder just how many unimmunised children attend ECE settings as the health risk involved, of being in such a social environment, is quite evident.

Another issue becoming more apparent is the transmission of viruses from teacher to child.  In my personal experience, flu vaccinations for staff are now funded by some ECE settings, to stop the spread of the flu virus.  The recent whooping cough epidemic brought to light the need for primary carers to get boosters, to ensure the virus is not being passed on to infants who have not yet received their full schedule of vaccines.  This suggests that all ECE teachers should also have boosters, to stop any potential threat of passing the virus on to infants in their care.  I believe that this particular issue will become more crucial as the Government drives to increase participation in early childhood education.

References

Education Review Office. (1998). Handbook of contractual obligations and undertakings - Early childhood services volume 1 [for services chartered or licensed under the 1998 regulations]: Section D: Health safety and environment. Retrieved from http://www.ero.govt.nz/Review-Process/For-Early-Childhood-Services-and-Nga-Kohanga-Reo/Handbook

Ministry of Health. (2011). Responsibilities. Health Ed. Retrieved from https://www.healthed.govt.nz/resource/immunisation-guidelines-early-childhood-services-and-primary-schools-%E2%80%93-english-version#immunisation11

Ministry of Health. (2013, April, 16). ‘You just shouldn’t take the risk’.  Retrieved from http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/whooping-cough/whooping-cough-babies-fight-survival-video#nixson

To immunise or not to immunise? That is the question.

Historically, New Zealand’s statistics of children who were immunised against certain diseases, such as diphtheria, tetanus and pertussis (a) have not improved much.  In some years immunisation statistics have decreased for certain viruses, for example the measles virus (b).

Why are parents choosing not to immunise their children?  The Ministry of Health (MOH, 2007) reported that a main reason prompting parents to be against immunisation were their fears of adverse reactions to immunisations.  Hamilton, Corwin, Gower, and Roger’s (2004) research found that parents who chose not to immunise because of fears of adverse effects were highly educated and had read widely on the issue themselves as they lacked trust in the information that the Government provided.  However, the data sample for their research was taken from Christchurch and therefore is not a nationwide representation. Many examples of this ideology became evident with the recent outbreak of the measles virus.  Gluckman (as cited in Kirk, 2011) states “parents have been taken in by misinformation that immunisations can cause autism, which is a load of rubbish” (para. 4).

In 1992, Dr Andrew Wakefield published two articles relating to the Mumps Measles Rubella (MMR) immunisations and autism, the first in 1998 and the second in 2002.  The Lancet, who published the 1998 article, retracted it after an inquiry into the validity of the research. Opposing research then countered the findings of the second article. The American Medical Association (n.d.) states that “four studies have been performed to refute a causal association between receipt of MMR and autism” (para. 15).  The MOH (2011a) states “there are many examples in the medical literature of negative press coverage, and a subsequent reduction in vaccine uptake, followed by a resurgence of disease” (p. 354).

The Immunisation Awareness Society (IAS) promotes the right to having an informed decision regarding immunisation. Although the society states that it does not advise parents not to immunise, I found their articles to be anti-immunisation, by advising other options to remain healthy.  They advise alternate ways to remain healthy, yet they do not discuss what parents can expect if their child does get infected with the wild form of a virus.  The wild form of a virus is to contract it naturally without being vaccinated.  In a recent reported case of tetanus, parents said “they made what they thought was an informed decision not to vaccinate any of their children because of concerns over adverse reactions, but had since changed their minds” (Akoorie, 2012, December, 22, para. 18).  The IAS has stated their opinion relating to this article.

The Royal New Zealand Plunket Society (1993) states there is a greater risk in developing worse cases of illnesses from the wild form of a virus, such as encephalitis and meningitis, compared to those cases who had been vaccinated.  In addition, the MOH (2011b) reports “the only absolute contraindication to receiving a vaccine is an anaphylactic reaction to a prior dose of, or an ingredient in the vaccine.  However, immune dysfunction can be a contraindication to receiving live vaccines” (p. 349).  So yes there are risks of anaphylactic (allergic) reactions and virus related illnesses associated with immunisation.  However, allergic reactions are rare, and the severity of illness caused by viruses is reduced by being vaccinated (by not being the wild form).

What is now becoming apparent is that many children are not completing their immunisation schedules, which is also a major issue. “Ministry of Health figures showed about 5 per cent of parents object to childhood immunisation” (Kirk, 2011, para. 10).  Therefore, if only a minority are against child immunisation, then it is parents from within the majority, being pro-immunisation, who are not completing the immunisation program.  I found this very surprising as I thought the percentage of parents against immunisation was much greater.  The Herald reported recently that nearly 20 percent of New Zealand parents failed to immunise their children on time.  I was unaware that so many parents were not completing their children's immunisation schedules.  A recent news article concerning the death of a teenager, who contracted the Meningococcal C virus, reiterates the need for parents to know exactly what their children are being immunised for and ensure the vaccines are administered on time.

The MOH (2007) stated that two main risk factors for young children failing to complete their immunisations are missed appointments and frequent address changes.  Missed appointments were due to parents’ identifying their child as being unwell and rescheduling being not followed up (MOH, 2007).  Frequent address changes mobility were identified as an issue for a large percentage of Māori; health providers failed to follow-up on their immunisations (MOH, 2007).  Both of these risk factors seem to suggest that children’s health providers are lacking the necessary processes required to effectively monitor and manage their clients’ immunisations.

So how is the government addressing these issues?  “Since August 2007, increased immunisation has been a health target.  In July 2009, the Government showed its commitment to immunisation by making it one of six nationwide Health Targets” (MOH, 2011c, para.1).  More research by the MOH (2011a) identified another major reason why parents choose not to immunise: they believed it not necessary due to a low number of vaccine preventable disease outbreaks in 2010.  The MOH (2011c) reports that, while two year-old immunisation rates have recently improved, the low rates prior to this time had enabled the breakthrough of vaccine preventable diseases, such as measles and whooping cough.  Due to these recent outbreaks of diseases, parents’ awareness of immunisation has been brought to the forefront, with the Government recognising the need to increase immunisation rates at earlier ages (MOH, 2012, December, 3) as a priority.  The Health Promotion Advisory (HPA, 2012) has been established by the Government to assist in reaching immunisation targets.  “The HPA’s work is to provide quality resources to promote immunisation and disease prevention, and to support the Ministry of Health with outbreak responses” (p. 17).

References

Akoorie, N. (2012, December, 22). 'It was hideous' - Family's tetanus agony. The New Zealand Hearld. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10855638

Akoorie, N. (2013, January, 19). Son’s ordeal was our fault, say parents. The New Zealand Hearld. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10855638

American Medical Association. (n.d.). The relationship between the MMR vaccine and autism. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/public-health/vaccination-resources/pediatric-vaccination/relationship-between-mmr.page

Kelso, J. M. (n.d.). Allergic reactions to vaccines. Retrieved from http://www.uptodate.com/contents/allergic-reactions-to-vaccines

Kirk, S. (2011, April, 18). Vaccination rate ‘dismal’. Retrieved from http://www.stuff.co.nz/national/health/4900007/Vaccination-rate-dismal

Hamilton, M., Corwin, P., Gower, S., & Roger, S. (2004).  Why do parents choose not to immunise their children? Journal of the New Zealand Medical Association. Retrieved from http://journal.nzma.org.nz/journal/117-1189/768/

Health Promotion Advisory. (2012). Statement of intent 2012-2015.  Retrieved from http://www.hpa.org.nz/sites/public_files/documents/FINAL%20SOI%202012-15%20single%20pagesFinal.pdf

Immunisation Awareness Society. (2013, January, 20). Informed choice: More than just ‘yes’ or ‘no’. Retrieved from http://www.ias.org.nz/vaccines/informed-choice-more-than-just-yes-or-no/

Immunisation Awareness Society. (2013, January, 17). Vaccine deaths. Retrieved from http://www.ias.org.nz/vaccination-2/vaccine-deaths/

Immunisation rates must improve – Plunket (2012, April, 27). Retrieved from http://www.3news.co.nz/Immunisation-rates-must-continue-to-improve---Plunket/tabid/423/articleID/252044/Default.aspx

Ministry of Health. (2007). The national childhood immunisation coverage survey 2005. Wellington, New Zealand: Author.

Ministry of Health. (2011a). Immunisation Audience Research. Retrieved from http://www.health.govt.nz/publication/immunisation-audience-research

Ministry of Health. (2011b). Immunisation handbook 2011. Retrieved from http://www.health.govt.nz/publication/immunisation-handbook-2011

Ministry of Health. (2011c). Targeting immunisation: Increased immunisation. Retrieved from http://www.health.govt.nz/publication/targeting-immunisation-increased-immunisation

Ministry of Health. (2012, August, 9). Measles scare prompts immunisation rethink. Retrieved from http://www.health.govt.nz/our-work/diseases-and-conditions/measles/stories-2011-measles-outbreaks/measles-scare-prompts-immunisation-rethink

Ministry of Health. (2012, December, 3). Health targets 2012/13: Increased immunisation. Retrieved from http://www.health.govt.nz/new-zealand-health-system/health-targets/2012-13-health-targets/health-targets-2012-13-increased-immunisation

Organisation for Economic Cooperation and Development. (2012, October, 30a). Immunisation: Diphtheria, tetanus, pertussis percentage of children immunised. Retrieved from http://www.oecd-ilibrary.org/social-issues-migration-health/immunisation-diphtheria-tetanus-pertussis_immu-dtp-table-en

Organisation for Economic Cooperation and Development. (2012, October, 30b). Immunisation: Measles percentage of children immunised. Retrieved from http://www.oecd-ilibrary.org/social-issues-migration-health/immunisation-measles_immu-measle-table-en

Quilliam, R. (2013, April, 17). NZ parents slow to immunise children. The New Zealand Herald. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10878171

Royal New Zealand Plunket Society. (1993). Immunisation: Questions and answers. Dunedin, New Zealand: Author.

Wakefield, A. J. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract

New Zealand's Immunisation History: from past to present

The history of immunisation (a) dates back hundreds of years.  Vaccines were created to immunise individuals in order to prevent outbreaks of infectious disease within populations.  Immunisations, through the use of antigens being injected into the body, provoke an immune system (b) response which enables the body’s natural production of antibodies to overcome the infection.

New Zealand’s introduction to immunisation occurred in 1926, when the Ministry of Health (MOH), formally the Department of Health, began administering Diphtheria vaccines to children at “selected schools and orphanages” (refer to the PDF: MOH Immunisation Handbook 2011, p. 371).  Immunisations during the 1940s were administered through the Schools Medical Service and the Plunket Service (MOH, 2011).  In 1961, a national immunisation policy was formed and a scheme put in place which provided three free vaccinations for children (MOH, 2011).  The National Immunisation Scheme (NIS) has since developed into the extensive programme available today (c), providing children with vaccines for eleven infectious diseases (c).

Technological advancements in medicine have enabled vaccine manufacturers the ability to combine vaccines into one dose, thus reducing the number of injections being administered to children, in particular infants, at any one time.  Pharmaceutical companies, such as GlaxoSmithKline (GSK), manufacture and refine vaccines for purchase.  PHARMAC is the pharmaceutical management agency of the Crown.  In 2012, the MOH handed control of New Zealand’s Immunisation purchasing and management to PHARMAC, although the MOH remain responsible for the NIS.

The National Immunisation Register (NIR, b) was initiated in 2004, by the MOH, as a method of accurately recording each child’s immunisation history, and therefore monitoring each child’s immunisation delivery.  Children’s immunisation details are recorded for the NIR and details written in the back of their Well Child Health Book.  Well Child Health books are issued for each child at birth as a general health guide for parents, and a place to record their children’s health and development information.

The MOH, using the data the NIR has recorded, provides organisations such as the World Health Organisation (WHO) with New Zealand’s statistics annually.  The WHO, “the directing and co-ordinating authority for health within the United Nations system” (WHO, 2013, para. 1), creates and manages plans in order to achieve immunisation objectives on a global scale.  The WHO (as cited in MOH, 2011) states that “vaccines – which protect against disease by inducing immunity – are widely and routinely administered around the world based on the common-sense principle that it is better to keep people from falling ill than to treat them once they are ill.” (p. iii).

Partnered with the WHO are the Bill and Melinda Gates Foundation who have a vision to “eliminate vaccine-preventable diseases worldwide.”  I found this information very interesting as it is a good example of how a corporate giant can use their influence to promote personal agendas.

New Zealand, being a member of the United Nations, has an obligation to ensure immunisation targets are reached.  This ‘obligation’ is a good example of political globalisation.  I was unaware that New Zealand’s immunisation schedule was influenced by worldwide organisations that monitor to ensure accountability for immunisation delivery.  It seems to me that generally the worldwide view reflects immunisation as being positive and necessary.  However, while New Zealand’s immunisation rates are monitored with the worldwide delivery targets set, the choice whether to immunise or not remains with its citizens.  Therefore, it seems to me, in order to ensure an increase of immunisation percentages, the New Zealand Government must actively promote immunisation to ensure all its citizens are informed, and therefore choose to ‘be wise’ (a) and immunise.

References

Bill and Melinda Gates Foundation. (2013). Vaccine delivery. Retrieved from http://www.gatesfoundation.org/What-We-Do/Global-Development/Vaccine-Delivery

GlaxoSmithKline. (2008). Our company. Retrieved from http://www.gsk.co.nz/company.html

GlaxoSmithKline. (2012). Immunisation calendar. Retrieved from http://www.whoopingcough.co.nz/immunisation-calendar.html

Immunisation Advisory Centre. (2013a). A brief history of vaccination. Retrieved from http://www.immune.org.nz/brief-history-vaccination

Immunisation Advisory Centre. (2013b). The immune system and vaccination. Retrieved from http://www.immune.org.nz/immune-system-and-vaccination

Immunisation Advisory Centre. (2013c). Vaccine preventable diseases. Retrieved from http://www.immune.org.nz/vaccine-preventable-diseases

Ministry of Health. (2011). Immunisation handbook 2011. Retrieved from: http://www.health.govt.nz/publication/immunisation-handbook-2011

Ministry of Health. (2013a). Immunisation week 2012 – Protect your child, protect our community. Retrieved from http://www.health.govt.nz/news-media/news-items/immunisation-week-2012-protect-your-child-protect-our-community

Ministry of Health. (2013b). National immunisation register. Retrieved from http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/national-immunisation-register

Ministry of Health. (2013c). New Zealand immunisation schedule.  Retrieved from http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/new-zealand-immunisation-schedule

Ministry of Health. (2013d). Vaccine purchasing.  Retrieved from http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-programme-decisions/vaccine-purchasing
National Network for Immunization Information. (2006, May, 1). Combination vaccines. Author. Retrieved from http://www.immunizationinfo.org/issues/general/combination-vaccines
PHARMAC. (2013). Our history. Retrieved from http://www.pharmac.health.nz/about/our-history

Well Child. (2011). The well child / Tamariki ora health book. Retrieved from http://www.wellchild.org.nz/85/%3Cstrong%3Ewell%3C/strong%3E%3Cem%3Echild/tamariki_ora%3C/em%3E_health_book

World Health Organization. (2013). Immunization, vaccines and biologicals. Retrieved from http://www.who.int/immunization/documents/general/ISBN_978_92_4_150498_0/en/index.html

United Nations. (2013). Member states of the United Nations. Retrieved from http://www.un.org/en/members/#n

 

Introduction

The social topic I have chosen to investigate is child immunisation in New Zealand.

I decided on this topic to both increase my knowledge and to gain a deeper understanding of the issues that surround child immunisation.  As a teacher, working alongside young children, their parents and whānau, I feel that I should be aware of these issues in order to have an informed understanding of decisions made by parents and whānau around child immunisation.

Researching this issue interests me with the prospect of finding and presenting informative facts that surround this topic, in particular the factors that determine decisions made for/or against immunisation.

Helen Richardson