Health policy assign2 collins presentationPresentation Transcript
Australian Immunisation PolicyAn AnalysisBy Tracey Collins 15065065
Immunise Australia Program• The aim of the Immunise Australia Program is to protect individuals in thecommunity by providing individual vaccines, which will also lead to herdimmunity.• This leads to a stronger population with less burden on our healthservices, and ultimately, economy• This presentation will analyse how the Immunise Australia programperforms in reducing incidence of disease through immunisationsfollowing the National Immunisation Program Schedule.• This analysis strategy was selected due to the lack of clear goal indicatorsto compare against. The data available from external sources is able toindicate health benefits without goals for comparison.• A brief overview of the policy information that is publicly available will alsobe performed, to show how it meets some of the criteria of policyimplementation“With the exception of safe water, no other modality,not even antibiotics, has had such a major effect onmortality reduction” (WHO, 2009)
National Immunisation Program Schedule• The whole program is managed by the federal, state and localgovernments, with advisory bodies also.• The records of immunisation are managed through the NationalImmunisation Register.• This schedule is routinely updated, so only the current one is shown.• The schedule details the immunisations that should be given routinelythroughout life from birth.
Brief Policy Overview Analysis• This analysis covers a brief overview of the policy documents availablefrom the government websites detailing the Immunisation program inAustralia.• This analysis is manipulated from a policy analysis that is written by TCollins (2005)• Each part is graded according to the amount of literature available:• 1= Not mentioned at all• 2 = Briefly mentioned• 3 = Discussed in minor detail• 4 = Discussed with enough detail to answer question• 5 = covered in lengthy detail• PART A- Policy Background• Scientific grounds are established: The literature covers the diseasesindividually, with the data as to why the immunisation works. GRADE 5• There is a conclusive review of literature: Yes, the literature review is detailedthoroughly, with the full reference list given also. GRADE 5• The source of the health policy is explicit: Yes, multiple sources are given, andquantitative and qualitative data are used to support. GRADE 5
Brief Policy Overview Analysis• Part B: Goals• Goals are explicitly stated: No, they are only briefly mentioned. Grade B• Goals are concrete: There is no data given on what goals actually are. Grade A• Goals are intended to improve health of population: Yes, and is clearlyindicated as such through herd immunity. Grade C• Policy is supported by internal validity: No information for internal validitygiven, but can be inferred when reading supporting documents. Grade B• Part C: Resources• Cost of condition to community given: Not mentioned. Grade 1• Estimated financial resources stated: Not mentioned. Grade 1• Allocated financial resources stated: Not mentioned. Grade 1• Rewards and/ or sanctions of policy discussed: Payments through parentincentive payments and GP incentives discussed in some detail. Grade 4• Human resources discussed: Only mentioned very briefly. Grade 2
Brief Policy Overview Analysis• Part D: Monitoring and Evaluation• Monitoring and evaluation discussed: Not mentioned. GRADE 1• Nominated a committee or independent body: Multiple nominated, anddiscussed in some detail. GRADE 4• Outcome measures are identified: Not mentioned. GRADE 1• Other alternatives to policy identified: Not mentioned. GRADE 1• Part E: Public Opportunities• The population supports the action: Only discussion on population support isthrough consultation section, where public comment was reviewed. Doeshave a Question and answer section for public concerns though. GRADE 3• Primary concerns of stakeholders are recognised: This is covered in thequestion and answer sections. Grade 3• Part F: Obligations• The obligations of various implementers are specified: Yes, these arediscussed in various detail in many documents available. GRADE 5Total Score: 51 out of 100 for document content
Global Immunisation Outcomes• The World Health Organisation’s data on immunisation shows that globalimmunisation has reduced the global child mortality rate, and theirprediction for 2015 indicated they believe this is to reduce further.• Other data from WHO indicates that the eradication of small pox throughvaccination saves US$1.3 billion a year that would have been spent ontreating and preventing the illness (WHO, 2011)• In Europe and North America, there has been a 95% reduction in doctorvisits and hospital admissions from rotavirus diarrhoea since theintroduction of the rotavirus vaccine
Australian Immunisation Program Outcomes Analysis• The policy documents themselves do not contain much detail on how theprogram has reduced the incidence of disease, but it does reference theliterature that supports this.• The evidence that follows is all from this literature, and from my ownliterature search for supporting documents that discuss the healthbenefits of the Australian immunisation program• The incentive payment program for parents is aimed to encourageimmunisation by offering payments dependent on whether the child ofconcern is fully immunised. These payments have differed over the years,but started in 1998 as two different incentive payments (Lawrence et al.,2004 )• The current incentive payment is three individual payments of $726 perchild per year for each of the immunisation checkpoints. (DOH, 2012)• This payment is to increase the immunisation rates so as to increase herdimmunity, as the government aims to reach near 100% immunity for 5year old, and the current rate is 89% (DOH, 2012)
Australian Immunisation Program Outcomes Analysis• The reported number of cases for the diseases immunised against hasgenerally dropped dramatically in Australia.• The only outlier is Pertussis, which is being assessed by the relevantauthorities as to the reasoning for the rises in reported cases in a diseasethat should have a high immunisation rate within the population• Data from NCRIS (2012), WHO (2012), Dept of Health Australia (2012)Disease Year VaccineIntroducedReportedcases in1980 (per1000population)Reported casesin 1990 (per1000population)Reported casesin 2000 (per1000population)Reported casesin 2011(per1000population)Diptheria 1940 1 7 0 0Tetanus 1953 9 6 1 0Polio 1966 0 0 0 0Measles 1969 - 9 - 1.5Mumps 1980 - 2 - 0.4Rubella 1971 - 8 - 0Pneumococcal 2001 - - 27 11Meningococcal 2001 - - 8.1 2.2Pertussis 1942 124 892 16 411
Australian Immunisation Program Outcomes Analysis• CHICKEN POX (ZOSTER) OUTCOMES• Prior to being included on the vaccination schedule, there were onaverage 240,000 cases, 1200 hospitalisations and 4.2 fatalities peryear from chicken pox in Australia (Scuffham et al., 2000)• Once introduced on the vaccination schedule in 2003, the varicellahospitalisation rate for children aged 1-4 reduced to 9.4 per 100000by 2010 (Ward et al., 2013)• RUBELLA• Australia is now noted as being at an elimination phase for rubella,with only five reported cases since 1998, with only two of those beingAustralian born and unimmunised. The other three cases were bornoverseas (Song et al., 2012).• Prior to immunisation being offered as part of the immunisationschedule, the incidence of congenital rubella syndrome was 1 per2000 live births (Song et al., 2012).
Australian Immunisation Program Outcomes Analysis• PERTUSSIS• In the 1970s and 1980s pertussis was not routinely immunisedagainst, which saw a large increase in pertussis outbreaks inadolescents and adults over the last couple of decades (Quinn &McIntyre, 2011). This pertussis outbreak is still ongoing, and is beingreviewed by the immunisation authority bodies to assess how best toreduce the incidence in the community.• MEASLES• Measles has been on the immunisation schedule in varying degreessince 1969, with a immunisation coverage of 85% in 1989. Anepidemic of measles occurred in 1993-94 with 10000 notified casesand 4 deaths, which led to the government reviewing the policy, andintroducing a second dose of the measles vaccine (Turnbull et al.,2001)• From here, in 1994 there were 27 cases per 100000, then only 7 per100000 in 1995, and 1998 the reported cases was 2 per 100000(Turnbull et al., 2001)
Australian Immunisation Program Outcomes AnalysisAustralian Immunisation Program Outcomes Analysis• HPV• In 2007 HPV vaccine was introduced on the Australian ImmunisationProgram• Since then there has been a 59% decline in HPV presentations infemales aged less than 27 years and a 28% decline in HPVpresentations in unvaccinated males, indicating herd immunity iscommencing (Garland et al., 2011)• ROTAVIRUS• Rotavirus causes acute gastroenteritis (AGE), which in 2004 causes 53per 1000 attendances at the emergency department of the RoyalChildren’s hospital in Victoria (Akikusa et al., 2013)• The rotavirus immunisation was introduced in Australia in 2007, andsince then there has been a 58% reduction in admissions to the RoyalChildren’s hospital due to AGE, and the presentations to theEmergency department dropped to 34 per 1000 presentations(Akikusa et al., 2013)
Australian Immunisation Program Outcomes AnalysisAustralian Immunisation Program Outcomes Analysis• Success of the Policy• The data shown on previous slides indicates that the immunisationprogram in Australia has been successful in improving the health ofthe Australian population through individual and herd immunity• The use of the different advisory bodies assist in ensuring that theAustralian Immunisation Program is a government policy that will beupdated according to accurate literature and correct data• Failures of the Policy• The limitation of available data on the exact goals that thegovernment wishes to achieve and the method of evaluationindicates that the policy is one that is just believed to be successful,and not necessarily using any particular policy implementationtechnique that could assist in ensuring the best possible outcomes• The lack of a mention of alternatives strategies for each of thediseases covered under the immunisation schedule indicates that thepolicy assumes that this is the best method for all diseases, but theremay be potential alternatives not yet explored.
REFERENCESAIHW. "A Picture of Australias Children 2012." edited by Australian Institute of Health and Welfate.Canberra, 2012.Akikusa, Jonathon, Sandy Hopper, Julian Kelly, Carl Kirkwood, and Jim Buttery. "Changes in theEpidemiology of Gastroenteritis in a Paediatric Short Stay Unit Following the Introduction ofRotavirus Immunisation." Journal of Paediatrics and Child Health 49 (2013): 120-24.Accessed 17thApril 2013 From Wiley www.wiley.comCollins, T. "Health Policy Analysis: A Simple Tool for Policy Makers." Public Health 229 (2005): 192-96.Accessed 7th May 2013 From Science Direct www.sciencedirect.comDOH. "Strengthening Immunisation for Children." Every Child 18, no. 1 (2012).Accessed 17th April2013 From Informit www.informit.comGao, Z., Wood, J., Burgess, M., Mezies, R., McIntyre, P., & MacIntyre, R. (2013). Models of strategiesfor control of rubella and congenital rubella syndrome- A 40 year experience from Australia.Vaccine, 21, 691-697.Garland, Suzanne, Rachel Skinner, and Julia Brotherton. "Adolescent and Young Adult HhovVaccination in Australia: Achievements and Challenges." Preventive Medicine 53 (2011): S29-S35.Accessed 17th April 2013 From Science Direct www.sciencedirect.comLawrence, Glenda, Raina MacIntyre, Brynley Hull, and Peter MacIntyre. "Effectiveness of theLinkage of Child Care and Maternity Payments to Childhood Immunisation." Vaccine 22 (2004):2345-50.Accessed 17th April 2013 From Science Direct www.sciencedirect.com
REFERENCESNCIRS. "Significant Events in Vaccination Practice in Australia." In, (2012). www.ncirs.edu.au.Accessed 3rd April 2013.Quinn, H., & McIntyre, P. (2011). The impact of adolescent pertussis immunisation, 2004-2009:lessons from Australia. [EbscoHost]. Bulletin of the World Health Organisation, 89, 666-674.Scuffham, PA, AV Lowin, and MA Burgess. "The Cost-Effectiveness of Varicella Vaccine Programs forAustralia." Vaccine 18 (2000): 407-15.Accessed 17th April 2013 From Science Directwww.sciencedirect.comSong, Ning, Zhanihai Gao, James Wood, Linda Hueston, Gwendolyn Gilbert, Raina MacIntyre, HelenQuinn, Robert Menzies, and Peter McIntyre. "Current Epidemiology of Rubella and CongenitalRubella Syndrome in Australia: Progress Towards Elimination." Vaccine 30 (2012): 4073-78.Accessed17th April 2013 From Science Direct www.sciencedirect.comTurnbull, F., Burgess, M., MacIntyre, P., Lambert, S., Gilbert, L., Gidding, H., . . . Mead, C. (2001). TheAustralian Measles Control Campaign, 1998. Bulletin of the World Health Organisation, 79(9).Ward, Kirsten, Aditi Dey, Brynley Hull, Helen Quinn, Kristine Macartney, and Robert Menzies."Evaluation of Australias Varicella Vaccination Program for Children and Adolescents." Vaccine 31(2013): 1413-19.Accessed 17th April 2013 From Science Direct www.sciencedirect.comWHO. "Immunization Profile- Australia." World Health Organisation, www.who.int.Accessed 10thMay 2013.WHO, UNICEF, and World Bank. "State of the Worlds Vaccines and Immunisation 3rd Edition." In,(2009). www.who.int. Accessed 10th April 2013.