Eliminating the Spread of Preventable Diseases

10 February 2020

Article from January edition of INPractice

Vaccination. It’s a polarising issue; one that regularly ignites heated discussion and sends social media into overdrive. So, where to turn in the face of conflicting opinion?

According to South Australia’s School Nurses’ Association President Anna Thomson, the community needs to turn to science and facts, not emotion and sensationalism for the answer.

“The scientific evidence is clear – immunisation remains the safest and most cost-effective way to protect individuals and the community from vaccine preventable diseases,” Ms Thomson says.

“However, worrying trends of vaccine hesitancy and refusal are on the rise, bringing with it increases in individual cases and the spread of vaccine preventable diseases,” she says. 

These trends are certainly not limited to Australia, in fact falling vaccination rates globally are fuelling increases in preventable diseases, and in some cases resulting in the resurgence of diseases previously close to elimination. 

Occurring at such a concerning rate, vaccine hesitancy has been identified by the World Health Organization (WHO) as one of the top 10 current threats to global health.

Ms Thomson says the misinformation available online is a key influencer driving these trends.

“People are turning to factually incorrect articles and social media posts to form their views, instead of validated websites with correct information,” she says.

“There is a huge need for people to turn to evidence-based information; not hearsay, urban myth and personal opinions.

“The stakes of making an ill-informed decision are high, as complications from diseases such as measles can be severe, including pneumonia and encephalitis.

“Measles can cause encephalitis in children as a result of the brain becoming infected with the virus and this can sadly end in permanent brain damage or even death.”

Since the measles vaccine was added to the National Immunisation Program in 1975, the number of measles deaths in Australia has fallen to near zero – a stark and self-evident comparison to the 20 years prior, which saw 356 measles related deaths in a single year. 

To protect the community from both emerging disease and resurgence, Ms Thomson says we need to attain and maintain vaccination uptake at a high enough rate to establish ‘herd’ immunity.

“Herd immunity means the population is protected from the spread of contagious disease because a high proportion of individuals are immune to the disease – and the best way to effect this is with vaccination,” she says.

SA School Nurses’ Association President Anna Thompson
wants people to base their vaccination decisions on evidence-based
information rather than factually incorrect articles on social media.

“It’s important because herd immunity not only protects the vaccinated individuals, it decreases the chance of infection for those unable to be vaccinated, while also decreasing the likelihood of a broader outbreak within the community.”

South Australia’s vaccination rate currently sits below our overall target of 95 per cent, with coverage across the State averaging between 86 and 95 per cent; however, it is even lower in some areas.
In response, the State Government introduced ‘No Jab, No Play’ legislation in May last year. As a result, immunisation records are now required for attendance at childcare services and centres, demonstrating children attending are up-to-date, on a regulated catch-up program, or exempt due to medical reasons.

Further to these changes, mid-last year the Government consulted on phase two of the ‘No Jab, No Play’ Bill, proposing the exclusion of unvaccinated children from enrolling in and attending early childhood care services. 

It is a proposal overwhelmingly supported by the Australian Nursing and Midwifery Federation (SA Branch) in its June 2019 submission on the South Australian Public Health (Early Childhood Services and Immunisation) Amendment Bill 2019. 

“The ANMF (SA Branch) has communicated its clear support of the most comprehensive option presented within the Bill,” says ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM, “and that is the option that requires currency of vaccination beyond enrolment and up to the age of six years as a prerequisite for ongoing attendance.” 

The ANMF (SA Branch)’s submission also included additional measures that Ms Dabars says warrant Government consideration. 

“We want the State Government to consider increasing ongoing vaccination requirements up from six years to 16 years and expanding the vaccine schedule to include influenza immunisations,” she says. 

“Our submission also calls for a comprehensive public health campaign to combat vaccine misinformation.”

Ms Thomson says the exclusion of unvaccinated children in early years, along with extending this into the school yard, makes sense.

“While children missing out on early education and social development opportunities is not ideal, the risks of unvaccinated children contracting and spreading disease deserves serious consideration,” Ms Thomson says.

“The new legislation is an obvious progression from the existing Federal Government ‘No Jab, No Pay’ policy, which links eligibility for family assistance payments to a child’s vaccination schedules,” she says. 

“Encouraging broader uptake of childhood immunisation by linking it to subsidy payments or access to services is a policy approach utilised by governments in a variety of ways throughout the world.

“Some countries already extend beyond the childcare and kindergarten age and into the child’s school years, which makes perfect sense and maintains a focus on vaccination’s ongoing role in disease prevention.”

Samoa measles epidemic: WHO blames anti-vaccine scare as death toll hits 65
Just as this magazine was going to print, Samoa was facing a deadly measles epidemic with at least 65 deaths and 4500 of the nation’s 200,000 population infected with the disease. Fifty-seven of those who died were children. 

The World Health Organization (WHO) attributed the outbreak to a steep decline in vaccination rates in the Pacific island nation where, in 2018, only a third of children under five were vaccinated.

A two-day government shutdown enabled 120 teams of public servants to sweep through the country as part of a vaccination campaign that has since tripled Samoa’s immunisation rate to 90 per cent.

Click here to read the January 2020 edition of INPractice.