Timeliness

The importance of timeliness

As Aboriginal and/or Torres Strait Islander children are at greater risk of severe disease, timely vaccination at the earliest appropriate age remains an important public health goal. ‘Fully vaccinated’ coverage (i.e. completed scheduled vaccinations) of Aboriginal and/or Torres Strait Islander children has improved since 2016 and is higher than that of other children by the 60-month milestone; however, coverage at this milestone can hide overdue or late vaccinations happening before 60 months. Delayed vaccination continues to be a concern for Aboriginal and/or Torres Strait Islander children in Australia.

For each vaccine, the percentage of Aboriginal and/or Torres Strait Islander children vaccinated on time is substantially lower compared with the percentage for other children, with a particular concern being the higher percentage of Aboriginal and/or Torres Strait Islander children receiving vaccines very late (over 7 months after the scheduled time).

Timeliness

DTPa vaccine timeliness

In 2019, 19.1% of Aboriginal and/or Torres Strait Islander children had a vaccination delayed for the second dose of diphtheria, tetanus and acellular pertussis-containing (DTPa) vaccine, compared to 8.2% for other children. Delay was relatively short for most children (1–<3 months after the scheduled point). The percentage of Aboriginal and/or Torres Strait Islander children with a very late receipt of the second dose of DTPa has decreased from 3.2% in 2016 to 2.0% in 2019 but remains higher than other children (ranging between 0.7% and 1.0%; see Figure 1).

a Based on the number of children who received vaccine dose at particular ages divided by the total number of children who received the vaccine dose, expressed as a percentage.   
Cohort born in 2014 for 2016 timeliness assessment  
Cohort born in 2017 for 2019 timeliness assessment  
Source: Australian Immunisation Register; data as at 31 March 2020

MMR vaccine timelines

The percentage of Aboriginal and/or Torres Strait Islander children vaccinated with the first dose of measles-mumps-rubella (MMR) vaccine on time (by 13 months of age) did not vary substantially over the reporting period and was 66.0% in 2019, 11.1 percentage points below other children. In comparison, the percentage of Aboriginal and/or Torres Strait Islander children with very late receipt of the first dose of MMR vaccine was higher than in other children in each year of the reporting period, although it declined from 2.9% in 2016 to 2.3% in 2019. Most of the delay in receipt of the first dose of MMR was relatively short (1–<3 months after the schedule point) for both Aboriginal and/or Torres Strait Islander and other children (see Figure 2).

a Based on the number of children who received vaccine dose at particular ages divided by the total number of children who received the vaccine dose, expressed as a percentage. 
Cohort born in 2014 for 2016 timeliness assessment 
Cohort born in 2017 for 2019 timeliness assessment 
Source: Australian Immunisation Register; data as at 31 March 2020.

 

Pneumococcal vaccine timeliness

The percentage of Aboriginal and/or Torres Strait Islander children with any delay in receiving the second dose of pneumococcal vaccine was higher throughout the reporting period (19.0% in 2019), compared with the percentage for other children (8.4% in 2019) but decreased 3.3 percentage points for Aboriginal and/or Torres Strait Islander children from 2016 to 2019. Most of the delay was relatively short (1–≤3 months after the schedule point) for both Aboriginal and/or Torres Strait Islander and other children. Only a small percentage of other children (ranging between 0.6% and 0.8%) received the vaccine very late, at ≥7 months after the schedule point. In comparison, the percentage of Aboriginal and/or Torres Strait Islander children with very late receipt of the second dose of pneumococcal vaccine was higher, although this decreased from 3.1% in 2016 to 1.8% in 2019 (see Figure 3).

a Based on the number of children who received vaccine dose at particular ages divided by the total number of children who received the vaccine dose, expressed as a percentage. 
Cohort born in 2014 for 2016 timeliness assessment 
Cohort born in 2017 for 2019 timeliness assessment 
Source: Australian Immunisation Register; data as at 31 March 2020

Key strategies aimed at closing the vaccination timeliness gaps between Aboriginal and/or Torres Strait Islander and other children include:

  • improving Aboriginal and/or Torres Strait Islander identification
  • contacting parents of Aboriginal and/or Torres Strait Islander children before the child’s vaccination due date (pre-call notices)
  • personalised vaccination calendars/applications
  • providing immunisation providers with tools to monitor timely coverage data for Aboriginal and/or Torres Strait Islander children
  • promoting immunisation in local Aboriginal/or and Torres Strait Islander communities.

In New South Wales, the dedicated Aboriginal Immunisation Healthcare Worker Program, funded by NSW Health since 2012, is proving to be an effective public health intervention in that state and has improved the timeliness of Aboriginal and/or Torres Strait Islander childhood vaccinations. (2)

2 Hendry AJ, Beard FH, Dey A, Meijer D, Campbell-Lloyd S, Clark KK, et al. Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program Medical Journal of Australia. 2018;209(1):24-8.

Kids Research, Sydney Children’s Hospitals Network, 
Cnr Hawkesbury Rd & Hainsworth St, 
Westmead Locked Bag 4001, 
Westmead NSW 2145  
ABN 53 188 579 090

SCHN-NCIRS@health.nsw.gov.au

We acknowledge that the National Centre for Immunisation Research and Surveillance (NCIRS) is on the land of traditional owners who are part of the Aboriginal and Torres Strait Islander peoples, the First Australians, and recognise their culture, history, diversity and their deep connection to the land. Together, through research and partnership, we aim to move to a place of equity for all. NCIRS acknowledges and pays respect to all Aboriginal and Torres Strait Islander nations from which our research, staff and community are drawn.