Factors associated with immunisation coverage for the childhood immunisation programme in New Zealand: 1999 to 2012

Abstract

Introduction National childhood immunisation programmes are some of the most cost-effective activities in healthcare. Reductions in morbidity and mortality from vaccine-preventable diseases (VPDs) can be maximised if universal high immunisation coverage and timeliness of delivery is achieved with all the schedule vaccines. Despite this knowledge, New Zealand (NZ) traditionally has had poor immunisation coverage for its childhood programme; with significant equity gaps particularly for children from Māori and Pacific Island ethnic groups. Aims To document and analyse the reasons behind the improvement in childhood immunisation coverage and reduction in socioeconomic and ethnic equity gaps that have been seen since 2000. Methods A range of studies were conducted from 2000 to 2012 with NZ parents, the media, and primary care providers focused on identifying the major factors for low immunisation coverage and poor timeliness of delivery and the positive factors where high immunisation rates were obtained. Factors identified from these studies were then used to advise policy and design intervention studies to improve immunisation coverage rates. Findings NZ factors associated with low immunisation coverage and poor timeliness of delivery include parental knowledge and attitudes, environmental issues, media drivers, health professional knowledge and attitudes, and primary care systems. The most significant factors identified were maternal knowledge and experience in the antenatal period, socioeconomic, ethnicity, age of registration with a general practice, practice systems, and staff support, knowledge, and education. Multicomponent interventions particularly focused on general practice systems and providers are effective. Conclusions Prioritising and goal setting at the national, district, and provider levels, having the right tools to measure coverage, feedback loops, public reporting, and supporting an educated and confident provider workforce appear to have underpinned the improvement in childhood immunisation coverage in NZ. The components that need to be in place to make this happen include a mixture of factors from the broader political and health service setting, provider systems and characteristics, factors associated with the families and their children, and other environmental issues such as the general community awareness and communication as driven via traditional and social media.