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Vaccines are still on. Please call ahead. (Photo: Getty Images)
Vaccines are still on. Please call ahead. (Photo: Getty Images)

ParentsMay 26, 2017

Immunisation in New Zealand: the freedom to grow up healthy

Vaccines are still on. Please call ahead. (Photo: Getty Images)
Vaccines are still on. Please call ahead. (Photo: Getty Images)

This week Dr Lance O’Sullivan publicly criticised the film Vaxxed, expressing his despair that screenings are being held in some of New Zealand’s most deprived areas, where immunisation rates are already lower than average. Here The Spinoff Parents’ Dr Jess Berentson-Shaw looks at the current state of immunisation in our country – and explains why our poorest children are least likely to have the freedom of a healthy childhood. 

This is the second in a series of articles on immunisation. The first asks whether you should get your child immunised; the third will be published next week.

As I covered previously, vaccinations are effective at preventing disease. But, like all medical advances made in the last 100 years or so, they are not perfect. Vaccines do require parents to make some assessments of what risk is worth living with: the small risk of a reaction from a vaccine or the much greater risk to a child when they catch an infectious disease. Here are those risks again (all figures are per million children either vaccinated, in blue, or having contracted measles, in brown):

Severe complications due to MMR vaccine and measles among 1 million children aged under 5 years. Source: The Australian Academy of Science

It is of course difficult at times to accept a small risk right now in exchange for something that may not happen. We experience a fierce protective love for our children. Vaccination sometimes requires we recalibrate our instincts so that we see that the small risk right now is worth taking to give our children the freedom of a healthy childhood.

Where it gets more complicated is for the parents of a child who has a problem with their immune system – they cannot vaccinate their children AND these children are at greater risk of getting and dying from a disease like measles. These parents have their choice removed. For immune compromised children the chance of death if they contract measles is one in two. Parents of these children live in fear from a runny nose and temperature. Their children cannot live a childhood free from the threat of disease unless other parents and children gift them this freedom.

What do we mean by “gifting”? Many of the contagious diseases we vaccinate against are viruses and they need “hosts” to duplicate themselves. The more people vaccinated against a virus, the fewer hosts it can find and the disease dies out. Which of course lowers the chances that all children (both healthy and immune compromised) can contract the disease. We call this herd immunity and the key target to achieve this herd immunity is a 95% vaccination rate in a community (depending on the disease). The 5% not vaccinated are safe because the disease cannot take off when most of the population is immune. But we need to keep that 5% for the vulnerable children who can’t get immunised.

So in achieving herd immunity, both vulnerable children and your own child will have the freedom to live healthy and disease-free childhoods; a freedom that children in other countries do not have.

So how are we going to ensuring all our children (yours and mine) can experience such freedom?

Progress is good, but we aren’t there yet

In general New Zealand is a nation of vaccinators. Our latest coverage rates at six months of age (an age when children are really vulnerable to disease) are near 80% and have been steadily climbing since the introduction of a National Immunisation Register in 2005. The register helps keep track of children and their vaccinations, and ensures parents and GPs know when a child is due for their booster and when they have missed one. In 2005 various outreach programmes to improve uptake in vulnerable groups were also implemented. Even better news is that at eight months and two years of age our overall coverage rates are past 90% – this is edging ever closer to the magic number of 95% of children being fully immunised.

So if 95% is the target, who do we need to get vaccinated to ensure all our children experience positive childhoods free from disease? There are two groups – those who choose not to immunise their children and those from deprived communities.

Active Decliners

There is a small group of parents (around 3-6%) who decline vaccinations. By international standards this rate is low – Kiwis generally get what a gift vaccinations are to children and communities. Zero declines would be the ideal. Unfortunately, by being active decliners, for whatever reason and despite what they believe, these parents are risking both their own children’s and more vulnerable children’s wellbeing.

Think of that ‘lifeboat’ of 5% (the wiggle room between 95% and 100% immunisation). That lifeboat is for those who can’t swim, not for those who don’t want to swim. As it fills up with able-bodied swimmers, not only do the non-swimmers sink but those swimmers in the lifeboat are at greater risk of being swamped too. So while the 3-6% of decliners is small (and it has not grown recently despite being vocal in media and on immunisation blogs), it is important we work together to reduce it. We need to reassure parents that love for our children can mean doing scary little things right now in order to give them the freedom of healthy lives later. In part three we talk about how we might do this.

Poorer children are also missing out

Worryingly, immunisation rates are lower for the most deprived communities of our society. Slightly less than 70% of our most deprived children are fully immunised at six months, compared to 80% of the least deprived children. This gap remains at six months, but by two years is closing up.

Figure 1. Immunisation Coverage in NZ for all 6 month old babies by Deprivation (Level of Wealth in a Community). Source Immunisation Advisory Centre

Children living in our poorest communities in New Zealand are shut out of healthy affordable housing. They are exposed to dampness and mould and cold and are at a greater risk of having weakened immune systems because they are more likely to be premature. These children end up in the wards of our hospitals with infections and preventable diseases of the third world with parents desperate for something to be better for their families. What happens when you find yourself poor in this country? Your children do not have the freedom of experiencing a healthy childhood.

There are a number of big social, environmental and financial policies that can address these circumstances for families – income support, quality social housing, a welfare net that is not based on punishing people but supporting them, for example. In terms of infectious diseases specifically a universal immunisation programme is one really effective, cheap (relatively speaking) and fair way to give these children the same chance other children in New Zealand have to have to experience a childhood free from infectious disease.

Why do deprived children miss out on vaccination?

Studies have shown there are a bunch of reasons vulnerable kids miss out on vaccinations in New Zealand (and all over the world). This list includes a whole range of things from how we deliver health care, language differences through to individual knowledge. However, poverty and deprivation are what primarily prevents or delays immunisation.

What do we mean when we say poverty prevents immunisation? Put yourself in the shoes of two low income parents working long hours, with no transport and in jobs where taking time off for kids’ medical appointments (and the time you need to spend calming and caring for them afterwards) does not really meet your boss’s threshold for leave. They may also have a debt at the GP office that they are shamed by. For these parents getting that booster shot for a two year old exactly on time might be less critical than managing all the other issues they are facing. This is especially true if no one has taken time to talk through why initial immunisation and booster shots (at two years) are really critical, or they recently heard another parent talk negatively about vaccination. For such parents and their kids, outreach programmes – where the vaccination goes to the child, not vice versa – have been found to have a real impact in improving rates of uptake.

So we have a lot work to do still to ensure all kids in New Zealand have equal uptake of vaccinations. In the meantime it is critical that we convince those who may be thinking about declining vaccinations of the benefits that they offer – both for their own children and the vulnerable children in our society who are not getting a fair chance to grow up free from infectious diseases.

In our third and final blog I’ll talk about exactly how we can talk about vaccinations to help keep our rates up.

Dr Jessica Berentson-Shaw is a mother of two, scientist, writer, and author. This is her approach to writing about science for The Spinoff Parents.

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unit

ParentsMay 25, 2017

When love aint enough: Are we about to lose another rural maternity centre?

unit

Lumsden Maternity Centre in rural Southland, where Bill English was born, is in imminent danger of closure. Southerner Victoria Crockford explains why it would be a devastating loss for the community.

I must admit, I really questioned myself the day that the pigs broke into a multi-million dollar building site down the road.

Pinky and the Brain were their names. The genius one got stuck behind the fence and just ran up and down it squealing while I wildly shook food at it. The insane one tried nibbling at my toddler, who was strapped into the bike seat and leaned against a gate as I made my vain attempt to ‘muster’ his mate. She thought it was a game. I had other ideas: I’ve seen the film Snatch.

There was no-one around to help me as I yelled to the boundless Otago sky, “I just wanted to go for a fucking bike ride like a normal peeeeerrrrson!”

There have been those sort of moments.

But, everything that is weird about being a displaced North Island urbanite in rural ‘somewhere near Queenstown’ pales in comparison to the sense of community that I have living near my in-laws, with a tight-knit community of friends – many parents – who give, and care, and share.

And that sense of a community knitting itself around young families is what is at risk as primary care units in rural areas face closure.

I’ve previously written about my love of rural maternity units on the Spinoff Parents.

The birthing room. Practically a day spa. Credit: Lumsden Maternity Centre

Between then and now, I have had my second baby. He is pink and hefty and smells of freshly mown grass and baking biscuits and rose gardens after the rain and all the smells of our very best dreams.

He arrived in this world at Lumsden Maternity Centre in rural Southland – the same place his dad was born. He was delivered safely and with confidence by a midwife who held my hand and made me feel strong and ready; who gently guided my son through warm water and into my arms, into his future.

It was a relaxed atmosphere. My partner was scoffing chili lime cashews between my contractions (and I mean handfuls). There was fresh air and humour. And just like with our eldest, there was most definitely a massive bowl of ice cream and chocolate sauce for after (that is after the pork chops, mash and buttery silverbeet).

The proof is in the pudding – Lumsden Maternity Centre serves food that is actually edible.

I am not alone in my love for Lumsden. Comments on the Lumsden Maternity Centre Facebook page are, quite frankly, gushing.

“An amazing unit with so much love and care from all the staff. Words cannot express how grateful I am to have been able to spend three nights here introducing my husband and I to parenthood!”

“Such a fabulous asset to our community!”

“A home away from home!”

“Amazing place with wonderful caring staff…”

These comments have been backed up by recent media profiling of the unit. New mother Sarah Phillips recently told the Southland Times that, “I had good care in Lumsden with delicious meals, monitoring of visitors so I could get rest, help and encouragement with breast feeding and was able to stay for six days to get the help I needed.”

Delicious meals. Rest. Six days. Enough said.

Not only does Lumsden provide a valued community service, its location on the way to Invercargill means that it provides an emergency service as well.

I have heard more than a few anecdotes from women based in Queenstown-Lakes, Te Anau and Northern Southland along the lines of “that time when I was on my way to Invercargill to birth and my labour started progressing really quickly and we were speeding and a local cop pulled us over and redirected us to Lumsden and the midwife met us and I gave birth in the hallway after she just yanked off my tights”. Seriously.

Lumsden, and its counterpart in Winton, provide waypoints along the 1.5 hour plus drive to Kew Hospital in Invercargill for many expecting parents. I myself thought I would have to pull into Winton to have my first baby. As it was, I was fully dilated and ready to push by the time we got to Invercargill and my partner had to wheel me from the entrance to the maternity unit.

Now Lumsden Maternity Centre – this place of well-being and emergency assistance and so many exclamation marks – is facing an uncertain future.

While I canvassed the threats that rural units face in my previous piece, this imminent threat to the place that has meant so much to our family over two generations spurred me to delve deeper into the specific issues that primary care units are facing. Who are the stakeholders? What are they saying? What does this tell us about the future of other units?

At a public meeting on May 9 it was laid out to the nearly 100 members of the community in attendance that there is a very real possibility that Lumsden will close on July 31 this year, when the contract between the health company that runs it, Northern Southland Health Company, and the Southern District Health Board is up. To stay open, Lumsden needs a “reasonable increase in funding”, according to Carrie Williams, who chairs the NSHC.

At this point, the SDHB has offered a 1 percent increase to the funding Lumsden Maternity receives (the offer expires in September 2018). All signs point to this figure not slotting into the ‘reasonable’ category.

This despite the fact that the use of the unit has actually increased over recent years, and that primary birthing rates are about 12 percent for all births in the southern district – placing it among the highest in the country.

What about central government’s role? Living near Arrowtown, I share an MP with the Lumsden community – Todd Barclay. He has been quoted as “following the process… with great interest” and is scheduled to meet with the other stakeholders soon. Soon is also when a report is expected from the SDHB, which was commenced in March 2016 and is still being finalised.

I get it, it’s a circular thing and one entity can’t act without the other. I get it, Todd Barclay is getting crap flung at him from Gore to Glenorchy as his electorate both booms and struggles. But this level of inaction by the SDHB and the government on a fundamental community service seems inadequate.

Call me naive. Or call me a mother living rurally who relies on funders to have their shit together. Call me someone who would rather give birth in Lumsden than be holding in a baby in an emergency helicopter. Call me eternally grateful to my stellar midwife and the staff in Lumsden. Call me concerned that they will be forced out of the community where their entire lives are because their jobs have evaporated. Call me sad and just a bit pissed about the characterisation of the decline of small communities as inexorable in the face of rationalisations.

I know health funding is complex, and I will not pretend to being any sort of expert. I understand that birth rates have been falling at other rural maternity centres. But, as a parent and a citizen who cares, I am fearful that we are going so far down the road of putting a dollar value on the wellbeing of new families that we will lose the opportunity to turn around. Lumsden is just one example of how we are turning new parents and babies into units of spending.

We know how it takes a village to raise a child. It seems as though our institutions are slowly dismantling our villages, one “amazing unit with so much love and care” at a time.

Donald Andrew with his grandson, Cormac Kahu. Because it takes a village. Credit: Richard Andrew

Victoria Crockford is an Arrowtown-based researcher, writer and analyst. She lives with her partner, daughter and a sheep dog that is probably smarter than her. Find her tweeting @VicLeeCrockford and online at Coronet Wordsmith.

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This content is entirely funded by Flick, New Zealand’s fairest power deal. In the past year, their customers saved $489 on average, which would buy enough nappies for months… and months. Please support us by switching to them right now