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):
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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