URGENT updates to the Australian Immunisation Register (AIR) are needed to optimise Australia’s COVID-19 vaccine rollout and ensure vulnerable patient groups are accessing recommended vaccines, experts say.

Under new legislation, all COVID-19 vaccines and seasonal influenza vaccines administered must be reported to the AIR. In addition, all other vaccines given under the National Immunisation Program (NIP) must be reported to the AIR from 1 July 2021.

However, experts say data in the register fall far short of what is required to evaluate the success of the COVID-19 vaccine rollout and other immunisation programs in specific medically at-risk populations.

In a Perspective in the MJA, Dr Jane Tuckerman of the Murdoch Children’s Research Institute in Melbourne, together with leading clinicians, says there is an “urgent need to have the ability to identify individuals with risk factors such as pregnancy or medically at-risk status”.

Tuckerman and colleagues offered two possible solutions.

Either the register itself should be modified to collect data on medical risk factors – which would involve working with immunisation providers and practice management software firms to ensure data on patients’ medical status were correctly entered and up to date – or the register should be linked with existing datasets, including the Medicare Benefits Schedule and hospital admission records.

One of the MJA article’s co-authors, Dr Frank Beard, of the National Centre for Immunisation Research and Surveillance (NCIRS), told InSight+:

“COVID-19 should focus peoples’ attention on the importance of being able to accurately monitor the uptake and impact of the biggest national immunisation program we’ve ever conducted.

“The options we propose are certainly complex, but the barriers are not insurmountable if sufficient effort and resources are put into it,” he added. “Routine linkage of national data including immunisation registers is done successfully in Scandinavia.”

Data linkage would enable researchers to accurately assess what proportion of people vaccinated for COVID-19 went on to be hospitalised for the disease compared with those who were not vaccinated, he added.

Associate Professor Margie Danchin, clinician scientist and immunisation expert at Murdoch Children’s Research Institute and co-author of the article, told InSight+:

“Adding data on medical risk factors to the register is a critical change that needs to occur.

“Without it, our ability to evaluate the effectiveness of the COVID-19 vaccination program and other programs such as maternal immunisation is hampered, because we can’t clearly delineate the denominator.”

While COVID-19 has brought an urgency to the issue, adding medical risk data to the register is something many working in immunisation have long sought. Current estimates of vaccine coverage in pregnant women and at-risk children are based on a patchwork of state-based perinatal datasets and patient/carer surveys which are likely to be subject to recall bias.

The limited available data suggest there is much work to be done in both of these cohorts (here and here) to boost influenza vaccine uptake, the MJA authors noted.

“Strategies to improve uptake, such as reminders or prompts for clinicians or text messages from clinicians to patients, will not be optimal without accurate vaccination data”, they wrote.

They also noted challenges assessing compliance with the new meningococcal and pneumococcal vaccination schedules for at-risk children, introduced in July 2020.

“Both patients and medical practitioners need capacity to track [vaccine] receipt, ensuring that the most vulnerable people receive the recommended vaccines, and avoid unnecessary repeat vaccinations,” they wrote.

The AIR has only existed as a whole-of-life register since 2016, when it replaced the Australian Childhood Immunisation Register, which only recorded vaccines in children up to 7 years of age. The register records patient age and Aboriginal or Torres Strait Islander status. A tick box was also added to the register in December 2020 for immunisation providers to flag “at-risk” patients.

Dr Beard commented:

“While [the tick box] is a step forward, because of its generic nature, it is likely to be of limited usefulness in evaluating vaccine uptake in specific medically at-risk population groups for which there are targeted vaccination programs under the NIP.”

The Department of Health has not expressed any intentions to update the AIR to include data on specific medical risk factors.

A Department of Health spokesperson told InSight+:

“Vaccination providers cannot record on the AIR which additional vaccines may be required or why an individual is considered medically at risk or part of a special risk group.

“Recording in the AIR that an individual is considered medically at risk or part of a special risk group [using the generic tick box] will prompt vaccination providers to discuss an individual’s circumstances and administer vaccines appropriate to their individual needs as recommended by the Australian Immunisation Handbook.”



The COVID-19 vaccine rollout needs to drastically improve
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8 thoughts on “COVID-19 vax rollout: immunisation register update vital

  1. Anonymous says:

    The government must also answer questions as to why there is insufficient Pfizer vaccine (superior on most metrics) for frontline workers, for which the AZ is insufficient to cover new strains such as the SA from which we are most vulnerable. Appalling. If it’s good enough for the Prime Minister to receive Pfizer, so is it for frontline workers and hotel quarantine staff.

  2. Anonymous says:

    Mr Greg Hunt’s bungle with the COVID-19 roll out had caused a lot of stress and distress to the elderly vulnerable Australian who are least able to use technology to search for the nearest vaccine centre to have their COVID-19, as their usual GP who are close by, were excluded from giving the COVID -19 vaccine but is allowed to give the flu vaccine.
    The GP practice who are not supplied with the COVID-19 vaccine had to waste a lot of their unpaid time on the phone having to explain to their regular patients why they are not able to give the C0VID-19 vaccine.

    If the Govt wants to collect data on vaccine uptake, efficacy, side effects etc, the Govt could supply the resources -being it software, hardware [computer] and financial support for the employment of staff to do this for the GP practices.
    NSW Health Minister, Mr Hazzard, had asked the same question – why patients get the COVID-19 vaccine from their regular doctors.

    To lessen their load and responsibility, the selected COVID-19 vaccine practice demand that persons who are not their patient, get a health summary from their usual family doctor, before they are eligible to have the COVID-19 vaccine – which in effect is a consultation with their usual GP before they can get their COVID-19 vaccine jab.

  3. Anonymous says:

    There are problems with obtaining supplies of vaccines, certainly, but surely it should be possible to communicate information accurately on official websites. Otherwise how can people be expected to obtain their vaccination as soon as possible, without unnecessary stress and pressure on GPs?
    Come on NSW Health, be organized, list the clinics which will actually have supplies, and keep the list updated. It can’t be so hard.

  4. Anonymous says:

    Copy of email tter sent to Greg Hunt,Mark Butler Shadow Minister for Health, and my local MP
    To: Greg Hunt
    Federal Minister for Health
    Date 17th March 2021
    Dear Minister,
    Re: Covid vaccination distribution and costs for GP patients
    I write to express my concern about the poor organisation and MISINFORMATION re the distribution of the Covid 19 vaccine.
    My husband and I are in the 1B category, being both aged > 70 years. I rang today to make an appointment at an Immunisation Centre in our district nearest to my post code, listed on the government website. I was advised to make an appointment with this practice first to get on their waiting list, for which we would be charged, and we also had to present for an initial appointment prior to the vaccination with a medical summary from our regular GP requiring another appointment for which we also would be charged. (Our regular practice to date has not been included in the scheme even though they have indicated their willingness to contribute to the vaccination rollout).
    These appointments prior to the jab are necessary we are told in order to get the jab. This means a cost to us of at least $140 each, a total of $280 excluding the Medicare rebates for a vaccination we are told is free by the Morrison government. We find this outrageous and question why NSW Health/ Hospitals and pharmacists are not currently included in the vaccination rollout as well as NSW GP clinics and why our own GP Clinic, Highlands Medical Practice, has not been included in the scheme. Our understanding is the NSW Premier has also indicated NSW is willing to be included in the scheme to facilitate and speed up the rollout.
    Clearly Treasury is not releasing funds to support this important programme and GPs are not being adequately informed or reimbursed for their vaccination activity.
    It is interesting to note the efficiency with which UK and USA are now demonstrating in their vaccination rollouts. Australia is woefully way behind. It is inconceivable CSL have not already commenced vaccine distribution. This matter needs to be addressed with urgency and we request you act with haste to sort out this organisational mess and use the state and allied health resources offered to you.

  5. Anonymous says:

    There has been ample time to plan the delivery of COVID-19 vaccines and allow for unforeseen events. This has been bungled!

  6. Anonymous says:

    Some problems are inevitable. I expect the professions and government to work things out fairly quickly and that huffing and puffing from the sidelines won’t be very helpful.

  7. Anonymous says:

    there is no detail about how to implement the AIR with the COVID19 vaccine.
    I cannot obtain any COVID-19 vaccine for my patient, because there is a lot red tapes in order to get the vaccine for patient.

  8. Dr Richard Hillock says:

    What is being done to ensure that people who live in Australia but are not eligible for Medicare/ PBS etc are being vaccinated and recorded as being vaccinated. Examples of public health failure in this regard include breast screening in south Australia using an electoral role to identify women for screening. Marginalised and vulnerable people need to be vaccinated as well to protect everyone.

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