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.
“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.”