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What is Immunisation and How it Works?

Describe about the Effective Immunisation for Medical Diseases.

An effective immunisation has been documented to be successful in declining of many diseases (Hull et al., 2013). With this effective medical intervention, children and adults are protected against range of diseases. According to Thompson et al., (2016) the underlying principle of immunisation is provoking a primed status such that upon the initial contact with the infectious agent a secondary immune response will be induced so as to minimise the chance of illness and outbreaks. The objective of immunisation is to provide “herd immunity” (Tabrizi et al., 2014). It refers to increasing the immune status of the entire population in a given community such that it prevents the successful transmission of the pathogen due to lack of vulnerable to individuals. Infectious diseases prevented by the vaccines include mumps, polio, whooping cause, rubella, diphtheria, and measles. The non-infectious diseases prevented by the vaccines are hepatitis B, human papiloma virus, and others. These are the diseases which caused significant disability and death in pre-immunisation era. In early 19th century, opposition was raised against vaccination owing to religious beliefs and lack of faith on the effectiveness of the vaccination (Allen, 2015). Due to immunisation, there has been an increased awareness of the vaccines side effects. The benefits of immunisation far outweigh the risk from the infections, which it strives to prevent (Levy et al., 2014). Children and newborns are at higher need of vaccination because of poorly developed immune system (Baum et al., 2013). 

The essay deals with the immunisation status in Australia. Today there are various immunisation programmes available in Australia. In this context, the essay describes the socio-political determinants that have impact on the health of the Australian community. It highlights the three socio-political determinants that are addressed in the immunisation initiatives. The paper also discusses the influence of the socio-political determinants of health on the planning and development of immunisation initiatives and on the outcomes of the immunisation initiatives. The essay uses literature evidence to support the all the facts used in context of immunisation in Australia. Based on the overall discussion the essay draws an overall conclusion.

In 1997, Australia has implemented the “Immunisation Australia: Seven Point Plan” which aims to increase the immunisation status of the children. The “Australian Childhood Immunisation Register” has expanded to become the “Australian Immunisation Register” which records the vaccinations provided to Australians of all ages (Edwards & Homel, 2016). The government initiative “Department of Health Immunise Australia Program” is responsible to promote immunisation in Australia. All the age groups are supported by this program to increase the rate of immunization at national level for all the diseases that can be prevented by vaccines. There is a decreasing rate of both infectious and non-infectious diseases due to strong immunisation programs in Australia (Fisher et al., 2016). However, it has been a longstanding challenge for the Australian government to improve the health status of the Indigenous population. The cultural, political, and socioeconomic context leads to the social stratification process, allocating people to different position in the society (Wiley et al., 2013). However, the end results includes unequal distribution of economic resources, prestige and power. Aborginality, ethnicity, gender, educational attainment, occupational status, income level, and disability are the primary indictors of the social position (Edwards & Homel, 2016).

Benefits of Immunisation

The socio-political determinants affecting the health of the Australian community are many. The area with the lower vaccine uptake has been associated with low socioeconomic status, which is measured as highest individual class, occupation, income within the household or depression index for the location resided by the patient. Low income decreases the ability to access medicines and high quality health care services. Higher probability of the vaccine uptake correlated with higher income (Fisher et al., 2016). Therefore, the infectious diseases are more prevalent in lower social classes than the upper social classes. Ethnicity has been well documented as the contributing factor of health inequity (Edwards & Homel, 2016). Indigenous Australians are more considerate with the cultural values and health beliefs about vaccinations (Gibbs et al., 2015). The Aboriginal and the Torres Strait Islanders are more likely to adhere to the indigenous health practices. They mostly rely on healthy lifestyles and doubt the efficacy of the vaccines. On the other hand, the vaccinated people are more confident about efficacy of vaccines. They value and respect the benefits associated with immunisation (Tayler et al., 2013).

People with low education and literacy levels lack awareness about health and illness. In addition lack of support and social relations deprive people of the practical and emotional resources. This diminishes their ability to use the health resources or information (Tayler et al., 2013). People living in the remote areas, overcrowded and run-down housing are highly susceptible to spread of communicable diseases (Edwards & Homel, 2016). The cultural norms in Aboriginal community negatively impacts the health of the children. Racism is self-reported among the carers of the children causing illness. The Anglo-Australian cultural dominance underpins the Australian health services, which causes overt incidents of racism. This is the outcome of exclusion of the Indigenous Australians from the mainstream power structures prior to 1967 (Mahajan et al., 2014). The other well documented factor for health inequalities in Australia are high rate of alcohol and drug abuse among adolescents and adults. It is the increasing cause of high prevalence of mental illness in Australian community and is mainly attributed to experience of social exclusion and poverty (Hull, 2014). The history of illness in Australian community to a great extent is due to memory of traumatic past preserved by the family and the education in school that does not recognise the Indigenous culture in depth (Fisher et al., 2016). Overall, these social determinants are found to affect immunization.

According to Allen et al., (2015) the Indigenous community control of health services has a significant health impact. The controlled health services of the Aboriginal community are an example of empowering the community. This initiative is expected to have broader health benefits. There is a reduction in the psychiatric admissions of the Indigenous Australians by 58% with the initiation of the mental health project at the “Geraldton Regional Aboriginal Medical Service” (Hull, 2014). Similarly, the “Northern Territory Well Women’s Program” has achieved a high rate of cervix screening that is 61%. This rate is comparable to the general Australian women. This program has a long history of women involvement and local “Aboriginal Health Services” and has positive health impact on the Australian community (Tabrizi et al., 2014).

Immunisation in Australia

Recently, there is an increase in the child development services in Australia. The federal government initiatives committed to all aspects of the “National Quality Agenda for Early Childhood Education and Care” has decreased the rate of illness in children (Tayler et al., 2013). The policy area contributing to health inequities in Australia among young children is the fortification of commonly consumed food, such as bread, with folate. The neural tube defects in infants can be prevented by supplementing folic acid to the pregnant women. The less advantaged community in Australia were unaware of the importance of the folic acid supplements during pregnancy. No disparity was however observed with the folate-fortified food (Wiley et al., 2013).

The immunisation initiatives in Australia have addresses three of the socio-political determinants that are education, low income and children living in remote areas. The government policies in Australia currently provide incentives. This eliminates the barrier of low vaccine uptake due to low income (Gibbs et al., 2015). Addressing this determinant, the Australian government is able to enhance the uptake of vaccines for children. People were encouraged by explaining that the risk of immunisation was far less than the risk of diseases. The basis of the policy is “universal immunisation of the children” which will prevent the spread of diseases and death among Australian children (Mahajan et al., 2014). The “Immunise Australia Program” is based on the initiatives developed under “the National Childhood immunisation Program”. One of these initiatives includes the provision of community education programs (Hull, 2014). With the help of community education, it was possible to eliminate the problem of negative perception on immunisation prevalent in Indigenous communities (Fisher et al., 2016). Therefore, more people favour immunisation for their children after perceiving its health benefits. Health of people living in remote areas is severely affected. Therefore, the immunisation initiatives are extended widely to the remote areas of Australia, which have been successful in combating serious illness among Australian children in remote areas (Allen et al., 2015). In Victoria, the “Australian Childhood immunisation Register”, identified the home vaccination of the children who are in remote areas and unvaccinated. It is a cost effective method to achieve the goal of universal immunisation (Gibbs et al., 2015). The mothers intending to vaccinate their child during visits favoured the maternal and the child health nurses. They also favoured the opportunistic vaccination provided by GPs. In conclusion, addressing these social determinants has increased the uptake of immunisation in Melbourne.

Despite of the increasing government efforts to increase the immunisation rate in Australia, a low rate of uptake have been found in some communities. The communities with low income, education, and social connectedness had low rate of vaccine uptake.  Higher probability of the vaccine uptake correlated with higher income (Edwards & Homel, 2016). Therefore, the infectious diseases are more prevalent in lower social classes than the upper social classes. Therefore, in order to increase the rate of vaccine uptake it is necessary to eliminate the fear of unfamiliar diseases due to immunisation, which is mainly prevalent among the disadvantaged society. Other than that there is a need of provision of adequate interventions such that any new policy or medicine advocated for child development is disseminated to all the communities. Both the upper social class and the lower social class people should be aware of that advocacies.  For example, the need of taking folic acid supplements by pregnant women was recognised only in the high-income group of society but not the socioeconomically disadvantaged community (Wiley et al., 2013).

Socio-Political Determinants Affecting Immunisation in Australia

The immunisation initiatives should be planned keeping in view all the socio-political determinants affecting the rate of vaccine uptake in Australian community. Hence in order to improve the vaccine uptake immunisation programs were combined with other preventive interventions (Levy et al., 2014). To completely achieve the goals of immunisation there is a need of flexible delivery modalities. The lack of cultural appropriateness in the vaccination related messages hampers the uptake of immunisation due to poor concept of illness treatment among the Indigenous communities (Hull, 2014). Based on the existing socio-political determinants, the “general practioner based outreach programs with home visits” are best to positively attain the outcome of universal child immunisation. Home visits helps parents to access detailed information on the vaccination programs, its benefits and reactions. The study conducted by Allen et al., (2015) showed that 90% of the parents are willing to take decision guided by the general practioners. Therefore, GPs have great influence on overcoming the barriers due to social determinants of Australian community and increase the rate of vaccination uptake. Hull et al., (2013) highlighted that there is an increase in rotavirus coverage (83%) within 21 days after its commencement however, the coverage was low in Indigenous infants (11-17%). In 97% of the cases vaccinated children showed adherence to vaccine. As per this data rotavirus vaccines is successful in covering high population when introduced on the timeliness of other scheduled vaccines. Similarly, under the “Australian National Immunisation Program for Aboriginal and Torres Strait Islander”, hepatitis A vaccine was funded and it was found to have significant impact with relatively modest vaccine coverage in the targeted population (Thompson et al., 2016)

Immunisation as a public health measure had a significant impact on the reducing the burden of mortality and morbidity. It is the matter of grave public concern to enhance the rate of immunisation.  It is effective in decreasing the rate of transmission of diseases and outbreaks. Hence, improving and increasing the vaccination rates via efforts is a vital aspiration of equity particularly among the target subgroups affected due to above discussed socio-economic factors.

References

Allen, T. J., Georgousakis, M. M., & Macartney, K. K. (2015). Childhood immunisation in Australia: 2015 update.

Baum, F. E., Laris, P., Fisher, M., Newman, L., & MacDougall, C. (2013). “Never mind the logic, give me the numbers”: Former Australian health ministers' perspectives on the social determinants of health. Social Science & Medicine, 87, 138-146.

Edwards, B., & Homel, J. (2016). Demographic, attitudinal and psychosocial factors associated with childhood immunisation. Annual statistical report 2015, 71.

FISHER, M., BAUM, F. E., MACDOUGALL, C., NEWMAN, L., & MCDERMOTT, D. (2016). To what Extent do Australian Health Policy Documents address Social Determinants of Health and Health Equity?. Journal of Social Policy, 45(03), 545-564.

Gibbs, R. A., Hoskins, C., & Effler, P. V. (2015). Children with no vaccinations recorded on the Australian Childhood Immunisation Register. Australian and New Zealand journal of public health, 39(3), 294-295.

Hull, B. P. (2014). Australian childhood immunisation coverage, 1 July to 30 September cohort, assessed as at 31 December 2013. Communicable diseases intelligence quarterly report, 38(2), E157.

Hull, B. P., Menzies, R., Macartney, K., & McIntyre, P. B. (2013). Impact of the introduction of rotavirus vaccine on the timeliness of other scheduled vaccines: the Australian experience. Vaccine, 31(15), 1964-1969.

Levy, A., Sullivan, S. G., Tempone, S. S., Wong, K. L., Regan, A. K., Dowse, G. K., ... & Smith, D. W. (2014). Influenza vaccine effectiveness estimates for Western Australia during a period of vaccine and virus strain stability, 2010 to 2012. Vaccine, 32(47), 6312-6318.

Mahajan, D., Dey, A., Cook, J., Harvey, B., Menzies, R. I., & Macartney, K. M. (2014). Surveillance of adverse events following immunisation in Australia, 2012. Communicable diseases intelligence quarterly report, 38(3), E232-46.

Tabrizi, S. N., Brotherton, J. M., Kaldor, J. M., Skinner, S. R., Liu, B., Bateson, D., ... & Malloy, M. (2014). Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study. The Lancet Infectious Diseases, 14(10), 958-966.

Tayler, C., Ishimine, K., Cloney, D., Cleveland, G., & Thorpe, K. (2013). The quality of early childhood education and care services in Australia. Australasian Journal of Early Childhood, 38(2), 13.

Thompson, C., Dey, A., Fearnley, E., Polkinghorne, B., & Beard, F. (2016). Impact of the national targeted Hepatitis A immunisation program in Australia: 2000–2014. Vaccine.

Wiley, K. E., Massey, P. D., Cooper, S. C., Wood, N., Quinn, H. E., & Leask, J. (2013). Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey. Vaccine, 31(37), 3972-3978.

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