Falling vaccination rates put children at risk of preventable diseases. Governments need a new strategy to boost uptake
- Written by Peter Breadon, Program Director, Health and Aged Care, Grattan Institute
Child vaccination is one of the most cost-effective health interventions. It accounts for 40% of the global reduction in infant deaths since 1974 and has led to big health gains in Australia over the past two decades.
Australia has been a vaccination success story. Ten years after we begun mass vaccination against polio in 1956, it was virtually eliminated. Our child vaccination rates have been among the best in the world.
But after peaking in 2020, child vaccination in Australia is falling. Governments need to implement a comprehensive strategy to boost vaccine uptake, or risk exposing more children to potentially preventable infectious diseases.
Child vaccination has been a triumph
Thirty years ago, Australia’s childhood vaccination rates were dismal. Then, in 1997, governments introduced the National Immunisation Program to vaccinate children against diseases such as diphtheria, tetanus, and measles.
Measures to increase coverage included financial incentives for parents and doctors, a public awareness campaign, and collecting and sharing local data to encourage the least-vaccinated regions to catch up with the rest of the country.
What followed was a public health triumph. In 1995, only 52% of one-year-olds were fully immunised. By 2020, Australia had reached 95% coverage for one-year-olds and five-year-olds. At this level, it’s difficult even for highly infectious diseases, such as measles, to spread in the community, protecting both the vaccinated and unvaccinated.
Gaps between regions and communities closed too. In 1999, the Northern Territory’s vaccination rate for one-year-olds was the lowest in the country, lagging the national average by six percentage points. By 2020, that gap had virtually disappeared.
The difference between vaccination rates for First Nations children and other children also narrowed considerably.
It made children healthier. The years of healthy life lost due to vaccine-preventable diseases for children aged four and younger fell by nearly 40% in the decade to 2015.
Some diseases have even been eliminated in Australia.
Our success is slipping away
But that success is at risk. Since 2020, the share of children who are fully vaccinated has fallen every year. For every child vaccine on the National Immunisation Schedule, protection was lower in 2024 than in 2020.
Gaps between parts of Australia are opening back up. Vaccination rates in the highest-coverage parts of Australia are largely stable, but they are falling quickly in areas with lower vaccination.
In 2018, there were only ten communities where more than 10% of one-year-old children were not fully vaccinated. Last year, that number ballooned to 50 communities. That leaves more areas vulnerable to disease and outbreaks.
While Noosa, the Gold Coast Hinterland and Richmond Valley (near Byron Bay) have persistently had some of the country’s lowest vaccination rates, areas such as Manjimup in Western Australia and Tasmania’s South East Coast have recorded big declines since 2018.
Missing out on vaccination isn’t just a problem for children.
One preprint study (which is yet to be peer-reviewed) suggests vaccination during pregnancy may also be declining.
Far too many older Australians are missing out on recommended vaccinations for flu, COVID, pneumococcal and shingles. Vaccination rates in aged care homes for flu and COVID are worryingly low.
What’s going wrong?
Australia isn’t alone. Since the pandemic, child vaccination rates have fallen in many high-income countries, including New Zealand, the United Kingdom and the United States.
Globally, in 2023, measles cases rose by 20%, and just this year, a measles outbreak in rural Texas has put at least 13 children in hospital.
Alarmingly, some regions in Australia have lower measles vaccination than that Texas county.
The timing of trends here and overseas suggests things shifted, or at least accelerated, during the pandemic. Vaccine hesitancy, fuelled by misinformation about COVID vaccines, is a growing threat.
This year, vaccine sceptic Robert F. Kennedy Jr was appointed to run the US health system, and Louisiana’s top health official has reportedly cancelled the promotion of mass vaccination.
In Australia, a recent survey found 6% of parents didn’t think vaccines were safe, and 5% believed they don’t work.
Those concerns are far more common among parents with children who are partially vaccinated or unvaccinated. Among the 2% of parents whose children are unvaccinated, almost half believe vaccines are not safe for their child, and four in ten believe vaccines didn’t work.
Other consequences of the pandemic were a spike in the cost of living, and a health system struggling to meet demand. More than one in ten parents said cost and difficulty getting an appointment were barriers to vaccinating their children.
There’s no single cause of sliding vaccination rates, so there’s no one solution. The best way to reverse these worrying trends is to work on all the key barriers at once – from a lack of awareness, to inconvenience, to lack of trust.
What governments should do
Governments should step up public health campaigns that counter misinformation, boost awareness of immunisation and its benefits, and communicate effectively to low-vaccination groups. The new Australian Centre for Disease Control should lead the charge.
Primary health networks, the regional bodies responsible for improving primary care, should share data on vaccination rates with GPs and pharmacies. These networks should also help make services more accessible to communities who are missing out, such as migrant groups and disadvantaged families.
State and local governments should do the same, sharing data and providing support to make maternal child health services and school-based vaccination programs accessible for all families.
Governments should also be more ambitious about tackling the growing vaccine divides between different parts of the country. The relevant performance measure in the national vaccination agreement is weak. States must only increase five-year-old vaccination rates in four of the ten areas where it is lowest. That only covers a small fraction of low-vaccination areas, and only the final stage of child vaccination.
Australia needs to set tougher goals, and back them with funding.
Governments should fund tailored interventions in areas with the lowest rates of vaccination. Proven initiatives include training trusted community members as “community champions” to promote vaccinations, and pop-up clinics or home visits for free vaccinations.
At this time of year, childcare centres and schools are back in full swing. But every year, each new intake has less protection than the previous cohort. Governments are developing a new national vaccination strategy and must seize the opportunity to turn that trend around. If it commits to a bold national plan, Australia can get back to setting records for child vaccination.
Authors: Peter Breadon, Program Director, Health and Aged Care, Grattan Institute
