Primary healthcare news, information & resources

Our immunisation rates: together what can we do?

A message from Dr Jo Scott-Jones, medical director. Please read and take action by completing the matrix.

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  • Immunisation coverage by region.
  • Challenge, care and concern - what our practices are already doing.
  • The matrix - what is leading to people's decisions?
  • How else can we help?

Immunisation coverage by region

We are all acutely aware of the declining immunisation rates in New Zealand, and across the globe. The impacts of this are clear and highlighted in our national press.

Our DHBs are all under pressure to show they are doing everything they can to meet the targets set by the Ministry of Health. With the falling rates the DHB's are seeking our support to try and turn the tide. 

How is your locality going? The following graphs show the immunisation coverage of children at 6 months and 8 months enrolled with Pinnacle practices in each DHB area. 

The purple and green lines are the ones to concentrate on, these show the level of immunisation at 8 months. (The blue and red lines show achievement at six months and are an indication of the challenges coming over the next two months.) 

Waikato DHB region

Taranaki DHB region

Tairāwhiti DHB region

Lakes DHB region

The picture for Lakes DHB region looks the worst and we have looked at whether this was a data collection issue, but unfortunately it's not. 

It is important to note no area is doing well and in the words of a DHB staff member "we are losing herd immunity".

Challenge, care and concern

I know this is a daily concern for Pinnacle members, and that it is not a new problem.

I firmly believe practices are already doing everything possible to make sure immunisations are provided to those who accept them. I know you do everything you can to get alongside your patient and explain the pros and cons of immunisation.

I know you are non-judgmental and address every whānau's concerns individually. I know you are aware of the very limited exclusions for an immunisation and that you never turn a child away just because they have a cold.

I know you review the rate of immunisation uptake for your practice and make this a priority at your morning huddles and clinical meetings. 

I know it all takes time; the "pre-calls", "recalls" and reacting to patient prompts. Anyone who works in general practice knows that sometimes it just feels too hard to take on the conversation. Building trust and a relationship slowly will sometimes help whānau to make the right decision. 

The IMAC website has advice relevant to the challenges being presented - the family that don't trust the medical profession at all, the family that think immunisation causes harm,  the family that believe in "natural immunisation".

For those who respond to less formal information you may want to check out how this USA based paediatrician does it.

Or you may be interested to take a look at the TED talk collection on immunisations.  

The matrix - what is leading to decisions?

To help identify the scale of the problem 'at the coalface' I have put together a matrix. I hope your clinical team can take a little time to complete it by looking at your list of unimmunised children and considering what may have led to that decision. The aim is to feedback to the DHB's the numbers of people in each category in the matrix, as evidence suggests each group will respond to different approaches and support.

  • The outreach box - Families who have immunised before and have a positiveattitude to immunisation but are now late or not immunising may respond to being reminded of the benefits along with easy access through outreach or extended hours.
  • The positive benefit box - Families who have immunised before but have developed negative attitudes to immunisation due to anxieties may respond to rational arguments, especially from a trusted health professional.
  • The frozen chicken/grocery voucher box - Families who have positive attitudes to immunisation but just don't get around to it due to a busy or chaotic life may respond to inducements and rewards - on the basis some people will do anything for a frozen chicken.
  • The confrontation/peer group box - Families who have negative attitudes to immunisation and don't immunise are the hardest group to change but may respond to sensitively given yet direct warnings face to face from expert health professionals. Evidence also suggests the determined decliners may change their minds if their peer group changes its mind - friends and social media groups can play a big part in making this happen. 

It would be great if you could sit down with your team and look at your patient list. Consider all those who are "non-immunised" or only partially immunised as well as those who are currently late for immunisations. Where do they fit in this matrix? 

With a good idea of numbers we'll be better informed to discuss with our DHBs how much effort needs to be put into outreach immunisation and extended access opportunities, how much to put into incentive programmes or personal education and connections, and how much needs to be put into the public health messaging to try and develop peer opinion change.

You can also use the "delay/decline" matrix to consider approaches to your population. We're hearing the most difficult issue for practices now is not those who delay out of ignorance or chaotic lifestyles, but instead the growing numbers of people whose mindset is antagonist to immunisation. Some of this group may respond to expert persuasion, but most need to see a change in their peer group attitudes and behaviours.

We are hoping you will be prepared to share the number of patients that fit in each category with us so we can tailor a network wide response to DHBs. For example, if we know how many people fit in the "frozen chicken/grocery voucher box" we may be able to persuade the DHBs to help with that, but more importantly we need to know how many people in your practice are in the confrontation/Facebook/peer group box. These are "the never have, never wills" determined decliners who our public health colleagues need to be more aware of.

If you are happy to share your numbers, please enter these online or contact myself or your practice support person.

Find more on the matrix here.

What else can we do to help?

I am keen to hear from practice staff with ideas for anything more Pinnacle or the DHBs could do to help improve immunisation rates in our districts. Email me on, or let your practice support person know.

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