رونوشت کامل [Contagious Conversations] Responding to vaccine hesitancy

started doing the primary health care um nursing with them. 00:05:05.759 --> 00:05:16.319 Did my child health and immunisation training and was then off flying around delivering immunisation services to rural and remote areas and loved it. 00:05:16.319 --> 00:05:18.240 Went from there. 00:05:18.240 --> 00:05:23.439 So I guess it's about getting that qualification and immunisation. 00:05:23.439 --> 00:05:26.800 Um and that can take you anywhere, really. 00:05:26.800 --> 00:05:31.759 And I I guess all my roles in nursing have involved immunisation in some way or another. 00:05:32.160 --> 00:05:33.279 Wonderful, thank you. 00:05:33.279 --> 00:05:35.519 And Margie, what about yourself? 00:05:36.720 --> 00:05:38.639 Yeah, it's a really interesting question. 00:05:38.639 --> 00:05:49.279 I actually did my PhD with Professor Jonathan Carapeters, who's the current uh director at the Kids Institute in Perth, on group A strep infections. 00:05:49.279 --> 00:05:56.720 And at that time he was telling me, as part of my PhD, my burden of disease study, that group A strep vaccines were imminent. 00:05:56.720 --> 00:06:03.439 So I first learnt about vaccines then, but then I became aware that that was going to be a very long process. 00:06:03.439 --> 00:06:27.759 And I started a postdoc working at MCRI with the amazing Professor Ruth Bishop, who discovered rotavirus, and I became involved in these incredible vaccine clinical trials of this new oral rotavirus vaccine that was to be given to babies at birth to be developed to prevent rotavirus disease in developing countries. 00:06:27.759 --> 00:06:35.199 So as a baby postdoc, I was asked to run those trials in Melbourne and then New Zealand and be involved in Indonesia. 00:06:35.199 --> 00:06:48.560 And I think that just sparked for me a love of immunology and vaccines and just the extraordinary impact that public health and global child health could could, you know, we could have with vaccines. 00:06:48.560 --> 00:06:52.000 And I didn't want to be an ID infectious disease physician. 00:06:52.000 --> 00:06:57.519 I decided I didn't love weird fungal infections enough, so I decided to focus on vaccines. 00:06:57.920 --> 00:06:58.639 Okay, wonderful. 00:06:58.639 --> 00:07:04.160 So both, I think, very sort of serendipitously fell into the vaccine pathway. 00:07:04.160 --> 00:07:06.639 But uh we're glad that you both did. 00:07:06.639 --> 00:07:14.720 Now, Wendy, just uh looking, you're on the ground in the middle of the Sunshine Coast uh childhood vaccination program. 00:07:14.720 --> 00:07:15.040 Yes. 00:07:15.040 --> 00:07:16.959 How is it doing at the moment? 00:07:17.439 --> 00:07:30.800 Well, look, in the Sunshine Coast, we do have some of the lowest rates in Queensland and Australia, and we've always uh traditionally lagged behind state and national averages by about 5 to 10%. 00:07:30.800 --> 00:07:40.399 Uh unfortunately, some of our childhood age groups are now sitting around 80% coverage rate or just under even with the latest figures. 00:07:40.399 --> 00:07:52.160 And in our region, we know there are clusters of non-vaccinators, so some of our local areas have coverage rates sitting over 90% and others around 50%. 00:07:52.160 --> 00:07:54.079 So it's really varied. 00:07:54.079 --> 00:08:00.319 And it just highlights how complex and regionally specific vaccine hesitancy can be. 00:08:00.319 --> 00:08:08.160 Interestingly, our local First Nations children have higher immunization rates than non-First Nations children here. 00:08:08.160 --> 00:08:17.519 Um that may be influenced by a wonderful home visiting immunization service we've had in place for some time here called Jabba Jabba. 00:08:17.519 --> 00:08:29.920 Um we're also seeing a growing trend where parents are requesting to split vaccines, which means I guess there is hesitancy around specific antigens. 00:08:29.920 --> 00:08:33.200 Um, one of those, for example, is hepatitis B. 00:08:33.200 --> 00:08:34.960 I'll just clear my throat. 00:08:34.960 --> 00:08:43.840 Um that's not only the birth dose, but more recently the scheduled two, four, and six month vaccinations. 00:08:43.840 --> 00:08:59.840 Um look, I don't have any data to support this, but um it's an observation, I guess, based on the inquiries we're getting all the time from our immunization providers and what we're seeing in our um reviews of the immunization register data. 00:09:00.240 --> 00:09:01.840 So yeah. 00:09:01.840 --> 00:09:10.639 Wendy, I might just clarify a point you mentioned now that you said there's concerns about certain antigens like hepatitis B. 00:09:10.639 --> 00:09:18.639 Have uh the the parents of those children vocalized or what the can specific concern is? 00:09:19.759 --> 00:09:30.240 Uh initially I think it was around um uh there there was some information going around uh that that was related to the RNA uh myths. 00:09:30.240 --> 00:09:38.480 Um and then more recently, I guess, uh related to some of the comments that are coming out of out of America as well. 00:09:38.480 --> 00:09:45.519 So and you know that um it's a sexually transmitted disease and that therefore their babies don't need it. 00:09:46.159 --> 00:10:00.559 Yeah, no, it's interesting, and the reason I ask is of course the hepatitis B vaccine has been around for you know very long time, so it's interesting that at this point we're starting to see questions for such a well-established vaccine. 00:10:00.559 --> 00:10:04.879 And you also mentioned the low coverage rates in certain areas. 00:10:04.879 --> 00:10:11.919 Have have you seen an exacerbation of this after the pandemic or has it stayed fairly stable? 00:10:13.360 --> 00:10:32.159 No, we've seen an exacerbation, and I can give you like our even in our adolescent school immunisation program, for example, the uptake of HBV through the school program has decreased from around 75% in 2019 to 59% in 2025. 00:10:32.159 --> 00:10:34.080 So that's a significant drop. 00:10:34.080 -->

00:10:45.360 Um we hope we we're looking into how we can gather data around whether those um adolescents are being vaccinated in GPs as well or other in in other places, and we hope so. 00:10:45.360 --> 00:10:47.440 Because otherwise that's very alarming. 00:10:48.080 --> 00:10:51.440 And Wendy, is that uh again, I'm not sure if you know the answer to this one. 00:10:51.440 --> 00:11:02.799 Is this more the stigmatization of the HBV vaccine as uh preventing a sexually transmitted cancer, for instance, uh uh versus concerns about the vaccine itself? 00:11:04.639 --> 00:11:07.200 We haven't really got that specific information. 00:11:07.200 --> 00:11:14.799 I guess anecdotally, there are some parents, especially um they don't think that their boys need to have the vaccine. 00:11:14.799 --> 00:11:21.279 That that's that's still being voiced, uh, but I I guess I don't have a large amount of data. 00:11:21.279 --> 00:11:30.799 We are in the process of looking at our school immunisation program and trying to work out why those rates are dropping so considerably. 00:11:32.480 --> 00:11:32.960 Thank you. 00:11:32.960 --> 00:11:47.039 And Margie, at a national level and perhaps uh trans-TASM level, if you look at uh Australia and New Zealand, what is the current state of our vaccine uptake, uh particularly in the childhood and adolescent immunisation programs? 00:11:47.679 --> 00:11:48.879 Yeah, thanks, Sanjay. 00:11:48.879 --> 00:11:56.480 I mean, without alarming your listeners, um we are actually facing a crisis in childhood immunisation coverage. 00:11:56.480 --> 00:12:00.639 In Australia, we've got the worst coverage in more than a decade. 00:12:00.639 --> 00:12:12.639 And in fact, fully vaccinated coverage for children under five has continued to decrease every year from 2020 across all three milestones. 00:12:12.639 --> 00:12:17.519 So that's 12 months, 24 months, or two years, and five years. 00:12:17.519 --> 00:12:23.759 So, for example, the coverage has been below 90% at two years since 2024. 00:12:23.759 --> 00:12:39.919 It's currently sitting around 88%, and that's for two doses of the measles mumps for bella vaccine, which is not enough to provide that herd immunity and protection in the community to stop local transmission of measles. 00:12:39.919 --> 00:12:55.360 And unfortunately, as we see across the board, the decline in coverage has been greater for Aboriginal and Torres Strait Islander children, with nearly a 5% decline in coverage at two years to sort of 88%. 00:12:55.360 --> 00:13:02.879 And at one year, we've seen you know over a 4% drop in coverage to 90.5%. 00:13:02.879 --> 00:13:08.080 So, I mean, these are really alarming when you translate this into the number of children. 00:13:08.080 --> 00:13:14.080 We're talking about thousands of children who are unvaccinated or not fully vaccinated. 00:13:14.080 --> 00:13:31.919 And unfortunately, alongside this, the on-time vaccination, so these are kids who are receiving their vaccine within 30 days of the recommended age time point, has continued to decline, especially for Aboriginal and Torres Strait Islander kids. 00:13:31.919 --> 00:13:43.120 So, for example, for the second dose of the DTP vaccine due at four months, one in five kids have not received it by five months of age. 00:13:43.120 --> 00:13:45.919 Now in 2020, it was one in ten. 00:13:45.919 --> 00:14:00.159 And similarly for the MMR vaccine at one year, at the end of last year, two in five children had not received their first dose of MMR by 13 months, and that used to be one in five. 00:14:00.159 --> 00:14:04.559 So, I mean, these are really concerning statistics for kids. 00:14:04.559 --> 00:14:20.000 And unfortunately, as you heard from Wendy, the HPV vaccine coverage has declined sort of between 8 to 9% for boys and girls since 2020 and is sitting nationally around 75.6%. 00:14:20.000 --> 00:14:31.600 But for Aboriginal and Torres Strait Islander boys and girls, particularly girls, it's declined 15 to 16% to sort of 67%. 00:14:31.600 --> 00:14:35.200 And we've not seen coverage in Australia like this. 00:14:35.200 --> 00:14:39.039 It's really alarming amongst adults. 00:14:39.039 --> 00:14:42.720 Uh we look at pneumococcal vaccination. 00:14:42.720 --> 00:14:50.799 We've seen actually it's gone up slightly for adults over the age of 70, but it still remains very low at around 48%. 00:14:50.799 --> 00:14:55.919 And then you asked about New Zealand, and that's been really interesting. 00:14:55.919 --> 00:15:04.799 We're working very closely with our immunisation colleagues in New Zealand to understand barriers to coverage, which we might talk about later. 00:15:04.799 --> 00:15:20.720 But essentially, their coverage at two years has improved to around 83% as of October last year, but their six-month coverage has declined to 67% as of March this year. 00:15:20.720 --> 00:15:26.000 And that is particularly for Maori and Pacific Islander children. 00:15:26.000 --> 00:15:36.240 So in New Zealand, they are they are facing a bit of a coverage crisis and are extremely concerned to develop tailored strategies to try and turn this around. 00:15:36.799 --> 00:15:48.080 And Margie, you also mentioned the comparator for all this has been 2020 data, and of course, 2020 is when the pandemic occurred. 00:15:48.080 --> 00:15:54.000 So presumably that has been a big factor in driving some of these changes. 00:15:55.039 --> 00:15:55.679 Absolutely. 00:15:55.679 --> 00:16:02.240 There's been a massive decline in Australia and globally in vaccine coverage, particularly for children. 00:16:02.240 --> 00:16:07.679 Um, and as I said, in Australia it's declined every year for the last five years. 00:16:07.679 --> 00:16:22.320 But what I want to stress is when we talk about coverage, I think the natural inclination, and you'll hear this in the media all the time, is that that gap in coverage is always due to vaccine hesitancy, and that is not true. 00:16:22.320 --> 00:16:41.279 That

that undervaccinated gap of children is always due to a mix of access barriers, practical barriers to families actually receiving and getting their child vaccinated, as well as what we call acceptance barriers, which includes vaccine hesitancy. 00:16:41.279 --> 00:16:51.919 And when we think about why, what is the reason that coverage has continued to decline, it's always a mixture of barriers in those two big buckets. 00:16:51.919 --> 00:17:01.759 And we've actually developed a national program with NSIAS or the National Center for Immunisation Research and Surveillance called the Vax Insights Project. 00:17:01.759 --> 00:17:04.960 And I encourage you to jump on and have a look at the website. 00:17:04.960 --> 00:17:15.279 And we've just published, or in the process of publishing, a paper that compares barriers to childhood vaccination for 2024 to 2025. 00:17:15.279 --> 00:17:18.319 It's a national survey of about 2,000 parents. 00:17:18.319 --> 00:17:24.559 I thought you'd be interested to understand well, what is driving coverage to go lower? 00:17:24.559 --> 00:17:43.039 And what we found is the two main reasons that coverage is lower in 2025 compared to 2024 is that parents do not believe that vaccines are safe and they don't trust the information about vaccines from their doctor or nurse. 00:17:43.039 --> 00:17:45.440 And that's really important to understand. 00:17:45.440 --> 00:17:50.880 In fact, those access barriers between the two years had actually declined a bit. 00:17:50.880 --> 00:18:03.599 And those leading access barriers were not being able to afford the costs associated with vaccinating and finding it difficult to travel to get a vaccination appointment, but they were less. 00:18:03.599 --> 00:18:13.680 So, you know, we've got a real crisis here in families not trusting information, they're hearing from the doctor and nurse, and they really don't believe vaccines are safe. 00:18:14.559 --> 00:18:39.599 Yeah, I think with the, and we're going to touch on the COVID-19 response inquiry report later, but uh certainly coming out of that was that if we have another pandemic, not just relating to vaccine, whatever health information is given by people in authority, both uh political and public health figures, they need to ensure that they're conveying a sense of honesty. 00:18:39.599 --> 00:18:50.079 Because I suspect that some of that trust was was eroded during COVID, during that messaging, even if it wasn't directly related to vaccination. 00:18:50.160 --> 00:19:04.799 So I think we've really identified that providers are seeking more capacity building around how to have an effective conversation with a parent or caregiver who has questions. 00:19:04.799 --> 00:19:10.079 And also that the you know, the national immunization program schedule is complex. 00:19:10.079 --> 00:19:16.720 They need some support to understand the schedule and to be able to answer some of these vaccine safety questions. 00:19:16.720 --> 00:19:26.480 You know, we don't need to create a whole um army of vaccinologists, but I think we need to help people to have those facts ready to be able to reassure parents. 00:19:27.119 --> 00:19:45.359 And just to throw another figure into the mix is, and in fact, this was an article, uh, there was a news news article in which you you commented, uh Margie, about health providers being essentially paid by parents to falsify vaccination records. 00:19:45.359 --> 00:19:46.799 If you'd like to comment on that. 00:19:47.039 --> 00:19:48.880 Yes, this is very concerning. 00:19:48.880 --> 00:20:09.119 We've become aware that um certain anti-vaccine groups online advertise, um, and these are healthcare providers, doctors and nurses, to offer to falsify vaccine records for families and say that the child received vaccines when they didn't for up to two and a half thousand dollars. 00:20:09.119 --> 00:20:18.480 So these are healthcare providers profiting uh by falsifying immunization data on the Australian immunisation record. 00:20:18.480 --> 00:20:24.559 So an incredibly um, incredibly alarming story. 00:20:24.559 --> 00:20:28.640 And we had evidence, you know, of emails and texts and so on. 00:20:28.640 --> 00:20:36.079 So we did do an article with some journalists and flag this issue and have spoken to the Commonwealth and they're following it up. 00:20:36.079 --> 00:20:39.279 But I think that's you know, comes back to trust. 00:20:39.279 --> 00:21:01.359 If you can't trust your healthcare provider to do the right thing and record kids as vaccinated or not accurately, you know, you've got families sending their children to childcare and kindergarten in good faith, and you know, measles, hooping cough can spread because in fact there are more unvaccinated children than vaccinated children uh at the centre. 00:21:01.359 --> 00:21:04.559 So it's something the Commonwealth are looking at very seriously. 00:21:04.880 --> 00:21:15.599 Yeah, no, no, as you correctly say, if uh an unwitting family sends their infant to daycare and there's a child with uh hooping off, what a disaster could ensue, isn't it? 00:21:15.599 --> 00:21:16.000 Yeah. 00:21:16.000 --> 00:21:22.319 Wendy, on on the ground in the Sunshine Coast, is this something you've heard about or encountered? 00:21:22.799 --> 00:21:24.720 Oh, absolutely, absolutely. 00:21:24.720 --> 00:21:40.880 Um obviously we have quite a significant um vaccine hesitant or non-vaccinating population, and and we're doing a lot of work to understand our local population, um, what's going on here and what their concerns are. 00:21:40.880 --> 00:21:54.160 And uh there's been some research done in our unit um talking to people or families of children who have had who've experienced vaccine preventable disease and aren't vaccinated. 00:21:54.160 --> 00:21:59.839 And you know, there they're just as Margie has said, there's this there's this group of people that we call them non intentional. 00:21:59.839 --> 00:22:12.960 Non-vaccinators,

you know, they they may be a big family, lots of kids, lots of things happening, they might not be able to access, they may have become complacent, they didn't understand the risk, all of those sort of things. 00:22:12.960 --> 00:22:23.359 And they were really um uh you know that they were uh happy that they could get received that information about vaccination and regretted not getting vaccinated. 00:22:23.359 --> 00:22:47.599 And then there's this other group that are very intentional about their non-vaccination and um they have strong stances around their beliefs uh and quite often they may have they they voice that they've had misinformation or they weren't listened to, or but a lot of it is a around mistrust in the government and vaccines. 00:22:47.599 --> 00:22:48.400 Yep. 00:22:49.680 --> 00:22:58.160 And both of you welcome to comment just about the uh disparity in coverage rates in indigenous populations. 00:22:58.160 --> 00:23:07.039 Is you there are of course a whole lot of factors we talked about, access, costs, uh, and uh just mistrust, etc. 00:23:07.039 --> 00:23:18.160 Do any of those, are they are any of those risk factors more disproportionately happening in those indigenous populations, uh either in Australia and or New Zealand? 00:23:18.480 --> 00:23:19.599 Yeah, absolutely. 00:23:19.599 --> 00:23:27.440 I think those socio-cultural and socioeconomic barriers are are really uh impactful for a lot of these families. 00:23:27.440 --> 00:23:48.480 Many of them do struggle to afford the costs associated with vaccination, which is quite shocking when you think that the vaccines are free, but they might not be able to get an appointment or afford the gap that in Australia, you know, that Medicare gap if the if the GP doesn't bolt the bill, or they might not get be able to get child care for other children. 00:23:48.480 --> 00:23:51.359 There are many costs associated with vaccination. 00:23:51.359 --> 00:23:58.799 They might not be able to leave work and be paid um appropriately for the hours if they take time off and they're a single parent. 00:23:58.799 --> 00:24:10.000 So I think this is really pronounced, and um, you know, that gap for for indigenous kids is um is quite pronounced, and I think we need to work hard to close that. 00:24:10.480 --> 00:24:11.440 Thank you, Margie. 00:24:11.920 --> 00:24:27.279 Sanjay, I was just gonna add when when in our research with the the people that were intentional about their non-vaccination, they didn't regret not having the vaccinations, even though they they or their children had experienced illness and even hospitalization. 00:24:27.279 --> 00:24:31.519 So even after illness, they really still had that strong stance. 00:24:32.160 --> 00:24:36.400 Oh, well, that's disappointing to hear, but uh no, no, thank you. 00:24:36.400 --> 00:24:38.319 Thank you for letting us know that. 00:24:38.319 --> 00:24:41.519 And uh we've talked about Australia and New Zealand. 00:24:41.519 --> 00:24:46.799 Globally, Margie, how would you say we're how are we doing with immunization? 00:24:46.799 --> 00:24:56.319 And I'm doing that in the context of not just your area of just general area of expertise, but also the fact that you advise DFAT on on vaccinations for the region. 00:24:57.599 --> 00:25:10.319 Yeah, I mean, we're very fortunate to work closely with DFAT and the World Health Organization, UNICEF, and many ministries of health in our Asia Pacific region, as well as many in-country academic partners. 00:25:10.319 --> 00:25:19.920 So, um, and the most accurate data we have is from the state of the world's children report around coverage globally, which does lag by a year. 00:25:19.920 --> 00:25:24.240 So the most recent data is the end of 2024 data. 00:25:24.240 --> 00:25:29.039 But what that has told us is there there was some recovery after COVID. 00:25:29.039 --> 00:25:35.119 There was a massive decline in routine vaccination through the pandemic, and then there was some recovery. 00:25:35.119 --> 00:25:40.240 But now, unfortunately, we're starting to see a decline in many areas again. 00:25:40.240 --> 00:25:57.680 Um, and you know, at the end of 2024, that that zero dose statistic, so children who have not received any vaccines or the first dose of DTP, um, they were estimated to be over 20 million under or unvaccinated kids. 00:25:57.680 --> 00:26:02.559 And I'm sure that's an underestimate, but it's a pretty alarming number globally. 00:26:02.559 --> 00:26:18.960 And when we look at that actual first dose of DTP, which is really used as a proxy indicator for access to immunization services, that has been really flat at around 89%, which is quite concerning. 00:26:18.960 --> 00:26:30.960 Um, and for that third dose of DTP, it's been around 85%, and that's more thought of as a marker of overall strength of the system to deliver vaccination. 00:26:30.960 --> 00:26:42.720 And when we look at that first dose of measles vaccine, um, the estimation was you know nearly 21 million kids missing out on the measles vaccine coverage around 84%. 00:26:42.720 --> 00:27:02.079 So quite alarming, but just getting back to the zero-dose kids again in our region, in the Asia Pacific region, Indonesia is the equal fourth country with the highest number of zero-dose kids at around 5%, and the Philippines is equal seventh at around 2%. 00:27:02.079 --> 00:27:07.680 So these are thousands and thousands of children who are completely unvaccinated. 00:27:07.680 --> 00:27:19.440 And overall, the the number of zero-dose children has gone from about 13 million to 14.5 million at the end of 2024. 00:27:19.440 --> 00:27:34.559 So unfortunately, I wish I could say there was a better story globally, but we've got a lot of work to do, and the US is facing a really dramatic situation in decline of routine immunization coverage, which we might talk about later. 00:27:34.880 --> 00:27:35.839 Yeah, no, absolutely. 00:27:35.839 --> 00:27:49.680 And of course, you touched on

Indonesia and the Philippines, and very regionally relevant to us, very large populations, large diasporas here, a lot of travel back and forth between uh the two countries, uh the three countries. 00:27:49.680 --> 00:27:49.920 Yeah. 00:27:50.240 --> 00:27:50.799 Well, that's right. 00:27:50.799 --> 00:27:55.680 I mean, people often say, well, why do we, you know, worry about what's happening in our region? 00:27:55.680 --> 00:28:02.480 But in fact, travel, you know, we're a small world these days, and travelers are bringing measles into the country. 00:28:02.480 --> 00:28:12.720 Last year we had three times as many measles cases in 2025 at about 180 compared to 2024, and some local transmission. 00:28:12.720 --> 00:28:19.839 So, what's happening in the region is directly relevant for Australian children and families. 00:28:20.160 --> 00:28:28.640 Yeah, certainly when I used to see a measles case during my sort of early years of my training in Australian, the question would be, where have you been? 00:28:28.640 --> 00:28:30.319 That that was the question. 00:28:30.319 --> 00:28:33.200 Which country have you been to? 00:28:33.200 --> 00:28:34.960 But of course, that's changed now. 00:28:34.960 --> 00:28:45.680 And just taking this a bit further when we we talk about this reluctance uh to have uptake of vaccination, I I mean, I think of two types, and both of you can correct me if I'm wrong. 00:28:45.680 --> 00:28:59.440 There's that hardcore anti-vaxxer who embraces not just anti-vaccination but a whole lot of other sort of conspiracy theories, etc., versus a vaccine hesitant person. 00:28:59.440 --> 00:29:06.000 And Wendy used another term for that, which I like, but I've completely forgotten, and you can remind me again. 00:29:06.000 --> 00:29:12.400 Now, are both of these groups amenable to changing their views, or is it really just one? 00:29:14.319 --> 00:29:21.599 Well, I've done a lot of work on vaccine communication, and the first thing to say is that vaccine acceptance exists on a spectrum. 00:29:21.599 --> 00:29:35.359 You know, we think of it from fully accepting families, families with a few questions who are very hesitant, then those those families that cherry pick and they select a few vaccines and then all the way up to those refusers. 00:29:35.359 --> 00:29:40.960 And what I would say is that, you know, the evidence shows we need to tailor our approach. 00:29:40.960 --> 00:29:48.559 We need to try and understand where the the parent or the caregiver sits on that spectrum and tailor the approach. 00:29:48.559 --> 00:30:02.240 Because to be honest, with a vaccine-hesitant parent, so I sit in my specialist immunisation clinic every Tuesday morning at the Royal Children's and have done so for 15 years or so, and I'll I'll speak with a parent. 00:30:02.240 --> 00:30:09.279 And if I get a sense that they are highly hesitant and questioning vaccines, I'll spend more time with them. 00:30:09.279 --> 00:30:17.200 But a family who is very refusing, has lots of conspiracy theory beliefs, and is very anti-government. 00:30:17.200 --> 00:30:24.240 I tend to try and you know be respectful and keep the door open, but I'll keep that conversation shorter to about 20 minutes. 00:30:24.240 --> 00:30:38.079 So in all of our teaching and training, we try and help providers to recommend where people are on that spectrum and then to tailor their communication to effectively communicate with the parent. 00:30:38.400 --> 00:30:38.559 Yeah. 00:30:38.720 --> 00:30:43.279 And Margie, now to who ends up coming to your clinic? 00:30:43.279 --> 00:30:47.599 Uh, is it it's not just run-of-the-mill, I'd imagine. 00:30:47.599 --> 00:30:49.680 It's it's people who've been referred. 00:30:50.400 --> 00:30:50.960 That's right. 00:30:50.960 --> 00:31:11.279 So there is actually a specialist immunization clinic in every state, um, and we all come together and discuss um really interesting questions and cases in a in a national network called the Adverse Events Following Immunization Clinical Assessment Network, or EFICAN, which is great. 00:31:11.279 --> 00:31:24.559 But in our clinic, about half of our parents come with a child who've had an adverse event, so um following immunisation, whether it's common and expected or whether it's rare and more serious. 00:31:24.559 --> 00:31:41.279 And then about a quarter are what we call special risk vaccines, where we are seeing children post-transplant, for example, or with a complex immunodeficiency, and they need special risk vaccines that are not on the schedule, such as the Men B vaccine, for example. 00:31:41.279 --> 00:31:46.720 Um, and then only about a quarter actually truly vaccine hesitant or refusing. 00:31:46.720 --> 00:31:49.759 And funnily enough, most of them are sent to me. 00:31:50.799 --> 00:31:51.920 Okay, no, no, no. 00:31:51.920 --> 00:31:54.319 So a lot of experience in that area, yeah. 00:31:54.640 --> 00:32:20.400 Yes, do a lot of hours of talking, and but I can't tell you how satisfying it is to talk with a family who are genuinely questioning and are concerned about vaccines, and then you can get them across the line to make a really um proactive decision to vaccinate the child that's there, and then they might go, that'll affect the other children in the family, the cousins, the people in their network, you know, in the in the um mother's group. 00:32:20.400 --> 00:32:24.640 So we have to remember that ripple effect of every conversation matters. 00:32:24.960 --> 00:32:28.400 Yeah, sort of a herd effect rather than herd immunity, I guess, isn't it? 00:32:28.400 --> 00:32:29.279 A follow-through. 00:32:29.279 --> 00:32:37.680 And but would you say overall you'd have a can you estimate, would it be a 50% success rate or 30, 70? 00:32:38.559 --> 00:32:48.319 Uh we actually did a study which we published looking at this, and sadly the um success rate with the truly refusing parents is incredibly low. 00:32:48.319 --> 00:33:04.880 It's very hard

to get those people to change their mind, even with you know, um, good information from trusted sources from government or NSIS or the Melbourne Vaccine Education Centre, very low chance of getting those families across the line. 00:33:04.880 --> 00:33:13.839 But the most important thing there is to make sure that they don't disengage from healthcare and that they are aware of the risks of not vaccinating and what to look out for. 00:33:13.839 --> 00:33:19.200 But the the success with the highly vaccine hesitant or cherry-picking families is very high. 00:33:19.200 --> 00:33:22.400 I would say it's over 80, nearly maybe 90%. 00:33:22.400 --> 00:33:30.400 If you spend the time and you listen carefully and you are respectful and understanding of their questions and concerns. 00:33:30.799 --> 00:33:36.720 I mean, wow, that that's that's really good to hear that you can get such a high sort of positive outcome. 00:33:36.720 --> 00:33:41.920 In fact, I'm I'm surprised that the people who are really resistant even turn up. 00:33:42.079 --> 00:33:43.839 So well, exactly. 00:33:43.839 --> 00:33:59.039 Most of them, as you would appreciate, come because they want a medical exemption so that they can access kindergarten through the no jab, no play, they're not penalised by no jab, no play, or the family assistance benefits, no jab, no pay. 00:33:59.039 --> 00:34:07.599 So we have some very difficult conversations and sometimes very aggressive parents when you explain that they're they're not eligible for a medical exemption. 00:34:07.599 --> 00:34:10.800 So I'm sure Wendy has these conversations as well. 00:34:11.039 --> 00:34:11.199 Yeah. 00:34:11.199 --> 00:34:12.400 Exactly. 00:34:12.400 --> 00:34:14.880 And Wendy, I was gonna touch base with you now. 00:34:14.880 --> 00:34:27.840 Uh, how do you I mean you did talk about it a little bit earlier, but yeah, if you're presented with a vaccine hesitant uh person or someone who's highly resistant, how do you interact with them, how do you engage with them? 00:34:27.840 --> 00:34:37.360 Is it very much a uh a personal thing, or as a a group of clinical nurses, do you have a particular strategy that you uniformly use? 00:34:38.480 --> 00:34:45.760 Look, I think this uh it's a rel it's a relatively new phenomenon, really, um, and it's growing all the time. 00:34:45.760 --> 00:34:53.039 We are getting more and more requests for education around having confident conversations around vaccination, which is great. 00:34:53.039 --> 00:35:00.800 Um that's really good that our local GPs and GP nurses are are asking for those that that education. 00:35:00.800 --> 00:35:22.719 I think Margie covered off on all the the major points that I was going to discuss, but I think it's really important now that anybody working in that that primary care uh area or immune or vaccination area has it had a think about how they're going to talk to people that present um with any level of hesitancy. 00:35:22.719 --> 00:35:28.960 Or if they haven't been vaccinated, how you ask permission to discuss why they haven't been vaccinated. 00:35:28.960 --> 00:35:31.119 It has it can be just very simple, you know. 00:35:31.119 --> 00:35:39.119 Um I notice your child hasn't had any vaccinations, you don't have to say unvaccinated, I think, but you know, just hasn't had any vaccinations. 00:35:39.119 --> 00:35:40.639 Can we have a chat about it? 00:35:40.639 --> 00:35:42.480 And they might say no then. 00:35:42.480 --> 00:35:45.519 You say that's fine, okay, you have to leave it at that. 00:35:45.519 --> 00:35:50.159 I think we have this reflex, we want to write it and give them all the information. 00:35:50.159 --> 00:35:53.679 But if they say no, you have to stop there and leave it open. 00:35:53.679 --> 00:36:04.960 And then there will be some parents that you know it's just about not having had the right information on or that you know, the realization that there actually is a risk of a certain disease. 00:36:04.960 --> 00:36:11.599 So it's about having had that conversation, having had those thoughts and how you're going to talk to people about it. 00:36:11.599 --> 00:36:15.440 Um and I I guess making time. 00:36:15.440 --> 00:36:28.719 So if you have um parents or a person that you think may need um more information, you you sort of take the time to to take you know to give them that information. 00:36:28.719 --> 00:36:29.760 It's really important. 00:36:29.760 --> 00:36:32.800 You can't rush this with this, you really can't. 00:36:33.519 --> 00:36:33.920 Yeah. 00:36:33.920 --> 00:36:51.519 And if I would add to that, Wendy, you know, we spent um about five or six years developing a new website with um NSIERS, um, with my colleague Julie Leiske and many others called Sky, which is sharing knowledge about immunization. 00:36:51.519 --> 00:36:58.960 And and this uses really good social and communication science to answer questions. 00:36:58.960 --> 00:37:05.199 There are fact sheets that providers can can use or can print off to have a good conversation with parents. 00:37:05.199 --> 00:37:10.400 And it's as I say, it's tailored to where the family is on the vaccine hesitancy spectrum. 00:37:10.400 --> 00:37:17.920 We have fact sheets and answers for families who are happy to vaccinate but still have questions, are hesitant or refusing. 00:37:17.920 --> 00:37:22.400 And it really uses this motivational interviewing approach. 00:37:22.400 --> 00:37:45.760 And Sanjay, you know, we teach in all of our training in the Asia Pacific region or in Australia when we run workshops for doctors or nurses or anyone who's having these conversations, we we teach this structured approach to a conversation with a vaccine hesitant parent, which sort of has six steps, I guess, and it really strongly pulls from motivational interviewing. 00:37:45.760 --> 00:37:50.800 And the first is really to recommend vaccination, if that's appropriate. 00:37:50.800 --> 00:38:02.880 If they come through the door with

questions, then the first step is to really ask them to share their concerns and to actively listen and not interrupt and understand those kind of top three concerns. 00:38:02.880 --> 00:38:14.880 And then, as Wendy said, we always ask if we can share our knowledge and establish our credibility and then provide resources and links with facts to be able to answer the questions. 00:38:14.880 --> 00:38:24.880 But then there's a very important step, and I always in my conversations come back and try to refocus the conversation on the disease itself. 00:38:24.880 --> 00:38:28.719 Because I think parents forget why we're vaccinating in the first place. 00:38:28.719 --> 00:38:30.159 You know, what is Hoopingkoff? 00:38:30.159 --> 00:38:32.079 What is Meninga Cockle disease? 00:38:32.079 --> 00:38:33.679 What are these funny names? 00:38:33.679 --> 00:38:37.760 You know, so really coming back to focus on disease severity. 00:38:37.760 --> 00:38:43.519 And then the second last step is facilitating vaccination and where to go. 00:38:43.519 --> 00:38:46.719 Don't assume that the family knows where to get the vaccine. 00:38:46.719 --> 00:38:50.639 If the clinic doesn't offer it, help them to know where to go. 00:38:50.639 --> 00:38:52.960 And that's that big access piece. 00:38:52.960 --> 00:38:57.440 And then the very last step is to, you know, recommend vaccination. 00:38:57.440 --> 00:39:07.760 But if they're not ready, you continue the conversation, you keep that door open, and then I always invite them back, if they're a highly hesitant family, to continue that conversation. 00:39:07.760 --> 00:39:10.960 And I think that's how we get such a high success rate. 00:39:10.960 --> 00:39:25.679 Because if you go through all of that, I think people feel heard, they have their vaccine questions answered, they're reminded about the diseases, they know how to get vaccinated, and they know that you're willing to talk more with them if they have more questions and concerns. 00:39:26.000 --> 00:39:28.960 No, and I I do like that structured approach. 00:39:28.960 --> 00:39:46.480 That's uh really good, Margie, because I I was thinking if you're a corporation and you have a product and the product isn't working, and someone calls into your call center to complain, all the people working at that call center would have a flow, structured flow sheet saying, uh, sir, what is the problem? 00:39:46.480 --> 00:39:47.840 Oh, okay, it's this. 00:39:47.840 --> 00:39:51.119 Well, then I'll put you onto this and ask about this, this, this. 00:39:51.119 --> 00:39:57.440 So I mean, I I think that would potentially make it easier for everyone in a highly stressful situation or interaction. 00:39:57.760 --> 00:39:58.400 Totally. 00:39:58.400 --> 00:40:24.000 And I think a lot of um maybe GPs in particular, especially younger GPs who perhaps haven't had the training in understanding vaccine effectiveness and safety, feel very threatened when there's a very well-informed parent who's come in with lots of information and questions, and so they might get a little bit aggressive and and get angry that they're being questioned so you know carefully on vaccine safety. 00:40:24.000 --> 00:40:27.199 And so that's how the conversation can get derailed. 00:40:27.199 --> 00:40:42.639 So you want the healthcare provider, the nurse, the doctor to feel comfortable, well armed with good information, and have that approach to a positive and effective conversation, and then that generally disables the aggression from the parent. 00:40:44.320 --> 00:40:47.760 I think what you're describing there is that we're also a victim of our success. 00:40:47.760 --> 00:40:58.960 Vaccination programs or immunisation programs have been so successful people have forgotten what childhood uh tetanus is like, hooping, cough, diphtheria, these horrible, horrible infections. 00:40:58.960 --> 00:41:06.960 Now, Australia has a brand new centre for disease control, the Australian Centre for Disease Control. 00:41:06.960 --> 00:41:14.000 Where should it does have a section for vaccination under its communicable disease branch? 00:41:14.000 --> 00:41:23.280 Where do you see the CDC taking a role or in in vaccine oversight in Australia? 00:41:24.079 --> 00:41:26.719 I think the CDC is going to be absolutely critical. 00:41:26.719 --> 00:41:40.719 And as you said, it was officially born on the 1st of January this year, and it's so welcome in terms of being able to support the Australian immunisation handbook and those you know, advice for providers. 00:41:40.719 --> 00:41:52.880 Obviously, the National Centre for Immunisation Research and Surveillance does those chapters, provides the information through community consultation and experts, but the handbook's really important. 00:41:52.880 --> 00:42:00.239 But I think the CDC is also going to support delivery of the program more broadly and that coordination. 00:42:00.239 --> 00:42:03.679 And also, very importantly, those data dashboards. 00:42:03.679 --> 00:42:22.000 We didn't get an opportunity really to talk about the new national immunisation strategy that was launched last year from 2025 to 2030, but that six-point plan also really clearly highlights the use of data, effective use of data to inform programs. 00:42:22.000 --> 00:42:43.360 And so there's going to be these new data dashboards that include vaccine coverage, hopefully the vaccine sites, so why people aren't vaccinating, as well as the vaccine preventable disease data, so that you know, at that PHN and community level, the providers can use the information to actually tailor strategies. 00:42:43.360 --> 00:42:45.360 So that's just one example. 00:42:45.360 --> 00:43:01.599 But I think the CDC is going to be critical in terms of supporting the delivery of an effective immunisation program in Australia and really helping us to rebuild that strong coverage that we've previously enjoyed and that we've lost now. 00:43:01.920 --> 00:43:15.599 And I think the

big challenge for the C Australian CDC will be trying to make sure they get good data and thorough lots of data and good data from all the states and territories. 00:43:15.599 --> 00:43:19.840 Wendy, in the Sunshine Coast, do you talk much about the Australian CDC? 00:43:19.840 --> 00:43:20.559 We do. 00:43:20.719 --> 00:43:28.480 And look, the immunization schedule is complex, and the organization of immunization is so complex. 00:43:28.480 --> 00:43:40.079 For providers, just working out which which vaccine, you know, which fund where where is the vaccine funded from and what do I put here and what do I put there? 00:43:40.079 --> 00:43:41.519 It's really complex. 00:43:41.519 --> 00:43:44.320 They they they need that coordination. 00:43:44.320 --> 00:43:45.119 They really do. 00:43:45.119 --> 00:43:48.400 There needs to be coordination about information going out. 00:43:48.400 --> 00:43:53.360 As a nurse, the immunization handbook is my Bible. 00:43:53.360 --> 00:43:58.079 That's you know, that's our health management protocol, that's what we refer to all the time. 00:43:58.079 --> 00:43:59.199 It's fantastic. 00:43:59.199 --> 00:44:06.159 Um Sky, the sharing knowledge about immunization is another uh much used resource. 00:44:06.159 --> 00:44:57.519 And I think yes, look, the we we just need that coordination around what we are doing because um while we have this issue around vaccine hesitancy and it's huge, and we're trying to get people to trust vaccination, but the providers don't necessarily understand how it all works or and if they show some hesitancy themselves around that coordination and organization of vaccination, then that's just going to come through in the conversations that they have around vaccination and also um result when they're not when they're not confident around processes, there's you know errors occur and things like that, then that has a flow-on effect, you know, about um that confidence in vaccination. 00:44:57.519 --> 00:44:58.719 So really important. 00:44:59.360 --> 00:45:02.320 And if I may say, um, I so agree, Wendy. 00:45:02.320 --> 00:45:10.320 If I may say, Sanjay, this issue of trust in vaccination is a really critical uh piece that we need to talk about. 00:45:10.320 --> 00:45:18.000 We don't have time today, but um there's been a Lancet Commission called on trust in vaccines, which I'm fortunate to be contributing to. 00:45:18.000 --> 00:45:20.960 It's been co-chaired by Professor Julie Leeske. 00:45:20.960 --> 00:45:31.599 And you know, we're really trying to understand how we can rebuild trust in vaccines and how providers and institutions and governments can be more trustworthy. 00:45:31.599 --> 00:45:33.920 So I'd encourage people to look out for that. 00:45:33.920 --> 00:45:47.760 I think it might be published sort of mid-year or so, and also an approach to an effective conversation with a vaccine hesitant parents going to come out in the New England Journal of Medicine with a colleague of mine, um,

Dr. 00:45:47.760 --> 00:45:50.320 Sean O'Leary, if people are interested. 00:45:50.960 --> 00:45:54.880 I think people are very interested, so yes, we'll we'll look out for that one. 00:45:54.880 --> 00:46:06.400 And now we're talking, we've been talking about Australia and New Zealand largely, but other developed nations are seeing their vaccination programs being dismantled from within. 00:46:06.400 --> 00:46:09.360 Do you get this sense that it might happen here? 00:46:09.360 --> 00:46:11.119 How do we prevent it? 00:46:12.320 --> 00:46:14.400 I don't think it'll happen here. 00:46:14.400 --> 00:46:29.920 I think what we've seen in the US with the current administration being particularly anti-vaccine in their views and their influence over the CDC and to try and reduce the number of vaccines on the schedule. 00:46:29.920 --> 00:46:43.199 I think it's been really encouraging to see the American Academy of Pediatrics and all the other professional societies pushing back strongly, recommending the previous vaccine schedule with all the recommended vaccines. 00:46:43.199 --> 00:46:55.840 So I think in the end, um science and academia will win out, and I think we're very fortunate in Australia that we have a very pro-vaccine government or governments. 00:46:55.840 --> 00:46:57.679 I don't think it'll happen here. 00:46:57.920 --> 00:46:58.880 I would agree with that. 00:46:58.880 --> 00:47:00.559 I I don't see it happening here. 00:47:00.559 --> 00:47:06.800 I think we're getting more and more investment all the time, so I I think it's going to continue. 00:47:07.119 --> 00:47:07.440 Okay. 00:47:08.079 --> 00:47:19.519 Look, we could talk for hours on this, and in fact, I've got all these questions we haven't gotten through, but uh what we've talked about today has been so interesting, so fascinating. 00:47:19.519 --> 00:47:23.679 We might have to get you both back for a part two or a part three. 00:47:23.679 --> 00:47:34.239 But Professor Margie Dantin and clinical nurse Wendy Tao, thank you so much for your time, your knowledge, your expertise. 00:47:34.239 --> 00:47:39.280 It has been a real excellent lesson in vaccinology. 00:47:39.599 --> 00:47:41.039 Thanks so much, Sanjay. 00:47:41.599 --> 00:47:42.559 Thank you. 00:47:52.320 --> 00:48:00.079 Thank you not only to our guests but also to Associate Professor Sanjaya Sananyake for taking the plunge to host the first episode of Contagious Conversations. 00:48:00.079 --> 00:48:04.559 The plan is to publish half a dozen of these over the year, so keep an eye on your pod feed. 00:48:04.559 --> 00:48:13.519 Today's episode was developed with assistance also from the Vaccination Special Interest Group at the Australasian Society for Infectious Diseases, chaired by Pediatric ID specialist Dr. 00:48:13.519 --> 00:48:15.039 Archana Koedala. 00:48:15.039 --> 00:48:22.800 As I was putting the finishing touches on this podcast, she and some colleagues published an explainer in the conversation about the recent outbreak of diphtheria. 00:48:22.800 --> 00:48:30.880 Scores of cases have been reported over the last month in Western Australia and the Northern Territory, with about a quarter of those being respiratory infections. 00:48:30.880 --> 00:48:38.800 But it's worth noting that the re-emergence of respiratory diphtheria after three decades of control started in far north New South Wales in 2022. 00:48:38.800 --> 00:48:44.880 Childhood immunisation rates have now dropped to 90% or below for the first time since the year 2000. 00:48:44.880 --> 00:48:52.960 For information about the Australian Society for Infectious Diseases, its member events and supporting work, go to the website acid.net.au. 00:48:52.960 --> 00:48:57.039 And if you'd like to get your own specialty society up in lights, please get in touch. 00:48:57.039 --> 00:49:04.239 My email is podcast at racp.edu.au, and we can talk about what kind of input and commitment is required to get a series like this going. 00:49:04.239 --> 00:49:15.199 At the website racp.edu.au slash podcast, you'll find almost 150 previously published episodes of pomegranate health from various domains of clinical specialty and professionalism. 00:49:15.199 --> 00:49:23.039 It's easiest to search through the archive and stay up to date using a podcasting app like Apple Podcasts, Spotify, Castbox, and others. 00:49:23.039 --> 00:49:28.719 Feel free to leave a review or a rating if you like what's on offer, as this helps others find the show. 00:49:28.719 --> 00:49:32.800 This podcast was produced on the lands of the Gadigal clans of the Euro Nation. 00:49:32.800 --> 00:49:35.599 I pay respect to their elders, past and present. 00:49:35.599 --> 00:49:37.280 I'm Mika Kabatsini. 00:49:37.280 --> 00:49:38.639 Thanks for listening.