GSK IMMUNISATION GRANTS
In 2020, the GSK Immunisation Grants was managed by the Public Health Association of Australia (PHAA) as part of the 17th National Immunisation Conference.
Four grants of $20,000 each, will be awarded to support innovation programs of activity that clearly aim to meet one or more of the following criteria in either childhood, adolescent and/or adult vaccines:
Improve access, coverage and/or timely delivery as per the Australian National Immunisation Program schedule;
Improve access, coverage and/or timely delivery for hard-to-reach populations (including geographically distant populations, new Australian immigrants, refugees, asylum seekers);
Utilise digital technology and/or social media to improve the Quality Use of Vaccines through innovation;
Improve access, coverage and/or timely delivery for indigenous populations;
Improve access, coverage and/or timely delivery for international travellers.
Objectives of the grants are to improve the update, compliance, timeliness and/or awareness of immunisation in Australia.The projects submitted for entry should be innovative, and adaptable by other immunisation groups.
Winners Announcement - Recording
2020 FINALISTS AND WINNERS
Finalist – Monash University - WINNER
Recently, vaccine preventable diseases have seen a resurgence in countries where diseases had been considered eliminated2. The reasons for this are complex but a key factor, vaccine hesitancy, is a serious concern, and has been listed by the World Health Organisation as one of the top 10 threats to global health in 2019, alongside climate change and antimicrobial resistance 3. Reaching the World Health Organisation vaccination target of 95% is a key goal in population vaccination programs including within Australia 4.
Vaccination Coverage and confidence
Vaccination rates and hesitancy vary depending on geography, socioeconomic status, loss to follow up and objection to vaccination.5 Vaccine confidence rates vary country to country and by how they are measured. According to the Vaccine confidence index, 91% of Australians agreed vaccines are safe.6 Soon to be published data from our pilot study of vaccine hesitancy rates in teenagers participating in the Australian national immunisation program found very high levels of vaccine hesitancy, on par with some of the world’s most hesitant countries adult populations. This was unexpected. Only 80% of students agreed vaccines were important, 70% agreed they were safe and only 66% agreed vaccines were effective. This is far below Australian adult responses. It is clear that this has been a missing target group in education and intervention to increase vaccine confidence for intergenerational change. Education, incentives for vaccination, and engagement with those who are hesitant to vaccinate are critical areas to further investigate in order to increase vaccination rates.5 Therefore, interventions designed to address these factors may be the best to increase vaccination rates.
Vaccination incentives and education
Incentive for vaccination is a common practice in population health programs. It has been shown that monetary and non-monetary incentives improve vaccination uptake by up to three times 10. In school students, peer incentive and educational incentives can increase return of consent forms for vaccination and motivation of school students to participate in vaccination programs 11. Education about vaccination also appears to play a motivating role in school age children in relation to vaccination uptake even when parental consent is required and the educational material is directed at the children 11. This suggests schoolchildren also direct the educational material towards consenting guardians and importantly can lead conversation about requesting immunisation. The issues are different when discussing under-vaccinating of very young infants. The minority are children of parents who are conscientious objectors and barriers appeared to be heterogeneous requiring tailored interventions that specifically target areas including for example; low social contact and service information, psychological distress, larger families not using formal childcare and child health issues/concerns 12.
Summary of research problem
For older children, such as adolescents who receive vaccinations in Australian secondary schools, the return of the consent form is reported to be a main limiting factor in delivery of vaccines 13. Before out pilot trial showing such low vaccine confidence levels, there is also little evidence around the levels of hesitancy and vaccine confidence in this age group. Interventions to incentivise return of this consent form might improve rates of vaccination delivered through this program. However, there is no consensus as to what interventions are most effective to incentivise and educate about vaccination in adolescents. The information available in the form of handouts and consent forms usually measures parental attitudes as the proxy consenting guardian in the vaccination of minors 14. Further understanding of the adolescent receiving the vaccination could unlock insights into intergenerational vaccination confidence, and considered an area of potential great impact.
Finalist – The Murdoch Children’s Research Institute Vaccine Uptake Group - WINNER
The Migrant Immunisation Access (MIA) Project will determine the extent of and examine the specific reasons behind under-immunisation among children of migrant parents by identifying gaps in health service delivery and exploring migrant experiences and awareness of immunisation services in the City of Melbourne, Victoria. Barriers to accessing immunisation services, not lack of acceptance, are the predominant causes of under-immunisation in this vulnerable group, with current models of immunisation service delivery not meeting the needs of many migrant families. Providers also face many challenges, predominantly related to the extensive workload in determining required catch-up schedules for migrants from different countries.The primary aim of the MIA Project is to determine the extent of under-vaccination amongst migrant children in Inner City Melbourne, including vaccination status by age and vaccine type. Secondary aims include understanding migrant parents’ patterns of healthcare service use, sources of immunisation information, access to immunisation ‘catch-up’ schedules, potential impact of the No Jab immunisation policies and the service delivery needs of immunisation providers. We will also explore the impact of COVID-19 on access to routine immunisation services and interpretation of public health messaging. This innovative project will identify barriers and improve understanding of current immunisation service delivery for migrant children, explore pathways and gather behavioral insights and experiences to inform provider training and tailor appropriate resources to improve immunisation uptake in these vulnerable communities.
The project is a collaboration between the Vaccine Uptake Group at the Murdoch Children’s Research Institute and the City of Melbourne’s Immunisation Section, as well as key stakeholders including General Practitioners (GPs) and migrant parents.
The Project is defined by three phases:
Phase I: Retrospective data review of City of Melbourne immunisation encounters for 2013-2019 (descriptive analysis of immunisation administrative data: i) client demographics, ii) council workload and iii) resourcing impact)
Phase II: Prospective surveys with migrant parents presenting to City of Melbourne Immunisation Service (explore health service use and referral patterns to immunisation service providers, parent experiences of immunisation service delivery, access, and sources of immunisation information. Patterns of early childhood education and the impact of the No Jab No Pay and Play policy will also be sought. We will also explore immunisation messaging within migrant families in the context of COVID-19.)
Phase III: Qualitative interviews with Council Immunisation Providers and GPs (understand available resources and provider training needs: barriers to coordinating and providing complex catch-up schedules for migrant families)
Finalist – The Murdoch Children’s Research Institute Vaccine Uptake Group - WINNER
Project: Development of guidelines on holding students with disabilities to give immunisations in schools.
High overall immunisation coverage in Australia masks under-immunisation of young people with a disability. Comprehensive and timely immunisation is especially important for this high-risk group due to the associated health issues which predisposes them to severe consequences of vaccine-preventable disease. There are a number of barriers to immunisation for young people with disability, particularly the absence of assent due to difficulties with cognition, communication and/or severe anxiety about immunisation. This can lead to severe behavioural difficulties and vaccine refusal as well as possible psychological and physical harm to the young person and/or provider(s).
Guidelines for the ethical and practical use of procedural holding children for immunisation are not well developed. Holding adolescents with disability in order to administer vaccinations within the School-based Immunisation Program is a specific issue. Currently there is a wide variety of practice in the use of procedural holding for students with disability for immunisation in specialist schools. Whilst ethically, there must be attention paid to the autonomy of the individual, there are consequences in respecting student refusal and not immunising in this already under-immunised population.
This proposal seeks to design and develop a best-practice guideline, including a decision tree to guide the use, appropriateness and method of holding to immunise young people with disabilities in the school setting to ensure optimal safety for immunisers and students. Such a guideline would ensure best practice, minimise variation in care and ensure appropriate support is given to maximise immunisation coverage in this vulnerable population. This tool would also provide guidance for alternative pathways to achieve successful immunisation, such as psychological support for needle phobia or immunisation under sedation in a hospital setting.
The first phase of this project would be a comprehensive literature and document review by the research team. The second phase would involve consultation with a small group of experts in immunisation, disability, education, policy, ethics and consumer representatives. These experts would convene for a meeting in which the summary of evidence would be analysed and discussed and key logistical, clinical and ethical issues in immunising young people with disability in schools would be raised. They would then participate in modified Delphi technique with embedded vignettes based on the key contentious issues, ensuring consensus is reached before the third phase of writing the guideline. The guideline will optimise adolescent immunisation for all young people with disability across Australia and may be adapted for other situations where immunisation is being considered in cases where an individual’s assent is unable to be obtained. This is an innovative approach to optimising immunisation service delivery for young people at risk of missing immunisation to ensure safe and successful immunisation in the least distressing and restrictive way.
Finalist – Monash University (School of Public Health and Preventive Medicine) - WINNER
The current coronavirus disease (COVID-19) crisis highlights the key role that travellers play in the spread of infections globally. In Australia, a country with high public health standards and robust communicable disease control systems, travellers are an important source of a range of vaccine preventable imported infections, including hepatitis A, typhoid and measles. Migrants who return to their country of origin to visit friends and relatives (VFR travellers) are at greater risk for a range of preventable infections compared to other travellers. In culturally diverse Australia, a quarter of the population are first generation migrants, and almost 1 in 4 short-term international departures are for the purpose of VFR. VFR travellers are less likely to seek pre-travel health advice and more likely to decline vaccine recommendations than other travellers. Contributing factors include a lack of awareness of or access to pre-travel services, misconceptions of health risks, and language barriers. Despite nearly two decades of literature highlighting the disproportionate burden of travel-related infectious disease acquisition in VFR travellers, evidence-based strategies to improve VFR traveller engagement in pretravel care and address barriers to uptake of pre-travel vaccination are lacking.
Australia is currently in an unprecedented state of lock down, with overseas travel currently banned (with few exceptions). However, when Australia’s borders re-open, there will be more need than ever to ensure that travellers are adequately prepared for the potential health risks associated with travel.
We propose to develop and launch an evidence-based health promotion campaign targeted at VFR travellers that aims to increase awareness of the risks associated with VFR travel, encourage greater attendance for pre-travel health consultations, and motivate VFR travellers to protect their health through pre-travel vaccination. Our proposal has three phases. In Phase 1, we will utilise existing collaborations to recruit two groups of VFR travellers through three Australian tertiary hospitals and their associated pre-travel clinics: i) unwell VFR travellers presenting to hospital with a travel-related infection, and ii) well VFR travellers attending for pre-travel advice. With both groups, we will conduct quantitative surveys and qualitative semi-structured interviews informed by established conceptual frameworks for health beliefs and behaviour (Health Belief Model and COM-B model) and use a mixed methods analytic approach to identify and understand key barriers and enablers to engagement in pretravel care and uptake of pre-travel vaccination. Data collected in Phase 1 will also be used to identify the top 3 VFR communities of highest priority, key information sources for VFRs, and key stakeholder groups (e.g. migrant healthcare providers, migrant community groups, community organisations, travel agents) for the next phase of our project. In Phase 2, we will use a co-design process to develop culturally-appropriate health promotion materials and determine the most appropriate channels for dissemination (e.g. social media, internet-based, local radio, print materials). A purposive selection of VFR travellers, representatives from community stakeholder groups and healthcare providers will be invited to participate in co-design workshops, with interpreters employed where necessary. In Phase 3, we will work with stakeholders to launch a health promotion campaign that aims to improve knowledge and awareness of travel health risks, engagement in pre-travel care, and uptake of pre-travel vaccination amongst VFR travellers.
Finalist – SmartVax
SmartVax Bexsero reminders – a platform to aid the completion of Bexsero vaccination schedules.
Men4B, Bexsero, has a complex dosage schedule and competes within an already crowded NIP vaccination space. Completion of dosage schedule is essential to achieve and maintain protection. Data suggests a significant incompletion of the recommended schedule. SMS reminders has been demonstrated to increase vaccination rates as well as improve timeliness.
SmartVax proposes the development and implementation of an intelligent and automated SMS reminder platform for Bexsero across the network of 330 GP and local government immunisation clinics.
Pending the findings, this reminder platform could be rolled out at low cost.
Analysis and monitoring will measure success of the project coupled with a communication strategy to engage with GP’s, public health and the general public.
Finalist – The Sydney Children’s Hospital Network
Title: Understanding the Perception of Risk in Travel-associated Enteric Disease – The UPRiTE Study
Western Sydney Local Health District (WSLHD) is home to more than a million residents and is the second most populous LHD in New South Wales (NSW). 47% of WSLHD residents were born overseas, with India the leading country of origin. Residents from these regions frequently travel to their country of origin to “visit friends and relatives” (so-called VFR travel) and carry a higher risk of contracting certain diseases due to the length and nature of travel and perception of disease risk.
Over the past decade, enteric fever (typhoid/paratyphoid fever) cases within WSLHD have increased by 50%, double the rate of population growth, and WSLHD has consistently reported the highest number of enteric fever and hepatitis A cases in NSW. The majority of affected families had not sought pre-travel health advice and were unaware that vaccines were available. Furthermore, among families who had consulted a general practitioner (GP) prior to travel, most had failed to recommend vaccines. Thus, there is an increasing need to improve risk perception and uptake of preventative strategies against travel-associated enteric diseases in Western Sydney, to reduce disease burden, decrease hospitalisations and prevent community transmission events. Correspondingly clinician knowledge needs to be improved to enable appropriate provision of healthcare in the community.
The proposed study will build on existing collaborative projects between WSLHD and The Children’s Hospital at Westmead and seeks to engage health practitioners beyond the hospital sector which are key in the translational research pathway to improve prevention of travel-associated enteric diseases. The proposed research design is a multi-modal, mixed-methods study in three parts:
1) Enhanced surveillance (epidemiological, clinical and travel) data for all cases of travel-associated enteric diseases notified to Western Sydney Public Health Unit July 2021-June 2022. This information is routinely collected under the NSW Public Health Act 2010.
2) Survey of patients (or parents/carers of children) diagnosed with travel-associated enteric diseases to elucidate pre- and during-travel health-seeking behaviour and travel risk-perception. The questionnaire will be administered during routine public health follow up of cases.
3) Survey of Western Sydney GPs, stratified by case resident postcodes, to ascertain their Knowledge, Attitudes and Behaviours (KAB) on pre-travel health advice and vaccinations via: telephone interview of local GPs linked to notified cases (contacted routinely as part of public health follow up); a random sample of GPs invited to participate in interviews through Western Sydney Immunisation Committee and WentWest Primary Health network; survey of attendants at a GP education event on vaccine-preventable infections in travellers.
Qualitative data will be collected by recording and transcribing responses to open-ended questions and thematic analyses will be carried out using NVivo qualitative data analysis software. Enhanced case data will be aggregated with health-seeking behaviour and travel risk-perception as well as GP KAB. Data will be analysed by specific enteric disease, postcode, ethnicity (of cases and GPs), and travel destination. Barriers to vaccination will be identified to inform development of effective health promotion messages.
Finalist – Logan City Council
Logan City Council (LCC) is seeking the 2020 GSK Immunisation Grant to introduce immunisation services that cater for the needs of persons with Autism Spectrum Disorder (ASD) within the Logan Community as an extension to the existing comprehensive school and community-based vaccination service.
Approximately 1 in 59 youth are diagnosed with Autism Spectrum Disorder (ASD).1 These youth have heightened health care needs and face psychosocial and sensory challenges like sensitivities to light, noise, temperature and unfamiliar processes and procedures.
The standard vaccination environment is generally not supportive for those with ASD and may cause distress to them and/or their parents/caregivers. For these persons currently only 2 options exist, submit to the current service offerings or be offered sedation prior to the procedure. This reduces vaccination rates, increases disease risks and can in some jurisdictions create a negative financial impact resulting from an incomplete vaccination record. Implementing processes to modify and reduce sensory stimuli which can lead to agitated behaviours is key to supporting these persons.1
LCC is proposing to create a dedicated space at the Logan Administration Centre to cater to the needs of those with ASD. Prior to vaccination Council staff would firstly consult with the person or parent to establish specific recommended requirements and to identify sensitivities. They would then tailor the room set up to best cater for those needs. If successful, the GSK grant would be spent directly on furniture and equipment to ensure this space can be a changeable space that caters to the specific needs of an individual with ASD. The proposal would see a space with adaptive lighting, sound and music and play equipment to support ASD persons, along with a specialised booking system to eliminate waiting times.
Furniture configuration and design will ideally allow for close and personal contact between parent and child yet still facilitate the unobtrusive but efficient administration of vaccination services and possibly, into the future, other primary health care services. The focus will be on creating a supportive and safe environment tailored to the specific sensory needs of the person, one which they can feel confident in returning to and complete the full immunisation schedule.
The space will provide child and family centred care used by 1 family group at a time with allocated time slots being booked in advance.
In addition to providing the space, LCC will resource the consultative process to design, develop and implement the fit out. LCC will deliver awareness training to all staff within the immunisation program on techniques to support ASD persons.
If successful in obtaining the GSK grant the Logan City Council proposal will increase the vaccination coverage for ASD persons and improve the experience for both child and parent.
1 Straus, J, Coburn, S, Maskell, S, Pappagianopoulos, J, Cantrell, K, 2019, ‘Medical Encounters for Youth with Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions’, Clinical Medical Insights: Pediatrics. Published on line GSK Immunisation Grant