Paul Hutchison: Too many children miss immunisation

COMMENT

The Ministry of Health does not know what proportion of our children have either completed or begun their routine immunisations and Well Child checks. In my view, this failure is a national scandal that must be resolved.

It is particularly salutary as the meningococcal vaccination campaign begins. These interventions cost hundreds of millions of dollars, yet there is no proper accountability. It is thought that completion of immunisations in many parts of New Zealand is less than 70 per cent, leaving a pool of children highly vulnerable to a range of preventable diseases.

Just as bad is the fact that Well Child checks are not completed or not funded to be completed. (These checks give an opportunity for problems such as hearing, eyesight or heart defects to be picked up early and treated.)

There have been calls for compulsory vaccination, but for those who have a genuine and informed conscientious objection, such a move would be untenable. Immunisation decisions should be based on understanding the science, not coercion.

However, I advocate that the Government makes it compulsory for all preschools and schools to require children to present a certificate that either confirms the child has been immunised or confirms the parent has made a firm conscientious objection.

There is a need for a national strategy to portray the profound benefits and any disadvantages of immunisation both at an individual level and to our population.

Such an education campaign should be through all media, at antenatal classes, at preschools, schools and universities. Ultimately it is up to the individual responsibility of parents to be informed by the facts and to act on them.

We have become complacent about our children and it is vital that every effort is made to ensure the basics are not only provided but made use of, so that all our children have the chance to achieve their full potential.

Though infant mortality has come down dramatically over the past century, new problems have arisen which include unacceptable completion of immunisations and Well Child checks, poor dental health, child obesity, truancy, high teenage abortion and suicide rates, child poverty and youth offending.

The horrifying story that has lately emerged of a young child from Waiheke Island who required limbs to be amputated because of meningitis is a reminder of how vulnerable all children can be to a broad range of serious afflictions.

Whooping cough, polio, tetanus, rubella, hepatitis B and diphtheria are all preventable, yet New Zealand appears to have one of the worst immunisation rates in the South Pacific.

As I write, health officials are giving warning of a whooping cough epidemic that should have been prevented. It is because these diseases are not now so visible that many people find it hard to understand the need for vaccination.

Have we lost a national determination to protect our children? Have we become overtly complacent? I believe we have. How many more children will die of whooping cough before it dawns on the public that we must improve the low immunisation rates of our children.

Over the past four decades, New Zealand has become a much more heterogeneous society, far less willing to be regimented and compliant as perhaps we were in the good old days of military service, the traditional family unit, a high Plunket presence and routine school milk.

It is true that immunisation can have a very small, serious adverse reaction rate, and for those who are badly affected it can be a disaster. However, there is overwhelming evidence that routine immunisations are generally safe and the advantages of protecting the whole population from diseases such as polio, rubella and meningitis far outweigh very rare adverse reactions.

Immunisation data collected from general practices scattered through the country show that more than 90 per cent of children received their initial vaccinations, but by age 11 only some 70 per cent had completed immunisation. This leaves a large pool of children not only vulnerable to infectious diseases but also able to spread them to others.

Miningococcus is different from many infectious diseases; despite vaccination, the bacteria may continue to be carried in the throat. This is the 13th year of the meningitis epidemic which has affected thousands. In the first four months of this year alone, 118 people have contracted the disease and three have died of it. The epidemic was estimated to have cost the country $630 million by 2002, with direct costs to the health sector of $300 million.

The campaign is ambitious. It aims to vaccinate all under-20-year-olds with three doses of vaccine, six weeks apart. The logistics of achieving this are immense, particularly given our abysmal compliance with routine immunisations.

The Immunisation Advisory Centre, which is ably and enthusiastically run by Dr Nikki Turner, has noted that while some 5 per cent of New Zealand parents conscientiously object to their children being immunised, there is a further 25 per cent who are unsure.

These parents are not anti-immunisation, they often have specific fears about the vaccines and little personal experience of the disease. For this reason there is a place for the Ministries of Health and Education to create a culture that completing immunisations is the right thing to do.

For those children who are hard to reach or fail to turn up, special effort is made to track them down, and in places such as Rotorua, which has a well-integrated and comprehensive network of general practitioners, nurses and Plunket working together, overall immunisation completion rates have been greater than 90 per cent.

That experience proves it can be done without the stick approach in modern New Zealand. Plunket is willing to work with Primary Health Organisations and there is every reason that both immunisation and Well Child checks be carried out through integrated teams working together. General practitioners are acknowledged as key elements to success.

It would be a tragedy for our children and an indictment of our society if this epidemic of meningitis does not shake us out of our complacency.

There is every reason for the Ministries of Health and Education to work together to make the rollout successful and at the same time ensure an audit is put in place to measure whether routine immunisations are completed.

And I repeat: all preschools and schools make it compulsory for children to present a certificate that either confirms the child has been immunised or confirms the parent has made a firm conscientious objection.

Some would go even further and consider a monetary or taxation penalty on the parent who persistently fails to comply with certification.

* Dr Paul Hutchison is MP for Port Waikato and National science and associate health spokesman.