Vaccines for such a time as this

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from Luke’s Journal 2020 | Ageing Gracefully | Vol.25 No.3

Background: The ATSI people are a particularly vulnerable population. Since colonisation by the British and Europeans, these people have experienced very high morbidity and mortality from infectious disease epidemics with serious effects, such as smallpox (mortality rate >30%)³, tuberculosis, annual influenza, measles (mortality rate >20%)⁴, and syphilis. Lack of previous exposure⁴ and high-density living in newly established settlements caused high rates of disease which, over the decades, have become associated with a higher burden of chronic disease (eg. diabetes, heart disease and chronic kidney disease). Additional factors include poorer access to water, housing and health care.⁵ Some social determinants of health, such as poor standards of education, loss of control over life circumstances and lack of cultural safety⁴ also contribute to their healthcare burden.

Aboriginal and Torres Strait Islander (ATSI) people have a shorter life expectancy than the non-Indigenous Australian population.¹ 

We are living in very particular times. COVID-19 has brought about an awareness of the need to prevent illnesses from spreading and this year (2020) has seen uptake of the influenza vaccine at extraordinary rates. Commonwealth Public Health Orders directed all healthcare and aged care workers to have the influenza vaccine before 1st May, 2020 and recommended influenza vaccination for all “at risk” groups. 

The pneumococcal vaccine schedule was also revised in 2020, as the incidence of pneumonia affecting adults between the ages of 65-70 years does not indicate that either Prevenar 13 or Pneumomax 23 are required in otherwise healthy people before the age of 70 years. An exception is where a person identifies as ATSI. In such a case, Prevenar 13 remains the first choice pneumococcal vaccine at the age of 50 years. (See Table below).

It is not just a person’s physical health that needs to be considered when introducing the topic of longevity²; there are spiritual, mental health, social and psychological needs that also need to be addressed when employing immunisation programs within the context of person-centred care. Some of these needs are acknowledged by public health departments when considering why and how to make essential vaccines available to ATSI people.^3-8 

Vaccination programs

Through vaccination, Australians have benefited from the elimination or substantial reduction in the rates of many vaccine-preventable diseases in recent decades. This has also substantially improved ATSI child mortality rates⁵. Successful vaccination programs among ATSI people have significantly reduced the incidence of diphtheria, poliomyelitis, tetanus hepatitis A and B, measles, mumps and rubella.

ATSI people have higher rates of some diseases, therefore some extra vaccines are recommended. Some vaccines indicated for non-Indigenous people may be recommended in a broader age range for Aboriginal and Torres Strait Islander people (see table below).

Adult vaccine schedules

One example of a vaccine-preventable disease that has a disproportionately high burden of disease in ATSI people compared with non-Indigenous Australians is invasive pneumococcal disease. Vaccination has reduced the burden of disease caused by serotypes that are in the vaccines, but not all serotypes are included in the available vaccines. These other serotypes continue to cause disease among ATSI people.⁶ Environmental factors mentioned beforehand may also contribute to increased exposure to the disease,^6-8 and untimely administration of vaccines may be another factor.^9,10

Extra vaccines recommended for Aboriginal and Torres Strait Islander adults

These are a few of the vaccines indicated for ATSI people, which are in addition to those recommended for all Australians, including those for particular medical, occupational, behavioural or other risk groups.

Vaccination services to ATSI people are important to the success of immunisation programs, and can be provided by:

• General Practitioners

• Aboriginal Community Controlled Health Services

• Aboriginal Medical Services

• Community Health Services

• The Royal Flying Doctor Service

• State and Territory Corrective Services

It is important to ascertain if people identify as being of Aboriginal and/or Torres Strait Islander background, in particular during presentations to urban mainstream health services. Patient information systems can be employed to record ATSI status, and preventive health services scheduled to increase opportunistic vaccination and enable patients to receive reminders.¹¹ These measures will help ensure increased quality of life and increase longevity¹ for this vulnerable patient group.

Improvements in coverage ensures that people receive their vaccines according to the relevant schedules.¹² ATSI status records also play a critical role in conveying changes to vaccine recommendations for these people. Culturally-appropriate service delivery and communication strategies are essential,¹³ as well as the relevant Medicare items, to bring about improvements and access to health services for ATSI people.^14-16 

Providing ATSI people with preventive measures through vaccination will enable them to age well, and without the acquired disabilities procured by untreated risk factors1⁷. 

Acknowledgement

The Author acknowledges the Australian Government Immunisation Handbook (online, accessed 15 June 2020, as the source of the specific immunisation information contained in this article.)

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References

1. Australian Government Department of Health and Ageing. (2013). National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Australian Government Department of Health and Ageing.
2. Gee, G., Dudgeon, P., Schultz, C., Hart, A., Kelly, K.. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In Dudgeon, P. Milroy, H. Walker, R. (Ed.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed., pp. 55-68). Canberra: Department of The Prime Minister and Cabinet.
3. Dowling, P.J. (1998) ‘A great deal of sickness’: introduced diseases among the Aboriginal people of colonial southeast Australia, 1788–1900 [PhD thesis]. Canberra: Australian National University.
4. Boughton, C.R.(2002) Smallpox and Australia. Internal Medicine Journal 32:59-61.
5. Australian Institute of Health and Welfare (AIHW) (2011). The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview. Cat. no. IHW 42. Canberra: AIHW.
6. Eades, S.J. (2000) Reconciliation, social equity and Indigenous health [editorial]. Med J Aust 172:468-469.
7. Grant, E.K., (2004) Unseen, Unheard, Unspoken: Exploring the Relationship Between Aboriginal Spirituality & Community Development. University of South Australia: Adelaide, pp.8-9.
8. SNAICC. Healing in Practice: Promising Practices in Healing Programs for Aboriginal and Torres Strait Islander Children and Families. 2012; Available from: https://www.snaicc.org.au/wp-content/uploads/2015/12/02926.pdf
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16. Couzos, S., & Delaney Thiele, D. (2010) The new “Indigenous health” incentive payment: issues and challenges. Med J Aust 192:154-157.
17. Weinberger, B (2018) Vaccines for the elderly: Current use and future challenges. Immun Ageing, 15:3 https://www.ncbi.nlm.gov/pmc/articles/PMC5778733/ accessed 3 Dec’19