During COVID the World Health Organisation (WHO) established the following principles, which we believe should guide all our work on immunisation:
These are consistent with and additional to our commitment in Aotearoa New Zealand to te Tiriti o Waitangi in healthcare: providing Tino rangatiratanga, equity, active protection, options and partnership in all that we do.
Best practice immunisation requires us to address equity and clinical issues. We consider what are the barriers to people getting vaccinated, and how can we remove them, through to how to ensure immunisation is safe and effective, and that people understand what to look out for after they're vaccinated.
The following story depicts the experiences that many whānau have. We need to think about how we can deliver more appropriate and acceptable care that recognises the challenges families and individuals face.
When my baby turned 6 weeks old, I rang the GP to get an appointment for her immunisation. I had to ring 3 times to get through. When we finally got through, they said that we owed $20 on the account from some phone calls. I booked for the next week so I would have the money to pay.
On the day of the appointment my other kids had colds so they were home from school, even though it was not covid, you’re not allowed to bring your other children in to the doctor’s appointments, so we couldn’t go for her shots. So, I booked another appointment for the next week.
Next week my in-laws got sick, my father-in-law was in hospital and my husband needed the car that day to take him up to the hospital and help his mum, so we couldn’t get there. I tried to get my sister to take us, but she didn’t have a car-seat. I booked again for 10 days later, we were short on money that week as my husband had taken time off work, so we needed to wait to get money for petrol and fees we owed for the clinic
I finally got to take my baby to the doctors when she was 9 weeks old. We had to answer lots of question before we were even allowed in the door, but we’re getting used to that these days. I tried to keep her all wrapped up while waiting outside, and away from anyone else in the waiting room, someone in there was coughing, it’s scary these days with Covid around.
When I saw the nurse, she commented that we were overdue for the injections. She was new, we didn’t know each other, and she was in a rush, so I didn’t have a chance to explain, but I felt like she was saying that I was a bad mother. I asked her if the baby injections were the same as the ones my other kids had, she seemed to get annoyed and said it was up to me if I didn’t want them to get the injections. That wasn’t what I meant; I didn’t want to ask her anything else after that even though I would have liked another bottle of paracetamol. I used to feel more comfortable with the old nurse, she knew my whānau and we could have a nice chat.
I’m not sure if I can get my baby’s next injections at 3 months, or if I should get the next ones late since we were late for the 6-week-old ones. I might not be able to book an appointment; the receptionist asked me to fill in lots of forms and said I need to give them a copy of baby’s birth certificate, but I don’t have one yet. And I’ll be back at work by then - I can’t take a day off when I’ve just started back. Hopefully one of the whānau will be able to take them.
[The patient journey is reproduced with the permission of Dr Ranche Johnson (she/her), Clinical Director, Ngāpuhi]
Research shows that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies that you can utilise and adapt for your community.
We are always keen to hear about what strategies you are using that have been successful so we can add to our tips for others to trial.
Here are some options you can consider for your clinic or practice to follow.
1. Have a practice or clinic Immunisation Champion.
2. Accept all newborn nomination messages daily.
3. Pre-call babies at 4 weeks of age. Welcome baby to practice, book appointment, offer enrolment. Phone to confirm appointment.
4. Consider barriers to access and offer support *(see below).
5. Offer opportunistic immunisation, all practice staff can use patient alerts or check recalls to identify attending patients who have overdue immunisation. Also immunise non-enrolled casual babies if the opportunity arises.
6. Do not postpone or cancel immunisation appointments for babies or other people who are mildly unwell.
7. Ensure your practice feels safe to whānau with precious babies.
8. Ensure your practice is welcoming to whānau. Whakawhanaungatanga is important.
9. Prioritise immunisation recalls with an equity approach.
10. Prompt referral to outreach services (OIS) if whānau have not been immunized after 3 recalls, 4 weeks overdue. Continue to recall whānau of children who have been referred to OIS.
Consider offering staff to transport whānau, using FFP, offering petrol vouchers, St Johns Shuttle, early referral to outreach.
Check contact details at every contact, get email details, next of kin contact.Time
Offer immunisation out of working day eg, evening or weekend Well Child clinic.
Immunisation services need to be holistic and listen to the concerns of whānau; staff who look like the whānau they serve; staff trained in cultural safety and Māori models of care.
Immunisation offered completely free without any requirement for other accounts to be paid.
Babies are eligible to be enrolled if in the care and control of a parent/ legal guardian who is eligible to be enrolled – do not delay enrolment until a birth certificate is presented.
Authorised User Agreements:
Promotion and education:
NB: A second person must be onsite at the time of vaccination and for at least 20 minutes post vaccination
NB: It is acceptable to wait for the ambulance to bring oxygen and airway equipment in settings where they are not needed for other emergencies.
*Consideration may be given to the vastus lateralis as an alternative vaccination site, providing it is not contraindicated.
Record details in the Well Child Tamariki Ora book (WCTO); vaccines given, injection site, and route used.
Record the following information in the PMS: