Underutilization of Important Geriatric Vaccinations in Australia

Introduction

Background Information

Vaccines and vaccination programs have remained one of the greatest medical achievements of the modern civilization. The public health practice has created a ‘new world order’ by offsetting the high mortality rates that were associated with diseases such as tetanus, polio, mumps, diphtheria, rubella, and measures at the beginning of the 20th century (Becker & Gardner, 2012, p.42). Immunization has not only reduced the burden of the infectious diseases that affected children by 90% but have also minimized susceptibility to common geriatric conditions (Ivanov & Blue, 2008, p.111). The benefits have seen the establishment of the National Immunisation Program, where the Australian government, in collaboration with state and territory programs, is funding vaccination activities among children as well as offering financial assistance to offset barriers in adult jabs (Aph.gov.au, 2016). 
The public funding has improved accessibility among high-risk groups such as the Aboriginal and Torres Strait Islander ethnoracial groups as well as the elderly through special schemes. It has also engaged other stakeholders to provide immunization services through workplace settings and continues to invest heavily in research to improve current vaccines (Rabba, 2012). While the investment in the disease prevention approach has helped in addressing a number of public health challenges facing Australians, the vaccine-preventable diseases are still a major problem in the country (Chan, Dey, Wang, Martin, & Beard, 2015). For instance, in 2013, over 55 people were infected by avian influenza in Young, Canberra (Thistleton, 2014). While the number was small, the outbreak caused a widespread scare even across borders as H7N2 virus subtype is highly contagious.  Similarly, Australia experienced the worst pertussis outbreak since the introduction of DTPa vaccine where 34,790 cases were reported in a wave of outbreaks witnessed between 2008 and 2012 (Cherry, 2012).
Despite the high media publicity, the unusual occurrence of the disease across Australia was not a unique public health incident as the country has been struggling with Pertussis-related deaths and complications since the 1990s, with experts suggesting that Australia reports the highest incidence of Pertussis in the globe (McIntyre & Nolan, 2014). Regrettable in the disease dynamics is that millions of taxpayers’ money continue to be directed to a vaccination program, which does not yield substantive benefits in addressing the public health issue. Nevertheless, practitioners have quashed the observation by suggesting the increased prevalence have been attributed by new testing approaches as well as comprehensive disease reporting tools. Such has been the case since the 1990s, where the use of serological tests strategies as well as the enactment of mandatory reporting to the National Notifiable Diseases Surveillance System of all positive cases of vaccine-preventable diseases (Quinn & McIntyre, 2007. The developments ensure comprehensive reporting where all cases are included in the surveillance report, a move that has seen the prevalence of Pertussis rise by 700% than previously thought (Kaczmarek et al., 2013). While the advancement of diagnostic tests, as well as improved surveillance and reporting system, is one of the contributing factors, the dynamics of Pertussis is self-defeating to reasons why Australia has invested billions of dollars in the immunization program.
The question of the effectiveness of some vaccines comes at a time when the National Immunisation Program is faced with a myriad of issues. For instance, a growing body of evidence has been discrediting the benefits presented by the vaccines, with recent studies focusing on the adverse effects of current vaccines in Australia (nps.org.au (a), 2015). Similarly, a number of scholars have focused on assessing safety aspects of vaccines. A widely accepted concept informs the research trend that some vaccines are associated with adverse issues such as sudden infant death syndrome (SIDS), thimerosal, autism, and syncope (Science.org.au, 2016). Despite the problem being scientifically recognized, no explanation has been offered, an issue that raises ethical questions regarding the use of vaccines. Similarly, recent findings have raised concerns over the preparation of vaccines, with the centre of focus being the use of virulent organisms.  The issue is informed by anecdotal evidence which points out that “when attenuated vaccine is introduced in the body, it holds the risk of reverting to a more virulent strain of pathogen” (Gomez et al., 2013). According to Carlin et al. (2013) and Seward, Marin, & SAGE VZV Working Group (2014), “the danger persists despite the highly selective process of choosing pathogens to be used in attenuated vaccines”, such as Rotavirus and Varicella. Another concern has risen over the use of live-attenuated vaccines in special groups. If used in individuals with an immunocompromised system, attenuated vaccines expose them to the disease of interest. The challenge has resulted in an anti-vaccine movement, where some activists are calling for alternatives to live-attenuated vaccines, especially among high-risk groups such as children and the elderly (Cunningham, 2016). 
Whether mythical or informed by evidence, the concerns raised are playing a central role in informing behavioural aspects among Australians. The view is echoed in Qureshi & Shaikh (2006) suggestion that misconceptions and fallacies have been influencing health care seeking behaviour for ages. Qureshi & Shaikh (2006) suggest that the high-risk population and socially disadvantaged individuals in the society suffer most, a proposition that informs the coverage of this study, which will explore the trends of vaccine-preventable diseases among the elderly population. The focus on the group is informed by the immunological responses among the elderly, where immunosenescence increases susceptibility to infectious diseases as well as adverse effects from vaccines (Weinberger, Herndler‐Brandstetter, Schwanninger, Weiskopf, & Grubeck‐Loebenstein, 2008). The phenomenological experiences have informed a number of misconceptions, which could jeopardize geriatric vaccination.

Problem Statement

While the current immunization approaches have been credited for lowering the burden of infectious diseases, preventable diseases continue to steal the sense of life among Australians. Such has been the case of viral Influenza, which accounts for 250,000 cases every year, with the majority being the elderly. While the disease is usually disregarded where many people do not take the annual vaccination seriously, data on the burden of the disease highlight need for increased awareness. Influenza accounts for 18,000 hospitalisations and 2000 deaths every year (Taule'alo, 2015). While the numbers are relatively small, they highlight complacency in taking preventive precautions against a disease that have high mortality and morbidity value. The behavioural choice is against the widely-accepted concept of risk aversion, where people are naturally motivated to pick options that have the least chances of a catastrophic outcome.
Against the backdrop, the study seeks to explore knowledge, attitude, and perceptions surrounding the lack of urgency in embracing a useful public health aspect. While the subject has been a major area of research, the current literature exhibits worrying inconsistencies, an issue that warrants further explorative studies. Despite being one of the high-risk groups in vaccine-preventable diseases, the elderly has also been an ignored. The contribution of the fallacies and misconceptions is thus not understood, a shortcoming that informs this research. An underlying motive in the exploration is understanding why the elderly are not conforming to an evidence-based postulation that vaccination minimizes the risk of common old age diseases such as pneumonia, influenza, tetanus, pertussis, shingles, and diphtheria. 

Purposive Statement

The study seeks to assess aspects that have made the elderly to continue embracing a negative behaviour, even when there are approaches that would not only protect them from financial constraints of vaccine-related diseases but also improve their socioeconomic wellbeing.

Justification

Because of improved health care and welfare state, Australia has experienced a demographic shift in recent years, where the number of the elderly has significantly increased. One of the underlying reasons has been primary health interventions, with vaccinations being one of the most important approaches. The government has continued to support the primary health plan, with the Aboriginal and Torres Strait Islander and the elderly being the biggest beneficiaries in the financial incentives. Despite the support, the coverage of immunization campaigns has remained low in some diseases. According to a 2009 survey, only 74.6% of over-65s Australians were vaccinated against seasonal influenza and 54.4% for pneumococcal disease (Australian Institute of Health and Welfare, 2009). However, the coverage of pertussis and pandemic influenza was 11.3% and 18.8% respectively among the adult population, which entailed the senior citizens (Australian Institute of Health and Welfare, 2009). 
The trend is worrying as most of the vaccine-preventable conditions are not only catastrophic to the Australian economy, but also the holistic functioning of individuals. The high prevalence of diseases increases direct medical-related costs through by changing service utilization patterns, the number of hospitalization, as well as premature deaths. Similarly, vaccine-preventable ailments contribute significantly to school and work absenteeism among other socioeconomic aspects. The elderly has elevated risks of experiencing the socioeconomic issues because of immunosenescence (Weinberger, Herndler‐Brandstetter, Schwanninger, Weiskopf, & Grubeck‐Loebenstein, 2008). The biology of the immune system exhibits functional defects, with innate and adaptive responses being impaired. Primary responses to neoantigens among the elderly are poor where the effective induction of memory lymphocytes is weak. Despite the systemic issues that expose the senior citizens to increased likelihood of being infected by vaccine-preventable diseases and need for booster jabs, trends in immunization coverage indicate that most of the senior citizens miss out of vital vaccines. Underlying the underlying motives is thus a critical public health issue. 

Research Questions

1. What is the understanding of the elderly on the significance of important vaccines proposed under the National Immunization Program?
2. Which are common misconceptions on the use of vaccines in offsetting the risk of vaccine-preventable disease?
3. Which are the underlying factors in the formation of misconceptions against vaccination?
4. Which approaches possess the potential to change the patterns in vaccination services?

Significance of the Study

While the underlying reasons for the low turnout rates for immunization programs are varied and complex, knowledge, attitude, and perceptions remain the main factors in influencing the views of the public health concept. However, the effects of the misconceptions among elderly Australians are not understood as the area has been ignored. The study seeks to generate evidence on the subject with the aim of influencing policy formulation and adoption. The study coverage will inform means of improving immunization strategies through addressing perceptions on vaccines as well as highlighting need for new adjuvants to overcome the effects of immunosenescence. The ultimate objective of the study is to promote better protection of the elderly Australians from vaccine-preventable diseases.  

Delimitation and limitation

While the study seeks to promote trustworthiness through random sampling of participants, the aspect is limited by the desire to observe the ethical value of voluntary participation. Recruitment of respondents will thus be based on willingness to participate rather than strict observation of the sampling selection process.