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Immunisation Coverage In New Zealand Conference

Hon Annette King Speech Notes

Thank you for inviting me to open today’s proceedings. It is a pleasure to talking with a group of dedicated health professionals committed to “making a difference” to the health and wellbeing of New Zealand’s children. Your efforts in the area of immunisation are indeed making a real difference.

You have an impressive line-up of speakers at your meeting, including Greg Sam from Australia, David Sinclair, Inez Kingi, Harry Pert, Sue Taft, Pat Tuohy, Kathy Grace, and, of course, Nikki Turner.

All these people are committed to children's health and immunisation. I would like to acknowledge particularly Inez Kingi's work through Tipu Ora. At a time when North Health's immunisation rate at five months was 76.5 percent, Rotorua rates were 90 percent. This reflects the work of Tipu Ora and local GPs.

Last week the World Health Organisation declared the Western Pacific, including New Zealand, to be polio free. This is a fantastic victory for immunisation, but we still have a major challenge ahead – to improve access for ‘hard to reach’ children and boost immunisation rates for other vaccine preventable diseases. New Zealand has set a target of attaining 95% immunisation coverage by 2004.

When I look at what other countries have achieved, I am ashamed of New Zealand's current rates of immunisation. It's not good enough just to say we can do better. We must do better to protect the health of all children.

I know you are gathered here to discuss ways we can meet this challenge. And the Labour-Alliance Government is committed to working with you, and the wider health sector, to tackle this issue.

We all acknowledge the difficulties, but some key work from the National Health Committee and the Health Funding Authority is developing practical ways to get the immunisation message out, and to encourage all families to ensure their children are protected against measles, whooping cough and rubella.

We have provided frameworks for action, and action is what this Government is seeking across the whole of the sector.

Immunisation provides protection for the whole population when we have a critical mass of children who have been covered. We must achieve that critical mass. The Government has provided an extra $11.8 million in this year's Budget to secure better immunisation rates, particularly for Maori and Pacific children. I am also concerned at an apparently increasing number of middle-class families who are making ill-considered decisions not to have their children immunised.

The Government’s intentions with respect to immunisation in New Zealand are clearly set out in the National Immunisation Strategy (Immunisation 2000), the Child Health Strategy and the Child Health Information Strategy.

Many here are quite familiar with these strategies, but in light of your focus on strategies for immunisation coverage, it seems appropriate to recap them as they provide the basis on which we can address disparities and improve all children’s health in New Zealand.

The National Immunisation Strategy, Immunisation 2000, developed in 1995, was one of the first frameworks aimed at improving the status of New Zealand’s children through immunisation.

It was composed of five elements:
 a simplified immunisation schedule;
 introducing the Immunisation Certificate for primary schools and early childhood centres;
 standards for immunisation providers;
 local immunisation co-ordination;
 improved immunisation surveillance.

With the support and hard work of many of you here, most of these elements have been implemented successfully. We still, however, need to implement a comprehensive immunisation information system so we can measure our progress on immunisation and to assist us in the recall and follow up of children not being immunised.

I know that an information strategy in itself cannot assure that children get the services they need. But it can provide the information necessary to know which children need services and positively contribute to improved outcomes for children.

Clearly, we have to be innovative in getting the immunisation message out. Which groups have low rates? Where do they socialise? What television programmes do they watch? How can we make sure the messages get out to them?

Then how do we deliver the services so the people who need them can get them? I sometimes regret, in these politically correct times, that we cannot do some things the way we used to do them. I remember the efficiency with which I and my friends and classmates were immunised at school.

But to return to information: The need for an information strategy for child health was also identified during extensive consultation on the New Zealand Child Health Strategy, launched in 1998.

When the child health sector was consulted about a Child Health Information Strategy, the sector made it very clear there should be a ‘bottom-up’ strategy. Such a strategy further develops and enhances the ability of providers to collect data about the children they care for, and share it with other providers who also care for children, to ensure that children get a better, more comprehensive and seamless service.

To make this work, we need a commitment by providers to work better together in a cooperative fashion with the health of the children and families as their common and agreed goal.

We need to share information between providers using robust, secure information systems that address issue of privacy and don’t require multiple data handling by providers.

The Government has allocated $1.78 million in the last budget round for the development of the child health information systems.

We also need to ensure that when information is shared, we use that information well. This is particularly important because unless someone contacts children who are not immunised and offers them immunisation or support to get their children immunised, we will have collected data to show our level of coverage yet achieved nothing. We need to find innovative solutions. Other countries have addressed this through incentives for improving immunisation coverage and this is something we are looking at as well.

As you know, since June of this year, all claims to Health Benefits Limited (HBL) have had to be done electronically using a child’s NHI number. I believe this is a good start in generating accurate information on immunisation including coverage levels and breakdown by ethnicity.

Information strategies must also address misinformation to ensure people make decisions based on evidence. I acknowledge the concerns some parents have about individual risks from immunisation, and it is certainly tragic for families when babies have an adverse reaction that may harm them and leave children with disabilities. Those risks are tiny, however. They need to be weighed against the frightening images we have all seen on television of a tiny baby, not yet immunised for whooping cough, desperately fighting for breath to survive. Parents have a right to make a choice, but it must be an informed one, based on balanced and factual information both about the risks, and how significant they are, and the benefits.
I now wish to speak briefly about the primary health care strategy because most immunisation is carried out by primary care providers. The Government recognises the contribution primary health care can make to an effective public health care system, and this is why primary health care was the first strategy we developed and sent out for community consultation.

The strategy emphasises the importance of prevention, with a focus on population health, health education and promotion and community partnership. As health professionals, I know you support the need for a well-coordinated primary health care service that serves its community well and enables you to make your best contribution to health service provision.

We received nearly 300 submissions on The Future Shape of Primary Health Care discussion document. Responses to the discussion document aired a range of views and concerns, but most people wanted flexibility so that different communities could meet their own needs. I support such flexibility.

The Ministry is currently undertaking the task of developing a definitive Primary Health Care Strategy in the light of the submissions. I have recently released a report on the submissions and the Ministry has established a reference group to help develop the final strategy. In addition, the Ministry will hold other discussions with key stakeholders during the process. This is an important process that will involve my office as well as the offices of other Ministers. We are expecting to announce the final strategy later this year.

Although the primary care strategy will go some way towards reaching children on the fringes of primary care services, I recognise that the hardest to reach children often need specific programmes. This issue was highlighted in a report released by the National Health Committee on The Health Funding Authority’s Strategy for Immunisation of ‘Hard to Reach’ Children.

It made nine specific recommendations for the HFA to achieve better immunisation coverage for “hard to reach” children in New Zealand. Some of these recommendations included HFA support of outreach immunisation services for ‘hard to reach’ children, an improvement in provider education and continued support of immunisation promotions that target hard to reach children. The Government supports the NHC’s advice and has begun implementing the recommendations. The HFA is completing the preparatory work for incentives, outreach and catch-up programmes and is expected to commence the implementation of the outreach programmes by January 2001.

You will know that the health sector’s ability to recruit and retain competent staff is particularly topical at the moment. As health services change to meet new and different needs of their communities the mix of workforce skills may also need to change.

In terms of immunisation provider development, we need to ensure a wider range of health professionals who can be contracted to deliver immunisation in a number of ways. This is of particular importance to Mäori and Pacific communities.

I am establishing a Health Workforce Advisory Committee to provide advice on the workforce needs of the sector and how we should meet those needs. The terms of reference for the committee have been agreed and the committee will be established when the NZ Public Health and Disability Bill is passed at the end of this month.

A key theme running through all the various health strategies, including, of course, the over-arching New Zealand Health Strategy, is the need for cooperation and collaboration throughout the health sector. The Government is dedicated to creating an environment that encourages strong partnerships and collaboration between those providing the health services and the communities they serve.

You all can play an important role in facilitating this cooperation by working together, sharing your knowledge, resources and expertise. This conference presents an ideal opportunity for you to share your ideas, research and specialist knowledge with each other.

I would like to thank the Immunisation Advisory Centre and those of you here involved in the delivery of immunisation services. Your role is an invaluable one.

I reiterate that this Government’s vision for immunisation in New Zealand involves the need for a partnership approach, involving the Government, health professionals and the community, if we are to develop the successful and innovative services we all want to develop. We all must work together to make a difference. Thank you once again for inviting me to open this most important conference, and I will look forward to receiving a report on your achievements over the next three days.

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