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Ko a tātou tamariki, ngā taonga mo āpōpō

Our children are the treasures of tomorrow

Do we truly treasure our tamariki, our children?

If you had a treasure that required protection against the deadly vaccine-preventable pneumococcal disease, and you had a choice of two vaccines, which one would you choose? One that cost more or one that was cheaper but provided protection against fewer pneumococcal serotypes? Since we did choose this cheaper vaccine, how do you feel now that that we can see, since this choice was made, that the number of pneumococcal serotype 19A cases in young children, and the proportion of pneumococcal isolates that are penicillin-resistant, has increased?[[1]]

And if, in 2021, you had seen that when international borders opened briefly, respiratory viral infections quickly re-entered Aotearoa New Zealand and caused many of your treasured children to be hospitalised,[[2]] and caused some to die,[[3]] how would you plan for 2022 when borders would open more fully? Would you immediately offer your children the influenza vaccine knowing that the influenza virus would be entering Aotearoa New Zealand in 2022, and knowing that influenza infection can then lead onto severe bacterial pneumonia?[[4]] Or would you only offer the influenza vaccine to adults and wait for influenza to arrive, for many of your children to be hospitalised with severe illnesses caused by influenza and bacterial pathogens that influenza enables,[[4,5]] and then offer the influenza vaccine to your children also?

If a schedule of life-saving vaccines were required to be delivered on time to all your treasured children, whilst you were focussing on the vaccine prevention of life-threatening illness in adults, would you stop giving the schedule of life-saving vaccines to your children? How would your children feel if they knew that, in 2022, one-in-three of them were not given all of their infant vaccinations?[[6]] Would they feel treasured?

Knowing that Māori and Pasifika children are at increased risk of vaccine preventable diseases, how would you feel if, in 2022, only 46% of your Māori children and 62% of your Pasifika children at age six months had received all of their infant vaccinations?[[6]] And how would your Māori and Pasifika children feel if they knew that since 2019, while vaccine coverage at age six months had decreased by 12% for your New Zealand European children, it had decreased by 26% for your Māori children and by 19% for your Pasifika children?[[7,8]] Would they feel treasured?

If you knew that fewer than 3% of pregnant women in New Zealand do not intend for their children to receive vaccines,[[9,10]] would you be surprised that, in June 2022, only 67% of children at age six months had received their infant immunisations?[[6]] And, if you knew that pregnant women living in the poorest neighbourhoods had the highest intentions for their children to receive their vaccines,[[11]] would you be surprised if their children had the lowest coverage for infant vaccines?

If you knew that infants in other developed countries, such as the United Kingdom, Ireland and Italy, receive the meningococcal vaccine,[[12]] but not infants in Aotearoa New Zealand, how would you feel? You might remember that this vaccine was available in New Zealand in the past,[[13]] and that because we used it then, other countries now feel confident to include it in their childhood immunisation schedules now.[[12]] But we have decided not to.

Albert Einstein is quoted as saying: “Insanity is doing the same thing over and over and expecting different results”. Having read the preceding paragraphs, would you now agree that Aotearoa New Zealand is systematically failing in its childhood vaccine delivery and needs to do this differently?

It is time Aotearoa New Zealand learnt how to vaccinate all its treasured children and to vaccinate those most at risk of vaccine-preventable diseases first. As a result of COVID-19, we now have a larger and more diverse vaccination workforce and many more strategies for delivering vaccines to those who want them and really need them, but for whom the current healthcare system is incapable of delivering. We need to apply lessons learnt from the COVID-19 vaccine strategy to address the insanity of our childhood vaccine delivery system. But will we?

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Dr Cameron C Grant: Head of Department – Paediatrics: Child & Youth Health; Professor, The University of Auckland; Paediatrician, Starship Children’s Health, New Zealand. Dr Owen Sinclair, Te Rarawa: Chair, Metro Auckland Immunisation Governance Group, New Zealand. Dr Teuila Percival: Paediatrician, Kidz First Children’s Hospital & Community Health, Counties Manukau District; Honorary Associate Professor, The University of Auckland, New Zealand.

Acknowledgements

Correspondence

Dr Cameron C Grant: Department of Paediatrics: Child and Youth Health, Grafton Campus, Building 507, Room 1016, 22–30 Park Road, Grafton, Auckland, The University of Auckland, Private Bag 92019 Auckland 1142, New Zealand

Correspondence Email

cc.grant@auckland.ac.nz

Competing Interests

Nil.

1. Anglemyer A, McNeill A, DuBray K, et al. Invasive Pneumococcal Disease: Concerning Trends in Serotype 19A Notifications in New Zealand. Clin Infect Dis 2022;74(10):1859-61. doi: https://dx.doi.org/10.1093/cid/ciab766

2. Grant CC, Huang QS, Trenholme A, et al. What can we learn from our 2021 respiratory syncytial virus experience? N Z Med J. 2021;134(1540):7-12.

3. Stats NZ Tatauranga Aotearoa. Births and deaths: Year ended December 2021 (including abridged period life table) Wellington: Stats NZ; 2022 [Available from: https://www.stats.govt.nz/information-releases/births-and-deaths-year-ended-december-2021-including-abridged-period-life-table/ accessed October 26 2022.

4. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respi Viruses 2016;10(5):394-403. doi: https://dx.doi.org/10.1111/irv.12398.

5. Jansen AG, Sanders EA, A VDE, et al. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity? Epidemiol Infect 2008;136(11):1448-54. doi: https://dx.doi.org/10.1017/S0950268807000271

6. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 April 2022-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

7. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 January 2019 -31 December 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

8. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 July 2021-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

9. Grant CC, Chen MH, Bandara DK, et al. Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy. Vaccine 2016;34(11):1379-88. doi: https://dx.doi.org/10.1016/j.vaccine.2016.01.048.

10. Pointon L, Howe AS, Hobbs M, et al. Evidence of suboptimal maternal vaccination coverage in pregnant New Zealand women and increasing inequity over time: A nationwide retrospective cohort study. Vaccine 2022;40(14):2150-60. doi: https://dx.doi.org/10.1016/j.vaccine.2022.02.079.

11. Morton SMB, Atatoa Carr PE, Bandara DK, et al. Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Auckland: University of Auckland, 2010.

12. Parikh SR, Campbell H, Bettinger JA, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect 2020;81(4):483-98. doi: https://dx.doi.org/10.1016/j.jinf.2020.05.079.

13. Arnold R, Galloway Y, McNicholas A, et al. Effectiveness of a vaccination programme for an epidemic of meningococcal B in New Zealand. Vaccine 2011;29(40):7100-6. doi: https://dx.doi.org/10.1016/j.vaccine.2011.06.120.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Ko a tātou tamariki, ngā taonga mo āpōpō

Our children are the treasures of tomorrow

Do we truly treasure our tamariki, our children?

If you had a treasure that required protection against the deadly vaccine-preventable pneumococcal disease, and you had a choice of two vaccines, which one would you choose? One that cost more or one that was cheaper but provided protection against fewer pneumococcal serotypes? Since we did choose this cheaper vaccine, how do you feel now that that we can see, since this choice was made, that the number of pneumococcal serotype 19A cases in young children, and the proportion of pneumococcal isolates that are penicillin-resistant, has increased?[[1]]

And if, in 2021, you had seen that when international borders opened briefly, respiratory viral infections quickly re-entered Aotearoa New Zealand and caused many of your treasured children to be hospitalised,[[2]] and caused some to die,[[3]] how would you plan for 2022 when borders would open more fully? Would you immediately offer your children the influenza vaccine knowing that the influenza virus would be entering Aotearoa New Zealand in 2022, and knowing that influenza infection can then lead onto severe bacterial pneumonia?[[4]] Or would you only offer the influenza vaccine to adults and wait for influenza to arrive, for many of your children to be hospitalised with severe illnesses caused by influenza and bacterial pathogens that influenza enables,[[4,5]] and then offer the influenza vaccine to your children also?

If a schedule of life-saving vaccines were required to be delivered on time to all your treasured children, whilst you were focussing on the vaccine prevention of life-threatening illness in adults, would you stop giving the schedule of life-saving vaccines to your children? How would your children feel if they knew that, in 2022, one-in-three of them were not given all of their infant vaccinations?[[6]] Would they feel treasured?

Knowing that Māori and Pasifika children are at increased risk of vaccine preventable diseases, how would you feel if, in 2022, only 46% of your Māori children and 62% of your Pasifika children at age six months had received all of their infant vaccinations?[[6]] And how would your Māori and Pasifika children feel if they knew that since 2019, while vaccine coverage at age six months had decreased by 12% for your New Zealand European children, it had decreased by 26% for your Māori children and by 19% for your Pasifika children?[[7,8]] Would they feel treasured?

If you knew that fewer than 3% of pregnant women in New Zealand do not intend for their children to receive vaccines,[[9,10]] would you be surprised that, in June 2022, only 67% of children at age six months had received their infant immunisations?[[6]] And, if you knew that pregnant women living in the poorest neighbourhoods had the highest intentions for their children to receive their vaccines,[[11]] would you be surprised if their children had the lowest coverage for infant vaccines?

If you knew that infants in other developed countries, such as the United Kingdom, Ireland and Italy, receive the meningococcal vaccine,[[12]] but not infants in Aotearoa New Zealand, how would you feel? You might remember that this vaccine was available in New Zealand in the past,[[13]] and that because we used it then, other countries now feel confident to include it in their childhood immunisation schedules now.[[12]] But we have decided not to.

Albert Einstein is quoted as saying: “Insanity is doing the same thing over and over and expecting different results”. Having read the preceding paragraphs, would you now agree that Aotearoa New Zealand is systematically failing in its childhood vaccine delivery and needs to do this differently?

It is time Aotearoa New Zealand learnt how to vaccinate all its treasured children and to vaccinate those most at risk of vaccine-preventable diseases first. As a result of COVID-19, we now have a larger and more diverse vaccination workforce and many more strategies for delivering vaccines to those who want them and really need them, but for whom the current healthcare system is incapable of delivering. We need to apply lessons learnt from the COVID-19 vaccine strategy to address the insanity of our childhood vaccine delivery system. But will we?

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Dr Cameron C Grant: Head of Department – Paediatrics: Child & Youth Health; Professor, The University of Auckland; Paediatrician, Starship Children’s Health, New Zealand. Dr Owen Sinclair, Te Rarawa: Chair, Metro Auckland Immunisation Governance Group, New Zealand. Dr Teuila Percival: Paediatrician, Kidz First Children’s Hospital & Community Health, Counties Manukau District; Honorary Associate Professor, The University of Auckland, New Zealand.

Acknowledgements

Correspondence

Dr Cameron C Grant: Department of Paediatrics: Child and Youth Health, Grafton Campus, Building 507, Room 1016, 22–30 Park Road, Grafton, Auckland, The University of Auckland, Private Bag 92019 Auckland 1142, New Zealand

Correspondence Email

cc.grant@auckland.ac.nz

Competing Interests

Nil.

1. Anglemyer A, McNeill A, DuBray K, et al. Invasive Pneumococcal Disease: Concerning Trends in Serotype 19A Notifications in New Zealand. Clin Infect Dis 2022;74(10):1859-61. doi: https://dx.doi.org/10.1093/cid/ciab766

2. Grant CC, Huang QS, Trenholme A, et al. What can we learn from our 2021 respiratory syncytial virus experience? N Z Med J. 2021;134(1540):7-12.

3. Stats NZ Tatauranga Aotearoa. Births and deaths: Year ended December 2021 (including abridged period life table) Wellington: Stats NZ; 2022 [Available from: https://www.stats.govt.nz/information-releases/births-and-deaths-year-ended-december-2021-including-abridged-period-life-table/ accessed October 26 2022.

4. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respi Viruses 2016;10(5):394-403. doi: https://dx.doi.org/10.1111/irv.12398.

5. Jansen AG, Sanders EA, A VDE, et al. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity? Epidemiol Infect 2008;136(11):1448-54. doi: https://dx.doi.org/10.1017/S0950268807000271

6. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 April 2022-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

7. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 January 2019 -31 December 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

8. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 July 2021-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

9. Grant CC, Chen MH, Bandara DK, et al. Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy. Vaccine 2016;34(11):1379-88. doi: https://dx.doi.org/10.1016/j.vaccine.2016.01.048.

10. Pointon L, Howe AS, Hobbs M, et al. Evidence of suboptimal maternal vaccination coverage in pregnant New Zealand women and increasing inequity over time: A nationwide retrospective cohort study. Vaccine 2022;40(14):2150-60. doi: https://dx.doi.org/10.1016/j.vaccine.2022.02.079.

11. Morton SMB, Atatoa Carr PE, Bandara DK, et al. Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Auckland: University of Auckland, 2010.

12. Parikh SR, Campbell H, Bettinger JA, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect 2020;81(4):483-98. doi: https://dx.doi.org/10.1016/j.jinf.2020.05.079.

13. Arnold R, Galloway Y, McNicholas A, et al. Effectiveness of a vaccination programme for an epidemic of meningococcal B in New Zealand. Vaccine 2011;29(40):7100-6. doi: https://dx.doi.org/10.1016/j.vaccine.2011.06.120.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Ko a tātou tamariki, ngā taonga mo āpōpō

Our children are the treasures of tomorrow

Do we truly treasure our tamariki, our children?

If you had a treasure that required protection against the deadly vaccine-preventable pneumococcal disease, and you had a choice of two vaccines, which one would you choose? One that cost more or one that was cheaper but provided protection against fewer pneumococcal serotypes? Since we did choose this cheaper vaccine, how do you feel now that that we can see, since this choice was made, that the number of pneumococcal serotype 19A cases in young children, and the proportion of pneumococcal isolates that are penicillin-resistant, has increased?[[1]]

And if, in 2021, you had seen that when international borders opened briefly, respiratory viral infections quickly re-entered Aotearoa New Zealand and caused many of your treasured children to be hospitalised,[[2]] and caused some to die,[[3]] how would you plan for 2022 when borders would open more fully? Would you immediately offer your children the influenza vaccine knowing that the influenza virus would be entering Aotearoa New Zealand in 2022, and knowing that influenza infection can then lead onto severe bacterial pneumonia?[[4]] Or would you only offer the influenza vaccine to adults and wait for influenza to arrive, for many of your children to be hospitalised with severe illnesses caused by influenza and bacterial pathogens that influenza enables,[[4,5]] and then offer the influenza vaccine to your children also?

If a schedule of life-saving vaccines were required to be delivered on time to all your treasured children, whilst you were focussing on the vaccine prevention of life-threatening illness in adults, would you stop giving the schedule of life-saving vaccines to your children? How would your children feel if they knew that, in 2022, one-in-three of them were not given all of their infant vaccinations?[[6]] Would they feel treasured?

Knowing that Māori and Pasifika children are at increased risk of vaccine preventable diseases, how would you feel if, in 2022, only 46% of your Māori children and 62% of your Pasifika children at age six months had received all of their infant vaccinations?[[6]] And how would your Māori and Pasifika children feel if they knew that since 2019, while vaccine coverage at age six months had decreased by 12% for your New Zealand European children, it had decreased by 26% for your Māori children and by 19% for your Pasifika children?[[7,8]] Would they feel treasured?

If you knew that fewer than 3% of pregnant women in New Zealand do not intend for their children to receive vaccines,[[9,10]] would you be surprised that, in June 2022, only 67% of children at age six months had received their infant immunisations?[[6]] And, if you knew that pregnant women living in the poorest neighbourhoods had the highest intentions for their children to receive their vaccines,[[11]] would you be surprised if their children had the lowest coverage for infant vaccines?

If you knew that infants in other developed countries, such as the United Kingdom, Ireland and Italy, receive the meningococcal vaccine,[[12]] but not infants in Aotearoa New Zealand, how would you feel? You might remember that this vaccine was available in New Zealand in the past,[[13]] and that because we used it then, other countries now feel confident to include it in their childhood immunisation schedules now.[[12]] But we have decided not to.

Albert Einstein is quoted as saying: “Insanity is doing the same thing over and over and expecting different results”. Having read the preceding paragraphs, would you now agree that Aotearoa New Zealand is systematically failing in its childhood vaccine delivery and needs to do this differently?

It is time Aotearoa New Zealand learnt how to vaccinate all its treasured children and to vaccinate those most at risk of vaccine-preventable diseases first. As a result of COVID-19, we now have a larger and more diverse vaccination workforce and many more strategies for delivering vaccines to those who want them and really need them, but for whom the current healthcare system is incapable of delivering. We need to apply lessons learnt from the COVID-19 vaccine strategy to address the insanity of our childhood vaccine delivery system. But will we?

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Dr Cameron C Grant: Head of Department – Paediatrics: Child & Youth Health; Professor, The University of Auckland; Paediatrician, Starship Children’s Health, New Zealand. Dr Owen Sinclair, Te Rarawa: Chair, Metro Auckland Immunisation Governance Group, New Zealand. Dr Teuila Percival: Paediatrician, Kidz First Children’s Hospital & Community Health, Counties Manukau District; Honorary Associate Professor, The University of Auckland, New Zealand.

Acknowledgements

Correspondence

Dr Cameron C Grant: Department of Paediatrics: Child and Youth Health, Grafton Campus, Building 507, Room 1016, 22–30 Park Road, Grafton, Auckland, The University of Auckland, Private Bag 92019 Auckland 1142, New Zealand

Correspondence Email

cc.grant@auckland.ac.nz

Competing Interests

Nil.

1. Anglemyer A, McNeill A, DuBray K, et al. Invasive Pneumococcal Disease: Concerning Trends in Serotype 19A Notifications in New Zealand. Clin Infect Dis 2022;74(10):1859-61. doi: https://dx.doi.org/10.1093/cid/ciab766

2. Grant CC, Huang QS, Trenholme A, et al. What can we learn from our 2021 respiratory syncytial virus experience? N Z Med J. 2021;134(1540):7-12.

3. Stats NZ Tatauranga Aotearoa. Births and deaths: Year ended December 2021 (including abridged period life table) Wellington: Stats NZ; 2022 [Available from: https://www.stats.govt.nz/information-releases/births-and-deaths-year-ended-december-2021-including-abridged-period-life-table/ accessed October 26 2022.

4. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respi Viruses 2016;10(5):394-403. doi: https://dx.doi.org/10.1111/irv.12398.

5. Jansen AG, Sanders EA, A VDE, et al. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity? Epidemiol Infect 2008;136(11):1448-54. doi: https://dx.doi.org/10.1017/S0950268807000271

6. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 April 2022-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

7. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 January 2019 -31 December 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

8. Ministry of Health. Childhood Immunisation Coverage by milestone - fully immunised - 1 July 2021-30 June 2022. 2022. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data.

9. Grant CC, Chen MH, Bandara DK, et al. Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy. Vaccine 2016;34(11):1379-88. doi: https://dx.doi.org/10.1016/j.vaccine.2016.01.048.

10. Pointon L, Howe AS, Hobbs M, et al. Evidence of suboptimal maternal vaccination coverage in pregnant New Zealand women and increasing inequity over time: A nationwide retrospective cohort study. Vaccine 2022;40(14):2150-60. doi: https://dx.doi.org/10.1016/j.vaccine.2022.02.079.

11. Morton SMB, Atatoa Carr PE, Bandara DK, et al. Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Auckland: University of Auckland, 2010.

12. Parikh SR, Campbell H, Bettinger JA, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect 2020;81(4):483-98. doi: https://dx.doi.org/10.1016/j.jinf.2020.05.079.

13. Arnold R, Galloway Y, McNicholas A, et al. Effectiveness of a vaccination programme for an epidemic of meningococcal B in New Zealand. Vaccine 2011;29(40):7100-6. doi: https://dx.doi.org/10.1016/j.vaccine.2011.06.120.

Contact diana@nzma.org.nz
for the PDF of this article

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