Conducting influenza vaccination in schools could significantly reduce Australia’s annual influenza burden
George Milne, Hannah Moore, Chris Blyth, Ben Cowling, Sheena Sullivan

Background Australia’s 2025 influenza season resulted in over 50% more deaths than previously, continuing beyond the winter peak, e.g., 573 reported cases in WA in December. Funding for free flu vaccination is limited, and influenza vaccination rates remain stubbornly lower than needed. Our influenza vaccination modelling study conducted for the Commonwealth DoH highlighted the benefit of increasing vaccination rates in those aged 5-17 years, offering significant indirect protection to other age groups. Live Attenuated Influenza Vaccines delivered in schools may address Australia’s low vaccination rates and record high case numbers.
Methods Using individual-based transmission models of Newcastle, we evaluated 61 increased vaccination strategies, including LAIV vaccines for ages 3-17. These highly-detailed simulation models identify all individuals within a community using census data, their ages, household structure, location, schools, workplaces to capture movement between and potential virus transmission. Resulting infections were translated to cases, hospitalisations and deaths using historical health burden data. Effectiveness was quantified as ratio of burden reduction per 100,000 extra doses.
Key Results Increasing QIV vaccination in ages 5-17 from 9% to 20% was highly effective, reducing hospitalisations and deaths by ~33%. Given lower VE of LAIV (48% vs 67% QIV), 40% LAIV coverage is needed to reduce hospitalisations/deaths by ~47%. Recent FluMist-based studies suggest higher LAIV efficacy, from 46% to 64%, suggesting better direct protection in children/adolescents and consequential wider indirect protection to others.
Conclusions LAIV coverage in ages 5-17 greater than 30% may be feasible when administered in schools. This vaccines-to-people strategy, and indirect protection offered by vaccinating these high-transmitter ages, may allow influenza immunisation rates to be raised to levels which will significantly reduce Australia’s influenza health burden.

Background and Aim

Childhood vaccination rates in NSW have gradually declined since the COVID 19 pandemic, despite continued high awareness and accessibility of immunisation services. Although overall coverage remains comparatively strong, emerging hesitancy and declining urgency highlight the need for renewed behaviour change communication.

Methods and Analysis

Formative research was undertaken to explore the drivers of vaccine hesitancy and parental attitudes. Findings indicated that discourse had reshaped parental risk–benefit assessments, contributing to reduced urgency and heightened caution. Rather than rejecting vaccination outright, many parents exhibit decisional ambivalence—delaying, deferring, or deprioritising timely vaccination. The research also identified inconsistent experiences with healthcare providers; where clinical reassurance was insufficient, many parents relied on peer networks and online communities for decision making support.

Four creative concepts were developed and tested across a range of target audiences. The concept ‘Kids will be kids’ performed strongest, demonstrating high emotional resonance, clarity and motivational impact. Behavioural science principles informed the final design.

Outcomes

The campaign seeks to build trust, normalise childhood vaccination and position it as the default health behaviour for parents and carers and pregnant women. Key components include targeted advertising, and a new digital tool enabling personalised vaccination schedules with the ability to add reminders to the caregiver’s calendar. Creative materials were culturally adapted for Aboriginal and CALD audiences. Testing confirmed strong comprehension, relevance and motivational impact across all audiences.

Conclusion and Future Actions

This campaign forms the foundation for a longer-term approach that can be developed year on year. This iteration will run February–June 2026, with evaluation including media metrics, website analytics and immunisation data.
As this is a new campaign, further information will be available closer to the time.

Background and Aim:
Amid growing workforce shortages and increasing pressure on primary healthcare systems, Village Health Worker (VHW) programs serve as critical community-based mechanisms for delivering essential healthcare services in health resource-limited settings. Although VHW programs are widely implemented across many low- and middle-income countries (LMICs), their impact on routine childhood immunisation uptake has not been synthesised at the global level. To address this gap, we mapped and described the available evidence on the impact of VHW programs on routine childhood immunisation in LMICs.

Methods and Analysis:
We conducted a scoping review of English-language literature published from 2010 onwards, searching MEDLINE, EMBASE, Global Health, and Google Scholar. MedRxiv and other grey literature sources were also screened to identify relevant pre-print or unpublished articles. Searches identified 2,447 records, with 42 studies meeting eligibility criteria. Included studies were undertaken in LMICs and reported on the impact of a VHW program on routine childhood immunisation outcomes. Data were extracted and analysed using descriptive numerical summary and thematic analysis to identify common program strategies and reported impacts.

Outcomes:
Impactful VHW programs employed diverse strategies, often in combination, to improve immunisation uptake. These included service integration, community engagement, communication training, vaccine education, mobile technology, and performance-based incentives. Seventy-four per cent of included studies reported improvements in immunisation coverage, timeliness, completeness and/or uptake. Programs that applied multiple complementary strategies and leveraged trusted relationships between VHWs and communities reported more positive outcomes.

Conclusion and Future Actions:
VHW programs represent an effective, community-centred approach to addressing persistent immunisation inequities. However, there is considerable heterogeneity in settings and community needs, and program success is therefore highly context dependent. Future programs should prioritise contextually informed design, multi-strategy implementation, and robust evaluation to strengthen community–health system linkages and support sustainable improvements in routine childhood immunisation coverage.

Background and Aim
Two gaps persist in literature on vaccine mandates: 1) whether/how they are implemented and 2) how design and/or implementation responds to population variations. These issues were pertinent to formulating and executing policy responses during the COVID-19 pandemic. Senior health officials faced complex challenges deriving from the characteristics, societal norms, and values of their populations; governance structures; and geopolitical dynamics. Possessing strong understandings of prevention measures appropriate for their populations, not all could design policies accordingly. This paper compares three novel cases with similar COVID vaccine mandates requiring healthcare workers to be vaccinated and (for two cases) also requiring vaccination for hospitality and leisure venues.

Method and Analysis
The French territory of Guiana was chosen for its distinct demography. Guiana is contrasted with two Australian territories of broadly similar population size (under 500K) with distinct demographics. The Northern Territory (NT) is, like Guiana, remote and disadvantaged, with 25% First Nations. The Australian Capital Territory (ACT) differs from the national profile in being home to many highly educated and “vaccine compliant” bureaucrats, academics, and professionals. Across the three cases, 31 key informants involved in COVID-19 vaccine mandate policymaking and/or implementation were recruited and interviewed, with qualitative data analysed abductively in NVivo.

Outcomes
ACT and NT authorities utilised available governance structures to design and implement vaccine mandates with local populations in mind. Each implemented the national requirement for healthcare workers differently, and the ACT eschewed public space mandates. Meanwhile, facing top-down national policies, Guiana officials used “administrative creativity” (West and Berman 1997) for “compliant non-compliance” and did not implement policies as intended.

Conclusion and Future actions
Democratic local governance enables coherent policy design and implementation. In exploring how policy actors respond without these structural capacities, the paper sheds light on mandate non-implementation and how senior leaders exercise discretion.

Background and aim: COVID-19 vaccination during pregnancy was routinely recommended in Australia from June 2021, with a booster program for eligible people commencing November 2021. Changing epidemiology means that since August 2022, people previously vaccinated are no longer routinely recommended a dose in pregnancy. In this study we described the characteristics of people eligible to receive COVID-19 vaccination during pregnancy in NSW in 2022.

Methods and analysis: We linked data from the NSW Perinatal Data Collection (PDC) and the Australian Immunisation Register (AIR). We classified people giving birth in 2022 (PDC) according to their COVID-19 vaccine status based on linked AIR records. Among those eligible for COVID-19 vaccination during pregnancy, we examined demographic and other factors as reported in the PDC.

Outcomes: Among 90,182 people who delivered in NSW in 2022, 7,029 (8%) were considered fully vaccinated prior to pregnancy (≥3 COVID-19 vaccines), leaving 83,153 eligible for vaccination during pregnancy. Nearly two thirds (51,610, 62%) received at least one dose during pregnancy, while 17,941 (22%) received at least one dose before but none during pregnancy and 13,602 (16%) received no COVID-19 vaccines before or during. Eligible non-recipients (n=31,543) had a lower mean age than recipients (30y vs 32y). 29% of non-recipients resided in highly disadvantaged socioeconomic areas, compared with 19% of those fully vaccinated by delivery. Recipients of COVID-19 vaccines were more likely to receive influenza and pertussis vaccination during pregnancy (influenza 51% vs 40%; pertussis 82% vs 69%) .

Conclusion and future actions: Similar to studies of influenza and pertussis vaccination during pregnancy, our findings suggest that uptake of COVID-19 vaccination during pregnancy was related to indicators of relative socio-economic disadvantage and receipt of other vaccines during pregnancy.

Background and Aim
Immunisation programs in the Southeast Asia and Pacific regions face the persistent challenge of reaching every person with life-saving vaccines. Achieving equitable immunisation and vaccine delivery outcomes requires consideration of the gendered, disability-related and social factors that shape access and trust in health services. Despite countries’ commitments to equity, systemic barriers continue to exclude specific populations. Gendered caregiving roles, disability-related stigma and inaccessibility, geographic isolation, language diversity, and gaps in health data prevent women, young people, people with disabilities, and remote communities from accessing services. Through the Australian Government–funded RISE2 program managed by the National Centre for Immunisation Research and Surveillance (NCIRS), with project partners from the Australian Regional Immunisation Alliance (ARIA), Gender Equality, Disability Equity and Rights, and Social Inclusion (GEDSI) analyses were conducted across immunisation, surveillance and social behavioural factors activities in Fiji, Papua New Guinea, Timor-Leste, Solomon Islands and Laos. The aim was to identify why inequities persist and to implement practical, context-appropriate strategies that strengthen inclusion and improve vaccination coverage for all.

Methods & Analysis
NCIRS employed a participatory, multi‑country approach. The analysis consolidated findings from GEDSI assessments undertaken in each partner country. Methods included literature reviews, key informant interviews, and focus group discussions with diverse stakeholders, such as women's rights organisations and organisations of persons with disabilities. This process enabled the identification of recurrent barriers limiting equitable access to immunisation and surveillance services. In response, RISE‑2 partners co-designed and implemented feasible strategies tailored to each context. These included developing inclusive communication materials, deploying disability-aware, mixed-gender field teams, establishing mobile and community-based outreach, creating tailored consent processes for low-literacy caregivers, and trialling disaggregated data-collection tools, such as the Washington Group Questions on disability. NCIRS also embedded GEDSI systemically through mandatory program-wide action plans, partner coaching, safeguarding prompts, and the development of the NCIRS GEDSI Guidance Note.

Outcomes
The integrated GEDSI approach, supported by the GEDSI Guidance Note and Tool, tailored coaching calls, and country‑specific action plans, strengthened GEDSI integration into ARIA RISE-2 projects. Project partners used the tools to identify context‑specific barriers and design feasible actions, which were then refined and monitored through coaching sessions. This participatory process guided partners to adopt more inclusive outreach and communication to improve access for previously under-reached groups. For example, applying the Washington Group Questions revealed higher-than-anticipated disability prevalence across several sites, prompting adjustments to service delivery. Strengthened safeguarding measures and co‑design processes ensured that interventions were not only accessible but also culturally safe and community‑owned.

Conclusion and Future Actions
RISE2 partners implemented feasible, context-appropriate strategies that improved equity in practice. These included participatory co-design with women’s organisations and organisations of persons with disabilities; inclusive communication materials; disability-aware and mixed gender field teams; mobile and community-based outreach; tailored consent processes for low-literacy caregivers; and the introduction of disaggregated data tools such as the Washington Group Questions. By addressing GEDSI-related barriers, countries can strengthen immunisation programs and ensure that everyone is protected. This presentation shares lessons from these approaches, demonstrating how integrating GEDSI strengthens immunisation system performance, builds trust, and supports resilient, inclusive public health.

Background and Aim: The Vietnamese has committed to introducing human papillomavirus (HPV) vaccination into the National Expanded Immunization Program from 2026. To inform effective national implementation, we conducted a review of existing evidence on HPV vaccination coverage, barriers, facilitators, and delivery experiences in Vietnam.

Methods: We searched PubMed, Embase, national health surveys databases for published studies reporting on HPV vaccination in Vietnam. Eligible studies included data on HPV vaccination coverage, uptake determinants, and implementation experiences between 2010 and 2025.

Outcomes: Nationally, HPV vaccination coverage among women aged 15–29 years was of 12.0%. The mean age at first dose was 19.2 years and at last dose was 20.0 years, indicating that vaccination often occurs after the recommended early adolescent period. Limited knowledge and awareness of HPV and cervical cancer prevention were the most consistently reported barriers to vaccine uptake. Among individuals aware of the HPV vaccine, high cost was the primary reason for remaining unvaccinated, cited by 50% - 75% of respondents.
Rural populations experienced greater financial barrier but demonstrated higher acceptability of vaccination. In contrast, urban populations reported greater affordability but lower willingness to vaccinate. Vaccination decisions were typically made jointly by parents and adolescents, following consultation with friends, family members, health workers, and community opinion leaders. Adolescents’ decisions were influenced by perceived sexual activity status, whereas many parents, particularly girls, did not perceive their teenage children to be at risk. Several research gaps were identified, including limited evidence on male vaccination and public-sector implementation strategies.

Conclusion and Future actions: HPV vaccination coverage in Vietnam remains low, with substantial financial, knowledge, and sociocultural barriers. As Vietnam prepares for national introduction of HPV vaccination in 2026, improving affordability, strengthening public awareness, and engaging trusted community stakeholders will be essential to achieving high and equitable coverage.

Background and Aim

Vietnam’s central government maintained that COVID-19 vaccination was voluntary, but vaccine mandates emerged at sectoral and subnational levels. This paper investigates why, revealing the reasons and conditions that made these mandates both acceptable and practicable.

Method and Analysis

This study applied qualitative research methods via extensive document analysis. Documents were collected from the central government, ministries, subnational authorities, and relevant agencies. Content analysis was employed to systematically examine COVID-19-related regulatory documents and reports, ensuring objective identification of policy messages and substantive content. Interpretation adopted a hermeneutic approach, situating documents within their social, institutional, and historical contexts to understand the rationale and significance of policy decisions. We developed a structured coding protocol based on the Multiple Streams Framework, with categories derived from the three streams (problem, policy, politics). Emerging themes, interpretations, and instances of ambiguity were regularly discussed between the authors to clarify coding decisions, refine thematic boundaries, and ensure a shared understanding of key concepts.

Outcomes

Vietnam’s mandates arose from the effective coupling of the three streams: problem, policy, and politics. In the problem stream, insufficient community immunity, negative feedback from macro policies, and pressure from the central government posed challenges for sectoral and subnational policymakers. Within the policy stream, vaccine mandates offered a feasible and politically viable solution. The politics stream demonstrates that political leadership and determination both facilitated and exerted pressure for the adoption of vaccine mandates. A strong decentralized approach to pandemic responses granted substantial autonomy to the ministries and subnational governments, opening a window of opportunity for them to mandate despite the national position of voluntarism.

Conclusion and Future actions

Vietnam’s vaccine policy reflects a whole-of-government approach, with the mandatory vaccination policy emerging from the interaction of institutional hierarchies, functional responsibilities, and broader socio-political pressures. The study calls for further research into policymaking during crises, suggesting the use of adaptive public policy theories and multiple methods to better understand the diverse and complex nature of policy adoption worldwide.

Background and Aim:
Australia maintains strong vaccination policy frameworks and supply systems; however, gaps remain between vaccination intent and delivery capacity. Workforce pressures within general practice and limited public health unit resources constrain the ability to identify and reach under-vaccinated populations at scale. These challenges were highlighted by the need to rapidly distribute measles-mumps-rubella vaccination across multiple Victorian public health units, including regional and rural communities, to address adult immunity gaps among those aged 20–59 years. A community pharmacy immunisation workforce exists but remains under-utilised in coordinated public health responses. This project aimed to design and implement a scalable, pharmacy-integrated delivery model to bridge the gap between vaccination policy intent and execution.

Methods and Analysis:
A multi-sector implementation model was developed across five Victorian public health units, integrating surveillance insights, digital voucher systems, and community pharmacy vaccination infrastructure. Approximately 500 pharmacies were mobilised and supported through a central coordination framework providing standardised workflows, governance processes, workforce training, and real-time reporting capability. A digital eligibility platform enabled individuals to enter their postcode to determine eligibility and identify their nearest participating provider, linking population identification to vaccination access.

Outcomes:
The initiative established an implementation infrastructure capable of reaching most of the Victorian population. It strengthened collaboration between public health units and primary care providers, mobilised an immunisation workforce, and created a scalable mechanism to translate vaccination policy into delivery. Early indicators include strong endorsement, high pharmacy participation, and readiness for program launch.

Conclusion and Future Actions:
This first statewide implementation of a coordinated pharmacy-integrated vaccination delivery model demonstrates how mobilising community immunisation infrastructure can expand system capacity. The program provides a proof-of-concept for bridging gaps between vaccination policy intent and execution. Future evaluation will assess uptake, equity of access, and applicability across broader immunisation programs and public health priorities.

Background and Aim
Population ageing in New South Wales (NSW) is increasing pressure on healthcare systems, particularly due to vaccine-preventable diseases such as influenza, pneumococcal disease, and COVID-19. Adults aged 65 years and older experience higher rates of hospitalisation, severe complications, and mortality from communicable diseases, contributing substantially to healthcare expenditure. Although vaccination and preventive health programs are recognised as cost-effective public health strategies, evidence synthesising their economic impact within the NSW context remains limited. This systematic review aims to evaluate the impact of preventive health and vaccination programs on healthcare utilisation and expenditure among older adults in NSW and comparable high-income settings.

Methods and Analysis
This review follows PRISMA guidelines. Peer-reviewed and grey literature published between 2010 and 2025 were identified through MEDLINE, Scopus, Embase, Web of Science, and Australian policy databases. Inclusion criteria encompassed economic evaluations, cost-effectiveness analyses, and population-based studies assessing vaccination or communicable disease prevention programs targeting adults aged ≥65 years. Methodological quality was appraised using CASP and CHEERS frameworks. A narrative synthesis examined impacts on hospital admissions, emergency department presentations, length of stay, and direct healthcare costs.

Outcomes
Evidence indicates that influenza and pneumococcal vaccination programs are associated with reduced hospitalisations, shorter lengths of stay, and lower acute care expenditure among older adults. Cost-effectiveness improves when vaccination coverage exceeds recommended thresholds and when outreach strategies target high-risk groups. However, disparities in vaccine uptake persist among socioeconomically disadvantaged and culturally diverse populations in NSW.

Conclusion and Future actions
Strengthening equitable vaccine delivery, expanding targeted outreach initiatives, and embedding routine economic evaluation into immunisation planning are essential to reduce preventable disease burden and sustain health system efficiency in an ageing population