Background: Even with calls to action and considerable attention, childhood vaccination uptake has declined for a thirteenth consecutive year in England. Understanding the reasons for sub-optimal vaccine uptake is essential in developing appropriate interventions to increase coverage. Scoping work identified that vaccine accessibility was poorly conceptualised and under-investigated as a potential cause of poor uptake with a dominant focus on vaccine hesitancy. This study aimed to explore the potential contribution of vaccine accessibility in driving the pervasive challenge of sub-optimal vaccine uptake.

Methods: A longitudinal cohort study was established in May 2023. Sequential interviews were conducted with 22 parents from the birth of their child approximately four weeks after each vaccination appointment was due. In addition, parents kept dairies which captured appointment correspondence, booking systems, and appointment attendance in-real-time. Data were analysed using temporal thematic analysis.

Results: Four vaccination trajectories were observed collectively referred to as the 4S Vaccination Trajectory Framework: supported (n=9), struggled (n=10), stalled (n=2), and shunned (n=1). Those with a struggled trajectory assumed a driving role in ensuring their child received their vaccinations on time, while those in the stalled trajectory faced challenges securing appointments resulting in delayed vaccination. Which journey parents encountered was highly dependent on the features of the booking system and how their General Practices responded to parents who were late, or forgot, to attend appointments. Parents often had to contend with notable administrative burden or endure adversarial events to get their child vaccinated.

Conclusions: This study reveals the nature of access constraints faced by parents trying to secure vaccination appointments for their children in England. To address declining vaccination coverage, it is vital that accessibility is improved, and services meet parents’ needs. This study deepens our understanding of accessibility issues with the vaccination service and has implications for policy and practice.

Background:
Immunisation coverage for First Nations children living in high income countries (HIC) remains inequitable. The majority of The Organisation for Economic Co-operation and Development (OECD) members have high-income economies, and 18 have First Nations populations. To understand what has proven successful in closing the gap, we aimed to systematically identify approaches to improve childhood (0-5 years) vaccination coverage and timeliness among First Nations populations in HIC who are members of the OECD, and systematically assess the quality of study designs and approaches from a First Nations perspective.

Methods:
A Collaborative Yarning approach underpinned review of First Nations people’s engagement using The Aboriginal and Torres Strait Island Quality Appraisal Tool (QAT) alongside the Effective Public Health Practice Project Quality tool (methodological quality) and a taxonomy of intervention component purposes (to determine the primary component).

Results: Fourteen studies met inclusion criteria (12 quantitative and two qualitative studies). Six studies were conducted in Australia, four in Canada, three in New Zealand and one in the USA. Included studies reported interventions in 6 of the 11 taxonomy categories as their primary purpose. No studies were of high quality from a methodological or cultural point of view. Most approaches for closing the immunisation gap achieved only low-certainty and very few reached recommended population-level coverage. We found the taxonomy categories “To Remind and Recall”, and “To improve service infrastructure” (opportunistic immunisation) were most effective.

Conclusions:
While there is extensive international documentation of immunisation coverage gaps in First Nations populations, we identified a paucity of high quality research on solutions. There is an urgent need for high quality research optimising childhood immunisation coverage and timeliness in partnership with First Nations communities in high-income countries. Results highlight the benefit of access approaches. We posit incorporating the QAT in research with First Nations peoples.

Aboriginal and Torres Strait Islander research:
Sharing of knowledge is essential to First Nation communities. By using Collaborative Yarning, we laid the groundwork for ensuring First Nation Communities benefit and that Aboriginal researcher voices were heard and listened to, thus confirming the process was not influenced by an academic setting shaped by Western epistemologies.

Background

Communicable diseases encompass a large proportion of acute paediatric presentations and admissions to hospital. These include both seasonal respiratory illnesses such as influenza as well as emerging infections such as COVID-19.

Existing surveillance systems for these diseases are often retrospective in nature, require manual data collation and contain one of demographic data or clinical data – but usually not both. We designed the Communicable Disease Platform (CDP) to aggregate dynamic clinical, laboratory and demographic data into a single platform for all communicable disease presentations to The Royal Children’s Hospital (RCH).

Methods

In the pilot phase, the CDP was tested on ten common respiratory infections. Using automated extraction from the hospital electronic medical record, demographic data including age, sex, length of stay for patients with positive laboratory results for each infection were linked with clinical data (ICU admission, use of ventilation, ECMO, vasodilators or inotropes, presence of any secondary infection) in a de-identified aggregated fashion. All data was displayed on a Microsoft PowerBI dashboard.

Results

Pilot phase results yielded data for respiratory pathogens ranging from 2016 to 2025. For each pathogen, trends for positivity rate, positivity rate by hospital admission and total hospital admission trends were trended by week/year. Clinical filters allowed result visualisation or segmentation by age group, type of hospital presentation (including ICU), clinical interventions and severity of disease.

Discussion & Conclusion

The flexibility and adaptability of the CDP allows aggregation and visualisation of historical and dynamic data of any known or emerging communicable disease presentations. It can also be used to describe clinical profiles, disease burden and seasonal peaks to allow for better prediction of outbreaks and patient flow. Future developments combining the CDP with immunisation data and evaluation using machine learning algorithms will allow estimations of both real-world vaccine effectiveness and predictive modelling of respiratory patterns in real-time.

Context
The NSW Health Sepsis Public Awareness Campaign aims to empower people to recognise the symptoms of sepsis, deterioration and obtain urgent medical assistance through a targeted stakeholder engagement approach.
Process

In September 2023, the NSW Urgent Sepsis Expert Advisory Group was assembled, comprising multidisciplinary clinicians across relevant specialty groups. This group facilitated the exploration of strategies for enhancing sepsis care in response to a surge in paediatric sepsis cases.
Learnings from this group, along with extensive consultation with key stakeholders, including Sepsis Australia, the NSW Health Clinical Excellence Commission, NSW Ambulance, healthdirect, the Australian Commission on Safety and Quality in Healthcare and the Royal Australian College of General Practitioners informed the campaign’s development. In partnership, NSW Health ensured the campaign materials aligned with clinical best practices and tailored to the needs of both clinicians and the public.

Analysis
The campaigns educational component targeted the high-risk groups of developing sepsis and priority populations including Aboriginal and Torres Strait Islander people and culturally and linguistically diverse communities. Key messaging highlighted the serious nature of sepsis and empowering the public to ask their doctor ‘could it be sepsis?’ if concerned and sicker than ever before.

Outcomes
This is the first sepsis public education and awareness campaign to be launched in NSW and has run over 2 consecutive years. Through a collaborative effort, a suite of resources were developed, including a website landing page with a public-facing sepsis fact sheet, social media tiles, clinician-led educational videos, and translated materials to reach diverse audiences. Campaign outcomes showed social posts were shared (a total of 34 posts) across a campaign period (17 March to 30 June 2024) and it was seen a total of 1,326,160 times (total impressions). The landing page was viewed 53,071 times. Further results are forthcoming.

Background: The Australian Bureau of Statistics (ABS) presents a nationally consistent framework for the collection and dissemination of data on cultural and linguistic diversity (CALD). While these standards exist, it is not clear if they are being used and applied consistently.
Aim: We aimed to undertake a systematic review to understand what indicators of cultural, ethnic, and linguistic diversity are collected in routinely collected administrative datasets and research studies in Australia, and if the variables collected align with ABS standards.
Methods: We undertook a systematic review of published and grey literature research articles to capture studies of CALD populations in Australia, using three databases (Medline, Embase, CINAHL), for the period 1 January 2013 to 31 March 2024. A grey literature search for the same time-period was undertaken using Google Advanced Search and Dimensions, to capture government reports and documents.
Results: Initial search yielded 1843 articles. After removal of 659 duplicates, 1184 titles and abstracts were screened. 810 irrelevant articles were excluded, and 374 articles were screened for eligibility. 169 articles were eligible for the data extraction; 97 studies used routinely collected health datasets and a further 72 studies used data specifically collected for research purposes. ‘Country of birth’ was the most common variable collected (n=41, 42% in routinely collected datasets, n=22, 30% in research studies). A combination of ‘Country of birth’ and ‘language spoken at home’ was the second most common variables used in research studies to define CALD status. Data on ‘proficiency in spoken English’ was not collected routinely. Five articles, using routinely collected datasets, used ‘Interpreter required’, as proxy for ‘proficiency in spoken English’ (n=5, 9%). The most common utilisation of CALD variables was to determine epidemiological trends, however there are opportunities for wider application of CALD variables and alignments with ABS recommended standards.
Conclusions: There was significant inconsistency in CALD variables collection in health research studies which did not align with the ABS standards. No studies included all the ABS recommended standards.
Implications: Not including appropriate indicators while collecting CALD data can underestimate the disease burden and hence misinform health policies and interventions for CALD communities.

Achieving and maintaining high immunisation coverage is critical to protecting public health and preventing disease outbreaks. Although progress has been made, coverage rates still frequently fall short of strategic targets.

Digital technology offers an opportunity to revolutionise how immunisation strategies are executed, making vaccination program delivery more efficient, equitable, and responsive to emerging challenges.

Vitavo has demonstrated technology's impact on increasing uptake:
• 61.2% uptake of influenza vaccine in children under 5yrs (Australian average in 2023 was 16.8%)
• 93% average ATSI uptake of MenB (3 doses)
• 97% average ATSI uptake of HepA (2 doses)
• Up to 23% increase in school vaccination uptake

Technology can drive even greater impact. This presentation covers:

• The biggest mistakes health departments and immunisation providers make when going digital
• Five practical ways technology can be used to implement State and National Immunisation Strategies:

1. School Immunisation Programs: A highly underutilised delivery model which may also provide the solution to shrinking state budgets and rising operational costs.

2. Automated communications: Can be used to deliver promotional education campaigns, recalls and eligibility notifications needed to improve access and uptake of vaccinations for all Australians. Used to drive highly targeted campaigns and education for medically at-risk, maternal, indigenous, linguistically diverse groups and more. Ultimately ensuring people get the right information, at the right time, via the right delivery communication method.

3. Real-time data: Inform strategic decision-making and identify gaps with real-time data relating to coverage rates, at-risk groups, and eligibility reports. Data-driven insights support more effective policy and program delivery decision-making, with significantly enhanced data beyond what AIR provides.

4. Hospitals and newborn vaccinations: Could be the key to solving declining childhood vaccination coverage rates.

5. Community programs: Leverage technology to streamline delivery, reduce costs, enhance public health, aid outbreak response, ease GP workloads, and lower hospitalisation rates.