On a Saturday morning in the sleepy town of Bangalow on the NSW Far North Coast, growers have set out their produce for the weekly farmers’ market in the car park behind the pub.
Wandering among the stalls selling locally grown flowers and vegetables, organic meats and more are Stephanie and Simon Hamlet, a couple from nearby Mullumbimby.
Their four young children, Gabrielle, Chiara, Bazil and Jade, dart around the market chasing each other and looking at the stalls.
They are full of life and energy, and when their mum comes away from one stall with punnets of strawberries, they pounce.
In most parts of Australia, kids like the Hamlets’ would most likely have received all their childhood vaccinations.
But this part of NSW is well known for its low vaccination rates — running at below the 80% mark, compared with the national average of just over 90%.
Simon and Stephanie’s four (pictured below) are among those not immunised. “It was a conscious decision,” explains Simon. “Our concerns were the uncertainty of immunisation and we decided there was a greater risk of a reaction to the immunisation so we didn’t do it.
“We got medical advice and made as much of an informed choice as we could,” Stephanie adds. She says she believes there is mounting evidence “that vaccination causes autism and other tragic consequences”.
Pockets of resistance
Generally, Australia’s vaccination rate is the envy of other countries. For many years, Australia’s childhood vaccination rates have been stable at 91% for one-year-olds and 92% for two-year-olds, says epidemiologist Brynley Hull, from the National Centre for Immunisation Research and Surveillance.
Even the rates for five-year-olds have steadily improved during the past couple of years from 80% to 90%.
But there are pockets throughout the country that buck the trend, including the NSW Northern Rivers, the Sydney suburb of Bondi and the Adelaide Hills. And a raft of pressures on vaccination recently has raised questions whether the rest of Australia could start to look a little bit more like Bangalow.
This concern has been exacerbated recently by the well-publicised measles outbreak in Europe. After three years of historically low measles rates, WHO figures show the number of reported measles cases increased sharply in late 2009. In 2010, 30,639 measles cases were reported in the WHO European Region (consisting of 53 member states), the most since 2006. This figure blew out even further in 2011 to more than 37,000.
Some Australian health experts fear Australia could be next on the measles outbreak hit list.
Falling vaccination rates have been cited as playing a major role in the European measles outbreak, so Australia cannot afford to slip even a little in its vaccination rates.
It seems some parents like Stephanie and Simon Hamlet aren’t too concerned about diseases like measles. They casually mention that their four children have all had whooping cough and measles, although the couple says they were careful to quarantine the children when they were sick.
“They got through it, they weren’t hospitalised,” says Simon. “It wasn’t pleasant but that is the risk you are willing to take when you don’t immunise.”
'Horrified'
As the morning sun warms up the streets of Bangalow, more locals head in to the farmers’ market. I meet Amanda Top (pictured below), a well-dressed young mum pulling a trolley laden with fresh produce. She is also pulling her toddler’s loaded toy trolley, as he is busy hiding behind her back while he eats his croissant.
Amanda lives in Lennox Head with her emergency physician husband and their children, a boy aged three and a girl of five months. When asked about her thoughts on vaccination, her face hardens.
She wants to talk about people who don’t vaccinate their kids. “It’s awful, we’re horrified, it’s disgusting,” she says. “I absolutely vaccinate and I get really worried when I am out sometimes because there are so many people up here who don’t.
“Sixty kids from Lennox Head got whooping cough recently from one kid who was on their bus who wasn’t vaccinated,” she says. “It’s not fair.”
She wonders if some parents have any idea about how serious vaccine-preventable diseases like whooping couch and measles can be, especially on the very young. “Children can suffer brain damage and they can also die from these diseases,” she says.
The WHO estimates that 139,300 people died around the world from measles in 2010 — mostly children under the age of five. This is a massive improvement from pre-immunisation years, when measles caused an average 2.6 million deaths annually.
Dr Sue Page, a Northern Rivers GP and former president of the RDAA says Australia has worked hard to improve vaccination rates. She recalls a time when the town of Nimbin had a vaccination rate hovering around 2% — now it is much closer to the area’s average.
“Our division implemented a vaccination program to raise awareness, provide information and improve access to vaccination,” she says.
“Other divisions have done different things that have also been successful. I think the most important things are access and information.”
These programs have been funded by the Federal Government through the divisions of general practice, while GPs have also had financial incentives through the Practice Incentives Program scheme.
Incentives scrapped
But the vaccination process in Australia took a blow in May when changes to the PIP scheme were announced in the federal budget. This means the General Practice Immunisation Incentive will be scrapped from 1 May 2013.
The decision has been roundly condemned by Australian GPs and in a recent Australian Doctor poll, almost half of respondents said they believed vaccination rates would fall as a result of the cuts.
Although the government will continue payments to practitioners for notification of scheduled immunisations through the Childhood Immunisation Register, many GPs said the loss of PIP money was a blow for practices.
Dr Page says she “would hate to see any GP not vaccinate”.
Although she doubts the PIP payments will prevent GPs from vaccinating kids, she does worry about whether it will impact notification rates.
“I don’t believe they vaccinate because they get paid, but they do the data because they get paid.”
Dr Page thinks some GPs may boycott the register and not submit vaccination details, potentially making data less reliable. She believes this could in turn increase the risk of disease outbreaks as it will be difficult to know actual vaccination rates.
“We need the data to keep flowing or we won’t know where there are problem areas that need attention,” says Dr Page.
Dr Julie Leask, from the National Centre for Immunisation Research and Surveillance, says she is also concerned about changes to the PIP scheme.
“We know that one of the most important things in keeping rates high is making sure GPs are kept up-to-date and can support their patients in staying up-to-date with their vaccinations,” she says.
Having removed the carrot of PIP payments for GPs, the government has also recently changed the incentive payment it gives lower-income parents for vaccinating their children. This has in effect taken the responsibility for encouraging immunisation away from doctors and put it on the shoulders of parents.
In what the government calls a “Strengthening Immunisation” measure, immunisation will be linked to the Family Tax Benefit A Supplement of up to $726 per child each year.
This strategy is designed to increase the proportion of four-year-olds in Australia who are fully immunised, and replaces the Maternity Immunisation Allowance, which will no longer be available after 1 July 2012.
From 1 July, families must have their children (aged one, two and five years) fully immunised (see current vaccination schedule in box) to receive the Family Tax Benefit supplement.
'Conscientious objectors'
However there is an out — parents who are ‘conscientious objectors’ can also receive the payment. They must visit a GP or other vaccination provider to have a conscientious objector’s form signed. The GP is required to declare they have explained the benefits and risks of immunisation, and the parent must also sign a declaration that they understand the risks and potential outcomes from not vaccinating.
Simon and Stephanie Hamlet are conscientious objectors, and not bothered about having to sign a form in order to secure their Family Tax supplement.
“That form is not a big deal; we don’t want to vaccinate our kids so it doesn’t matter to us signing a form,” says Stephanie.
Australia’s strong vaccination record is nonetheless threatened by an adversary — a small, but vocal, anti-vaccination lobby that critics accuse of using scare tactics and subterfuge to disseminate its message.
The Northern Rivers region is home to one of the most active members of this lobby, the Australian Vaccination Network, which claims to support freedom of choice when it comes to immunisation. The group’s website suggests otherwise, even flagging a link between immunisation and autism:
“The link between autism and vaccinations has been discussed in the medical literature since early in the 20th century — before there was even a name for this condition. It had been given various titles, such as post-vaccinal encephalitis, but the description and symptoms described can fit into what we call today — the autistic spectrum. Anyone who thinks that the vaccine–autism link began and ended with Dr Andrew Wakefield needs to do more research. This link has been around for over 100 years now and with a rate today of one child in 88 — up from one child in 10,000 just 20 years ago, it is time to stop obfuscating and start looking at what is causing this epidemic in our children and do something to stop it!”
But there are people working to discredit and even shut down groups such as these — like Stop the Australian Vaccination Network, a Facebook site with some 4000 members. Among those members is Ken McLeod, a former public servant who says the group will not stop until the network is closed down.
He says the network does pose a threat to vaccination rates in Australia, but that its reach is limited.
“There’s a whole bunch of complaints that have gone in to various authorities [about the network],” he says. “We are extremely committed to this.”
Dr Julie Leask says parents who actively oppose vaccination make up about half of those children not vaccinated.
“We need to pay less attention to the anti-vaccination lobby and more to the people who would like to vaccinate but don’t because they have access difficulties," she says.
“Those are the people we need to be giving our attention to.”
She is confident that Australia can ride through these vaccination challenges and is sure that in the long run, rates don’t suffer.
“That’s not going to happen — but we can always do better,” she says.
Back in Bangalow, the Hamlet kids are still scampering around the markets.
Before we part ways, Simon and Stephanie tell me they are hoping someone they know will have chicken pox soon, so they can expose their children to the virus and build up their natural immunity.
What other Bangalow residents and visitors had to say about vaccination.
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"From the information I've read about vaccination, there is a potential health risk for children."
Celia Brooke, Bangalow
"I vaccinate, I've just never thought not to. I've heard that bad things can happen, but I know that's really rare." Kerry Loder, Bangalow, with Sonny, 3.
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None of my family is vaccinated byt I vaccinated
because I guess I felt it was the right thing to do."
Lisa Ryan, Brisbane
"I had infantile paralysis from my first vaccination, but it was not until they gave me my second vaccine and they realised what the problem was. I vaccinated ny t
hree children but I was very nervous about it."
Liz Gray, Goonengerry
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