Policies, practices, and future directions in the provision of immunisation services to newly arrived refugees in Australia

Refugees are at increased risk of being under-immunised due to a range of factors associated with fragile public health systems and limited access to basic services in their country of origin and while in exile. It is unlikely that a new arrival will be fully immunised according to Australia’s National Immunisation Program (NIP). While a few studies examine the underlying causes of under-immunisation from the refugees’ perspective, little research explores the overarching health system and provider-specific issues that may contribute to under-immunisation in this group. Based on the premise of equity, refugees should be immunised equivalent to Australian-born residents of the same age. This thesis examines the policies and practices with regards to immunising refugees in Australia with the aim of advocating and informing evidence-based policy and practice changes to improve vaccine coverage for refugees. Immunisation policies for refugees across all jurisdictions in Australia were analysed to identify gaps and opportunities for improvement in future policy developments. From a policy perspective, the key issues identified included a dissonance between national and jurisdictional policies and significant gaps in funding and mechanisms to monitor immunisation coverage of this group. In-depth interviews were conducted with key immunisation stakeholders across Australia to gain a rich understanding of the barriers and facilitators impacting service delivery; and strategies for enhancing vaccine uptake among refugees. Key themes arising from this research were need for training on refugee-specific immunisation needs among general practitioners and clarity of roles and responsibilities for catch-up, both impediments to service delivery. The final component of this doctoral research was the development of an online training program targeting Australian general practitioners informed by data gathered collectively from the literature review, interviews and policy review. This thesis established a clear need for a national strategy for refugees to ensure there is consistency and improved immunisation coverage among refugees across Australia. This research has identified the need for strategies including improved data collection nationally, improved integration between key stakeholders in service delivery, increased guidance and support for general practitioners on catch-up vaccine delivery and universal funding for vaccines for refugees of all ages to ensure equitable access