In July 2024, Grattan Institute shared a report on the importance of GPs in providing vaccination services. The authors, Peter Breadon and Anika Stobart, call for better government support for these “trusted experts” in delivering this service, such as increased investment or better data. Although there are other barriers to vaccination, Breadon and Stobart describe the role of GPs in closing the vaccination gap as “clearly crucial”. Their report presents specific recommendations to improve vaccination rates for GP patients, suggesting that the government should “level the playing field”.
Differing vaccination rates
“GPs are the foundation of Australia’s healthcare system. As well as diagnosing and treating many conditions, GPs give advice and treatment to prevent problems or stop them getting worse. This includes ensuring patients are up to date with their recommended vaccinations.”
The report begins by identifying a range in GP patient vaccination rates, with some GPs having “very low” adult vaccination rates and others exceeding expectations. These rates range from a two-fold difference for flu to a 13-fold difference for pneumococcal. The lowest coverage is linked to “disadvantaged areas”, “culturally and linguistically diverse backgrounds”, and “residential aged care”. This is concerning as these groups are “often” at “greater risk of severe illness”.
“Structural barriers to vaccination are often to blame for low vaccination, not individual, or cultural, attitudes towards vaccines.”
To determine variation in adult vaccination rates and which GPs might need “more targeted support”, the authors used data at patient and GP level. For COVID vaccination, the bottom 5% of GPs (around 1,600) had only 16% of their patients aged 65 and older up to date, less than one third of the average. Flu vaccination saw a two-fold difference, with GPs with lowest flu coverage having only 43% of their patients vaccinated compared to 90% for highest flu coverage.
Shingles had a four-fold difference, ranging from 5% to 22% on average; the top 5% had 85% of their patients up to date. However, pneumococcal had the “biggest disparity”. The bottom 5% of GPs had only 6% of their patients vaccinated, compared to the top 5% who had 82% of their patients vaccinated. This was a 13-fold difference.
“While some variation is inevitable, these differences are unacceptably large, especially for COVID and pneumococcal. They suggest the system is failing to give everyone good access to potentially life-saving preventative healthcare.”
Key barriers
The report identifies an “imbalance” in the health system, finding that “Australians who are more vulnerable to disease are less likely to get the high-quality, preventive care they need”. Factors such as proficiency in English, where someone lives, or highest level of education attained, have a “big effect”. For example, people who speak a language other than English at home or “do not speak English proficiently”, are “much less likely” to be up to date with vaccinations. People born in North Africa and the Middle East were between 15 and 25% less likely to be vaccinated than people born in Australia, and being born overseas was “nearly always associated with lower vaccination”.
“These low vaccination rates could be due to a range of factors including discrimination, language barriers, lower health literacy, or higher rates of vaccine hesitancy. But because vaccination is lower for virtually all non-English language groups, and for migrants from almost all international regions, it is clear that the problem is not just about the beliefs or preferences of any specific cultural group.”
Other groups are also less likely to be vaccinated, including “older people with higher rates of economic disadvantage” and people with “lower levels of education”. Although people from “disadvantaged areas” suffer greater rates of chronic disease and are “more than twice as likely to die from potentially preventable causes”, people in “outer regional and remote areas” are less likely to be vaccinated.
“Groups who need healthcare more having a greater risk of missing out is a systemic problem that goes well beyond vaccination”.
People in aged care are also at “significant risk” of severe illness and death from disease, but their vaccination rates are “far too low”. For example, only 38% of aged care residents were up to date with COVID vaccinations in June 2024. Almost 100 aged care facilitates had less than 10% of residents vaccinated against COVID in a year, and a quarter of facilities have “less than half” of their residents vaccinated. These rates are “far below” those of “similar countries” – the authors refer to Ireland and England as examples.
Another trend is that people who visit a GP “frequently, regularly, or who visit more expensive GPs, are more likely to be vaccinated”. People who visit a GP “frequently” are up to 27% more likely to be vaccinated than those who don’t, and seeing a GP who charges more “increases your chances of being vaccinated” by up to 17%. While the report highlights a “range of barriers” to vaccination and recognises that they demand “structural changes to healthcare”, it suggests that “some” differences in GP vaccination rates could be attributed to differences in GP practices.
GP practices
Despite accounting for a “wide range” of barriers to vaccination, the report found that some GPs still have lower rates than might be expected. The authors infer that “other factors” may be contributing. These might include the effects of the primary care funding model, which has caused GPs to compress “increasingly complex care” into appointments that average around 15 minutes. They are “under pressure” to complete appointments quickly and “skip” preventive healthcare. Therefore, they may find it hard to make time for patients who are hesitant about vaccination, call in interpreters, or handover to a nurse (if there is one), to enable patients to get vaccinated.
Funding and regulatory barriers also mean that GPs might have “less support from a broader team”, such as nurses or allied health professionals. Thus, explaining vaccine risks and benefits or countering misinformation “often falls on the GP alone”. They also might have “different levels of focus” on vaccination; an Australian study found that GPs only initiate discussions about vaccinations in around 10% of consultations. There is also the possibility that GPs are “unaware of the latest vaccination information” as the guidance is “unclear and changing”. Finally, they may not “immediately” have information on a patient’s vaccination history on their software programmes.
What should be done?
“Australia’s health system can only get better and fairer if governments measure care and outcomes and strive to improve them at every level, using funding, data, and focused improvement support.”
A key concern for the authors is that GP clinics should be able to “choose a funding model” that “supports team care” and enables GPs to spend time with complex patients by combining appointment fees with a budget that is based on each patient’s level of need. This “blended” funding model is “common in other countries” and has been introduced by the federal government for some patients through “MyMedicare”. It should be expanded to other patients to increase funding for “older, poorer, and sicker patients”.
“This funding based on need not speed would give GPs the opportunity to provide preventive care to the patients who need it most.”
GPs should also be supported with “better information” on how their patient vaccination rates compare to their peers. The federal government could give Primary Health Networks data to share with GPs, even extending to pharmacies. As Primary Health Networks are “responsible for improving primary care”, they should also get new funding to “expand their work supporting GP clinics to boost vaccination”.
The authors emphasise that efforts to improve vaccination rates “cannot be one-size-fits-all” but should respond to different barriers with specific support. Breadon comments that “Australia urgently needs to lift its vaccination game”.
“Our report shows that the system is failing to give every Australian good access to potentially life-saving preventive healthcare.”
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