Transcript: Launch of Academy of Science Immunisation App

Subjects: Immunisation

SUZANNE CORY: It's a very important day today. The Questions and Answers on Immunisation Booklet, which you all have on your chairs, has been an outstanding success. It shows that there has been a big hunger out there to actually understand more, especially by young parents, and we thought that we needed to complement this booklet with an app which, of course, for all of those who use tablets, is a much more convenient way of doing it.

Our goal is to increase understanding about immunisation and to just summarise in lay language from the best immunologists in the world, including Sir Gus Nossal and Professor Ian Frazer, how the immune system works, how vaccination works, how vaccines are made, and it includes a great summary of the benefits and risks. Our intent is to inform, not to direct decisions, but I think personally that it's really important that parents truly understand before they make this big decision.

We've been disturbed in Australia to find pockets where immunisation rates have dropped to levels which make it quite dangerous in the community for newborns and the elderly. This is something that we do not want to happen - do not want to increase in Australia. Therefore, the Academy has been concerned to provide this information in an easily digestible and understandable fashion.

So the app is available for Apple and Android tablets. I don't have a tablet but I think I should get one now! And it's available free through Google and Apple by searching Science Q&A. And you'll get two for one because we've also got our climate change Q&A on the same app, so - and that's also been highly informative and useful.

So thank you all for coming. Could I ask Gus to just talk a little bit more about immunisation. Thank you, Gus.

SIR GUS NOSSAL: Thank you very much. I'm thrilled and delighted to be here to help launch this app. I think there's one message above all that I would like to bring forward; I would like to spread the message that we should persuade all parents to have their children immunised.

There's something very funny about vaccines and that is in a curious way they are the prisoners of their own success. Because of vaccines we do, with certain exceptions, really no longer have any first-hand experience of what a real epidemic is. When I was a kid, I got diphtheria. I very nearly died. I was born in 1931, vaccines had just become available and my parents didn't believe in them. I also got a pretty bad dose of whooping cough. I didn't get tetanus, but plenty of people still did.

And, anyhow, then parents were alert to what an epidemic's like because everybody got measles. And whereas with measles in the industrialised countries, deaths are quite rare, but serious complications are not at all uncommon. And in the developing countries measles has a case fatality rate of two to three per cent. Pretty high fatality rate for a disease that everyone gets.

So what's happened is a certain complacency has come into the picture. People say oh, well, these disease really aren’t around anymore so I don't need to get my kid immunised.

Now, what's wrong with that? What's wrong with it is that first of all, if you don't have your kid immunised you leave your kid at risk of any one of these many diseases, including very serious ones like pneumonia and meningitis.

And the second thing is it's just a tiny bit more difficult to catch a hold of if - unless immunisation rates are up there, as they are in Australia, in the 90s, 92, 93 per cent. If they're up there, you get this phenomenon which somewhat infelicitously we term herd immunity. It's a term borrowed from veterinary medicine and that herd immunity simply says when such a big proportion of the population's immunised, the virus or the bacteria no longer has soil in which it can grow. So, curiously enough, the fact that 92 per cent are immunised has a certain protective effect on the eight per cent who aren't, and that's been objectively shown across a number of diseases. So that's what I want to persuade parents of.

Now, a word or two about adverse events: the very worst thing that I as a doctor could do is to pretend that adverse events don't happen. They do happen. Fortunately, the serious adverse events are vanishingly rare. Serious adverse events are far, far rarer than the risks that you run by exposing your child to diseases which do have complications.

The final word, don't forget the third world. In the industrialised countries, we are reasonably on top of the problem, don't be complacent, do immunise the kids, we're reasonably on top of the problem. In the developing countries, infectious diseases are still a very serious threat and it is vital that we extend the hand of friendship and make it possible for the poorer countries to purchase these vaccines.

In 1960 there were far fewer people in the world, but there were 20 million deaths in children under five. Today there's slightly less than seven million deaths in children under five. And if you project that graph down, the death rate - you know by 2025, there will be very few.

Thanks very much.

SUZANNE CORY: Thank you Gus, just to say some words about Immunisation is the President of the Australian Medical Association, Dr Steve Hambleton.

STEVE HAMBLETON: Thank you very much and I'd really like to thank Suzanne Cory for the invitation today and obviously the Walter and Eliza Hall Institute for hosting this event. And thank you for the words of Sir Gus Nossal to remind us about the fact that we need to be honest with the population, we need to talk to them about the benefits of immunisation, and the risks, because we need to be honest and we need to be judged fairly.

Now, there's a lot of good information out there, and we congratulate the Academy of Science for producing this really very good booklet, which has actually contributed significantly to the information that parents can get hold of to actually make the right decision. And I truly believe most parents want to make the right decision. So, there's good information out there, the problem is there's bad information out there.

Where do we go these days to look for information? Well, we go onto the internet, and yes this booklet is not only in hard copy, it's widely available on the internet and it's been really thoroughly utilised. But the other avenues on the internet - we've all got one of these, well I have, most of us have got one of these, which is a tablet, and it's really very pleasing to see the Academy come forward with a product which is using the modern delivery systems to get that information out there.

The AMA was very disturbed by the variation in the amount of immunisation that we saw around - in Australia, and we actually were quite surprised that many of these suburbs were pretty well off, pretty well informed. So, what was the problem?

And we actually believe that when you go onto the internet, when you look up vaccination on the internet, you get misinformation, and you get more misinformation than good information.

We're very, very pleased to say that the - New South Wales recently has ruled that the AVN needs to be honest about what they stand for, the ‘Anti Vaccination Network’ should be honest about what they stand for because they're misleading parents, and that's just simply not good enough.

So we need balanced information, and we need information that's been well researched, that's written in such a way that parents can actually work it through, understand the logic, and it's a prompt to go to their family doctor, to have a conversation about vaccination, to make the right decision. And we've heard from Sir Gus the benefits of immunisation.

We just don't see those epidemics, and we don't see those disturbing images that we all saw, our parents and grandparents saw. We built entire hospitals for polio to treat children who couldn't breathe for polio. For things like tuberculosis which we don't see in this country. If we ask our grandparents about tetanus, they'll all say yes we know someone who died from tetanus.

Nobody's contracted diphtheria in Australia up until a few years ago, a young woman was affected by someone coming back from overseas. Air transport now means that organisms can travel very quickly across borders. We don't have to look very far; Indonesia, our northern neighbour, is having an outbreak of measles as we speak. In Melbourne and in Queensland only last year, or earlier this year, we saw an outbreak of measles. It still happens in our community.

In built up, first world communities we don't see the death rates which you see internationally. But one in 1000 people is going to get encephalitis from an infection with measles. And there's about a 10 to 15 per cent death rate from those people who get encephalitis. There's a very high morbidity rate. We just don't want to see that back in our country.

Measles is one of those very interesting germs. Measles will spread to about 20 others in a susceptible population. Enormously infectious. We worry about the flu, but the average case of flu will spread to two others. Measles will spread to 20. And I understand that we don't realise that. We don't realise how sick those victims can get.

No doctor who's actually seen a case of whooping cough will ever forget an infant in that terrible distress both the infant and the parent show. So these are the benefits from immunisation. Millions of lives have been saved internationally. Parents are trying to do the right thing. The Australian Academy of Science is trying to put that information out there, we can congratulate them for doing that. We thank everyone for coming here today and we certainly recommend to access this information, make that judgement, we need to make sure we immunise our children to keep them safe.

QUESTION: I guess if the evidence of the vaccination is so efficient, and the risk of being unvaccinated is quite high to the rest of the community, why isn't the Government implementing a compulsory vaccination among small children?

SIR GUS NOSSAL: Well for my money, I'm not in favour of compulsion. I am in favour of communication through publicity, and I'm actually in favour of being immunised. Now, there's various ways that you can skin the cat but I think the fact that GPs get a reasonable help now for immunising an infant has helped. Has helped substantially. Some countries require compulsory immunisation before you can go to school. So if you decide to opt out of immunisation, you opt out of school. Except if you get some kind of declaration. I personally would be against legislation.

STEVE HAMBLETON: Well look I'd agree with you. I don't think we want to take away that responsibility of parents to be informed, to make the right decision. We know there are people out there no matter how good the information is, they just won't make that decision to immunise. We've heard about herd immunity.

We need to make sure that we can still manage as a society with that very small number. Now that's a very small number, it's something like less than two per cent of individuals who are true conscientious objectors.

Our problem is the swinging voter. In some areas we've got 10 to 15 per cent of people who are just looking for the right sort of information. That's the opportunity here. Barriers like making it awkward, not impossible.

They're awkward to get into school. If we look internationally, those little barriers actually make a difference. Asking someone to positively decide often means they'll go to their family doctor, they'll have a conversation, or they'll actually look up some reasonable information and say look yes, I will vaccinate. Taking that responsibility away from parents I think is not the right thing to do. We can achieve sufficiently higher vaccination rates to protect all of our children.

And I will say to parents, you vaccinate your children for two reasons. One is to protect them, but also to protect the herd. Similarly, the other parent vaccinates their child not only for their child's sake, but for your child's sake. No vaccine is 100% effective, so we need to take that into consideration to make sure that we vaccinate to protect each other. And I think that is something that's a parental responsibility but we want to support that.

SUZANNE CORY: Having said that, I think it's really quite alarming that we have 27,000 more conscientious objections to immunising children than we did in 1999. So that's why we felt compelled to produce this information so that parents have it readily accessible and that they don't get all their information from the anti-vaccination network as they have seemed to have been doing. I think it's also in thinking about herd immunity, it's important to think about what the level of immunisation is in your immediate community. Not in the whole of Australia. Because if there's a very active set of objectors in a certain community they can put the whole community at risk.

QUESTION: So as troubling as the anti-vaccine movement is in the western world, I think in the developing world where western medicine hasn't necessarily taken quite a toehold, there's a lot more murky information floating around. What do you see is our role and how can we liaise with people on the ground from these communities to make the benefits of immunisation a little clearer?

STEVE HAMBLETON: Well I think we've all got a role in providing information in a culturally appropriate way. I think that's really important that we engage with the local health services, in many cases partner with the local health services, to provide that information. Providing vaccinations out to reasonable prices is really important.

But information that's translated into the appropriate style is really important too. And this document is not a scientific paper, it's

STEVE HAMBLETON: Well the (HPV) vaccination program actually is targeting schools, and of course it's targeting children. Girls and boys, actually, at pre-sexual exposure ages. You know, 12, 13. Really important because the prevalence of HPV is really high. Something like 80 per cent of adults have been exposed. When we talk about STDs we think eight per cent is a high number. Well 80 per cent is a lot higher. So it's almost ubiquitous exposure.

The target group now is those younger girls and boys at school. And we do need to increase the penetration of that vaccine because the rate's moving to get up higher.

For young women and young men in fact, they can voluntarily decide to accept the vaccine. It is of benefit, and certainly the older you are and the more sexual contact you had, the less benefit there is. But it's extraordinarily highly useful vaccine which nearly 100 per cent conversion.

So highly useful. It actually uses the body - when it looks at this vaccine, it actually looks at what looks like actually a live virus particle. The entire envelope is available to stimulate immunity. And it's not surprising, therefore, that it's so potent. But there is information provided for young people who aren't in those programs anymore to pick it up because if they didn't get vaccinated in school it's an absolute benefit. Probably diminishes somewhere, depending on how much sexual exposure there's been. But we often have that conversation in general practice with our patients about whether you need it or not. If you're happily married with the same partner at the age of 40 the answer's probably not much benefit. But it varies.

SIR GUS NOSSAL: There's one other point that we need to make here. I always think the medical researcher's job is never done. It's never over. We can never be satisfied. Because the strands that are comprised in the present two vaccines cover something like about 70 per cent of the cases.

QUESTION: It sounds to me like you've released the book before you release the app, and it sounds like you've been happy with the fair amount of success for that, what sort of response have you had form the book so far, and what new audiences are you hoping to reach with the app?

SUZANNE CORY: I think it's been downloaded hundreds of thousands of times. So - and not just in Australia but overseas as well. I brought along an email that we got at the Academy yesterday, and I thought I'd read it out because I think it's particularly poignant. It's from David McCaffery, and his daughter died, as an infant, of whooping cough at one month of age. And he said to pass on to those involved in creating the app, this message of thanks.

And I quote, ‘congratulations on your continuing good work, we're fully supportive of what you're doing, it's so important that we educate people so that they know how vital it is to build up herd immunity and protect the vulnerable people in our community who are too young or too sick to be immunised. We're very grateful for the work of the Academy.’

And I think that says it all, sums it up. And, as I think of my new granddaughter, I'm very grateful to the immunologists, such as you Gus, and the doctors, such as you Steve, and all of you researchers in this room.  I think that's a very good note to finish on, thank you all for coming.

13 December 2013

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