Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005

Appendix 5. Government funding of national immunisation programs in Australia

Disclaimer: This is the fourth report on vaccine preventable disease and vaccination coverage in Australia, and is produced by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases and the Australian Institute of Health and Welfare on behalf of the Australian Government Department of Health and Ageing published as a supplement to the Communicable Diseases Intelligence journal Volume 31, June 2007.

Page last updated: 20 July 2007

Prior to 1988, the Commonwealth provided childhood vaccines to states and territories for distribution to providers in the public sector. During the same time, live attenuated vaccines such as oral polio vaccine (OPV) and measles vaccine were provided to private practitioners, although it is not certain that this occurred in all states and territories. Private practitioners who provided vaccination services were required to issue prescriptions for the supply of inactivated vaccines, such as DTPw, by a pharmacist.

In July 1988, the Commonwealth made a decision to withdraw from the direct provision of funding to purchase childhood vaccines, and instead increased funding provided to states and territories as part of the Financial Assistance Grants (FAGs) and the Hospital Funding Grants (HFGs). The increase in funding was equivalent to the level of immunisation activity in each jurisdiction in 1988.

As there were increases in vaccination activity above the 1988 levels, states and territories expressed concern about the level of funding provided via the FAGs/HFGs. Details of the funding arrangements were also interpreted differently by the Commonwealth and each state and territory, leading to variations in implementation of immunisation programs and uncoordinated and fragmented service delivery.

In April 1993, the National Health and Medical Research Council (NHMRC) reported on Australia’s immunisation programs and made recommendations concerning a National Immunisation Strategy (NIS). The NHMRC Report identified a number of factors contributing to poor immunisation coverage and the rising incidence of vaccine preventable diseases in Australian children. These included the lack of a coordinated scheme for the provision of vaccines, and the wide variation in prices which the states and territories paid for vaccines, with the smaller jurisdictions paying higher prices. The Strategy recommended that the Australian Health Ministers’ Advisory Council (AHMAC) consider vaccine funding arrangements.

In 1992, the first Haemophilus influenzae type b (Hib) vaccine was approved for use in children aged 18 months and older. In January 1993, vaccines approved for use in younger children became available. As these were new vaccines, no funding was available within existing arrangements for purchase by states and territories. In July 1993, the Commonwealth provided funds to states and territories for Hib vaccines.

In 1994, the Commonwealth Government agreed to fund the purchase of a number of childhood vaccines (DTP, MMR, OPV) via Specific Purpose Payments (SPPs) to states and territories. Commonwealth funding was conditional on vaccines being provided to all public and private immunisation providers, including medical practitioners, and was formalised in bilateral agreements with each state and territory.

From 1997/1998 to 2003/2004, funding for some vaccines was included in the Public Health Outcome Funding Agreements (PHOFAs). However, a number of vaccines continued to be funded via FAGs (OPV doses 1, 2, 3 and 4 and MMR dose 1) and HFGs (ADT).

In 1997, the NHMRC recommended that the diphtheria-tetanus-acellular pertussis vaccine (DTPa) be used for the fourth and fifth doses of DTP vaccination. These became funded nationally in September 1997.

The 1998/1999 Commonwealth Budget included an initiative to streamline all childhood vaccine funding from 1999 to 2000, with funding for all childhood vaccines on the Australian Standard Vaccination Schedule (ASVS) (up to 15 years of age) being included in the PHOFAs. In the same financial year, pneumococcal vaccine for Indigenous Australians and influenza vaccine for those aged over 65 years were also funded. Existing vaccine funding through the FAGs and HFGs were not adjusted, thereby freeing up state and territory resources to purchase non-Commonwealth funded vaccines.

Federal funding to use DTPa for all five infant vaccinations began in February 1999, immediately after the NHMRC recommended that it be included on the ASVS.

In 1999 to 2000, the funding provided through the PHOFAs for vaccine allowed the states and territories to purchase enough vaccine for 105% of the eligible cohort for each vaccine. The exception at that time was influenza. Commonwealth funding for vaccines is approved by the Federal Minister for Health and Ageing as a ‘special appropriation’ under the provisions of Section 9B of the National Health Act 1953. Based on interpretation of this provision, funds appropriated are for the sole purpose of vaccine purchase.

From May 2000, universal infant vaccination with hepatitis B vaccine was recommended by the NHMRC and funded by the Commonwealth. In 2001, the 7-valent pneumococcal conjugate vaccine was provided at no cost to children in the following three categories: (1) all Aboriginal and Torres Strait Islander children aged up to two years; (2) in the Central Australian region, Indigenous children aged up to five years and non-Indigenous children aged up to two years; and (3) all children under five years with medical risk factors predisposing them to a high incidence or severity of pneumococcal infection.

Meningococcal C conjugate vaccine was recommended and funded at 12 months of age from January 2003. In September 2003, the DTPa booster dose at 18 months of age was no longer recommended.

In September 2003, the recommended schedule was changed to include the universal 7-valent conjugate pneumococcal vaccine at 2, 4 and 6 months of age, the varicella-zoster vaccine at 18 months of age, and the inactivated poliomyelitis vaccine in place of oral vaccine, although these recommendations were not immediately funded. In January 2005, the 7-valent pneumococcal conjugate vaccination program was extended to all children.

In May 2005, the National Immunisation Program (NIP) schedule replaced the Australian Standard Vaccination Schedule (ASVS) for children aged up to 6 years, with all recommended vaccines on the Schedule to be funded, including the varicella-zoster vaccine and inactivated poliomyelitis vaccine from November 2005.

Table 43 summarises the dates when vaccines were provided at no cost in the public sector and through private medical practitioners, as outlined above. There are separate arrangements for the funding of vaccine not provided through the NIP, such as travel-related vaccines, vaccines listed on the Pharmaceutical Benefits Scheme (PBS) and those provided by employers.

Table 43. Dates when childhood vaccines became available in Australia free of charge* in the public and private sectors, up to December 2005

Vaccine
Public sector Private sector
  Australia Exceptions Australia Exceptions
OPV 1966   1994 Qld (? 1998)
NSW 1966
Tas 1966
DTPw 1953   1994 WA 1988
Rubella
(adolescent girls)
1971      
MMR
(infant dose)
1989   1994 NSW 1989
Qld 1989
MMR
(adolescent dose)
1994 SA 1996 1994 WA 1993
SA 1996
ADT 1982   1994 WA 1988
CDT 1975   1994 WA 1988
Hib vaccines
(infants born from Feb 1993)
1993 Apr   1993 Apr  
Hib vaccines
(all infants aged <5 years)
1993 Jul WA 1993 Jan
NT 1993 Apr
1993 Jul WA 1993 Jan
NT 1994
DTPa boosters
(infants aged 18 months and
4–5 years)
1997 Sep Tas 1997 Oct
Qld 1997 Dec
1997 Sep Tas 1997 Oct
Qld 1997 Dec
dTpa booster (at 15 years replaces ADT) 2004 Jan   2004 Jan  
DTPa
infants aged 2, 4
and 6 months)
1999 Feb NT 1997 Aug
SA 1997 Aug
Tas 1999 Feb
Qld 1999 Apr
1999 Feb NT 1997 Aug
SA 1997 Aug
Tas 1999 Feb
Qld 1999 Apr
Hep B
(at-risk infants)
1987 NT 1988 Jan
SA 1996
Not funded by
the C'wealth
NSW 1987
Hep B
(adolescent dose)
1998 Jan Qld 1998 Mar
Tas 1998 Mar
NT 1998 Apr
NSW 1999
SA 1999
?1998 Qld 1998 Mar
Tas 1998 Mar
NT 1998 Apr
NSW 1999
Hep B
(universal infant dose)
2000 May NT 1990 Aug 2000 May NT 1994
7vPCV
(at-risk children)
2001   2001  
Influenza and pneumococcal for Indigenous at risk (15–49 years) 2003   2003  
Conjugate meningococcal C (infants aged 12 months and catch-up aged 1–18 years) 2003 Jan   2003 Jan  
7vPCV
(all children)
2005 Jan   2005 Jan  
VZV (infants aged 18 months and children aged up to 12 years without previous history of varicella) 2005 Nov   2005 Nov  
IPV (replacing OPV) 2005 Nov   2005 Nov  

* Vaccines on the current Australian Standard Childhood Vaccination schedule became free of charge in the public and private sector in all jurisdictions in 1999–2000. Where vaccine is provided by a private medical practitioner, there may be costs associated with the consultation.

† Refers to vaccines provided by private medical practitioners. All scheduled childhood vaccines became free in the private sector in the Australian Capital Territory in 1993 (except for MMR vaccine which became free in the private sector in 1994) and in the Northern Territory in 1994.

Acknowledgement: Rebecca Dadds, Australian Government Department of Health and Ageing.

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