Vaccine Preventable Diseases in Australia, 2005 to 2007

Appendix 6.5 Government funded national immunisation programs in Australia (up to December 2007)

Page last updated: 24 December 2010

Prior to 1988, the Australian Government provided childhood vaccines to states and territories for distribution to providers in the public sector. During the same time, live attenuated vaccines such as 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 the diphtheria-tetanus-pertussis (whole cell) vaccine (DTPw), by a pharmacist.

In July 1988, the Australian Government 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 Australian Government 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. 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 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 Hib vaccine was approved for use in children aged 18 months to 5 years of age. 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 Australian Government provided funds to states and territories for Hib vaccines.

In 1994, the Australian Government agreed to fund the purchase of a number of childhood vaccines (DTP, MMR, OPV) via Specific Purpose Payments (SPPs) to states and territories. Australian Government 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-pertussis (acellular) vaccine (DTPa) be used for the fourth and fifth doses of DTP vaccination. These became funded nationally in September 1997.

The 1998/1999 Australian (Commonwealth) Government Budget included an initiative to streamline all childhood vaccine funding from 1999/2000, 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 and influenza vaccines for Aboriginal and Torres Strait Islander Australians with risk factors or aged ≥50 years, and influenza vaccine for Australians aged ≥65 years, were also funded. Existing vaccine funding through the FAGs and HFGs were not adjusted, thereby freeing up resources of states and territories to purchase non-Commonwealth funded vaccines.

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Federal funding to use DTPa for all five infant vaccination doses 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 vaccines 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. Australian Government 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 the hepatitis B vaccine was recommended by the NHMRC and was funded by the Australian Government. In 2001, the 7-valent pneumococcal conjugate vaccine (7vPCV) was provided at no cost to children in the following three categories: (1) all Aboriginal and Torres Strait Islander children aged <2 years; (2) in the Central Australian region, Indigenous children aged <5 years and non-Indigenous children aged <2 years; and (3) all children aged <5 years with medical risk factors predisposing them to a high incidence or severity of pneumococcal infection.

Meningococcal C conjugate vaccine was recommended and funded for all infants 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 publicly funded 7-valent pneumococcal conjugate vaccination program was extended to all Australian children.

In May 2005, the NIP schedule replaced the ASVS for children aged up to 6 years, with all recommended vaccines on the Schedule being publicly funded, including the varicella-zoster vaccine and inactivated poliomyelitis vaccine from November 2005. Hepatitis A vaccine was also recommended and funded under the NIP from November 2005 for Indigenous children aged <5 years living in jurisdictions with a high incidence of hepatitis A (the Northern Territory, Queensland, South Australia and Western Australia).

The HPV vaccine for all girls aged 12–13 years (with a time-limited catch-up program for females aged 13–26 years) and rotavirus vaccines for all infants were added to the NIP in April 2007 and July 2007, respectively.

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Table 6.5.1 summarises the dates when each of the vaccines was provided at no cost to recipients in the public sector and through private medical practitioners, as outlined above. There are separate arrangements for the funding of vaccines not provided through the NIP, such as travel-related vaccines, vaccines listed on the Pharmaceutical Benefits Scheme (PBS) and those provided by employers.

Table 6.5.1: Dates when vaccines became available free of charge to recipients* in Australia, delivered in the public and private sectors, up to December 2007

Vaccine
Public sector delivery Private sector delivery§
Australia Exceptions Australia Exceptions
DTPw vaccine 1953   1994 WA 1988
Child diphtheria-tetanus vaccine
(children aged 5–6 years or prior to school entry)
1975   1994 WA 1988
ADT vaccine
(adolescent aged 15 or prior to leaving school)
1982   1994 WA 1988
DTPa boosters
(infants aged 18 months and 4–5 years)
1997 September Tas 1997 October
Qld 1997 December
1997 September Tas 1997 October
Qld 1997 December
DTPa vaccine
(infants aged 2, 4 and 6 months)
1999 February NT 1997 August
SA 1997 August
Tas 1999 February
Qld 1999 April
1999 February NT 1997 August
SA 1997 August
Tas 1999 February
Qld 1999 April
dTpa booster
(adolescent dose, replaced ADT)
2004 January   2004 January  
Salk (inactivated poliomyelitis vaccine) 1956      
OPV vaccine 1966   1994 NSW 1966
Tas 1966
Qld (? 1998)
IPV (replacing OPV) 2005 November   2005 November  
Rubella vaccine
(school girls aged 10–14 years and susceptible women post-partum)
1971      
Measles vaccine for infants aged 12 months 1975      
Combined measles-mumps vaccine replacing measles vaccine 1982      
MMR vaccine
(infant dose)
1989   1994 NSW 1989
Qld 1989
MMR vaccine
(adolescent dose)
1994

NSW 1994 females only;
1996 both sexes
SA 1996

1994 WA 1993
SA 1996
Hep B vaccine
(at-risk infants)
1987 November NT 1988 January
SA 1996
Not funded nationally NSW 1987
Hep B vaccine
(adolescent dose)
1998 January Qld 1998 March
Tas 1998 March
NT 1998 April
(with catch-up for children aged 6–16 years)
NSW 1999
SA 1999
1998 Qld 1998 March
Tas 1998 March
NT 1998 April
NSW 1999
Hep B vaccine
(universal infant program)
2000 May NT 1990 August 2000 May NT 1993 August
Hib vaccines
(infants born from February 1993)
1993 April   1993 April  
Hib vaccines
(catch-up for children aged <5 years)
1993 July WA 1993 January
NT 1993 April
1993 July WA 1993 January
NT 1994
Influenza vaccine for all adults aged >65 years 1999

(2000: lower age limit changed from >65 to ≥65 years)
Vic 1997 1999

(2000: lower age limit changed from >65 to ≥65 years)
Vic 1997
Influenza vaccine for Aboriginal and Torres Strait Islander people aged >50 years or aged 15–50 years with risk factors (NIPII program) 1999

(2000: lower age limit changed from >50 to ≥50 years)
  1999

(2000: lower age limit changed from >50 to ≥50 years)
 
23vPPV for Aboriginal and Torres Strait Islander people aged >50 years or aged 15–50 years with risk factors (NIPII program) 1999

(2000: lower age limit changed from >50 to ≥50 years)
Vic 1998 for Indigenous adults aged ≥50 years

NT 2000 for Indigenous adults aged ≥15 years
1999

(2000: lower age limit changed from >50 to ≥50 years)
Vic 1998 for Indigenous adults aged ≥50 years

NT 2000 for Indigenous adults aged ≥15 years
23vPPV for all adults aged ≥65 years 2005 Vic 1998 2005 Vic 1998
7vPCV
(at-risk children only, including Aboriginal and Torres Strait Islander children aged <5 years)
2001

(2003: list of at-risk conditions expanded)
  2001

(2003: list of at-risk conditions expanded)
 
7vPCV
(universal infant program, with catch-up for all children aged <2 years)
2005 January   2005 January  
Conjugate meningococcal C vaccine (infants aged 12 months and catch-up aged 1–18 years) 2003 January   2003 January  
VZV vaccine (infants at age 18 months with school-based catch-up for children aged 10–13 years who have no history of varicella) 2005 November   2005 November  
Hepatitis A vaccine for Indigenous children living in jurisdictions with high disease incidence (NT, Qld, SA, WA) 2005 November northern Queensland
1999
2005 November  
HPV vaccine (ongoing for girls aged 12–13 years, with a time-limited catch-up program for females aged 13–26 years until December 2009) 2007 April   2007 July  
Rotavirus vaccines (for all infants) 2007 July NT 2006 October 2007 July NT 2006 October

* Vaccines on the Australian Standard Vaccination Schedule and the current National Immunisation Program 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.

† This table focuses on the time when a particular vaccine first became available free of charge to recipients, grouped by vaccine antigens. For more details regarding change of vaccination practice in Australia 1992–2007, please refer to Appendix 6.4.

‡ Please refer to the text or the abbreviations list for abbreviations of the vaccines.

§ 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: Australian Government Department of Health and Ageing.

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