PROJECT SMILE Optimising the New Zealand Prevenar Immunisation

PROJECT SMILE Optimising the New Zealand Prevenar Immunisation Programme Amongst Healthcare Professionals And Mothers Prepared by: August 2007

Broad Research Objectives To understand knowledge of and attitudes to pneumococcal disease To determine attitudes to the vaccine against pneumococcal disease To determine triggers and barriers to recommendation /usage of the newly reimbursed vaccine Optimising uptake of the Prevenar offer… in the context of a NZ government approved vaccination schedule. 2

Research Methodology HCPs How? : at place of work or home – – group focus discussion conducted in central location 1 hour length – 1 ½ hours duration – n=8 GPs – n=4 groups of 7 mums and future mums – Logistics: in-depth, one-one, in situ interviews – Who? : – Consumers n=12 Nurses – all talking to mothers about immunisation – all pregnant or trying to get pregnant: – all either recommending or actually giving vaccinations – from high paediatric practices – non-rejectors of immunisation – mix of age, gender, practice type and SES area – mix of repeat and first time mums – 25 -40 years old – mix of SES, working status, Pakeha and Maori/Pacific Islander mums – babies to be born from 1 st January 2008 – all research conducted by Nicole Inglis, Group Account Director, from 27 th June – 5 th July, 2007 – all participants paid an honorarium for their time 3

KEY FINDINGS 4

GPs And Nurses 5

All Our HCP Sample Were Convinced Of The Benefit Of Vaccinations Motivators – risk factors: • even small risk factor becomes large when own child involved – diseases themselves much worse than vaccinations – helps keep general community healthy – availability of vaccinations: • why not use them? “They ask me if I’ve given them to my child and I can truthfully say yes” A well accepted ‘rite of passage’ in a child’s life. 6

And Vaccinations Are Discussed With Parents At A Number Of Points Pregnancy/ Antenatal Classes (GP and Midwife): – Bounty Book – pamphlet on vaccinations included – some midwives talk vaccinations in detail Birth (Hospital): – Bounty Book – contains vaccination information 1 st Home/ Clinic Visit (Midwife or Plunket Nurse): – nurse may give more specific information – point it out in Bounty Book and Well Child Book 6 Week Visit (GP): – asks if vaccinations have been considered – prompts mother to read information – books in with nurse The 6 week visit is key but many opportunities to reach mothers before this point so they have time to consider options. Subsequent Check-ups (GP or Nurse): – asks mother if up to date with vaccinations – pop up GP/Nurse reminders on screen through. Medtech 32 – check over Well Child Book – send reminder letter 7

Both GPs And Nurses Have Ways Of Getting Through To Some Wavering Mums. . . “The mother needs to weigh up intensive care visits with two seconds of pain at vaccination time” “The baby won’t die from feeling a bit poorly after the vaccination, but will die from the disease” “The risk of contracting this disease is low but the stakes are high” …the trouble is, it’s not only GPs and Nurses who talk to mums about vaccinations. . . 8

There Is Thought To Be A Segment Of HCPs, Midwives In Particular, Who Are Vocally Anti-Immunisation “It’s frustrating that the mothers are being fed propaganda by the very people who should be encouraging them to vaccinate” “I really don’t understand what their problem is, but it seems to be the richer alternative types of parents that listen to these midwives and then decide not to vaccinate” And the way the system works in New Zealand, these midwives have access to the mothers before the practice nurses and/or GPs. 9

And Tales Of Anti-Immunisation Midwives Are Borne Out By The Mums Research “At my antenatal class for my first child the midwife said we needed to think about vaccinations. Then she told us there is plenty of information for immunising, but it’s hard to find information against it so she gave us a handout on the side effects and complications” - Second time mum “I haven’t heard anything from anywhere about vaccinations yet and I’ve seen a midwife a couple of times” - Pregnant first time mum “I was told by friends that midwives are supposed to be impartial but they reckon they’ve seen really biased ones” - Trying to conceive, first time mum Of great concern to practice nurses especially. Feeling they are left to counter this information. 10

However, In General, Pro-Vaccination Parents Take This All Very Seriously And Nearly Always Return For Subsequent Vaccinations And Follow-Up Appointments – – rop one d let on’t w ide” “They the ways by easy to generate call-back letter through computerised database data from GP surgery sent via local PHO (Primary Health Organisation) to NIR (National Immunisation Register): • a ‘double check’ on some parents • another recall letter • “Par tidio ents a re us a bout this ” fas “Between them and us it’s like the Kremlin tracking them down! None escape!” “We find that if they’re going to immunise then they’re going to immunise… they don’t drop out half way through. It’s only at the 15 month or 4 year stage that they can get complacent” “We keep track of them easier now that there is a subsidy for being enrolled at just one practice” Computerised recall systems are already set up and well utilised. 11

This Dedication To Immunisation Is Thought To Be Pretty Strong Amongst Maori And Pacific Islander Families Too Thought to be two main reasons for this: Vaccination Free – – visit to GP/Nurse will not cost anything vaccination itself is free: • – and majority are on the schedule supported by the Government Higher Risk Group – larger families – more crowded living conditions – extended families: • – knowledge that relatives outside of mainland NZ are not immunised: • – sharing food/cups etc higher risk for children visiting relatives seen/know of higher prevalence amongst these communities “They tend to be more grateful that immunisation exists here in NZ for free” Perceived to be fairly motivated. Any barriers tend to be logistical, such as lack of transport, rather than attitudinal. 12

By Contrast, Practice Nurses And GPs Are Somewhat Frustrated By Attitudes Held Within Some White Middle Class Communities “It’s the alternative types in Devonport you need to be careful of. They question everything and think you want to harm their precious child with your wicked western medicine ways” “The hippy midwife talks to the hippy mother and there’s nothing we can do to change their mind… maybe we need to tell them we’re vaccinating with soy milk or something!” And a real sense that arguing their stand is futile. 13

In Fact, Some GPs Appear To Be Open To Taking The Path Of Least Resistance GPs from higher SES areas: – educated mothers: • cynical of government involvement GPs can sympathise with mother’s concerns: – three injections in small baby – potential to ‘hold off’ on vaccinations until the baby is older “These mums are very firm in their ideas so I may as well just support them… I don’t have all the final answers and immunisation is not 100% safe or effective…” “I’m not sure the world is as sickly as the schedule makes out…” “It’s a vexed and emotional issue, I don’t like to upset new mums” Less likely to push back on these mothers. By contrast, nurses stand firm… less likely to take any nonsense! 14

The Pneumococcal Disease Vaccination In Context 15

Only A Handful Of IPD Cases Have Been Experienced First Hand, Therefore, GPs And Nurses Have A General Knowledge Base Only… At Risk Of IPD – – – 0 -4 years: • 0 -2 years specifically Maori and Pacific Islander kids: • crowded living conditions premature children respiratory susceptibility HIV and chronic diseases like heart and respiratory conditions, splenectomy and general immune deficiencies ] More likely to be exposed ] If exposed, less able to fight infection Long Term Consequences Of IPD Outcome Of IPD – – pneumonia meningitis ear infections septicaemia – – – ] More than one outcome deafness retardation limb loss septicaemia death ] Less loss of limb and death than Meningococcol Disease Yet still a bit too remote from their world to be panicked. 16

Education, So Far, Has Been Centred On The Need For ‘At Risk’ Children To Have The Vaccine, So At Best, Nurses Are Mentioning It To Parents Of Healthier Children “There is a condition that is more common than meningitis, but still quite rare” What Parents Are Told: – kids 0 -5 years, and especially 0 -2 years are most at risk: • ear infections = higher risk • childcare = higher risk • Maori/Pacific Islanders = higher risk there is a vaccine available to help protect your child – why haven’t I heard of this disease before? – how much is it? is it really necessary? why isn’t it funded already if it is that important? what should I do? – What Parents Ask: – – – “I’m not as passionate about this one yet” - Nurses, rather than GPs, leading this but not necessarily widespread practice. Certainly not pro-actively recommending like schedule vaccinations. 17

All Of Which Means More Information Is Needed To Ensure HCPs Are Prepared For The Launch To Schedule “I know about it but wouldn’t feel truly comfortable answering lots of questions about it from a parent. I’d feel silly if I couldn’t answer them properly so I’m keen to be trained up” - GP Seeing a need for greater education… and happy to take up the opportunity to learn more. 18

The Market Situation - The Meningococcal B Vaccine In New Zealand - 19

The Vaccination Response To The Meningococcal B Outbreak Was Successful, But The Anti-Vaccination Lobby Have Since Been Active… Respected media programmes such as 20/20 and 60 Minutes have since run stories regarding: Test Market – Transient Need vaccine was originally for another population: • Scandinavian government deemed it untested and unnecessary – vaccine was in response to a specific strain of meningococcal disease – Side Effects/Coverage and in response to a specific outbreak – stories abound of children ‘contracting Men B from the vaccine’: • or being given the vaccine and still getting sick NZ government able to ‘pick it up cheap’ because of this – only protecting some of the population against one strain of disease First needed 3 then 4 vaccines…lacked credibility ] Therefore, New Zealanders were ‘guinea pigs’ for a potentially unsafe vaccine – only 50% effective at 6 weeks and 75% at 3 mths • • ] Therefore continued vaccination is both unnecessary and unlikely to be efficacious against other strains ] Therefore no point in potentially injecting child with killer disease when they may not be then protected anyway Spreading all sorts of negative information… making it very hard to get a clear picture now. 20

In Addition, Much Of The Media Noise Focused On The ‘At Risk’ Populations Maori And Pacific Islander Children – larger family and extended family groups – living in closer contact – in less hygienic living conditions: • less able to heat house etc • sharing cups etc “We live over on the Shore… really, my kid’s not at risk of this” Allowing middle class Pakeha families to breathe a sigh of relief… and also question the need for vaccination at all. Their child is deemed ‘safe’. 21

As A Result Of This Subsequent Negativity, GPs And Nurses Call For Facts And Data They Can Be Armed With To Counter Concerned Parents Questions Test Market – Transient Need Prevenar has been used successfully in other countries: • tried and true • reduced PD by ? % • reduced hospitalisation/ death etc by ? % – – Pneumococcal disease a continuing threat to New Zealand children always present: • not dependent on epidemic Side Effects/Coverage – – incidence figures for consequences of vaccine: • % severe and mild side effects reassurance that most people covered for most strains: • cuts antibiotic use? Real Threat – – not in grip of epidemic need to convince that it is needed: • relatively high number of complications/ deaths in New Zealand from disease Taking away the fear of the unknown. 22

It Is Essential That HCPs Are Provided With As Much Information As Possible Before Launch To The Schedule 4 Otherwise, HCPS know the alternative can be damaging in many ways: Patient Finds Info Patient Asks HCP Uninformed Lose credibility… Lose confidence… Lose patient… More than a bruised ego involved… potential to lose the patient’s (sometimes already quite shaky) belief in immunisation too. 23

Upcoming Changes To The Schedule 24

Both The HCP Groups Agree That If The IPD Vaccine Had Been Launched Before The Meningococcal B Debate, There Would Be Fewer Potential Problems Schedule – “We’ll just incorporate it in the visit like we do any other vaccination” in the Well Child Book: • • mums will be informed from birth at home/clinic visits too information about IPD included like other vaccinations mothers will not question it – do not normally question others on schedule “First time mums are particularly conscientious” ’t m don the at Half of “ ctly wh y xa ab know e their b ns cinatio ” vac anyway gets For those left unaffected by the Meningococcal B launch, it will be plain sailing… but this may be a minority currently. 25

So, In Some SES Areas In Particular, Being On The Free Schedule May Not Be Reason Enough To Give A Jab To Your Child “I fear the anti-vaccination lobby has turned some pro-mums into questioning mums” Careful education needed here. 26

Beyond This Though, It Is The Introduction Of A Fourth Jab That Most Worries HCPs Their own concerns mirror what they expect mums will say: Small Baby – baby is still tiny at 6 weeks: • – – if parents did return in 1 -2 weeks: • would mean 8 different vaccines in the baby at once: • greater potential for side effects/interactions • • • – no fat for needle to go into! Time Consuming is it safe? would expect parents to prefer 2 by 2 vaccines: • doubles nurse workload – more visits a minority would ‘drop out’ and need reminder letters mums need to find the time to get into surgery: • now 9 visits instead of 5 in first 15 months “The Meningococcal B and PD ones sit naturally together” “Maybe we should tell them that in other countries kids get lots more jabs for everything… we’re 3 rd world in comparison!” Nurses more practical so less concerned than GPs. Most happy to let patients spread the load if desired. 27

In Addition, Some HCPs Are Open To Patients Wishes To ‘Defer’ All Vaccinations Until Baby Is A Little Older “If they could still have the Men B vaccine at an older age, maybe they would think to put this one off too” “As long as they have all 4 it won’t really matter” “Mums think they’re keeping baby safe from outside influence in the first few months” “Mums have seen catch up vaccinations before and those babies were well covered” “They feel happier if the baby has had a chance to fatten up” Worrying trend and some HCPs feeling ill equipped with info/data to convince mothers to act otherwise. 28

Therefore, It Is Imperative We Provide Further HCP Education To Minimise The Impact Of The Four Injections Before Injection – what tests have been done to ensure 4 can be given at once? : • • – reassure mothers and HCPs baby’s immune system can ‘take the strain!’ – which order should the injections go in? : • – After Injection – will government pay cost of extra visit to nurse? and one in each limb? how will I know which has caused a reaction? is it possible to offer parents 2 in combination? : • used in other countries? • even if private pay? • – At Injection best to encourage the MD and PD to be put with one of the better accepted vaccinations? trials info to show benefit of starting vaccinations at 6 weeks: • “Baby needs them at this age” Helping to overcome concerns and provide HCPs with ammunition to convince parents to receive all the vaccinations in one visit, from the age of 6 weeks. 29

HCP Information Needs 30

Upon Learning All This Information, HCPs Thoughts Turn To Education “They’re launching this next year and we still don’t know about it yet? !” “They need to get out there now so it’s not a big shock for people come next year” Keen to get moving. 31

Our HCPs Need Information On Two Levels GP/Nurse – what is happening – what their role is Parents – alerting to schedule changes – tools for managing parents Expecting to play a key role in disseminating information to their patients. 32

Though Already Well Informed, Nurses Would Appreciate The Same Information As GPs In A Mail Out A one or two page fact sheet for HCPs will suffice: “I don’t have time for too much detail”: Pneumococcal Disease – – – incidence: • numbers hospitalised • effect of vaccine on otitis media • more prevalent than MD risk factors: • ethnicity • reinforce lack of known risk factors consequences: • more meningitis than MD • loss of life • just as serious as MD • leading meningitis cause PD Vaccination – – – schedule changes: • date of initiation • how long will it last? • what to do with 15 months + children • relation to Pneumovax injection information: • four vaccinations together ok • likely reactions to look for • how to encourage earlier vaccination impact of vaccine: • in other countries • efficacy • safety “Get it into our Nursing Journal and the Immunisation Handbook and we’ll read it” The source of this information is key - needs official endorsement. GPs and nurses looking to MOH, IMAC, NIR and their local PHO especially. 33

The Vast Majority Of Our HCPs Claimed They Would Like To Attend An Educational Meeting Sponsored/organised by their PHO: – even at cell level within PHO Interactive session… chance to ask questions. Drinks, food and a chance to catch up with colleagues. “Yes, my nurse does a lot of this but the mums will be asking me questions too… I can’t look like a fool” “Our PHO Pro. Care is excellent at this sort of thing. I can’t fault them” PHOs deemed to play an integral part in educating and disseminating information. 34

Two Assumptions Are Made About The Introduction Of The Schedule Well Child Book – assume that the books will be updated: in time for 1 st January 2008 information on IPD similar to other diseases • – – “No need to go into too much detail or they’ll get scared” IMAC/NIR – involvement in helping practices to send out letters to mums: • best way to reach widest audience • takes the load off practices • “They did it for Meningococcal B” Without these adaptations, our HCPs will need to be more pro-active. Most are willing to send out letters, by utilising their computerised database. 35

Our HCPs Also Expect To Be Provided With The Means To Educate Their Patients Poster Booklet 4 will put in surgery 4 believe mothers look at them while waiting 4 impactful 4 prompts conversations with GP/nurse 4 providing depth of info to complement poster 4 can take it away to discuss/ read further 4 needs to be available in different languages: • or could download from website? 4 reminder bring in Well Child book at vaccinating appointment 4 explanation of different diseases and vaccines Tools for managing their patients. Schedule 4 one page, coloured schedule 4 glossy/laminated 4 use as tool to talk to parent 36

Mums Research 37

- Childhood Diseases In Focus - 38

Second Time Mums Especially Have Good Knowledge Of Meningococcal Disease tle poor lit “That irl” rlotte g Cha Meningococcal Awareness: all aware Knowledge level: – medium to high Risk/ contraction: – body fluids – sharing spit – – airborne? sharing cups? – particularly older children (teens) – flu like – “It was everywhere on the news an d in the media” – rash – sudden onset – – death loss of limbs – meningitis Symptoms: e id got th “Every k vaccine” Implications: “Hold a c up to the rash” “Get them to hospital fast” “Doctor s don’t always r ecognise it… cou ld be so many th ings” The urgency and consequences of meningococcal B have been cemented by persistent media attention. 39

Despite The Meningococcal B Outbreak, Some Of The Upcoming First Time Mums Were Slightly Less Aware “It didn’t really affect me at the time… I was in my late 20’s so past the age of vaccination and high risk… and I certainly wasn’t thinking about babies back then either!” Off the radar… lacking the in-built mum’s tracking device! 40

Across Both First And Repeat Mums Groups Only A Small Handful Knew Of Pneumococcal Disease No Knowledge Some Knowledge “I’ve never heard of it… are you saying pneumonia? ” “There’s another coccal but I don’t know much more than that” “I’ve heard of it” Majority here “There was a case in the news recently of the mum contracting it from the baby and they both died” “It causes ear infections and brain damage… another meningitis” 1 or 2 here A few snippets of information filtering through the general media but generally not reaching our target yet. 41

So When Shown The PD Concept, Mums Were Immediately Hungry For More Knowledge Prevalence Risk Level – is there an epidemic like Meningococcal B? – how likely is my child to contract it? – how common is it? – – what are the symptoms? does it affect one ethnic group more than another? : – how many of these common symptoms are needed to indicate presence of PD? Vaccination • – why do we suddenly need to vaccinate against all these diseases? : • or those that live in poor/crowded areas? these mums weren’t vaccinated themselves as children against PD/MD “Meningococcal B hit South Auckland so I think my child would be okay” are there any more vaccinations the public should know about? – “How can it be so serious if we’ve never heard of this disease before today? ” – will this vaccine be adequately tested before use? “Will we be guinea pigs again? ” Mums can’t help but to think back the Meningococcal B situation… which then leads to a certain amount of cynicism beginning to show through. 42

And This Cynicism Is Evident When Discussing Vaccination In General “If we vaccinate so much are we making ourselves so immune that we can’t fight off other diseases? ” “Will there be repercussions in later years? ” “The flu jab is just as bad as having the flu itself” Vaccinations Make You Sicker!!! “I read about a kid that contracted Meningitis from the Meningococcal B vaccine” “Everyone I know got really sick form the flu jab” “It’s better to get chickenpox rather than have a jab” “The risk of contracting these diseases is so low” * Note: Mums were recruited as at least neutral if not pro-vaccination Losing sight of the reasons we vaccinate. 43

So, Overall, New Zealand Mums Now Seem To Be Less Pro-Vaccination Than In Previous Generations Anti. Vaccination Pro. Vaccination Most here now “We’re older mums nowadays… we’ve been in the workforce, we’ve learnt to question the “We’re into organic and government” alternative as a country” “I’m in two minds nowadays” Most here 5 -10 years ago “New Zealanders tend to be a little nonconformist” “A necessary evil… but are they all necessary? ” A very noticeable shift… and all mums acknowledge this. 44

Pneumococcal Vaccination Needs 45

At This Stage, Mums Have Many Questions That Need To Be Answered Pneumococcal Disease Pneumococcal Vaccination Prevalence Risk Levels Efficacy Safety Symptoms Consequences Schedule Payment Starting from a very low knowledge base so keen to find out as much as they can. 46

Mums Information Needs 47

There A Variety Of Information Sources For Mothers Regarding Childhood Disease Media – TV: • • • – – – Medical Professionals – – – family health diary advertorial current affairs shows news bulletins radio: • news/discussion forums internet magazines: • women’s • parents’ (eg. Littlies, Treasures) • PHO inserts in weekend papers (Pulse) GP Nurses Paediatrician midwives Plunket nurses Social Influences – – – family friends mothers groups child care facilities schools Government – – – education campaigns Well Child Book/Bounty Book NIR, IMAC And these same sources expected to be employed in future pneumococcal communications. 48

Each Channel Holds Its Own Benefits To Employment… Government – – honest altruistic cements the credibility • does not recommend unless very important • does not reimburse unless essential Ministry of Health already publishes useful vaccination info ] Important endorsement Medical Professionals – – knowledgable trustworthy child’s best interests ongoing care/relationship ] Reliable recommendation Media – – high cut through • TV • radio • magazines high engagement • forum for debate • easy to digest ] Emotional engagement Social Influences – – familiar/trusted source more motivating/ persistent pre-requisite for childcare/school social acceptance ] Community approval Government and HCP involvement in campaign provides credibility. Media and social influences help get the message out there. 49

Furthermore, Government Is Expected To Endorse The Issues And Ensuing Discussion “The Ministry of Health usually puts out good information when we need it” “I'd just expect their logo on it to validate the information” “They’re really only likely to pay for the ones we really need” Government Endorsement – honest/credible source – trustworthy/autonomous – financial support should be backed by Government voice – less hype driven – less profit driven ] Taking the campaign seriously Providing both reassurance and credibility to the changes, essential to dispel scepticism over media-hype. 50

Mums Also Likely To Seek Out Further Information From Their GPs… A Trusted Source “I’d trust what my GP told me to do” – interactive process doctor raise topic “Have you thought about vaccinations yet? ” – Mums – mum discuss options with GP – provide information and vaccination • poster in waiting room • GPs leaflet to read “The nurse is just the technician” Despite the fact most GPs would acknowledge that their practice nurse is more knowledgeable in this area, a real need for GPs to be upskilled. 51

THE WAY FORWARD FOR THE PREVENAR LAUNCH IN NEW ZEALAND 52

GPs And Nurses 53

GPs And Nurses Are Keen To Learn About The Schedule Changes ASAP They expect information to come via their PHO, the IMAC and MOH. This would be in the form of meetings and booklets: Pneumococcal Disease – – – PD Vaccination incidence: • numbers hospitalised • effect of vaccine on otitis media • more prevalent than MD risk factors: • ethnicity • reinforce lack of known risk factors consequences: • more meningitis than MD • loss of life • just as serious as MD • leading meningitis cause – – – schedule changes: • date of initiation • how long will it last? • what to do with 15 months + children • relation to Pneumovax injection information: • four vaccinations together ok • likely reactions to look for • how to encourage earlier vaccination impact of vaccine: • in other countries • efficacy • safety They also expect information to share with mums and dads at the surgery: Poster Leaflet Schedule Arming them with the answers to questions they are sure to be asked. 54

In Addition, GPs And Nurses Have Some Specific Questions Regarding The Four Vaccinations And Schedule Itself Before Injection – – – At Injection what tests have been done to ensure 4 can be given at once? : • reassure mothers and HCPs • baby’s immune system can ‘take the strain!’ is it possible to offer parents 2 in combination? : • used in other countries? • even if private pay? • best to encourage the MD and PD to be put with one of the better accepted vaccinations? trials info to show benefit of starting vaccinations at 6 weeks: • “Baby needs them at this age” – – which order should the injections go in? : • and one in each limb? how will I know which has caused a reaction? After Injection – will government pay cost of extra visit to nurse? 15 Months ? if mothers are deferring vaccinations, or having over 2 -3 weeks, is there a cut off: • must they all be finished by 18 months? By 2 years? ‘Catch Up’ ? could babies born just before 1 st January 2008 be eligible to qualify somehow? : • pay for 1, get others free? Getting the comfortable with the new schedule. 55

With Regards The Information They’d Like To See Given To Mothers… “Maybe we need to re-educate people as to why we vaccinate to take some of the power from the anti-vaccination lobby” - GP “Some GPs give in to mothers and let them vaccinate later… people forget why it is so vital to get to babies at a very early age… that’s when they are most vulnerable” - Nurse “We need to Let people know how successful the Men B campaign was so it sows the seeds for a successful PD vaccination launch” - GP Potential to provide a community service… a pro-vaccination strategy that enables parents to make an informed decision. 56

The Idea Then Is A General Vaccination Campaign Rather Than Specific PD Information Along the lines of… Efficacy – a reminder of the good that has come from vaccinations: • • – – % and figures needed for both Maori/PI and Pakeha avoid complacency in Pakeha community how we have moved on from ‘bad old days’ encourage parents not to defer vaccination child is better off being immunised than contracting disease: • to individuals and communities why babies need, and can take, the vaccines at 6 weeks: • Safety – at higher risk if not at all community immunised Cost – • – side effects from vaccinations are minimal • vaccinations are free for kids: synthetic vaccine…will not ‘catch’ PD from it when new vaccines are developed, we try our best to provide them to the community: ” • – government takes it seriously eg like this new vaccine for PD talk to your HCP “It needs to be impartial - yes, there are risks and side effects with vaccinations but not vaccinating is much worse. Parents will think it is much more credible if they hear both sides of the story - it also then gives the antivac people no legs to stand on!” Taking some of the strain off GPs and Nurses… backing them up, with impartial information that then speaks for itself. 57

In Addition, GPs and Nurses Want To See Other HCP’s On Board Midwives Plunket “They get to see our mothers first so if they encourage them not to have vaccinations there is nothing much we can do” And Paediatricians can provide the credibility called for: Nicky Turner, Peter Nobbs, Dianna Lennon, Prof Innes Asher Getting to mothers earlier in the piece…but again with impartial information. 58

Mums 59

Mums Know That They Are Not Necessarily An Homogenous Group And So Information Is Needed From A Variety Of Sources Media – TV: • • • – – – Medical Professionals – – – family health diary advertorial current affairs shows news bulletins radio: • news/discussion forums internet magazines: • women’s • parents’ (eg. Littlies, Treasures) • PHO inserts in weekend papers (Pulse) GP Nurses Paediatrician midwives Plunket nurses Social Influences – – – family friends mothers groups child care facilities schools Government – – – education campaigns Well Child Book/Bounty Book NIR, IMAC There is Potential to reach mothers through these sources at various times throughout their pregnancy. 60

And They Concur With HCPs That If A Media Campaign Is To Be Built… Efficacy – a reminder of the good that has come from vaccinations: • • – – % and figures needed for both Maori/PI and Pakeha child is better off being immunised than contracting disease: • to individuals and communities – at higher risk if not at all community immunised Cost – vaccinations are free for kids: • – side effects from vaccinations and minimal – government takes it seriously when new vaccines are developed, we try our best to provide them to the community: ” • how we have moved on from ‘bad old days’ why babies need, and can take, the vaccines at 6 weeks: • Safety eg like this new vaccine for PD talk to your HCP not to defer “If they come out with another scare campaign about this it will go one of two ways. People will switch off as they haven’t seen the cases of PD like we did for Meningococcal B. Or they’ll get scared about the vaccine again, like we are for Meningococcal B” … that it should revolve around vaccinations in general… not just IPD. 61

Any General Campaign Will Help The New Zealand Government For All Vaccinations “I’m thinking of not giving my baby the Meningococcal B one, so I might not give this new one either” “When will it stop… do we have to vaccinate against everything? ” “My first baby cried so much, there’s no way I’m giving my new baby so many injections at 6 weeks. I’ll wait till he or she is 6 months” Putting a halt to a worrying trend. 62