Study to lift vital vaccine uptake to protect pregnant women and vulnerable children

The University of Adelaide has secured more than $960,000 from the NHMRC to lead an international project to improve the uptake of vaccinations against influenza and COVID-19 for some of our most vulnerable people – pregnant women and children with chronic health conditions.

Led by South Australian of the Year, University of Adelaide Professor Helen Marshall, AM, the project team includes researchers from around Australia and the UK and paediatric and obstetric specialists in hospitals in South Australia, Victoria, and Western Australia. 

Partners on the project include the Women’s and Children’s Health Network, Southern Adelaide Local Health Network, Northern Adelaide Local Health Network, SA Health and Dept. for Trade and Investment, SA Government, Victoria Dept. Health, Government of WA, and Women’s and Children’s Hospital Foundation.

Professor Marshall says part of the problem is that the risks of negative health outcomes for unvaccinated pregnant women and vulnerable children are widely underestimated in the community. 

“Pregnant women are three times more likely to die from COVID-19, and with influenza, they are more than seven times more likely to be admitted to an intensive care unit, than non-pregnant women," she says.

“What we are also seeing with COVID-19 is damage to the placenta and a greater risk of still and pre-term births.

“Children with some chronic diseases already have a higher risk of hospitalisation and admission to intensive care from influenza, and following COVID-19 infection, there is increased potential for long term disability.” 

Despite these alarming risks, Professor Marshall says vaccination rates in these two vulnerable groups are suboptimal. 

“Uptake of the recommended influenza vaccine among pregnant women and medically at-risk children in Australia is only about 50 per cent and based on recent surveys, the uptake of COVID-19 vaccine among children is similar,” she says.

“We are heading into winter with co-circulation of influenza and COVID-19 and a likely severe influenza season. 

“Adding to the elevated risk is that a large proportion of the population now has low immunity due to no exposure to influenza for the past two years.”

"Pregnant women are three times more likely to die from COVID-19, and with influenza, they are more than seven times more likely to be admitted to an intensive care unit, than non-pregnant women."Professor Helen Marshall

Professor Marshall says the NHMRC-funded project brings together not only health experts and practitioners but will also engage pregnant women and parents of children with chronic health conditions, to look at what factors can positively influence the uptake of vaccinations.

“We will be exploring what elements of health care and health communication will act as an effective nudge to encourage vaccinations,” Professor Marshall says.

 “Targeted, evidence-based interventions in hospital settings are urgently needed rather than a ‘one size fits all’ approach, if we are to reduce hospitalisations, long-term negative health outcomes, and deaths for these most vulnerable groups.” 

Using randomised controlled trials, the project team will evaluate the effectiveness of new, multi-level interventions, that have been co-designed with parents, pregnant women, doctors, nurses, and hospital administrators.

“We are looking at how, across a person’s engagement with the health care system, a combination of “nudges” might deliver increased vaccination rates,” co-investigator, Ivo Vlaev, Professor of Behavioural Science at the University of Warwick says.

“It could be a combination of things - easier access to vaccines, text message reminders, or checklists for doctors, nurses or health professionals to discuss vaccination with their patients,” he says. 

“It might be where vaccination clinics are located, pre-booking vaccine appointments – we want to canvass ideas form pregnant women and parents and health sector workers by holding ‘nudegethons’, and then use gold standard research methods to assess whether nudges work.”

Professor Marshall says the team will be working to find strategies that are easily implementable in hospitals and that are proven to increase immunisation coverage for two very vulnerable groups.

“We know that COVID-19 is not going away in a hurry and every year influenza is a risk,” she says. 

Co-investigator on the study and paediatrician at the Royal Children’s Hospital in Melbourne, Associate Professor Margie Danchin says passive health information alone is not enough to move the vaccination uptake statistics. 

“Proven strategies that can be rolled out nationally at obstetric and paediatric hospitals have the potential, not only to reduce the cost of hospitalisations, but also to save many lives,” she says. 

Participating hospitals in the project include:
SA – The Women’s and Children’s Hospital, Lyell McEwin hospital, Flinders Medical Centre
Victoria – The Royal Children’s Hospital and Royal Women’s Hospital 
WA – Perth Children’s Hospital, King Edward Memorial Hospital