3.02 Immunisation

Key messages

• In 2022, based on data from the Australian Immunisation Register (AIR), the proportions of Aboriginal and Torres Strait Islander children aged 1, 2 and 5 who were fully immunised were 91%, 89% and 96%, respectively. Of concern, while there have the proportion of Indigenous children who were fully immunised decreased between 2020 and 2022, coinciding with the COVID-19 pandemic – this will be explored further in future reports.
• Between 2013 and 2022, the proportion of Indigenous children aged 1 who were fully immunised increased from 86% in 2013 to a peak of 94% in 2020 before declining to 91% in 2022. A similar pattern was seen for Indigenous children aged 5, where the proportion who were fully immunised increased from 93% in 2013 to 97% in 2020 and then declined to 96% in 2022.
• In 2022, Tasmania had the highest rates of immunisation coverage for Indigenous children (between 95% and 98%, depending on age), while Western Australia had the lowest (between 82% and 94%).
• The gap in immunisation coverage between Indigenous and other children aged 1 narrowed between 2013 and 2022. Between 2013 and 2021, the proportion of fully immunised Indigenous children at age 5 has consistently exceeded that of other children.
• As at 31 May 2023, based on data from the AIR, 36,631 Indigenous adults had received a COVID-19 vaccination in the previous 6 months (7%), 395,893 had received one more than 6 months ago (79%), and 70,241 were unvaccinated (14%).
• Almost one-quarter (22.5%) of Indigenous Australians aged between 6 months and 5 years had received an influenza vaccination in 2021 (based on data from the AIR). Among Indigenous adults, 43.5% of those aged 50–64 had an influenza vaccination in 2021, as did 64.6% of those aged 65–74, and 67.7% of those aged 75 and over.
• In 2021, 73% of Indigenous girls had completed a full dose of human papillomavirus virus (HPV) vaccine by 15 years of age, compared with 80% of all Australian girls. Among Indigenous boys, 66% had completed a full dose of the HPV vaccine by 15 years of age, compared with 77% of all Australian boys.
• In 2018–19, 32% of Indigenous Australians aged 50 and over had been vaccinated against invasive pneumococcal disease in the past five years. The vaccination rates for pneumonia for Indigenous Australians aged 50 and over was 34% in remote areas and 32% in non-remote areas. These rates were slightly lower than that in 2012–13, where pneumococcal vaccination rates were 35% in remote areas and 27% in non-remote areas.

Why is it important?

Immunisation is highly effective in reducing morbidity and mortality caused by vaccine-preventable diseases. Childhood vaccination for diphtheria was introduced in Australia in 1932 and the use of vaccines to prevent tetanus, pertussis (whooping cough) and poliomyelitis became common in the 1950s. This was followed by vaccines for measles, mumps and rubella in the 1960s, and later vaccines for hepatitis B, Haemophilus influenza type b, varicella (chicken pox), pneumococcal disease, meningococcal C, rotavirus, human papillomavirus (HPV) and influenza.

Deaths from vaccine-preventable diseases have fallen for the general population by 99% since the introduction of childhood vaccinations - it is estimated that vaccinations have saved around 78,000 lives between 1932 and 2003 (Burgess 2003). Internationally, vaccinations have been effective in reducing the disease disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations, despite differences in the socioeconomic circumstances of these populations (Menzies & Singleton 2009).

Vaccinations are necessary not only in childhood; pregnant and post-partum women are subject to high risk from severe illness and complications from influenza, and maternal vaccination is shown to protect mothers and infants from illness (Overton et al. 2016). Indigenous adults may be at increased risk of severe illness resulting from influenza and invasive pneumococcal disease due to other risk factors and comorbidities. Programs to make these vaccines accessible have led to improved vaccination rates.

Findings

What does the data tell us?

Childhood immunisation coverage

The Australian Immunisation Register (AIR) is a national register that details all funded vaccinations and most privately purchased vaccines given to individuals of all ages who live in Australia. It was set up in 1996 as the Australian Childhood Immunisation Register and renamed following its expansion in 2016 to allow inclusion of information on adult vaccinations.

According to the National Immunisation Program Schedule, Australian children are expected to have received specific immunisations by age 1, 2 and 5. As at December 2022, slightly lower proportions of Aboriginal and Torres Strait Islander children were fully immunised at age 1 and 2 than other children; however, at age 5 the proportion was higher for Indigenous than other children. Based on AIR data, the proportion of children who were fully immunised:

• at age 1, was 91% for Indigenous children, compared with 94% for other children.
• at age 2, was 89% for Indigenous children, compared with 92% for other children.
• at age 5, was 96% for Indigenous children and 94% for other children (Table D3.02.1, Figure 3.02.1).

Across states and territories, the proportion of Indigenous children who were fully immunised at age 1 varied from 87% in Western Australia to 96% in Tasmania. Similarly, the proportion of Indigenous children aged 2 and 5 who were fully immunised was lowest in Western Australia (82% at age 2, 94% at age 5), and highest in Tasmania (95% at age 2, 98% at age 5) (Table 3.02-1).

Table 3.02-1: Proportion of children fully immunised at age 1 year, 2 years and 5 years, by Indigenous status and jurisdiction, 2022

Jurisdiction	Indigenous children age 1 year	Other children age 1 year	Indigenous children age 2 years	Other children age 2 years	Indigenous children age 5 years	Other children age 5 years
NSW	93.1	93.8	91.2	92.0	96.9	94.0
Vic	91.6	94.0	89.6	92.6	95.6	95.0
Qld	90.3	93.5	89.4	91.9	96.0	93.2
WA	86.8	94.1	82.2	91.8	94.4	93.2
SA	91.3	94.7	90.1	92.5	96.8	95.5
Tas	96.4	94.2	94.5	91.6	97.7	94.1
ACT	92.5	96.6	89.8	95.0	97.0	95.7
NT	87.9	95.9	84.4	92.9	94.9	93.1
Australia	91.1	94.0	89.1	92.2	96.1	94.1

Note: Other children includes non-Indigenous children and those whose Indigenous status is unknown.

Source: Tables D3.02.2, D3.02.3 & D3.02.4. AIHW analysis of the Australian Immunisation Register (AIR).

Change over time in childhood vaccination

Between 2013 and 2022, there were statistically significant increases in the proportion of Indigenous children aged 1 and 5 who were fully immunised. There was no statistically significant change in the proportion of Indigenous children aged 2 who were fully immunised over the decade from 2013 to 2022, though this may be affected by an increase in the number of vaccines scheduled for this age group during the time period.

While there was an overall improvement in immunisation coverage over the decade for Indigenous children aged 1 and 5, there were decreases in coverage rates between 2020 and 2022, coinciding with the COVID-19 pandemic. For Indigenous children aged 2, the coverage rate was the same in 2021 as in 2020, though it dropped in 2022.The recent decline in childhood vaccination coverage in these age cohorts is of concern and will be explored further in future reports as more data become available.

Between 2013 and 2022, the proportion Indigenous children aged 1 who were fully immunised increased from a low of 86% in 2013 to a peak of 94% in 2020 before declining by 3 percentage points to 91% in 2022. A similar pattern was seen for Indigenous children aged 5, where the proportion who were fully immunised increased from 93% in 2013 to 97% in 2020 and then declined to 96% in 2022. Similarly, among other children aged 1 and 5, the proportion who were fully immunised increased between 2013 (91% and 92%, respectively) and 2022 (both 94%), peaking in 2020 (both 95%) (Table D3.02.5, Figure 3.02.1).

For Indigenous children aged 2, over the period 2013 to 2022, the proportion who were fully immunised ranged between 86.2% (in 2015) and 91.7% (in 2013), with no trend apparent. In 2022, 89.1% of Indigenous children were fully immunised – about 2 percentage points lower than in 2020 and 2021 (91.4% in both years) (Table D3.02.5, Figure 3.02.1).

The gap in immunisation coverage between Indigenous and other children aged 1 narrowed between 2013 and 2022. There was no statistically significant change in the gap for children aged 2. The proportion of fully immunised Indigenous children at age 5 consistently exceeded that of other children over the period from 2013 to 2022 (Table D3.02.5, Figure 3.02.1).

Figure 3.02.1: Proportion of children fully immunised at age 1, 2 and 5, by Indigenous status, 2013 to 2022

Note: the age at which older children are assessed changed from 6 years to 5 years in 2007 and comparisons of trends over time are affected by the introduction of new vaccines on the schedule.

Source: Table D3.02.5. AIHW analysis of data from the Australian Immunisation Register (AIR).

Human papillomavirus vaccination coverage among adolescents

Human papillomavirus virus (HPV) is a viral infection that is sexually transmitted and can cause cancers and genital warts. The HPV vaccine is free under the National Immunisation Program (NIP) for young people aged around 12 to 13, primarily provided through school immunisation programs, though adolescents who missed the HPV vaccination at 12 to 13 years of age can catch up for free up to age 26 (DoHAC 2023a).

In 2021, 73% of Indigenous girls had received a full dose of the HPV vaccine by 15 years of age, as had 66% of Indigenous boys (Table 3.02-2) (NCIRS 2022). These HPV coverage rates were lower than among all Australian girls and boys at age 15 (80% of all girls, and 77% of all boys)

Across states and territories, the HPV vaccination rate among Indigenous girls by age 15 was lowest in South Australia at 50%, and highest in New South Wales at 81%. For Indigenous boys by age 15, the coverage rate ranged from 50% in South Australia to 75% in New South Wales (Table 3.02-2).

The difference in HPV vaccination coverage rates for Indigenous adolescents by age 15 compared with the state average for all adolescents was largest in South Australia (difference of 27.1 percentage points for girls, and 22.4 percentage points for boys). The smallest differences were in Tasmania (1.6 percentage point difference for girls, and 4.0 percentage points for boys).

Table 3.02-2: HPV vaccination coverage for girls and boys by 15 years of age, by Indigenous status and jurisdiction, 2021

Jurisdiction	Indigenous girls	All girls	Indigenous boys	All boys
NSW	81.0	83.5	75.0	80.1
Vic	75.2	81.2	63.3	78.4
Qld	69.9	76.4	63.9	73.3
WA	67.8	79.1	62.7	78.4
SA	49.6	76.7	50.3	72.7
Tas	76.8	78.4	68.1	72.1
ACT	72.1	84.9	62.2	81.2
NT	72.9	75.5	57.1	65.7
Australia	73.3	80.3	66.2	77.2

Notes

1. Course completion defined as receipt of 2 doses if dose 2 given ≥5 months after dose 1 or receipt of 3 doses if dose 2 given

2. ‘By 15 years of age’ refers to HPV vaccinations received after 11th birthday and before 15th birthday in cohort born 1 January 2006 – 31 December 2006 (i.e. vaccines due from early 2018 to late 2019).

3. All girls/boys includes both Indigenous and non-Indigenous children, and those whose Indigenous status is unknown.

Source: Annual Immunisation coverage report 2021 (Tables 4 and 5), based on Australian Immunisation Register data as at 3 April 2022 (NCIRS 2022).

COVID-19 vaccination coverage

Vaccination against COVID-19 is recommended for everyone aged 5 and over. Booster doses are recommended for people at higher risk of severe illness, including everyone 65 years and over, and everyone 18 years and over with medical comorbidities, disability or complex health needs. All adults aged 18 and over are eligible for a COVID-19 booster if it’s been 6 months or longer since their last COVID-19 booster or confirmed infection (whichever is most recent) (DoHAC 2023b).

As at 31 May 2023, based on data from the Australian Immunisation Register, among Indigenous adults aged 18 and over:

• 36,631 had received a COVID-19 vaccination within the previous 6 months (7% of Indigenous adults, noting the denominator includes those who would not have been eligible for a booster in the last 6 months due to recent infection, and people outside the groups recommended to get booster doses)
• 395,893 had received a vaccination 6 or more months ago (79%)
• 70,241 (14%) were unvaccinated (Table 3.02-3).

Table 3.02-3: COVID-19 vaccination status for Indigenous adults aged 18 and over, 31 May 2023

Vaccination status	Number	Per cent
Unvaccinated(a)	70,241	14.0
Last dose <6 months ago	36,631	7.3
Last does more than 6 months ago	395,893	78.7
Total	502,765	100.0

(a) Unvaccinated population is based on the total number of individuals on the Australian Immunisation Register who have identified as being Aboriginal and/or Torres Strait Islander origin, minus those who have a dose recorded on the Register.

Source: AIHW analysis of (DoHAC 2023c) based on Australian Immunisation Register data as at 31 May 2023.

Influenza vaccination coverage

Annual influenza vaccination is recommended for all people aged 6 months and over, and under the NIP, is available free to the following groups:

• all Indigenous Australians aged 6 months and over,
• all Australian children aged 6 months to less than 5 years,
• all Australians aged 65 and over,
• all Australians aged 6 months and over with certain medical conditions putting them at higher risk, and
• pregnant women (DoHAC 2023d).

Until recently, data on influenza vaccination coverage have been based on population surveys. Since 1 March 2021, there has been mandatory reporting of influenza vaccines to the AIR. Note that these data may underestimate true coverage, due to under-reporting of adult vaccinations to the AIR, and relatively recent introduction of mandatory reporting (NCIRS 2022). 

Based on AIR data for 2021, one quarter (25.0%) of Indigenous Australians aged 6 months and over received an influenza vaccination.

In 2021, among Indigenous children aged from 6 months up to 5 years, 22.5% received an influenza vaccination– this was lower than among all Australian children (26.5%) (Figure 3.02.2).

Influenza vaccination coverage for Indigenous children aged from 6 months up to 5 years was highest in the Northern Territory, at 53.2%; coverage rates in other jurisdictions range from 18.9% (in Queensland and Western Australia) to 35.1% (in the Australian Capital Territory).

Among Indigenous adults aged 50–64, the proportion who received an influenza vaccination was 43.5%. This increased to 64.6% for those aged 65–74, and 67.7% for those aged 75 and over (NCIRS 2022). 

Indigenous adults aged 65–74 had a slightly higher influenza vaccination coverage than all Australians of this age (64.6% compared with 62.1%). However, Indigenous adults aged 75 and over had slightly lower influenza vaccination coverage than all adults aged 75 and over (67.7%, compared with 68.5% for all Australians).

Figure 3.02.2: Influenza vaccination coverage among Indigenous Australians, by age group, 2021

Source: Australian Immunisation Register, data as at 3 April 2022 (NCIRS 2022).

Based on self-reported data from ABS Aboriginal and Torres Strait Islander health surveys, between 2012–13 and 2018–19, there was an increase in the rate of vaccination against influenza among Indigenous Australians aged 50 and over, from 57% to 68%. In remote areas, the rate increased from 68% to 73% over the period, and in non-remote areas, the increase was from 54% to 67% (Table D3.02.8).

Influenza vaccination among Indigenous primary health care organisation clients

As at June 2022, 21% (77,580) of Indigenous regular clients of Indigenous primary health care organisations who were aged 6 months or older had received an influenza immunisation. The proportion of Indigenous clients vaccinated against influenza varied across remoteness areas, ranging from 18% in both Inner regional (13,560 of 75,031 regular clients) and Outer regional (12,235 out of 69,150 regular clients) areas to 26% in Very remote areas (20,064 of 76,100 regular clients) (Table D3.02.9, Figure 3.02.3).

Young children and older people infected with influenza have a higher chance of serious illness and complications, such as pneumonia. At 30 June 2022, among Indigenous regular clients aged 6 months to under 4, 18% of males, and 19% of females had an influenza vaccination in the previous 12 months. Among older Indigenous regular clients, 34% of males and females aged 55–64 received an influenza vaccination, with this increasing to 44% of males and 45% of females aged 65 and over (AIHW 2023).

Figure 3.02.3: Influenza vaccination coverage of Indigenous regular clients of Indigenous primary health care organisations, by remoteness, June 2022

Source: Table 3.02.9. AIHW analysis of the National Key Performance Indicators for Aboriginal and Torres Strait Islander Primary Health Care collection.

Invasive pneumococcal disease vaccination coverage among adults

Data on immunisation of adults for invasive pneumococcal disease is available from the National Aboriginal and Torres Strait Islanders Health Survey (NATSIHS), based on self-report.

In 2018–19, 32% of Indigenous Australians aged 50 and over had been vaccinated against invasive pneumococcal disease in the last five years. The vaccination rates for pneumonia for Indigenous Australians aged 50 and over was 34% in remote areas and 32% in non-remote areas. In 2012–13, these proportions were 35% in remote areas and 27% in non-remote areas (Table D3.02.8, Figure 3.02.4). 

In 2018–19, Indigenous Australians aged 65 and over had higher rates of immunisation against invasive pneumococcal disease in the last five years (46%) compared with those aged 50–64 (27%) (Table D3.02.7).

Figure 3.02.4: Indigenous Australians aged 50 and over who had immunisation against invasive pneumococcal disease in the last 5 years, by age and remoteness, 2018–19

Source: Table D3.02.7, Table D3.02.8. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

Adult vaccinations are also targeted at younger Indigenous Australians who have various risk factors, such as chronic medical conditions. In 2018–19, 40% of Indigenous Australians aged 15–49 were vaccinated for influenza in the previous year, and 7% had received a pneumococcal vaccination in the previous five years.

The 2018–19 NATSIHS found that Indigenous Australians aged 15–49 who had diabetes/high blood sugar levels or circulatory diseases were significantly more likely to have had recent vaccinations against influenza (1.7 and 1.4 times, respectively) and pneumococcal disease (2.4 and 1.8 times, respectively) than Indigenous Australians without those diseases (Table D3.02.6).

What do research and evaluations tell us?

Recent research illustrates the importance of vaccinations for Indigenous Australians. The results point to the ongoing requirement for improvements in the rate of timely vaccinations for Indigenous children and the importance of vaccination in pregnancy and for older Indigenous Australians with increased risk of severe illness. Health care providers play a vital role in encouraging vaccinations for Indigenous Australian adults.

Hendry and others (2018) found that a program aimed at improving the rates of vaccinations contributed to the improved vaccination rates in Indigenous Australian children in New South Wales (Hendry et al. 2018). The cross-sectional study assessed both the vaccination rates and the timeliness of receipt of vaccinations in children. Vaccinations were compared across Indigenous and non-Indigenous children in New South Wales and the rest of Australia, between 2008 and 2016. A comparison of vaccination coverage before and after the introduction of the Aboriginal Immunisation Health care Worker (AIHCW) Program in New South Wales in 2012 showed a significant increase in rates of Indigenous and non-Indigenous children fully vaccinated at 9, 15 and 51 months of age. The increases in the vaccination rate were prominent in New South Wales after the introduction of the AIHCW Program compared with the rest of Australia.

Kabir et al. estimated the effectiveness of the NIP on the uptake of all 3 doses of pneumococcal vaccines before the age of 1 by comparing the vaccine coverage among children born before and after the universal program period in New South Wales and Western Australia. The overall 3 dose vaccine coverage for Indigenous children increased from 36.6% to 82.9%. For Indigenous children with medically at-risk conditions, the rates increased from 38.5% to 80.7%. However, coverage for additional recommended booster doses, such as having the 4^th dose of the pneumococcal vaccines, remained low. The findings highlight the need for improved implementation strategies to strengthen the routine vaccination schedule and ensure adequate coverage for high-risk groups (Kabir et al. 2021).

Maternal immunisation has the potential to reduce the burden of infectious diseases in both pregnant women and infants. Marshall et al. (2016) assessed maternal immunisation internationally and noted the role of cultural factors in vaccination programs in order to maximise the uptake of new vaccines for pregnant women (Marshall et al. 2016). They also emphasised the importance of pregnant women having confidence in immunisation providers.

Moberley et al. (2016) recommend prioritising activities to improve and monitor maternal influenza vaccination coverage for Indigenous women (Moberley et al. 2016). Indigenous pregnant women who participated in a vaccination trial before and during the 2009 H1N1 influenza pandemic were studied to determine vaccination coverage. Key findings included:

• Vaccine coverage over the study period increased from 2.2% in the period 2006 to 2009 to 41% in the period 2009 to 2010.
• Increased maternal influenza vaccination coverage signified greater readiness of Indigenous women to be vaccinated.

In a survey of Indigenous Australian mothers who had recently given birth in Central Australia, Krishnaswamy et al. (2018) found:

• Awareness and uptake by pregnant mothers of influenza vaccination was greater than for pertussis (whooping cough).
• Vaccination self-reporting underestimated vaccine coverage.
• There was a good understanding of public health messages of the benefits of maternal vaccination.
• Lack of health care provider recommendations is the main reason for non-vaccination (Krishnaswamy et al. 2018).

A study in New South Wales found barriers to influenza vaccination among Indigenous Australian adults included health system barriers and misconceptions among Indigenous Australians about the vaccine. Poor quality Indigenous status identification in primary health care settings and insufficient recommendations and reminders from health care providers may be contributing to a lack of awareness and lower uptake of the vaccine. There were also misconceptions among Indigenous Australians over vaccine effectiveness, safety and the severity of influenza. Younger adults and more highly educated adults were less likely to get vaccinated (Menzies et al. 2020).

Data from the national key performance indicators for Indigenous-specific primary health care show that influenza vaccination coverage for adults aged over 50 is improving and stronger improvements are being seen in major cities (albeit from a lower base) (AIHW 2020). This highlights the value of having good quality service-level data for driving improvements, and that Aboriginal Community Controlled Health Services are demonstrating to mainstream services that progress is possible even in difficult to reach non-remote environments. Further research is needed to unpack successful strategies to improve vaccination that can be implemented, in particular in mainstream primary health care.

High rates of the first dose of the HPV vaccination among Indigenous Australian adolescents is being seen in school-based programs, but strategies are needed to improve the completion rates for Indigenous Australians (Brotherton et al. 2019).

A study involving 35 Aboriginal people aged 15–80 years living in Western Sydney found that Aboriginal people preferred to access COVID-19 vaccination through their local Aboriginal medical service or a GP they had an existing and trusting relationship with. Reasons why some participants were hesitant about being vaccinated included: fear of vaccine side effects; negative stories on social media; and distrust in Australian governments and medical institutions (Simon et al. 2022).

Implications

Achieving good immunisation coverage reflects the strength and effectiveness of primary health care and demonstrates the benefits of large scale vaccination programs that have little or no cost to eligible participants. The high rates of vaccination for Indigenous Australian children is a significant achievement. However, there are still improvements that can be made to increase the vaccination rates in Indigenous Australian children, adolescents and adults. Targeted communication strategies to overcome barriers to vaccination and misconceptions about vaccination could be beneficial. Activities to encourage uptake among Aboriginal and Torres Strait Islander audiences for influenza and routine childhood vaccinations were undertaken in 2022–23.  

Health care providers play a central and vital role in encouraging vaccination. Research is needed into effective strategies for encouraging vaccination among Indigenous Australian clients of mainstream primary health care. There is also a need for better identification of Indigenous clients of mainstream primary health care in order for services to make vaccinations more available to Indigenous Australian adults. Data collection for continuous quality improvement can be used to drive or at least demonstrate improvements.

The policy context is at Policies and strategies.

References

• AIHW (Australian Institute of Health and Welfare) 2020. Indigenous primary health care: results from the OSR and nKPI collections. Canberra: AIHW.
• AIHW 2023. Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections. Canberra: AIHW. Viewed May 2023.
• Brotherton JM, Winch KL, Chappell G, Banks C, Meijer D, Ennis S et al. 2019. HPV vaccination coverage and course completion rates for Indigenous Australian adolescents, 2015. Medical Journal of Australia 211:31-6.
• Burgess M 2003. Immunisation: a public health success. New South Wales Public Health Bulletin 14:1-5.
• DoHAC (Department of Health and Aged Care) 2023a. HPV (human papillomavirus) vaccine. Australian Government Department of Health and Aged Care. Viewed June 2023.
• DoHAC 2023b. Who can get vaccinated. Canberra. Viewed June 2023. 
• DoHAC 2023c. COVID-19 vaccination – vaccination data – 2 June 2023. Canberra. Viewed 4 June 2023.
• DoHAC 2023d. 2023 Influenza vaccination – Program advice for vaccination providers. Viewed June 2023.
• Hendry AJ, Beard FH, Dey A, Meijer D, Campbell-Lloyd S, Clark KK et al. 2018. Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program. The Medical journal of Australia 209:24-8.
• Kabir A, Newall AT, Randall D, Menzies R, Sheridan S, Jayasinghe S et al. 2021. Estimating pneumococcal vaccine coverage among Australian Indigenous children and children with medically at-risk conditions using record linkage. Vaccine 39:1727-35.
• Krishnaswamy S, Thalpawila S, Halliday M, Wallace EM, Buttery J & Giles M 2018. Uptake of maternal vaccinations by Indigenous women in Central Australia. Australian and New Zealand journal of public health 42:321.
• Marshall H, McMillan M, Andrews RM, Macartney K & Edwards K 2016. Vaccines in pregnancy: The dual benefit for pregnant women and infants. Hum Vaccin Immunother 12:848-56.
• Menzies R, Aqel J, Abdi I, Joseph T, Seale H & Nathan SA 2020. Why is influenza vaccine uptake so low among Aboriginal adults? Australian and New Zealand journal of public health 44:279-83.
• Menzies R & Singleton RJ 2009. Vaccine preventable diseases and vaccination policy for indigenous populations. Pediatric Clinics of North America 56:1263-83.
• Moberley SA, Lawrence J, Johnston V & Andrews RM 2016. Influenza vaccination coverage among pregnant Indigenous women in the Northern Territory of Australia. Commun Dis Intell Q Rep 40:E340-E6.
• NCIRS (National Centre for Immunisation Research and Surveillance) 2022. Annual Immunisation Coverage Report 2021. The National Centre for Immunisation Research and Surveillance.
• Overton K, Webby R, Markey P & Krause V 2016. Influenza and pertussis vaccination coverage in pregnant women in the Northern Territory in 2015 – new recommendations to be assessed. Vol. 23 (ed., Health Do). Centre for Disease Control, 1-8.
• Simon G, Megan B, Reuben B, Mitchell B, Kristy G, Kacey M et al. 2022. Aboriginal peoples’ perspectives about COVID-19 vaccines and motivations to seek vaccination: a qualitative study. BMJ Global Health 7:e008815.