The number of Australians getting vaccinated against COVID-19, shingles and other serious diseases has dropped, prompting a plea to reset national immunisation strategies to target more high-risk groups.

A Grattan Institute report exposed big gaps in vaccination rates, leading to too many people needlessly dying and suffering.

The think-tank is urging authorities to roll out jab 'surges' to protect as many people as possible heading into cooler months.

At the beginning of winter this year some 2.5 million Australians over 65 were not up to date with COVID vaccines and less than half of those aged in their 70s were protected from shingles, the report found.

Just one in five were immunised against pneumococcal disease, which can cause meningitis and pneumonia.

It revealed people who do not speak English at home were half as likely to have the recommended number of COVID vaccines, Indigenous Australians were one third less likely and many people in rural areas missed out.

Vaccination rates also varied greatly within capitals such as Brisbane, with the take up rate of flu vaccines varying by 30 per cent across different parts of the city.

The report called on governments to "get their house in order" and sign on to a new national vaccine agreement, claiming current strategies are out-of-date.

It proposed a vaccine 'surge' before winter to ensure as many people are protected as possible.

That would mean rules around the time between jabs would become flexible for high-risk people, regardless of recent infection or when they had their last jab, bolstered by an advertising campaign and SMS alerts.

The 'surge' would need more funding for immunisers and community groups to reach people in aged care homes, some cultural groups, indigenous Australians and homeless people.

"Without a national agenda to reset vaccination, adult vaccination is likely to remain stuck in a rut or even decline, causing needless suffering, death, and healthcare spending," the report stated.

It found barriers to immunisation include forgetfulness, convenience, having time off work to recover from side effects and misinformation, however many barriers were not attributed to attitudes towards vaccines or individual choice.