Experts are calling for urgent updates to the Australian Immunisation Register (AIR) to optimise the national COVID-19 vaccine rollout out and protect vulnerable patients.

Writing in an MJA article, a group of experts said that several targeted vaccine programs introduced to the Australian National Immunisation Program (NIP) in 2020 exposed the register’s limitations. In particular, they highlighted the AIR’s inability to collect information on medical risk factors, such as pregnancy, to monitor vaccine uptake in at-risk groups.

Lead author, Dr Jane Tuckerman of the Murdoch Children’s Research Institute in Melbourne, told HealthTimes “we must ensure that we have the mechanisms to accurately assess coverage in these vulnerable groups, not just the routine childhood NIP-funded groups, to drive optimal uptake and best practice.”

“We are at risk that specific groups who are recognised as being vulnerable and/or medically at-risk will not receive the vaccine recommendations they need.”

“We know that in many cases, a healthcare provider recommendation is critical, particularly for targeted groups, such as during pregnancy.”

The lack of pregnancy-status capture in the AIR means that other data sources need to be used, such as perinatal datasets in jurisdictions where maternal immunisation is collected, or population surveys to obtain coverage estimates. However, these are of no use to clinicians at the individual level.

“This is also the case for children who are medically at-risk, with no capacity to link medical risk factors with vaccine receipt for identification and tracking of these children.”

The authors wrote that the COVID‐19 pandemic highlights the requirement for a more adaptable AIR.

“With more than 200 COVID‐19 vaccine candidates in development, the rollout of COVID‐19 vaccines will be complex due to expected availability and the delivery capacity of immunisation providers”, they explained.

As it stands, however, data in the register falls far short of what is required to evaluate the success of the COVID-19 vaccine rollout, and other immunisation programs, in medically at-risk populations.

Part of the issue with the AIR is that it has only existed as a whole-of-life register since 2016, when it replaced the Australian Childhood Immunisation Register, which only recorded vaccines in children up to 7 years of age.

While a tick box was included on the register in December 2020 for immunisation providers to flag “at-risk” patients, Dr Tuckerman said this fell short.

“A tick box, ‘additional vaccines required’, was added. However, it is quite generic and fails to identify the reasons for and/or which vaccines are actually required.”

“It also needs to be entered manually on the AIR website, so it’s possible that there would be issues with data completeness and quality. It would also be of limited use to evaluate coverage in targeted programs.”

In the article, Dr Tuckerman and her colleagues wrote that one potential solution was to “consider the linkage of AIR data to other national datasets (eg, Medicare, the Pharmaceutical Benefits Scheme, hospitalisations, the Therapeutic Goods Administration adverse event database)”.

“Another solution would be to include pregnancy and medical risk factor data fields in the AIR. This information could be entered directly by providers if reporting on the AIR secure website or reported in a semi-automated manner via practice management software.”

Dr Tuckerman and her colleagues concluded that “there is opportunity for improvement if the AIR is to fulfil its potential as a lifelong register”.

“We are seeking support from the broader medical community to raise awareness and advocate that these changes should be prioritised, not only to improve accuracy in recording of vaccinations and at-risk status but also to facilitate providers’ ability to access AIR data for better patient care,” they wrote.

Dr Tuckerman said she appreciated that any changes to the AIR and provider may be challenging, “but not impossible given adequate consideration and resources are put towards it.”