Nurse Uncut is pleased to bring you the first in a regular post by Coral Levett, President of the Australian Nursing and Midwifery Federation and of the NSW Nurses and Midwives Association. Coral’s columns appear in the Australian Nursing and Midwifery Journal, which goes to more than 120,000 members each month.
In this stimulating piece, Coral compares vaccination with unionism – and finds many similarities.
Since 1945, when vaccines first came into widespread use in Australia, we’ve seen a significant and steady decline in vaccine-preventable disease across all populations. Vaccines available until the late 1960s included tetanus, diphtheria, pertussis and polio. The ‘70s and ‘80s added measles, mumps, rubella and hepatitis B to the mix and eventually in the last 20 years we’ve seen the widespread use of Haemophilus influenzae type b (Hib), hepatitis A, influenza, varicella, pneumococcal, meningococcal, human papillomavirus and rotavirus vaccines throughout Australia.
Coral is second from left in the red cape with members of the NSWNMA holding placards showing gains made by unions for nurses and midwives (Sydney May Day 2013).
The evidence that Australia has one of the highest rates of immunisation is well reported in the literature. A better understanding of disease processes, the human immune system and the spread of disease has focused Australian efforts towards a number of initiatives that have led to improvements in immunisation rates, particularly over the last 10-15 years. Many vaccines are provided free through the Immunise Australia program to certain members of the community, especially infants and children, and those with special health needs such as the elderly and indigenous peoples.
Immunise Australia is a Commonwealth Government funded program that is also responsible for:
• Parent and provider incentives such as cash payments to those parents who provide evidence of immunising their children
• The Australian Childhood Immunisation Register (AICR) – a national register to record the uptake of immunisation programs and activities
• The National Centre for Immunisation Research and Surveillance (NCIRS)
• General Practice Incentive Programs – where GPs (or their practice) are paid if they reach determined targets of immunisation.
These initiatives and continued progress in this field of health promotion are truly remarkable and thousands of unnecessary Australian deaths have been prevented as a result.
In my reading about vaccination and immunity in recent times, I’ve come to the realisation that my interest in this field probably lies with its similarities to unionism. Now, I know some of you will think this link is a bit of a stretch, but let me tell you why I think the link exists.
For those not currently working in an immunisation context, you may remember the concept of ‘herd immunity’ from your training days. It occurs when a significant portion of individuals within a population are protected against a disease through immunisation. It offers indirect protection for people who are still susceptible to the disease by making it less likely that they will come into contact with it. It also benefits a small number of people who fail to respond to vaccines or who cannot be vaccinated for medical reasons. So the more people who are vaccinated (or have immunity by another means) in a given group, the more protection is afforded to the whole group.
Similarly, we know in our industry that where more nurses and midwives are union members, they tend to be better off in terms of pay, work conditions and patient ratios. Although there are always exceptions to this rule, it is particularly well demonstrated in nursing and midwifery when you compare these outcomes in the public sector (highest level of union membership), the private sector (lower level of union membership) and the aged care sector (lowest level of union membership).
From the National Tertiary Education Union.
The concept of ‘herd immunity’ is a key determinant of the success or otherwise of vaccination programs in Australia. Until we achieve vaccination rates of 100 percent, we will continue to have the potential for disease outbreaks. The closer we are to achieving that 100 percent figure, the better the situation for those unable to be vaccinated (for health reasons) and those who despite vaccination do not seroconvert.
The same can be said for union membership. If all nurses and midwives were members of the Australian Nursing and Midwifery Federation (and their relevant state union), our potential for best outcomes in pay, conditions and ratios is far higher. Conversely, low and non-unionised workplaces will continue to bear the brunt of unscrupulous employers who will always take advantage of this fact.
Australian Government Department of Health, Immunise Australia Program, accessed February 2014
Australian Technical Advisory Group on Immunisation (ATAGI) 2013, The Australian Immunisation Handbook, 10th edn, Department of Health and Ageing, Canberra. Accessed February 2014
Thank you to Coral Levett and to the Australian Journal of Nursing and Midwifery for permission to republish this article.