Dissertation/Thesis Abstract

Avoiding inaction in the face of need: How a publicly funded human papillomavirus (HPV) vaccine could be implemented in Aotearoa/New Zealand to avoid Māori:non-Māori immunisation inequalities
by Loring, Belinda, M.P.H., The University of Auckland (New Zealand), 2008, 145; 1484467
Abstract (Summary)

Māori suffer higher morbidity and mortality from cervical cancer than non-Māori, and also have lower vaccination rates of publicly funded vaccines than non-Māori. The HPV vaccine provides an exciting opportunity to prevent cervical cancers, but if Māori receive this vaccination less than non-Māori, cervical cancer inequalities for Māori will be further widened.

Aim. To consider the HPV vaccine from an inequalities and KMR-consistent perspective, and determine how the vaccine could be implemented in New Zealand to avoid increasing Māori:non-Māori inequalities in immunisation and cervical cancer.

Methods. (1) Critical literature review to identify strategies for improving vaccination coverage rates for Māori, and other indigenous/ethnic minority groups. (2) Quantitative analysis of school-based vaccination coverage data for 11 year olds in CMDHB—the HPV vaccine is recommended for adolescent girls, but there are no published data regarding vaccination coverage rates in this age group in New Zealand. (3) Health Equity Assessment Tool (HEAT) analyses of possible policy options for the HPV vaccine in New Zealand. (4) Key informant interviews with experts in fields such as Māori health, immunisation and policy-making to enhance analyses.

Results. There is insufficient evidence relating to Māori immunisation strategies in New Zealand, although attitudes do not appear to explain immunisation inequalities. Universal vaccination programmes have been more successful than targeted programmes for indigenous people elsewhere. Coverage of the 11 year old vaccinations through CMDHB's school based programme was 48% for Māori and 56% for non-Māori, with non-return of consent forms a major driver of lower coverage for Māori. There are a number of interventions which could make a publicly funded vaccination programme work better for Māori, including national and local awareness-raising targeted at Māori, a culturally appropriate and piloted consent form, providing sufficient time and information to enable parents to make a decision, and intensive culturally appropriate follow-up/outreach. Catch-up clinics should be built in to the programme from the start.

Conclusion. The HPV vaccine should be universally publicly funded for 11 year old girls, in conjunction with additional efforts targeted at Māori, to avoid immunisation and cervical cancer inequalities widening. The HPV vaccine should be delivered through a school-based programme, supported by database tracking of all children on school rolls, and with intensive, culturally-appropriate follow-up of children who do not have consent forms returned.

Indexing (document details)
Advisor: Curtis, Elana Taipapaki
School: The University of Auckland (New Zealand)
School Location: New Zealand
Source: MAI 48/05M, Masters Abstracts International
Subjects: Public health, Public policy, Ethnic studies
Publication Number: 1484467
ISBN: 978-1-109-72820-0
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