Immunisation Coverage in Aotearoa New Zealand

Childhood immunisation plays a significant role in protecting children from vaccine-preventable diseases (VPDs). For vaccines to have their optimal effect a high proportion of the population needs to be immunised. High coverage and on-time immunisation benefits those who have been vaccinated and can also provide protection for people who are not able to be immunised due to their age or a specific health condition. Unfortunately, Aotearoa New Zealand (NZ) has struggled with low immunisation coverage, which means that we have been unable to prevent outbreaks of VPDs (Nowlan et al., 2019).

Immunisation coverage has changed significantly over time in NZ. The graph below visually displays coverage history at two years of age between 1993 and 2021 in relation to policy changes and other events.

Although immunisation coverage has improved over time, it has remained lower, particularly for Māori and for populations from socioeconomically deprived areas (Mueller et al., 2012). Previously, there was a period of increasing vaccination coverage with significant reductions in the equity gaps by ethnicity and socioeconomic status. However, since 2018 coverage had stopped improving and started to decline, especially for the groups who were already at the greatest risk of VPDs (Nowlan et al., 2019). Since the start of the COVID-19 pandemic in 2020, the decline in coverage, and increase in equity gaps, has been much steeper.

Factors that influence vaccination uptake

There are multiple factors which can influence vaccination uptake. The “increasing vaccination model” by Brewer et al. (2021), adapted by a World Health Organization working group, summarises some of the determinants of childhood immunisation. These factors include enablers and barriers stemming from the healthcare system, including the health workforce.

Well-informed health professionals who recommend, and actively demonstrate acceptance of, vaccination can have a strong influence on parents’ choices about immunisation of their children (Nowlan et al., 2019; Priday et al., 2023).

On-time immunisation can be further supported by health professionals working in contexts that enable them to prioritise immunisation discussions and delivery. Research has shown that working in well-staffed teams and using practice management systems which facilitate systematic management of immunisation data and recalls are important to achieving high vaccination coverage in primary care settings (Petousis-Harris et al., 2012).

Access to high quality, culturally safe and supportive immunisation services also greatly impacts vaccination uptake (Brewer, 2019). Multiple barriers persist, which unnecessarily and inequitably prevent on-time childhood immunisation in NZ. For example, although vaccinations on the schedule are funded, affordability may still be a barrier for families on low incomes including transport costs and time off work to attend appointments (Turner et al., 2017). Other barriers to access in a NZ context include poverty and housing insecurity (including affordability, transience, and homelessness), which can also both lead to lack of engagement with a trusted general practice (Walker et al., 2019). Newborn Enrolment in primary care remains a significant area where systems are failing Tamariki (Chan et al., 2022; Te Whatu Ora, 2022).

Antenatal Immunisation

Antenatal immunisation provides an important opportunity for whānau and health care professionals to have discussions about immunisation and to offer children protection from VPDs from the very start of their lives.

Some antenatal immunisations, if given at the right time, confer protection to the infant before they’re able to be immunised themselves. For example, if wāhine hapū are immunised against pertussis (whooping cough) between 16 and 38 weeks of pregnancy, their pēpi is more than 90% protected from pertussis infection in the first 3 months of their life due to antibodies being shared across the placenta (Amirthalingam et al., 2016).

A recent NZ study has shown antenatal vaccination coverage remains far below the level required to adequately protect communities, and that there are large differences in coverage by ethnicity and socioeconomic status (Pointon et al., 2022). Drivers of these differences include barriers in access to primary and maternity care, geographical access, and racism (Marek et al. 2020; Sinclair & Grant, 2021).

Background references

Amirthalingam, G., Campbell, H., Ribeiro, S., Fry, N. K., Ramsay, M., Miller, E., & Andrews, N. (2016). Sustained effectiveness of the maternal pertussis immunization program in England 3 years following introduction. Clinical Infectious Diseases, 63(suppl 4), S236-S243.

Brewer, N. T. (2021). What works to increase vaccination uptake. Academic Pediatrics, 21(4), S9-S16.

Grant, C. C., Turner, N. M., York, D. G., Goodyear-Smith, F., & Petousis-Harris, H. A. (2010). Factors associated with immunisation coverage and timeliness in New Zealand. British Journal of General Practice, 60(572), e113-e120.

Hobbs, M. R., Morton, S. M., Atatoa-Carr, P., Ritchie, S. R., Thomas, M. G., Saraf, R., Chelimo C., Harnden A., Camargo C.A., & Grant, C. C. (2017). Ethnic disparities in infectious disease hospitalisations in the first year of life in New Zealand. Journal of Paediatrics and Child Health, 53(3), 223-231.

Immunisation Advisory Centre (2023), Breaking down barriers to immunisation is a sector-wide job. IMAC. https://www.immune.org.nz/news/breaking-down-barriers-to-immunisation-is-a-sector-wide-job

Marek, L., Hobbs, M., McCarthy, J., Wiki, J., Tomintz, M., Campbell, M., & Kingham, S. (2020). Investigating spatial variation and change (2006–2017) in childhood immunisation coverage in New Zealand. Social Science & Medicine, 264, 113292.

Mueller, S., Exeter, D. J., Petousis-Harris, H., Turner, N., O’Sullivan, D., & Buck, C. D. (2012). Measuring disparities in immunisation coverage among children in New Zealand. Health & Place, 18(6), 1217-1223.

Nowlan, M., Willing, E., & Turner, N. (2019). Influences and policies that affect immunisation coverage-a summary review of literature.

Petousis-Harris, H., Grant, C., Goodyear-Smith, F., Turner, N., York, D., Jones, R., & Stewart, J. (2012). What contributes to delays? The primary care determinants of immunisation timeliness in New Zealand. Journal of primary health care, 4(1), 12-20.

Pointon, L., Howe, A. S., Hobbs, M., Paynter, J., Gauld, N., Turner, N., & Willing, E. (2022). Evidence of suboptimal maternal vaccination coverage in pregnant New Zealand women and increasing inequity over time: a nationwide retrospective cohort study. Vaccine, 40(14), 2150-2160.

Priday, A., Clemons, J., Krishnan, T., Gillard-Tito, S., Fielder, A., & McAra-Couper, J. (2023). Women’s knowledge, attitudes and access to vaccines in pregnancy: A South Auckland study. New Zealand College of Midwives Journal, 59, 14-20.

Sinclair, O., & Grant, C. (2021). New Zealand’s immunisation policy fails again and entrenches ethnic disparities. The New Zealand Medical Journal (Online), 134(1542), 92-95.

Te Whatu Ora. (2022). Initial Priorities for the National Immunisation Programme in Aotearoa. Wellington (New Zealand). Te Whatu Ora – Health New Zealand.

Turner, N. M., Charania, N. A., Chong, A., Stewart, J., & Taylor, L. (2017). The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand. BMC nursing, 16(1), 1-9.

Turner N. (2014) Factors associated with immunisation coverage for the childhood immunisation programme in New Zealand: 1999 to 2012 [from unpublished medical doctorate]. University of Auckland.

Walker, L., Ward, E., & Gambitsis, D. (2019). Improving New Zealand’s childhood immunisation rates: evidence review.Wellington (NZ): Allen and Clarke Policy and Regulatory Specialists Limited.

The following interactive graphs show how childhood immunisation coverage has changed over time at age-milestones between 6 months and 5 years in Aotearoa New Zealand. Before interpreting the data on the following pages, it is important to keep a few things in mind.

1. Immunisation coverage reflects the proportion of babies and children who received all the immunisations they were eligible for at specific age milestones. This means that coverage at any given milestone can be affected by children receiving only a subset of the vaccinations they are eligible for as per the schedule, or vaccinations not being received on-time.

2. Different age milestones provide different insights about immunisation coverage. Some are absolute measures which are more easily compared with similar data from other countries (including coverage at the 1- and 2-year milestones), whereas others are measures of immunisation timeliness. For example, the 6-month milestone is a measure of timeliness as it reflects pēpi receiving the first three immunisation events on time, within one month of the third event. Timeliness is extremely important as the schedule has been designed to protect infants when they are most vulnerable to each disease. Although timeliness is vital, coverage tends to improve by later milestones as infants receive vaccinations at times later than specified on the schedule.

3. Coverage data can become challenging to interpret when changes to the National Immunisation Schedule occur. For example, in 2020 it was recommended that the measles, mumps and rubella (MMR) vaccine doses be given at 12 and 15 months rather than 18 months and 4 years, to enable children to be protected as early as possible. This schedule change meant that some children appeared to be overdue in practice management systems when they had not yet had an opportunity to be immunised, and that immunisation coverage became difficult to compare to other points in time.

4. The “Other” ethnicity grouping in the following graphs contains all those who have a non-NZ European ethnic group listed on their current NHI record, who also don’t have any Māori, Pacific or Asian ethnic group listed.

Further information about the data which informed these graphs can be found here.

How to use these graphs:

The following graphs are interactive. You can hover at any point along the lines of each graph to reveal the exact coverage at quarterly intervals. It is possible to remove or reintroduce lines on the graphs by clicking on the group of interest in the legend (e.g. 6 months). You can adjust each graph to timeframe of interest by clicking on small grey bars and moving them to the time of interest in the viewfinder (the blue bar below each graph). Raw data can also be accessed by selecting the drop-down menu in the top right corner of each graph, then selecting ‘Download CSV’.

The patterns of immunisation coverage have differed significantly by age milestone in Aotearoa New Zealand. This graph shows coverage for all age milestones from 6 months to 5 years between the June 2009 and September 2023 quarters.

6 months: Immunisation coverage for those aged 6 months reached its highest point to date of 82.0% in December 2015. Coverage at the 6-month milestone has since decreased and was 67.4% in September 2023.

8 months: Immunisation coverage for those aged 8 months reached its highest point to date of 93.7% in December 2015. Coverage at the 8-month milestone has gradually decreased and was 82.6% in September 2023.

12 months: Immunisation coverage for those aged 12 months reached its highest point to date of 95.0% in June 2016. Coverage at the 12-month milestone has since decreased and was 87.0% in September 2023.

18 months: Between June 2009 and September 2023 immunisation coverage for those aged 18 months reached its highest point to date of 86.5% in September 2016. The immunisation coverage for the 18-month age group in September 2023 was 67.3%.

24 months: Immunisation coverage for this age group reached its highest point to date of 93.5% in March 2016. Coverage has subsequently decreased and was 82.5% in September 2023.

54 months: Data on Immunisation coverage at the 54-month milestone has only been monitored since March 2020, at which point coverage was 82.1%. Immunisation coverage for the age group was 67.0% in September 2023.

5 Years: Between June 2010 and September 2023 immunisation coverage reached a peak of 89.2% in December 2019. Coverage has since decreased and was 78.8% in September 2023.

Please note that coverage at the 18-month milestone was especially affected by the MMR schedule change in 2020, which is described in more detail on the Immunisation Coverage page.

If an infant is fully immunised by 6 months of age, they will be protected against 9 vaccine-preventable diseases: Rotavirus, diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B, Haemophilus influenzae type b (Hib), pneumococcal disease, and meningococcal B.

Immunisation coverage for all infants at 6 months of age reached its highest point of 82.0% in 2015 but had fallen to 67.4% in the September 2023 quarter.

Immunisation coverage for Māori infants has been consistently lower than coverage for other ethnic groups at the 6-month milestone. Although there was a 22.5% increase in immunisation coverage between 2009 and 2015 for this group, coverage has trended downwards since. In September 2023, less than half (45.4%) of Māori infants were optimally protected from vaccine preventable diseases by 6 months of age.

Immunisation coverage for Pacific infants aged 6 months increased from 65.4% in 2009 to reach a peak of 81.9% in June 2016. Between June 2016 and September 2023 immunisation overage for Pacific infants aged 6 months decreased by 24.4%. Although changes in vaccination coverage had followed a similar gradient to NZ European infants, there has been a divergence in immunisation coverage compared to this group since 2020. Immunisation coverage in September 2023 was 59.8%.

Immunisation coverage for infants whose ethnicity is classified under the Asian ethnic grouping (henceforth infants/babies/children from Asian communities) has been consistently higher compared to other groups. Coverage at the 6-month milestone reached 94.6% in September 2020 but had decreased to 86.1% by September 2023.

Infants from the “Other” ethnicity grouping reached their peak immunisation coverage of 88% in March 2021. Coverage for this group at the 6-month milestone was 70.1% in September 2023.

Immunisation coverage for this age group reached 90% in June 2013 and remained above this point until 2020. In September 2023, immunisation coverage at 8 months of age was 82.6%.

Although immunisation coverage for Māori infants aged 8 months was lower than for non-Māori groups in 2012, the gap in coverage relative to non-Māori ethnic groups decreased between 2012 and 2014. Coverage of over 90% was achieved for Māori infants at the 8-month milestone in 2014. Māori infants had immunisation coverage of 66.1% in September 2023.

Immunisation coverage for Pacific infants remained above 90% between 2012 and 2020 and reached peak coverage of 96.5% in December 2016. Coverage has been trending downwards for Pacific infants aged 8 months, who had coverage of 79.3% in September 2023.

Infants from Asian communities have consistently had higher immunisation coverage at the 8-month milestone compared to other ethnic groups and reached a peak of 98.3% in March 2021. Immunisation coverage at the 8-month milestone was 95.3% for infants from Asian communities in September 2023.

Immunisation coverage for infants aged 8 months from the “Other” ethnic grouping reached a peak of 93.6% in December 2021. Coverage for this group was 88.6% in September 2023.

If a baby is fully vaccinated at 12 months they will have had their first dose of measles, mumps and rubella vaccine, and have received boosters for pneumococcal and meningococcal disease to continue their protection longer.

Between 2009 and 2023, the maximal coverage reached for all infants at the 12-month age milestone was 94.9%. Coverage had decreased to 87.0% by September 2023.

For Māori babies aged 12 months, immunisation coverage increased from 77.2% in 2009 to reach the maximal coverage of this group of 94.4% in June 2016. Since this point there has been a 19.3% decline in vaccine coverage for Māori infants aged 12 months. Coverage was 75.1% in September 2023.

Immunisation coverage for Pacific babies aged 12 months increased from 86.3% to 98.1% between 2009 and 2014. For several quarters between 2014 and 2016, Pacific infants achieved the highest immunisation coverage of any ethnic group at this age milestone. In September 2023, the immunisation coverage for Pacific Infants aged 12 months was 84.9%.

Immunisation coverage for babies from Asian communities at the 12-month milestone has remained above 90% since at least 2009, peaking at 98.9% in June 2021. In September 2023, immunisation coverage for this ethnic grouping was 95.5%.

Coverage for babies aged 12 months from the “Other” ethnic grouping reached its peak of 94.1% in March 2022. Coverage for this group was 91.6% in September 2023.

If a child is fully immunised at 18 months of age they will have received a dose of the varicella (chickenpox) vaccine, finished their course of MMR vaccines, and have received further protection against Haemophilus influenze type b (Hib).

Between June 2009 and December 2019, there was a 13.4% increase in immunisation coverage at the 18-month milestone for all ethnic groups combined (as indicated by the “total” line). There has been a decrease in coverage since, partially due to an immunisation schedule change in 2020 (as described further here). Immunisation coverage for those aged 18 months was 67.3% in the September quarter, 2023.

Māori have consistently had the lowest immunisation coverage at the 18-month milestone compared to all other ethnic groups. The highest immunisation coverage achieved for Māori in this age group was 79.7% in 2016. Immunisation coverage for Māori infants aged 18 months in September 2023 was 48.6%.

Immunisation coverage for Pacific children aged 18 months increased by 17.6% between 2009 and 2015 to reach peak coverage of 87.0%. Coverage declined from December 2019 and had fallen to 50.8% by March 2022. Immunisation coverage for Pacific babies at the 18-month milestone was 54.4% in September 2023.

Asian communities have consistently had the highest vaccination coverage of any ethnic group at this age milestone, with coverage of up to 93.8% in September 2015. Coverage for this group was 83.3% in September 2023.

Immunisation coverage for those aged 18 months in the “other” ethnic grouping reached a peak of 82.3% in March 2021. Coverage has since decreased and was 71.6% in September 2023.

Immunisation coverage at the 24 months milestone increased for all ethnic groups combined between 2009 and 2012 (as indicated by the “total” line). Coverage remained above 90% between 2011 and 2020 but had fallen to 82.5% by September 2023.

Immunisation coverage for Māori children increased by 19.3% between 2009 and 2012 and remained above 90% from December 2012 until March 2018. Coverage decreased between 2017 and 2022 and had fallen to a low of 66.0% in June 2022. In September 2023 immunisation coverage for this group was 68.4%.

Immunisation coverage for Pacific children aged 24 months reached 90.6% by September 2010 and remained above 90% until 2020. At several points in this time, Pacific children had the highest immunisation coverage of any ethnic group at the 24-month milestone. Coverage has decreased since 2020 and was 80.2% in September 2023.

Children from Asian communities have high immunisation coverage compared to other ethnic groups at the 24-month milestone. Coverage has remained above 90% since December 2009. In September 2023 coverage for this group was 93.7%.

Immunisation coverage for those aged 24 months in the “other” ethnic grouping reached a peak of 91.7% in March 2021. Coverage has since decreased and was 87.8% in September 2023.

Immunisation coverage at the 54 months milestone decreased for all groups combined since March 2020 from 82.1% to 67.5% (as indicated by the “total” line). In September 2023, immunisation coverage at the 54-month milestone was highest for children from Asian communities (76.7%), followed by NZ European children (74.9%). Māori and Pacific children had lower coverage in September 2023 (50.8% and 54.9% respectively).

If a child is fully vaccinated by 5 years of age, they will have received boosters for diphtheria, tetanus, pertussis, and polio. Being fully immunised at this milestone will ensure optimal protection through their primary school years.

Between 2009 and 2023, immunisation coverage increased from 69.5% to 80.3% for all ethnic groups combined at the 5-year milestone (as indicated by the “total” line). Coverage for those aged 5 years reached its peak to date of 89.2% in December 2019 and decreased to 78.8% in September 2023.

Coverage for all ethnic groups increased between 2009 and 2016, but decreased for all ethnic groups from 2020 to 2023. The greatest reduction in coverage was observed for Māori children (an 18.0% decrease).

Prioritised ethnicity was the method used to determine ethnicity in the dataset. This refers to a method of selecting one ethnicity when multiple are listed, with the order of priority being Māori/Pacific/Asian/Other/NZ European. For example, if someone has both a Pacific and NZ European ethnicity listed, for the purposes of this data they will be counted as Pacific.

All coverage information in these resources is based upon data provided by Manatū Hauora - Ministry of Health. Prior to September 2023, the information was derived from the National Immunisation Register database. Since that point, data is derived from the new Aotearoa Immunisation Register (AIR)*.

While the Ministry of Health has taken all reasonable steps to ensure that the information is accurate and complete, it accepts no liability or responsibility for the manner in which the information is used or subsequently relied on.