Top Doctor Caroline McElnay Says 'No' to Vaccination Doesn't Always Mean 'Never'

Dr. Caroline McElnay, the outgoing clinical lead for immunisation at the National Public Health Service, has delivered a compelling message to New Zealand's vaccination landscape. As she steps down from her role, McElnay asserts that the government's ambitious 2030 target of 95% vaccination coverage is still within reach — provided that health providers can rebuild trust with vaccine-sceptical parents.

McElnay’s tenure has been marked by a focus on understanding the nuances behind vaccine 'declines.' While some parents may initially say 'no' to vaccination, she emphasizes that this doesn't always equate to a permanent stance. In fact, research has shown that a significant portion of those who decline vaccinations are later convinced to proceed after further conversations with health professionals.

“We do know already that about a third of those people who we currently call 'declines' do get vaccinated,” McElnay explained. “They're not real declines. We want to understand better what sits under those declines and I think by doing that piece of work we will reduce that category.”

McElnay’s insights are particularly relevant given the historical context. A decade ago, New Zealand's childhood immunisation rates were among the highest globally, with 93% of children fully vaccinated by the age of two. However, rates have since declined, and while they are slowly recovering, experts are concerned that achieving the 2030 goal may be challenging without a significant shift in public sentiment.

“We are tracking upwards in terms of our coverage,” McElnay said. “But we need to understand what's driving the 'declines' and find ways to address them. If we don't get those declines down, we're not going to get to 95 percent. That's simple mathematics.”

McElnay also highlighted the importance of 'trusted messengers' in combating vaccine hesitancy. She noted that many parents are influenced by individuals they know and trust, rather than official sources. This underscores the need for local health providers — especially Māori and Pacific health providers — to play a central role in immunisation conversations.

“People decline and delay for different reasons, which are deeply personal and specific to their own contexts,” she said. “Anti-vaccination messages being spread via social media can only be countered by 'trusted messengers' in my experience.”

McElnay also pointed to a government-funded initiative aimed at supporting Māori health providers to boost immunisation rates across the lifespan. She believes that these efforts are beginning to show results, even if the process is slow and requires patience.

“Sometimes the first encounter doesn't result in vaccination, but we get there in the end,” she said. “It's about building relationships and trust over time.”

McElnay’s departure marks the end of an era for New Zealand's immunisation programme. As she moves to Australia to take up the position of Victoria's Chief Health Officer, she leaves behind a legacy of dedication to public health and a clear message that the fight for higher vaccination rates is far from over.

“We have new babies joining the cohort all the time. The two-year-olds from the end of March will be a different group by the end of October,” she said. “So we need to be focused on childhood immunisations all the time.”

With the Aotearoa Immunisation Register now providing more detailed data on vaccination rates and gaps, McElnay believes that local providers can use this information to target under-coverage areas more effectively.

Her insights offer a roadmap for the future — one that requires a combination of trust-building, data-driven strategies, and community engagement to ensure that New Zealand's immunisation rates can once again reach the levels that made the country a global leader.