Does the Emergency Department Have a Role in Immunisation? Yes—But Not as a Routine Vaccine Clinic

ABSTRACT

EDs are not routine immunisation settings, yet they often provide care for patients whose immunisation needs may be unrecognised, unmet or not recently reviewed. This is particularly relevant for people who experience fragmented access to healthcare, vulnerability, language or cultural barriers, or who have questions or concerns about immunisation. Immunisation care in emergency departments should be opportunistic and proportionate rather than framed as universal vaccine delivery. For emergency clinicians, the practical task is to assess where a presentation reveals an immunisation‐related need and respond in a way that fits the patient, clinical presentation and local service capacity. This may include administering an indicated vaccine, providing education, addressing concerns, documenting unmet need or supporting follow‐up with relevant immunisation services in the community. Consistent with the National Immunisation Strategy 2025–2030, a team‐based approach is important to support immunisation care in ED settings.

1. Introduction

Aside from the occasional animal bite and/or wound management requiring a tetanus booster [1], EDs are not care areas where routine immunisations take place. Immunisations are best provided in a controlled environment where counselling on the best vaccination schedule, varied stocks and skilled health practitioners are available. Immunisations usually take place in a variety of settings such as community health centres, local council immunisation clinics, Aboriginal health centres and community pharmacies to provide the community with the best advice on vaccination needs. EDs can also deliver care for patients whose immunisation needs may be unrecognised, unmet or not recently reviewed. Although general practices (GPs), pharmacies and community health centres remain the cornerstone of routine vaccination delivery, limiting vaccination opportunities to these settings may overlook patients who experience barriers to accessing primary care. EDs may offer an important opportunity to improve vaccine uptake among underserved populations.

One of the key principles in immunisation is the need for equity for people to access and equity of outcomes [2]. The newly created Australian Centre for Disease Control underscores the need for priority populations to be front and centre of immunisation efforts. Priority populations such as First Nation Peoples, people experiencing homelessness or harms from substance abuse and as such potentially marginalised, represent a higher proportion of ED attendance. Osman et al. (2026) [3] highlighted that people who experience homelessness and attend EDs often experience fragmented healthcare contact, limited opportunity for care, or barriers to preventive care.

ED clinicians do not need to discuss immunisation needs at every presentation. However, some encounters may provide an opportunity to identify vaccine‐preventable risk, review immunisation status and unmet immunisation needs, address concerns and provide a safety net for more vulnerable populations. Unfortunately, such discussions will only be successful and bring an immunisation outcome if the system is designed for it. Yes, raising immunisation needs during some presentations appears essential, but we need to make sure there is a follow‐up system in place to make sure the lack of continuity of care is addressed and follow‐up is initiated. Unless a vaccine is clinically mandated during a presentation (e.g., tetanus after an injury), such discussion does not need to result in on‐the‐spot vaccine administration but can be an opportunity to identify immunisation needs and provide advice on how to access vaccines under the National Immunisation Program (NIP).

2. Understanding Immunisation Hesitancy, Refusals and Access Barriers

Not all unmet immunisation needs seen in ED reflect active vaccine refusal. Some patients may have had limited opportunities to access immunisation services, learn about vaccines and their benefits, or discuss how immunisation relates to their circumstances. Others may experience practical barriers, fragmented access to healthcare, or previous negative immunisation or healthcare experiences, communication or language barriers, or lack of culturally appropriate care. Vaccine hesitancy, which is a distinct form of vaccine refusal, may also reflect concerns about vaccine safety or effectiveness, mistrust of healthcare information, conflicting advice or misinformation from social media sources [4]. Australian data show that under‐vaccination is shaped by both access barriers, such as difficulty obtaining appointments and costs and acceptance barriers, including concerns about safety, effectiveness and trust in immunisation information [5].

When immunisation becomes relevant during routine ED care, brief clarification can help identify whether the issue relates to access, uncertainty, hesitancy, refusal or lack of previous opportunity for discussion. Short, non‐judgemental questions such as “Can you tell me a bit about what has made immunisation difficult?” or “What concerns do you have about vaccines?” can help distinguish practical barriers from concerns or refusal. This should be balanced against the urgency, workload and clinical priorities of the ED setting. Where concerns, mistrust or misinformation are present, clinicians should avoid turning the encounter into a debate or attempting to resolve complex concerns during a single ED presentation. A more realistic goal may be to acknowledge the concern, ask permission to share brief information, provide targeted factual advice, offer trusted resources and preserve trust for future discussions. A simple way to approach immunisation care in ED is to first assess whether an immunisation‐related need is present, then respond in a way that is appropriate to the patient, the clinical context and the ED setting.

3. Assess: Identifying Immunisation Opportunities

Assessment begins with routine ED care. Immunisation opportunities may become apparent when taking a history, identifying risk factors and comorbidities, providing treatment, reviewing medications or during discharge planning. The aim is not to complete a full immunisation assessment for every patient but to recognise when the encounter reveals a relevant vaccine‐preventable disease risk or immunisation need.

During history‐taking, clinicians can identify uncertain or incomplete immunisation histories, delayed childhood immunisation, incomplete vaccine courses, recent migration or refugee backgrounds with unclear overseas immunisation records, lack of a regular GP or usual source of care, and previous concerns about immunisation. These details may suggest that the patient has limited opportunity for immunisation review, education or follow‐up.

During clinical assessment, clinicians should consider whether the patient's medical history, age, pregnancy or immune status, First Nations status or social circumstances may be relevant to vaccine‐preventable disease risk, immunisation eligibility, access to care or culturally appropriate follow‐up. This may include chronic disease, immunocompromise, older age, pregnancy, Aboriginal and Torres Strait Islander or Māori and Pacific peoples, homelessness, alcohol and other drug use, unstable housing, rurality or other circumstances that make routine preventive care difficult to access [6]. When an immunisation need is suspected, the practical step is to check eligibility and recommendations against the National Immunisation Program schedule, the Australian Immunisation Handbook and the Australian Immunisation Register where available [7, 8]. This is particularly important for age‐based, pregnancy‐related, risk‐based and catch‐up immunisation needs.

During ED treatment and interventions, immunisation needs may be directly related to the presentation, such as a tetanus vaccine in wound care. During medication review, clinicians may identify treatments or conditions that change immunisation needs, such as chemotherapy, transplant medications, biological therapies or long‐term corticosteroids. Discharge planning may also identify whether an immunisation need has been raised but still requires documentation, follow‐up or completion of a subsequent dose.

4. Respond: Tailoring Immunisation Care in ED

The response should be guided by what was identified during the ‘assess’ phase. If the assessment reveals an immediate immunisation indication such as tetanus for wound care, the response may focus on explaining why the vaccine is recommended and seeking consent for administration. If a subsequent dose is required, patients should be told when and where the next dose is due and it should be clearly documented in the discharge information.

If the concern is uncertainty, hesitancy, incomplete immunisation, poor access to care or an unmet need that may be better managed through follow‐up or shared care after ED visit, the response may instead focus on education, addressing concerns, documenting or explaining why follow‐up with a GP, immuniser or other provider is needed [9]. However, these discussions may still lead the patient to receive a vaccine in the ED if this is clinically appropriate and feasible.

In all cases, immunisation should be made clearly relevant to the patient and their current situation. This means linking the conversation to the patient's presentation, risk factors, medical and immunisation history or follow‐up needs rather than giving a generic lecture about vaccines. A clinician may say, “Because of your medical history, it may be worth checking whether your vaccines are up to date,” or “I know you did not come to ED to talk about vaccines, but I am raising it because your health history may put you at higher risk of some vaccine‐preventable diseases.” The goal is to keep the conversation brief, relevant and proportionate to the ED setting. For some patients, this may lead to receiving an immunisation in ED; for others, a useful discussion may improve understanding, reduce concern, identify barriers or support follow‐up with a more appropriate health provider.

5. Immunisation Care Is Team‐Based

Immunisation care in ED should not sit with one type of clinician alone. This aligns with the National Immunisation Strategy 2025–2030, which emphasises strengthening the immunisation workforce and embedding immunisation across preventive healthcare [2]. Physicians, nurses, pharmacists, Aboriginal, Māori and Pacific health workers, social workers and other allied health professionals may contribute to identifying immunisation needs, supporting communication and arranging appropriate follow‐up to address unmet needs [10]. Where available, ED clinicians can also consult an in‐house nurse immuniser or immunisation service for advice on eligibility, contraindications, catch‐up schedules, documentation or follow‐up requirements. The key point is that immunisation care is often shared and one clinician may identify the opportunity, another may support the conversation or help arrange the response.

6. Conclusion

Immunisation care in ED should be appropriate to the patient's presentation, circumstances and needs, risk factors or access to ongoing care. ED clinicians can recognise when an immunisation‐related need has emerged and respond within local service capacity. This may include administering an indicated vaccine, providing education, addressing concerns, documenting unmet needs or supporting follow‐up through a team‐based approach.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.