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Nikki Turner (public health advocate)

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Nicola Mary Turner
Born
New Zealand
Other namesNikki Turner
Education
  • 1985 Bachelor of Medicine and Surgery (University of Auckland)
  • 2006 Masters of Public Health (University of Auckland)
  • 2014 Doctorate of Medicine (University of Auckland).[1]
Scientific career
FieldsVaccine safety and effectiveness
Institutions
  • Immunisation Advisory Centre, University of Auckland.
  • Newtown Union Health Centre, Wellington, NZ.

Nicola Mary Turner is a New Zealand public health advocate who is a Professor at the University of Auckland and Medical Director of the Immunisation Advisory Centre, an organisation that advises the New Zealand medical profession and the New Zealand Government. She has contributed to advisory committees for the New Zealand Ministry of Health, is a spokesperson for the Child Poverty Action Group (Aotearoa New Zealand) and works in general practice. Much of her research and outreach has focused on improving immunisation coverage and closing equity gaps for the national schedule vaccine delivery in New Zealand and she has commented publicly on these issues during COVID-19 in New Zealand.

Education and career

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Turner holds a Bachelor of Medicine and Surgery (MBChB), a Diploma of Obstetrics Gynaecology and Family Planning (Dip Obs) and a Masters of Public Health (MPH Hons) from the University of Auckland. She was awarded a Diploma of Paediatrics (DHC) by the UK Royal College of Physicians.[2] In 2014 the University of Auckland awarded Turner a Doctorate of Medicine (MD) for a thesis titled Factors associated with immunisation coverage for the childhood immunisation programme in New Zealand: 1999–2012.[1]

In 1997, in response to low immunisation coverage and equity gaps in the New Zealand immunisation programmes, Turner developed the Immunisation Advisory Centre, (IMAC) an organisation situated at the University of Auckland, that nationally provides independent and factual research-based scientific information regarding vaccine-preventable diseases and the benefits and risks of immunisation.[3][4] Turner noted that at the time the Immunisation Advisory Centre was set up, there was a "vocal and influential anti-vaccination movement reflecting, an absence of trust in science and a primary healthcare system that wasn't very well organised...[but]...as the New Zealand community...got behind this, the angry anti-immunisation stuff [was] a lot less, because immunisation's normalised now as a positive part of raising healthy children. Whereas back then you had to make an active decision to immunise, now you have to make an active decision not to".[5] As of 2023, Turner is Medical Directory for IMAC.[2]

Turner was a senior lecturer at the University of Auckland from 2005 until becoming an Associate Professor in 2013. On 1 January 2014, she was appointed as a Professor in the Department of General Practice and Primary Care at the same university.[2][6]

Turner has been part of the General Practice team at Newtown Union Health Services (NUHS), Broadway, Wellington since 2011,[7] and is an Associate and spokesperson for the Child Poverty Action Group.[8]

Research and writings

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Improving vaccination coverage

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Turner has been involved in research into how the structures and organisation of general practice are associated with immunisation coverage in New Zealand. A 2010 paper, co-authored by Turner concluded that while practice immunisation coverage and timeliness did vary widely in New Zealand, "organisational and structural aspects of general practices are key determinants of general practice immunisation delivery".[9]

Turner co-authored an Immunisation Advisory Centre (IMAC) study in 2011 that assessed the effectiveness of the cold chain management for delivery of childhood vaccines from national stores to delivery sites in New Zealand.[10]

In 2018, IMAC collated a synopsis of strategies used since the 1918 influenza pandemic to deal with unanswered questions about how to manage future pandemics.[11] The data indicated that the burden of the disease in 1918 in New Zealand was inequitably carried by vulnerable populations such as the Maori, Pacific Island and Asian communities.[11] In a related research project, Turner and epidemiologists Nick Wilson and Michael Baker presented data that showed the birth rate for Maori dropped disproportionately after the 2018 pandemic, confirming the importance of pregnant women being vaccinated against seasonal influenza to reduce the rate of stillbirths.[12] In a later discussion about this research, Turner reiterated the importance of protecting pregnant women from any infection, and if vaccines were in short supply, prioritising them for "access to antivirals and ventilators in hospital intensive care units if they get sick".[13]

Advocacy for children

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In her role as spokesperson for Child Poverty Action Group, Turner commented in the media on the relationship between low income and poor child health,[14] and in 2008 co-authored a research report which stated that poverty was causing "devastation" in the health sector, with data showing New Zealand children had "higher rates of preventable illness and deaths from injuries than children in almost any other OECD country".[15] The report drew attention to the fact that Maori and Pasifika children were disproportionately affected by this.[15]

In 2012, Turner, as a member of the Office of the Children's Commissioner's Expert Advisory Group on Solutions to Child Poverty, contributed to a major report that explored how child poverty in New Zealand could be reduced.[16] Turner later said she was disappointed at the response by the New Zealand government and that they had only focussed on a few areas instead of taking a fully systemic approach to reducing child poverty.[17] This report supported the findings in a previous paper, endorsed by the New Zealand Medical Association and co-authored by Turner, which contended that overcrowding, poor nutrition, exposure to tobacco and stress contributed to creating a social environment in which the population was vulnerable and likely to have less access to health care services.[18]

Commenting on a report released by The Asthma Foundation[19], Turner said it confirmed concerns that poverty and deprivation impacted greatly on respiratory disease in New Zealand children, and the underlying causes needed to be addressed to ensure that children and families had adequate income, good housing and easy access to health care.[20] In 2015 after the Children's Commissioner released data showing that at the time, there were 305,000 children living in poverty in New Zealand – an increase of 45,000 from the previous year – Turner said that child poverty was now a national issue, not just for individual parents, and there appeared to be an unwillingness to resource a solution to the problem.[21]

Closing equity gaps

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Turner co-authored a paper in 2019 summarising the findings of a retrospective cohort study of New Zealand children (born 2006–2015), which identified that hospitalisation rates for infectious diseases since 1989 had increased disproportionately for Maori and Pacific children and those who were socioeconomically most deprived, but that those children who received the pneumococcal conjugate vaccine (PVC) between 2008 and 2014, wereless likely to be hospitalized. The paper concludes that the use of PVC was associated with "reductions in ethnic and socioeconomic disparities in hospitalization". [22]

Turner co-authored another report on a research study that showed foreign-born migrant children living in New Zealand had an overall lower vaccination rate than NZ-born migrant and non-migrant children. It was acknowledged that there needed to be an improvement in the way such data were gathered, highlighting the importance of having "better national surveillance and migrant-specific data related to vaccination coverage to help uncover health inequities among children living in NZ and inform immunisation policy and practice".[23] A follow-up paper on this research highlighted that to get a better understanding of migrant health, data must be disaggregated to locate hidden trends, provide information about subsets and make vulnerable groups more visible.[24]

Much of Turner's research and writing has been on the importance of people getting accurate information about immunisation, particularly to reassure parents that vaccines were safe.[25][26] Turner has been actively involved in media discussions of vaccine safety including the Meningococcal vaccine in 2004[27] and the cervical cancer vaccine Gardasil in 2009.[28][29]

Turner has highlighted the importance of building trust between the public and those delivering health programs, either government-funded,[30][31] or at the level of general practice.[25] She noted that the decision-making process for consent can be influenced by anti-vaccination views,[32] but while making vaccinations mandatory would be helpful, there was a risk that some families might be less inclined to discuss their concerns openly, impacting engagement their with, and trust in, healthcare professionals.[33]

Commentary on COVID-19 in New Zealand

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In May 2020, Turner, speaking as director for the Immunisation Advisory Centre, supported the use of a vaccine in managing the COVID-19 pandemic in New Zealand and highlighted that it was important to avoid issues of equity of access across the world by privileging the wealthier nations.[34] She concurred with other experts that the vaccine was a key component in responding to the virus and cautioned against unrealistic hopes that it would happen quickly in New Zealand because of supply issues and prioritisation of the administration to the most vulnerable, and those at "heightened risk of infections like border workers and health staff".[35]

When New Zealand confirmed the purchase of the Pfizer COVID-19 vaccine, Turner said that while the country had access to both clinical and "real world" data, and was well situated to approve it,[36][37] there was no need to rush the process.[38][39] She noted that because there was little "severe illness and death from this disease" in New Zealand, the country was in the privileged position of being able to "scrutinise the science, watch how the vaccine rollout goes for other countries."[40] To Turner, the rollout of a vaccine in New Zealand would be planned and sequential, aiming ultimately for widespread community vaccination.[41]

Turner spoke with Jesse Mulligan after two health workers in the United Kingdom had suffered allergic reactions to the COVID-19 vaccine early in December 2020, and noted that some reaction to any vaccine is always a possibility but "good quality services delivering vaccines" were crucial to deal with these reactions. She suggested people with very severe allergies did need to be careful and it was important good information about the strengths and limitations of this vaccine, based on clinical data that was appropriately scrutinized, was shared by the media, scientists and the general community .[42]

In December 2021, Medsafe gave provisional approval for the vaccine to be used for children in age group of 5 - 11 year-olds in New Zealand. Turner told Corin Dann on Radio New Zealand that initial internal clinical data from the use of the vaccine for children overseas had shown it was being rolled out well. She noted that it didn't need to be mandatory but would protect children with other health issues or living in poverty, would limit the spread of COVID-19 in families and have less impact on schools.[43] Prior to this approval, Turner acknowledged there were "pros and cons" about children getting the vaccine, but a strong case could be made that this would be in the interests of protecting the community.[44] Turner stated that the gap for New Zealand children to get their second dose of COVID-19 vaccine needed to be longer than that for adults and maintaining it at eight weeks was likely to result in better immunity.[45]

As booster vaccines for COVID-19 were rolled out in New Zealand early in 2022 with the wait time between the second and third doses shortened to three months, Turner responded to several suggestions about this. She refuted that the booster needed to be in the non-dominant arm, noting while it was good to keep fluid levels up during heat, drinking water, [won't] "make any difference to the vaccine response" and while stress on the immune system was understandable, there was little cause for concern.[46] When the New Zealand government announced in May 2022 that there would be a second COVID-19 booster available to some members of the community, Turner expressed concern about the low rate of uptake for the first booster..."particularly the lower rate of boosters for older people and those with medical conditions...[adding]..."but still, there are quite a few people who feel like two doses aren't enough, and don't realise the importance of a booster".[47]

In November 2022, when parents of a four-month-old baby in New Zealand who needed heart surgery requiring a blood transfusion refused to accept blood from a donor who had received the COVID-19 vaccine, Turner said there was no scientific evidence suggesting there would be any risk to the baby. She noted [that] "blood donations are carefully screened for safety to ensure it was a match for the recipient", and people with concerns about this should talk to a professional.[48] Turner also told Newshub programme The Project, that doing a "one-off emergency screening to get blood from someone who is unvaccinated" might create the impression that there is a potential problem, and urged people to "sit down and work through where their fears and anxieties", concluding that the New Zealand health services were offering the best quality service to the baby.[49]

National advisory roles (New Zealand)

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  • 2021-Member of Strategic COVID-19 Public Health Advisory Group (SPHAG)[50][51]
  • 2020–present Member, COVID Vaccine Immunisation Implementation Advisory Group to the Ministry of Health[52]
  • 2020–present Member, COVID-19 Vaccine Technical Advisory Group (CV TAG)[53][54]
  • 2020 Member, The Immunisation Handbook Advisory Group[55]
  • 2015–present Chair, National Verification Committee for measles/rubella[56]
  • 2013–present Member, Well Child / Tamariki Ora Expert Advisory Group[56][57]
  • 2013 Member, Vaccine Safety Expert Advisory Group[58]
  • 2012–2018 Member, New Zealand Children's Commissioner's Expert Advisory Group on Solutions to Child Poverty[16]
  • 2011–present Member, PHARMAC advisory subcommittee for Immunisation[59][60]

Awards and distinctions

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Turner was awarded an Honorary Fellowship of the New Zealand College of Public Health Medicine in 2021,[61] and is a Fellow of the Royal New Zealand College of General Practitioners (RNZCGP).[2] In 2020, Turner was a finalist for the Green Cross Health award for outstanding contribution to health at the inaugural New Zealand Primary Healthcare Awards.[62]

Turner was the principal investigator leading the Vaccine Effectiveness arm for The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) project (2012–2016) designed to measure the effectiveness of vaccination for influenza and other respiratory infectious diseases.[63] In 2019, in recognition of their major contribution to influenza research, the SHIVERS team, including Turner, received the New Zealand Association of Scientists' Shorland Medal.[64]

References

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  1. ^ a b Turner, Nikki Mary (Nicola) (2014). "Factors associated with immunisation coverage for the childhood immunisation programme in New Zealand : 1999–2012 : Thesis MD University of Auckland". www.library.auckland.ac.nz. Archived from the original on 16 February 2022. Retrieved 4 February 2021.
  2. ^ a b c d "Niki Turner Bio". University of Auckland. Archived from the original on 21 March 2023. Retrieved 21 March 2023.
  3. ^ "Prof. Nikki Turner". The Immunisation Advisory Centre. 2021. Archived from the original on 29 January 2023. Retrieved 22 March 2023.
  4. ^ "About The Immunisation Advisory Centre (IMAC)". The Immunisation Advisory Centre. 26 July 2016. Archived from the original on 26 August 2021. Retrieved 12 December 2020.
  5. ^ "GP and Child Poverty Action Group health spokesperson". The Royal New Zealand College of General Practitioners. 19 May 2019. Archived from the original on 20 February 2022. Retrieved 21 February 2022.
  6. ^ "Professor Nikki Turner". Research Review. Archived from the original on 7 February 2022. Retrieved 27 February 2022.
  7. ^ Newtown Union Health Service (30 June 2019). Annual Report 2018 – 2019 (PDF). Archived (PDF) from the original on 26 January 2022. Retrieved 17 December 2020.
  8. ^ "Associate Professor Nikki Turner". Child Poverty Action Group. Archived from the original on 15 August 2020. Retrieved 21 February 2022.
  9. ^ Grant, Cameron C; Turner, Nikki M; et al. (1 March 2010). "Factors associated with immunisation coverage and timeliness in New Zealand". British Journal of General Practice. 60 (572). Royal College of General Practitioners: e113–e120. doi:10.3399/bjgp10x483535. ISSN 0960-1643. PMC 2828859. PMID 20202354. Archived from the original on 2 June 2018.
  10. ^ Turner, Nikki; Laws, Athene; Roberts, Loretta (December 2011). "Assessing the effectiveness of cold chain management for childhood vaccines". Journal of Primary Health Care. 3 (4): 278–282. doi:10.1071/HC11278. PMID 22132380. Archived from the original on 16 February 2022. Retrieved 21 December 2020.
  11. ^ a b Turner, Nikki M.; Charania, Nadia G. (31 August 2018). "100 years since the 1918 influenza pandemic progress made, yet questions remain. A synopsis of the 4th New Zealand Influenza Symposium, February 2018". The New Zealand Medical Journal. 131 (1481): 50–55. PMID 30161112. Archived from the original on 5 February 2022. Retrieved 22 December 2020.
  12. ^ Wilson, Nick; Turner, Nikki; Baker, Michael G. (13 December 2019). "One hundred years ago in 1919: New Zealand's birth reduction shock associated with an influenza pandemic". New Zealand Medical Journal. 132 (1507): 57–62. PMID 31830017. Archived from the original on 3 February 2022. Retrieved 28 December 2020.
  13. ^ "Sharp drop in birth rate as a result of miscarriages in 1918 flu pandemic, study finds". University of Otago Wellington Te Whare Wananga o Otago ki Poneke. 16 December 2019. Archived from the original on 28 November 2021. Retrieved 29 December 2020.
  14. ^ "PRESS RELEASE: Gap between poorest children and the rest continues to widen" (PDF). Child Poverty Action Group. 11 July 2006. Archived (PDF) from the original on 6 February 2022.
  15. ^ a b "Major report urges government to prioritise ending child ending child poverty in New Zealand" (Press release). Child Poverty Action Group. 28 April 2008. Archived (PDF) from the original on 6 February 2022. Retrieved 31 December 2020.
  16. ^ a b Expert Advisory Group on Solutions to Child Poverty (December 2012). Solutions to Child Poverty in New Zealand evidence for action (PDF). Children's Commissioner. ISBN 978-0-909039-38-7. Archived (PDF) from the original on 3 February 2022. Retrieved 17 December 2020.
  17. ^ "Recommendations largely been ignored by Government". Child Poverty Action Group. 31 May 2013. Archived from the original on 4 February 2022. Retrieved 30 December 2020.
  18. ^ D'Souza, Amanda J.D.; Turner, Nikki; et al. (30 March 2012). "Every child to thrive, belong and achieve? Time to reflect and act in New Zealand" (PDF). The New Zealand Medical Journal. 125 (1352): 71–80. PMID 22472714. Archived (PDF) from the original on 31 January 2022. Retrieved 31 December 2020.
  19. ^ Telfar-Barnard, Lucy; Baker, Michael; et al. (April 2015). The impact of respiratory disease in New Zealand: 2014 update (PDF). The Asthma Foundation. ISBN 978-0-473-32235-9. Archived (PDF) from the original on 9 February 2022. Retrieved 31 December 2020.
  20. ^ News Release. "New Zealand must address major underlying causes of respiratory disease – poverty and poor housing". Child Poverty Action Group. Archived from the original on 4 February 2022. Retrieved 31 December 2020.
  21. ^ Ashton, Alex (15 December 2015). "A third of NZ children live in poverty". RNZ. Archived from the original on 22 January 2022.
  22. ^ Petousis-Harris, Helen; Howe, Anna S.; et al. (February 2019). "Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006–2015". Clinical Infectious Diseases. 15 (68(5)): 818–826 Cited in Conclusions. doi:10.1093/cid/ciy570. PMID 30032236.
  23. ^ Charania, Nadia A.; Paynter, Janine; et al. (17 August 2018). "Exploring immunisation inequities among migrant and refugee children in New Zealand". Human Vaccines & Immunotherapeutics. 14 (12): 3026–3033 Cited in Conclusion. doi:10.1080/21645515.2018.1496769. PMC 6343632. PMID 30024825.
  24. ^ Charania, Nadia A.; Paynter, Janine; et al. (April 2020). "Vaccine-Preventable Disease-Associated Hospitalisations Among Migrant and Non-migrant Children in New Zealand" (PDF). Journal of Immigrant and Minority Health. 22 (2): 223–231. doi:10.1007/s10903-019-00888-4. PMID 30945094. S2CID 92998692. Archived from the original on 26 June 2022.
  25. ^ a b Petousis-Harris, Helen; Grant, Cameron C.; et al. (March 2012). "What contributes to delays? The primary care determinants of immunisation timeliness in New Zealand". Journal of Primary Health Care. 4 (1): 12–20. doi:10.1071/HC12012. hdl:2292/24007. PMID 22377545. Archived from the original on 29 June 2022. Retrieved 29 December 2020.
  26. ^ Goodyear-smith, Felicity; Turner, Nikki; et al. (2002). "Barriers to childhood immunisation among New Zealand mothers". NZPF. 29: 396–401. Archived from the original on 17 February 2022. Retrieved 30 December 2020.
  27. ^ Turner, Nikki (11 November 2004). "Enough of this 'debate' on vaccine". The New Zealand Herald. Archived from the original on 4 February 2021. Retrieved 20 January 2021.
  28. ^ Van der Stoep, Leigh (25 April 2009). "Fear and fallacies behind smear campaign – doctor". Stuff. Archived from the original on 28 January 2021. Retrieved 20 January 2021.
  29. ^ Breakfast (10 May 2018). "HPV vaccine could potentially eradicate cervical cancer, expert urges anti-vaxxers to 'look at the science'". 1 News. Archived from the original on 29 January 2021. Retrieved 20 January 2021.
  30. ^ Turner, Nikki (4 October 2018). "Anti-vaccine billboard highlights lack of trust in authorities". Archived from the original on 20 March 2019. Retrieved 20 January 2021.
  31. ^ 1 News (3 September 2019). "'Fears and concerns' – why some Kiwis won't get vaccinated explained by immunisation expert". TVNZ. Archived from the original on 2 September 2019. Retrieved 20 January 2021.{{cite news}}: CS1 maint: numeric names: authors list (link)
  32. ^ Nowlan, Mary; Willing, Esther; Turner, Nikki (30 August 2019). "Influences and policies that affect immunisation coverage—a summary review of literature". New Zealand Medical Journal. 132 (1501). Archived from the original on 28 March 2021. Retrieved 27 December 2020.
  33. ^ Martin, Hannah (30 August 2019). "Mandatory vaccinations not the best way to encourage participation, study finds". Stuff. Archived from the original on 26 November 2021. Retrieved 20 January 2021.
  34. ^ Martin, Hannah (6 May 2020). "Coronavirus: Covid-19 vaccine our 'only clear exit strategy', so where is it?". Stuff. Archived from the original on 4 February 2021. Retrieved 29 January 2021.
  35. ^ Ray, Willian (1 October 2020). "NZ and the Covid-19 vaccine". RNZ. Archived from the original on 16 January 2021.
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  45. ^ Bonnett, Gill (26 February 2022). "Coronavirus: No change on wait between children's COVID-19 vaccines". Newshub. Archived from the original on 27 February 2022. Retrieved 27 February 2022.
  46. ^ Cook, Charlotte (4 February 2022). "COVID-19: Dr Nikki Turner myth busts booster recovery tips". Newshub. Archived from the original on 4 February 2022. Retrieved 22 March 2023.
  47. ^ Morton, Jamie (29 May 2022). "Covid-19: Why are more than a million eligible Kiwis unboosted?". NZ Herald. Archived from the original on 29 May 2022. Retrieved 29 May 2022.
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  49. ^ "Expert explains why sick baby can't just be given blood from unvaccinated people" (The Project). Newshub. 30 November 2022. Archived from the original on 3 December 2022. Retrieved 3 December 2022.
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  55. ^ "The Immunisation Handbook Advisory Group". Ministry of Health Manatu Hauora. Archived from the original on 7 December 2021. Retrieved 21 January 2021.
  56. ^ a b "Associate Professor Nikki Mary Turner". The University of Auckland Te Whare Wananga o Tamaki Makaurau. Archived from the original on 31 January 2022. Retrieved 4 February 2021.
  57. ^ Well Child / Tamariki Ora Programme Practitioner Handbook (PDF). Ministry of Health. October 2013. ISBN 978-0-478-42800-1. Archived (PDF) from the original on 29 January 2021. Retrieved 21 January 2021.
  58. ^ "Vaccine Safety Expert Advisory Group". The Immunisation Advisory Centre. 27 February 2017. Archived from the original on 9 February 2022. Retrieved 21 January 2021.
  59. ^ "PTAC subcommittees". PHARMAC Te Pataka Whaioranga. Archived from the original on 20 April 2021. Retrieved 21 January 2021.
  60. ^ "Record of the Immunisation Subcommittee of PTAC Meeting held via videoconference on 02 September 2020" (PDF). 2 September 2020. Archived (PDF) from the original on 7 April 2022. Retrieved 21 January 2021.
  61. ^ "Honorary Fellowship Award certificate" (Certificate awarded to Nicole Mary Turner). 17 November 2021. Archived from the original on 24 June 2022. Retrieved 22 February 2022.
  62. ^ "2020 WINNERS". NZPH Awards. Archived from the original on 27 January 2022. Retrieved 27 March 2021.
  63. ^ Huang, Qui Sue; Turner, Nikki; et al. (March 2015). "Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance". Influenza and Other Respiratory Viruses. 9 (4): 179–190. doi:10.1111/irv.12315. PMC 4474494. PMID 25912617.
  64. ^ "Shorland Medal 2019- SHIVERS team award". Science for Communities. Archived from the original on 27 January 2022. Retrieved 29 January 2021.
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