Nikki Turner (academic general practitioner)

Nicola Mary Turner is a New Zealand academic general practitioner who specialises in the areas of primary care, immunisation and preventive child health. She is Director of the Immunisation Advisory Centre, University of Auckland and a general practitioner in Wellington, New Zealand. Her Governance roles have included contributing to advisory committees for the New Zealand Ministry of Health and overseas, working for the World Health Organization's Strategic Advisory Group of Experts.

This article is about the New Zealand medical practitioner. For the American author, see Nikki Turner. For the New Zealand cricketer, see Nicki Turner.

Nicola Mary Turner
Born
New Zealand
Other namesNikki Turner
Education
  • 1985 MBChB: Bachelor of Medicine and Surgery (University of Auckland).
  • 1987 Dip Obs: Diploma of Obsterics Gynaecology and Family Planning (University of Auckland).
  • 1990 DHC Diploma of Paediatrics (Royal College of Physicians, UK).
  • 1999 FRNZCGP: Fellowship in General Practice (RNZCGP, New Zealand).
  • 2006 MPH Hons:Masters of Public Health (University of Auckland).
  • 2014 MD: Doctorate of Medicine (University of Auckland).
Known for
  • Immunisation-related research
  • Primary care systems
  • Child wellbeing
  • Translational research
  • Systems science
Scientific career
FieldsVaccine safety and effectiveness
Institutions
  • University of Auckland.
  • Newtown Union Health Centre, Wellington, NZ.

Turner is a spokesperson for the NZ Child Poverty Action Group, has had roles in UNICEF, and is a regular science communicator in the news media. She is Associate Professor at the University of Auckland and Honorary Professor at University of Otago.

Turner was awarded a Doctorate of Medicine in 2014.

Education

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. She is a Fellow of the Royal New Zealand College of General Practitioners (FRNZCGP).[1] 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.[2]

Career

As a general practitioner and paediatric specialist, Turner has been actively involved in primary care in New Zealand and other countries. In 1980 she was Paediatric Registrar at the Royal Bolton Hospital in the United Kingdom, returning to her home country and becoming House Surgeon/Senior House Officer at Napier Hospital, Napier, New Zealand (1985-1897). From 1988 to 1989 she was Paediatric Registrar at the Battledown Centre for Children and Families Cheltenham in the United Kingdom and then worked as Head of Paediatrics at Rundu State Hospital in Namibia (1990-1991). She was a General Practitioner at Peter House, Westhoughton in the United Kingdom (1991-1992) and then General Practitioner and Management Team member, Wai Health, Te Whanau o Waipareira Trust, Henderson, Auckland.

Turner continued to work as a General Practitioner at Panmure Medical Centre from 1996 to 1999 and was part of the team that established Wai Health, the Health services arm of Te Whānau O Waipareira Trust, 1999 to 2007. Between 2008 and 2010, Turner set up and was involved with the Calder Health Centre, the general practice service for the Auckland City Mission. Since 2011 she has been part of the General Practice team at Newtown Union Health Services (NUHS), Broadway, Wellington.[3]

Since 1996, Turner has been Director of the Immunisation Advisory Centre (IMAC) at the University of Auckland. IMAC is a national communication centre that provides independent and factual research-based scientific information regarding vaccine-preventable diseases and the benefits and risks of immunisation.[4][1]

Research and outreach

Vaccination levels

Much of Turner's research and outreach has focused on improving immunisation coverage and closing equity gaps for the national schedule vaccine delivery in New Zealand. In 2009, she co-authored a paper that noted immunisation coverage in New Zealand (NZ) was "mediocre...[with]...the 2005 national survey... [showing]...only 77% of children at 2 years of age had received all scheduled childhood immunizations."[5]

She has been concerned with both personnel and systems, showing that adequately trained and stable medical and nursing staff, practice management systems and early enrollment of children on a national immunisation register are key to improved vaccination levels.[5][6][7] Her joint survey research has found that New Zealand parents, family physicians and practice nurses identified the importance of educating parents about immunisation and vaccine safety.[8][9] It also identified a need for vaccination training including a better knowledge of contraindications to vaccination.[10] Further work summarising international literature on influences and policies that affect immunisation coverage identified the need to develop policies that acknowledged "social and ethnic sensitivities"; engagement with local communities; having well trained and informed medical staff, and consistent demonstration of a "high degree of consensus among medical scientists through positive messages."[11]

Turner has also examined physical processes involved in community immunisation. In 2011 Turner co-authored an Immunisation Advisory Centre (IMAC) study to assess the effectiveness of the cold chain management for delivery of childhood vaccines from national stores to delivery sites in New Zealand.[12]

Speaking to Kathryn Ryan on Radio New Zealand in 2019, Turner discussed the significance of a worldwide drop in measles vaccinations below the level needed to create herd immunity. She stressed that it was an international problem and noted again that some of the underlying causes of insufficient rates of vaccination were lack of trust in medical authorities and increasing inequalities, resulting in less equitable access to vaccines. [13]

Vaccine effectiveness

Turner was in the research team for The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) project (2012–2016) designed to measure "disease burden, epidemiology, aetiology, risk factors, immunology, effectiveness of vaccination and other prevention strategies for influenza and other respiratory infectious diseases of public health importance."[14] Annual studies from 2012 to 2014 for the first time in New Zealand, estimated how effectively trivalent inactivated influenza vaccine (TIV) prevented general practice visits and hospitalisation for patients with influenza-confirmed respiratory infections. In each year the data showed mostly moderate effectiveness of the vaccine,[15][16][17] but it was noted that future data gathered in the SHIVERS project would allow estimates for specific high-risk population groups and enable "more extensive comparisons between VE [vaccine effectiveness ] estimates in primary care (general practice) and hospital settings."[17]

The SHIVERS Project (I) continued to develop an effective population-based surveillance system for acute respiratory illness in New Zealand until 2017 producing over 17 peer-reviewed publications. In 2018 SHIVERS won a national Team Award from Science New Zealand.[18] In 2019, in recognition of their major contribution to influenza research, the SHIVERS team, including Turner, received The New Zealand Association of Scientists (NZAS) Shortland Medal. [19]

Equity of access to vaccination

Following the hosting of a major influenza symposium involving international experts in 2018, IMAC collated a synopsis of the key topics to inform a reflection of strategies used since the 1918 influenza pandemic and deal with unanswered questions about how to manage future pandemics.[20] Data gathered from seasonal influenza epidemics indicated that the burden of the disease had been inequitably carried by vulnerable populations such as the Maori, Pacific Island and Asian communities.[20] In another 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 and this was consistent with the general mortality rate for Maori during this period. The findings of the study confirmed the importance of pregnant women being vaccinated against seasonal influenza to reduce the rate of stillbirths, and highlighted the need to "eliminate poverty and ethnic inequalities in health in New Zealand, as well as more specific strategies to protect Māori health (eg, via eliminating tobacco, controlling the obesogenic environment and improving access to healthcare)."[21] 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."[22]

She co-authored a paper in 2019 that summarised 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, were less likely to be hospitalized. The paper concluded that the use of PVC was associated with "reductions in ethnic and socioeconomic disparities in hospitalization." [23]

Another report on a research study co-authored by Turner showed that 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."[24] A follow-up paper on this research highlighted that "children need to be age-appropriately vaccinated, and other individual and environmental factors addressed, to reduce the risk of infectious diseases", and 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.[25]

Misinformation about immunisation

Much of Turner's research and writing has been on the importance of people getting accurate information about immunisation particulary to reassure parents that vaccines were safe.[7][8] Turner has been actively involved in media discussions of vaccine safety including the Meningococcal vaccine in 2004 [26]and the cervical cancer vaccine Gardasil in 2009.[27][28]

Turner has highlighted the importance of building trust between the public and those delivering health programs, either government-funded,[29][30] or at the level of general practice.[7] Her research noted that the decision-making process for consent could be influenced by anti-vaccination views, often from those in the healthy population, resulting in immunisation hesitancy in the community. Coercive approaches to increase vaccine uptake were seen as likely to increase mistrust of vaccines and medical professionals, particularly by those members of the population with low levels of social inclusion and less access to systems and services. The study concluded that "vaccination advocates with similar backgrounds to the target population can help to increase trust and acceptance within health services."[11] Discussing the research, Turner said that while making vaccinations mandatory might be helpful, it could result in some families being less inclined to discuss their concerns openly and develop a strong sense of engagement with, and trust in healthcare professionals.[31]

2019 NZ measles epidemic

In 2019, New Zealand had a serious outbreak of measles.[32][33][34] Turner has written, researched and commented extensively on this epidemic and how such outbreaks can be prevented.[35][36] The paper on the research, co-authored by Turner concluded that these were also factors that had contributed to the pandemic in New Zealand and suggested management strategies such as a national campaign targeting the at-risk age groups; putting in place systems to ensure adequate supplies of vaccines; provision of support for their delivery at the practice level; and creative use of community facilities to improve accessibility.[35]

Figures as at 1 December 2019 indicated that it was a challenge to get the measles vaccination to the estimated 300,000 people aged between 15 and 30 who needed in New Zealand. Turner said this left the country very vulnerable and that because most countries were focused on COVID-19 vaccinations, measles was on the rise worldwide.[37][38]

The impact of poverty on child health

In her role as spokesperson for Child Poverty Action Group, Turner has commented in the media on the relationship between low income and poor child health,[39] and in 2008 co-authored a research report which stated that poverty was causing "devastation" in the health sector, with data showing that New Zealand children had "higher rates of preventable illness and deaths from injuries than children in almost any other OECD country."[40] The report drew attention to the fact that Maori and Pasifika children were disproportionately affected by this, being more likely to grow up in poverty and be most at risk of poor health.[40]

When the New Zealand government decided to allow schools to sell 'junk' food in 2009, Turner suggested that this was giving the wrong message to young people and ignoring the fact that "obesity is disproportionately a burden of low-income families...[who needed]...community support to combat the obesity epidemic." It was suggested that there is evidence that showed changing the school environment is a key factor in children and families making healthy food choices.[41]

In 2010 Turner noted that with one in five of New Zealand children living in poverty, the rates of preventable disease in this group were among the highest in the developed world. She said, addressing this required innovative ways to get and use funding where it was most needed as the key issue was to ensure children's access to health care at all times.[42] An article in the same year, co-authored by Turner, also noted that after-hours access was a barrier to children under six years of age receiving health care.[43]

In 2012, Turner, as a member of the New Zealand 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.[44] 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.[45] 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 contribute to creating a social environment in which the population is vulnerable and likely to have less access to health care services.[46]

The Child Poverty Action Group continued to call on the New Zealand government at this time to invest more in children,[47] and when the annual Child Poverty Monitor was released in 2104,[48] Turner noted that it showed too many New Zealand children were still in poverty and a "substantial commitment is needed to improve incomes and housing for families with children...[because]...childhood poverty has life-long consequences for people's health and well-being."[49] A paper co-authored by Turner focussed on the cost of visits to general practitioners for New Zealand children aged between 6–17 years old concluded that the amount for both unexpected and out-of-hours trips to the doctor would be difficult for families that were struggling financially.[50]

Commenting on a report released by The Asthma Foundation[51], Turner said it confirmed concerns that poverty and deprivation impacted greatly on respiratory disease in New Zealand children, and the underlying causes need to be addressed to ensure that children and families had adequate income, good housing and easy access to health care.[52] 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.[53]

On 17 May 2017, with a General Election pending in New Zealand, The Child Poverty Action Group stated it was crucial that policies for the wellbeing of the country's children be enacted. As their health spokesperson, Turner said "Poverty makes children sick. It may cause illnesses that affect their physical and mental health for their whole lives, decreasing their chances of good educational outcomes, and future success, as well as that of future generations."[54]

COVID-19 pandemic

Early in 2019 Turner, speaking as director for the Immunisation Advisory Centre, supported the importance of a vaccine in managing the COVID-19 pandemic in New Zealand, but noted that it would be necessary to moderate the "traditional model...[when a]... a pharma company produces a vaccine and everyone puts in a bid for the product...[which could result in]...a free-for-all" likely to create issues of equity of access across the world by privileging the wealthier nations.[55] 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."[56]

When New Zealand confirmed 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,[57][58]there was no need to rush the process.[59][60] 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."[61] To Turner, the rollout of a vaccine in New Zealand would be planned and sequential, aiming ultimately for widespread community vaccination.[62]

National advisory roles (New Zealand)
  • 2020-current Member, COVID Vaccine Immunisation Implementation Advisory Group to the Ministry of Health[63]
  • 2020-current Member, COVID-19 Vaccine Strategy Taskforce (Science and Technical Advisory Group -STAG)[64]
  • 2020 Member, The Immunisation Handbook Advisory Group[65]
  • 2015–current Chair, National Verification Committee for measles/rubella[66]
  • 2013–current Member, Well Child / Tamariki Ora Expert Advisory Group[66][67]
  • 2013 Member, Vaccine Safety Expert Advisory Group[68]
  • 2012-2018 Member, New Zealand Children's Commissioner's Expert Advisory Group on Solutions to Child Poverty[44]
  • 2011–current Member, PHARMAC advisory subcommittee for Immunisation[69][70]

References
  1. "About Associate Professor Nikki Turner - The University of Auckland". unidirectory.auckland.ac.nz. Retrieved 4 February 2021.
  2. 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. Retrieved 4 February 2021.CS1 maint: extra punctuation (link)
  3. Newtown Union Health Service (30 June 2019). Annual Report 2018 - 2019 (PDF). Retrieved 17 December 2020.
  4. "About The Immunisation Advisory Centre (IMAC)". The Immunisation Advisory Centre. Retrieved 12 December 2020.
  5. Turner, Nikki; Rouse, Paul; Airey, Stacey; Petousis-Harris, Helen (December 2009). "The cost of immunising at the general practice level". Journal of Primary Health Care. 1 (4): 286–296. Retrieved 29 December 2020.
  6. Grant, Cameron C.; Turner, Nikki M.; York, Deon G.; Goodyear-Smith, Felicity; Petousis-Harris, Helen (March 2010). "Factors associated with immunisation coverage and timeliness in New Zealand" (PDF). British Journal of General Practice. 60 (572): 113–120. doi:10.3399/bjgp10x483535. PMID 20202354. Retrieved 29 December 2020.
  7. Petousis-Harris, Helen; Grant, Cameron C.; Goodyear-Smith, Felicity; Turner, Nikki; York, Deon; Jones, Rhys; Stewart, Joanna (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. Retrieved 29 December 2020.,
  8. Goodyear-smith, Felicity; Turner, Nikki; Petousis-harris, Helen; Godinet, Sue (2002). "Barriers to childhood immunisation among New Zealand mothers". NZPF. 29: 396–401. Retrieved 30 December 2020.
  9. Petousis-Harris, Helen; Goodyear-Smith, Felicity; Turner, Nikki; Soe, Ben (2004). "Family physician perspectives on barriers to childhood immunisation". Vaccine. 22: 2340–2344. Retrieved 30 December 2020.
  10. Petousis-Harris, Helen; Goodyear-Smith, Felicity; Turner, Nikki; Soe, Ben (2005). "Family practice nurse views on barriers to immunising children". Vaccine. 23: 2725–2730. Retrieved 30 December 2020.
  11. 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). Retrieved 27 December 2020.
  12. 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. Retrieved 21 December 2020.
  13. Ryan, Kathryn (18 December 2019). "2019 - the year of measles". Nine to Noon (Programme). RNZ. Retrieved 26 December 2020.
  14. Huang, Qui Sue; Turner, Nikki; Baker, Michael G.; Williamson, Deborah A.; Wong, Conroy; Webby, Richard; Widdowson, Marc-Alain (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. Retrieved 24 January 2021.
  15. Turner, Nikki; Pierse, Nevil; et al. (June 2014). "The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012". Vaccine. 32 (29): 3687–3693. doi:10.1016/j.vaccine.2014.04.013. PMC 4620982.
  16. Turner, N.; Pierse, N.; et al. (28 August 2014). "Effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2013". Eurosurveillance. 19 (34): 20884. doi:10.2807/1560-7917.ES2014.19.34.20884. ISSN 1560-7917. Retrieved 25 December 2020.
  17. Turner, N.; Pierse, N.; Huang, Q. S.; Radke, S.; Bissielo, A.; Thompson, M. G.; Kelly, H.; Team, Collective on behalf of the SHIVERS investigation (23 October 2014). "Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014". Eurosurveillance. 19 (42): 20934. doi:10.2807/1560-7917.ES2014.19.42.20934. ISSN 1560-7917. Retrieved 25 December 2020.
  18. "Science New Zealand National Awards - 2018 ESR SHIVERS team award". Science for Communities. Retrieved 29 January 2021.
  19. "Shorland Medal 2019- SHIVERS team award". Science for Communities. Retrieved 29 January 2021.
  20. 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. Retrieved 22 December 2020.
  21. 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). Retrieved 28 December 2020.
  22. "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. Retrieved 29 December 2020.
  23. Petousis-Harris, Helen; Howe, Anna S.; Paynter, Janine; Turner, Nikki; Griffin Jennifer (February 2019). "Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006-2015". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 15 (68(5)): 818–826. doi:10.1093/cid/ciy570. PMID 30032236.
  24. Charania, Nadia A.; Paynter, Janine; Lee, Arier C.; Watson, Donna G.; Turner, Nikki M. (17 August 2018). "Exploring immunisation inequities among migrant and refugee children in New Zealand". Human Vaccines & Immunotherapeutics. 14 (12): 3026–3033. doi:10.1080/21645515.2018.1496769. Retrieved 22 December 2020.
  25. Charania, Nadia A.; Paynter, Janine; Lee, Arier C.; Watson, Donna G.; Turner, Nikki M. (April 2020). "Vaccine-Preventable Disease-Associated Hospitalisations Among Migrant and Non-migrant Children in New Zealand". Journal of Immigrant and Minority Health. 22 (2): 223–231. doi:10.1007/s10903-019-00888-4.
  26. Turner, Nikki (11 November 2004). "Enough of this 'debate' on vaccine". NZ Herald. Retrieved 20 January 2021.
  27. Van der Stoep, Leigh (25 April 2009). "Fear and fallacies behind smear campaign - doctor". Stuff. Retrieved 20 January 2021.
  28. Breakfast (10 May 2018). "HPV vaccine could potentially eradicate cervical cancer, expert urges anti-vaxxers to 'look at the science'". 1 News. Retrieved 20 January 2021.
  29. Turner, Nikki (4 October 2018). "Anti-vaccine billboard highlights lack of trust in authorities". Retrieved 20 January 2021.
  30. 1 News (3 September 2019). "'Fears and concerns' - why some Kiwis won't get vaccinated explained by immunisation expert". TVNZ. Retrieved 20 January 2021.
  31. Martin, Hannah (30 August 2019). "Mandatory vaccinations not the best way to encourage participation, study finds". Stuff. Retrieved 20 January 2021.
  32. "Measles outbreak: 759 cases now confirmed in Auckland". Radio New Zealand. 30 August 2019. Retrieved 1 September 2019.
  33. "New Zealand measles cases top 1000 mark as push to get vaccinations continues". 1 News. 5 September 2019. Retrieved 5 September 2019.
  34. "New Zealand measles outbreak rises above 1,000 cases". BBC News. 5 September 2019. Retrieved 5 September 2019.
  35. Turner, Nikki (25 October 2019). "A measles epidemic in New Zealand: Why did this occur and how can we prevent it occurring again?". New Zealand Medical Journal. 132 (1504). Retrieved 25 December 2020.
  36. World Health Organization (April 2019). "Meeting of the Strategic Advisory Group of Experts on immunization, April 2019–conclusions and recommendations". Weekly Epidemiological Record 2019. 94 (22/23): 261–279.
  37. Quinn, Rowan (1 December 2020). "Measles vaccination drive stalling amid pandemic response". Newshub. Retrieved 26 December 2020.
  38. Quinn, Rowan (16 September 2020). "Measles contact tracing failed and vaccination too slow during 2019 epidemic - review". RNZ. Retrieved 26 December 2020.
  39. "PRESS RELEASE: Gap between poorest children and the rest continues to widen" (PDF). Child Poverty Action Group. 11 July 2006.
  40. Media Release (28 April 2008). "Major report urges government to prioritise ending child ending child poverty in New Zealand" (PDF). Child Poverty Action Group. Retrieved 31 December 2020.
  41. Media Release (9 February 2009). "Child Poverty Action Group calls on government to reinstate healthy food in schools" (PDF). Child Poverty Action Group. Retrieved 31 December 2020.
  42. Media Release (1 December 2010). "Can our kids get to a doctor when they need to?". Child Poverty Action Group. Retrieved 31 December 2020.
  43. Fancourt, Nicholas; Turner, Nikki; Asher, M Innes; Dowell, Tony (December 2010). "Primary health care funding for children under six years of age in New Zealand: why is this so hard?". Journal of Primary Health Care. 2 (4): 338–342. Retrieved 4 February 2021.
  44. Expert Advisory Group on Solutions to Child Poverty (December 2012). Solutions to Child Poverty in New Zealand evidencefor action (PDF). ISBN 978-0-909039-38-7. Retrieved 17 December 2020.
  45. News (31 May 2013). "Recommendations largely been ignored by Government". Child Poverty Action Group. Retrieved 30 December 2020.
  46. D'Souza, Amanda J.D.; Turner, Nikki; Simmers, Don; Craig, Elizabeth; Dowell, Tony (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). Retrieved 31 December 2020.
  47. News Release (20 February 2012). "Study highlights need for greater investment in children". Child Poverty Action Group. Retrieved 31 December 2020.
  48. Simpson, J; Oben, G; Wicken, A; Reddington, A; Duncanson, M (November 2014). Child Poverty Monitor 2014 Technical Report. University of Otago. Retrieved 22 January 2021.
  49. News (1 December 2014). "2014 Child Poverty Monitor shows bold action needed to reduce child poverty". Child Poverty Action Group. Retrieved 22 January 2021.
  50. Haran, Cheyaanthan; Ruscoe, Catherine; Turner, Nikki; Asher, Innes (July 2014). The cost of GP visits for 6-17 year olds in New Zealand (PDF). Child Poverty Action Group Inc. ISBN 978-0-9941105-3-4. Retrieved 22 January 2021.
  51. Telfar-Barnard, Lucy; Baker, Michael; Pierse, Nevil; Zhang, Jane (April 2015). The impact of respiratory disease in New Zealand: 2014 update (PDF). The Asthma Foundation. ISBN 978-0-473-32235-9. Retrieved 31 December 2020.
  52. News Release (6 May 2015). "New Zealand must address major underlying causes of respiratory disease - poverty and poor housing". Child Poverty Action Group. Retrieved 31 December 2020.
  53. Ashton, Alex (15 December 2015). "A third of NZ children live in poverty". RNZ. Retrieved 24 January 2021.
  54. Child Poverty Action Group (4 June 2017). "Health priorities for a New Zealand where children can flourish" (PDF). Early Education Federation: 5. Retrieved 17 December 2020.
  55. Martin, Hannah (6 May 2020). "Coronavirus: Covid-19 vaccine our 'only clear exit strategy', so where is it?". Stuff. Retrieved 29 January 2021.
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  57. Quinn, Rowan (27 January 2021). "Uncertainty over Pfizer Covid-19 vaccine's arrival, as health staff learn to administer jab". RNZ. Retrieved 29 January 2021.
  58. Keogh, Brittany (5 January 2021). "Covid-19: How NZ is preparing for the biggest vaccine roll-out in history". Stuff. Retrieved 30 January 2021.
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  61. The Science Media Guest writer (17 December 2020). "'There are still many unknowns': experts on the big NZ vaccine plan". The Spinoff. Retrieved 30 January 2021.
  62. Daalder, Marc (13 January 2021). "Vaccine rollout will be 'mammoth undertaking'". Newsroom. Retrieved 30 January 2021.
  63. COVID-19: Who we’re working with. "COVID-19 Immunisation Implementation Advisory Group (IIAG)". Ministry of Health. Retrieved 6 February 2021.
  64. "COVID-19 Vaccine Strategy". Ministry of Business, Innovation & Employment. Retrieved 21 January 2021.
  65. "The Immunisation Handbook Advisory Group". Ministry of Health Manatu Hauora. Retrieved 21 January 2021.
  66. "Associate Professor Nikki Mary Turner". The University of Auckland Te Whare Wananga o Tamaki Makaurau. Retrieved 16 December 2020.
  67. Well Child / Tamariki Ora Programme Practitioner Handbook (PDF). Ministry of Health. October 2013. ISBN 978-0-478-42800-1. Retrieved 21 January 2021.
  68. "Vaccine Safety Expert Advisory Group". The Immunisation Advisory Centre. Retrieved 21 January 2021.
  69. "PTAC subcommittees". PHARMAC Te Pataka Whaioranga. Retrieved 21 January 2021.
  70. "Record of the Immunisation Subcommittee of PTAC Meeting held via videoconference on 02 September 2020" (PDF). 2 September 2020. Retrieved 21 January 2021. Cite journal requires |journal= (help)
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