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Forget 'no jab, no welfare' immunisation, says expert

IMMUNISATION in Australia isn't compulsory - and doesn't need to be controversial. Most Australians recognise the incredible benefits that vaccination provides to prevent serious disease; we have high and stable coverage rates of around 93%.

Getting childhood immunisation to the 95% target rate would be even better, providing more individual protection and "community immunity".

However, the McClure Review recommendation that child and youth welfare payments be conditional on having up-to-date immunisation is not the answer to maintaining or improving vaccine uptake.

Nor is the Productivity Commission's recent suggestion that parents who have not had their child fully vaccinated should not receive the childcare benefit tax rebate the right way forward.

Most parents whose children are un- or under-vaccinated need more support to help protect their child: a carrot rather than stick approach.

Why aren't all children vaccinated?

Financial incentives are in place to encourage parents get their child to the clinic multiple times early in life to get their shots on time. We all know this can be challenging.

ells us that parents of the 7% of incompletely vaccinated children fall into two distinct groups.

The first group, more than half of the 7%, face practical, economic, social or geographic impediments to full and timely vaccination. They are more likely to experience poverty or social exclusion.

A smaller proportion, estimated at 2-3% of the population, have beliefs, attitudes and concerns that cause them to reject or delay some or all vaccines.

In addition, some parents who are up-to-date with their child's routine immunisation can be hesitant or uncertain about vaccines. Who can blame anyone for having questions about vaccines when misinformation abounds, promulgated by small fringe groups.

Reminding and supporting parents

Recent changes to childcare legislation in New South Wales require parents to provide documentation about their child's immunisation when they enrol into childcare. Other states are examining the legislation and Victoria plans to follow suit in 2015.

This is a great initiative for a number of reasons. First, it provides another "reminder point" to check on a child's immunisation status and gives an opportunity to enrol the child in a "catch up" program.

Second, it requires that parents who actively decline vaccination have visited an immunisation professional or GP to discuss their decision. If those parents continue to choose not to vaccinate, they need to produce a signed objection form.

Parents who follow any of these options are currently eligible for the childcare rebate.

Unfortunately, these system improvements have been characterised by the media as "no jab, no play": that unimmunised children don't have the right to attend childcare. This is blatantly untrue; "no form, no play" is more accurate but not as sensational.

To protect both themselves and others, unimmunised children are required to stay at home from childcare for weeks in the case of a vaccine-preventable disease outbreak, such as measles or whooping cough. This is a financial and practical disincentive for parents who don't vaccinate their children.

Punishment can backfire

Removing welfare payments or childcare rebates for parents who do not fully immunise their children is unnecessarily punitive and could have a number of negative repercussions.

On the one hand, these measures are unlikely to influence the completely committed vaccine objectors. But not all parents who haven't vaccinated are completely committed to that position.

On the other hand, removing incentives could paradoxically push very hesitant parents who have some willingness to immunise their children further against doing so.

Removing childcare subsidies carries the risk that children of low-income non-vaccinating families may not attend childcare or access much needed financial support to visit the doctor at all - a terrible outcome.

Removing welfare payments would obviously have a devastating effect on these children and their families.

History tells us that coercive policies can galvanise and further radicalise fringe movements. These proposals, together with a steady flow of adversarial public discussions, may actually increase exposure of everyone to anti-vaccination arguments and "normalise" vaccine objection.

Kristine Macartney is Associate Professor, Discipline of Paediatrics and Child Health at University of Sydney

- The Conversation



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