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‘No jab, no pay’ recommendation raises concerns March 2015, Volume 25, Issue 2

Anne Messenger

Published 30 March 2015. doi:
Citation: Messenger A. 'No jab, no pay’ recommendation raises concerns. Public Health Res Pract. 2015;25(2):e2521525

  • Citation

THE ability of ‘conscientious objectors’ who claim federal government benefits to be exempt from having their children vaccinated is in doubt, following the release of the McClure Review of Australia’s welfare system.

Public health and medical professionals have expressed concern that a recommendation in the review report, that a proposed child and youth payment “should be conditional on the child or young person having up to date immunisations”, may lead to a punitive rather than persuasive environment for parents.

The McClure review, commissioned by the federal government to examine the welfare system and released last month, recommends simplifying 20 income support and 55 supplementary payments, including recommending just one “Child and Youth Payment” for dependent children aged under 22.

At present, the government requires that for recipients of the family tax benefit A and childcare benefits, children under seven must be up-to-date with their immunisations or have an approved exemption, which may include evidence of ‘conscientious objection’.

Decision yet to be made

A spokesperson for the Minister for Social Services, Scott Morrison, said the McClure Review was independent, not a government report, and no decisions had been made yet about its recommendations.

In October, a Productivity Commission review of childcare recommended immunisation be required for child-based subsidies unless children were being cared for in their own home. NSW already prevents enrolment of children in early childhood facilities unless parents provide certificates of immunisation, a certificate of conscientious objection, or medical contraindication.

Associate Professor Julie Leask from the University of Sydney − who has authored a Perspective article in this issue of PHRP − said it was not clear from the report if the McClure Review proposed removal of the ‘conscientious objection’ exemption.

“Removing exemptions for the 2% of vaccine ‘objectors’ will make no difference to their decision – it will alienate them even more from the medical system,” she said. “It will also disenfranchise their children. It unwittingly punishes the children for the decisions of the parents, locks them out of educational opportunities and contributes to stigmatisation of children who are not vaccinated.

“These payments and rebates were introduced to support families and reflect a bipartisan commitment to increasing workforce participation for women in particular.”

Insufficient evidence

Associate Professor Leask said systematic reviews had found that while there was strong evidence that incentives worked in increasing vaccination rates, there was insufficient evidence that sanctions worked.

“[Sanctions] essentially punish the unvaccinated and don’t do much to address the groups who are under-vaccinated. It may even undermine programs. There are much better ways to approach this. So far, Australia has done it well and given us immunisation rates that rival most countries.”

Much more research was needed, she said, to understand non-vaccination, but in the meantime huge gains could be made across all ages by bringing in a whole-of-life immunisation register.

Immunologist and Emeritus Professor of Medicine at the University of New South Wales, John Dwyer, agreed that a national register was essential. “We could expect a 3% rise in full vaccination compliance with improved reminder systems, [which are] done very efficiently elsewhere via an electronic health record (EHR) … we need to accelerate the introduction of an efficient EHR.”

Defining ‘conscientious objector’

However, Professor Dwyer said ‘objectors’ should only be regarded as conscientious if they availed themselves of the opportunity to talk about their concerns with a GP or health professional expert in immunisation science. “They must understand the risk their decision could have for other children. They must document their compliance with this,” he said

Professor Dwyer agreed with a recent article in The Conversation by Associate Professor Kristine Macartney, who wrote that the both the McClure and Productivity Commission suggestions were “not the answer to maintaining or improving vaccine uptake. Most parents whose children are un- or under-vaccinated need more support to help protect their child: a carrot rather than stick approach.”

“[But] I do not see any logic in paying conscientious objectors the bonus benefit that parents receive after their children are fully vaccinated. That is a step too far,” he said.