“No Jab, No Pay” is the pointed name given to the Australian policy of withholding child benefits from parents who do not vaccinate their kids.
Since January 2016, recalcitrant or forgetful parents have taken a financial hit on their welfare payments – now $28 (all figures in Australian dollars) every two weeks (on a payment of $400). Parents can also lose their family tax benefit (worth $2,170 per child) and child-care rebate (worth up to $7,500).
In total, a family could lose up to $15,000 in support for failing to vaccinate.
In some Australian states, unvaccinated children are barred from child care, either permanently or during disease outbreaks, and daycare centres that admit them can face fines of up to $30,000.
Children who are not fully vaccinated can also be barred from schools – though that policy is common in developed countries.
Where Australia distinguishes itself, once again, is that it does not allow exemptions for “conscientious objection” – people who refuse to vaccinate for religious or philosophical reasons.
(The only exemptions are for children for who vaccination could pose a health risk, such as those who are severely immunocompromised because of cancer or other conditions. Paradoxically, these children are the greatest beneficiaries of the herd immunity conferred by mass vaccination.)
“Immunization is the safest way to protect children from vaccine-preventable diseases,” Dan Tehan, the Minister for Social Services, said in a statement. “Parents who don’t immunize their children are putting their own kids at risk as well as the children of other people.”
Public health officials, medical practitioners and academics take no issue with that view but many question whether the get-tough approach is effective or fair.
The financial penalty for non-vaccination is imposed principally on the poor – those who receive income-tested benefits – while it is wealthier parents who are most likely to eschew vaccination.
Similarly, the ban from daycare seems cruel and counterproductive considering that early childhood education is at least as important to health and well-being as vaccination.
The “No Jab, No Pay” philosophy is popular, but has it been effective? On the surface, yes.
Australia, which already had one of the world’s highest rates of childhood vaccination, has seen the numbers increase, to almost 93 per cent from 90 per cent since the policies were implemented.
But why do 7 per cent of parents still not vaccinate their kids?
The hard core anti-vaxxers are, at most, 1.8 per cent (based on a registry of conscientious objectors that existed before the law was changed). Another small group are people who are deemed “vaccine hesitant” – meaning they have some concerns or doubts, and their kids are at least partially vaccinated.
But the majority of parents of unvaccinated and under-vaccinated kids are not dogmatic; they are overwhelmed, usually by monetary and logistical issues.
What they need are not financial penalties, but practical help – carrots, not sticks.
There are a host of ways that the barriers to vaccination can be lessened: recall systems to ensure parents know children are due for vaccines, catch-up plans for those who have missed shots, home visits for those who have trouble getting to appointments and minimizing out-of-pocket costs (while childhood vaccines are provided at no charge, ancillary issues such as taking time off work can be costly).
We should not forget either that, in addition to financial penalties, Australia greatly improved its monitoring of vaccination. Having a register that shows what vaccinations children have – or haven’t – received has contributed greatly to bolstering rates.
This is an area where Canada fares particularly poorly, resulting in one of the worst rates of childhood vaccination in the developed world.
Before this country could even consider a “No Jab, No Pay” approach, we have to get our act together on basic data collection.
Canada would do well too to learn from Australia and abolish the nonsensical acceptance of “conscientious objection” to vaccination.
People have a right to practise religion (or embrace so-called alternative medicine) but that does not include the liberty to expose a child or a community to a communicable disease that can cause illness or death.
Australia should be commended for wanting to increase and maintain high vaccination rates, but it should recognize, too, that “No Jab, No Pay” is a blunt instrument that has delivered, at best, mixed results.
In health policy, as in law, the punishment should fit the crime. Above all, we need to ensure that children do not pay for the sins (or stupidity) of their parents.
André Picard