Michael Klapdor and Alex Grove
Immunisation measures feature strongly in this
Budget, with three measures aimed at improving vaccination rates and reducing
the spread of vaccine preventable disease.
‘No Jab No Pay’
In April 2015, the Government announced that it would close
off some exemptions from the immunisation requirements for eligibility for the
FTB-A end-of-year supplement, Child Care Benefit (CCB) and Child Care Rebate
(CCR) payments stating that it was extremely concerned at the risk
non-vaccinated children pose to public health. A requirement for
children to meet immunisation schedules has been attached to childcare payments
since 1998 and for the FTB-A supplement from 2012 (coinciding with the
abolition of a separate, immunisation specific payment: the Maternity
Immunisation Allowance). Exemptions from the immunisation requirements for
those with medical reasons and for those who submit a conscientious objection
to immunisation have been included in the relevant legislation since these
immunisation requirements were put in place in 1998, as have legislative
instruments allowing for an exemption specifically for members of the Church of
Christ, Scientist. On 12 April 2015, the
Government announced that it would remove the conscientious objector exemption
but retain the medical and Christian Scientist exemption.
On 19 April 2015, Minister for Social Services, Scott Morrison, announced that
after discussions with the Church of Christ, Scientist, their specific
exemption would be removed as the Church advised it was no longer necessary.
The measure not only removes these exemptions but will
extend the requirements to include children of all ages—currently, for the
FTB-A supplement, qualifying children need to meet the relevant vaccination
schedule requirements for the financial year in which they turn one, two and
five years old. For child care payment
eligibility, all children under seven years must meet the relevant vaccine
schedule requirements on any day CCB/CCR is claimed. From 1 January 2016,
children of all ages must be up-to-date with their childhood immunisations or
lose eligibility for these payments, with exemptions granted only for medical
reasons. The Government expects the measure will result in savings of $508.3
million over five years. Media
reports suggest around 10,000 families will lose eligibility for payments in
2016–17 as a result of the measure, though many more are expected to act to
ensure all their children are up-to-date with their childhood immunisation
schedules (including teenagers who missed some childhood vaccinations).
The percentage of children under seven years with a
conscientious objection recorded on the Australian Childhood Immunisation
Register (ACIR) has risen from 0.23 per cent in December 1999 to 1.77 per cent
in December 2014. The Government holds that
removing non-medical exemptions will ‘reinforce the importance of immunisation
and protecting public health’ and that ‘the choice made by
families not to immunise their children is not supported by public policy or
medical research nor should such action be supported by taxpayers in the form
of child care payments’.
Registered conscientious objectors
represent a minority of the total number of children not up-to-date with their
vaccination schedules—around 20 per cent of all children aged one, two or five
who are not fully immunised. For children up to five
years of age, immunisation rates range from around 90 to 92 per cent (depending
on the age group). While there has been an increase in immunisation coverage
since 1998, overall rates have remained static in recent years.
The Budget measure is primarily targeted at
conscientious objectors but will affect all those who receive child care
subsidies or the FTB-A supplement and whose children’s vaccination records are
not up-to-date. Some parents refuse to vaccinate their children out of a
concern that potential harms outweigh the benefits or because of particular
moral or philosophical beliefs, but many others have failed to keep up-to-date
with vaccination schedules as a result of practical difficulties in accessing
services. A Western Australia
survey of families with children who had no vaccinations recorded on the ACIR found
that the most common reason was that the families had moved from overseas and
their children’s vaccination records had not been added to the national
register (though only a small number of these children would have been
considered fully immunised under the Australian schedules).
While the measure poses a significant
financial incentive for parents to ensure their children are immunised, some
health professionals and researchers have questioned whether imposing financial
penalties is an effective way of lifting immunisation rates and engaging with
parents who are hesitant about vaccinations. Hal Willaby and Julie Leask from
the University of Sydney have argued that other measures which address access
issues and which prompt parents who are behind on their children’s vaccination
schedules would be more effective in boosting coverage rates.
The other budget measures relating to immunisation, described below, are aimed
at addressing some of these issues. Willaby and Leask also argue that removing
the chance for conscientious objectors to discuss their position with a health
professional (which is required in order for a parent to register their
objection) forgoes an opportunity to engage with these parents and address
their concerns. President of the
Australian Medical Association, Brian Owler, stated that it was a concern that
such large savings were expected from the measure: ‘it indicates that a number
of people aren't going to vaccinate their children. What we should be saying is
we need to make sure that we do get all those children vaccinated and we should
be aiming to actually continue to spend the same amount on those sorts of
Family Tax Benefits’.
Other immunisation measures
The Budget includes $161.8 million over five
years for new and amended listings to the National Immunisation Program (NIP)
Schedule of free vaccines. Listings include an
extra dose of Diptheria, Tetanus and Acellular Pertussis (DTPa) vaccine for 18 month olds, for extra protection against whooping cough, and Zostavax vaccine to
prevent shingles for 70 year olds (with a catch up program for 71–79 year
There is also $26.4 million over four years to
improve immunisation coverage rates, particularly in children and adolescents.
The Government intends to:
make an incentive payment to doctors and other
immunisation providers when they identify a child who is overdue for
vaccination and call them in for a catch up
fund an awareness campaign to promote the NIP and
address parents’ concerns regarding immunisation and
expand the existing National Human Papillomavirus
Vaccination Program Register (the HPV register) to include all adolescent
vaccinations delivered in schools under the NIP.
Currently the ACIR records NIP vaccinations
for children up to the age of seven. Adolescent and adult NIP
vaccinations are not recorded nationally, with the exception of the HPV
register, which is specific to the one vaccine.
Expanding the HPV register to become the ‘Australian School Vaccination
Register’ will allow for the recording of other adolescent vaccinations, and is
intended to ‘provide the tools needed, such as recall and reminder systems, to
improve adolescent coverage rates.’
Health professionals have previously called
for the introduction of a whole-of-life register to include adult vaccinations.
The Government appears to have heeded these calls, although the exact nature of
their response is not yet clear. The NIP Budget measure states that ‘[a]n adult
vaccination register will be established to record all adult vaccines provided
under the NIP from 1 September 2016’, but a media release from the Minister has
the Government ‘exploring options to capture adult immunisation records.’
Similar ideas have been proposed in the past, but not fully investigated. In
2006 the Government announced $1.2 million for a scoping study to examine ‘the
feasibility of establishing a whole-of-life immunisation register’, but it
appears that the study did not proceed.
Through these efforts to improve coverage
rates, coupled with financial penalties for non-compliance with immunisation
schedules, the Government believes that it is taking a ‘balanced “carrot and
stick” approach’ to encouraging vaccination. Of
course, the sizeable savings expected from the ‘stick’ element may not be
realised if these policies succeed in significantly lifting childhood
T Abbott (Prime Minister) and S Morrison (Minister for Social Services),
jab – no play and no pay for child care, media release, 12 April
Legislation Amendment Act 1998 (Cth).
T Abbott, op. cit.
S Morrison (Minister for Social Services), Government
ends religious ‘No Jab No Pay’ of benefits exemption, media release, 19
T Abbott, op. cit.
The budget figures in this article have been taken from the following
document unless otherwise sourced: Australian Government, Budget
measures: budget paper no. 2: 2015–16.
S Maiden, ‘Budget
2015: No Jab, No Pay to hit teens’, Herald Sun , 13 May 2015.
Department of Health (DoH), ‘ACIR
– National Vaccine Objection (Conscientious Objection) Data’, DoH website,
T Abbott, op. cit.
National Health Performance Authority (NHPA), Healthy
communities: immunisation rates for children 2012–13, NHPA, Sydney, p. iv.
– Annual Coverage Historical Data’, DoH website, 2015.
J Lowinger, ‘Who’s
missing out on vaccinations?’, ABC Health & Wellbeing website, 4 May
Western Australia, Department of Health (WADoH), Investigation
of Western Australian children with no vaccinations recorded on the Australian
Childhood Immunisation Register, WADoH, Perth, 2014.
H Willaby and J Leask, ‘Opinion:
with vaccination rates stable, ‘no jab, no play’ rules are beside the point’,
The Conversation, 22 May 2013; J Leask, ‘Will
stopping vaccine objectors from accessing payments have its desired impact’,
Human factors weblog, 11 April 2015.
Willaby and Leask, Ibid.
Australian Medical Association, Budget
2015: Transcript of doorstop interview with Brian Owler: Parliament House,
Canberra: 2015 Health Budget, 13 May 2014.
measures: budget paper no. 2: 2015–16, op. cit., p. 106.
Ibid.; Australian Government, Portfolio
budget statements 2015–16: budget related paper no. 1.10: Health Portfolio,
measures: budget paper no. 2: 2015–16, op. cit., p. 101; S Ley (Minister for Health), $26m
booster to Immunise Australia, media release, 19 April 2015.
immunisation coverage rates, Fact sheet, DoH, 2015.
Department of Human Services (DHS), ‘Australian
Childhood Immunisation Register for health professionals’, DHS website.
L Chin, N Crawford, G Rowles and J Buttery, ‘Australian
immunisation registers: established foundations and opportunities for
improvement’, Euro Surveillance, 17(16), 19 April 2012, p. 29.
immunisation coverage rates, op. cit.
L Chin, N Crawford, G Rowles and J Buttery, op. cit., p. 29.
measures: budget paper no. 2: 2015–16, op. cit., p. 106; S Ley, op. cit.
Department of Health and Ageing (DoHA), ‘Australian
Childhood Immunisation Register – Redevelopment scoping study’, DoH
website; Senate Community Affairs Committee, Answers to Questions on Notice,
Health and Ageing Portfolio, Budget Estimates 2007–08, 30 and 31 May 2007, Question
E07–130. The study is listed in a table of ‘Measures Terminating from 2006–07
Onwards’, but does not have any actual expenditure listed.
S Ley, op. cit.
All online articles accessed May 2015.
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