‘No Jab No Pay’ and other immunisation measures

Budget Review 2015–16 Index

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.[1] 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.[2] On 12 April 2015, the Government announced that it would remove the conscientious objector exemption but retain the medical and Christian Scientist exemption.[3] 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.[4]

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.[5] 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.[6] 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).[7]

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.[8] 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’.[9]

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.[10] 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.[11]

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.[12] 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).[13]

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.[14] 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.[15] 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’.[16]

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.[17] 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 olds).[18]

There is also $26.4 million over four years to improve immunisation coverage rates, particularly in children and adolescents.[19] 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.[20]

Currently the ACIR records NIP vaccinations for children up to the age of seven.[21] Adolescent and adult NIP vaccinations are not recorded nationally, with the exception of the HPV register, which is specific to the one vaccine.[22] 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.’[23]

Health professionals have previously called for the introduction of a whole-of-life register to include adult vaccinations.[24] 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.’[25] 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.[26]

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.[27] Of course, the sizeable savings expected from the ‘stick’ element may not be realised if these policies succeed in significantly lifting childhood immunisation rates.



[1].          T Abbott (Prime Minister) and S Morrison (Minister for Social Services), No jab – no play and no pay for child care, media release, 12 April 2015.

[2].          Child Care Legislation Amendment Act 1998 (Cth).

[3].          T Abbott, op. cit.

[4].          S Morrison (Minister for Social Services), Government ends religious ‘No Jab No Pay’ of benefits exemption, media release, 19 April 2015.

[5].          T Abbott, op. cit.

[6].          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.

[7].          S Maiden, ‘Budget 2015: No Jab, No Pay to hit teens’, Herald Sun , 13 May 2015.

[8].          Department of Health (DoH), ‘ACIR – National Vaccine Objection (Conscientious Objection) Data’, DoH website, 2015.

[9].          T Abbott, op. cit.

[10].       National Health Performance Authority (NHPA), Healthy communities: immunisation rates for children 2012–13, NHPA, Sydney, p. iv.

[11].       DoH, ‘ACIR – Annual Coverage Historical Data’, DoH website, 2015.

[12].       J Lowinger, ‘Who’s missing out on vaccinations?’, ABC Health & Wellbeing website, 4 May 2015.

[13].       Western Australia, Department of Health (WADoH), Investigation of Western Australian children with no vaccinations recorded on the Australian Childhood Immunisation Register, WADoH, Perth, 2014.

[14].       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.

[15].       Willaby and Leask, Ibid.

[16].       Australian Medical Association, Budget 2015: Transcript of doorstop interview with Brian Owler: Parliament House, Canberra: 2015 Health Budget, 13 May 2014.

[17].       Budget measures: budget paper no. 2: 2015–16, op. cit., p. 106.

[18].       Ibid.; Australian Government, Portfolio budget statements 2015–16: budget related paper no. 1.10: Health Portfolio, p. 49.

[19].       Budget 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.

[20].       DoH, Improving immunisation coverage rates, Fact sheet, DoH, 2015.

[21].       Department of Human Services (DHS), ‘Australian Childhood Immunisation Register for health professionals’, DHS website.

[22].       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.

[23].       DoH, Improving immunisation coverage rates, op. cit.

[24].       L Chin, N Crawford, G Rowles and J Buttery, op. cit., p. 29.

[25].       Budget measures: budget paper no. 2: 2015–16, op. cit., p. 106; S Ley, op. cit.

[26].       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.

[27].       S Ley, op. cit.

 

All online articles accessed May 2015. 

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