WARNING:
This Digest is prepared for debate. It reflects the legislation as
introduced and does not canvass subsequent amendments.
This Digest was available from 4 June 1996
CONTENTS
Date Introduced: 8 May 1995
House: Senate
Portfolio: Health and Family Services
Commencement: The amendments contained in the Bill
will commence on a day fixed by Proclamation or, if such a day has
not been Proclaimed within 6 months of the Bill receiving the Royal
Assent, on the first day after the end of that period.
To incorporate provisions dealing with the Australian Childhood
Immunisation Register (ACIR) into the Health Insurance Act
1973 (the Principal Act) and to allow information from ACIR to
be provided to others in restricted circumstances.
Immunisation against specific diseases has been in use in
Australia since the 1920s. The process of immunisation involves
administering a vaccine to a person to allow their own immune
system to develop anti-bodies to a disease (the process was
pioneered by Edward Jenner approximately 200 years ago). Current
Australian immunisation programs relate to rubella, measles,
pertussis (whooping cough), a variety of meningitis (Hib),
diphtheria and tetanus.
The potential of immunisation campaigns to lessen the frequency
of a disease is best illustrated by the World Health Organisations
successful campaign to eradicate smallpox. The campaign was
launched in 1958 and, by 1977, had eradicated smallpox except in
research institutions. In more developed countries, including
Australia, poliomyelitis has also been eradicated. In 1988 the WHO
introduced a program aimed at the global eradication of this
disease.
While immunisation campaigns have been in use for a long time,
there are few reliable statistics available on the frequency of
diseases that could be prevented by immunisation or the proportion
of people who are immunised. In a 1993 paper, titled National
Immunisation Study, the National Health and Medical Research
Council (NHMRC) states:
Moreover, the data [on preventable diseases] probably
understate the incidence, by up to 90% for some diseases, because
notification procedures are not uniform across Australia and cases
of measles, mumps, rubella and whooping cough are often undiagnosed
or unnotified.(1)
Having noted potential problems with the statistics available,
the Department of Human Services and Health compiled the following
figures for the occurrence of vaccine preventable diseases, with
the 1994 data relating to cases reported to mid-April 1994 and not
being full year figures.(2)
| Disease |
1992 |
1993 |
1994 |
| Rubella |
3747 |
3623 |
411 |
| Measles |
1400 |
4339 |
830 |
| Pertussis |
725 |
3826 |
1210 |
| Hib |
501 |
393 |
44 |
| Diphtheria |
no data |
no data |
5 |
| Tetanus |
no data |
no data |
2 |
The Australian Medical Association and the Australian College of
Paediatricians have claimed that whooping cough and measles killed
457 Australian children between 1980 and 1990.(3)
A survey by the Australian Bureau of Statistics published in
1992 deals with the coverage of immunisation for children aged
between 0 and 6 in 1989-90. Findings of the survey include:
- only 52.9% of such children were fully immunised, with 29.5%
partly covered;
- 3.6% had no vaccination and 14% were unsure;
- the rate of vaccination varied between diseases, with rates
high for diphtheria and tetanus and lower rates for whooping cough
and polio;
- ACT had the highest rate of immunisation while the Northern
Territory had the lowest rate; and
- in addition to variations across States/Territories, there were
differing rates of immunisation between regions, with urban areas
tending to have higher rates.(4)
A number of reasons have been suggested for the above figures,
including:
- children from economically disadvantaged families and areas
have lower immunisation rates;
- lower rates of immunisation are also found in Aboriginal
children, children of recent immigrants and children of Arabic and
Asian, other than Chinese, background;
- if a child has two or more siblings, or an older sibling who is
not fully immunised, they are more likely to not be fully
immunised;
- many children are not fully immunised because of parents fear
of side effects of the vaccine, particularly for whooping
cough;
- refusal to have children immunised is rare and is concentrated
in relatively highly educated groups that prefer 'natural' methods
(although there is no scientific evidence on the effectiveness of
such methods);
- many parents do not have children vaccinated against diseases
perceived to have been eradicated (the main case is for
poliomyelitis which, while it no longer exists in Australia, can be
found in many areas of the world);
- booster shots can be forgotten so that a child is not fully
immunised; and
- immunisation services are fragmented with little co-ordination
so that follow-up reminders often do not occur.(5)
Failure to implement universal immunisation can cause diseases
that were thought to have been eradicated from a region to reoccur.
An article in the Medical Journal of Australia reports two such
cases. The first related to the reintroduction of paralytic
poliomyelitis. It is reported that twice within 15 years a
religious group in Holland that refused immunisation were
responsible for outbreaks of the disease in that country and that
the disease was also spread to the United States and Canada on both
occasions by visiting members of the group. At the time of the
visits poliomyelitis was considered to have been eradicated in the
latter countries. The article also reports that following adverse
publicity regarding the effects of whooping cough vaccine in the
1970s, which were later proved to be incorrect, the rate of
vaccination in the U.K. fell from approximately 80% to 40% and that
there were two subsequent outbreaks of the disease (1977-79 and
1981-82) in which more than 100 000 cases of the disease were
reported and 27 people died.(6) It was announced in the 1995-96
Budget that funds would be allocated to establish ACIR which would
monitor immunisation coverage and provide a central register to
enable parents to determine the immunisation status of their child
regardless of where the immunisation service was provided. ACIR
commenced operation on 1 January 1996. According to the second
reading speech for the Bill, approximately 450 000 immunisations
had been registered by 1 April 1996.
ACIR was originally funded for two years, after which the scheme
would be evaluated to determine whether it should be continued.
This included funding for preparatory work on the scheme during the
period 1 July 1995 until its commencement on 1 January 1996 so that
funding for the ACIR would end after 18 months of its operation on
30 June 1997. In the second reading speech to the Bill the Minister
states that:
Under this government funding for the Register will be
continued beyond this 18 month period.
The explanatory memorandum to the Bill provides a financial
impact statement which states that ACIR will cost $3.18 million in
1995-96 and $3.30 million for 1996-97. There is no estimate of
costs beyond 1 July 1997.
ACIR is currently established under regulations made under the
Principal Act. However, those regulations do not provide for
information sharing, which prevents ACIR being used to share
information with those who provide immunisation services and
State/Territory immunisation bodies. This also prevents 'reminder
notices' being sent to those on ACIR when their next immunisation
is due.
Item 1 of Schedule 1 of the Bill will insert a
new Part IVA into the Principal Act that deals with the ACIR.
Proposed section 46B deals with the Health Insurance
Commission's (HIC) responsibilities in respect of ACIR. HIC is
to:
- establish and keep ACIR;
- record on ACIR all immunisation encounters that are notified to
the HIC;
- make payments in respect of the administrative costs incurred
by those providing information; and
- provide information in respect of immunisation (see
below).
The information that may be provided from ACIR is dealt with in
proposed section 46E which allows the Managing Director of HIC
to:
- give information about the immunisation of children that will
not identify the individuals involved to: a recognised immunisation
provider for a purpose relating to the immunisation or health of
the child (as individuals are not to be identified such information
could, amongst other matters, relate to the incidence of a disease
in an area); a prescribed body; an officer of the Department; or an
officer of a Department, authority of a State or Territory that has
requested the information;
- provide information about a particular child where that is
requested by an immunisation provider and a (not both) parent or
guardian of the child agrees to the provision of the information;
and
- post information to a parent or guardian of a child relating to
the immunisation of the child (which will allow 'reminder notices'
to be sent).
Item 2 will save the ACIR kept under regulation
3 of the HIC regulations and provide that it is to be taken to have
been kept under proposed Part IVA (NB. Regulation
375 of 1995 provides for ACIR to be kept under regulation 3Q rather
than regulation 3 as referred to in the Bill).
Section 130 of the Principal Act contains a number of provisions
to make it an offence for officers of the HIC to disclose
information received due to their duties except in restricted
circumstances. Item 3 of the Bill will amend
section 130 to extend restrictions to those who receive information
under proposed section 46E. Such information may only be used for
the purposes for which it was provided, and is not to divulged to
another unless necessary for the performance of that person's
functions as a provider of immunisation. The information may also
be divulged by an officer of an authority or department to which it
has been provided under proposed section 46E for the performance of
their duties in relation to immunisation.
(1) NHMRC, National Immunisation Strategy, April 1993, p.
vii.
(2) Department of Human Services and Health, Childhood
Immunisation, August 1994, p. 4 (this work provides a review of the
literature on immunisation in Australia).
(3) Ibid.
(4) Ibid., p. 5.
(5) Ibid.
(6) The Medical Journal of Australia, Vol 160 , 18 April 1994,
pp. 459 & 460.
Chris Field Ph. 06 277 2439
29 May 1996
Bills Digest Service
Parliamentary Research Service
This Digest does not have any official legal status. Other
sources should be consulted to determine whether the Bill has been
enacted and, if so, whether the subsequent Act reflects further
amendments.
PRS staff are available to discuss the paper's contents
with Senators and Members and their staff but not with members of
the public.
ISSN 1323-9032
© Commonwealth of Australia 1996
Except to the extent of the uses permitted under the
Copyright Act 1968, no part of this publication may be
reproduced or transmitted in any form or by any means, including
information storage and retrieval systems, without the prior
written consent of the Parliamentary Library, other than by Members
of the Australian Parliament in the course of their official
duties.
Published by the Department of the Parliamentary Library,
1996.
This page was prepared by the Parliamentary Library,
Commonwealth of Australia
Last updated: 4 June 1996
Back to top