A controversial policy that withholds family payments from parents of unvaccinated children has been credited with raising the vaccination rate in Australia. However, critics remain unconvinced, saying the causes remain uncertain.
When the policy, dubbed “no jab, no pay”, was announced last year, it attracted predictable outrage from the anti-vaccination movement. Even many staunch supporters of vaccination were concerned, fearing it might backfire on children whose unvaccinated status occurred through a lack of medical access, rather than parental opposition.
However, Social Services Minister Christian Porter claimed in a statement that experience has vindicated the policy, with immunization rates for one and five-year-olds having increased from 90 to 93 percent. “To give our kids the best protection against diseases such as whooping cough, we’re aiming towards a herd immunity level of 95 per cent and it’s clear that the No Jab, No Pay policy is helping to achieve this,” Porter said.
The policy does not apply to families where children have medical reasons for not being vaccinated, but philosophical or religious exemptions were removed in January. In six months, 5,738 children whose parents listed themselves as vaccination objectors have since received injections as the parents decided their objections were weaker than the lost money.
The much larger effect, according to Porter, has been among children who the Australian Childhood Immunisation Register recorded as having missed one or more vaccinations by accident, rather than a deliberate decision. Of these, 148,000 have now caught up with the schedule for their age.
However, those who had concerns about the plan remain unconvinced. University of Sydney Public Health Researcher Dr Julie Leask described the reduction in conscientious objectors as “close to my predicted best case scenario”, but questioned whether the far larger reduction in unintentional non-vaccination was entirely a result of the aspect of the policy that stopped payments to objectors.
Leask told IFLScience that the high-profile changes coincided with other reforms, such as making vaccination free for children over five who had missed the schedule and paying doctors who “catch-up” previous unvaccinated children. Consequently, she argues, it is not possible to state with confidence how much of the improvement is a result of the “no jab, no pay” aspect.
“Andrew Wakefield caused fears about the MMR vaccine by taking something that was increasing over time and attributing it to a single cause,” Leask said. “I see people doing the same thing with vaccination rates, saying ‘because A came before B, A must have been the cause of B’ without considering the context of what else was happening.”
Leask noted that even the apparent improvement may not all be real, with some children who were previously listed as being unvaccinated actually having been fully up to date. The financial penalties may have inspired many parents to ensure their children’s status was accurately recorded.
Having spent two decades researching how to raise vaccination rates, Leask argues that any rise the policy did produce needs to be weighed against the impact on children whose families missed out on payments, irrespective of their parents' motivations.
