Guest Post: JABBING, PLAYING, AND PAYING – HIGH SEASON ON ANTI-VAXXERS
In the strange, upside-down world of the Southern Hemisphere, cold and gloomy Winter is quietly slinking away, and raucous Spring in all his glory begins to stir. Ah, Spring! The season of buds and blooms and frolicking wildlife. One rare species of wildlife, however, finds itself subject to an open hunting season this Spring – the anti-vaxxer.
In April this year, the Australian Federal Government announced a so-called “no jab, no pay” policy. Families whose children are not fully vaccinated will now lose subsidies and rebates for childcare worth up to almost AUD$20,000 per child, except if there are valid medical reasons (e.g. allergies). Previously, exemptions had been made for conscientious and religious objectors, but these no longer apply forthwith.
Taking things a step further, the Victorian State Government earlier this week announced an additional “no jab, no play” policy. Children who are not fully vaccinated, except once again for valid medical reasons, will additionally now be barred from preschool facilities such as childcare and kindergartens.
I should, at this point, declare my allegiances – as a finishing medical student, I am utterly convinced by the body of scientific evidence supporting the benefits of childhood vaccination. I am confident that these vaccines, while posing a very, very small risk of severe side-effects like any other medicine, reliably prevent or markedly reduce the risk of contracting equally severe diseases. And finally, I believe that the goal of universal childhood vaccination is one worth pursuing, and is immensely beneficial to public health.
Despite my convictions, however, I still find myself wondering if the increasingly strict vaccination regime in Australia, and every-increasing punishments for anti-vaxxers, is necessarily the best means to go about achieving a worthy goal. It’s not clear, to me, that the recent escalation will have significant positive effects beyond a mere simple political stunt.
Childhood vaccination rates in Australia hover between about 91-92%, and have been relatively stable for the last decade or so. This is a significant improvement from the early 90’s, when vaccination coverage was much lower, closer to 50-60%. Much of this can be attributed to policy changes, including a more coherent national immunisation strategy, better education and counselling, and the introduction of certain welfare payments as a reward for vaccination.
Contrary to popular media and political portrayals, not all, or even a significant minority, of parents who fail to vaccinate their children are hard-core anti-vaccination ideologues. This excellent article on The Conversation notes that about half of parents who fail to fully vaccinate their children fail because of issues surrounding access to healthcare services – poverty, lack of transport or time, poor education or knowledge of immunisation schedules. Of the other half who have issues around vaccine acceptance, only a small minority might be characterized as hard-boiled anti-vaxxers. Far more are simply hesitant or equivocating, and delay or partially vaccinate.
As noted in a previous blog on this site, Australia has generally been in favour of legislation in the name of the public good, but has tread a fine line between coercive and compulsory measures to ensure childhood vaccination. The new measures introduced, however, would seem to quite firmly be of the latter sort.
These “Big Stick” measures that current governments propose, however, do little to address access issues reducing vaccination rates; and are additionally unlikely to do much to shift the small, resilient core of ideological anti-vaxxers. Better health education, financial incentives, and measures to improve access are likely to improve vaccination uptake in those confronted by access issues or are uncertain about vaccination, and are far gentler and less ethically concerning.
The small minority of anti-vaccination ideologues who are convinced that vaccinations cause a litany of fatal diseases, that the diseases they claim to prevent are mythical extinct unicorns, or that the whole thing is simply a ploy by Big Pharma will, by hook or by crook, find ways to avoid vaccination. These measures, then, mean that that those who are already unfortunate enough to be children of resolute anti-vaxxers will furthermore be denied preschool education and welfare support.
The purpose, then, would seem to be to push the last fraction of vacillating parents into vaccinating – not because they acknowledge the benefits of these childhood programs, but rather because they fear the steep financial penalties. This feels somewhat problematic. It may indeed work, though the lack of ongoing empirical monitoring associated with these policy announcements means we may never know. Yet the knock-on effects on faith in the government and mainstream scientific institutions are likely to be negative.
While vaccination rates in Australia are not entirely ideal, or even world-leading, they are far from catastrophic. It is not clear that such heavy-handed intervention is ideal, or even necessary, given the restrictions it places on the public (and the ‘nanny-state’ concerns some may hold), the risk of further alienating hesitant parents, and the already coercive measures in place.