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Christopher Chew
Monash University

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.

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4 Comment on this post

  1. The issue needs to be seen in the wider context of populism, and the consolidation of a disillusioned minority, who are hostile to mainstream politics and media. The internet may not have created this group, but it made it far easier for them to disseminate and reinforce each others views. I would guess, for instance, that US and Australian anti-vaxxers are also more likely to be home-schoolers: both are practices rooted in distrust, rather than a choice for specific benefits. In western Europe I would expect anti-vaxxers to be a subset of the broad right-wing anti-immigrant populist electorate.

    However, there are also religious minorities which are traditionally anti-vaccination, such as the orthodox Calvinist minority in the Netherlands. Since liberal-democratic governments are traditionally reluctant to interfere with religious beliefs, these minorities are less likely to be subject to pressure to vaccinate, by measures similar to those now proposed in Australia. In the Netherlands they are also concentrated in specific areas, where local authorities are often sympathetic to their views. The emergence of a secular anti-vaxxer movement would upset such traditional accommodations.

    I think it is clear that western democratic governments have failed to address the rise of populism, a failure which is most evident in immigration policy. Certainly, the political class in western Europe never made any attempt to engage with populist issues, and continues to pretend that the populists don’t exist. As the anti-vaxxer movement inevitably spreads to western Europe, the political class will predictably repeat these failures. I’m not familiar with Australian politics, but the proposed measures are clearly punitive, and apparently no serious attempt has been made to engage with the fears and suspicions of the anti-vaxxer minority. I therefore fear that anti-vaxxers are on their way to becoming a classic persecuted minority.

    We should recognise that refusal to vaccinate children is a strategy of resistance, and one of the few forms of resistance that is available to disempowered and marginalised minorities. It is morally problematic because the person most harmed is the non-vaccinated child, and secondarily other children who might catch an infectious disease from that child. The parents who take the non-vaccination decision, are rarely at risk themselves.

    Nevertheless refusal to accept vaccination can have some value as a desperate act of resistance by the powerless, against a hostile society, and an arrogant and remote political elite. It would be less problematic in cases where adults refuse vaccination, for instance against Ebola. (It would also be preferable, although almost impossible in practice, that adults could undo the effects of childhood vaccination).

    Of course those who refuse an Ebola vaccination might well die a horrible death if they catch it themselves. It would an extreme act of resistance, comparable to self-immolation as a political protest. What the political class should ask itself, when people do that kind of thing, is why people are prepared to go to such lengths. And so too with the anti-vaxxers in general: their existence ought to be a signal to the political class, that communication with the population has broken down.

  2. Until reading this article, I was of the opinion that parents who don’t vaccinate should have the kids taken away—permanently. But I had no idea that it was partially an access problem. How is that possible in a country like Australia?
    I guess we need to send the U.S. Army down there to take over the public health system. Don’t worry, we won’t stay long.

  3. This article is exactly the sort of conversation we should be having around vaccination and I applaud any rational, reasoned debate around improving the health outcomes for our children.

    Disclaimer: I do not vaccinate my children. I have come to that decision after many years of research, soul searching and questioning. As “misguided”, “ill-informed”, “dangerous” or “selfish” as my decision is, it is not a decision made in ignorance. I am a lawyer. It is my job to research. You may not like or respect the fruits of my research, but I have come to my decision based on the research that I have done (which extends far further than google websites like “hippyorganicmummyblogspot”. I have read scientific studies, research papers on the reasons for vaccination and extremist pro and anti-vax views. The reasons I have chosen not to vaccinate to date are irrelevent.

    I love my children passionately. Their well being is my number one priority. As I watch Royal Commissions into the appalling ill-treatment of children, I struggle to comprehend suggestions that parents who don’t vaccinate their children should have their children removed. There is clearly something more than just the issue of injections to prevent diseases at play here.

    With Australia attempting to bring in legislation affecting welfare payments for children who aren’t vaccinated, we need to look at exactly what these laws are trying to achieve and whether these laws will achieve that outcome.

    I am certain that the goal is that we have a society of healthy strong children, free from unnecessary pain and suffering. I think the legislators want this, doctors want this and the community wants this. But compulsory vaccination will not achieve this result. The author is right: people who are strongly anti-vaccination will not suddenly go out and get their children vaccinated because of the welfare cuts. They will either remove children from childcare and or take up extra work to pay the higher childcare rates; they will quit their jobs to homeschool their children, or they will group together to take care of each other’s children. Importantly, any opportunity to engage with these parents to address their concerns about vaccination will be lost. If a person is cut off from receiving benefits, there is no incentive for that person to be willing to be engaged in any discussions in an attempt to persuade them to change their minds. Further, as with any disenfranchised group, they will gather together, reinforcing each other’s views and further disenfranchise themselves.

    There seems to be a misconception that anti-vaxxers will run to their doctors to get their children jabbed when confronted with financial penalties. That is not correct. There is a misconception that anti-vaxxers have just read “woo” websites. While I am sure that is true for some people, most anti-vaxxers have done more reading on the issue than the rest of the population. Most anti-vaxxers have reached their decision after weeks and months of research. Compulsory vaccination will not persuade these people to change their minds.

    I believe that vaccination is a good thing. I don’t think it should be optional. I believe that people should be actively encouraged to vaccinate (themselves as well as their children). I just don’t think it should be compulsory. Sure, tighten up the conscientious objection provisions (currently a parent only has to get a form signed for the child once. Make the parent get a CO form signed every couple of years so ensure that the parent is constantly thinking about the issue). Give incentives to vaccinate. Make the opt-out more difficult. But don’t remove the opt-out altogether.

    A recent study from the University of Adelaide found that only 1/6 unvaccinated children are not vaccinated to conscientious objection. The remaining 5/6 are for other reasons, such as the reasons set out in this article. So why aren’t we targeting those parents and giving them access to and incentives to, vaccinate? If we want to increase our vaccination rates, it seems obvious to me that, rather than targeting those whose minds will not change, target the 80-85% who aren’t vaccinated due to apathy, complacency, access and economic issues.

    Vaccination is an invasive medical procedure. It does not come without risks. And when there are risks there has to be choice. Sure those risks have to be weighed up against the greater good. But removing the common law doctrine of informed consent? That seems like a very drastic step when it will not do what it is setting out to do.

    Lets remove the crazy emotion from this debate. Let’s stop calling the the anti-vaxxers terrorists and child murderers (and I’d like the anti-vaxxers to stop calling the pro-vaxxers Big Pharma shills, sheeple and ignorants). Lets try to understand why the other side has the beliefs they have and from there, lets look at what we can do to improve the health outcomes for our children. I don’t know what the answer is. But what I do know is that this proposed legislation will not achieve that outcome.

  4. KS,

    You have clearly based your decision not to vaccinate your children (despite approving of vaccination) on the basis that you’ll have the advantage of herd immunity from the rest of the community, but you won’t take the tiny risk of the vaccines.

    Thus you are the worst type of non-vaxxer of all, a leecher. Your profession does not surprise me.

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