No Jab No Pay

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Australia has always been at the forefront of immunisation legislation, but the new ‘No Jab No Pay’ law takes our immunisation laws to a new level.

The ‘No Jab No Pay’ law, passed today, and to be implemented in Jan 2016, removes the option of being a ‘conscientious objector’. This means that if you refuse to vaccinate your child, you will not be eligible for child care rebate, child care benefit, and family tax benefit.

What was the conscientious objector exemption?

Prior to ‘No Jab No Pay’ being passed, immunisation status was already linked to child care benefit. So technically, if you didn’t immunise your child, you could lose out.

However, any parent who did not want to immunise their child only had to sign a conscientious objector exemption form to be eligible for all benefits.

This form could be signed by visiting a GP and explaining your reasons.

How many people will this affect?

The number of conscientious objectors has been on the rise, and accounted for 1.77% of all children in 2014. A recent report suggested there were 39,000 conscientious objector forms signed in 2014.

Conscientious objectors only account for around 20% of all unimmunised children.

Is this for children of all ages?

Yes. Prior to the new legislation, the vaccination schedule only had to be up to date in the years they turned 1, 2, and 5. The new legislation applies to children of all ages.

Are there any exemptions?

Exemptions will still be allowed on medical grounds, but that is the only reason. There will be no religious or non-medical reasons for not immunising your child.

Aren't we losing the part where parents discuss their concerns with their GP?

Indeed. Not everyone in healthcare thinks it’s a great idea. Some argue that a better way would be to engage families in more discussion and education around vaccination, whilst also addressing issues around access to immunisations.

As there is no conscientious objector form to sign, these families will no longer be obliged to discuss their reasoning with a medical practitioner; so we will lose this opportunity for engagement and discussion.

It's often middle class families who 'conscientiously object' - surely they aren't the ones receiving tax benefits?

There doesn’t seem to be clear figures to identify the incomes of these families. Certainly, many conscientious objectors will not be eligible for family tax benefit or child care benefit. However, all families (regardless of income) can benefit from child care rebate – this provides up to $7500 each year for each child attending child care. This is a significant benefit for most middle class families, so I think you’d have to be an extremely high earner not to care.

Many healthcare bodies have been opposed to this legislation. The paediatrics and child division of the Royal Australasian College of Physicians said that “of the small proportion of parents who fail to vaccinate their children, few are conscientious objectors” and that “the majority fail to vaccinate their children due to other reasons, primarily difficulty of healthcare access.” So it is clear that this new legislation doesn’t solve the whole problem.

But what it does do, is target conscientious objectors. Families who do not immunise because of difficult access to healthcare aren’t any better or worse off because of ‘No Jab No Pay’. They still, unfortunately, lose their child care benefits. And I agree with the RACP and Julie Leask that this law does not help them. Some resources and funding going into improving access to immunisations would be a great step forward.

This legislation does not affect them, but it does affect the conscientious objectors. These are the people who sign a form to say that they choose a non-medical reason not to immunise their children. They have to do this by seeing a medical practitioner, so access to healthcare is not their barrier to immunisation.

The government have boasted that this new legislation will give a saving of $508.3 million over the next five years. This does suggest that they are assuming all these families will still choose not to vaccinate. Actually, the policy should be aiming to encourage these families to immunise their children, reducing the government saving. This is the main reason that the Australian Medical Association President was hesitant about supporting the legislation in a recent interview.

Although it’s not perfect, the ‘No Jab No Pay’ legislation gives a clear message to the public that the government does not support parental decisions not to immunise their children. If they chose to do so, they have to face a financial penalty.

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Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts