Governments in Australia, the US and Italy have recently introduced or modified policies that penalise parents who don’t vaccinate. Penalties might seem like appealing solutions to the problem of vaccine rejection but they come with unintended consequences, of which I have written about in previous blogs here and here. Having vaccination rules with
hard-to-reach exemptions strikes a balance between policy fairness and effectiveness. Earlier this month, Dr Margie Danchin and I published a Viewpoint article commissioned by the Journal of Paediatrics and Child Health, the official journal of the Royal Australasian College of Physicians’ Paediatrics and Child Health Division.
Vaccine rejection presents a persistent challenge for clinicians and policy makers. In response, some countries are penalising parents who actively reject vaccination for their children. The Australian government introduced the “No Jab No Pay” amendment bill in 2015 which removed vaccine objection exemptions so that parents who actively rejected some or all vaccines were no longer able to obtain family assistance payments.
We consider this approach with Verweij and Dawson’s seven ethical principles for public health immunisation programs which relate to benefits and risks, effectiveness, equity and justice, autonomy, reciprocity, and trust. Despite some marginal gains from the removal of objection exemptions, there are significant social and economic risks for the most vulnerable. The penalties are applied differentially through income testing, causing lower income vaccine objectors to be more affected than those on a higher income. They also compound the disadvantage for children already at greater risk of vaccine-preventable diseases and they create more alienation from a healthcare system that vaccine rejecting and hesitant parents already struggle to trust. Furthermore, the No Jab, No Pay amendment bill has been implemented without a no-fault vaccine injury compensation system , in ackowledgement of the risks of rare, serious side effects of vaccination. Such policies should be evaluated with these and other unintended negative consequences in mind.
An evidence-based approach to under-vaccination requires multifactorial approaches that ensure the inadvertently under-vaccinated are reminded and supported to fully vaccinate their children whilst active rejectors of vaccination are able to access services and financial assistance through exemptions that are difficult to obtain. There is also a need for stronger evidence on ways to address vaccine hesitancy and rejection.