By Shelby Huffman
Australian Prime Minister Tony Abbot just announced the country’s newest vaccination policy, under which parents who refuse to vaccinate their children will no longer be able to claim subsidies (1). But will this really do anything to improve vaccination rates? Vaccine refusal and hesitancy are as polarizing as ever of late, with the re-emergence of measles and its surrounding publicity. That people are being misinformed about the safety and efficacy of mandatory childhood vaccinations is unfortunate to say the very least, and the consequences of this endangers the health of children- something that rightfully elicits strong reactions.
Vaccine resistance wasn’t pioneered by Jenny McCarthy, Andrew Wakefield or any number of Internet conspirators- people have been opposing vaccines for as long as vaccines have existed. And for as long as people have been opposing vaccines, governments have been coming up with ways to coerce or persuade them to vaccinate themselves and their children. Over time strategies have moved away from coercion, which makes this particular policy interesting.
I’m inclined to agree with Professor Raina MacIntyre, head of the School of Public Health and Community at the University of New South Wales who said that “Bringing in something draconian like this is not a very good public health strategy”, citing concerns about perceptions of coercion and noting that people who are hardcore contentious objectors have not been found to be receptive to efforts to change their views (2). The success of vaccine programs is dependent on their perceived acceptability by the public, and public resistance to coercive policies is a real possibility.
At the same time, public opinion seems to be growing increasingly hostile towards the types of parents that this policy purports to punish- parents whose children will, in the absence of an epidemic, reap the benefits of herd immunity without incurring any of the extremely rare risks of vaccination or worse, will contract and transmit these vaccine preventable diseases to others. This policy seems to be capitalizing on this resentment but it’s not clear whether it is designed to significantly improve Australia’s vaccination rates, which are already very high. I think the guardian’s Jason Wilson accurately sums it up as “a pretty authoritarian piece of political theatre” (3).
A large proportion of unvaccinated children have highly educated, well-off parents (2). These are the hardcore conscientious objectors who have been found to be so resistant to efforts to change their views, and they’re unlikely to be swayed by such coercive efforts. On top of that, they probably don’t need the government’s money all that much anyway. Personally, I expect tactics that attempt to bully and patronize anti-vaccine parents will end up polarizing their views even further, and not in the intended direction. Focusing on the vaccine hesitant, rather than vaccine refuters seems to be the most promising course of action. One Melbourne virologist and member of a group that opposes the Australian Vaccine-Skeptics Network spoke to the importance of taking vaccine hesitant parents’ concerns seriously: “There’s no point in trying to bully someone or demean them because their goal is the same as mine: to give their children the best life and health that they can” (4).
Returning to this ‘no jab, no pay’ policy, the concern is that it will unfairly punish the disadvantaged, without doing anything substantial to improve vaccination rates. Membership in anti-vaccine groups like the Australian Vaccine-Skeptics Network is already declining (4), while vaccination rates are high and holding steady (2). As Dr. Julie Leask from the University of Sydney points out, the current system of maximizing procedural complexity for non-vaccinators and using incentives to encourage vaccination is “fair and proportional to the contribution that vaccine rejectors make to under-vaccination” (5). Hardcore vaccine refuters may elicit the strongest emotional reactions among voters, but policies like this will ultimately do very little to protect the health of children and the community. In this case, the benefits probably won’t outweigh the harms.