Australasian Science: Australia's authority on science since 1938

Why Do We Pay Parents Who Won’t Vaccinate their Kids?

By Peter Speck

The federal government wrestles with the cost of health care for Australians, so isn’t it time they stopped paying parents not to vaccinate their children?

Vaccination is critically important to maintaining the health of our children and society. Smallpox, the biggest killer of all time, was vanquished by vaccination, and the scourge of polio is almost gone, again through successful vaccination campaigns.

Measles, a vaccine-preventable disease, is highly infectious and very dangerous. Unvaccinated people, especially young children and individuals with impaired immunity, are especially vulnerable. Roughly one in ten children who contract measles ends up in hospital with complications such as pneumonia, diarrhoea and encephalitis. Up to 3% of these children may die. Vaccination prevents measles yet our government pays people not to vaccinate their kids.

Keeping infectious diseases under control relies heavily on herd immunity, the effect where vaccinating most of the community protects unvaccinated individuals. Herd immunity helps protect babies and young children before they can be fully vaccinated, those few individuals who, for legitimate medical reasons, cannot be vaccinated, and the sick or elderly with reduced immune function.

Measles demonstrates the importance of herd immunity, being so infectious that each case infects up to 18 other people. To stop a measles epidemic taking off in our community, vaccination rates must be close to 100%. Even a small proportion of unvaccinated people is enough to sustain the spread of measles.

To encourage vaccination, families in Australia are paid $726 through Family Tax Benefit Part A if their children are fully vaccinated at each of the ages 1, 2 and 5. This is a great idea: families collect a total of $2178 per child – a powerful incentive to keep their kids’ shots up to date. But the devil is in the details: conscientious objectors also collect the cash!

No other country pays parents not to vaccinate their kids, but here we appear to have so much spare cash that our government does exactly this, driving vaccination rates down and conscientious objector numbers up. Department of Health figures reveal an alarming annual increase of more than 10% in the number of families claiming conscientious objection (http://tinyurl.com/pye8dtx).

And why wouldn’t you claim it? Some worry about side-effects, it’s probably inconvenient to get all those shots and, by paying conscientious objectors, the federal government in effect endorses vaccine refusal.

The story is even worse than the figures suggest. In pockets of south-eastern Queensland and northern New South Wales, the conscientious objection rate is above 10%, creating pockets of the country where epidemics of infectious diseases can spread readily.

No one has advanced a good reason to pay parents for not vaccinating their kids. This dismal idea has simply become entrenched. When the vaccination incentive payments were introduced, objector numbers were tiny and the regrettable decision was made to extend payments to them. In 2012 the Labor government dramatically increased the payment to its current level, but it seems that no modelling was done to predict the effect of strongly incentivising vaccine refusal.

Arguments that “it’s an entitlement”, “families need the money” or “removing it will offend the anti-vaccine crowd” are misguided, and show a fundamental lack of understanding of the nature of an incentive. To get the payment, parents must be counselled – the justification being that the payment forces them to discuss vaccination with their doctor. But doctors who have been involved say that “it’s a confrontational consult; parents don’t want the information, they just want a signature”. Others maintain that parents avoid their family doctor for this consultation and go to a locum service.

In 2013, Kevin Rudd and Tony Abbott both promised that, if elected, they would end this absurd policy, but nothing has been done. The Prime Minister must immediately honour his promise to stop paying parents to not vaccinate their children.

Dr Peter Speck is Senior Lecturer in Biological Sciences at Flinders University, and National Secretary of the Australasian Virology Society.