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30 Jun 2017

Research suggests ‘No Jab, No Pay’ could unfairly penalise low-income families

New research analysing Victorian vaccination data in the lead-up to the Federal Government’s ‘No Jab, No Pay’ policy suggests it could be unfairly penalising families living in the lowest-income areas.

In the five years prior to the policy’s introduction, vaccination coverage was lowest in both the highest and lowest socioeconomic areas, the researchers from the Peter Doherty Institute for Infection and Immunity and the Murdoch Children’s Research Institute (MCRI) found.

The study, published today in the Australia and New Zealand Journal of Public Health, is the first to go beyond income as a measure of socioeconomic status, to parents’ educational attainment and occupation.

Victorian postcodes were ranked and evenly grouped using the Australian Bureau of Statistics Indexes of Economic Resources, and Education and Occupation, then vaccination coverage was calculated for each of the groups.

Co-author, Royal Melbourne Hospital epidemiologist Dr James Fielding, at the Doherty Institute, said low immunisation coverage in poorer populations may be due to financial barriers, whereas in higher socioeconomic populations, it is more likely to be based on vaccine concerns.

“Further research is needed to prove the specific reasons behind low vaccination coverage,” Dr Fielding said.

“However, if financial barriers are associated with difficulty accessing health services for vaccination, such as transport, time off work and medical fees, the ‘No Jab, No Pay’ policy may result in further financial stress and hardship.

“Families in the higher socio-economic group are not penalised for incomplete or non-vaccination of their children, as they either do not stand to lose welfare payments or the loss of them does not cause the same financial hardship.”

“If we are to persuade families to vaccinate their kids, public health campaigns will have a better chance of hitting the mark if they’re based on data that tracks trends in vaccine objection, and can differentiate between vaccine reluctance and financial barriers.”

Co-author Dr Margie Danchin, a senior research fellow at MCRI, said parents with higher educational attainment were more likely to question the safety and necessity of vaccines, despite being aware of the science.

“This cognitive dissonance underpins why knowledge transfer alone is not enough to change the minds of vaccine-hesitant or vaccine-objecting parents, and why we need both communication and education strategies to tackle vaccine hesitancy,” Dr Danchin said.

“These data will help us to develop and introduce equitable and effective policies to maximise immunisation rates at either end of the socioeconomic spectrum.” 

“Ultimately, we need to be able to measure vaccine acceptance, as distinct from access issues, and develop effective interventions.”

Dr Danchin said one unfortunate consequence of No Jab No Pay is that, since the policy’s introduction, vaccine objection is no longer recorded on the Australian Immunisation Register.

“If we are to persuade families to vaccinate their kids, public health campaigns will have a better chance of hitting the mark if they’re based on data that tracks trends in vaccine objection, and can differentiate between vaccine reluctance and financial barriers.”

“Different reasons require different responses – we will be able to go beyond a one-size-fits-all response if we have the right data on why parents don’t vaccinate their kids.”

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