Parents support “No Jab, No Pay” policy in Australia, but new research raises questions about equity

Four in five parents support the Australian Government’s controversial ‘No Jab, No Pay’ vaccination policy, but the policy may be disproportionately impacting low-income families, new research from the Kirby Institute at UNSW Sydney suggests.

The ‘No Jab, No Pay’ legislation, introduced in 2016, removed the option of non-medical exemptions from the vaccination requirements to receive certain family and childcare tax benefits, with the intention of boosting vaccination coverage.

Kirby Institute researchers conducted an online survey of 400 parents with children under five to understand knowledge, attitudes and opinions in relation to the ‘No Jab, No Pay’ policy.

“82% of parents in our survey supported the policy,” said Ms Mallory Trent, the first author on the paper and a PhD candidate at the Kirby Institute. “This mirrors attitudes to vaccination across the country, as the significant majority of Australians support vaccination.”

The survey also found that 40% of parents rely on the financial incentives associated with ‘No Jab, No Pay’ in order to make ends meet. Participants were asked if they would change their view on vaccination as a result of the policy and the survey found that the parents who were more reliant on the payments, were also more than twice as likely to change their view and support vaccination.

“While it’s possible to view these results as evidence of the policy’s success in changing attitudes, the reality is that the policy has more influence on low income families. Wealthy families who do not wish to vaccinate their children can afford to opt out, while low income families cannot,” said Ms Trent. “More research is needed to understand whether the increased willingness to vaccinate is due to an actual change in parents’ opinion about vaccination, or whether parents are feeling pressured to vaccinate because of the threat of losing the payments.”

There has been a slight increase in childhood vaccination since the policy was introduced (currently almost 95% of five-year old children are fully vaccinated), but the researchers caution that punitive measures to improve childhood vaccination also have the potential to erode public trust in vaccination programs.

“Widespread support of ‘No Jab, No Pay’ reflects a healthy relationship between Australian public opinion and vaccination. However, the disproportionate impact of the policy on low-income families suggested by this research should prompt us to consider other options to improve vaccination; such as increasing access to services and education,” said Professor Raina MacIntyre, head of the Kirby Institute’s Biosecurity Program.  “We found that most parents whose kids were not fully vaccinated were not anti-vaccination; rather, they had not yet gotten around to vaccinating.  Making vaccination easier is more likely to motivate this group.”

This research was funded by the Biosecurity Program at the Kirby Institute, UNSW Sydney.