Carrots and Needle Sticks

I’m in favour of universal vaccination, aside from in cases of genuine medical contraindication. Rates of vaccine refusal are rising, threatening herd immunity in many areas of Australia. Herd immunity offers protection to those who are unable to be vaccinated, and reduces spread of vaccine-preventable diseases.

It makes sense for the government to design incentive schemes to improve immunisation coverage. They have to do something. It’s a good idea to provide a financial incentive for parents to vaccinate. However, I am unconvinced that rendering the child care rebate provisional on having your child vaccinated is the right way forward.

Public health leaders and some health professionals are warning that the scheme could backfire.

I worry that the scheme will further alienate many vaccine refusers and be used by some as ‘evidence’ that the government is part of some huge Big Pharma conspiracy, which may help them gain more followers.

In a highly predictable turn of events, removing the ‘conscientious objector’ clause but keeping religious exemption had hordes of vaccine refusers conspiring online about how they could get suitably religious.

Now the government has removed the religious exemption loophole. An aside- as an agnostic I am heartened by this belated acknowledgement that church and state are and should be separate. I also would argue that religious beliefs are no different in nature to the frequently unscientific health beliefs of many vaccine refusers.

The punitive approach the government seems to be taking doesn’t feel quite right to me, though the majority of GPs seem to be in favour. I agree immunisation is the right choice to make, but if you choose otherwise, you now face losing financial benefits that significantly alleviate the struggle of raising a family.

Could there be a better way forward?

It’s one thing to make the Family Tax Benefit part A contingent on being up to date with vaccinations. Fine. Perhaps rename the payment though. How about ‘Family Vaccination Incentive Payment?’ And make it a bigger payment, by all means. To provide a financial incentive is a completely different notion to withholding an unrelated payment.

Anyone who is paying for childcare and who is a tax paying citizen should be able to claim the childcare rebate, while such a rebate exists.

Vaccination is currently not mandatory in Australia. Choosing not to vaccinate your child is usually the wrong choice, but I defend the right of any person to have the choice just the same.

What would be a better way forward? Aside from offering a ‘carrot’- incentive payment rather than a ‘stick’- punishment, I propose that public science education would yield better results than the No Jab No Pay scheme.

The decision not to vaccinate is often based on poor quality information, myth, hype and pseudoscience.

Empowering parents to access quality information and to assess the validity of that information they are presented with would allow them to decide which information to use and which to discard, as they make this important decision.

Teaching about science, how science works and how to evaluate studies would enhance the general health literacy of the Australian public, helping protect well-meaning parents from hazardous and inaccurate ideologies on this and other topics.

It is pleasing that the government has plans to fund some education/advertising on vaccination. An increase in the incentive payment for GPs and provision of educational resources to GPs is in the pipeline. I have mixed thoughts about this.

I for one would continue to educate my patients without any added financial incentive, and in a way I would prefer not to be seen as benefitting financially from every childhood vaccine I give. I give them because it’s the evidence based, best thing for my patients, not for the six dollars that later floats my way.

Also, I already have good information to give my patients. I would rather they be educated about how to deal with health information they come across elsewhere, and learn why the information I give them is good quality.

Parents want to make the best choice for their children. Many who have decided not to vaccinate are still willing to discuss their concerns and to take new information on board. We need to reach these people, not alienate them. They need time and resources to address their concerns and develop their understanding.

Of course, there are some who are lost forever, who will dismiss all evidence as being cooked up by the evil Pharm empire; who think that doctors are either ignorant or part of the conspiracy. These people will never be convinced by scientific fact. I’m quite happy for them to miss out on an incentive payment. I’m just not sure their whole family should be punished by denying the childcare benefit.

I welcome comments and discussion aside from vitriol (from either ‘pro’ or ‘anti’ camps), which will be promptly removed! I’m especially interested in hearing what other GPs out there think about No Jab No Pay.

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3 comments

  1. With complex problems like this the evidence suggests a punitive measure is more effective at motivating behaviour than an incentive, but that said it seems that it’s one of those classic conundrums that are best served by being approached from as many directions as possible. So let’s have carrots, sticks AND education. It’s too important not to give it our every effort.

  2. Thanks for your thoughtful article. I’m a GP from NZ, I disagree with No Jab No Pay thing and feel people should be able to make their own choices regarding healthcare. In what other area of healthcare do we coerce in this way? I’m glad it’s not happening I my country and I hope we don’t follow suit.

    1. Thank you for your comment. I wonder what is next on the menu: denying paid parental leave to those who have a BMI greater than 30? De-activating the Medicare cards of those who purchase cigarettes?

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