Julie Leask writes:
The Federal Government has announced a major shake up to the way vaccination is linked to financial incentives, which will begin taking effect from July 2012.
Changes to financial incentives for immunising
The former immunisation allowance, with instalments of $129 paid at 2 and 5 years of age, has been scrapped. Now the Family Tax Benefit Part A that most parents already receive, will be linked to full immunisation. A total amount of $2100 will be paid for each child who is fully vaccinated at one, two and five years of age ($726 each time).
Also the Government has expanded the range of vaccines linked to the incentives to other vaccines already on the schedule but previously not linked: chicken pox (varicella), pneumococcal and meningococcal C vaccines. This will happen from 1 July 2013.
These changes will raise the ire of some parents who selectively vaccinate, some social policy commentators and the anti-vaccination lobby. Others will continue to object to non-vaccinating parents being able to still claim the payments.
History repeats itself
The idea of taking a welfare payments already given, and linking them to vaccination is not new in Australia.
The Howard Government did this back in 1998 when the then Maternity Allowance was linked to immunisation status, thus being re-named the Maternity Immunisation Allowance (MIA). It was paid to all parents or carers whose children were fully vaccinated by 18 months of age or those with a registered medical exemption or ‘conscientious objection’.
Vaccination was also linked to child care rebates. From January 2009, the MIA payment was split into two instalments at 2 and 5 years of age to try to boost low coverage for children in the latter age group.
Incentives increase immunisation rates
Incentives appear to work. Although such moves have been never rigorously evaluated, immunisation rates appear to be very sensitive to changes in incentive payments, particularly in disadvantaged population groups who already are at risk for under-immunisation.
Splitting the MIA receipt to ages 2 and 5 years was followed by a sharp rise in vaccination rates for 5 year olds from 79% to 89%, mostly through improving timeliness.
Conscientious objectors should have access to the payments
One contentious issue will be whether parents who refuse to vaccinate their children should still be able to receive incentives. Currently, they must register as ‘conscientious objectors’. This requires a form to be signed by them and a health professional. About 1.7% of parents are doing so.
While it’s preferable to have no parents refusing vaccines, it is better that these families can still access the payments for two reasons. First it means that children who already miss out by not being immunised are not further disadvantaged through economic disparities. Second, the interaction with the doctor or nurse that is required for parents to register a conscientious objectors enables health professionals to (1) ensure the parents are fully aware of the risks of not immunising (2) persuade some to reconsider their decision. This does occur.
Need for a broader set of players in the debate
Vaccination opponent groups like the Australian Vaccination Network have always objected to the linking of immunisation to welfare payments, calling them bribes. This will be another opportunity for them to air their views in the media as outlets predictably seek out opponents to the policy.
Perhaps the media should go further afield and seek out social commentators who oppose the linking of health behaviour to tax benefits – a more nuanced issue that should be raised.
Coverage will appear to decline in late 2013
One note of caution. Once full set of changes come into effect by July 2013, it will look like our immunisation rates have declined due to changes to the way immunisation will be measured.
Currently, the “fully immunised” algorithm only incorporates the vaccines under the current incentives scheme. It has not included pneumococcal, meningococcal C or chicken pox (varicella) vaccines. Once they will be linked to the incentives scheme, they will be part of the calculation for Australian immunisation coverage.
To date, immunisation rates for the 18 month varicella vaccine dose have been just 82%. No other vaccine is given then. So incorporating the varicella vaccine into coverage estimates will drag our rates down by a few percentage points until parents and providers get used to the new requirements. And it will be important they do because that 18 month dose will incorporate a combined vaccine against measles-mumps-rubella and varicella (MMRV) and pneumococcal vaccine.
Ultimately the changes will be good for children – more will be protected, in a more timely fashion.
• Dr Julie Leask is Senior Lecturer in the Sydney Medical School at the University of Sydney
• The Australian General Practice Network has welcomed the changes.