No Jab, No Pay and vaccine refusal in Australia: the jury is out

The main thrust of our Perspective1 was to weigh the potential benefits of legislative changes in increasing immunisation coverage against the identified potential for unintended adverse consequences,2,3 in order to assess the balance of risks and benefits. On this basis, we emphasised the importance of fully evaluating the No Jab, No Pay legislation and of teasing out the relative impacts of its three main policy components2 and associated measures, including free catch-up vaccines and incentive payments for GPs, on immunisation coverage.

We agree with Jamrozik that immunisation coverage as close as possible to 100% will maximise individual and community protection against vaccine-preventable diseases. We also agree that intentionally opting out of vaccination may impose risks on others, particularly on people who are either too young to be vaccinated or who cannot develop or maintain immunity due to immunosuppression. However, in our view, there are other important considerations that have a strong bearing on risks and benefits.

We have particular concerns about the No Jab, No Play legislation in its strictest form, currently in place in Victoria, an approach which the federal government has urged other states and territories to adopt.4 Given existing powers to exclude infected or unvaccinated children from childcare settings, we argue that the incremental benefits of the Victorian blanket ban, compared with current New South Wales legislation,1 are likely to be small across all ages, and miniscule when applied to pre-school education for children aged 3–4 years. In this age group, the cognitive development benefits are especially strong,5 while the risk of exposure to, and serious illness from, vaccine-preventable diseases is very low compared with infants. Unlike some states in the United States,1,2 no Australian jurisdiction has proposed restrictions on primary school attendance, although some — very appropriately in our view — require full documentation of immunisation status at school entry. We argue that the immediate pre-school years are no different, in either risk to others or educational importance, to early school years. We contend that Victorian-style No Jab, No Play legislation is an overreach, which unnecessarily risks condemning children who are not fully vaccinated, through no fault of their own, to suboptimal educational opportunities.