Could Australia's 'No Jab, No Pay/No Play' policies work in NZ?

• Under Australia's long-standing 'No Jab, No Pay' legislation, parents must have kids immunised to qualify for the Family Tax Benefit and subsidised childcare
• Heightened vaccine hesitancy post-Covid makes that 'tough sell' in NZ
• Low immunisation rates more about poor access to GPs, doctors say
• Early childhood teachers argue kids shouldn't pay the price for parents' vaccine stance.

Penalising families who refuse to vaccinate their children could help boost New Zealand's low vaccination coverage, but may have "unintended consequences", experts warn.

Under Australia's long-standing 'No Jab, No Pay' legislation, parents must have their kids immunised to qualify for the very generous Family Tax Benefit and subsidised childcare.

Some exemptions are possible - for example, if a child has had an allergic reaction to a previous dose - but "vaccine objection" is not valid grounds to avoid immunisation.

On top of that, five states - New South Wales, Victoria, Queensland, Western Australia and South Australia - have 'No Jab, No Play' policies, requiring children to be fully vaccinated to even enrol in childcare and early education services.

Māori paediatrician Dr Owen Sinclair, who chaired New Zealand's National Immunisation Taskforce, said it was "not a bad policy" but this country may have missed its opportunity to introduce it.

"I think in a perfect world (or in my perfect world), there would be some compulsion for people to immunise their children."

The measles vaccine was so effective, it could eradicate the disease globally - if everyone had it, he said.

"You could save your own child's life, but also you could save other children's lives, so we don't ever have a repeat of the situation that occurred when our low immunisation rate in New Zealand [meant the disease] went to Samoa and killed 83 children there."

Furthermore, New Zealanders tolerated other mandatory public health measures, he pointed out.

"For example you're not allowed to smoke in a car with a child, you have to have a child buckled in the seat properly, you have to wear a seatbelt.

"So some of our public health policy is compatible with compulsion.

"But I think this one would be a very hard one to sell."

In the wake of the Covid-19 epidemic, anything that suggested "mandates" would be unlikely to get any political traction, he said.

The Immunisation Advisory Centre's medical director, Professor Nikki Turner, said Australia's 'No Jab, No Pay' policy was introduced 10 years ago when that country's immunisation rates were already rising.

The "stick" also came with quite a lot of "carrot" in the form of supports, education and community outreach programmes.

"It clearly has had some benefit, but it's very small - like overall there's probably a less than 1 percent gain in coverage from it, probably more focused on low income families. It does have some benefits, but you do have unintended consequences."

Imposing 'No Jab, No Play' could further erode trust in health providers, hit struggling families in the pocket, and undermine efforts to get more kids into early childhood education.

Australian kids have higher protection

About 90 percent of all two-year-olds in Australia are fully immunised, compared with just 82 percent in New Zealand.

For Māori two-year-olds, rates are even lower, at just 68.4 percent.

By contrast, Aboriginal and Torres Strait Islander children actually have higher rates of coverage than the Australian national average at five-years-old: 94.45 percent vs 93.27 percent. For New Zealand five-year-olds, the national average is 76.7 percent, compared to 67.6 percent for Māori.

Professor Turner said from a high point in 2018 - when about 94 percent of New Zealand two-year-olds were fully vaccinated - resource constraints in the wider health sector were starting to bite, even before the pandemic hit.

"The New Zealand infant programme has taken a significant dive since Covid. We are beginning to see gains slowly, but we have a long way to go.

"Post-Covid when you've got this out-of-control social media, alongside a lot of mistrust and people who are fearful after going through Covid, you really have to think about the environment when you put a stick in place."

Dr Sinclair agreed the GP shortage was a huge barrier to improving immunisation coverage.

"If you made it compulsory, you would have beef up the system that's failing significant numbers of whānau who are really struggling to access primary care."

He welcomed the surge in the number of people lining up for the MMR (measles, mumps and rubella) vaccine with the current outbreak.

Since the current measles epidemic began just over 50 days ago, MMR doses delivered had surged nearly three-fold to more than 60,000.

"But the disheartening thing is, none of those people were actually anti-vax, were they? It's just because of whatever else is happening in their lives, they haven't been able to access immunisation services."

Teachers would not want kids to 'miss out' - education expert

Schools and early childhood centres are currently required to keep a record of children's immunisation records, and during an outbreak, they have the power to exclude unimmunised children.

Early childhood education specialist, associate professor Sue Cherrington - who heads Victoria University's School of Education, said preschool teachers - particularly those working with under-two's - were very aware of the importance of immunisation in protecting children.

"They're probably in a really nice place to have unpressured conversations with families around immunisation.

"But I think most teachers would be more focused on children having access to the early childhood centre as a first principle."

Early childhood teachers tended to have caring, supportive relationships with families, and were less likely to be seen as "heavy handed" or judgmental, she said.

"You would not want to see parents get upset and take their children away, and then you're back to square one."

Not on the government agenda

Associate Education Minister David Seymour, who is responsible for Early Childhood Education, said the government was not considering any form of 'No Jab, No Play' policy.

"Early learning services can already set their own conditions for enrolment. This could include immunisation status for example, though I'm told this is rare."

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