'No jab, no pay' disadvantages migrant children

The Commonwealth government’s “no jab, no pay” legislation is disadvantaging migrant children, say immunisation experts from Melbourne. The paper, published today in the Medical Journal of Australia, warns many families are having essential payments withheld despite their children being vaccinated.

Coming into effect in January 2016, “no jab, no pay” is the federal legislation aimed at increasing childhood immunisation rates by withholding government benefits to parents who don’t vaccinate their children.

Centrelink payments that can be withheld under this legislation include the Family Tax Benefit Part A end of year supplement, which is up to A$726.35 per child, per year; the Child Care Benefit Support Costs, which are up to A$208.50 per week; and the Child Care Rebate, which covers 50% of out-of-pocket expenses for childcare.

Paediatrician and senior research fellow at the Murdoch Children’s Research Institute, Dr Margie Danchin, said “no jab, no pay” was introduced with little thought for the complexities of minority groups such as migrants, who were almost always pro-vaccination.

“These families are seeking to have their children immunised and to catch up and be up-to-date,” said Dr Danchin, who co-authored the report.

But, she said, there were barriers for migrant families in accessing health providers. Many families were mobile for the first few years after resettling and saw multiple health-care and immunisation providers.

Dr Danchin said it was also difficult to maintain an accurate Australian Immunisation Register (AIR), the database used to assess immunisation status for Centrelink payments. While overseas vaccines can be entered on the AIR, most children do not have written records when they arrive and need catch-up vaccines. There is also a lag between vaccination and updating the register.

And before 2016, the AIR only recorded information for children younger than seven years old. This meant that any child arriving in Australia after the age of seven (prior to 2016) wouldn’t be up-to-date in the register even if they had received catch-up vaccinations. These children would lose Centrelink payments until their record was updated.

“A number of families are sent letters from Centrelink to clarify the immunisations when the child is up-to-date but it hasn’t been entered into AIR because there’s often long delays,” she said.

Despite these barriers, Australia has an overall immunisation rate of 92%, said Dr Danchin. Only 3% of of the population identify as vaccine refusers. Some 5% are partially or not vaccinated.

“The ‘no jab, no pay’ policy appears to be stimulating catch-up in this last group, but this needs to be formally evaluated,” she said.

Dr Danchin said there were also significant workforce pressures on GPs who found it difficult to design catch-up schedules and enter the immunisation history directly into the AIR due to time pressures and a lack of resources.

Professor of General Practice at the University of Melbourne, Jane Gunn, agreed. She said GPs and GP nurses played a key role in entering immunisation data into the AIR, but it was a time-consuming process.

“This highlights the problem of duplication in our health care system and the need for more integrated medical records and information-sharing,” she said.

There are also some children who can’t be immunised for medical reasons or because they already have natural immunity, said Dr Danchin. Often vaccination services are provided by hospital or community-based specialists and nurses, but only GPs can sign exemptions for these children. This necessitates referral back to GPs, which adds to the bureaucratic burden.

Professor of psychiatry at The Royal Women’s Hospital and the University of Melbourne, Louise Newman, called for a commission of inquiry to better understand the needs of migrant children.

“There has to be special provisions within the legislation so that payments and adequate support is not delayed,” she said. “Because they’ve got nothing else – it’s not as if there are alternatives.”

Professor Newman said it was important to look closely at government initiatives that aimed to improve immunisation rates but had the secondary effect of penalising people with multiple social disadvantages.

“At the moment, we have a deficit in thinking around social justice issues and how to better meet the needs of people in a complex social mix,” she said.