Public health is an important issue in the medical sense as it provides outlines and helps in the formulation of policies which improve the well-being of a population. In the paramedic field, the purpose is to help in public health promotion and to provide general health services. In Australia, there are numerous policies and programs that support the function of a paramedic professional. My policy of choice is the “No Jab, No Play” policy which aims at raising the percentage of immunization in the country. It aims at saving the children from preventable deaths due to communicable disease outbreaks such as measles and smallpox. This paper will discuss the importance of the policy and the main ideas behind its formation. Also, it will explain the perceptions of the public and critics on its campaign. The paper also puts across the issues facing the policy which underpins its efficiency and effectiveness.
Children are a vulnerable group when it comes to communicable diseases. Their immune system is not fully developed to fight the strong pathogens that cause the spread of such illnesses. When there is a disease outbreak such as measles, the children’s immune system becomes weakened further and this can lead to fatalities if not protected (WHO, 2018). This shows that the costs of dealing with the disease after an outbreak are always high. Thus, there is the need for a proactive intervention in the management of the preventable diseases. The most cost-effective and effective solution is procedure so far is vaccination (immunization).
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According to World Health Organization, expanding the access to the vaccination is one of the ways of achieving Sustainable Development Goals (SDGs) (WHO, 2018). Vaccines are helpful in the control of many chronic diseases that are caused by infectious agents and preventing millions of deaths. Some of the targeted infections are measles, meningitis, pneumonia, whooping cough, diarrhea, and polio. In 2000, the global deaths from measles were estimated to be 550,000 (WHO, 2018). This number reduced by 84 percent in 2016 to stand at 89,780 deaths, thanks to immunization. The deadly Meningitis A epidemics have also been controlled to near elimination through vaccination in Africa (WHO, 2018). Governments are forming and managing campaigns and schedules for immunization with recommendations from the World Health Organization. In Australia alone, vaccination on measles alone has saved the country in excess of 9.2 billion Australian Dollars and prevented cases that sum up to 4 million (Armstrong, 2017). This shows how vaccination is a pillar of public health.
However, there is some negative information concerning vaccination with critics saying that it causes some injuries and complications (Beard et al., 2017). This has made the process to be met with mixed reactions despite the evidence of its benefits. In Australia, some parents to have attitudes thus refusing their children from being immunized. This topic has gained global attention and spans to the extreme. Some individuals opt to be selective on the types of vaccines they or their children receive, while others fully reject any form of immunization (Leask et al., 2012). These attitudes form the basis of some legislative policies in countries such as Australia and the United States to actively target the vaccine refusal attitude.
Some people base the reasons for refusal of religious and philosophical beliefs. Others just feel lazy to take a child for immunization and still can access the Family Assistance fund through documenting the refusal. As a result, the immunization coverage rate goes down and thus does not meet the international standards set by the WHO. The Australian government introduced the No Jab, No Pay bill on 1st January 2016 to curb the issue of vaccine refusal. The rationale that explains this development is the health priority sectors which aimed at increasing the percentage of vaccination coverage (Barker, 2017).
The policy was introduced as an amendment to the “A New Tax System (Family Assistance) Act” of 1999. This act saw the parents being eligible for the Family Tax Benefit Part A supplement, Child Care Rebate, and Child Care benefit for children who were up to date with the National Immunization Program Schedule (Barker, 2017). This program previously outlined the exempt to some vaccines based on documented reasons like religious, philosophical, or medical beliefs and this made such parents be able to access the family assistance program. No Jab No Pay initiative was brought to remove the exemptions and put up a policy to see that all the children are immunized and are up to date regardless of the mentioned beliefs (Johnson, 2017).
Failure to do this, they were excluded from the assistance and in some cases, prevented from joining school (Barker, 2017). The medical practitioners were to identify and vaccinate the children who were not yet immunized and update their reports accordingly. The primary purpose of the bill was to remove the exemption categories and tighten the immunization requirements for families to be eligible FTB-A, CCB, and CCR supplement payments (Barker, 2017). The implementation would see the refusal of vaccines on grounds of religious beliefs and conscientious objection being removed thus making the access to vaccines higher (Armstrong, 2017). This program would also mean that the children who are at a risk of neglect and abuse have to meet the criteria to receive Special Child Care Benefit. In short, the aim of the amendment is to increase the coverage of vaccination. The program is designed for all children living in Australia.
Despite the need for higher vaccination coverage, there are some social issues underpinning the policy framework. First, the personal freedoms of choice can be violated as most people would feel they are forced to carry out immunization regardless of their beliefs (Leask et al., 2012). Equity and equality are also some social impediments to the policy. While there are some parents who refuse vaccines on grounds of their beliefs, there are those who are forced due to the access and logistic barriers (Beard et al., 2017). Some families are already living in despair of separation and low income and thus access to vaccines can be problematic. There is also an aspect of social justice. The children who are under-immunized are supposed to be locked out of accessing childcare and kindergarten (Wilcken, 2017). The government, however, does not consider this act as a violation of social rights and justice. The above issues make the policy limited by the ethical concerns.
The key stakeholder in this policy is the government who design, implement, and evaluate the policy. The Coalition Government officials are the champions of the No Jab No Pay policy and are keen to defend it. Their interest is to see Australia having the highest coverage of vaccination and the eradication of vaccine-preventable diseases. The people who deliver this policy are the medical practitioners who are instructed to check and update the status of immunization of the children accordingly (Beard et al., 2017). The rules are varying in terms of strictness in various states. Victoria State has the harshest rules and this includes the exclusion of any child of a parent who refuses vaccine and to allow only exemptions for children with medical contraindications (Armstrong, 2017). Queensland State has the most lenient policy which makes the childcare provider make a decision as they wish after looking at the vaccine records of the individuals.
The children are the stakeholders who receive the policy. However, there are some stakeholders that are left out in this bill. The voice of the parents and their views are not heard anywhere in the policy and it now looks like a directive to deal with those who refuse of vaccines. The policy may be targeted to the parents who refuse to immunize their parents but does not take into consideration the reasons behind this move. In some cases, there are legitimate reasons why parents do not have the full vaccination (Leask et al., 2012). For instance, they might have difficulties accessing the services. This includes not being close to a childcare facility or having financial constraints.
Despite vaccine refusal are a factor of disease communicability between people, they occur within a geographically small area. There are only a small proportion of parents who strongly oppose immunization, and there is also little evidence that this number is increasing. This makes the scope of entrenched vaccine opposers to be relatively low thus it is a fortunate thing to the government. The policy should, therefore, consider the voice of the parents who have genuine reasons for missing vaccination opportunities (Beard et al., 2017). In some sense, the children are the ones who suffer from the ideas of the parents who refuse to immunize them. The policymakers should not be in rush to solve vaccine refusal but leave hesitancy. Some people hesitate to get their children immunized due to some legitimate reasons (Armstrong, 2017). For instance, the factor of vaccine scare is a crucial issue as there are vaccines which are known to have severe effects on the children. An example is a link between the measles-mumps-rubella vaccine and autism.
The policy has undergone several criticisms and this has unveiled the gaps that exist in its conception and implementation (Leask & Danchin, 2017). The impact of the policy has been scrutinized by many medical practitioners and scholars. An example is the one done by professionals in the National Center for Immunization Research and Surveillance located in the Children’s Hospital at Westmead, Sydney. In this critical analysis, the researchers found that the policy, though aimed at increasing the coverage of vaccination and preventing vaccine-preventable diseases, has some shortcomings (Beard et al., 2017). The only benefit that the policy is aimed at bringing is that it can be able to bridge the gap that exists in immunization cover. But, it has some limitations and severe consequences (Holden, 2018).
To begin with, in the three factors surrounding vaccines (barriers to access, hesitancy, and refusal), refusal is the least important and its eradication will not create a major impact in the goal to achieve a higher coverage rate (Thomas et al., 2017). Thus, while the policy focuses on vaccine refusal, it also misses curbing the more important issues of hesitancy and the access to vaccine whose solutions the government should provide. Also, the unintended impacts of the amendment are severe especially in the harsh Victorian policy (Beard et al., 2017). The severe health and welfare impacts that are unintended are even higher than the benefits of the law as compared to the effectiveness that the monetary sanctions can create (Holden, 2018).
In conclusion, the No Jab No Pay policy was introduced as an amendment to the “A New Tax System (Family Assistance) Act” of 1999 in January 2016. It was aimed at reducing the rate vaccine refusal and increase the immunization coverage. However, it fails to capture the legitimate concerns of the parents who miss the immunization such as hesitancy and vaccine scare (Thomas et al., 2017). The policy is important in the paramedical field as it involves the health impacts of the public. Its concerns bring the issues of gaps in the implementation of policies that produce commendable results to the public. Despite trying to reduce the refusal rate, it misses on many things including unintended severe consequences (Holden, 2018).
The government should, therefore, evaluate the policy and keep refusal low by continuing to enforce the exclusion policy during outbreaks (Leask & Danchin, 2017). Also, it should offer regulatory support to the centers to fulfill the requirements of the amendment so that checks occur universally (Thomas et al., 2017). This should include evaluation of the impact of the policy. The regulations should also engage the parents in enforcing yearly registration of a vaccine objection exemption with the facility. The government can also form a parent peer educator program in the refusing communities (Armstrong, 2017). The government should solve the problem of access to immunization. Finally, the healthcare professionals can be taught counseling techniques to offer services to the vaccine-hesitant and refusing parents (Thomas et al., 2017).
References
Armstrong, R. (2017, March 14). No Jab No Play: Vaccination rules should be fair to all children. Retrieved March 22, 2018, from https://croakey.org/no-jab-no-play-vaccination-rules-should-be-fair-to-all-children/
Barker, R. (2017). No Jab-No Pay, No Jab-No Play, No Exceptions: The Removal of Conscientious and Religious Exemptions from Australia's Childhood Vaccination Policies. Quaderni di diritto e política ecclesiastica , 25 (2), 513-526.
Beard, F. H., Leask, J., & McIntyre, P. B. (2017). No Jab, No Pay and vaccine refusal in Australia: the jury is out. Med J Aust , 206 (9), 381-3.
Holden, S. S. (2018, March 15). 'No jab, no pay' policy has a serious ethical sting. Retrieved March 22, 2018, from https://theconversation.com/no-jab-no-pay-policy-has-a-serious-ethical-sting-40078
Johnson, C. (2017). No jab no pay gets tougher. Australian Medicine , 29 (9), 10.
Leask, J., & Danchin, M. (2017). Imposing penalties for vaccine rejection requires strong scrutiny. Journal of paediatrics and child health , 53 (5), 439-444.
Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics , 12 (1), 154.
Thomas, S., Islam, F., Durrheim, D. N., & Cashman, P. (2017). Addressing Barriers to Immunisation Using a Tailored Approach. Journal of paediatrics and child health , 53 (8), 826-826.
Wilcken, H. (2017, May 15). No Jab, No Pay: Does it actually work? Retrieved March 22, 2018, from https://www.doctorportal.com.au/mjainsight/2017/18/no-jab-no-pay-does-it-actually-work/
World Health Organization. (2018). 10 Facts on Immunization. WHO. Retrieved March 22, 2018, from http://www.who.int/features/factfiles/immunization/en/
