By Wendy Parmet
Australia’s recently announced “no jab, no pay” policy offers a potent reminder of the all-too-common tendency to penalize vulnerable populations for public health problems. Like many other countries, Australia has experienced a worrisome increase in the number of families deciding not to vaccinate their children. In response, the government of Prime Minister Tony Abbott has announced a program of carrots and sticks. The carrots include increased payments to physicians to incentivize them to urge families to vaccinate their children. The sticks include tightening the religious exemption (Australia does not provide an exemption for personal belief) and the “no jab, no policy” which will deny families whose children aren’t vaccinated certain income-based childcare and family tax benefits.
Governments have long used the denial of public benefits – traditionally public education – to push parents to vaccinate their children. Studies have shown that laws conditioning attendance in schools and daycares on vaccination can increase vaccination rates, although the particular formulation of the law (especially how difficult it is to receive an exemption) matters.
To be sure, laws that require children to be vaccinated to attend schools or daycare impose heavier burdens on poor families who are more apt to need daycare and are less able to homeschool their children. Still, these laws reach broadly, especially when they apply to private schools. Homeschooling remains relatively rare. Significantly, school-based vaccine laws do not single out low-income families.
The “no jab, no pay” policy is different in that it targets the most vulnerable families. Upper income families need not worry about the rise of vaccine preventable diseases. The policy doesn’t apply to them. Nor is there any equivalent financial penalty aimed at upper-income families.
By tying welfare to vaccination, the “no jab, no pay” policy sends the message that rising rates of vaccination resistance are due to the failure of low income parents to vaccinate their children. That’s not true. In Australia, as in the U.S., vaccine resistance is disproportionately found in more affluent communities.
Without question, recent outbreaks of vaccine-preventable diseases suggest the need for more effective vaccination laws. The California legislature is now debating a measure to end the personal belief exemption from that state’s school-related vaccine mandate. Much of the debate has centered around the disparate impact the measure would have on middle and low income families who can less readily escape the requirement by homeschooling their children. Less noticed is the fact that California, like Australia, ties welfare to immunization. Unlike Australia, however, welfare recipients in California can seek a personal belief exemption to the immunization requirement. If the state were to abolish that exemption, California would also have a “no jab, no pay” policy.
In her recent book On Immunity: An Inoculation, Eula Biss describes vaccination as a selfless act, one that is undertaken by the majority to help those who are especially vulnerable to disease. Ideally vaccine laws reinforce that solidarity, binding everyone within a jurisdiction to act for the greater good. “No jab, no pay” policies sever that bond. They blame those who are most vulnerable for vaccine-preventable disease while granting immunity to those who are most privileged.