No Jab, No Play Policy needs full investigation

The jury is still out on the full impacts of No Jab, No Pay/Play policies at Federal and State level, and as novel initiatives of international interest, they warrant careful assessment, say vaccine and infectious disease experts in today’s Medical Journal of Australia.

Achieving and maintaining a childhood immunisation rate as close as possible to 100 percent is an important public health goal that will maximize the benefits of vaccines for individuals and the community.

However, the authors say it is often not appreciated that Australia’s vaccination coverage is “relatively high and at least comparable with similar developed countries” ,”, with the proportion of Australian children fully vaccinated by 12 months of age above 90 percent for the past 15 years and currently sitting at 93 percent.

Also, contrary to common perceptions, vaccine objection is low and stable  – “vaccine objection in 2013 was about 3 percent – the same as in 2001.”

According to the MJA report, among the seven percent of unvaccinated children, the larger proportion are unvaccinated or under-vaccinated not because parents disagree with immunisation, but because of logistic reasons, such as difficulty in accessing appropriate healthcare services.

Therefore, the reports’ authors say: “It follows that measures to improve access to services, assist families challenged by logistic issues, and minimise missed opportunities to vaccinate

are the most important means to raise levels of complete immunisation.”

Report co-author, Associate Professor Julie Leask from the University of Sydney, says evaluation of No Jab, No Play Polices “should focus on identifying differential impacts on vaccine uptake, as well as any unintended adverse consequences for children.”

Victoria is the only state where No Jab, No Play legislation currently requires full immunisation for attendance at childcare centres, unless the child has an approved medical exemption or is on a recognised catch-up schedule, while NSW allows attendance if immunisation status is up to date and fully documented, which allows swift exclusion of any unimmunized children if a case of vaccine-preventable disease occurs.

“The likely unintended adverse impacts of the Victorian legislation include reduced access to important early childhood education,” says report’s co-author, Professor Peter McIntyre of the National Centre for Immunisation Research and Surveillance.

Vaccines are highly effective but there are differences between vaccines, say the report’s authors. “Although highly effective against severe disease, whooping cough (pertussis) vaccines give lower (71-78 percent) protection against mild disease.

So even if 100 percent of children were fully vaccinated against pertussis some children would still contract mild disease if exposed, and this would not generate strong herd immunity comparable to high coverage of measles vaccine.” 

In the case of whooping cough, maternal pertussis vaccine in pregnancy gives a much greater boost to protection of vulnerable babies than even 100% vaccination rates in child care or preschool.