We found that these policies, which removed non-medical exemptions from government benefits and childcare enrolments, were occasioned by an increase in vaccination coverage across states between 2-4% for one-year olds, 1-1.5% for two-year olds, and 1-3.5% for five-year-olds.
We also found that the effect of the policy differed significantly depending on characteristics of the area.
Areas that were characterised by either: lower socio-economic status, lower median income, more Family Tax Benefit recipients, or higher pre-intervention coverage had greater responsiveness to the policy changes.
Variation in response to the policy changes across areas suggest the effect was largely led by lower-socioeconomic status parents who were nudged towards full vaccination, while more affluent parents were relatively unaffected.
- Removing conscientious objection increased overall childhood vaccination coverage.
- The policy responses were heterogeneous.
- Socioeconomically advantaged areas were less responsive to policy changes.
- Benefit-dependent and lower-income areas were more responsive to policy changes.
- Areas with pre-existing low coverage were more persistent and less responsive.
Abstract: Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.
Here is link for full access: