Examining Ethical Dilemmas: Australia's 'No Jab, No Pay' Policy Debate

This essay critically examines the ethical issues surrounding Australia's 'No Jab, No Pay' policy, which denies childcare benefits to parents who do not fully vaccinate their children. The essay argues against the policy, highlighting Australia's already high immunization rates and questioning the effectiveness of financial penalties in achieving further increases. It discusses the potential for the policy to disproportionately affect vulnerable families, create psychological and emotional distress, and raise ethical concerns about individual autonomy and government coercion. The analysis includes a review of the policy's assumptions, empirical background, normative points, and counterarguments, ultimately concluding that the policy's negative effects outweigh its potential benefits. The essay emphasizes that while herd immunity is important, the policy may not be the most effective or ethical approach to achieving it, especially considering the complexities of infectious disease transmission in a globalized world. The essay also provides an overview of the Australian immunization program and the benefits provided by the government. The essay concludes that the policy should be changed and a different approach should be taken to improve vaccination rates.

Running head: ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
Ethical issues of ‘No Jab, No Pay’ policy
Name of the Student
Name of the University
Author Note:

1ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
Topic
The national Australian ‘No Jab, No Pay’ policy introduced on 1st January 2016 does not
permit an exemption for parents who object to vaccination. This should be changed. Parents
who register as objecting to vaccination should be able to receive the Child Care Benefit
(CCB), Child Care Rebate (CCR), and the Family Tax Benefit Part A end of year supplement
for their unvaccinated or incompletely vaccinated children.
Summary box
Argument: This essay will argue that the policy ‘No Jab, No Pay’ should be changed.
Assumptions: This policy will have detrimental effect on many families while not necessarily
improving existing structure significantly.
Empirical Background: Australia has one of the most robust immunization system for children.
Australian government also provides childcare benefits like Child Care Rebate (CCR), Family Tax
Benefit Part A and Child Care Benefit (CCB). Recently, Australian government has implemented a
‘No Jab, No Pay’ policy to boost immunisation rate further. There has been debate going on
regarding this policy as it will stopped providing childcare benefits to parents without or
incomplete immunisation.
Main normative points:
1. Australia already has a high immunisation rate and already attained threshold value for
several diseases. Also, infectious diseases cannot only be eradicated by immunisation in the
age of globalisation.
2. The policy will be burden to the many families financially who are unable to complete their
child’s immunisation due to access and logistical obstacles.
3. This policy will have detrimental effect on the objector families’ psychology and morale.
The policy is ethically dubious.
Provisional conclusion: Based on the argument provided, it can be inferred that policy should
change.
Counterargument: The policy will increase immunization rate. Apart from that, it will also force
objector parents to immunize their children and if they do not, it will save government money.
Conclusion: Arguments for the policy change far outweighs the counterarguments against it.
Hence, the conclusion is that the policy should change.

2ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY

3ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
Topic
The national Australian ‘No Jab, No Pay’ policy introduced on 1st January 2016 does not
permit an exemption for parents who object to vaccination. This should be changed. Parents
who register as objecting to vaccination should be able to receive the Child Care Benefit
(CCB), Child Care Rebate (CCR), and the Family Tax Benefit Part A end of year supplement
for their unvaccinated or incompletely vaccinated children.
Argument
This essay will argue for the topic that the new policy ‘No Jab, No, Pay’ implemented
on 1st January, 2016 should be changed and parents with objection to vaccinations should be
able to receive government provided benefits like Child Care Rebate (CCR), Family Tax
Benefit Part A and Child Care Benefit (CCB).
Assumptions
Immunisation rate in Australia is very high at the moment. However, the Australian
government’s recent ‘No Jab, No Pay’ policies to increase this immunisation rate even higher
has some ethical concern. Government is punishing and segmenting people for a decision
which should be free and individual decision. This policy will also harm people financially
who are not against anti-vaccinations but unable to vaccinate their children due to access or
logistical issue. Along with these, unvaccinated children need most support from the
government healthcare system. Thus, it can be assumed that the policy ‘No Jab, No Pay’
should be changed.
Empirical Background
Australia’s immunisation rate is one of the best in the whole world which is close to
93 percent. Almost 90 percent children in Australia become fully immunised before they
reach age five (1). In addition, Australia has a very stern vaccination law which became even

4ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
sterner. From 1st January, 2016 Australian government has introduced its ‘No Jab, No Pay’
policy boost its immunisation rate to 95 percent (2). By this policy, Australian government
decreed that parents who will not immunised their children without any medical ground, will
not receive government benefits like Child Care Rebate (CCR), Family Tax Benefit Part A
and Child Care Benefit (CCB). This is in clear contrast with the first Australian National
Immunisation strategy. This strategy specifically voted for the voluntary vaccination and
suggested that conscientious objections can be accepted. According to the Australian
government’s prediction, almost ten thousand family will lose these benefits which will save
the government 508.3 million Australian dollar over five year duration (3). Government
believes that removing the financial benefit which will help to reduce the percentage of non-
medical exemptions. Although, there have been an intense debate in Australia regarding
whether it is the best approach to increase immunisation rate since the inception of this
policy. Researchers are also concerned about the ethical implications of the approach of this
policy and argued that immunisation is not controversial and government should not make it
so.
Normative points
Point 1
With discussions and consultation with experts in respective fields, Australian
government has set their immunisation target rate at 95 percent (2). Reasoning behind this
target is to yield herd immunity benefits to the general population indirectly. Herd immunity
can be defined as percentage of population required to be immune to achieve community
level protection against a particular infectious disease. This percentage of population known
as herd immunity threshold and it is depends on basic reproduction number denoted by R0. R0
is different for every single disease (4). For example, herd immunity threshold for diphtheria,
rubella and smallpox varies between 80 to 85 percent. Australia already have an

5ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
immunisation rate close to 93 percent (5). Hence, for the disease like diphtheria, rubella and
smallpox Australia has already crossed the threshold barrier and benefitting from the herd
immunity. Only for measles Australia has yet to cross the threshold barrier and Australian
governments set target of 95 percent immunisation rate is indicative of this fact. However, it
is also good to keep in mind that 95 percent immunisation rate is not some magic number at
which every disease will be eradicated. Statistics from recent outbreaks of measles have
showed that outbreaks occurred in the area where immunisation rate is above 90 percent and
not in lower immunisation rate area. The reason behind this might be related to dense
population and travel related importation (6). Additionally, vaccine characteristics also
influence herd immunity. For example, immunity for the disease pertussis wanes very
rapidly. For this reason, 100 percent immunisation rate will not generate sturdy herd
immunity. Therefore, from the above discussion it can be inferred that threshold immunity
alone is not enough to eradicate a diseases. In any case, Australia has already achieved
threshold immunity for most of the infectious diseases. Hence, the recent ‘No Jab, No Pay’
policy might be little harsh to some families particularly to the children.
Point 2
The chance of disease transmission through vaccination refusal is limited to a very
small geographical location. The percentage of population who are strongly opposed to the
vaccination, are very small in number and there is no evidence to support that the number is
even increasing. Also, most of these people are just hesitant against vaccination (7). This
hesitancy and confusion were famously generated by the now retracted Lancet study which
connected measles-mumps-rubella (MMR) vaccination with autism. It has been argued that
proper medical communication by general practitioner might be greater tool to encourage
people who are hesitant regarding vaccination. Use of reward is better motivation than
punishment. The ‘No Jab, No Pay’ policy also intends to cut the benefit of parents whose

6ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
child have incomplete immunisation. Most of these parents are not against immunisation, but
according to the studies, were incapable to subjugate a range of access and logistic obstacles.
It is logical that measure should be taken to minimise these obstacles for these peoples
instead of putting another barrier in front of them. Studies have suggested that most of these
people have an annual income less than 50,000 Australian dollar (8). Without the government
aids and benefits, these families could be burden with a cost of 15,000 Australian dollar per
year. It will pose a significant burden to these families. Actions should be taken bring these
people under the wing of immunisation and not ostracise them because of their inability.
Studies have shown that actions and measures like incentives, catch up plans, client recall and
reminder systems, home visiting, free access to services and vaccines, and feedback of
professional healthcare personnel were efficient and effective to address this problem in both
Australia and abroad (9). Therefore, it can be conferred from above dialogue that punishment
method might not be best option to increase immunisation rate in Australia.
Point 3
Another aspect that should be considered for this ‘No Jab, No Pay’ policy is that the
psychological and emotional effect it can have on the parents of vaccination objectors. This
policy might not have any effect on the people who are totally against the vaccination and
logically it will have no effect on wealthy, unwilling parents. Additionally, this punishment
method can change the mind of hesitant parents against vaccination. This approach by the
government also challenges the consent process and free will of individuals. This forceful and
coercive nature of this approach also raises the questions of ethics (10). Apart from this,
history also showed that coercive and forceful polices can radicalise a fringe movement
further and it is consciously segmenting a part of the society. On the other hand, main victims
of this policy are the children. The policy are for their benefit and the immunisation are for
their benefit but they have no say in it. They are totally dependent on the decision and whims

7ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
of their parents in this regard. Given the chance, a vaccination objector child might choose
differently than their parents. Thus, punish them for the decision of their parents in
unjustified and unethical.
Provisional conclusion
Therefore, from the above discussion, it can be concluded in interim manner that the
policy ‘No Jab, No Pay’ has many negative effects and does not necessarily improve the
immunisation rate of the nation. Henceforth, it can be provisionally concluded that the policy
should be changed.
Counterargument
However, the government have also provided their argument for the policy “No Jab,
No Pay”. First and foremost of their argument is that it will increase the threshold barrier of
herd immunity which will leads to better shielding against infectious diseases. Also, the
immunisation rate of the whole country will increase significantly. According to the
government, these reasons in turn will be able to keep children safe from infectious disease in
childcare. Additionally, the thinking behind the policy is that the financial penalisation will
force parents who are against vaccination to immunise their child and if they are still
unwilling to vaccinate their child, it will save government significant amount of money.
Conclusion
Therefore, from the above discussion, it can be concluded that arguments for the
policy ‘No Jab, No Pay’ should change does not negate the counterarguments against it. The
main counterargument for the policy implementation is that it will increase immunisation rate
in the country and in turn herd immunity benefits. From the first argument, it can be said that
Australia already have a high immunisation rate and already crossed the threshold value to
attain herd immunity benefits for diseases like diphtheria, rubella and smallpox. To be

8ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
completely honest, in the age of globalisation, infectious disease cannot be eradicated by
immunisation only. As mentioned in the argument, infectious diseases can spread through
travel also. Another counterargument is that it either force vaccine objector parents to
vaccinate their child or it will save money for government. This essay also discussed in
details that this might not be the scenario. This might just alienate those parents and it has no
significant consequence on the wealthy parents who are against vaccination. Government will
save money by punishing the children who have no say in it and should be protected by
government no matter. Furthermore, this policy violates the ethical issues and takes away the
choice which should be free to each individual despite of their personal views. In a nutshell, it
can be said that the arguments to change the policy far outweighs the counterarguments to
implement the policy. Hence, to conclude, it can be firmly stated that the policy ‘No Jab, No
Pay’ should be changed.

9ETHICAL ISSUES OF ‘NO JAB, NO PAY’ POLICY
References:
1. Department of Health - Further Strengthening No Jab, No Pay [Internet]. Health.gov.au.
2018 [cited 27 October 2018]. Available from:
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2017-
hunt041.htm
2. Beard FH, Leask J, McIntyre PB. No jab, no pay and vaccine refusal in Australia: the jury
is out. Med J Aust. 2017 May 15;206(9):381.
3. Klapdor M, Grove A. ‘No Jab No Pay’ and other immunisation measures – Parliament of
Australia [Internet]. Aph.gov.au. 2018 [cited 27 October 2018]. Available from:
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/
Parliamentary_Library/pubs/rp/BudgetReview201516/Vaccination
4. Metcalf CJ, Ferrari M, Graham AL, Grenfell BT. Understanding herd immunity. Trends in
immunology. 2015 Dec 31;36(12):753-5.
5. Freidl GS, Tostmann A, Curvers M, Ruijs WL, Smits G, Schepp R, Duizer E, Boland G, de
Melker H, van der Klis FR, Hautvast JL. Immunity against measles, mumps, rubella,
varicella, diphtheria, tetanus, polio, hepatitis A and hepatitis B among adult asylum seekers in
the Netherlands, 2016. Vaccine. 2018 Mar 14;36(12):1664-72.
6. Najjar Z, Hope K, Clark P, Nguyen O, Rosewell A, Conaty S. Sustained outbreak of
measles in New South Wales, 2012: risks for measles elimination in Australia. Western
Pacific surveillance and response journal: WPSAR. 2014 Jan;5(1):14.
7. Pearce A, Marshall H, Bedford H, Lynch J. Barriers to childhood immunisation: Findings
from the Longitudinal Study of Australian Children. Vaccine. 2015 Jun 26;33(29):3377-83.