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No Jab, No Pay and vaccine refusal in Australia: the jury is out

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High immunisation rates in Australia mean that the threat of disease transmission posed by vaccine refusal is low — policy responses should be proportionate

The topic of vaccine refusal has received worldwide attention in recent years. Vaccine attitudes span a continuum from complete acceptance to complete rejection. Vaccine refusal (rejection of all vaccines) is at the extreme end, whereas vaccine-hesitant individuals are a more heterogeneous group, with some opting to fully vaccinate despite substantial concerns while others are more selective.1 People may also change their attitudes and positions over time.

Some countries, including Australia and the United States, have introduced legislative provisions actively targeting vaccine refusal. In Australia, No Jab, No Pay legislation was introduced nationally on 1 January 2016. It removed an exemption, which previously allowed parents whose children were not fully vaccinated, to remain eligible for family assistance payments if a health practitioner certified that they were conscientious objectors to vaccination. The requirement to be fully immunised for age to retain eligibility for family assistance payments commenced in the late 1990s.2 At state level, No Jab, No Play legislation, which requires children attending childcare centres to be immunised, has been tightened in New South Wales and passed in Queensland…