In our quest to improve vaccination rates in the United States, we can learn a lot from studies elsewhere. Several years ago, Australia had two government mandated policies to increase vaccination. One policy, called “No Jab, No Play,” implemented in 2014, prevents enrollment in pre-school if the family opted to not vaccinate for non-medical reasons. The other policy, “No Jab, No Pay,” implemented in 2016, prevented families from receiving financial entitlements and subsidies if they would not approve vaccinations for their children. Did these two policies improve vaccination coverage rates across Australia? Attwell et al (10.1542/peds.2020-0724) evaluated this in a study we are early releasing this week. The short answer to this fascinating study is no—they did not change coverage rates despite these government mandates with the exception of New South Wales where a slight increase in vaccination rates was noted.
So why did the government mandates not work? The authors offer note that there were other efforts in Australia to improve vaccine rates that might have taken the spotlight away from these two programs. We also asked Drs. Joshua Williams and Simon Hambidge from the University of Colorado (10.1542/peds.2020-024703) to share their observations on these findings by providing an accompanying commentary. They note that the mandates might have been more effective than they appeared to be in this study because the baseline rates of vaccination in Australia when these mandates were implemented were already high. They also noted however, that families with more financial resources might not have needed to use Australian public child care for their children so ignored the mandates. The authors speculate such mandates may be a harsher threat to poorer families causing them to lose trust in the government for making their lives harder when their philosophical or religious beliefs argue against vaccination. Take a shot at reading both the study and commentary and think about whether federal mandates in this country would be of more benefit than they were in this Australian study—and if so, would the effect of implementing such mandates help or hinder our desire to achieve health equity by enabling better access to essential services like vaccinations that can improve the health and wellbeing of all children.
