No Jab, No Pay

No Jab No Pay (and No Jab No Play) is an Australian policy initiative which withholds three state payments – Child Care Benefit, the Child Care Rebate and, as of 2018, the Family Tax Benefit Part A end of year supplement – for parents of children under 20 years of age who are not fully immunised or on a recognised catch-up schedule,[1] and imposes fines on childcare centres that admit unvaccinated children.[2]

The policies grew out of a grassroots campaign championed by News Limited,[3] in 2013.[4] It was boosted by parent activists representing children who had died of preventable disease, notably the families of Riley Hughes and Dana McCaffery,[3] infants who died of pertussis, leading to a backlash of harassment and trolling from anti-vaccination activists.[5][6] Far-right politician Pauline Hanson also opposed the policy, though she later walked this back[7] and clarified that she supports vaccination.[8] The campaign was a response to a rise in "conscientious objections", which had reached record levels[9] particularly in the Sunshine Coast area of Queensland,[10] where early attempts to pass legislation were knocked back in 2014.[11] Efforts to circumvent the legislation included the founding of fake religions, of which the best known, the "Church of Conscious Living", was promoted by anti-vaccine group the Australian Vaccination Network[12][13] (since renamed to Australian Vaccination-risks Network after legal action over its deceptive name),[14] and by anti-vaccination activist Stephanie Messenger.[15]

No Jab No Pay was introduced in 2015,[16] and expanded in July 2018.[17][18] By July 2016, 148,000 children who had not previously been fully immunised, were meeting the new requirements.[19]

No Jab No Play was introduced at the state level, in New South Wales, Queensland and Victoria in 2017,[20] leading to an immediate though small rise in immunisation rates,[21] with Western Australia, which has some of the lowest vaccination rates in the country, following in December 2018.[22]

Public health reseachers have had mixed evaluations of No Jab, No Pay and No jab, No Play. Removing non-medical exemptions from vaccine requirements have been questioned on ethical ground, the potential for coercive policies to lead to an increase in anti-vaccination sentiment, and the inequity of policy designed on welfare conditionality.[23][24][25] A study on the impact of removing conscientious objection from financial payments and childcare enrollments found that the policies lead to a significant increase in childhood vaccination above the pre-intervention trend. The effect of the policies were larger in areas with lower socio-economoic status, higher rates of government benefits, and higher pre-intervention coverage rates. [26] A study of adolescent catch-up vaccination found that No Jab No Pay occasioned a large rise in catch up vaccination.[27]