Impact of Australia's No Jab, No Pay policy on vaccination uptake – a before-after study in two national birth cohorts

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Frank Beard , Alexandra J. Hendry , Heather F. Gidding , Aditi Dey , Kristine Macartney , Julie Leask , Peter McIntyre
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Abstract

Background

Data on impact of financial penalties for non-vaccination are sparse. Australia has required full vaccination for government family assistance payment eligibility since 1998. In 2016, the No Jab, No Pay (NJNP) policy removed registered non-medical objection as exemption option and increased eligibility assessment to yearly. We aimed to examine NJNP impact on vaccine uptake in children.

Methods

Individual-level Australian Immunisation Register data were used to assemble two-year-wide pre-/post-NJNP birth cohorts aged 1–<3 years, stratified by registered objection (yes/no) and vaccination status (zero-dose/partially vaccinated/fully vaccinated). At 5–<7 years, we measured odds ratios (ORs) and 95% confidence interval (CIs) for vaccination outcomes post-versus pre-NJNP and compared observed post-NJNP numbers with those expected if proportions pre-NJNP applied.

Findings

Pre-NJNP of 562,316 children aged 1–<3 years, 92.1% were fully vaccinated, 4.9% partially vaccinated and 3.0% zero-dose; objection was registered for 1.1% overall (23.9% of zero-dose). Post-NJNP of 615,607 aged 1–<3 years, 92.7% were fully vaccinated, 4.7% partially vaccinated, 2.6% zero-dose; objection was registered for 1.5% overall (37.7% of zero-dose). By 5–<7 years of age, full vaccination was significantly higher post-than pre-NJNP in children with registered objection (zero-dose 14.6% versus 1.2% [OR 14.1; 95% CI 10.5–18.9]; partially vaccinated 41.7% versus 8.4% [OR 7.9; 95% CI 6.4–9.7]) and without objection (zero-dose 10.1% versus 4.9% [OR 2.2; 95% CI 2.0–2.4]; partially vaccinated 39.2% versus 34.5% [OR 1.2; 95% CI 1.1–1.3]). Post-NJNP we estimated 49,510 more children (3.7% with registered objection) to be fully vaccinated than expected. Odds of remaining zero-dose were 0.38 (95% CI 0.34–0.42) with versus 0.66 (0.63–0.70) without registered objection and fewer children (9,206, 1.5%) were persistently zero-dose post-than pre-NJNP (10,696, 1.9%).

Interpretation

Full vaccination by age 5–<7 years increased post-NJNP irrespective of baseline vaccination/objection status. Relative increases were much higher among children with registered objection than without, but partially vaccinated children without objection largely accounted for numerical increases, suggesting increased eligibility assessment was more important than changes in exemption criteria.

Funding

Australian Government Department of Health and Aged Care.
澳大利亚“不注射,不支付”政策对疫苗接种的影响——在两个国家出生队列中进行的前后研究。
背景:关于未接种疫苗的经济处罚影响的数据很少。自1998年以来,澳大利亚要求对政府家庭援助支付资格进行全面接种。2016年,“不注射,不支付”(NJNP)政策取消了注册的非医疗反对作为豁免选项,并将资格评估提高到每年一次。我们的目的是研究NJNP对儿童疫苗摄取的影响。方法:个人水平的澳大利亚免疫登记数据用于收集njnp前/后2年的1岁出生队列。研究结果:njnp前562,316名1岁儿童。解释:5岁全面接种疫苗。资助:澳大利亚政府卫生和老年保健部。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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