Effects Of Parents Selecting Non-vaccination Option Upon Children’s Health And Development In Australia: An Intervention Programme

Abstract

Australia has one of the most comprehensive fully funded vaccination programmes in the world. Most Australian parents keep their children’s vaccination up to date. Up to 48% of Australian parents are in favour of immunising their children. Vaccine hesitance is a public health concern. An intervention education programme which will investigate the parents who prefer non-vaccination because of their attitudes, perceptions, beliefs and issues with vaccines is highly beneficial.

In this intervention program, a public health strategy/intervention including a compulsory education session was designed for parents who hesitate or refuse to vaccinate their children. General practitioners, nurses and maternal and child health nurses play main roles for the delivery of the intervention programme.

This intervention of a compulsory education session involving an increase in Medicare levy if the parents subsequently fail to immunise their children increase immunisation coverage to a high level of compliance with vaccine uptake and changed the parental behaviour and misconception.

1.1 Introduction

Australia has one of the most extensive funded immunisation programmes globally. Thus, numerous diseases, such as tetanus, diphtheria and poliomyelitis, either has been eradicated or is rare in Australia. Immunisation it is not only to prevent individuals, nevertheless, is also prevent the whole populations through enriching overall level of their immunity system and also reducing the transmission of infection. Vaccination has been successfully programmed with an economical health involved. Immunisation is one of the important protection programmes against diseases and is designed in childhood and offered and implemented under the National Immunisation Programme (NIP) in Australia. The NIP programme comprises vaccines against 16 diseases (Beard et al. 2016, p.275). The vaccines under NIP are accessible to babies, children, young adults and vulnerable adults, such as Aboriginal and Torres Starts Islander communities and pregnant women. Every state and territory are accountable for the distribution of their immunisation programmes on the National Partnership Agreements on Essential Vaccines (Beard et al. 2016, p.275).

In the programme mentioned above, vaccines are given free of charge over a range of providers and accessible to all children at healthcare facilities. The purchase of vaccines is sponsored by the Australian Government. Australia has a strict vaccine system under Australian Childhood Immunisation Registry (ACIR), which is a crucial part of the programme and managed by the Department of Human Services. ACIR manages all the immunisation history given to children aged

Despite the facts mentioned above and the complete support for vaccination programmes in Australia, all Australians are not in favour of complying to the NIP. However, many Australian parents support childhood immunisation and keep their children immunisation records up to date. A research indicated that approximately 95% of parents mutually showed that all their children are fully vaccinated with all the recommended vaccine. In contrast many Australian parents have chosen not to have their children immunised. In Australia, a variety of barriers against vaccine uptake still exist. These barriers may be related to the attitudes of parents or guardians, lifestyle or religious beliefs. Other natural barriers, such as time limitation and lack of commitment, exist (Rhodes, A. (2017).

In this context, exploring the barriers of vaccine uptake, particularly parents who prefer ‘nonvaccination option’ is important in ensuring high compliance levels and ongoing support for vaccination programmes in Australia.

1.2 Definition of Terms

• ACIR – Australian Childhood Immunisation Registry
• CALD community – Culturally and linguistically diverse community
• NIP – National Immunisation programme
• NPEV – National Partnership Agreements on Essential Vaccines
• WHO – World Health Organisation
• NCIRS – National Centre for Immunisation Research and Surveillance
• MCHNs – Maternal and child health nurses
• GP – General practitioners
• QALYs – Quality-adjusted life years
• DALYs – Disability-adjusted life years

1.3 Background

According to the report published by National Centre for Immunisation Research and Surveillance in 2017, childhood immunisation coverage in Australia is up to 95% and comprises >0% coverage of 1-, 2- and 5-year-old children that are fully vaccinated (Rhodes, A. (2017). Attaining this target averts the onset of preventable diseases during childhood.

However, many parents still lack confidence in relation to vaccination in numerous areas in Australia. Across the states and territories, 1 in 10 children are unvaccinated or had missed at least one dose of the recommended vaccination. In many areas, the rate is only >90% for 5-year-old children.

The most serious problem in the vaccination programme of Australia is the growing number of parents who lack confidence in vaccination or have chosen the nonvaccination option.

On the one hand, a study published in 2017 reported that 48% of Australian parents fully support the vaccination programme under NIP and have no objection against vaccination; they completely allow their children to be fully vaccinated. On the other hand, 38% of parents have concerns about vaccination. Meanwhile, >21% of parents believe that vaccine causes autism despite that numerous medical studies have demonstrated that no causal linkage exists between autism and vaccination (Yui, M. (2017).

A total of 23% of parents believe that vaccines have not be tested sufficiently. A total of 22% who have concerns about their children’s immunity system being weakened by vaccination. Some parents believe that vaccine contain a specific ingredient that can cause autism. These parents also believe that the ingredients in vaccine is Haram or lawful enough to be taken due to their religion objection. The top most concern among these parents are vaccine safety, religious belief and severe side effects of vaccination. There are several comping and supports be place for uptake of vaccine. However, knowledge and awareness of vaccines remain lacking. Many public health policies have been placed and implemented under NIP (Kempe et al, 2019, pp.548).

The public health advocators and experts of the field should continue to aim to increase compliance to vaccine uptake by providing education programmes, especially for parents who choose the non-vaccination option for their children, to enhance the parents’ knowledge about vaccines.

1.4 Current Problems

According to extensive literature review about vaccine noncompliance, the top priorities that are the main associated factors against vaccination uptake are as follows (Eller et al, 2019, pp.445).

• Misconceptions and attitudes of parents on vaccine safety
• Belief that the government and pharmaceutical companies benefit from vaccines
• Lack of knowledge on vaccination safety
• No trust about vaccination
• Family hesitancy with regard to their religious objection
• Missed appointment or work burden
• Unspecified reasons

Most Australian families have concerns about the following:

Most parents believe that the government is interfering in regards to their children ownership or independence and willingness. Some parents also believe that vaccines are unsafe and did not undergo adequate testing. Vaccination is used by pharmaceutical companies for their own commercial benefit. With regard to fighting against diseases, some parents believe that the natural system is better than vaccinating against infection.

Therefore, according to the limitation and lack of knowledge above, the interventional education session offer to all parents will be Attempt to change attitudes and behaviours and increase vaccination coverage rates

1.5 Currently Existing Policies/strategies

Australia has one of the strictest immunisation programme designed under NIP. The Australian government has introduced and legislated new laws under role ‘no jab, no pay’ approach, which promotes and supports immunisation uptake (Rhodes, A. (2017).This approach penalises parents who do not vaccinate their children without any medical reasons, by suspending government payments (child care benefit or family tax benefit) until they meet the immunisation requirements.

This policy enforces severe penalties to services that has accepted or admitted any unvaccinated children. The policy has been accepted and widely implemented across the states in Australia. Under this policy, under vaccinated or unvaccinated children or children without any medical exemption will not be admitted to kindergarten or child care centres and schools. Despite this newly legislated policy, parents who continuously resist vaccination and have doubt on vaccine safety due to many reasons still exist. Therefore, compulsory education session programmes will enhance knowledge and perceptions about vaccines and break the current barriers against vaccination.

1.6 Proposal of Intervention Strategies or Public Health Policy

I would like to propose the following intervention programme for those who have chosen non-vaccination and want to be exempted from the immunisation schedule as follows:

• Introduce a compulsory education session for the informed nonconsent for those parents choosing non-vaccination option or seeking an exemption from the immunisation schedule
• Penalty: increased Medicare levy of −0.5% for those who attend and still decline. Those parents who do not provide informed nonconsent and attend the education session will have a 1% increase in Medicare levy.
• The compulsory education session will be delivery by general practitioners (GPs), nurses and maternal child health nurses (MCHNs).
• Schools required to publicise the unvaccinated children to assist parents to make an informed decision about where to send to school

I. Compulsory educational session for families seeking vaccine exemption

The main goals of this compulsory education programme are to increase the level of knowledge for the parents and compliance by exploring vaccine safety, benefits and side effects. At the same time, this engagement and communication will improve the understanding to gain additional knowledge and awareness to break down the barriers surrounding vaccines.

Therefore, this programme is particularly parents who fail to comply with vaccination schedule for their children are the target group for this intervention. The ultimate objective is to change the attitudes, beliefs and decisions of these parents. This programme will include an encouragement session for the recognition role of safe and civic responsibility to entire communities. The parents will be informed about children’s right for having quality health and development outcomes. However these parents believe they are protecting their children and indeed it’s a challenge

The goal of this public health strategy is to reduce the number of parents who are against vaccination and seeking medical exemption for vaccination schedule. The programme will ensure to maintain a high level of vaccine acceptability (increased up to 100%).

II. Penalty: increased Medicare levy from −0.5% to 1%

People who were offered a compulsory education session and still refused the vaccines will be subject to the following penalties:

• Approximately 0.5% increase in Medicare levy will be imposed to those who attended the education session but still refused to vaccinate their children without any genuine medical reason.
• A 1% increase in Medicare levy will be imposed to parents who refused to attend compulsory education session.

The final goal of the Medicare levy is to ensure a strict policy that will reduce immunisation exemption and the number of patients who prefer the non-vaccination option.

III. Compulsory education session delivered by GPs

GPs are the most trusted people in societies. Frequently, people contact GPs with regard to vaccines and other medical concerns (Yui, M. (2017).

GPs have fundamental roles of advocating parental concern with regard to vaccination. Compulsory education programmes delivered by GPs will expand the parents’ knowledge of vaccination and gain their trust. The goals are to improve the level of vaccination compliance and encourage support for vaccine uptake. Not only PGs but also other medical professionals, such as nurses, MCHNs and midwives, will be delivering the educational session.