2015-10-19
Speech in parliament: I rise to speak on the Public Health and Wellbeing Amendment (No Jab, No Play) Bill 2015. Before I begin my speech I would like to thank the minister’s office staff, who organised quite a comprehensive review for me and were also able to answer a number of questions during and after that briefing.
I want to begin by stating that the Greens join health and scientific experts in absolutely supporting vaccination as a safe, proven and critical preventative health measure. The elimination of horrific diseases such as polio in Australia is testament to the incredible effectiveness and importance of vaccines.
Unfortunately vaccine coverage rates in Australia, including Victoria, are not what they should be. Health organisations recommend vaccination rates of around 95 per cent to prevent outbreaks of most vaccine-preventable contagious diseases. Over the past decade in Victoria that rate of immunisation has remained at around 92 per cent. However, in some localities vaccination rates are below that average, with the lowest statistically reliable rate being about 82 per cent to 85 per cent coverage in a few suburbs, depending on the age of the child.
As vaccination coverage rates drop, there is an increased risk of disease outbreak. These outbreaks can affect every young child who has not yet been fully vaccinated, pregnant women, who put themselves and their foetus at risk, and other non-vaccinated children. Many of the diseases we vaccinate against are just horrible. They can leave people with lifelong disabilities or health problems, and some of the diseases can be life threatening. From a public health perspective there is a clear need to boost vaccination rates. The question is how best to do this.
To answer that question it is useful to understand why some parents have not vaccinated their children. In Victoria about 1.4 per cent of the population are conscientious objectors. These people make up the minority of those who have not vaccinated their children. Other reasons why someone might not vaccinate include that some people, perhaps genuinely, have not got around to it due to a range of life circumstances. There is a group of quite disadvantaged people who have not got their children vaccinated due to their difficult life circumstances or chaotic home environment. There are those people who have not got their children vaccinated for genuine medical reasons, such as being allergic to an ingredient in a particular vaccine or having a serious medical condition where vaccination is delayed until the child has recovered.
There is also a group of people who might be called ‘hesitators’. They are not strongly opposed to vaccination, but they have heard that there might be some risks and they are thus unsure about them. These people do not perceive a strong risk of their child contracting any of the horrible diseases that immunisation prevents, so they think that on balance it might be reasonable not to vaccinate or to delay vaccination until their child is older or they simply have not yet made a decision either way. Hesitating parents may not realise that in some areas the local vaccination rate is getting well below safe levels and thus the risk of an outbreak is increasing.
It is in this context that the government has proposed the no jab, no play bill. The bill requires a child to be age-appropriately vaccinated in order to enrol in virtually all public and private childcare and kindergarten services. Upon enrolment parents must provide an immunisation status certificate to the childcare centre or kindergarten showing that the child is age-appropriately vaccinated.
Those with genuine medical reasons for not vaccinating are required to provide a certificate of medical exemption. The bill creates a 16-week grace period in relation to the requirement to produce an immunisation certificate for low socio-economic and disadvantaged households. This critical part of the legislation will enable parents to get their child into child care while giving them time to organise the vaccination for the child or to have the paperwork completed. This is important because it recognises that some families can be under pressure and have multiple stresses. This provision enables time for support to be provided to get things in order.
The Greens believe that this legislation could be an effective trigger for hesitators and the disorganised to arrange an appointment with their GP or child and maternal health nurse and to have that conversation, get the information they need about the importance of immunisation and hopefully have their child vaccinated. It is for this reason that the Greens are willing to support the bill. However, we do have concerns about the bill, including its implementation, and we call on the government to monitor this legislation with a first review during mid-2017 when the second start-of-year enrolment period ends.
The reasons we believe the legislation needs to be reviewed are as follows. Firstly, a number of people have raised concerns about the issue of those opposing vaccinations losing access to early childhood education and child care, which is essential for mothers to return to work. The Greens, along with other parties, have been clear about our strong support for universal access to kindergarten in the year before school, and we strongly support continuing to professionalise and increase access to child care. We remain very committed to this.
In deciding to support this bill we have carefully considered its implementation in relation to the small number of people who oppose vaccination under any circumstances. Unfortunately conscientious objectors are unlikely to vaccinate their children even if this bill passes into law. These families will thus lose access to child care and early childhood education, which is of concern to us. However, we had to weigh up our concern about this with the risk posed by low rates of vaccination coverage and the risk of an outbreak of a terrible life-threatening but vaccine-preventable disease. We had to think of very young children who are not yet fully immunised. We had to think of pregnant women and their foetuses. We had to think of those who cannot be vaccinated due to medical conditions.
We cannot afford to put pregnant women and children at risk due to the choices of others not to vaccinate, which is why we have chosen to support this bill. Vaccinations are a collective social responsibility that the Greens believe we should all accept to protect ourselves and our communities. We must minimise the risk that those who choose differently—those who choose not to vaccinate—pose to others. Childcare centres are a likely place for contagious outbreaks and are frequented by at-risk people such as pregnant women and very young children. These children are of an age at which vaccinations are scheduled to be administered, so it makes sense to target these environments with this legislation.
However, our concern about full access to child care remains, and thus we believe the full impact of the legislation will need to be closely monitored. Given that this legislation is likely to have negative impacts on some families, we must be careful to verify that it is achieving what it set out to do and that it is effective at increasing immunisation rates. We also need to ensure that any potential negative impacts on families are minimised and that children and their families are not being excluded from child care unnecessarily.
This takes me to my second reason for the need to monitor and review the legislation and its implementation. While the government has provided a 16-week grace period after the enrolment of a child from a disadvantaged family into child care, we are concerned that it has not announced any funding or has not been clear enough about the additional resources and support it will make available to childcare centres and local councils to provide targeted assistance to low-income and disadvantaged households to get their children immunised.
We know that some households are chaotic or parents are under significant strain and need extra support to get vaccinations organised, even with a 16-week grace period. It is not enough to give those parents an information pack and expect that they will get it sorted. These households need support to make and keep appointments. They may need a child and maternal healthcare nurse to go to them and to provide the paperwork directly to the childcare centre, as well as to parents.
The burden of responsibility for adhering to this legislation is fully on the shoulders of the childcare centre, but it is not the body that can administer vaccinations. Nor would a childcare centre necessarily be able to put on extra staff. Already stretched staff would not have time to provide support to disadvantaged households to organise their immunisations and the paperwork. This could mean centres might be forced to expel children who do not comply after 16 weeks. I think the government would agree that this is not a desirable outcome, so appropriate steps need to be taken to minimise the risk of this happening.
Alternatively, this legislation may be poorly enforced, and that would be a bad outcome if the objective is to increase vaccination rates. To be effective, the implementation of this legislation needs to be well thought through and administered. Childcare centres are not experienced in this area and need support to understand the barriers to vaccinations and to develop best practice strategies and communication channels between the centres, councils, immunisation providers and government departments if the aim is to improve vaccination rates.
For those areas and childcare centres with large numbers of low-income families and disadvantaged children enrolling, or high levels of objectors, targeted funding will be necessary for council and childcare centres to provide support to parents and to undertake the required liaison between health professionals, parents and childcare centres to ensure that children are in fact vaccinated. Local governments might also need additional funding to put on extra staff to deal with a big boost in demand for vaccinations in the pre-enrolment period. This is particularly true of many of the councils in growth areas, such as the City of Wyndham, where I think approximately 70 babies are born a week. Are those councils going to be getting extra support, without having a lengthy wait period?
They will also need timely reimbursements from the government for the costs of providing this service.
This situation needs to be monitored closely so that children are not unnecessarily excluded from child care. This is particularly important in the Aboriginal early childhood services area, where it may even be more critical that no child is left behind in their educational opportunity.
To conclude, I would like to say that the Greens will support this bill in the interests of public health, but the implementation will be critical. We are seeking a commitment from the government in relation to monitoring and review, so that it can and does deliver the best possible outcome for all. I would also like to say to those who are unsure or hesitant about vaccines, the science and the evidence are absolutely clear. Do not let doubt stop you from giving yourself and your children potentially life-saving healthcare. Vaccinations are safe and proven. Do not believe everything you read on the internet. Please see your GP or your health professional, whom you trust, for expert advice on why vaccinations are so important.
After this speech, Colleen Hartland went on to question the Government around a range of aspects to the bill. To read to full transcript of this click here and go to page 19.