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Public Health and Wellbeing Amendment (No Jab, No Play) Bill 2015

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Ellen Sandell
State MP for Melbourne
8 October 2015

Ms SANDELL (Melbourne) — I rise to speak on the Public Health and Wellbeing Amendment (No Jab, No Play) Bill 2015. I want to begin by stating that the Greens join the health and scientific experts in absolutely supporting vaccinations and immunisations as a safe, proven and critical preventive health measure and will be supporting this bill. 

The elimination of horrific diseases such as polio in Australia is testament to the incredible effectiveness and importance of vaccinations.

However, unfortunately vaccination coverage rates in Australia and Victoria are not what they should be. As we have heard throughout this debate health organisations recommend vaccination rates of around 95 per cent or more to prevent outbreaks of most vaccine-preventable contagious diseases, but over the past decade in Victoria we have seen the rate of immunisation drop to around 92 per cent, which is worrying. However, in some localities — and this is the most worrying — vaccination rates are well below that average, with the lowest statistically reliable coverage rate being about 82 to 85 per cent in some areas, depending on the age of the child. As vaccination coverage rates drop there is an increased risk of disease outbreaks. These outbreaks can affect very young children, who are not yet able to be vaccinated; pregnant women, who themselves and also their foetuses can be at risk; and other non-vaccinated children or people who are immunocompromised.

I have been listening closely to the debate and have heard that many of the diseases we are seeking to prevent are simply horrible. They can leave people with lifelong disabilities or health problems, many of which are life threatening and cause death. So there is an absolutely clear need to boost the vaccination rates from a public health perspective. Once we all accept that, the question is: how do we achieve that? To answer that question it is useful to understand why some parents have not vaccinated their children. We have heard some of the reasons throughout the debate, but I want to reiterate some of them.

In Victoria the statistics are that about 1.4 per cent of the population are what people might call conscientious objectors or vaccination refusers. These people are the minority of people who have not vaccinated their children. There are other reasons that people may not vaccinate — for example, they may not have got around to it due to a range of life circumstances. There is a group of disadvantaged people who have not got their children vaccinated due to difficult life circumstances — perhaps a chaotic home environment — and there are people who have not got their child vaccinated due to genuine medical reasons, such as being allergic to an ingredient in a particular vaccine or having a serious medical condition, in which case the vaccination might be delayed until after the child has recovered.

There is also a group of people who we might call hesitaters. They are not necessarily strongly opposed to vaccinations, but they have heard there might be some risks and are therefore a bit unsure about them. These people do not perceive a strong risk that their child will contract any of these horrible diseases, largely because many of them have already been eradicated in Australia, so they think on balance it might be reasonable not to vaccinate or to delay until their child is older, or they simply have not made a decision either way. Hesitating parents might not realise that in some areas the local vaccination rate is getting well below the safe level, so the risk of their child contracting a disease due to an outbreak is increasing.

It is in this context that the government has proposed this no jab, no play bill. As we have heard, it requires a child to be age-appropriately vaccinated to enrol in virtually all public and private childcare services and early childhood education 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 are required to provide a certificate of medical exemption.

I am pleased to see that the bill provides a 16-week grace period for low-income and disadvantaged households to provide the certificate. From our point of view this is a crucial part of the legislation because it means parents are able to get their kids into child care or early childhood education and are then given some time and support to sort out the vaccinations and paperwork. This is important because it recognises that some families can be chaotic and have multiple stressors and pressures, and it gives them support to get things in order.

One of the main reasons the Greens are supporting the bill is that we believe it could be effective as a trigger for that group of parents who I have described as hesitaters. It might be a trigger for the disorganised to get an appointment with their GP or child and maternal health nurse, to have a conversation and to get the information they need about the importance of immunisations and then hopefully get their child vaccinated. For this reason we are willing to support the bill.

We have a couple of concerns that mainly relate to implementation. We would like to see the government monitor and review this legislation, with the first review after mid-2017, after the second start-of-year enrolment period ends. The reasons we believe the bill needs to be reviewed are as follows. Firstly, a number of people have raised the issue of those who oppose vaccinations losing access to early childhood education and child care, which is essential for mothers returning to work and is an important part of a child's development. In fact the most important time in a child's education is probably those early childhood years. The Greens, along with many others, have been clear in 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 much committed to this.

In deciding to support the bill we carefully considered the implications in relation to the small number of people who oppose vaccinations. Unfortunately, whether you call them conscientious objectors or vaccination refusers, they are likely not to vaccinate their children even if the bill passes into law, which is unfortunate. These families will therefore lose access to child care and early childhood education, which is a big concern for us because children need education and women need to return to work.

However, we had to weigh this concern against the risk posed by low rates of vaccination coverage and the risk of an outbreak of a terrible, life-threatening, vaccine-preventable disease. We had to think of the very young children who are not yet fully immunised, because it takes time. We had to think of pregnant women and their foetuses. We had to think about those who cannot vaccinate due to medical conditions. We cannot afford to put these women and their children at risk due to the choice of a very small number of people not to vaccinate, and that is why we choose to support the bill.

Vaccination is a collective social responsibility that the Greens believe we should all take on to protect ourselves and our communities. For those who choose differently and choose not to vaccinate, we must minimise the risk they pose to others. This is particularly important at childcare centres because they are a likely place for outbreaks as they are frequented by many at-risk people, such as pregnant women and very young children.

Having said that, our concern remains about full access to child care, which is why the legislation needs to be monitored and reviewed. Given the likely negative impacts of the legislation on some families, we must be careful to verify that it is achieving what it set out to do and that it is effective in increasing immunisation rates. We also need to ensure that the potential negative impacts on families are minimised and that children and their families are not excluded from child care unnecessarily, which takes me to the 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 enrolment for disadvantaged families to provide their immunisation status certificate, we are concerned that there has not been an announcement of an increase in funding. The government has not been clear enough about the additional resources and support it will provide to childcare centres and local councils so they can provide targeted support to low-income and disadvantaged households to get their children immunised. The Greens have asked the minister and the department many questions about this, but we are not fully satisfied that extra resources will be given to councils and the other providers that are expected to deal with this increase in immunisation demand.

We know that some households are chaotic, that parents are under strain and that they need extra support to get their children immunised, even with a 16-week grace period. It is not enough to just give parents an information pack on the first day of child care and then expect them to get it sorted. Parents often need a lot more support than that. They need support to make and keep appointments. Child and maternal health nurses might need to visit parents and provide the paperwork directly to childcare centres as well as to parents. The burden of responsibility for adhering to this legislation is fully on the shoulders of childcare centres, but they are not the bodies that administer vaccinations, nor are they able to put on extra staff to provide support to disadvantaged households to organise their immunisations and paperwork. This might mean that some childcare centres are 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 risks.

To be effective this legislation needs to be well thought through and well administered, which will take resources. Childcare centres are not necessarily experienced in this area and might need support to understand the barriers to vaccinations and develop best practice strategies and communication channels between the centres, councils, immunisation providers and government departments if the aim is to improve immunisation rates.

For those areas with high levels of disadvantage or large numbers of low-income families or vaccination refusers or objectors, targeted funding is likely to be necessary for councils and childcare centres to provide support to parents, which is what the Greens are calling for. Local governments might need additional funding to put on extra staff to deal with a big boost in demand for vaccinations in the pre-enrolment period without having lengthy waiting periods, and rate capping could have an impact on their ability to provide immunisations for all the children who need them. They will also need timely reimbursement from the government for the costs of providing this service.

For these reasons the situation needs to be monitored closely. We do not want to see any children unnecessarily excluded from child care, because we know how important early childhood education is both for children and for mothers returning to work. It is also particularly important in Aboriginal early childhood services. We have been in touch with a number of organisations that work with Aboriginal people in this area, and in this area it is even more critical that no child is left behind in their educational opportunity.

To conclude I say the Greens support this bill in the interests of public health but, as always, implementation will be critical. We are seeking a commitment from the government to monitoring and review so that it can and does deliver the best possible outcome for all. I also say to those who are unsure or hesitant about vaccines that the science and evidence is absolutely clear. Do not let doubt stop you from giving yourself and your children potentially life-saving preventive care. Vaccinations are safe and they are proven. Do not believe everything you read on the internet. See your GP or health professional for expert advice on why vaccinations are so important.

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Ellen Sandell
State MP for Melbourne
8 October 2015




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