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When two policies collide: vaccination and universal access across Australia

Immunisation
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The story so far…

In March this year, the Prime Minister Malcolm Turnbull wrote to all state and territory governments asking them to exclude children from any early childhood service or preschool unless they were immunised against preventable diseases or had a valid medical exemption. The intention was to close the ‘loophole’ present in many jurisdictions allowing children whose parents were conscientious objectors to immunisation to be enrolled in services even if they had to pay full fees under the No Jab No Pay policy.

The effect of the PM’s letter and general shifts in public health policy are likely to see a toughening of state based legislation around the country, with flow on effects for educators and providers including, in some locations, potential closure.

Last week we brought you news that the NSW government has tabled a bill to amend its Public Health Act and abolish conscientious objection as grounds for exempting children in any ‘child care facility’ in the state. The legislation is intended to close any opportunities remaining to families who do not believe in vaccination to claim that belief as a reason their non-immunised children should be enrolled in a preschool, long day care service or any other licensed service.

While conscientious objection is no longer accepted as an exemption for families seeking CCB/CCR subsidies (No Jab No Pay), it does remain grounds for those families to enrol their children in service and pay full fees in every state except Victoria, which removed conscientious beliefs as grounds under its No Jab No Play policy.  With the bill widely expected to pass in NSW, the two most populous Australian states will have closed the doors to formal, quality early education and care for children because of their parents’ beliefs.

We know from past CELA consultations that this causes concern for many educators – including those who are strongly pro-vaccination and who work in services where all the children are immunised. Is it possible to back a necessary public health policy that denies another necessary policy – universal access to early childhood education and care for a minimum of 15 hours a week in the year before school?

An educator’s dilemma

Spare a thought for educators like Donna, a preschool director from a tiny town outside Mullumbimby in far northern NSW, whose current enrolment consists of four immunised students and 11 non-immunised.  When she first heard the news about the NSW legislation Donna’s initial fear was closure: of the families who have children enrolled at her preschool, only one might consider vaccinating their children rather than withdraw them.

While closure is still a possibility, it won’t be immediate. Her preschool is on a safety net program for small enrolments under the NSW Start Strong scheme, and the legislation won’t be retrospective but will apply to children enrolled from 1 January 2018. These two factors buy Donna some time to work with her community and CELA and come up with a strategy for long term survival.

“This area has one of the lowest immunisation rates in the state,” Donna said.

“People move here to be with like minded families.”

In eight years the numbers of immunised children to non-immunised at Donna’s preschool have gone from 50:50 to less than a third.

“So yes, my first fear was that we would have to close down, but that’s closely followed by where will the children go if they can’t come here?” she says.

“There aren’t any other services nearby, so if I do have to shut down the immunised children will miss out too.

“How does that work with the principles of universal access? These children will have no early learning at all – that can’t be the best outcome.”

The academic’s story

Jennifer Ribarovski is a teacher, Sydney University lecturer, a consultant and former senior executive in both the NSW regulatory authority and ACECQA.  She has a strong professional interest in ethics and educational leadership and we spoke to her about how she sees educators juggle the two public benefits of vaccination against preventable diseases and investing in quality early learning for all children.

“To be honest, this is a hard area to teach and it’s only getting harder when it comes to immunisation,” Jennifer says.

“My students are all potentially directors within a few years of graduating and a big part of what we want them to do is think critically about policy and regulation and to develop and exercise professional judgement.

“For every other topic in this area there is scope to work with families and to offer a degree of autonomy on service policy.

“If a parent doesn’t want their child to wear sunscreen you can have the discussion about the brands you use or about their child wearing longer sleeves. If they want their child on a strict diet you can talk with them about nutritional needs at different ages and maybe get some flexibility.

“We would normally be saying to students that they need to have the same kind of discussion with parents who are conscientious objectors to immunisation too – but this amendment might close that opportunity off. If we can’t even enrol children from those families, then we can’t talk to their parents.

“I think it goes to the belief most educators have, that their role is also about supporting families when it comes to what we can see are benefits for children. It’s going to be very difficult for a lot of educators to reconcile the conflict between the obvious benefits of immunisation and denying children access to enrolment.”

The national picture

Since 1 January 2016, families with children who are not immunised (and do not have an approve exemption) have not received the FTB Part A end of year supplement and child care fee subsidies.

The policy states that vaccine objection (or conscientious objection) is not a valid exemption. Families with children who do not have an approved exemption — for example a medical exemption (medical contraindication or natural immunity certified by an general practitioner) — are not eligible to receive CCB, CCR, and the FTB Part A end of year supplement for that child (except for children under 12 months for the FTB Part A supplement).

Currently, unvaccinated children can enrol in approved services and preschools in the NT, ACT, SA, WA or Tasmania – and they can enrol or be refused enrolment in Queensland at the service provider’s discretion.

NSW and Victoria require children to be fully immunised or on an approved catch-up program. NSW currently allows conscientious beliefs as an exemption category.

How many children are we talking about?

The 2017 Australian Child Health Poll survey of almost 2,000 parents found that 5 per cent (100) of those children were not up to date with their vaccinations, and one in six of that group had been refused enrolment in an early learning service as a result.

The survey also found 74 per cent of parents believe they should be told how many children are not up to date with vaccines at schools or early childhood services.

Further, seven out of 10 parents said that knowing the number of under-vaccinated children would influence their decision in choosing early childhood services and schools.

While 95 per cent of Australian children are fully vaccinated, the survey said one in three parents held concerns about vaccination.

One in 10 parents questioned believed that vaccines could cause autism, and a further 30 per cent were unsure — despite medical research showing no causal link.

Shortcut: the nationwide policy picture

The Australian No Jab No Pay policy applies pressure to families by denying rebates and subsidies.

The proposed NSW legislation applies pressure to providers and directors by imposing fines of up to $5500 per offence (or child) for breaches.

NSW Health officials say there will be a heavy emphasis on parental conversion through information – the ideal outcome is more immunised children, not fewer children in quality early learning.

Victoria is the only state that has in place tougher legislation than NSW proposes.

Queensland does not make immunisations compulsory but the service provider has discretion to exclude children who are not immunised.

South Australia may follow Victoria’s No Jab No Play approach.

ACT, Tasmania, Western Australia, Northern Territory – not compulsory but need to supply immunisation statement, and children can be excluded if an outbreak occurs.

The NSW position, awaiting legislation

The NSW Health and Education departments are working with early childhood organisations like CELA to clarify questions raised by the sector so far, and to ensure the resources and toolkits being developed are meeting the needs of educators and families as this change comes in.  According to the most recent data from NSW Health, about 8100 children aged from birth to 7 years are not vaccinated because of their parents beliefs, rather than any medical or age related reason.

Non immunised children, 0-7, NSW
Non immunised children, 0-7, NSW. Source: NSW Health

 

While this number is a very small percentage of children in NSW, they tend to be concentrated in locations like inner Sydney and the far north of NSW.  This means some services may be affected severely while others will not notice any real difference in their practice.

Across the nation

Following is an analysis of the current and – if available – proposed policy on vaccinations and enrolment in children’s services across all states and territories.  If you are aware of any additional information you’d like us to include, please share it in the comments or email us info@cela.org.au – we are particularly interested in the way you apply the policies in your service.

Australian Capital Territory

At the time of enrolment into child care, preschool or primary school, the Regulation requires parents to provide two copies of their child’s immunisation history to the school or child care director.

This information will help identify those children most vulnerable to vaccine preventable diseases and will assist health authorities in protecting all children in the event of a vaccine preventable disease occurrence in a school, preschool or child care setting.

If a situation occurs where a child in one of these settings has a vaccine preventable disease, the child care centre coordinator or teacher must be able to quickly access immunisation histories and determine who has not been immunised. If there is a case of a vaccine preventable disease, and your child has not been fully immunised for that disease, they may be excluded from school or child care for a period of time.

If you do not provide your child’s immunisation history then your child will be recorded as being not fully immunised by the primary school, preschool or child care centre.

Immunisation is not compulsory. However, if there is a case of a vaccine preventable disease at the school or child care centre, and your child has not been fully immunised for that disease, they may be excluded for a period of time.

 

New South Wales

Since 1 January 2014, NSW early childhood services have been prevented under the Public Health Act 2010 from enrolling children unless approved documentation is provided that indicates that the child:

  • is fully immunised for their age, or
  • has a medical reason not to be vaccinated, or
  • is on a recognised catch-up schedule, or
  • has a parent who has an objection to vaccination

Proposed amendment

The NSW Government tabled a Bill in Parliament which aims to strengthen the vaccination requirements for enrolment in early childhood education and care services from 1 January 2018.

The amendment to the Public Health Act 2010 will:

  1. remove the exemption relating to the children of parents with a conscientious objection to vaccination.
  2. create an offence (with a penalty of 50 penalty units) for a principal who fails to comply with the childcare vaccination enrolment requirements in section 87
  3. create an offence (with a penalty of 50 penalty units) for a person who forges or falsifies a certificate that is required to be provided under these requirements.
  4. In addition, the temporary exemption (for 12 weeks after enrolment) will be extended to Aboriginal children, those in out of home care and those that have been evacuated due to a state of emergency.

Northern Territory

There are no specific immunisation requirements to attend child care services. However, if an outbreak occurs, unimmunised children may be excluded for a period of time.

Whenever your child is enrolled at a new school, you are required by the School Education Act (1999) to present your child’s immunisation records. This includes enrolling your child for kindergarten and pre-primary.

Proposed changes

No changes announced, however in March 2017 Associate Professor Robert Parker from the NT branch of the Australian Medical Association said it would support a move to put measures in place to prevent unvaccinated children from attending child care.

NT Health Minister Natasha Fyles said the Government was considering the ban.

“The Northern Territory Government will consider all the issues involved in this matter, recognising our unique circumstances, before taking a final position,” Ms Fyles said in a statement.

 

Queensland

Under the Public Health Act 2005, approved early childhood education and care services (ECEC services) can refuse the enrolment or attendance of children who are not up-to-date with their scheduled vaccinations.

This only applies to ECEC services approved under the Education and Care Services National Law (Queensland) or the Queensland Education and Care Services Act 2013. Unregulated services are not covered.

This legislation does not make immunisation mandatory, and does not force your service to refuse enrolment or attendance of children whose immunisation status is not up-to-date.

The course of action is at the discretion of your service. However, there are certain steps you must take to ensure that you are legally protected when refusing a child’s enrolment or attendance based on their immunisation status.

Your service can choose to ask parents to provide an:

  • immunisation history statement when enrolling their child
  • updated immunisation history statement when their child passes the 2, 4, 6, 12, 18 months and 4 years vaccination milestones.

The immunisation history statement will show if a child’s immunisation status is up-to-date. If the child is not up-to-date, your service can choose to:

  • refuse enrolment of the child
  • cancel enrolment or refuse attendance of the child
  • impose a condition on the child’s enrolment or attendance.

Your service may wish to establish a policy on the enrolment and attendance of children whose immunisation status is not up-to-date with the immunisatio schedule, or parents who do not provide an immunisation history statement.

You may need to prove that your child’s immunisation status is up-to-date before they can enrol or attend an approved early childhood service.

The legislation does not make immunisation mandatory or stop services from allowing unvaccinated children to enrol or to attend. It aims to protect children and adults who work in early childhood settings from vaccine-preventable diseases.

Refusing to allow a child to enrol or attend a service based on their immunisation status is not unlawful discrimination under the Anti-Discrimination Act 1991.

South Australia

From term 1 2017 parents and carers with children enrolled in a government preschool, rural care, occasional care, family day care or respite care service will be asked to provide evidence of their child’s immunisation status under a new procedure aimed at protecting children against vaccine preventable diseases (VPD).

Children who have a medical reason for not being vaccinated are required to have a general practitioner complete an exemption form. A completed copy should be provided to the site or service.

If a child is not up to date with their immunisations and there is an occurrence of a vaccine preventable disease at the service, their parents or caregivers will be asked to keep their child away from the service for a period of time which is known as an exclusion period.

The exclusion period is determined by SA Health and is designed to protect those who are at risk of getting the disease and those who may be able to pass the disease onto others.

While it is not mandatory to show evidence of a child’s immunisation status, if there is an outbreak of a vaccine preventable disease then the child will be treated as not up to date with their immunisations and excluded.

Proposed changes

The SA Government recently released legislation for public consultation, this public consultation closed on 11 August 2017.

They are proposing tough new laws to improve immunisation among children. The new ‘No Jab, No Play’ laws will mean children must be appropriately immunised, on an immunisation catch-up program or be exempt for medical reasons, in order to attend early childhood care services.

Services affected by proposed changes

Early childhood care services are those which provide care of young children (under the age of 6 years) for fee or reward such as:

  • childcare (also called centre based care, long day care and early learning centres)
  • family day care
  • preschool and kindergarten
  • rural care program
  • mobile child care services
  • occasional care.

Briefly, the proposed amendments are:

  • Children must be age appropriately immunised, on an immunisation catch-up program, or meet the exemption requirements (for example, they are unable to be immunised for medical reasons) in order to attend early childhood care services.
  • Parents/guardians will need to provide early childhood care services with evidence that their child meets the immunisation requirements. These records will need to be kept by the service whilst the child is enrolled.
  • A child with a vaccine preventable disease or who is at risk of getting a vaccine preventable disease may be excluded from the early childhood care service when an outbreak of that disease is occurring at the service.
  • A maximum penalty of $30,000

Tasmania

Under the Public Health Act 1997 parents and guardians must give schools and daycare facilities information about their child’s vaccinations. This aims to stop the spread of illness and disease. Immunisation is the only effective defence, and it is necessary to have as many children vaccinated as possible.

If your child is starting school or childcare, you must provide a written statement on whether your child is immunised.

Children do not need to be immunised to attend child care services. However, if an outbreak occurs, unimmunised children may be excluded from child care for a period of time.

Western Australia

Whenever your child is enrolled at a new school, you are required by the School Education Act (1999) to present your child’s immunisation records. This includes enrolling your child for kindergarten and pre-primary

There are no specific immunisation requirements to attend child care services. However, if an outbreak occurs, unimmunised children may be excluded for a period of time.

Victoria

Victoria has adopted a No Jab No Play approach.

Under the Public Health and Wellbeing Act 2008, in effect from 1 January 2016, to finalise enrolment for your child in long day care, kindergarten, family day care or occasional care you must provide the service with an immunisation status certificate that shows your child is:

  • up to date with vaccinations for their age OR
  • on a vaccine catch-up schedule OR
  • has a medical condition preventing them from being fully vaccinated.

To accept an offered place at a service, you must provide the service with an immunisation status certificate. This would usually be done within two months before your child is due to start at the service.

Some children, whose immunisations are not up-to-date, or who do not provide appropriate documentation may be able to enrol under the grace period provision. A 16 week grace period applies for families facing vulnerability and disadvantage including Aboriginal and/or Torres Strait Islander, refugees and asylums seekers, children in emergency care or from a multiple birth of triplets or more.

Conscientious objection is not a valid exemption in Victoria.

 

Sources for this story included:

https://www.dss.gov.au/our-responsibilities/families-and-children/benefits-payments/strengthening-immunisation-for-young-children

http://www.abc.net.au/news/2017-06-08/immunisation-rates-among-children-still-below-national-target/8600680

http://www.abc.net.au/news/2017-03-12/government-pushes-to-ban-unvaccinated-children-from-childcare/8347040

http://www.health.nsw.gov.au/immunisation/Pages/childcare_qa.aspx

https://www.qld.gov.au/health/conditions/immunisation/childcare

https://www.health.qld.gov.au/public-health/schools/immunisation/legislation

https://www.decd.sa.gov.au/department/media-centre/news/early-childhood-vaccine-procedure

http://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/About+us/Reviews+and+consultation/No+Jab+No+Play/

http://www.sahealth.sa.gov.au/wps/wcm/connect/e5864f8041f20af5a01de640535c9bd4/South+Australian+Public+Health+%28Immunisation+and+Early+Childhood+Care+Se….pdf?MOD=AJPERES&CACHEID=e5864f8041f20af5a01de640535c9bd4

http://www.ncirs.edu.au/consumer-resources/no-jab-no-play-no-jab-no-pay-policies/

http://www.dhhs.tas.gov.au/publichealth/communicable_diseases_prevention_unit/immunisation/childhood

http://healthywa.wa.gov.au/Articles/S_T/Starting-or-moving-schools-immunisation-records

http://www.health.act.gov.au/sites/default/files//Publications/Requirements%20for%20entry%20to%20school%2C%20preschool%20and%20childcare%20%E2%80%93%20Parent%20Handbook%202017.pdf

https://www2.health.vic.gov.au/public-health/immunisation/vaccination-children/no-jab-no-play/early-childhood-professionals

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Bec Lloyd

Bec Lloyd is the founder and managing director of Bec & Call Communication, providing professional writing, editing and strategy services to the school and early childhood education sector since 2014. In 2018 she launched UnYucky mindset and menus for happier family mealtimes. Formerly the communications lead at ACECQA and BOS (now NESA), Bec is a journo and mother of three who produces Amplify for us at Community Early Learning Australia.

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10 thoughts on “When two policies collide: vaccination and universal access across Australia

  1. What concerns me regarding this legislation and which no one is discussing is the fact that the medical exemption form was changed prior to the legislation’s introduction removing the rights of many families with additional needs children to achieve medical exemptions for their child. Families of children with complex medical needs have a greater right for freedom of medical choice as they have children who are more likely to be impacted by adverse reactions to vaccines. In Australia we are being fed a fairy story that vaccines are 100 percent safe for nearly everyone and that all doctors are in complete agreement regarding the matter. This is not the case and we need to consider what this legislation is doing to families with vulnerable children in Australia. These families have the right to make these decisions for themselves and they should have the right question if poor quality epidemiological studies proves that vaccines are safe for their child without financial penalty. Currently these families are being vilified as anti vaxers, have had their child care benefit removed and have become so impoverished many of them can no longer afford therapeutic interventions for their children. It is a national disgrace that people are too ignorant to notice what is occurring right under their noses.

  2. With the new law passed in NSW, I as a parent now have no need for conversation with anyone about my vaccination choices. Which surely goes against the intentions of this legislation?
    There is no point discussing with my Dr to ask if he can provide me with a Conscientious Objection form, nor can I discuss with a childcare service as there is no point, they will be fined for admitting my child to their service.
    Sadly my youngest won’t be able to access early childhood education which is very disappointing, but not likely to force me to vaccinate her to the full schedule of injections.

  3. What a disgrace. Why does the government get to decide what i inject into my children. As a mother it is my decision what drugs or injections go into my childs body. Where is the study on vaccinated versus unvaccinated.

  4. I have an extremely healthy, flourishing, unvaccinated daughter. She is only 18 months old and still regularly enjoys breastmilk as part of our overall holistic health care of her. The only way that I could enrol her into any sort of care or early schooling would be to enrol her in the next 2 weeks (before Jan 1st, 2018). I prefer to keep her with me until she is at least 2 years old as part of her chance to have an attached caregiver, regular breastfeeding, low stress and a healthy immune system. This new law means that I will miss the chance to enrol her (based PURELY on TIMING) and she will then not be eligible for any enrolment opportunities for another THREE years! Does this seem sensible government policy? NOTHING will ever force me to vaccinate her. The government can take our benefits, they can refuse her schooling, but they can not control a mothers choices. EVER.

  5. Well, unfortunately they might Natalie. In some other countries you are forced to vaccinate your children, period. Otherwise you are an unlawful citizen, can have your child taken from you etc. Touch wood but I don’t see Australia very far from this unless we all fight together for a reform to this already horrendous unfair nosense policies. Big Pharma, war, drugs – pharmacological or not, oil, terrorism, all from the same religion where Money is God. Watch Death by Medicine https://youtu.be/aRBvMQBucxg PS> does anyone know the percentage of families who fell into the no jab no pay bribe? I don’t know of ANY. I didn’t!!! Good luck to we all.

  6. ps> mother of 4 amazing and super healthy happy and strong children who don’t take drugs including poisoning vaccines, aged 12 to 28. They barely get a cold!!!

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