Karen Andrews (McPherson, Liberal Party) Share this | Link to this | Hansard source

I am very pleased to support this legislation, the Australian Immunisation Register Bill 2015 and cognate bill, that further strengthens Australia's immunisation regime by improving our registration system and essentially extending the successful childhood immunisation register to a lifelong register.

Immunisation rates are something that Australia cannot afford to become complacent about. It is quite incredible to think that childhood immunisation rates were around 52 per cent when the coalition government came to office in 1996. We worked hard to improve those rates and get them to around 90 per cent, where they have remained fairly steady. We also introduced vaccination programs for new vaccines like the HPV vaccination for school-aged females. In fact, it was the former Prime Minister, the member for Warringah, who, as health minister, introduced this vaccine and other measures to improve vaccination rates. They are part of his substantial and positive legacy of service, and I thank him for that.

Rates of immunisation matter not just for individuals but for the benefit of our community as a whole. The concept of herd community means that if vaccination rates fall below a certain point it becomes harder to stop a major outbreak, which will potentially infect people who are unable to be immunised. These include children who are too young to be vaccinated, people with immune system problems and those who are too ill to receive vaccines. So maintaining high immunisation levels is vital to protect some of the most vulnerable people in our community. The proportion of the population which must be immunised in order to achieve herd immunity varies for each disease but can be up to 95 per cent for some highly infectious diseases. The underlying principle is the same: once enough people are protected, they help to protect vulnerable members of the community by reducing the spread of disease. The herd immunity threshold for measles is somewhere between 83 and 94 per cent. For whooping cough it is between 92 and 94 per cent. Nationally, Australia sits at 94 per cent for measles and 92 per cent for whooping cough. However, in parts of Australia, including the Blue Mountains, the Sunshine Coast, inner Brisbane, inner Sydney, Adelaide and Darwin, the rates have fallen below 85 per cent for five-year-olds. On the Far North Coast of New South Wales the rates are under 85 per cent in all three age groups.

So there are sections of our community where the herd immunisation rates are well below what is required to stop a major outbreak. This is why our government acted decisively to further improve rates with the No Jab, No Pay policy. From 1 January 2016 conscientious objection is being removed as an exemption category for childcare payments and the Family Tax Benefit Part A end-of-year supplement. Immunisation requirements for the payment of Family Tax Benefit Part A end-of-year supplement will also be extended to include children of all ages. Existing exemptions on medical or religious grounds will continue. However, a religious objection will be available only when the person is affiliated with a religious group where the governing body has a formally registered objection approved. This means that vaccine objectors will not be able to access these government payments. The new policy will tighten up the rules and reinforce the importance of immunisation and protecting public health, especially for children. This policy clearly reflects the value to our community of ensuring that immunisation rates remain as high as possible. Parents need to know that vaccinating their children is a clear responsibility that must be fulfilled in order to access government payments.

The overwhelming benefit of immunisation cannot be disputed. Vaccination is considered the most significant public health intervention in the last 200 years, providing a safe and efficient way to prevent the spread of many diseases that cause hospitalisation, serious ongoing health conditions and sometimes death.

I have been fortunate in my role as Assistant Minister for Science and previously as Parliamentary Secretary to the Minister for Industry and Science to meet with many of our scientists and researchers, including those working in the field of immunology. Australia certainly has a very proud record when it comes to health and medical science research and development. The success of vaccines to date has largely been due to their impact on acute infectious diseases, like polio and influenza. However, the future will see scientists focusing on the prevention of chronic diseases, like cancer, heart disease and Alzheimer's. Indeed, the HPV vaccine developed here in Australia by Professor Ian Frazer has really sparked the hunt for other cancer vaccines, leading to increased investment and renewed public expectations. Current vaccines protect against two types of virus which cause 70 per cent of cervical cancers. The future of immunology is certainly fascinating and full of potential. It is of course one of the many STEM disciplines we need to be encouraging and supporting.

As I mentioned previously, this legislation will strengthen the way we record immunisations and therefore our procedures for ensuring that people are fully immunised. The scope of our two current immunisation registers will be broadened. The Australian Childhood Immunisation Register will be expanded to become the Australian Immunisation Register, which will capture all vaccines given from birth to death through general practice and community clinics. The ACIR currently records vaccinations given to children aged less than seven years. It will be expanded in two stages. From January 2016 it will expand to collect and record vaccinations given to young individuals under the age of 20 years, enabling implementation of the government's No Jab, No Pay budget measure. From September 2016 it will be expanded further to cover all vaccinations from birth to death given through general practice and community clinics, supporting the addition of the zoster virus vaccine to the national immunisation program for persons aged 70 years.

At the moment the coverage of vaccines given to adults is difficult to gauge, as no comprehensive national data is collected for these vaccines. A whole-of-life Australian immunisation register will allow vaccination records from multiple providers to be recorded in the one register, which will allow accurate assessment of whether an adult requires a vaccination rather than relying on patient recall, which is notoriously unreliable. A national register will also allow vaccination providers to take swift action to provide vaccinations when required. Accurate monitoring of vaccine uptake can also assist in identifying areas of low coverage within Australia, including those at greater risk of infection during an outbreak. Targeted information can help boost immunisation rates in these areas. Vaccination reminder services and proactive follow-up by vaccination providers will allow people to be contacted when they are due or overdue for their vaccinations. The register will also enable them to be contacted if a booster vaccination is required in the future.

As I mentioned earlier, this bill also expands the National HPV Vaccination Program Register to become the Australian School Vaccination Register, which will capture the adolescent vaccinations given through school programs from the start of the 2017 school year. The HPV register currently only records recipients of the HPV vaccine. Other adolescent vaccinations administered through the schools program that would be captured in the Australian School Vaccination Register include chickenpox and the diphtheria, tetanus and pertussis—whooping cough—booster.

Of course, the establishment of these registers and the No Jab, No Pay policies are just part of our budget commitment to improve immunisation levels. We are also providing an additional incentive payment to doctors and other immunisation providers who identify children who are more than two months overdue for their vaccinations and catch them up. This will be paid on top of the existing payment doctors receive to deliver the vaccinations. We are also developing a range of communication activities, tools and resources to increase awareness and understanding of the National Immunisation Program and to address parents' concerns regarding immunisation, including dispelling common myths. Specifically, we will also develop tools to assist doctors in having important conversations with their patients who may have concerns. Of course, all of these measures are just part of our overall commitment to health, which totals over $69.4 million in the 2015-16 budget.

I know that our government, with its renewed sense of purpose, will continue to be one that delivers practical benefits to ensure the ongoing improvement of health services in the community. Unlike the Labor Party, which offers nothing but scare campaigns and trumped up figures that never would have been delivered, we will continue to deliver practical benefits and ensure a more effective and efficient health system. I am very pleased to support this bill, which is a vital part of our plan to strengthen immunisation rates and therefore improve health outcomes for Australia. I commend this bill to the House.

Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

On 11 June this year Australia's Chief Scientist, Professor Ian Chubb, made a statement in relation to vaccination. He said that Australia has a proud record in advancing the science of vaccination and making sure it is available throughout the community. We have one of the highest rates of vaccination in the world and, unlike previous generations, Australians do not grow up in the shadow of polio and diphtheria. He went on to observe that on an annual basis between two million and three million deaths are avoided worldwide due to vaccination. So the power of vaccinations is very well known. They harness the capacity of our immune system to protect against pathogens.

Although our awareness of immunisation can be traced back to ancient Greece, it was the pioneering work of Edward Jenner in the 18th century that led to the modern era of the vaccination. In what became a famous anecdote shared in classrooms around the world, he noticed that milkmaids who suffered from skin infections from cowpox were resistant to the dreaded smallpox. In the decades that have followed, with the widespread introduction of vaccination, deaths from diphtheria, whooping cough, tetanus, polio and measles have fallen to close to zero in countries like Australia.

A vital component of any efficient vaccination scheme is a structured immunisation register. Registers are a key tool in improving the performance of immunisation programs. They do this by collecting data on the vaccinations that have been given; generating notices and prompting people to have their next vaccination, booster shots and the like; providing certificates of vaccination; and monitoring vaccine coverage, including hotspots across the entire population. Registers allow us to identify deficiencies and to adapt and respond to new and emerging threats.

The Australian Immunisation Register Bill 2015, currently before the House, creates a new, consolidated framework for the two existing immunisation registers. These are the Australian Childhood Immunisation Register and the National HPV—human papillomavirus—Vaccination Program Register. The first of these, the ACIR, which currently records vaccinations for children aged seven and under, will be expanded to collect and record vaccinations given to young individuals under the age of 20. This enables the transfer of data necessary to implement the government's No Jab, No Pay social security measure. From the September 2016 the register will be expanded even further. This will enable the register to cover every single vaccination from birth to death given through GPs and community clinics. For the first time we will have the framework for a comprehensive national immunisation register.

The HPV register will be replaced with the Australian Schools Vaccination Register. This new register will be able to capture data to assist vaccination providers to boost coverage rates. This is a common sense change and one that is supported by the Labor opposition. Currently the HPV register only catches administration of the HPV vaccine. But there are other adolescent vaccinations out there given through school programs that would now be captured. These include chickenpox and the diphtheria, tetanus and whooping cough booster. The changes are needed.

We often seem to think that vaccinations only apply to children, but this, of course, is not the case. There are a large number of vaccinations out there recommended for adolescents and young adults. In fact, the number of vaccinations is increasing each year. In addition to the ones that I have mentioned there is also the influenza vaccination, pneumococcal, whooping cough for pregnant mothers and, more recently, shingles for older Australians. This is the very reason why clinicians and public health workers have long advocated for this change. It is to have some information available for adolescents and adults and children.

How will this help health experts stay on top of the diseases that threaten the health and welfare of all Australians?

The answer is that unexpected disease outbreaks still occur. Recently there has been an outbreak of whooping cough, particularly in northern New South Wales, and this has had tragic implications for newborn babies. There is also the prospect of measles returning to Australia, as has occurred recently in the United States. Comprehensive immunisation registers will help determine whether it is due to low vaccine coverage and will enable a better and more targeted response.

The bill enables the transfer of data to Centrelink. This is necessary because it enables the government to effect the No Jab, No Pay measure that encourages parents to have their children immunised. I note that in the budget papers the government is booking in excess of $500 million worth of savings to the No Jab, No Pay initiative. I sincerely hope that those savings are not realised—not because I do not want the government to be making budget savings but because I want parents to immunise their children. If parents are immunising their children at the rates that are necessary, these savings will dwindle. I would also argue that the government would make up for those lost savings in other areas of health expenditure.

The policy achieves its objective by removing conscientious objection as grounds for people being able to refuse vaccinations while still being able to claim family tax benefits and other social security benefits. It is not going to be popular with everyone, but it is a necessary initiative. In fact, it is an initiative that Labor took to the last election. We did it for a very simple reason. I know there have been complaints. I have received many emails from anti-vaccination campaigners throughout my electorate and throughout the country. I am sure the member for Lingiari, who is at the table, would have received similar complaints from around his electorate. The member for Lingiari and I know that it is unreasonable for those people to expect the collective benefits of welfare payments if they are not themselves contributing to the collective wellbeing of the population as a whole by having themselves and their children vaccinated against preventable diseases. It is for this reason that Labor wholeheartedly supports these changes. It is important that we improve vaccination rates across the country.

As I said at the outset, vaccination rates in Australia have been amongst the best in the world, but we cannot rest on our laurels. Vaccinations are vital to the welfare of all citizens. It is not just about protecting yourself or your child; herd immunity relies on everyone doing the right thing. As the assistant minister mentioned earlier, we rely on quite high percentages of the population being immunised to obtain what scientists call herd immunity rates. For diphtheria the rate is up to 85 per cent; for measles, between 83 and 94 per cent; for mumps, around 75 to 86 per cent; for polio, between 80 and 86 per cent; and for smallpox and rubella, somewhere between 80 and 85 per cent. Against this background it is of deep concern to all opposition members to know that the number of people claiming to be conscientious objectors to vaccination is increasing. Last year, according to the Department of Health, nearly 40,000 Australians had registered as conscientious objectors to vaccinations.

There are some towns throughout the country where immunisation rates are some of the lowest in the world. I am advised that the town of Mullumbimby has vaccination rates of below 50 per cent of the population. This is deeply concerning. At the very same time that we are providing resources to Garvan, along with other international aid organisations, to ensure developing countries throughout our region have access to the benefits of vaccination, we have towns and regions within Australia where vaccination rates are below those of some of the countries we are providing overseas aid to. This cannot be allowed to continue. It is not only irresponsible for the parents of those children; it is collectively irresponsible because it downgrades the capacity of the entire population to resist the outbreaks of certain diseases. So we think it is absolutely critical.

I have mentioned one town in northern New South Wales, but there are others where the rate of unvaccinated children is as high as 60 to 70 per cent. This is unacceptable. There are also other areas where this occurs, and we cannot blame low levels of education, as sometimes people are quick to retort, saying, 'If only we could educate the parents, we could improve vaccination rates.' It might surprise many to know that some of the lowest vaccination rates are in suburbs throughout northern Sydney, in areas like Mosman and Manly, and in the inner city and the eastern suburbs. We all, as public leaders, have a responsibility to talk about this and to ensure that we get vaccination rates up to where they need to be for the good of everyone.

It is important that we have preventative health measures such as these in place, but it is also important to ensure that we wrap around them health resourcing which ensures we are dealing with all areas of health policy. When we are talking about health policy, I cannot remain silent on the lacklustre policy of this government for the last two years when it comes to areas of health policy. We have seen absolutely disastrous attempts to make changes in the area of primary care, not only with the eradication of Medicare Locals and the black hole that existed for many months when people did not know how they were going to be replaced or where they were going to be replaced. We have seen the disaster in terms of the war the government has attempted to launch against GPs in this country, with the GP tax versions 1, 2 and 3 and the freeze on Medicare rebates which is, in effect, another GP tax. It is an attempt to get GPs to pass on a tax that the parliament itself has refused to pass.

These are other areas of health policy that are in drastic need of repair. The Abbott government was fundamentally incompetent at the task. The challenge remains for the newly installed Prime Minister to see whether he is up to the challenge. To date, he has had precious little to say about health policy, but the country is crying out for some certainty around hospital funding and the future of Medicare. These are initiatives that a government is judged on.

While we offer the government full-throated support in its initiatives to improve our levels of vaccination, for the benefit of the entire country, we are deeply critical about other areas of the government's health policy. I commend the bill to the House.

Kelly O'Dwyer (Higgins, Liberal Party, Minister for Small Business) Share this | Link to this | Hansard source

In 2014 the number of measles cases in Australia hit a 16-year high, with 340 cases across the nation. Even in 2015 unnecessary suffering is being endured by children and their parents due to an avoidable disease. It is resurgent because enclaves of unvaccinated children have allowed the disease to gain a foothold. So it is timely that we in this place seek to implement legislation that will help ensure more Australian children are vaccinated. As a parent with a young baby I strongly believe that it is critical we grant our children freedom from avoidable diseases.

There is certainly very strong evidence for the need to vaccinate our children. If enough members in a community are vaccinated we achieve herd immunity, meaning that a disease can effectively be eradicated. This was the case with polio. The introduction of the polio vaccine saw the number of local polio cases in Australia fall from 39.1 per 100,000 population in 1938 to zero in 1978. The problem is that when parents do not have their children vaccinated they not only put their own children at risk but also risk the health of the community of children, allowing the disease to gain a foothold. It is not only children who are at risk but also vulnerable people in our community.

Many of us have forgotten how dangerous preventable diseases, such as measles and polio, are because they have been controlled so well in Australia through comprehensive vaccination programs. The reality is that they are deadly diseases. According to the World Health Organisation, in 2013, there were 145,700 deaths from measles around the world. That is approximately 400 deaths a day. The number of reported polio cases worldwide, on the other hand, has dropped from 350,000 in 1988, to 416 in 2013. This massive reduction was made possible through a global effort to immunise children. We must not underestimate the benefits that vaccination brings. However, with a highly infectious disease, such as measles, the immunisation rate required to interrupt disease transmission is above 95 per cent—a mark we have not yet met.

Immunisation rates in some parts of my electorate, Higgins, are concerningly low. According to 2012-13 data from the National Health Performance Authority, in Stonnington-West, which includes the suburbs of Prahran, Windsor, Armadale, South Yarra and Toorak, only 85.7 per cent of five-year-olds were fully vaccinated. This is compared to a national average of 91.86 per cent, at the time.

The Australian Immunisation Register Bill 2015 seeks to implement a comprehensive framework for our national immunisation registers and to expand the scope of our two existing immunisation registers, the Australian Childhood Immunisation register and the National Human Papillomavirus Vaccination Program Register. The changes made in this bill will help to increase national immunisation rates, along with the government's No Jab, No Pay budget measure. This latter measure is important because we need to provide parents with the incentive to ensure that their choices in not vaccinating their children do not impinge on the rights of other children to be free of the disease. The measures proposed in this bill work practically, in two ways, to encourage and track immunisation.

Firstly, the Australian Childhood Immunisation Register will be expanded to become the Australian Immunisation Register. This new register will, ultimately, capture all immunisation information, from birth to death, for vaccines detailed under the national immunisation program. This expansion will happen in two stages. The first, to start from 1 January 2016, will expand the register, which currently only tracks immunisation data for those under seven years of age, to collect vaccination records for all individuals under 20 years of age. This change will go hand in hand with the No Jab, No Pay budget measure, as it will allow the government to ascertain which families are entitled to family assistance and childcare payments on account of their children having been vaccinated.

The second stage, set to occur from September 2016, will expand the register to collect vaccine information for Australians of all ages. This will accommodate the introduction of the shingles vaccine into the national immunisation program for 70-year-olds. This is a highly practical and humane measure. The second immunisation register, currently in place—the National Human Papillomavirus Vaccination Program Register—will be expanded, under this legislation, to become the Australian Schools Vaccination Register from the beginning of 2017. This is significant, as there are a number of vaccines administered in schools that are not adequately recorded and, as a result, immunisation rates for adolescents in Australia are not well known. This includes information about vaccines for chickenpox, tetanus and diphtheria and the whooping cough booster. All of these can be extremely serious diseases and we should ensure that our adolescents are protected.

The expansion of our two existing immunisation registers will give vaccine providers the data they need on areas where immunisation rates are low, and it will allow them to send out the necessary reminder letters in an effort to improve vaccination rates. This bill also lays down important groundwork for a single immunisation register that may exist, in Australia, in the future.

In conclusion, we must ensure the ongoing protection of our children from easily preventable diseases by improving immunisation rates. The first step in doing so is to gather data on the current levels of vaccination. With this data we can target areas of the community where immunity is low to better protect our entire citizenry. This bill is therefore a major step in reducing the incidence of vaccine-preventable diseases and is good news for all Australian children. I commend the bill to the House.

Jim Chalmers (Rankin, Australian Labor Party, Shadow Parliamentary Secretary to the Leader of the Opposition) Share this | Link to this | Hansard source

Not for the first time I am in screaming agreement with the member for Higgins as she leaves the chamber. We should mark the occasion! I think the member for Higgins made a great deal of sense in her contribution to the Australian Immunisation Register Bill 2015. Like the member for Higgins and the member for Throsby, who spoke before her, and like other speakers from both sides of the chamber, I am a strong supporter of the immunisation of young people—children in particular—against dreadful diseases like diphtheria, tetanus, hepatitis, chicken pox, measles, polio, mumps and rubella.

This legislation consolidates the legislative framework to manage and expand the two existing immunisation registers, and it also broadens their scope. The Australian Childhood Immunisation Register will expand to collect and record vaccinations given to young people under the age of 20 from the start of next year and then, in September 2016, will be expanded to cover all vaccinations from birth to death. This is a good outcome and a good idea. The HPV register will be replaced with the Australian school vaccination register, which will broaden the immunisation data collected by school vaccination providers to include more types of immunisations administered in schools. I am very pleased, and this side of the House is very pleased, to be supporting this legislation through the House today.

There is a bit of a baby boom happening in the parliament at the moment. There are a lot of new parents in this building, including the member for Higgins, who spoke before me. A whole range of us in this place have become parents—the member for Kingston, the member for Adelaide, the member for Pearce very, very recently, and the member for Charlton recently had his second child. There are a whole bunch of us in this place—the member for Mitchell and the member for Greenway, a little bit earlier. Last year, was it?

Michelle Rowland (Greenway, Australian Labor Party, Shadow Assistant Minister for Communications) Share this | Link to this | Hansard source

It was a little while ago.

Jim Chalmers (Rankin, Australian Labor Party, Shadow Parliamentary Secretary to the Leader of the Opposition) Share this | Link to this | Hansard source

Three now! There is a whole range of us in this place who are recent parents, and I count myself among their number. I think one of the hardest parts of being a new parent—although people tell you it is the sleep or something like that—is taking the little bloke or the little girl along to their immunisation experience. You know in your head that it is in your child's best interest, but your instincts kick in and of course you want to protect your child from pain. But the long-term benefits far outweigh the short-term pain from the jab.

Fortunately, in my community the Logan City Council's community immunisation clinics have made what is a difficult day a whole lot easier. I want to spend some time paying tribute to my local council, which has been extraordinarily good and extraordinarily far-sighted when it comes to this issue. They have offered free immunisation for the community since 1979; so, for 36 years they have done that. Immunisations are now held weekly at six locations in Logan and are staffed by the most incredibly friendly, professional and helpful nurses. Over the last few months I have had cause to spend time with the nurses at Logan North Library and Logan Central Library just near my electorate office, and they really are the most extraordinary people. I want to thank them for the work that they do in our community.

The Logan City Council also offers a school-based immunisation program to local students in grade 8 and grade 10. Logan is also the first council in Australia to offer a vaccination outreach program to at-risk families in our communities who are less likely to take up that offer of free immunisations. For a long time now—36 years or so—we have had free immunisations, but there has been a group in our community which, for whatever reason, is less likely to take up that opportunity. Now we have an outreach program, which is very important to getting more kids immunised.

In 2009 the council found that in parts of my electorate those immunisation rates had fallen to unacceptable levels. Scientists believe that to have full effectiveness vaccination rates should reach at least 95 per cent. In Queensland just over 90 per cent of children aged between one and five are vaccinated, so we need to do better there. In 2009, when the council turned its attention to this issue, parts of my electorate were dropping towards the 80 per cent range. One of the reasons for this was lack of transport. That was one of the key reasons parents offered up for not getting their children vaccinated. So, in order to make immunisations more accessible, nurses involved in the outreach vaccination program now visit at-risk families in areas of Logan every Wednesday.

Now the program is vaccinating around 1,500 people every year at their home, which means 1,500 people every year are protected from suffering potentially life-threatening diseases themselves or from passing disease on to others, many of whom would not have been vaccinated were it not for the program. Again, I salute Logan City Council for that outreach program. I encourage other councils around the country to take up the Logan model, because it is doing such good in our community.

We all benefit from high rates of immunisation, as the member for Higgins, the member for Throsby and other speakers have said. We are all aware of the theory and the practice: vaccines trigger the immune system to fight against certain viruses, which makes the immune system able to respond to diseases more effectively. The World Health Organization puts the benefits of vaccination very, very clearly when they say that:

Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better.

There are incredible benefits of vaccination at the individual level, with decreased likelihood of contracting those deadly diseases and decreased severity if the disease is contracted. For society as a whole the benefits are even greater, with vaccination associated with what economists, in economicspeak, would call positive externalities. It was the World Health Organization that estimated that vaccines prevent almost six million deaths annually. In the US there has been a 99 per cent decrease in the incidence of the nine diseases for which vaccines have been recommended for decades. The greatest value of vaccination comes from what scientists call 'herd protection', which occurs when a sufficient proportion—usually 95 per cent, as I said before—of the population is immune. That is why getting every child immunised is so important, not only for their own protection but for the protection of others as well.

The Australian experience is that vaccination has been incredibly successful. One disease, poliomyelitis, was declared eradicated in Australia in 1987—because of vaccination. Smallpox was declared eradicated in Australia in 1938—because of vaccination. Measles was declared eliminated in Australia in March 2014—because of vaccination. But we still have a bit more work to do. The story is not all good for vaccination in Australia. In September 2014, the Department of Health reported that the rolling annualised rate of children fully immunised by two years of age decreased again by 0.9 per cent to 89.2 per cent. Further, measles re-emerged in Brisbane this year, with seven cases detected at the University of Queensland's St Lucia campus. More of these isolated outbreaks are likely to occur if we do not work to increase our community vaccination rates. All Australians should have an interest in ensuring all young people are fully immunised and taking advantage of the free vaccination programs available across the country—and perfected in my community.

Those are some of the reasons why Labor will be supporting this legislation before the House today. The broadening of the Australian Childhood Immunisation Register to become the Australian Immunisation Register and to include all vaccinations from birth to death will do a lot to help us understand vaccination trends and potentially improve vaccination take-up rates. Given the increasing number of vaccines now recommended for adolescents and adults in Australia—influenza, pneumococcal, whooping cough for pregnant mothers, HPV for adolescents and young adults, and shingles for older people—it is time for us to collect that information on behalf of all Australians and to put it to good use.

If unexpected disease outbreaks do occur, as recently with whooping cough—with tragic consequences for newborns—and with measles at UQ, immunisation registers will help determine whether they are due to low vaccine coverage in an area and will enable a better targeted response. They will also help us to determine areas and demographics on which to focus outreach and vaccination advocacy programs—as per the successful models seen in my community of Logan City.

This is why Labor will be supporting the Australian Immunisation Register Bill before the House today. I am very pleased to see that all sides of the House support the bill. We do so because we want to see the end of certain debilitating viruses in our lifetime—or certainly in the lifetime of our children. I sincerely support any initiative to increase the vaccination rate among young Australians, I support Logan City Council's vaccination outreach program, I support this bill and I am pleased to see that all members in this place are also likely to support this important legislation.

Matt Thistlethwaite (Kingsford Smith, Australian Labor Party, Shadow Parliamentary Secretary for Foreign Affairs) Share this | Link to this | Hansard source

I support the Australian Immunisation Register Bill 2015. Recently my wife and I were fortunate enough to welcome two beautiful new daughters—twins—into our family. When I look at those beautiful four-month-old babies and I think about how much they rely on their parents, I think that probably the most vulnerable a human being can be over the course of their life is when they are a newborn. They are completely reliant on their parents for their welfare, for their health and indeed for their survival. Without the support, the care and the nurturing of a parent, newborns simply do not survive. In many cases, going back centuries, that was the case—that children did not survive without the proper care and support of their parents.

Because of that, parents have a natural instinct, an in-built instinct, to care for their young children. In our society, through government policy and through legislation, we encourage that natural instinct. We in many respects enshrine parental duty in policy and legislation—a duty to care for and bring up their child to ensure they do survive and grow, to ensure we are catering for their every health and welfare need. Part of that obligation, in my view, is to ensure that a child is healthy. That entails accepting the conventions and the positive nature of western medicine and the advances of western medicine, particularly when it comes to vaccination against disease in children.

I have received a small number of emails from parents and constituents in Kingsford Smith who do not believe that vaccination is the most appropriate way to care for a child, to nurture a child, to grow a child. I accept a parent's right to have differing views about the way they wish to raise their children and to cater for and care for their health. That is a parent's right—it is both human nature and a human right. But, from a government perspective, in order to put in place policies to achieve greatest social benefit—the greatest need for the greatest number of individuals—the position on vaccinations is clear, in my view. The benefits far outweigh the costs. Quite simply, vaccination saves lives. The statistics and the evidence support this. Medical and scientific evidence now consistently asserts that vaccination is the safest and most effective way to protect a child and an adult from harmful diseases.

In June of this year, the Office of the Chief Scientist released a report on vaccinations, and the conclusions of that report are, I think, instructive for what is in this bill that we are debating here today. Those conclusions are that the risks of severe side effects from vaccinations are extremely rare. In fact, in terms of a statistical analysis, the data on severe side effects of vaccinations are that it is a one in 100,000 to one in one million chance of a child experiencing harmful side effects from vaccinations. So a side effect from vaccination is an extreme rarity.

The World Health Organization estimates that each year vaccinations prevent two million to three million deaths from preventable diseases. So the evidence and the medical research are, quite simply, irrefutable: vaccinations save lives. From a government perspective, we need to do all we can to ensure that we are encouraging as many children in our society as possible to be vaccinated. Vaccination works. Vaccination prevents disease, as we have seen, and in some cases completely eradicates diseases—smallpox is the classic example. We as a society are on the cusp of ridding the world of polio. But preventable diseases that many Australians do not believe exist in our society anymore because they are so rare due to vaccination, such as tuberculosis and whooping cough, still occur in other nations and, in some cases, in Australia. That is why it is important that as governments we are doing all we can to support and encourage the uptake of vaccination within our community.

My own consultations with local doctors in our community also provide me with peace of mind that vaccination is the best way to go in protecting the interests of children and preventing disease. Every local doctor whom I have consulted is of the view that the benefits of vaccination far outweigh the costs. In my view, the debate is one in which the evidence is quite clear: that vaccination is important, that we need to encourage vaccination, that we need to provide incentives for parents to vaccinate their child and that vaccinations save lives.

And that is why this bill is worthy of support. This bill establishes a new legislative framework to manage and expand the Australian Childhood Immunisation Register—the ACIR—and the National Human Papillomavirus Vaccination Program Register, or the HPV program. The ACIR will expand in two phases under this legislation. In January 2016, the ACIR, which currently records vaccinations for children aged seven and under, will expand to include those under the age of 20. The purpose of this change is for the implementation of the No Jab, No Pay policy, which is a positive measure and one that I support. From September 2016, the ACIR will further expand to cover all vaccinations from birth to death and to become a national immunisation register.

This bill also replaces the HPV register with the Australian School Vaccination Register, which captures a greater number of vaccinations, such as chickenpox, tetanus and whooping cough. The use of data in the management and delivery of health care, a relatively recent phenomenon, has become increasingly important in the support of evidence based health care which promises greater outcomes and saving a far greater number of lives across Australia.

Established in 1996, the ACIR has provided the opportunity to improve vaccination rates, in particular through the targeting of regions and demographics identified as having gaps in vaccine coverage. Indeed, through immunisation and the elimination of carriers to spread disease, it is even possible to completely eradicate some diseases. I have mentioned smallpox as one of those that were eradicated, but the same effect is being had with polio.

But the threat remains. Measles and whooping cough continue to be diseases which afflict, in particular, too many children in our community. There is a threat of measles returning to Australia, as was recently the case in America, with 644 cases recorded in 2014 despite the disease being declared eliminated there 15 years ago. With the threat of disease remaining high, there has been a concerted effort from health professionals, including the Public Health Association of Australia, which has been advocating for over 10 years for the expansion of the ACIR to include adults, and that is what this bill actually does.

With an increasing number of vaccines now recommended for adolescents and adults in Australia, such as influenza, whooping cough for pregnant mothers, shingles for older Australians and HPV for adolescents and young adults, the national immunisation register is an idea that will boost the vaccination and immunisation of people under those categories.

The bill will also facilitate the transfer of data to Centrelink to allow the government to undertake the No Jab, No Pay measures that encourage parents to have their children immunised by removing conscientious objection as a ground for being able to refuse vaccinations while still being able to claim family tax benefits. I mentioned earlier that governments have a duty to cater for the greatest need for the greatest good. That is what this particular measure does. I know some within our society and, indeed, within our community have been opposed to this, but, from a government perspective, there is no real alternative. The government must use public policy incentives to ensure that we increase the rates of immunisation in our community and that we do all we can to ensure all children in Australia are immunised against preventable disease. That is what this measure will do. It will boost that incentive and that rate of immunisation within our community and, on that basis, I support the measure. It builds on a number of measures that Labor undertook in government. When we were in government, we made important changes to family payments to lift immunisation rates, including linking the family tax benefit end-of-year supplement to immunisation.

Labor is committed to ensuring that every child grows up healthy, happy and strong. We also believe that parents have a right to a say when considering health decisions about their child, but, when it comes to immunisation, there is a strong public health interest in ensuring that every child is immunised. We have seen all too frequently, unfortunately, tragic stories of children who passed away in the vulnerable early years—particularly in the first year of life—from preventable diseases such as whooping cough. They are simply tragic stories. With the advances in medical science and with the changes in evidence based medicine that have occurred over the last century, we know that immunisation works and we know that we can prevent diseases such as whooping cough and measles from killing young children. That is why this initiative must be supported by the parliament.

Good health care is not just about the child-years; it is about cradle-to-grave health care. That is why it is pleasing to see, as part of these reforms, measures that will also increase the rate of immunisation amongst adult Australians, particularly with respect to HPV. That will ensure that we are not only doing all we can for vulnerable children but preventing diseases from cradle-to-grave in Australia. That is a sign of a good healthcare system. That is why Labor has been so vehemently opposed to the changes sought to be made by the Abbott and the Turnbull governments: cuts to health care, in particular, and the Medicare co-payment, which would have put a cost on seeing a doctor—the important first level of preventable health care in our country. The $50 billion worth of cuts to hospitals that are still sitting in the budget papers have had an effect on the Prince of Wales Hospital in the community that I represent, with beds being closed and positions lost. Cradle-to-grave health care is not simply about providing the right incentives for immunisation; it is about ensuring that we are providing the necessary resources through the whole healthcare system to prevent disease. This is an important measure that will ensure that we are doing all we can to provide the right incentives for parents to immunise their children and for more adolescents and adults to become immunised against preventable disease. On that basis, I support the legislation.

Alannah Mactiernan (Perth, Australian Labor Party) Share this | Link to this | Hansard source

Last year there was a very interesting novel published by a former Western Australian, Joan London. It was a book called The Golden Age. Joan's novels are generally fantastic and this one was no exception. The Golden Age is abook about the polio epidemic in Perth, in Western Australia, in the late 40s and the early 50s. For those who did not live through that or only have a vague folk memory from lessons passed down from the older generation, it is absolutely critical to read this book and understand what can occur in a community like ours—a sophisticated Western society—with the fear that comes with epidemiological disease, where the community can be highly fractured. One of the things that Joan London points out and captures extremely well in this book is the fear and anxiety that emerged from this disease, which affected vast numbers of Australian children. One in 1,000 children in Australia ultimately contracted polio, so parents were incredibly fearful of the impact of this disease.

Joan's novel showed the way in which fear drove some very severe reactions in the community. It tore communities apart. People became suspicious of each other and marginalised others. If someone in a family contracted the disease, there was often a great deal of stigma attached to that—a belief that the family's lifestyle was unhygienic; that they were in some way less hygienic people because of this disease. Families had difficulties in dealing with the sheer physical disability created by this disease and there was the ultimate establishment of facilities where children would be basically exiled for numerous years. In many cases, in that process they became very separated emotionally from their families and they took that with them throughout the rest of their lives. So, for those of us who perhaps have never lived through an epidemic, it is really important to understand the direct physical result of this. I think one in 20 children who contracted polio died and many more had a disability that remained with them for the rest of their life. So it is not just the direct physical impact, but then there are all the psycho-social consequences that can attend upon that.

So it is important for us to consider what this great mischief is that requires us to take a pretty hard line on the issue of vaccination. On this side of the House we have supported the No Jab, No Pay policy and we support this latest extension of that policy, which is to remove the exemption on the basis of conscientious objection. We think this is something that is undermining the very nature of the policy. Also, we are supporting the strengthening of the data we have about the immunological profile of our community, through the formation of and strengthening of the various registers, which will give us a better understanding of the penetration of vaccinations.

I have had some letters of concern, and I think there are some legitimate concerns raised around the emphasis that is being placed on, perhaps, people of lower incomes—that is, those who, by and large, have a reliance on the family benefits and various subsidies to which we are attaching the No Pay, No Jab rules. I heard with interest the member for Higgins, representing largely a very wealthy area in Melbourne, noting that in her electorate there are some of the lowest immunisation rates. That indeed reflects the research that has gone on across Australia—that indeed it is those wealthier areas that have the lowest rates of immunisation. I think this is a question we are going to have to address. For the effectiveness of these vaccines in respect of highly contagious diseases, to get proper herd immunity we need about a 95 per cent coverage rate. For diseases that are still communicable but perhaps not as readily transmissible we need a coverage rate of around 90 per cent. I think it is only fair that we ensure the burden—if I can call it that—of ensuring this level of herd immunisation does not fall disproportionately upon those people who are in the lower income brackets.

So I think we need to keep ourselves very much alive to who is being immunised and who is not. We do in fact have another lever available to us if we do not see the immunisation rates increasing equally across all socioeconomic groups. I put it to the government that just as we are quite rightly, and with the full support of the opposition, looking at family tax benefits and the child care payments as the leverage point, it may well be that if we continue to see this disproportionate level of vaccination we should also consider attaching it to the subsidies the federal government pays directly to government schools.

This is a really important issue and we need to ensure that we have the vaccination rates up there. But we must make sure that the task of ensuring we do this is spread evenly. I have had a very personal experience with this. When my daughter was only four weeks old, before she was capable of having her first shot, she contracted whooping cough. It was a really quite horrific experience to take this very small baby into the hospital and learn that she was clearly struggling with this condition. In the weeks before, she had had exposure to a child whose parents had not immunised the child. It is quite possible that that was the source from which she contracted whooping cough.

We have this great vulnerability. We need to understand that the scientific evidence has overwhelmingly shown us that the benefits of this vaccination program outweigh the risks. And, of course, there is some risk with everything. There are no free lunches in medicine, as there are no free lunches elsewhere. But all of the scientific evidence is really showing us that overwhelmingly the benefits outweigh the risks. On this issue we need to be putting the rights of the community before the rights of the individual, because it is only as a community that we can stamp out these illnesses. This cannot be something that becomes purely a matter of personal choice, any more than the issue of paying tax becomes an issue of personal choice—although with some of our tax laws some of us might be forgiven for believing there is an element of choice, for at least some in our community!

This is very important legislation and it is very important that we develop a very sound policy and that we have a database that is going to enable us to understand, with great clarity, just exactly how we are going in terms of this coverage, so that we can really plan our health policies around that.

To repeat: I think we have to look very closely at the reality behind the reflection made by the member for Higgins about the groups in society that, in fact, may not be pulling their weight in an immunological sense and look at how we can apply other Commonwealth financial levers to bring them into the herd, along with everyone else, to make sure that we get this right.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the Australian Immunisation Register Bill 2015. I believe it is very important legislation. The bill before us today establishes a new consolidated legislative framework to manage and expand the two existing immunisation registers. From 1 January 2016, the Australian Childhood Immunisation Register, or ACIR, which currently records vaccinations for children aged seven and under, will be expanded to collect and record vaccinations given to young individuals under the age of 20 years. I think that is particularly important with the newer vaccines that have been developed in recent times. It is important that this data is transferred so that the government's No Jab, No Pay budget measure can be implemented.

Prior to the last election, this was one of the policies of the Labor Party, and we are very consistent. We support good policy and this is good policy. It is something that I believe many, many Australians would endorse. There are some people who are conscientious objectors to immunisation. I acknowledge that fact, and this legislation will not force them to immunise their children. This legislation will lead to a situation where, if they do not immunise their children, they will not receive financial support from the government.

The other component of this legislation is that, from September 2016, Australia's immunisation system will be expanded further to cover all vaccinations from birth to death given through general practice and community clinics and become the Australian Immunisation Register. It will have considerable important data and will be a way to monitor, over the long term, the impact that immunisation has within our society. The bill also replaces the human papillomavirus register with the Australian School Vaccination Register. Once again, it is broadening a really good policy. The ASVR broadens the immunisation data, and that will assist vaccination providers to boost the coverage rates. That will make sure that more and more young Australians are immunised. Other adolescent vaccinations administered through the schools program are chickenpox, diphtheria, tetanus and the pertussis-whooping cough booster. It is a way of ensuring that young people have the vaccinations that they need.

It is almost 50 years since infant vaccinations for diphtheria, pertussis and tetanus became routine in Australia. The incidence of vaccine preventable diseases has declined dramatically. We have used existing vaccination records and the recollection of experts to compile a history of vaccination, and that has been quite useful because it demonstrates, very visually, the impact that vaccination has had in our society. I was looking at some figures that showed that, from 1926 to 1935, there were 4,073 deaths from diphtheria in Australia. From 1996 to 2000—I am working from a table that ends in 2000, but I can confidently say that the figures are the same now—there were zero deaths. So we have gone from over 4,000 deaths from diphtheria to zero deaths. To my way of thinking, that is a fantastic outcome. That is the kind of outcome that you like to see. It is good preventive health care, and the best kind of health care is preventive health care. That is why governments invest in preventive health care—and that is why I have been a little upset about the Abbott-Turnbull government not investing in preventive health in the way that they should. Taking money out of preventive health is really bad health policy. But I have to compliment them on following through on the Labor policy of No Jab, No Pay and maintaining a commitment to ensuring that young Australians and all Australians maintain their vaccinations, that we have a good record of the vaccinations and that incentives are put in place to ensure that people are vaccinated.

Since the introduction of childhood diphtheria vaccinations, which I was talking about just a moment ago, in 1932, there has also been the introduction of vaccines for tetanus and pertussis, which, for the record, is whooping cough. When the immunisation rate for whooping cough goes down, we hear about epidemics that take place. There have been a few of those in recent times—it is particularly dangerous for babies—and it really shows how important it is that we are vigilant in ensuring that Australians are immunised for whooping cough—and, of course, poliomyelitis in the 1950s. We have parliamentary friends of the late effects of polio in this parliament, and many of the members have met with people and constituents who are living with the late effects of polio. Former Senator John Tierney is one of those people. Representatives of the group Polio Australia will be down here in parliament this week, meeting with members and reminding us just how important it is to be immunised against diseases such as polio.

My own grandfather was a victim of polio. He did not lose his life, but he had a permanent disability and had to wear calipers throughout his life. The shadow minister for health's mother also is a survivor of polio. So these diseases were just so prevalent within our society, and the thing that changed that was immunisation. By immunising babies, children and adolescents, we are preventing the spreading of these diseases. It is in countries like Pakistan, where polio still exists and where there is suspicion about the immunisation of people against polio, that we still have a problem. So we need to get the message out very strongly into the community that immunisation saves lives. It is one of the best preventative health measures that can be introduced. You cannot separate the reduction in deaths and the incidence of these diseases from immunisation. It is the best argument that you could put forward for immunisation.

I know there are many people who feel that there are risks associated with immunisation, but the risks associated with not immunising are far, far greater. I have a niece who is quite an expert in the area of autism, and she had a baby and—because autism is one of those illnesses or disabilities that people tend to associate with immunisation—I asked her what she thought about it and whether or not she would be having her child immunised. She said to me that she has not seen any research that substantiates this. There was a paper that was prepared—I think it was in the UK—but that paper has been largely discredited. She said that without a doubt she would be immunising her children and she knew that immunisation saves lives.

This bill creates a new consolidated framework, as I have already said, and it further refines the monitoring of data, because it is important to monitor data and to make sure that people are having the immunisations that they need. It is going to ensure that children, young people and even older people follow through and they have all the vaccinations that they need from birth to death. That is the thing that is so exciting about this legislation.

One aspect that I am a tiny bit uncomfortable about relates to No Jab, No Pay, which I support. But I worry about some people that will not get the information or will not understand the information and will not be able to relate the fact that they are not being paid their Centrelink payments to the fact that their child is not immunised. They may not have their child immunised, because in their daily lives the importance of immunisation does not register. So I think there needs to be a very strong education campaign around the need to immunise. I do not think that we can ever move away from the fact that it is vital to educate all Australians that immunisation is imperative for good public health. The benefits of immunisation flow to all sectors of society and to all people, and it is so important that immunisation continue.

As I mentioned very briefly a moment ago, prevention is one of the most important public health measures that a government can put in place. I am really disappointed that the government cut $800 million from the health flexible grants. That will impact on community health groups. The cuts to preventative health will also impact on the overall health of Australians.

So immunisation is important, but all those other preventive health measures and the flexible health grant funds are very important too. The government needs to be very thoughtful of the impact that the freeze on Medicare will have on Australians; it can lead to fees, a GP tax or a GP surcharge, that will prevent people from accessing their doctor and prevent them from having the immunisations that they need.

This legislation is good legislation. It has my support. But I must say that the government has a lot more work to do in the preventive health area, and if it does not embrace preventive health then the consequences will be enormous.

Russell Broadbent (McMillan, Liberal Party) Share this | Link to this | Hansard source

I thank the member for Shortland for her contribution. Before I introduce the assistant minister, I would like to congratulate him on the role that he has been given by the Prime Minister. The question is that the bill be now read a second time.

Alex Hawke (Mitchell, Liberal Party, Assistant Minister to the Treasurer) Share this | Link to this | Hansard source

Thank you, Mr Deputy Speaker Broadbent, for those kind words. I do want to sum up these important bills in this important debate that we have had here in the chamber today, and I will start with the Australian Immunisation Register Bill 2015. The Australian Immunisation Register Bill 2015 creates a new consolidated legislative framework for the establishment and ongoing management of Australian immunisation registers. Currently, separate legislation within the Health Insurance Act 1973 and the National Health Act 1953 provide the foundation for how the two national immunisation registers are operated. In this context, it is considered timely to consolidate the two pieces of separate legislation for the Australian Childhood Immunisation Register and the human papillomavirus register into new legislation to provide for the ongoing management and data capture for both registers. This bill will lay the foundations for future work to move towards an integrated system that captures and reports on all vaccines given in Australia from birth to death, providing a single front door for consumers and immunisation providers.

This bill provides the foundations under which Australian immunisation registers are operated. The bill facilitates the appropriate collection of Commonwealth assigned identifiers, such as Medicare number, for the purposes of the registers. The bill provides for the establishment of the register and the reporting of certain personal information about individuals. The bill also creates an offence for the unauthorised disclosure of personal information contained within the Australian Childhood Immunisation Register. The bill will allow the register to facilitate cross-referencing of information about the vaccination status of individuals to databases developed for the purposes of the register.

I want to thank all members in this chamber for their contributions to the debate on this bill—the government members, of course, for their strong support for the government's legislation, but also opposition members for their very strong bipartisan endorsement of this important legislative approach that the government has taken. I do want to thank all members and commend all members on the very personal stories and experiences that they put forward during the course of this debate highlighting the urgent and important direction that the government is taking in this regard.

Through this bill, expansion of the national immunisation registers and the way they continue to operate in the future will not only benefit the health of individuals. General practitioners and healthcare providers will have a consistent way in which immunisation records can be obtained for individuals of all ages and not just the young.

Turning now to the Australian Immunisation Register (Consequential and Transitional Provisions) Bill 2015—obviously, the consequential and transitional arrangements coming from the immunisation register bill—this bill will provide for the consequential and transitional provisions required to support the operation of the Australian Immunisation Register Act 2015. Again, I thank members for their contributions to this debate and the manner in which this debate was conducted.

The Australian Immunisation Register Act 2015 will have amendments that commence in three stages. Part 4A of the Health Insurance Act 1973 will be repealed, along with the associated offence provisions relating to the register. These offences will be replaced by an offence under the new Australian Immunisation Register Act 2015. Additionally, minor amendments to subsection 130(5F) are proposed which will facilitate the disclosure of Medicare enrolment data to the register. Minor amendments to part 9BA of the National Health Act 1953 will be initiated to refer to a prescribed body within the meaning of the new Australian Immunisation Register Act 2015. The Freedom of Information Act 1982 schedule 3 will also be amended to provide for information in the registers to be exempt from disclosure under section 38 of the Freedom of Information Act 1982 in response to a freedom of information request. Amendments to the A New Tax System (Family Assistance) Act 1999 to allow the definition of a recognised immunisation provider to be consistent with the meaning of a recognised vaccination provider in the new immunisation register bill is also proposed to occur from 1 January 2016. Amendments to the Healthcare Identifiers Act 2010 will repeal the definition of the Australian Childhood Immunisation Register which links to the Health Insurance Act 1973 and refer instead to the register operated under the new Australian Immunisation Register Act 2015. Finally, amendments to the Child Support (Registration and Collection) Act 1988, the Human Services (Medicare) Act 1973 and the Human Services (Centrelink) Act 1997 are also proposed to prescribe that the Australian Immunisation Register Act 2015 is a designated program act.

Amendments commencing later in 2016 include changes to the Australian Immunisation Register Act 2015 to reflect the name change of the Australian Childhood Immunisation Register to become the Australian Immunisation Register and the provision to be able to collect vaccination information for all individuals regardless of age. A secondary amendment to the Healthcare Identifiers Act 2010 is proposed to repeal the definition of the Australian Childhood Immunisation Register and allow for the use and disclosure of healthcare identifiers for the purposes of uploading information from the register onto an individual's personally controlled electronic health record.

The final transition arrangement proposed is to commence from 1 January 2017 onwards. The provisions of the new Australian Immunisation Register Act 2015 will apply equally to the Australian Immunisation Register and the Australian school vaccination register. Following this expansion, part 9BA of the National Health Act 1953 will be repealed. The schedules listed in the transitional and consequential arrangements in this bill will only commence if the Australian Immunisation Register Act 2015 obtains royal assent.

Question agreed to.

Bill read a second time.