Jenny Macklin (Jagajaga, Australian Labor Party, Shadow Minister for Families and Payments) Share this | Link to this | Hansard source

I rise to support the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. This bill introduces a 2015 budget measure that will ensure children fully meet immunisation requirements before their families can access childcare benefit, childcare rebate or the family tax benefit part A supplement. The commencement date for this measure is 1 January 2016. This builds on important changes to family payments that were made by Labor in government that were designed to lift immunisation rates. We linked the family tax benefit end-of-year supplements to immunisations. Ahead of the 2013 election, Labor committed to further tighten immunisation requirements within the family payments system.

Let me say very clearly, Labor strongly believe in vaccinations. And we are pleased that the government is now taking this initiative. Labor are committed to strengthening immunisation rates so all Australian children have the best chance of growing up strong and healthy. Vaccines are arguably one of the most successful public health policies in human history. The mere fact that we can talk about terrible diseases like polio and smallpox as if they are some artefact of history is a testament to the success of vaccines.

According to the World Health Organization, immunisation averts an estimated 2.5 million child deaths a year. The Centers for Disease Control and Prevention estimate that vaccinations will prevent more than 21 million hospitalisations and more than 730,000 deaths among children born in the last 20 years in the United States alone. Of course, there are risks of side effects in some instances, but the science is very clear. The benefits far outweigh the risks. Vaccines work. It means less disease. It means healthier people in our communities. It means longer life expectancy for our citizens.

Higher rates of immunisations are vital for infant children who are too young to be vaccinated as well as for the elderly and sick who may be too frail to be vaccinated. High rates of immunisations are also vital to people for whom a vaccine may not produce a strong immune response. These vulnerable people in our community are generally protected from preventable diseases by what is called 'herd immunity'. This is where a large vaccinated population protect those who are weak or susceptible to disease. That is why it is so important that we maintain and encourage high rates of immunisation across the country. Just to give one example.

In December 2014, some 117 people caught measles in an outbreak that was traced back to Disney theme parks in Orange County in California. Fortunately, no-one died in the outbreak. But it could have been much worse. Measles is a dangerous and highly contagious disease. According to the World Health Organization in 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. In 2013, the number of deaths from measles had fallen to around 145,000. The evidence is compelling. Vaccines save lives. Falling immunisations rates increase the risk of outbreaks of preventable diseases and threaten the health of the most vulnerable members of our communities. Our responsibility as policymakers is to support policies that are designed to lift immunisation rates in the community.

There are some important exceptions to the No Jab, No Pay policy that I think are worth mentioning and that I hope allay concerns held by some members of the community. I know that many MPs and senators have been contacted by people in the community on this bill. Some people have raised legitimate questions around side effects and for those people I want to detail some of the exceptions that people may be interested in. Exceptions to the policy will apply for valid medial reasons, such as when a general practitioner has certified that vaccinating the child would be medically contra-indicated or that vaccination is unnecessary because the child has natural immunity from having contracted the disease in question.

Families with children participating in an approved vaccine study will be taken to meet the immunisation requirements for the duration of the study and similar rules will apply where a vaccine is temporarily unavailable. The requirements will also be met if a recognised immunisation provider certifies that the child has an equivalent level of immunisation through an overseas vaccination program.

Lastly, the secretary of the department will be able to determine that a child meets the immunisation requirements after considering any decision-making principles set out in a legislative instrument made by the minister. Importantly, immunisation requirements will also be extended to include children of all ages. At present, a child's vaccination status is only checked at ages one, two and five for the family tax benefit part A supplement, and up to age seven for the childcare payments.

Labor welcomes the commitment from religious leaders and organisations to support parents to ensure that children are vaccinated. Labor does think that parents should have the final say in making health decisions about their child but, when it comes to immunisation, Labor believes there is a strong public interest in ensuring children are immunised.

We note that the percentage of children under seven years of age with a conscientious objection recorded on the Australian Childhood Immunisation Register rose from 0.23 per cent in December 1999 to 1.77 per cent in December 2014. Removing non-medical exemptions will make clear the importance of immunisation and protecting public health. I want to emphasise that the choice made by families not to immunise their children is not supported by public policy or medical research. We want to see these changes implemented in a way that increases immunisation rates among vulnerable children and we ask that the government work with the childcare sector to ensure that children are not inadvertently excluded from early education and care.

Labor recognises the important work that Medicare Locals were doing to increase immunisation rates in local communities and welcomes the support to ensure the new Primary Health Network will continue this work. We also know that in many cases missed vaccinations are due to oversight rather than a specific objection. The establishment of a national immunisation register of school based vaccinations will assist all parents to do the right thing by their children. We ask the government work with the childcare sector to ensure children, as I said, are not inadvertently excluded.

We would also like to see a greater emphasis on public awareness campaigns. As our collective memory of disease outbreaks recedes in this country, it is important we remind people of the vital link between immunisations and disease prevention. In particular, we would like to see public awareness campaigns targeted at communities that we know have lower rates of immunisation—so-called refusal clusters. Labor also supports moves to explore a national immunisation register to enable adults to keep their vaccinations up to date.

This policy has been proposed by the family of Riley Hughes, the Perth baby tragically killed by whooping cough in March this year at just 32 days old. Riley's parents, Greg and Catherine Hughes, have urged others to get their children vaccinated. Greg and Catherine have also raised more than $71,000 for the Princess Margaret Hospital Foundation, which is far more than the $32,000 they had hoped to raise. Funds raised will go towards fighting terrible childhood diseases, such as whooping cough. I want to acknowledge tonight Greg and Catherine's brave advocacy.

This bill is not aimed at punishing people or denying people choice. It is all about increasing immunisation rates, preventing disease and, above all, saving lives. I commend the bill to the House.

Brett Whiteley (Braddon, Liberal Party) Share this | Link to this | Hansard source

I am not used to the member for Jagajaga finishing up early, but I thank her for her contribution. I rise this afternoon to speak on the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. It is a bill which delivers on our undertaking in the budget to enact measures to ensure our nation's children receive necessary immunisation against disease. From 1 January 2016, this bill will ensure children fully meet immunisation requirements before their families can access the childcare benefit, the childcare rebate or the family tax benefit part A supplement. This government believes in rights, but it also believes in responsibilities. This government makes no apologies for enacting a policy that will deliver better outcomes for our children, especially when it comes to ensuring their health.

Australian childhood vaccination rates are over 90 per cent across the ages of one, two and five. This is an excellent rate of vaccination and is part of the reason the health of our children is so good compared to countries across the world. While vaccination rates in Australia have increased since the Childhood Immunisation Register was established back in 1996, vaccine objection rates for children under the age of seven have also steadily increased. There has been a marked increase with the rise of social media and the impact of unfounded claims around vaccination of children. It is estimated that there are 39,000 children under seven years of age—1.7 per cent—who are not vaccinated because their parents are vaccine objectors. It is simply not right that these children are put at risk due to misinformation in this space.

This government are very concerned at the rate of vaccine objection and the risk it poses to the broader community. In the budget earlier this year we made the commitment to take steps to rectify this situation and we are delivering on that commitment today in this bill. The coalition government are strengthening immunisation requirements for children. From 1 January 2016, 'conscientious objection' will be removed as an exemption category for childcare payments—both the childcare benefit and the childcare rebate—and the FTB part A end-of-year supplement. Immunisation requirements for payment of the FTB part A end-of-year supplement will be extended to include children over 12 months old. From next year, no vaccination objections will be accepted in order to receive the FTB part A end-of-year supplement and childcare subsidies.

Exceptions to the policy will apply only for valid medical reasons, such as when a general practitioner has certified that vaccinating a child would be medically contraindicated or that vaccination is unnecessary because a child has natural immunity from having contracted the disease in question. Families with children participating in an approved vaccine study will be taken to have met the immunisation requirements for the duration of the study, and similar rules will apply where a vaccine is temporarily unavailable. The requirements will also be met if a recognised immunisation provider certifies that the child has an equivalent level of immunisation through an overseas vaccination program.

The coalition government takes the health of our children seriously. There are 39,000 Australian children under the age of seven who are not vaccinated at this very moment, because their parents are vaccination objectors. That is twice the population of the city of Burnie in my electorate of Braddon. Twice the population are, at this moment, at risk of contracting a serious disease. This government does not accept this state of affairs and is taking steps to rectify this situation.

The No Jab, No Pay policy that this bill seeks to implement will secure the health of our nation's children. The choice made by families not to immunise their children is not supported by public policy or medical research. It is simply fanciful to suggest that vaccination of our youngest Australians harms them in the way that many say it does. Australian children receive some of the best medical care in the world, and this government treats the health of our children as a priority. This is a public health issue. The government has determined that parents still have the right to be vaccination objectors, but their decision will not be endorsed by the provision of taxpayer funds in the form of child care benefit, child care rebate or the family tax benefit part A end-of-year supplement.

This government makes no apologies for enacting incentives to immunise our children, and that is what it is doing in this bill. I am proud to be part of a government which has the intestinal fortitude to take a hard stance against vaccination objectors who are risking the health and wellbeing of not only their own children but all children. I stand behind the No Jab, No Pay bill and I urge all members to stand with me. I would just like to reiterate that 39,000 Australian children are currently at risk of contracting disease due to vaccination objection. I think this is an absolute shame and I think this is something that this bill is long overdue to address.

Under the current system, eligibility for child care benefit and family tax benefit is linked to immunisation requirements, where children aged under seven must be fully immunised or have a valid exemption. To oppose the No Jab, No Pay policy is to endorse the position of the vaccination objectors, and that is something that the government are unwilling to do. The government will maintain exemptions, which, as I said earlier, include on medical grounds and for approved religions. Through this bill, the coalition government are delivering better health outcomes for our nation's children. We are taking a hard stance and we are strongly resisting the baseless proposition that vaccines are causing harm in our society. The government stand with our doctors and our medical professionals. We stand for a better future for all Australians, and that is why we stand for a No Jab, No Pay policy.

I think it is appropriate to acknowledge the small number of my constituents who made representation to my office in objection to this proposed bill. I say to those people that I respect that they have a different view in relation to this matter and I do respect that they have an entitlement not only to voice that view but to actually live it out, if that is their choice. But as I explained to each of them, the government, on behalf of all Australians, is also responsible for good public policy and good public health policy that, in this case, means that you can, if you are an objector, maintain your objection, but you will no longer be entitled to taxpayer benefits.

I will say though that, as a part of those discussions, one particular suggestion that came to me from a constituent is, I think, very worthy of consideration. It is that it would not be unhelpful for us, as a country, across all our state jurisdictions, to have a national register of children who have a radical reaction to immunisation and to have GPs' or specialist paediatricians' documentation attached to such a register. I do not think that is an unreasonable request for those that still see that this policy as something that they cannot support. They have made the case that there are examples—they would suggest many examples—of children negatively reacting to the immunisation programs of this country. I am not a medical expert, and I am certainly was not in a position to argue the toss one way or another with my constituents, but I did feel that it was a reasonable and sensible suggestion that we, as a country, through our health professionals, should be able to track such negative reactions to any of the immunisation programs.

Once again, I commend this bill to the House and I thank those opposite for the support that they are also providing.

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

I speak in support of the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015, which introduces a 2015 budget measure that necessitates that children fully meet immunisation requirements before their families can access child care benefit, child care rebate or the family tax benefit part A supplement under the provisions of this new legislation. Labor support the public health purpose behind this bill. In government, we made changes to family payments to lift immunisation rates, including linking the family tax benefit end-of-year supplement to immunisation. Before the 2013 election, we made the commitment to make further changes that would continue the push to increase immunisation rates across Australia, and we are pleased the coalition government has responded to that push with this bill.

I understand that there is some controversy and a small number of parents who do object to immunisation and choose not to immunise their children because of fears surrounding the potential for adverse reactions. The best science that we have access to asserts that vaccination is the safest and most effective way to protect children from harmful diseases. If there is medical evidence of a child's adverse reaction to vaccination, then this bill, importantly, provides the opportunity for some exemption to these provisions based on that medical evidence and a propensity for allergy to immunisations into the future.

It is important that, despite those objections, the Australian government is committed to ensuring that every Australian child grows up healthy, happy and strong. We believe that parents have an obligation to provide support to ensure that that aim is met. A child is probably at their most vulnerable in those early years. They completely rely on their parents for their health and wellbeing. Vaccination is proven to be the most effective way to reduce the possibility of a child contracting an infectious disease, including a deadly infectious disease. So, from a public health perspective, there is strong interest in ensuring that every child is immunised.

In June of this year, the office of the Chief Scientist to the Australian government released a report detailing the benefits of vaccination. The report detailed that severe side effects from vaccinations are quite rare. The data collected suggested that there is a one in 100,000 to one in one million per cent chance of a child experiencing any harmful side effects as a result of a vaccination.

Through immunisation and the elimination of carriers to spread diseases, it is even possible to completely eradicate some diseases. This is how smallpox was eradicated, and we are almost there with the eradication of polio worldwide. I was at a breakfast this morning hosted by a number of NGOs that work in this space. The name of the campaign that is being undertaken to completely eradicate polio throughout the world is One Last Push. But the threat remains in respect of other communicable diseases, most notably measles and whooping cough, which continue to be relatively common and highly contagious. There is still a threat of measles returning to Australia, as was recently seen in the United States, with 644 cases recorded in 2014, despite the disease being declared eliminated from the USA 15 years ago.

There is a far greater risk that a child may contract a serious disease as a result of nonvaccination than there is of a child experiencing side effects due to vaccinations. Indeed, the World Health Organization estimates that vaccines prevent two million to three million deaths every year. Those figures are indisputable and too hard for any government to ignore.

I am assured of the safety and effectiveness of any vaccine used in Australia, as all vaccinations undergo a series of rigorous testing procedures before they become available. Moreover, scientists continue to develop easier and more effective vaccines to be administered. I have also done some consultations with local doctors in my community, and every single one of them assures me of the safety of vaccination and, more importantly, that vaccination is the most effective, the cheapest and, from a public health perspective, the easiest way to ensure that we are reducing and, hopefully, eliminating the potential of children picking up communicable diseases, so that we can avoid severe injury and illness into the future.

I was pleased recently to speak in this chamber regarding a bill which was introduced last week, the Australian Immunisation Register Bill 2015. With the 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 whose time has come also.

I wish to congratulate and thank all of those people who have been campaigning for improvements in the rates of immunisation throughout the country and, importantly, for government to take a more active role in encouraging greater immunisation amongst children throughout the country. I think particularly of those parents who have lost dear children to communicable diseases that could be avoided if there were greater rates of immunisation and there were not as much spread of particular diseases. I am thinking of course of Catherine and Greg Hughes, the parents of baby Riley Hughes, who died of whooping cough in March this year before he could be vaccinated. They have been very strong and powerful advocates for the cause of vaccination. To have the harrowing experience of the death of your child and then to be able to come out and campaign for a particular cause is admirable, and I take my hat off to Catherine and Greg and their families and others like them who have been great advocates for this cause. It is quite admirable.

Labor also recognises the important work that Medicare Locals across the nation were doing to increase immunisation rates, achieving a rise from 70 to 72 per cent from 2012 to 2013 for girls aged 15, and I welcome the support that Primary Health Networks are giving to this task into the future.

Labor is generally supportive of this bill, largely because of the importance of the task of increasing immunisation rates in Australia. We also urge the government to go one step further and include in the yet-to-be-released framework for the Primary Health Networks the goal to continue the push to increase immunisation rates across Australia. Immunisation has been proved effective. The medical science, the medical expert advice, is that this is the most effective and efficient way to reduce the spread of communicable diseases across the country. Quite simply, immunisation saves lives, and any program in which the government encourages more Australians to be immunised, and particularly more parents to immunise their children, deserves our support, and that is why I am supporting this bill.

Natasha Griggs (Solomon, Country Liberal Party) Share this | Link to this | Hansard source

It is not very often the member for Kingsford Smith and I agree on things, but we do agree that immunisation saves lives, and any program that saves lives is important. When my son and his wife had a baby, 16 months ago, we were not allowed to spend a lot of time with our new granddaughter until we had had our whooping-cough vaccinations topped up.

There has been a lot of discussion about this particular legislation, this Social Services Legislation Amendment (No Jab, No Pay) Bill 2015, in my electorate. A minority of people are against it. I am pro-vaccination. The member for Kingsford Smith and I were involved in an immunisation program when we went to Laos. We saw the benefits of that; it was interesting how the country has embraced immunisation and is really seeing its benefits.

The purpose of this legislation is not to save money, it is to save lives and stop the spread of preventable communicable diseases. If this bill passes—and it looks like it may, because Labor are supporting it—it will make an amendment to the requirements for recipients of family tax benefit part A and the child care rebate. These changes will come into effect from 1 January 2016, meaning that family tax benefit part A and the child care rebate will not be paid to the families of any child who has not been fully immunised.

The purpose of this legislation is not to save money by restricting the payment of the family tax benefit and the child care benefit, it is to encourage parents to keep up the immunisations for their children. I sincerely hope the savings do not come to pass, because the much preferred outcome is for all those families who would otherwise be cut off from payments to get their children immunised.

This legislation will remove the 'conscientious objector' exemption to immunisation schedules and extend requirements to meet these schedules to all children under seven years of age on any day the benefit is claimed. In this place, when we discuss immunisation, it is very important that anyone taking part in or following the discussion remembers this parliament should be making decisions based, solely, on evidence—and, as far as the evidence goes, the public-health case for immunisations is an open-and-shut one.

Mass immunisation is, perhaps, the single most effective public-health policy that has ever been in place. To all those with concerns or objections, be they based on philosophical or religious ideals, I would respectfully remind them that this is a public-health debate. It is about preventing the spread of debilitating and sometimes fatal diseases, and we heard the member for Kingsford Smith give the example of a child dying from whooping cough.

When the stakes are this high, we should only be considering an evidence based approach. All the evidence—the hundreds of papers of peer reviewed science journal articles, the clinical trials and the decades of data—points to immunisation of children being incredibly beneficial. The number of children under seven years of age not immunised, because of a conscientious objection, was around 0.23 per cent of the population in December 1999. By 2014 it was more than 7½ times that number. Even with that exponential increase, the children of registered conscientious objectors are a minority—amounting to only about 20 per cent of the total number of children who are not up-to-date with vaccinations. If a child is not immunised and it is not a choice that can be supported by evidence, it is not a choice to be supported by taxpayers.

I had some people, from my electorate, approach me with concerns over what they called 'government mandated vaccinations'. There are two key points to raise to address this argument. The first is that no government is forcing anyone to have immunisations. This legislation proposes that for those parents who choose, for whatever reason, not to have immunisations they will not have that choice supported by government payments. The second is that the right of a child not to get a disease, like polio or whooping cough, is a far more important right than the freedom of someone to exercise a philosophical objection.

There will always be children who cannot—perhaps for medical reasons—be protected by vaccination. There will also be a minority of children who are vaccinated for whom the vaccination is not effective. For those children, every unvaccinated child they come into contact with is a risk. As the number of unvaccinated people in the society they live in increases, the risk of transmission of disease increases exponentially as the group's 'herd immunity' is lost. The protection of these children from polio, diphtheria and whooping cough is a higher ideal than financially supporting an anti-immunisation choice.

The government's policy in this area is not all stick with no carrot. There is $161.8 million, over five years, for improvements to the National Immunisation Program's schedule of free vaccines. There is also $26.4 million to improve immunisation in adolescence—including incentives for health-care providers to identify children overdue for vaccines—public awareness campaigns and expansion of the HPV register to include all adolescents.

The legislation here today will reinforce the importance of immunisation, it will restrict access to conscientious objections and make family tax benefit part A and the child care rebate conditional on a child being up-to-date with their immunisations. As it stands, there are 39,000 Australian children under the age of seven who are not vaccinated because their parents object. There are many tens of thousands more who are not vaccinated for other reasons.

But the evidence is clear, and that is that vaccination is a safe and effective public health measure. Every child who is not vaccinated is at risk of preventable communicable diseases and is at risk of spreading preventable diseases to those who are too young to be vaccinated. I draw the House back to the example that was given by the member for Kingsford Smith of the child who was too young to be vaccinated against whooping cough and who died. That is one of the reasons why my son and his wife did not want us to see our granddaughter until we had our whooping cough vaccinations topped up.

This legislation will provide a significant incentive for parents of those children to get vaccinated and to keep that vaccination up-to-date. Where it is not possible for medical reasons to provide that vaccination, we will continue to offer an exemption clause. The government will not, however, continue to provide government payments to those parents who choose not to have their children protected.

As I mentioned earlier, this legislation is calculated to have a $508 million saving over forward estimates. Let me say it one more time: I hope that this legislation serves its purpose and that not one cent of the saving is made, because I want as many as parents out there as possible to ensure that their children are vaccinated. We need to make sure that we can keep our kids safe from these terrible diseases. No-one wants to see a child dying of whooping cough. Nothing can be more terrible than seeing that.

I commend the bill to the House.

Gai Brodtmann (Canberra, Australian Labor Party, Shadow Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

I rise today to join with my colleagues and those opposite to speak on the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. That was a very powerful speech from the member for Solomon there. Obviously, she is a bit upset because she must know of someone who has lost their child to whooping cough. As she said, nothing could be more shocking, horrifying and terrible than watching your child die of whooping cough.

So I join with my colleagues right across the chamber to support this legislation. This legislation will ensure that children fully meet immunisation requirements before their families can access childcare benefits, the child care rebate or the family tax benefit A supplement. It builds on the work that Labor did in 2013 to further tighten immunisation requirements within the family payments scheme.

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. This is what this is all about. This bill builds on those reforms. The Leader of the Opposition also wrote to the then Prime Minister in April of this year, offering bipartisan support to increase immunisation rates across Australia. We also announced our support for this measure shortly after it was announced in this year's budget.

Labor is committed to strengthening immunisation rates so that all Australian children have the best chance to grow up strong and healthy. The importance of immunising our children cannot be underestimated. It is estimated that vaccinations currently save up to three million lives worldwide each year—three million lives worldwide each year! Immunisation is the safest and most effective way for parents to protect their children from disease, and one of the most important public health measures we have at our disposal. The Australian Medical Association, the National Centre for Immunisation Research & Surveillance and countless other experts all agree that immunisation is the safest and most effective way for parents to protect their children from disease.

Immunisation remains the safest and most effective way to stop the spread of many of the world's most infectious diseases. When a person is vaccinated their body produces an immune response in the same way their body would after exposure to a disease, but without the person actually suffering the symptoms of the disease. When that person comes in contact with that disease in the future, their immune system will respond fast enough to prevent the person actually developing the disease.

When levels of immunisation in a community are sufficiently high, the risk of specific diseases can fall so low that even those who are too young or too sick to be given a vaccine will not be exposed to it. It is this communal, or 'herd' immunity that can save countless lives. Likewise, those who choose not to immunise their children are exposing other children to potentially fatal diseases—diseases that can be avoided through immunisation. This is what is quite often overlooked by these people.

I would just ask everyone in the chamber to cast their minds back to the 1960s and 1970s, before the major vaccination campaigns. Diseases like tetanus, diphtheria and whooping cough killed thousands of young children each year. Today, deaths from these diseases are extremely rare in Australia—although there is a worrying trend that whooping cough is now coming back again—and in the rest of the developed world. This is because of immunisation. We want to get to a situation where enough people in the community have been immunised so that infections can no longer spread from person to person and a disease can die out altogether.

We have seen this happen with smallpox, which was declared eradicated in 1980 after a concerted campaign of surveillance and vaccination led by the World Health Organisation. Or measles, which last year the World Health Organisation declared had been eliminated in Australia. These are extraordinary achievements! Extraordinary—eliminating these evil diseases that have killed so many people over many years. Or polio—the Global Polio Eradication Initiative has been successful in reducing polio cases, with only a few isolated cases remaining in the developing world.

Just on polio, I just want to touch on what was etched in my brain when I was a young girl. My mum, who is now in her 70s, went through the polio epidemic that was around in the 30s, 40s and 50s in Australia. She told us when we were little of stories of the baths in Melbourne being closed down, of theatres being closed down and you could not go to the movies because of the polio epidemic. Schools were closed down and when she went back to school once it had been reopened she found that a number of students were no longer there because they had been paralysed by polio. I know that my husband's uncle contracted polio around that era when he was a child and has lived with the crippling legacy that is polio ever since.

If the anti-jab campaigners met with the people who actually have to live with the consequences of no immunisation, who have to live with the consequences of contracting polio, particularly as a young child, they would see the challenges and the battles that they have to face. I remember reading books about young children having to be in bed for months and months as a result of the disease and the fact that they could not have a normal childhood. They could not run and play because they had been crippled by the disease. Their education was stunted in many ways and their opportunities were limited as a result. This is something that can be avoided through immunisation. As I said, since I was a child my mother told me those stories of the baths being closed down, of the school being closed down and of those children returning who were crippled, it has been etched in my brain that immunisation is absolutely vital to keep Australians safe, to keep our young people safe, to keep our older people safe and to keep the world safe. Those stories were incredibly powerful. Seeing Chris's uncle every time with that crippled, stunted leg as a result of the fact that he contracted the disease is horrifying.

As mum said, when she used to take us as babies to the little infant welfare centre and get us immunised, it used to be very distressing to her as a young mother. Babies cry because it hurts and sometimes they get a bit fevery afterwards. Despite the distress that it was causing to us as children and babies and to her as a new young mum, she knew that the benefit not just for ourselves but also for our community and our nation was significant. I did not hear my colleague the member for Kingsford Smith's story but I did hear the member for Solomon and it is incredibly concerning when you hear cases of children falling ill or in some cases dying due to diseases that could have been avoided if their parents had got them immunised.

For example, low domestic immunisation rates for measles in some parts of the United States saw the disease re-emerge last year, prompting officials to actually issue a warning. According to the Centre for Disease Control and Prevention, there was a record 668 US measles cases from 27 states last year, mostly in unvaccinated travellers travelling to endemic regions or to areas experiencing a large ongoing measles outbreak. This was the largest number of cases since eradication was declared in 2000. We are seeing this resurgence as a result of people not being vaccinated. It was the largest outbreak to occur in unvaccinated Amish communities in Ohio and totalled more than 383 cases. There has been similarly a re-emergence of other preventable diseases like rubella, mumps, whooping cough and polio. It is so important that we immunise our kids and protect them against these preventable diseases. By immunising your child, you are protecting more than just their health; you are reducing the opportunity for that child to pass that disease onto another, especially to young babies who may not yet be fully immunised.

I was discussing this legislation with a dear friend of mine, who, unfortunately, is undergoing a battle with cervical cancer, and she recounted the story of her dear friend, Gay Davidson, who was a well-known Canberra journalist here and her husband, Ken, who lost their daughter Kiri after she contracted measles. Kiri had not been immunised because, according to my dear friend, Gay was an anti-vaxxer; she opposed immunisation. Kiri died at the age of 13 from complications after getting the disease. After her daughter's death, Gay became a prominent public campaigner for immunisation against measles. She worked with successive Commonwealth health ministers in promoting what became the national Bicentennial Measles Campaign.

Any death of any child for any parent is just devastating and it took a significant toll on Gay. Her health suffered significantly. She continued to work for some time but her health suffered and she did die, I regard, prematurely as a result of the guilt, the knowledge and the trauma of losing their child, particularly when she had been such a strong, as I understand, anti-immunisation advocate and the fact that she in a way felt that it was her fault that that her daughter had died from a disease that could have been prevented through immunisation.

Measles does take its toll in so many ways and I think that Gay Davidson's experience and response highlights how devastating it can be for families to lose a child to a disease that could have been entirely prevented through immunisation. Imagine if you had a child or little baby who died as a result of someone not immunising their child. Imagine the trauma and the horror of living with that.

All I can say to those anti-vaxxers out there is: homeopathic preparations do not provide natural immunity; nor does being fit and healthy. Only conventional vaccinations produce a measurable immune response. So all I can say is: vaccinate your children.

Modern vaccines are extremely safe, and serious reactions to them are rare. In development, vaccines are rigorously tested on thousands of people in progressively larger clinical trials, and they are not included in the National Immunisation Program until they have been approved for use by the Therapeutic Goods Administration to ensure they meet strict safety guidelines and are evaluated to ensure that they are effective, comply with strict manufacturing and production standards and have a good safety record.

Once a vaccine is in use, its efficacy and safety are continually monitored by the TGA—so it is not just a set-and-forget environment; the TGA is continually monitoring these vaccines—and by vaccine sponsors through further clinical trials and detailed surveillance of disease and vaccine adverse events. They are constantly looking at the effectiveness of these vaccinations and they are doing that through these clinical trials and also the surveillance of the disease, as I said.

So I reiterate to those who are against immunisation: the vaccines for the 16 infectious diseases that are currently included on the National Immunisation Program are subjected to some of the most rigorous vaccine testing and registration processes in the world. They are safe.

Labor believes that the only exemption to the community expectation that children are immunised should be on medical grounds, and this legislation includes room for those exceptions, such as when a general practitioner has certified that vaccinating the child would be medically contraindicated, or that vaccination is unnecessary because the child has natural immunity from having contracted the disease in question.

In conclusion, I offer Labor's support to this legislation, which requires children to meet their immunisation requirements in order for their families to access family benefits. It is sensible legislation that will increase the immunisation rates of Australian children—something that will have an overwhelmingly positive impact on our society. Immunisation is the safest and most effective way for parents to protect their children from disease, and I encourage all parents to do the research, and I encourage all parents to immunise your kids.

Teresa Gambaro (Brisbane, Liberal Party) Share this | Link to this | Hansard source

It is an honour to be following the member for Canberra, and I thank her for her wonderful contribution, as I thank the member for Braddon, the member for Solomon and the member for Kingsford Smith. It is not often in this place that we can come together on legislation that is agreeable to both sides of the House, but the No Jab, No Pay measure reinforces the Australian government's position that immunisation is a very important public health measure for children, their families and their community. The coalition is absolutely committed to making sure that every child in every home has a safe environment and has a safe educational environment as well.

As the member for Brisbane, I have a huge number of schools that I represent in my electorate as well as many child care centres, preschools and kindies. This policy will bring clarity to the rules, and it highlights the very importance of immunisation and of protecting public health, especially for those who are the most vulnerable in our community, children.

The measure aims to further increase the immunisation rates in the Australian community, because we know that the more that people are immunised, the safer that everyone is going to be. From 1 January 2016, the No Jab, No Pay measure amends the immunisation requirements for the family assistance payments, including the Child Care Benefit, the Child Care Rebate and the Family Tax Benefit Part A end-of-year supplement.

Currently, immunisation requirements only apply to children up to the age of seven for the Child Care Benefit and Child Care Rebate, and at ages one, two and five for the Family Tax Benefit Part A end-of-year supplement. This is simply not enough to encourage higher rates of immunisation.

From 1 January 2016, in order for an individual to be entitled to the Child Care Rebate and Child Care Benefit payments, their child will need to meet immunisation requirements up to the age of 20. This is very much a common-sense approach that not only will make sure we do not witness the return of some of those debilitating diseases, but also will reduce the burden on our healthcare system by keeping kids out of hospital.

Immunisation stops the spread of many harrowing and life-threatening diseases like diphtheria. The release of the diphtheria toxin in the blood can cause nerve paralysis and heart failure. In the early 1900s, diphtheria caused more deaths in Australia than any other infectious disease. I was hearing about that when I visited a historical photographic exhibition at the Royal Brisbane Hospital recently to mark the Anzac Centenary. It is absolutely incredible when you think about this—that the increasing use of vaccines has led to diphtheria's virtual disappearance. No vaccinated person has died from diphtheria in Australia in the last 20 years, and we must ensure that that statistic remains unchanged.

Measles is another very highly infectious, acute viral disease which can cause serious complications, particularly in very young children. Complications of measles include middle-ear infections and laryngitis, as well as more serious infections such as pneumonia and encephalitis, which can lead to brain damage and death. I know that today we have heard many stories of members having personal experiences. My personal experience was of a friend of the family who was not vaccinated when she was a child and who contracted measles. She had a lovely baby boy and unfortunately he suffered from deafness, and it was a terrible, terrible thing to go through. He is now contributing to society. But this could have been avoided if she had been able to have a vaccination and unfortunately she was unable to do that as a young child.

There is also meningococcal disease, one in 10 of the sufferers of which dies in Australia. Of those who survive, one in 30 has severe skin scarring or loss of limbs, and one in 30 has severe brain damage.

Finally, members have spoken today about whooping cough. It is an extremely contagious respiratory infection. The disease causes uncontrolled coughing and vomiting, which can last for several months and can be particularly dangerous for little babies under the age of 12 months. Patients have described the experience as if they were actually coughing up their lungs for months on end. It is clear, then, that we must act now to ensure that these diseases cannot spread any further.

In order for an individual to be entitled to the Family Tax Benefit Part A end-of-year supplement, their child will need to meet immunisation requirements from age one up to the end of the calendar year they turn 19. The changes do not impact fortnightly instalments of Family Tax Benefit Part A. The changes only impact the end-of-year supplement, which is currently $726.35 per year per child, as long as those conditions are met. Critically, this measure will remove vaccine objection, previously known as 'conscientious objection', as an exemption category. That measure is simply not good enough to protect the health of the broader community. Currently, if an individual makes a declaration that they have an objection based on personal, philosophical, religious or medical belief to being vaccinated, they meet the immunisation requirements.

According to the Australian Childhood Immunisation Register, more than 39,000 Australian children under the age of seven are not vaccinated because their parents object to vaccinations, which is an increase of more than 24,000 children over 10 years. This is a very dangerous trend that we must reverse. For every child who misses out on the chance to be vaccinated, the chance of infection increases. No child should be afraid to get the education they deserve simply because some parents decide to object to potentially life-saving vaccines.

This is a public health issue. The government has determined that, whilst parents have the right to decide not to vaccinate their children, if they are doing so as a vaccine objector their decision will mean that they will no longer be eligible for some government financial assistance. We have to take a tough stance for the good of public safety and the health of our youth. Children will meet the immunisation requirements if they are fully immunised, engaged in an approved catch-up schedule or have a valid exemption. We will allow for children who cannot be vaccinated for health reasons to be exempt so that they may not slip through the cracks financially.

Children with medical contraindications or natural immunity certified by a general practitioner will continue to meet immunisation requirements. Children are considered fully immunised when they have received the appropriate vaccines for their age cohort under the National Immunisation Program's early childhood schedule. A child will also meet immunisation requirements if they are a participant in a vaccine study approved by a Human Research Ethics Committee registered with the National Health and Medical Research Council. Additionally, the secretary will be given new legislative powers to exempt a child from immunisation requirements in a very limited range of circumstances—for example, where a non-parent carer does not have the legal authority to vaccinate a child in their care. Where a child cannot be vaccinated as required and the Commonwealth Chief Medical Officer has declared that the relevant vaccines or all vaccines are temporarily unavailable, the child is considered to meet the immunisation requirements. This measure is compatible with human rights because it advances the protection of the right to physical health and, to the extent that it may also limit human rights, those limitations are reasonable, necessary and proportionate.

The bill for this measure is accompanied by a statement of compatibility with human rights, in accordance with the government's normal processes. In conjunction with these changes, the Minister of Health has introduced legislation to extend the Australian Childhood Immunisation Register to record immunisation information for children aged between seven and 20 years. This measure is expected to produce savings of roughly $508 million over four years.

This has been a very hotly discussed topic that is important to me and the community that I represent. Often the balance on this debate has been conflated and misconstrued. Hopefully this bill will bring clarity to people as well as piece of mind. Tough choices have to be made for the safety of the greater community. I support the bill.

Tanya Plibersek (Sydney, Australian Labor Party, Deputy Leader of the Opposition) Share this | Link to this | Hansard source

When I was first elected to the parliament, the Leader of the Labor Party was Kim Beazley. Kim is very well known to my friend sitting here, Gary Gray, and he is very well known to members of this parliament as an erudite man, a compassionate man and a great lover of American history, and for his great and good humour. But there is another thing about Kim Beazley: he had polio as a child. That is how recently this disease, which is now unknown in Australia and is on its way to being eliminated worldwide, stalked the Australian community. Our current Ambassador to the United States was one of its victims

Kim said that he never forgot the day he woke up, at just five years old, unable to move. He said:

I don't think contemporary Australians can comprehend the fear that ran through our community at the thought of polio.

That is what he said in an interview in 2004. I cannot imagine the fear that the little boy felt, but I can certainly imagine the fear of his mother. I think any parent can. I can imagine it, but neither I nor any parent in Australia today will ever need to feel it, because we have eradicated polio in Australia and will eradicate it within coming years around the world.

Polio was beaten in Australia by vaccination—in Australia, in North America, in Europe and soon in the rest of the world. We see resistant pockets in Pakistan and Afghanistan, but I am confident that the huge steps that those countries have made, even in the last year, will see us tackle this disease fully. Vaccination is one of the most effective and cheapest ways we have of keeping a community healthy. The examples of polio and smallpox before it show that, with proper eradication campaigns, we can eliminate many of these diseases and we can certainly save many lives. Vaccination is the reason that the number of measles deaths around the world has declined from 2.6 million in 1980—which to us sounds like just yesterday, and it was mostly young children who died from measles—to under just over 145,000 in 2012.

If you put measles with diphtheria, rubella, polio, whooping cough and all of the rest of these diseases, between 2000 and 2013 vaccinations saved an estimated 15.6 million lives. Smallpox has been eradicated, as I have said. Polio cases have dropped from the hundreds of thousands in the late 1980s to a few dozen. Around the world, around three million lives a year are saved by vaccination. And for each of those lives saved, there are others who are spared lifelong disability from the complications of these diseases.

Labor has a very strong record on immunisation policy. Raising the rates of immunisation was a priority for me when I was the health minister. It was a priority for Nicola Roxon before me, and I know it is a priority for the current health minister and for our next health minister, Catherine King. In her capacity as shadow minister for health she spoke very movingly last week about meeting two sets of parents, Toni and David McCaffery, and Catherine and Greg Hughes, who had tragically lost their children to the easily preventable disease of whooping cough. Having worked as a director in the Commonwealth Department of Health and Aged Care, Catherine really understands the policy issues around health and community health. More important that just this systemic understanding, I could tell from her conversations with these parents, who have lost so much and have given so much to the campaign in favour of immunisation—and have become such targets in some cases of horrible internet trolls—she was moved not just as a health administrator, but as a parent, and I am sure she will take up this case as health minister.

In 1993, our National Immunisation Strategy brought consistency to vaccine schedules and vaccine pricing. We introduced the Australian Childhood Immunisation Register (ACIR), announced in the 1995-96 Keating budget. We support the expansion of the ACIR to become the Australian Immunisation Register and the expansion of the National Human Papillomavirus Vaccination Program Register to the Australian School Vaccination Register, capturing a greater range of vaccinations.

While I was health minister we added several new vaccines to the schedule, including the combination measles, mumps, rubella and varicella vaccine—called the MMRV vaccine, a combined meningococcal C-Hib vaccine, and, of course, we also did Gardasil for boys. Just as we were the first nation internationally to do Gardasil for girls, we were the first to do Gardasil for boys, because boys are also vulnerable to HPV and to the cancers that can result.

We made important changes to family payments to lift immunisation rates, including linking the family tax benefit end-of-year supplement to immunisation. We worked with the states to raise vaccine awareness, and on successful strategies, like requiring a child's ACIR record for school enrolment, to identify children who had slipped through the immunisation net or had not yet fully met the immunisation milestones. This, accompanied by the very innovative work of our Medicare Locals, helped increase the coverage rate amongst five year olds from 83 per cent to 90 per cent during our time in office.

In fact, in just one year, from 2011-12 to 2012-13, the percentage of five year olds fully immunised rose in the Lower Murray region from 86.2 per cent to 93.9 per cent. In Broken Hill and the far west it rose from 89.1 per cent to 95.6 per cent, which is a stunning result. In Kempsey-Nambucca it rose from 84.6 per cent to 91.1 per cent. All three are marvellous results.

But we know that in some communities kids are still at risk. In the same year, 2012-13, 13 out of 61 Medicare Local catchments had less than 90 per cent of five year olds fully immunised. The lowest rate—and I am really quite ashamed to say this—was in Eastern Sydney, an area that is home for me, where it was 86.2 per cent. For last year, in my own state of New South Wales, the Northern New South Wales Local Health District, at the other end of my state, recorded only 87.4 per cent of children fully vaccinated.

Some children miss vaccination because their parents have forgotten, or do not know fully about the childhood illnesses their children should be immunised against, or they have lost track. There are a number of different reasons parents have missed out on the information communicated to them. Perhaps it is even in a language they do not understand. So it is important to invest in reminders, in education programs, in community awareness raising, and in making the point through reminders to individual parents and to our broader community about the benefits of vaccination.

But there are cases, of course, where parents deliberately refuse to vaccinate their children. They prefer to rely on the rumour-mill of the internet rather than take medical advice. I say to those parents: talk to your GP. As a parent, I took the advice of my doctor and all of my children are fully immunized. As a health minister, I took the advice of the medical professionals and I prioritised raising immunisation rates as one of the best and most effective health interventions we can make as a nation.

The number of children whose parents or guardians lodged what some people call a 'conscientious objection' to vaccination has risen from 0.23 per cent in 1999 to 1.77 per cent at the end of last year. I have said many times—and it disappoints me that I still see this language used sometimes—that the term 'conscientious objector' is completely inappropriate for people who refuse to vaccinate their children. They are not Quakers carrying stretchers under fire from the battlefield back to the trenches during World War I. These are people who are deliberately refusing to vaccinate their children, to protect their own children and our community against these illnesses.

I think it is important to note that no major religion has a prohibition on immunisation. This is a decision that parents are making based on dangerous misinformation from the internet. They are vaccine refusers. Vaccine refusers think they know better than doctors and scientists and, in doing so, they put the health of their own children at risk and they put at risk the health of other kids, of babies who are too young to be fully immunised, of older people whose natural immunity has broken down with age and of people who are sick with immunodeficient type illnesses and cannot be vaccinated. For the protection of our whole community, we need the majority of people to be vaccinated where they can be.

It is very important to say that we are supporting the No Jab, No Pay policy introduced in this legislation. We certainly said before the 2013 election that we would move further in this direction, and we are pleased to see our policy reflected in this bill. It ends the vaccine refuser exemption and it makes sure that only those with legitimate medical reasons to not vaccinate their children can access child care benefit, child care rebate or the family tax benefit part A supplement.

One of the most important things that we learn in managing our vast and vastly successful health system is that prevention is better than cure, and that certainly is the case when it comes to vaccines.

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

The medical practitioners and medical scientists that I talk to about this bill and about vaccines are very clear that the two things that have really done the most to improve health in our community over the last couple of hundred years have been the availability of clean water and vaccination. So there is absolutely no doubt that there are very solid public health arguments behind the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015.

Like many members, I have personal experience here. I remember the enthusiasm with which my mother dragged me down to get I think the Sabin polio vaccination when I was around three or four. It is one of my first and clearest memories. With her recollection, and having lived through the risk of my older brother and sisters contracting polio, it was such a frightening thing for my mother. As I think I mentioned when we were debating an allied piece of legislation last week, a great book, The Golden Age, by Joan London was released this year. It really captured the social impacts as well as the health impacts of the polio epidemic. Also in last week's debate, I related my very personal experience with my daughter who, at the age of three weeks, contracted whooping cough from an unvaccinated child. So I completely and utterly support the principle of vaccination.

But now I am going to make what I judge to be a career-limiting move, because I am going to step outside, a little, that box of orthodoxy that I followed right up until last week, when I was contacted by some people who, having seen my speech, suggested that I might want to look at some of the other science. I have done so. I do not want to depart from the standard script, because I do support vaccination and I do support us requiring an element of incentive to be placed into the system to ensure that we have proper coverage. I am not contesting in any way that what we have done with polio, with diphtheria, with whooping cough—even though it is becoming a little more complex—and with measles is anything other than judged to be a good thing.

I have sat in this place and listened to speeches about this being a black-and-white issue—that you have to be totally and utterly one way, otherwise you are an anti-vaxxer—and saying that the science is unequivocal. I have some quotes—and these are all from people who support vaccination. I just want us to start being a little less condemning of those people who have their concerns; let us in fact be little bit more scientific. Let us not always, when contradictory evidence comes in, presume that we have to amend the hypothesis and have an auxiliary hypothesis that will help us patch up and bolster the principal hypothesis. From time to time, we have to be prepared to think that this data may have to be seriously considered and cause us to look at the paradigm.

I am going to quote people who are not crazy, unscientific trolls and anti-vaxxers. I do want to endorse comments by some of the previous speakers who have reprimanded in the severest terms those who have been trolling people like the Hughes family, who, quite rightly, have a very real concern about vaccination. Everyone should have the ability to do this without being vilified. I want to quote Natasha Crowcroft, the Chief of Infectious Diseases at Public Health Ontario, and her two colleagues from the University of Toronto in an article that appeared in The BMJ, formerly the British Medical Journal, earlier this year. I am going to quote this at length because I think it really sums up some of the issues that we need to face:

We are on a steep trajectory away from an era of inexpensive vaccines for diseases that are widespread in the absence of immunisation. Vaccines are increasingly being produced for diseases that are devastating at an individual level but have less impact on population health. Moreover, the costs of developing and getting a vaccine to market are rising because of increasingly complex technologies and the public intolerance of adverse events. For these reasons new vaccines are likely to be less cost effective than older vaccines and are unlikely to be cost saving.

Technologies such as searching genetic codes for possible antigens and the development of new adjuvants to stimulate immune responses also bring considerable uncertainty about safety and effectiveness. It may take many years for adverse events caused by vaccines to be identified and confirmed, as was the case for the link between a pandemic H1N1 influenza vaccine (plus adjuvant) and narcolepsy.

These challenges come at a time when some sections of society are less likely to vaccinate themselves or their children. Those who hesitate to vaccinate are often highly educated, well resourced, and demand respect for their perspectives. How best to reassure the public is unclear. But all the components of decision making about vaccination programmes must be high quality and transparent and should stand up to external scrutiny to sustain the confidence of both the public and healthcare providers.

I think there is a very clear message here. To lump anyone who has an objection or a concern about a particular vaccine or a particular adjuvant into the anti-vaxxer box is, I think, a very deleterious thing for the confidence that we need to have within our system.

Professor Collignon, professor of microbiology at the Australian National University and director of infectious diseases at Canberra Hospital, is a great supporter of the principle of vaccination and one of those who is very clear that vaccination has absolutely turned around public health outcomes in our community. In talking about flu vaccines for children, he made a couple of statements. He said:

To stop two or three children going to intensive care we had to immunise 600,000 people … We need to be very careful before we recommend universal vaccination against influenza every year until we have better data. Otherwise we’re talking about faith-based medicine, instead of evidence-based medicine.

When Professor Collignon made these reflections after seeing healthy children post-vaccine coming into his hospital, he was very surprised at the amount of negativity that he received from other health professionals. But his fundamental point is that we need a better system than voluntary notification to the TGA, because whenever you do that you really underestimate how much of a problem there is. If the notification process is purely voluntary you get an under-notification. He said:

When I interviewed families who claimed to have experienced an adverse reaction there was a common thread—medical professionals were unwilling to countenance the possibility, even when the symptoms were extreme and immediate, and their cases were never referred to the TGA.

I think that one of the things we could take out of the anti-vaxxer argument is that we do need a better system of notification. My friend and colleague at the table, the member for Brand, would no doubt be aware of Professor Bryant Stokes, a very eminent medical bureaucrat and medical specialist in Perth. He was chief medical officer and head of the health department, but I understand that he has recently stood down. He was commissioned by the state government to report on what happened during that ill-fated fluvax in 2009 when there were so many adverse reactions in Perth and across Australia in children who had the fluvax that year. His report that was tabled in the state parliament focused on just how poor and chaotic the reporting processes were. There was a lack of any real systemised process of collecting that data.

If we want the public to have confidence in this system, we have to be prepared to set in place a rigorous reporting system. We cannot continue to say to people, 'You've made it all up' or 'You're wrong and it's something else.' We do want people to have confidence in the vaccination system. It is a great benefit for our public health system. But we have an obligation to make sure that we are being scientific and that we are not falling into the same trap that we are accusing the anti-vaxxers of. We need to ensure that we are not engaging in faith-based medicine rather than evidence-based medicine.

Allan Cunningham, a retired paediatrician from the USA, said in an article in the British Medical Journal:

Vaccines are among the greatest medical advances of modern times, but public health officials have become intoxicated by success and have lost their sense of perspective. A case can be made for mandating vaccination against measles, which used to infect 3-4 million US children a year, but it is over-reach to mandate vaccination against hepatitis B, which was reported to infect only 300 children aged 1-9 years annually in the US.

One of the concerns that has been raised is what is happening with the adjuvants—those things that are added to the vaccine to enhance the immune response. I asked our library to find me the latest research on the impact of these adjuvants. I do not want to reflect negatively on the person, but the piece of research they found had been conducted by a researcher from Flinders University in Adelaide, who also just happened to be a director of a biotech firm producing adjuvants and vaccines. That certainly does not mean that he should be precluded from contributing to the academic and scientific debate but I think this is an endemic problem that we have in the pharmaceutical industry—there is not enough independence in the system; there are not enough people researching and providing this information who are free from the taint of preferment and funding by the pharmaceutical industry.

As I say, we need to get the science right here. Those who are advocating for vaccinations, like me, believe in science—but believing in science does not mean that you do not allow any contrary evidence to come within your field of operation and that you demean and belittle those people who are raising those concerns. I really do urge members to research some of these people who are raising an alarm about exactly what we are doing and whether or not employing all of these I think now 16 vaccinations—including for hepatitis B, rotavirus and the human papilloma virus—is really in the best interests of everyone and can be justified in terms of a mandated public health outcome.

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

The contribution by the member for Perth was an interesting one. I am a strong supporter of science and science-based evidence for any sort of medical procedure. I also put on the record that I do question the fact that many drug companies fund research in Australia. Unfortunately, government does not fund research to a level that would enable research to be undertaken independently. When it comes to immunisation, for every one paper that condemns vaccination there are 10 or 100 or maybe even 1,000 that support it. Some research asserted that immunisation led to autism, although I did not come into this place ready to talk about the scientific research in that area.

The Social Services Legislation Amendment (No Jab, No Pay) Bill in no way makes it mandatory for parents to immunise their children. This legislation makes it essential that parents immunise their children if they want to receive family tax benefit. I have thought about this very seriously. When my daughter was having her children immunised she researched the issue and talked to many people. As I said in a speech last week, I have a niece who has done leading research in the area of autism and she has worked with many people. We asked her what she thought about the connection between autism and immunisation, and she said to us that the risk from not immunising is much, much greater than the risk from immunising.

Vaccination has been one of the most effective interventions to prevent disease worldwide. I had a grandfather who had polio, and now polio has been eradicated in Australia. It has almost been eradicated worldwide, except for countries like Pakistan and a couple of other places. It is a preventable disease—if you are immunised against polio you do not get it. You do not have the epidemic that existed when my grandfather contracted polio; you do not have the epidemic that raged here in Australia postwar, in the late forties and fifties, when so many people had their lives changed. We do not have epidemics that see survivors of polio coming into this parliament with the late effects of that disease. Polio sufferers survived and led normal lives; in some cases they may have had a level of disability but as they aged the effects of the polio might have become much greater. It is estimated that immunisation prevents approximately 2.5 million deaths a year. How can we argue against immunisation? This legislation, as I have already said, does not prevent parents from choosing not to immunise their children, but I would encourage them to immunise their children. It not only gives their children protection but also gives protection to the whole community. It is a major public health issue and immunisation is a practice that we as a nation should be embracing.

Labor members who have spoken in this debate have made it quite clear that we will be supporting this legislation. It was part of the 2015 budget measures and it is one of a number of measures being put in place to ensure that children are fully immunised. It will commence from the beginning of next year, 1 January 2016.

However, included in this legislation is a clause that says that, where there are valid medical reasons for not vaccinating a child—where a general practitioner has certified that vaccinating a child would be medically contraindicated or it is unnecessary because the child has a natural immunity, having already contracted the disease in question—such children will be exempt. Australia has one of the best immunisation records in the world. Nationwide, around 92 per cent of children are immunised, and we should do anything we can to encourage an increase in that number. Other children who will be exempt are those in approved vaccine studies or for whom the vaccination is temporarily unavailable. I think that is a common-sense approach. A family should not be penalised because the vaccine is unavailable, but that would be on very rare occasions.

Immunisation requirements will also be extended to include children of all ages. Once again, that is very important. Just because you are an older child, it does not mean that you do not need to ensure that your vaccinations are up to date and that your immunity to such diseases is still in place. Last year, I think it was, there was an outbreak of measles within the community; even in Canberra, there were cases of measles. Measles, whilst it may have been considered a common childhood illness when I was younger, can lead to a very significant level of disability or even death. Now that children are immunised against measles, they no longer face this potentially disabling and life-threatening illness.

In the lead-up to the 2013 election, Labor supported tightening up requirements around immunisation. As such, we were very supportive of these measures when the government announced them in the budget. There is one point that worries me, though, and that is that the budget projects that this will lead to savings of $508.3 million. I see this as a good public health initiative. It is not a budget savings measure; it is a measure that should be put in place to ensure that children are immunised. I think that there should be a backup as well, to make sure that it is not just a cost-saving measure and that it really is a sound public health initiative. Those are the grounds on which I support it—as a sound public health initiative, not a cost-saving measure.

Professor Brian Owler from the AMA said he was concerned that such large savings were expected from these measures:

… it indicates that a number of people aren't going to vaccinate their children. What we should be saying is we need to make sure that we do get all those children vaccinated and we should be aiming to actually continue to spend the same amount on those sorts of Family Tax Benefits.

So, along with No Jab, No Pay, there should be initiatives put in place that will educate and encourage people to have their children vaccinated, and make them aware that their children may be due for immunisation but they may not have followed through.

Quite often, it is the people whose lives may be little more chaotic, who have a lot of things on their plate, who may not have access to a GP or to medical services at the same level as most Australians, who will fall through the cracks. They may not even pick up on the fact that they are not being paid their family tax benefit. I put on the table that I am very concerned about that group of people. So I think that, rather than looking at this from a cost-saving perspective, we should be looking at it from the perspective of using No Jab, No Pay as an incentive to parents to ensure their children are immunised, while at the same time making those parents aware of the fact that the reason they are not receiving their family tax benefit is that their child did not have the jab.

We on this side agree and, I think, every member of the House would agree that parents should have the final say on this. We live in a free society, and whether or not to immunise a child is a decision that ultimately rests with the parents—but there have to be incentives in place to encourage parents to ensure that their children are properly immunised. Also, we need to make sure that the registers are up to date. We need to make sure that the information going to parents is adequate. We need to make sure that those parents who may have missed their child's immunisation because of some sort of oversight are made aware of the facts which I referred to a moment ago. We need and do support a national immunisation register to enable adults to keep up to date with their vaccinations. I do not know how many members of this House keep track of their vaccinations, but as a group we probably do so more than others. Many Australians believe that once they have been through their childhood immunisation that is where it ends; it is not the case. There needs to be more information and more education around immunisation.

The case for vaccinations, the case for immunisation, is very strong. There are a small number of people for whom it is contraindicated, and this legislation covers that. There needs to be ongoing scientific research. I do not think any member of this House would approach the issue of immunisation and health with a closed mind. We are here to ensure the common good of all Australians. We are here to ensure good health outcomes. If research shows that one form of immunisation should be abandoned then we should seriously look at it.

I support this legislation. My only concern is that the $508.3 million worth of savings should be put towards education and ensuring that parents do not miss immunising their children simply because of an oversight.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

The Social Services Legislation Amendment (No Jab, No Pay) Bill 2015 adds to previous reforms which have linked immunisation to the family tax benefit end-of-year supplement payments. This legislation takes that measure even further and ties immunisation to child-care benefits, child-care rebates and the family tax benefit part A supplement, which I referred to a moment ago. I understand that the changes will commence on 1 January 2016.

Before I get into my general comments about the legislation and for the benefit of anyone listening, I want to say, as other speakers have made clear, there are exemptions to this legislation where it ties receiving government assistance to having children immunised to what we call Australian standards. The exemptions tying immunisation to those payments—whether they are child-care benefits, child care rebates or family tax benefits—are based on the child or the family having a valid medical reason for why the child should be exempt from being vaccinated. That valid medical reason might be that it will have ill effects on the child or it is contraindicated by the doctor. Clearly, it has to be a decision made by the family doctor. There is also an exemption if the child has a natural immunity to the particular disease. The child might have contracted the disease at an earlier stage in life and developed a natural immunity to it. Alternatively, if the child has come from overseas and has had an equivalent vaccination in an overseas country then, again, that child would be exempt from the measures in this legislation. I also note that there is a temporary exemption for a child who might be part of a medical study of some sort—it has to be an approved study—or if the vaccination is temporarily unavailable. Those exemptions are also only temporary.

I also note, as the previous speaker, the member for Shortland, did a moment ago, that in future the vaccination requirements will apply to children of all ages, whereas currently my understanding is that a vaccination status is only checked at ages one, two or five years with respect to its application to the family tax benefit part A supplement, which I referred to at the beginning of my comments, and up to age seven for children receiving child-care payments. I believe that applying the age extension right through does have some merit. If you are going to apply policy then I am not quite sure why it would be limited to those age groups in the first place.

Australia has a long and strong record of publicly funding immunisation programs. Indeed, almost for as long as I can remember there have been government funded immunisation programs available. In my own state of South Australia, in addition to the family doctor being able to provide the immunisation required, there were also what we referred to as mothers and babies centres where a nurse would come along and similarly provide the service. Local councils also provided immunisation services in many parts of South Australia. Indeed, there was a debate between local government and the federal government some years ago about the amount of money that was being reimbursed to the local councils for providing that very service. However, it was generally accepted that immunisation was part and parcel of Australian life. Just about all families immunised their children and very few people ever questioned it. In more recent years, I understand that Medicare Locals assumed much of the responsibility for ensuring that immunisation programs were carried out throughout the community. Since the closure of Medicare Locals, I understand that responsibility has been passed on to the Primary Health Networks.

The value of immunisation has and will continue to raise questions and lead to differences of opinion in the community. I suspect that has become the case more so in recent years than it was in years gone by. I have been contacted by several people in my electorate about this legislation. These people oppose the legislation and they wanted to speak to me about it. I have met with some of them. I have also read all of the material that has been sent to me on i I make it clear that I do not dismiss the concerns that those people have raised with me. Similarly, I do not dismiss the concerns, which I consider to be very often valid, with respect to the health effects that occur from a whole range of prescription drugs and agricultural chemicals that are used throughout our country. I accept that all drugs and chemicals will have adverse consequences and that there will be individual examples which provide living proof of the risks and the consequences.

I suspect that, for a whole range of reasons—more people in the world, more drugs being used, perhaps more pollution everywhere, and changes in our diet and air quality—there are all sorts of ailments and illnesses that are occurring and that are perhaps compounded by some of the chemicals and drugs that are already on the market. Indeed, I have a constituent who has become a tireless campaigner against drug companies not disclosing all of the information that they have about drugs before releasing them and putting them onto the market. I believe that her campaign has a lot of merit, particularly given that she has been permanently affected by a drug that was prescribed to her several years ago. She will most likely never entirely overcome the effects of that drug. Her claim is that the manufacturers of that drug were aware of the particular side effect that she suffered but yet did not make that information available to the public at the time. I suspect that with all drugs trials there is information that is not necessarily released at the time it should be. So, again, I do not dispute what people are saying to me about the risks when it comes to any form of medication. This is in respect of real people that I talk to and affects their lives in ways that are clearly apparent to me. I, therefore, do not deny or dispute what it is that they are saying.

I am sure that other MPs have had similar representations made to them about this legislation. Again, it is a matter that, quite rightly, ought to be debated in this place. Can I say to those people that make the representations to me: it seems to me that the real argument and the real debate should be taking place within the medical industry and that the real convincing needs to take place within that sector and the pharmaceutical sector, because that is where the real experts are, that is where all the testing is done, and that is where the people with the most experience do their work each and every day.

Governments also have a responsibility to make decisions for the greater good of society. In fact, I struggle to identify any legislation—be it medical or otherwise—that serves everyone's needs and does not create an unfair or unnecessary burden on some people somewhere in the community. I am equally conscious of the rights of children to participate in all forms of community activities and community events—such as kindergartens, schools, sports activities, childcare centres or wherever—in the knowledge that they will feel absolutely safe and be at no risk of being infected by someone else that participates in the same activity. It is noteworthy that the parties who are most affected by this legislation—that is, the children—do not get a say in it. There might be good reason for that, but the reality is that they do not get a say in it. They rely on the good judgement of their parents and of governments to do the right thing by them. They, too, have a right to grow and live healthily and be able to fully participate in society. We, as parliamentarians, have a responsibility to ensure that we protect them in the best way that we can. I am sure that governments—with respect to this kind of legislation—rely on the advice provided by the medical fraternity when it comes to what is in the best interest of a child's health. I am sure that—in respect of the immunisation programs that we have conducted in this country for decades, as well as those that are being conducted around the world—that is the underlying premise on which that immunisation is carried out.

This morning I attended a briefing on the global fight against polio. I notice that the member for Shortland and the member for Sydney both referred to polio. The briefing, in my view, brings context to this very legislation. If I can just quote some of the statistics that were provided to us this morning: in 1988, when the global polio eradication initiative commenced, some 350,000 people a year were affected by polio; by 2013, the number of cases had reduced to 416; by 2015, it had reduced to 359; and to the end of September of this year, there were just 44 cases, and only in two countries. There were only two countries this year where polio was detected. I commend all of the people who were involved in the global polio initiative, because quite frankly to see its effects on a young person really is disheartening, I also take this opportunity to commend Rotary International for the work that they have done for years and years as part of the polio eradication program and for the support that they have provided to that program.

Along with polio, other diseases or illnesses like smallpox, yellow fever, measles, diphtheria, mumps, rubella, tetanus and so on have also been either entirely eradicated or nearly eradicated. Certainly, the world has changed markedly from the years when those diseases were feared by community members around the world. I have no doubt that that is because of the vaccination programs and the vaccines that have been developed over those years. Yes, there might be other factors—and better education also helps in eliminating many diseases, as does having better water and food supplies—but I have no doubt that vaccination was at the heart of eliminating or reducing those diseases around the world.

My understanding is that presently over 90 per cent of all Australian children are immunised in accordance with Australian government recommendations and that only about two per cent of the parents do not comply, because of concerns that they have about immunisation or, perhaps, because of their religious beliefs.

The remaining four or five per cent of parents—and, again, I noticed that the member for Shortland touched on this point, and I commend her for doing so—do not have their children fully immunised because, primarily, they do not have access to immunisation programs. I can think of many reasons why that could be the case, and so I accept that that is a reality. It would, therefore, seem that, if we want to make an even greater difference to the health of our children, the focus should be on that four or five per cent rather than on the two per cent and that the emphasis of our efforts and government efforts should be on trying to overcome the barriers that are stopping that four or five per cent I refer to from having their children immunised. Nevertheless, even with the two per cent, I go back to the comments that I made earlier: in my view, every child has the right to be protected in the way that the government thinks it is providing the best possible protection and, quite frankly, in the way the parents think they are providing the best possible protection for their children.

This legislation imposes a financial penalty on parents who choose not to have their children vaccinated. That is the bottom line to it. Parents can of course still choose not to have their children vaccinated and wear the penalty. That is a choice the parents can still make. It might be an unfair choice, but it is still a choice they can make. Time will tell whether this legislation will have the desired outcomes or not. I will certainly watch with interest what happens in the years ahead.

Christian Porter (Pearce, Liberal Party, Minister for Social Services) Share this | Link to this | Hansard source

The Social Services Legislation Amendment (No Jab, No Pay) Bill 2015 will ensure children fully meet immunisation requirements before their families can access childcare benefit, childcare rebate or the family tax benefit part A supplement. I would like to take the opportunity to thank all of the members for their contributions, particularly the member for Jagajaga and the member for Solomon, and in a moment I might also touch on the contribution of the member for Makin. All members have touched on some of the very important issues that arise in the context of this bill and have also, I think, offered some very good statistical and historical information about why this bill is important to the parliament and to the nation.

It was interesting, Member for Makin, hearing you speak about the polio epidemics that occurred in Australia. I must say, it is a matter of great personal pleasure to be able to provide this summing up speech at the second reading point in this debate. I grew up with an older cousin, my eldest cousin, and he was one of the last handful of children in Australia who contracted polio. He was a lovely boy, is a fine man and has had an extremely successful career, but it is a life made very much more difficult than it would otherwise have been. The two vaccinations, the injected and oral vaccinations, are the Salk vaccination, which I think came to Australia in 1956, and the Sabin vaccination, which came to Australia in 1966. My cousin would have been one of the very last in the cohort around the time of the Sabin oral vaccination who was unlucky enough to contract polio. I think that the generation of Australians, of which I am very much at the tail end, who lived through those episodes bring to their experience a very different mindset to a modern generation who have not experienced what it must have been like. The reason why Jonas Salk's wonderful contribution to medicine that he pioneered at the University of Pittsburgh was so welcome in Australia and why that man was, frankly, such a hero to many Australians is that, between 1946 and 1955, there were several catastrophic polio epidemics in Australia which caused 1,000 deaths. In the context of Australia between 1946 and 1955, that was an enormous number of people to die, in a particularly unpleasant way, from a disease which we later found was completely preventable. Of course, not merely did those deaths occur in that decade but the disease itself left thousands of survivors handicapped, in many cases very seriously, including many who became ventilator dependent for the rest of their lives.

So, having grown up with a cousin who suffered at the very tail end of that time, the notion that we have a range of people in Australia who have formed the view on vaccinations that they have is a very strange thing, I think. The extent that this legislation can offer some ongoing educative component, both historically and by raising the issue in the minds and consciousness of the Australian people, is a very important aspect of what we are doing this evening.

Immunisation is, of course, an important health measure for children and their families. That it is the safest and most effective way of providing protection against disease has been verified statistically and historically for many decades now. From 1 January 2016, the government will extend current immunisation requirements to include all children of all ages. At present, a child's immunisation status is only checked at ages one, two and five for the family tax benefit part A supplement, and up to age seven for childcare payments. Parents of course have the right to decide to not vaccinate their children. However, the government considers that, if they are making such a decision as a vaccine objector, this decision can no longer be supported with government financial assistance provided through the effort of the taxpayer. Much has been said in very valuable and decent contributions this evening. Perhaps those contributions can be fairly summarised by noting that it is the view of the House that the choice made by some families not to vaccinate their children is their own choice, but it can no longer be supported, indirectly or directly, or tacitly, by public policy decisions of this House. Public policy, medical research and all other best available information does not support a decision to fail to vaccinate children, and that action, if it is taken by parents in question, can no longer be supported by taxpayers in the form of family assistance and childcare payments.

Critical for the government is that ending vaccine objections through this bill will have an ongoing positive effect for the nation's health and that of, particularly, the nation's children. This means that families who do object to vaccination will no longer be able to access the relevant family assistance payments. As has been noted, there are appropriate exceptions to the policy, which have been carefully designed. They will apply as exceptions for valid medical reasons such as when a general practitioner certifies that a child has a medical contraindication or vaccination is not required as the child has a natural immunity to any particular disease in question. Families with children participating in an approved vaccine study will be taken to meet the immunisation requirements for the duration of the study. Similar rules will apply where a vaccine is temporarily unavailable. The requirements will also be met if a recognised immunisation provider certifies that the child has an equivalent level of immunisation through an overseas vaccination program.

Finally, the secretary of the department will be able to determine that a child meets the immunisation requirements, in very limited circumstances, after considering decision making principles set out in a legislative instrument made by the minister. Such decisions of the secretary will be made on a case-by-case basis, and they are strictly to address unusual situations—for example, where a grandparent or non-parent carer does not have the requisite legal authority to require or compel the vaccination of a child or effect the vaccination of a child in their care. In those circumstances, it cannot be used to give effect to exemptions on the ground of vaccine objection. The example we are giving is a circumstance in which a parent who has the legal authority to prevent vaccination does so but the child is nevertheless in the care of another person.

This policy, as it has been presented and articulated in the bill before the parliament tonight, will tighten up the rules and reinforce the importance of vaccination in protecting public health, especially for children, and perhaps it will do something to bring to the forefront of the Australian consciousness issues that in the 1940s, 1950s and, very sadly, still in the 1960s left physical scars across the nation that were eventually cured by widespread use of relevant vaccinations. I commend the bill to the House.

Sarah Henderson (Corangamite, Liberal Party) Share this | Link to this | Hansard source

The question is that this bill be now read a second time.

Question agreed to.

Bill read a second time.