Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

Labor will be supporting this bill, the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. I reviewed the comments I made when we were talking in the last process and I saw that, at that stage in the debate, I pointed out a number of the concerns that I have with the legislation. I continue to have the concerns that I raised—about the need for education, the need for certainty, and the need to ensure that people and their views are respected effectively in our community—but it is very clear that Labor supports the legislation. We believe that there is a need to have strong immunisation policies in Australia. The evidence that we as a committee have received indicated that that was important and that it was real.

However, I also want to talk about some of the things that we need to get right in introducing this legislation because, as I said in the previous contribution, there will be a group of people in our community who reject immunisation, who do not believe in its effectiveness, and who are actually quite fearful about the processes. Those people will not change their views. Many people have spoken to parliamentarians about their concerns. The people who genuinely reject vaccination have strong views and will not change these. But we need to listen to the questions that are being asked, to respond effectively, and to ensure that the information process is accurate. I have spoken about my concern that I do not believe that the department was able to convince us effectively during the committee process that the education campaign which must go with this legislation is fully developed and effectively funded. In fact, to this day we still have not got the full budget to discuss in this place.

I know that there have been effective processes in Australia looking at the need for immunisation, and we pointed in the discussion to what had happened with some of the then Medicare Locals, where there was intensive effort put into particular regions to make sure that people knew about the value of immunisation, to talk about the safety issues, and to acknowledge that there was a need for people to make decisions and also to find out about the processes. That worked, Mr Deputy President—for the Medicare Locals which had this as a priority, we know that there were changes in the vaccination rates in those regions. Where this was not a priority, there continued to be a lack of effective information, and also fear—people were not certain about how the process worked, and about how it should work.

So, when you are introducing legislation as decisive as what is before the chamber today, what must go with that is the education and engagement program—well funded, well targeted and also done with respect so that people who have differing views are not excluded, demonised or ridiculed but have their views acknowledged with acceptance that there will not be agreement. That is important in ensuring that any program of change is effectively brought forward.

Another element is the Australian Childhood Immunisation Register. One of the parts of this legislation which has not been discussed as fully as others is the fact that now the registry vaccination program is there not just for early childhood but through until the late teens. We need to have an effective registration process for the whole of our lifetime of vaccinations. That has not been in place in the past. In fact there was considerable discussion around the way the current Australian Child Immunisation Register operates and there was a recent ANAO report which looked at the operations of that register and made suggestions for how the process could be improved.

Evidence that we received at our inquiry talked about some real concerns that the data was not always accurate, that there could have been multiple registrations made to this register and that by the evidence we received it was felt that perhaps it was not seen as a priority by the people who were putting this data into the system. We know this is an issue across the board in our systems with data collection and maintenance. If we are going to be sure that there is going to be real knowledge of what is happening with vaccinations across our nation, we have to have confidence that the data is accurate and that we will be able to use the Australian Childhood Immunisation Register effectively and with confidence.

That was part of the discussion we had during the committee process. We needed to ensure that the work which was done by the ANAO, which was looking at how the register was working now and also at the operations of the register into the future, would be accepted by the departments and by government and that there would be confidence that the register would be accurate. We did not at the inquiry because, naturally, the department that was in charge of the register was not there to provide evidence to our committee, but subsequent to the inquiry we did get evidence back from the Department of Human Services that said that they were meeting the time line of change, that they were confident that they had the resources and the skills to ensure that the register would be accurate and that we would be able to know that this register, which is kind of the infrastructure of vaccination, would be accurate. People would be able to have confidence that their details were accurate and that, when we have a system which is actually saying that you are not going to be able to receive payment unless you are up to date with your vaccinations, there is knowledge about what the vaccinations are, what is needed and what is required. The register would be able to confirm that you have received that process.

We accept the evidence provided by the department that they are aware of the needs, that they are working to cleanse the data and that they are ensuring that the site will be functional and secure by September 2017. There does seem to be a reasonable expectation that, if we bring the changes in on 1 January, it will take time to make sure that the system catches up and the register will be accurate.

In terms of ensuring that we actually know where there is genuine conscientious objection to using vaccines, the new system needs to have some consideration. This is something we discussed and put back to the department. We need to know where there is conscientious objection to vaccination so that we know where there are areas that may well have a lower vaccination protection rate. The department took that on board, and at this stage that is part of ongoing discussion to ensure that we do not lose contact, that we do not lose information about where there are and are not effective vaccination rates in the nation.

We know that this debate will continue. As I have said, there are people in our community who will not accept vaccination, and that is their right. Nothing in this legislation actually says that not taking up vaccination is illegal. What it does is change the family payment regime and the childcare benefit regime around having vaccination up to date. This is actually an extension of existing legislation, and we know that there have already been processes where we link access to family payments with vaccination, so this is not new, but it is wider and takes up more people. We need to ensure that we are working with the community to explain the reasons and to point out to them what the background to this process is and how it is going to operate.

During the committee process, the Labor Party recommended—and the committee took up this recommendation—that there would be reviews of how this legislation is operating after a year and after five years, with very intensive scrutiny of how this legislation operates—making sure the register process and the public campaigns of education and awareness are in place—and also of the impact of these changes on the childcare area, as I said. We do not think this is something that should just wait for the standard review process that is natural in departmental processes. I would be very interested to hear from the minister about whether there has been any agreement to the recommendations that the committee made about this concept of having a very intensive review, almost from the start, of how the legislation is impacting, who is affected and whether we get changes to ensure that the vaccination rates increase. It would be useless to introduce such a significant piece of legislation and not know how it is going and how it is working from the very start.

So I would be interested if in the minister's concluding comments and in committee, if it should go to committee, we can get some clear indication that the department will be taking up a very intensive review process which is linked to the necessary engagement with the community, with people who do not agree with vaccinations and, most importantly, with the almost seven per cent of people and families in our community who are non-vaccinators, who have not registered as conscientious objectors but have not vaccinated their children. That is the group that I believe will be most benefited by this change, but it will not happen if we do not work with them, if we do not have the engagement campaigns and public awareness campaigns targeted clearly, and if we do not get effective information out of the department about where the people are.

I think I have shown my frustration on a number of occasions during my contribution about the lack of information that we were able to extract from the various departments who have a role to play in this process. We need to have the data. We need to know where vaccinations are occurring and where they are not. Only then, when we find out where people are choosing not to vaccinate and why and we work in a targeted way with that group, will we be able to reach the kinds of results that this legislation is designed to do.

Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source

I rise today to speak to the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. The Australian Greens are very strong supporters of vaccination as an evidence-based approach to preventing disease, but we have some concerns about this specific legislation.

Immunisation is one of the great success stories of modern medicine and public health. Vaccinating against illness and disease is the easiest way a GP can protect people of all ages from vaccine-preventable disease. It is a proven method of reducing the incidence of deaths from causes such as measles, tetanus, diphtheria and Haemophilus influenzae type B. Measles, we know, can be fatal in young children. Tetanus is something that is almost nonexistent now, but people died from tetanus regularly. Diphtheria is another disease that led to the deaths of people, and Haemophilus influenzae is a cause of meningitis and pneumonia, a very serious cause of morbidity. We know that, since the introduction only recently of the vaccine against Haemophilus influenzae, we are seeing a reduction in the incidence of meningitis and pneumonia from that specific condition. And let's not forget, of course, polio. It was not that long ago that polio caused death and serious disease—a disease that resulted in muscle paralysis and ongoing problems with mobility and so on.

So we know that vaccines work and that they are effective, but of course they are only effective if we are able to immunise large numbers of the population, and vaccination rates over the last 20 years demonstrate that Australia has done a pretty good job of it. We have an excellent record of achievement in the prevention of vaccine-preventable diseases. It is a critical message for the community, though, where there is patchy immunisation coverage in places like the Northern Rivers in New South Wales and the Sunshine Coast in Queensland. It is very critical that this message be able to penetrate those communities, because we know that when immunisation rates fall below a particular level, in the 90 to 95 per cent range for a number of conditions, we lose that critical principle of what is called herd immunity.

Herd immunity is absolutely critical. What it means is that, when immunisation rates are low, illnesses like measles and whooping cough or pertussis can be much more easily spread. So, if we have a population where a large number of people are immune as a result of vaccine, the chain of infection can be disrupted or effectively stopped. The greater the number of people who are immune, the smaller the probability that those who are not immune will come into contact with the infection. So, once you reach that critical threshold and achieve herd immunity, you see the gradual elimination of a disease from a population, so you can actually eradicate the existence of that disease altogether.

What we saw with, for example, the eradication of smallpox in 1977 was exactly that. We were able to reach herd immunity and get a critical level of immunity across the population, and people now no longer die from smallpox, a hugely successful public health intervention. We are on the verge of eliminating polio altogether from the planet. What a wonderful thing that would be, and that is because of the huge investment that we are making across polio eradication in some of those very hard-to-reach populations. Of course, the final yards are the most difficult. The law of diminishing returns means you have to throw a lot at it to eliminate those final cases, but once we do that—and I am confident that we will—polio, much like smallpox, will be a thing of the past.

It is partly because of the success of immunisation that we are having the problems that we have with some communities deciding no longer to vaccinate children. Vaccination has been a victim of its own success in many ways. Because people are not exposed to these life-threatening illnesses, we do not have the level of knowledge and understanding that exists with exposure to diseases like polio and, of course, measles, diphtheria and so on. What that means is that people make the decision not to vaccinate their children because they are not aware of the consequences of those illnesses. Of course, it is a rational decision in some ways, because there is a very small risk associated with having a vaccine and, if we are talking about a population where herd immunity exists, you do not expose your child to the incredibly small risk of the vaccine and you get the benefit of herd immunity within that population. Those people are so-called free riders, and they benefit from the decision that other people make.

Now let's look specifically at the bill, which requires that families be up to date with the National Immunisation Program. They need to be up to date in order for either parents or guardians to be eligible for the family tax benefit part A, for the supplement and for childcare benefit and the childcare rebate. The rules that this bill—basically, the No Jab, No Pay bill—seeks to implement would remove the immunisation exemption categories for access to childcare benefit, childcare rebate and the family tax benefit part A supplement.

One of the positive things the government did as part of this initiative was provide a $26 million funding boost to the Immunise Australia Program to ensure that we saw doctors and immunisation providers identify and vaccinate kids in their practices who were overdue for their vaccinations. That is really important. It is a positive initiative and, if we can do more in boosting those programs that encourage doctors and other immunisation providers to identify kids who are not currently vaccinated, that is a positive thing.

The bill, as Senator Moore just said, does not remove the right to make a conscientious decision not to immunise. People will continue to have that choice. What it does is put a financial cost to that decision. The government's proposition is this: the disincentive of no longer being eligible for Centrelink payments may result in parents reassessing their conscientious objection or antivaccination stance. It is important to understand why people do not vaccinate. It is worth exploring that, because it really goes to the substance of whether this policy proposal is the right one. We know that there are people who do not vaccinate for all sorts of reasons. Interestingly, the majority of these families are not conscientious objectors. In fact, Professor Julie Leask told the inquiry into this legislation that the majority of families who do not vaccinate are not conscientious objectors. Of the eight per cent of people who are not vaccinating, only 1.5 per cent register as conscientious objectors. In her opinion, the remaining 6.5 per cent could benefit from other measures, and the best way to tackle those people is through supporting health professionals and, of course, ongoing education. That is one of the concerns we have with the bill: it does not focus enough on that large group of people who are not conscientious objectors but are not vaccinating their children for other reasons.

Professor Leask also told the inquiry that there need to be strategies to tackle those people who at present do not have fully vaccinated kids. She said that, when it comes to the issue of conscientious objectors, there are a number of what she called hesitant parents—people who are fence sitters and who are on the margins of vaccine acceptance. What we need to do with that group is ensure that there are community-based interventions and that there are provider-based interventions—things that we are working on the moment—and that we actually incentivise the interactions between those parents and the healthcare system. Under the current model, for someone to register as a conscientious objector they actually need to interact with the health system and get their forms signed by a health provider. That is the area in which we should be working. The real concern we have is that this is a very blunt measure. It limits the opportunities for engagement with people who might be at the margins of vaccine acceptance and their interaction with the healthcare provider.

I think it is important to note that the government's provision of $26 million in funding for Immunise Australia does include incentive payments to GPs who identify undervaccinated kids and initiate catch-up schedules. That is a good thing. Also, it improves public vaccination records, reminder systems and communication strategies to promote the benefit of vaccines. We welcome this recognition of the importance of reminder and recall strategies, and we look forward to seeing evidence of how these measures have led to an increase in the numbers of children who are vaccinated. That evaluation process is important. We also look forward to looking at how the reliability of the immunisation register, and their capacity to target Aboriginal and Torres Strait Island communities, has improved.

The bill provides that a child meets the immunisation requirements if a GP has certified, in writing, that the immunisation of the child would be medically contraindicated under the specifications set out in The Australian Immunisation Handbook. That is good; we think that is important. But we also think it is important also to recognise that the legislation says that if in the opinion of a GP a person has contracted a disease or diseases and that as a result has developed natural immunity, that that also is a factor. Importantly, GPs need to be able to use their clinical judgement in assessing children who are eligible for a medical exemption. As Dr Kidd testified to the inquiry, medical exemptions are rare, but with the guidance provided by the handbook and by using their own clinical judgement, GPs are the people who are best equipped to identify the small number of children who should not receive a vaccination.

Again, let's stress that point: that a GP can use their clinical judgement to determine whether somebody should receive a vaccination. But simply going to a GP and saying that you believe a vaccine is dangerous—that a vaccine will cause conditions such as autism—is not good enough. That will no longer qualify.

We do agree with the AMA's view:

All children have the right to be protected from vaccine preventable diseases. This includes infants who are too young to be immunised as well as those infants and children who are medically unable to receive immunisations. Immunising as many infants and children as possible affords these vulnerable infants and children the protection they deserve.

We do, however, as I said, have a concern that in order to register as a vaccine refuser under the current system you need to discuss that decision with a health professional. Often what we hear from health professionals is that sometimes it is a discussion that ends with the person changing their mind. It might not be about all vaccines, it might only be about some of them—but that interaction does create possibilities to influence somebody who is at the margins. We have concerns that removing that incentive for that encounter does deprive health professionals of the opportunity to encourage parents to reconsider that decision.

We also heard evidence from Dr Richard Kidd of the AMA, who said that there are occasionally severe reactions to vaccines. Depending on the degree of severity—we are talking about the extreme end—we are talking about cases that are close to one in a million. So, yes, there are minor reactions—I think that most parents will have had the experience of taking their child along to an immunisation provider and the child having a red, sore arm from the vaccine or, indeed, a little bit of a temperature overnight, but they recover reasonably quickly. But when we talk about serious vaccine injuries, we talk about in the order of one in a million or so. So we can expect a handful of serious vaccine complications to occur each year.

It is the Greens' view that it is a serious problem, and that in order to encourage greater acceptance of vaccines there should be a vaccine injury compensation scheme. We think that is really important. We heard evidence through the inquiry that the United States requires a compulsory levy on the manufacturers of vaccines that goes towards such a vaccine injury compensation scheme for those vanishingly small but very real and severe impacts associated with vaccines. We think that would lead to greater acceptance. Of course, that is at the opposite end of what some of the people who do not support vaccination claim is the consequence of vaccines. They cite links to autism, other mental health conditions and a range of conditions where there is absolutely no evidence of a connection between vaccines and those conditions.

We know that the AMA provided more detail about the Australian Immunisation Handbook and how that provides guidance about exemptions to immunisation. It also provides information on a range of contraindications and precautions for specific groups—those people who are at risk of anaphylaxis, those who are immunocompromised, those who are receiving particular blood products and so on.

One of the other things that we are concerned about is the accuracy and the quality of the data upon which the requirements for immunisation are enforced and, of course, the association with the removal of those particular benefits. The policy uses the Australian Childhood Immunisation Register as the primary data source. It is true that the ANAO did a performance audit of the register, and it reported that overall the administration of the register has been effective and that it has met or exceeded performance targets. That is a good thing. But we also acknowledge that there were concerns expressed through the hearing. Indeed, some were expressed by the Public Health Association of Australia, who documented some of the flaws in the register, which was developed in the 1990s. In evidence submitted on notice, the Department of Human Services wrote that:

In accordance with the phased expansion of the ACIR into a Whole of Life Australian Immunisation Register (AIR)—

and that is a good thing; to have a register that covers people right through their life—

a range of improvements will be implemented to the Register's functions and operations. This includes new functionality to enable providers to correct errors online through the AIR secure site, such as correction of an incorrect dose number or incorrect vaccine recorded. This will begin to be implemented in September 2017.

That is especially concerning. It is concerning because we have a scheme that is relying on data to remove payments from people, but we know that the system they are relying on will not be fully operational and accurate—in the way that we want to see it—until September 2017. That is why we think that if you are going to introduce this sort of legislation, you should at least do it once your data system is up to date. And that is why we are moving an amendment to delay the start date of this legislation until 1 January 2018, along with other specific amendments.

The Public Health Association of Australia told the committee that the government should seek to address the structural and practical barriers that exist, including socioeconomic reasons, and that explain why some children are not fully vaccinated. We absolutely agree with that, and we think that vaccination will be enhanced by supportive systems—reducing barriers to access, improving the reliability of the register, and further strategies that are specific to Aboriginal and Torres Strait Islander communities. We absolutely look forward to seeing the impact of reminder and recall strategies, through a thorough evaluation. These strategies should include a national immunisation reminder system, catch-up campaigns, and local initiatives to improve coverage, as well as home-visiting programs and other actions to address some of the barriers to health care.

Finally, there is some confusion in the information that has been provided on the departmental websites. The Department of Human Services and the Department of Health websites actually differ in terms of information about which vaccinations that are required for people to be able to access family assistance payments. That needs to be clarified as a matter of urgency. We need to know absolutely clearly what is and what is not mandatory for eligibility for family assistance payments.

In conclusion, I move the Australian Greens second reading amendment on sheet 7798:

At the end of the motion, add:

", but the Senate:

(1) recognises that it is of critical importance that GPs remain able to use their clinical judgement in assessing children who are eligible for medical exemption; and

(2) calls on the Government to clarify which vaccinations are mandatory to meet the immunisation requirements and make this clear on all their relevant websites and publicly available material.".

Zed Seselja (ACT, Liberal Party) Share this | Link to this | Hansard source

Thank you, Senator Di Natale. Your time has expired. The question is that the second reading amendment be agreed to.

David Leyonhjelm (NSW, Liberal Democratic Party) Share this | Link to this | Hansard source

Since it is about time somebody did, I rise to ask: won't someone think of the childless? Politicians seem to be obsessed with families, so it may come as a surprise to many that most households in Australia are childless. A quarter of all households consist of an individual and more than a quarter of all households consist of an adult couple. There are also hundreds of thousands of households where unrelated adults live together. Childless households are also on the rise, in part because kids have grown up and moved out of their parents' homes, and because of the increasing propensity of couples to remain childless. To the childless people of Australia I want to say, on behalf of this parliament, 'Thank you for being childless.'

You work for more years and become more productive than the rest of Australia. You pay thousands and thousands of dollars more tax than other Australians. You get next to no welfare, and your use of public health services is minimal. But you pay when other people get pregnant; you pay when they give birth; you pay when they stay at home to look after their offspring; you pay for the child's food, clothing and shelter; you pay when the child goes to child care; you pay when the child goes to primary and secondary school; and then you pay when it goes to university.

Thank you, for all you do for others. I am sorry that rather than receiving thanks, you are often ignored, pitied, considered strange or even thought of as irresponsible. For your sake, I hope the children you are forced to support do not end up as juvenile delinquents and I hope that they get immunised so that you do not end up getting sick, because you will pay then too.

For this reason, amongst others, I support the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015. This bill concerns parents who, on religious or conscientious grounds, refuse to immunise their children. The bill makes such parents ineligible for childcare subsidies and family assistance end-of-year supplements. This is as it should be. It is bad enough that people continue to bring wave upon wave of these little blighters into the world. The least they can do is immunise their bundles of dribble and sputum so they do not make the rest of us sick.

Withholding welfare payments from parents who fail to immunise their kids is entirely legitimate, including from a libertarian perspective. Immunisation generates a significant social benefit, and parents do not have a right to welfare payments. Such payments are, fundamentally, a gift from their fellow Australians. No work is done for the money, so there is nothing wrong with placing conditions on it. The fact is that most welfare payments to parents should be abolished, because people without children should not be forced to subsidise people with children.

Children generate great joy, warmth and meaning for their parents. They are a precious gift. What more do you want? It is unfair that people without children are forced to pay money to those people who have received the gift a child. Some people are childless by choice and are happy with that choice. There is no moral case to make them subsidise other people's choices. For some people, childlessness is not a choice; it is a great sadness. Forcing them to hand over money to more fortunate people is like charity in reverse. It is like making people in wheelchairs pay for other people's running shoes.

People without children are not freeloaders; they can look after themselves throughout their life through working, saving, and engaging in voluntary, mutually-beneficial exchanges. It would be weird to suggest that you need to pay for the upbringing and training of a baker just because one day you will want to buy bread. It is equally as weird to suggest that a childless person needs to pay for the upbringing and training of children just because they might want to buy services from those children in the future.

Some argue when taxpayers fund subsidies for today's children that this is a proxy for paying back the subsidies the taxpayers received when they were children. But this ignores the fact that some taxpayers received little or no subsidies when they were children. They have nothing to pay back. And forcing money on today's children, needing it or not, does not create any special obligations on them in the future either. And there are plenty of adults right now who pay little or no tax, so if they received subsidies when they were children they are not paying them back now. Overall, intergenerational wealth transfers are best achieved within families.

The Liberal Democrats support the abolition of childcare subsidies, coupled with deregulation of the childcare sector—including its excessive credentialism—to cut the costs of childcare. The Liberal Democrats support the abolition of taxpayer-funded paid parental leave, which is an arbitrary payment provided only to those new parents who were in employment in 10 of the prior 13 months. The Liberal Democrats believe that family tax benefit part A should be limited to low-income families, and that family tax benefits should end their march through the alphabet right there. Family tax benefit part B should be abolished, and, instead, we should have a flat income tax rate to ensure that families are not penalised if one member of a couple makes more money than the other. Parenting payment would remain only for low-income families with children who are not yet in school.

Some people may say that if this policy platform came to pass they would not be able to afford to have children. In response, let me make this very clear: people do not have a right to expect or force others to pay them to have children. The government is not your parent or your spouse. Get over it. In fact, do not just get over it; be thankful for it. The government does not make a good parent—just ask any ward of the state. What is more, when you allow the government to become a de facto parent it encourages the breakdown of traditional family units—something many politicians claim to support. Mark my words: when you treat the government like a parent, it will soon enough treat you like a child. The passage of the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015 should help. I commend the bill to the Senate.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

The issue of immunisation of children is highly emotive because it relates to our most treasured loved ones—our children. It is true that Australia is seeing a drop—many consider it a worrying drop—in immunisation rates and the herd immunity that comes with them. Australia has a vaccination rate across the nation of a little over 90 per cent, but in some parts of the community it has dropped well below that.

From 1 January 2016—just five weeks away now—this bill will introduce a requirement that children have up-to-date immunisation shots in order for the family to receive childcare benefits, childcare rebate or the family tax benefit part A supplement. The vast majority of families that would be affected by this bill already meet the immunisation requirements for their children at the appropriate age points—it is about 97 per cent. Figures provided by the Department of Social Services show that this 3 per cent of families represents an additional 18,000 children who would be required to undergo immunisation shots from 1 January 2016. But, crucially, this bill would also apply to children of all ages who do not have up-to-date immunisation shots. The parents of these children would need to have them undergo catch-up shots to the appropriate level for their age in order to continue receiving the childcare and FTB-A payments.

The bill also scraps the conscientious objection exemption to children's vaccinations. Exemptions will only be granted for valid medical reasons, such as when a GP certifies that the child already possesses a natural immunity from, say, previously contracting the disease in question. At this point it is worth mentioning that the Australian Greens second reading amendment seems, on balance, a sensible way to go forward—to allow GPs to make a judgement in these cases. It is a second reading amendment and it is not binding on the parliament, but, from a policy framework perspective, I think it is important that we do not ignore or shut out GPs who are on the ground, know the families and children and can make a reasoned judgement based on the medical evidence as to what is the best and most appropriate course of action to take.

Although we are talking about a small percentage of families, when added to those needing so-called catch-up shots and those families for which exemptions no longer apply, this bill will affect many thousands of Australian children and their parents. The DSS estimates that more than 200,000 children aged from one to 19—although if you are 19 you are not really a child, but I am relying on the DSS estimates—would need to be immunised to some level in the current financial year. That is 3.4 per cent of the total population of 5.9 million Australians in that age bracket of between one and 19. This is a large number of children, the future health of whom should be a priority for all of us. The arguments that weigh both sides of this debate cannot be discounted. I think we need to respectfully consider both sides of the debate. On one side of the equation there are parents who believe that their children will be at risk of contracting diseases because another child in the classroom has not been immunised. They say that that is unfair, despite any conscientious objection. These could be classmates at school or playmates in child care, or just kids that kick around together in the neighbourhood. On the other side of the equation, we should not discount the concerns of parents who do not want to see what they regard as pharmaceuticals injected into their children, even for the best intents and purposes, because there has been a concern that occasionally—rarely—there are adverse health impacts. There is a school of thought that has linked immunisation to autism. However, as reported in the Journal of the American Medical Association, this year there was a massive study of 95,000 children which found that the measles-mumps-rubella vaccine did not affect autism rates in a known risk group—those with autistic siblings. But I do understand that there are also contrary views in respect of that. It is not for me or for the Senate to repudiate what parents have observed in their children stemming from immunisation; I think that parents know their children best. There have been instances and evidence suggesting that vaccines are not risk-free. That is something that even the most ardent proponents of vaccination acknowledge—that there are, occasionally and rarely, adverse outcomes.

This year, the journal Vaccine reported that mistakes made in making Fluvax in bioCSL's Melbourne laboratory had led to dangerous side effects in children. Fluvax remains banned for children aged five and younger. The risks of injury from immunisation are very small but very real. I think there is a place for a statutory compensation scheme to cover the very small number of families who face a tragic outcome. And I note that, going back a number of years now, there have been calls for a vaccination injury compensation scheme. These are from people who support vaccinations; these are from advocates of vaccination who acknowledge that, where there is an adverse outcome and where that adverse outcome is linked to the vaccination, there ought to be such a scheme. My understanding is that Canada has had such a scheme in place for a number of years. That is something that we need to look at. That would appear to be a best-practice model. I ask the minister—and I would be satisfied if this were taken on notice—whether the government has looked at the Canadian approach, where vaccination programs are very much in place and supported by the community and where, for those rare cases of adverse outcomes, there is a compensation scheme.

I note that, back in 2011, Associate Professor Heath Kelly of the Melbourne University School of Population Health told Fairfax Media:

… although it was rare for children to be seriously harmed by vaccines, it was unfair not to compensate the few affected when there were known risks.

He is an advocate for vaccination, and he also said:

There is no doubt that the benefits of immunisation far outweigh the risks. However, on the very rare occasions that there is a serious complication, despite proper manufacture and administration of a vaccine, it is only fair that the community should provide for the individual suffering ... as there is a community benefit from as many people as possible being vaccinated.

That seems to be a measured view, which I think we ought to consider. But we also ought not to dismiss those who are critical of vaccinations; their views should be heard, and not derided.

We also need to ensure that the risks posed by future vaccines are closely monitored. Earlier this year, researchers writing in the PLOS Biology journal outlined the risks that vaccines against some of humanity's deadliest diseases, including HIV, Ebola and bird flu, can be 'leaky' and can lead to so-called 'super-bugs'.

For all the claims and counterclaims around this debate, I understand that this piece of legislation is about the risk of contracting diseases that have previously been eradicated, or largely eradicated, in Australia. I understand the government's argument about herd immunity, and that is a concern. But I also think it is important that we acknowledge the concerns of those who have said, 'we are worried about adverse outcomes'. We need to make sure that vaccines are produced to the highest possible standard. What happened with the Fluvax vaccine—where children were injured as a result of that situation—indicated, I think, a failure in appropriate quality controls. I also think that it is not unreasonable that there be ongoing monitoring of adverse effects of vaccines. We also need to look at what Canada has done for a number of years now with their statutory compensation scheme. That way, the issue is less about emotion, in a sense, and more about dealing with the facts that we have before us, on a scientific basis, so that we can ensure that our children are as safe as they can be, and free not only of disease but also of any unnecessary adverse impacts.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I support this bill, the Social Services Legislation Amendment (No Jab, No Pay) Bill, and I will be voting for it. I have no particular expertise in this area, but I accept what appears to be the overwhelming support of professionals and learned people who make immunisation and the control of diseases are a full-time study.

I was approached by a group of very sincere Australians who had an objection to this bill. Whilst I indicated to them that I did not necessarily support their arguments, I was very keen to ensure that they had the opportunity of putting their case and their concerns to the parliament—and through the parliament, to the general public. I was also pleased to see that the minister and the government allowed a committee investigation—which I note, Mr Acting Deputy President, that you were chairman of; as usual, a very distinguished chair. I note the recommendations of the committee which, broadly speaking, I support. The principal recommendation is that the bill be passed. The report contains recommendations that, in broad, call upon the government to keep the matter under review, to embark on education and communication strategies, and to look more closely at the question of conscientious objection. I note the thoughtful comments of the previous speaker in that regard. I will not take the time of the Senate by repeating a lot of those issues; suffice it to say, I think that the people who have a serious objection to the proposal are genuine. They are serious in their concerns and I think, in a country like Australia, we have the democratic right to make these views known. I was pleased that this group of people had that opportunity. I note that there were over 2,000 submissions to your committee's inquiry, Mr Acting Deputy President. I suspect and I see that quite a number of them were what we in this business call 'campaign letters' but, notwithstanding that, there is clearly a group of people who have concern about the compulsory nature of this.

In general, I am reluctant to impose these sorts of things on fellow citizens, particularly where there are serious objections, if—as most would say—not valid objections. I am a little bit uncomfortable about that. But I go along with the majority view—and Senator Xenophon mentioned this as well—that it is not just about the children involved: if particular children do not have these immunisations, there is a belief that this could impact unhealthily on other children in their sphere of influence.

I congratulate the committee on its report, and on its work in hearing the evidence and presenting this report to parliament. I think on balance that it is a bill that should be supported. However, I like the committee's urging—and I am paraphrasing here—that this matter should be kept under review, and perhaps some of the international incidences and experiences which have been spoken about in this debate should be looked at. I will be supporting the bill.

Mitch Fifield (Victoria, Liberal Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I thank those who have contributed and the spirit in which they have engaged not only in the debate in this place but also in the Senate committee inquiry. I think we can all agree that one of the great strengths of this institution is its committees, when they are directed to good purposes.

This bill will ensure that children fully meet the immunisation requirements before their family can access a childcare benefit, a childcare rebate or the family tax benefit part A supplement. Immunisation is an important health measure for children and families as it is the safest and most effective way of providing protection against disease. What is proposed is that from 1 January next year the government will extend the current immunisation requirements to include children of all ages. At present, a child's immunisation status is only checked at the age of one, two and five for family tax benefit part A supplement and up to the age of seven for childcare payments.

There has been a high degree of public interest in this policy, with a large number of submissions being made to the inquiry. A range of views from organisations and individuals have been presented. The government recognises that communication to medical professionals and families is a critical part of this policy, and that is something the Senate inquiry touched on. Materials provided to families will make it clear which vaccinations are necessary to meet the requirements, and communications to general practitioners will clearly stipulate how the catch-up program will operate.

While concerns have been raised in regard to this legislation's approach its intentions remain the same, and that is to prevent Australian children from preventable diseases—in particular, those who are unable to be immunised because they are too young or for valid medical reasons. Parents do have the right to decide not to vaccinate their children. However, if they decide to object to vaccination, this decision can no longer be supported with government financial assistance. The choice made by some families not to vaccinate their children is not supported by public policy or medical research, and nor should such an action be supported by taxpayers in the form of family assistance and childcare payments.

Crucially, the government is ending vaccine objection exemptions through this bill. This means that families who object to vaccination will no longer be able to access these family assistance payments. Exceptions to the policy will apply for valid medical reasons such as when a GP certifies that a child has a medical contra-indication or vaccination is not required as the child has natural immunity to a particular disease. Families with children participating in an approved vaccination 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 a 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 in very limited circumstances after considering decision-making principles set out in a legislative instrument to be made by the minister. Such decisions of the secretary will be made on a case-by-case basis to address unusual situations—for example, where a grandparent or non-parent carer does not have legal authority to vaccinate a child in their care—but it cannot be used to give effect to exemptions on the grounds of vaccine objection. This policy will tighten up the rules and reinforce the importance of vaccination in protecting public health, especially for children.

I should point out that the government supports the Australian Greens second reading amendment, which records the Senate's recognition of the importance of the role of GPs in assessing medical exemptions and the need to record publicly which vaccinations are mandatory to meet the immunisation requirements. I commend the bill to my colleagues.

Zed Seselja (ACT, Liberal Party) Share this | Link to this | Hansard source

The question is that the second reading amendment moved by Senator Di Natale be agreed to.

Question agreed to.

The question now is that the motion as amended be agreed to.

Question agreed to.

Bill read a second time.