Apr 13 2015

No Jab, No Pay

Australia┬áPrime Minister Tony Abbott has just announced a new policy that will go into effect January 2016 – the “no jab, no pay” policy. Under this policy parents who refuse to vaccinate their children will lose tax exemptions for children. This could cost them up to $11,000 per year (I have also seen estimates of up to $15,000) per child.

This new policy is reported to have bipartisan support and is supported by the Australian Medical Association.

The new policy would not apply to medical exemptions or religious exemptions, but the latter is enforced as a very narrow exemption.

Antivax parents are, of course, protesting, arguing that the new policy infringes on their rights as parents. But does it? The antvax community often makes the argument that they have the right as parents to make medical decisions for their children and the government cannot force them to vaccinate.

In the broader context of parental rights, it is clearly established that the state has a right and a responsibility to protect children from neglect and abuse at the hands of their parents. Parents cannot, ethically or legally, medically neglect their children, and not protecting them against communicable diseases can reasonably be considered medical neglect. There is an overwhelming scientific and medical consensus that vaccines are safe and effective – in the absence of any genuine controversy, antivax parents don’t have an ethical leg upon which to stand.

There is a further issue with vaccines as well – they protect the community, including vulnerable members of that community who cannot be vaccinated for various reasons. We don’t give people the freedom to speed on the highway, and we don’t give restaurant owners the right to raise chickens in their kitchen. There are numerous restrictions on personal freedom in the name of public health and safety.

The important ethical point is this: how does the restriction in freedom compare to the benefit to individual and public safety? Does the government have a compelling interest? In the context of vaccines I think the answer is clearly that the government and the public do have a compelling interest, and the restriction in freedom is justified by the safety concerns.

Further, no country (as far as I am aware – correct me if I am wrong) forces vaccines on children. No child is taken by government agents and force-vaccinated against the will of their parents. Countries that “mandate” vaccines, like the US, simply require them to access some public service or have some penalty for not vaccinating. In the US, for example, vaccines are required to enter public school. Parents, however, can refuse to vaccinate and still home school or enter certain private schools.

Australia is now taking a more aggressive approach, but this still falls within the same paradigm. They are withholding a benefit from parents who refuse to vaccinate their children. Parents can still choose not to vaccinate their kids, but they will lose certain tax exemptions if they do. The government is perfectly within its rights to use tax exemptions to encourage or discourage certain behaviors, as long as they are not discriminatory. In this case they are encouraging a behavior which is in the interest of public health.

This is similar to charging people higher health care premiums if they smoke. You are free to engage in this unhealthy behavior, but your bad behavior will not be subsidized by others. You will have to pay for the consequences of your own choices. At the same time you cannot smoke in certain public areas, so you are not free to impose your bad health choices onto other people.

It is a reasonable premise that parents who choose not to vaccinate put other children at risk and cost society money. Society therefore has a right to respond to their bad choices (and we have sufficient evidence and consensus to call them bad) by restricting access to certain public services and benefits.

I therefore think that Australia is on solid ethical and legal ground. I applaud them for having the political courage to take such a bold action. Hopefully their actions will set an example for other countries to follow suit. I would support a similar law in the US.

The Disneyland Measles outbreak has seemed to shift the balance of public opinion against the anti-vaccine movement, and so the time is ripe to lobby for laws to protect the public against anti-vaxxers.

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