The Impact of Australian Childhood Vaccination Mandates on Immunization Specialists and Their Interactions With Families

Abstract

Background: Recent global outbreaks of vaccine-preventable diseases, both before and since the coronavirus disease 2019 pandemic, have led to the introduction or strengthening of vaccine mandate policies to target vaccine refusal. Globally, there is wide variation in how governments and jurisdictions implement and enforce mandatory vaccination as well as the financial and educational consequences to those who fail to comply. We explored the impact of mandate vaccination policies on Australian Immunization Specialists who work in Specialist Immunization Clinics (SIC) for approving vaccine exemptions outside of the mandated criteria. In particular, their interactions with patients and families. Methods: A national, prospective, mixed methods, survey-based study conducted with members of the Australian Adverse Event Following Immunisation Clinical Assessment Network between February 2020 and June 2020. Results: Sixteen Immunization physicians and nurse practitioner specialists working in a SIC completed the survey. All sixteen respondents had been requested by parents to provide a Medical Exemptions at least once. 88% of respondents felt pressure to provide an exemption that was not medically justified according to legislation. Seventy-five percent of SIC consultants felt that the "No Jab" policies created a moderate or extreme amount of stress to both themselves and parents. All respondents reported experiencing hostility from parents with three respondents having received threats of violence. Conclusions: Mandatory vaccination policies are associated with increased vaccination coverage but can result in widened financial and social inequity, and may harm families' relationships with health care providers. Countries considering the implementation of vaccination mandates should use the least restrictive health policies to ensure a balance between the public health and individual benefit whilst minimizing burdens on health care professionals, children and their parents.

Medical exemptions to mandatory vaccinations: The state of play in Australia and a pressure point to watch

“…Yap et al examined the experiences of Specialist Immunization Clinic (SIC) Providers in Australia following the introduction of the Federal ‘No Jab, No Pay’ policy [ 39 ]. SICs are referral-only services for patients who require specialist immunization advice and care [ 39 ].…”

“…Yap et al examined the experiences of Specialist Immunization Clinic (SIC) Providers in Australia following the introduction of the Federal ‘No Jab, No Pay’ policy [ 39 ]. SICs are referral-only services for patients who require specialist immunization advice and care [ 39 ]. SIC providers reported an increase in the demand for MEs following the policy change, and the mean number of immunizations per clinic per month increased from 3.1 to 5.1.…”

“…Following the policy change, the study of SIC providers in Australia found that 69% ( n = 11) of the providers surveyed felt that Australia’s ‘No Jab’ childhood vaccination policies were moderately or seriously stressful in their practice. Respondents reported encountering hostility during their interactions with patients, including threats and even physical violence [ 39 ]. Echoing this, during the pandemic, Dr. Karen Price, president of RACGP, described ‘aggressive and abusive’ behaviour towards doctors by patients who were trying to get out of COVID-19 vaccine requirements.…”

“…Given the stressful nature of consultations with exemption-seeking patients, HCWs may seek to mitigate pressures by granting questionable MEs [ 39 , 40 , 46 ]. Yap et al reported that 88% ( n = 14) of Australian SIC respondents felt pressured to exempt ineligible children, [ 39 ] while Salmon et al found that up to a quarter of providers in four US states would grant MEs in the absence of valid medical contraindications [ 46 ]. Doctors in the Australian state of Victoria were found to be granting fraudulent exemptions after the introduction of its ‘No Jab, No Play’ policy in 2016.…”

“…HCWs may therefore feel stuck between their obligations to patients and their obligations to regulatory organizations, which RACGP President Dr. Price said ‘does add to our stress levels’ [ 34 , 47 ]. Another response may also be to outright refuse to see patients seeking medical exemptions, which some physicians in the United States have been doing for years in response to parents seeking either medical or NMEs [ 39 , 50 ].…”