Financial Interventions to Increase Vaccine Coverage

Katie Attwell · Rebecca Seth · Frank Beard · David M. Lawrence

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Vaccine Coverage and Hesitancy Child and Adolescent Health Ethics and Legal Issues in Pediatric Healthcare

Abstract

BACKGROUND: Recent vaccine mandates in Australia, as in other high income settings, have sought to change the behavior of parents, including those who would otherwise access nonmedical exemptions. Since 2014, Australian state governments have introduced and progressively tightened policies restricting the access of unvaccinated children to early education and child care. In 2016, the Federal Government removed financial entitlements and subsidies from nonvaccinating families. We sought to ascertain the impact of these policies on vaccine coverage rates by state, and also to consider their impact on communities with high numbers of registered refusers. METHODS: Interrupted time series models were fitted by using the Autoregressive Integrated Moving Average framework to test for changes in trend in vaccination rates following implementation of government policies. RESULTS: Australian vaccine coverage rates were rising before the vaccine mandates and continued to do so subsequently, with no statistically significant changes to coverage rates associated with the interventions. The exception was New South Wales, where vaccine coverage rates were static before the policy intervention, but were increasing at an annual rate of 1.25% after (P < .001). The impact of the policies was indistinguishable between communities with high, medium and low numbers of registered vaccine refusers. CONCLUSIONS: In our study, we show that childhood vaccine coverage continued on its positive trajectory without any conclusive evidence of impact of mandatory policies. Overseas policymakers looking to increase coverage rates would be well-advised to examine the contribution of pre-existing and parallel nonmandatory interventions employed by Australian governments to the country’s enhanced coverage.

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2006Nonmedical Exemptions to School Immunization Requirements 2017Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology 2012Vaccination Policies and Rates of Exemption from Immunization, 2005–2011 2019Mandate vaccination with care 2018Recent vaccine mandates in the United States, Europe and Australia: A comparative study 2020Adherence to Timely Vaccinations in the United States 2009The Australian Childhood Immunisation Register—A model for universal immunisation registers?2020Mandatory Vaccination in Europe

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