Since the Government released its budget proposal last week, there's been plenty of discussion about the people who will be hit hardest.
High-income earners and businesses will escape mostly unscathed. However, there is at least one knock-on effect from this budget that won't discriminate by tax bracket: vaccination and vaccine-preventable diseases.
The Australian Medical Association has confirmed that childhood vaccinations, previously free under the bulk-billing system, will now incur a $7 Medicare co-payment, along with all other bulk-billed services. As the budget currently stands, there will be no low-income exceptions.
As an academic researcher and PhD candidate, my work focuses on vaccination communication issues around the world. Vaccination depends on supply and demand in order to work. On the supply side, people need ready access to vaccines. Communication works on the demand side, by helping people make informed decisions and encouraging them to seek out vaccination.
Effective communication can overcome many barriers to vaccination. It can remind people when vaccines are due, explain their risks and benefits, correct misinformation, and help people find and access vaccination services. But effective communication cannot jump over every hurdle and requiring everyone to pay a fee may be a hurdle too high for even the most persuasive communication strategy.
The impact on the (family) budget bottom line
The current vaccination schedule requires six separate GP visits to receive vaccines in the first 18 months of a child's life. Let's imagine a fairly typical scenario: a family with young children has a bad week - the power bill is due, the car breaks down, one kid has an ear infection and the baby is due for a vaccination. If there is not enough to cover every expense, which one do you think will get dropped or postponed?
The vaccine schedule is designed to make sure children develop long-lasting immunity by delivering vaccines with a specific amount of time between doses. When children are late for a dose, they are considered "under-vaccinated" and they may be susceptible to diseases.
Even for parents who won't struggle with the co-payment, why add a disincentive to something we are trying so hard to encourage people to do?
New South Wales brought in the "no jab, no play" rule this year. Rather than throwing up hurdles to timely and appropriate vaccination, the Government should be encouraging it.
Reduced vaccination rates will be an issue for more than the families who can't afford the co-payment. Vaccines protect all of us by offering herd immunity - when most people in a population are vaccinated (generally more than 90 per cent, though for particularly infectious diseases like measles this number is more like 95 per cent), vaccine-preventable diseases can't get a foothold among the isolated unprotected people.
There will always be some people who are unprotected, and they come from all income levels. Very young babies are particularly vulnerable, as are people with allergies or other health conditions that mean they cannot receive certain vaccines.
Some people's bodies simply fail to develop complete immunity when they are vaccinated. These are the people affected when herd immunity drops and disease outbreaks occur.
It is baffling to see the Government create a new barrier that could lower vaccination rates and expose vulnerable citizens to disease. When vaccination rates fall and rates of diseases we once controlled begin to rise, family income level won't offer much protection.
What this budget does, ultimately, is remove access to vaccination for those who cannot afford the co-payment, and punish vulnerable people in our population when vaccine-preventable diseases return.
It means that instead of moving towards a model of informed decision-making where communication can engage parents, communities and health professionals to improve vaccination rates, we are putting financial barriers on basic vaccine access. That is not universal health care, and it's not wise health policy.
Vaccines save lives - is this really the place for budget cuts?
First published on The Drum on Tuesday 20 May, 2014
Photo credit: El Alvi, via Flickr