Incentives

By Jim McVeagh 15/03/2010 3


New Zealand is now contemplating using the same set of incentives to boost immunisation rates that Australia used to boost it’s rates from 50% to 91%. The MacDoctor is not convinced that New Zealanders will respond quite as well as Australians to the incentives. The incentives were:

  1. Cash payments to parents for completing immunisations at 6 months and four years.
  2. Cash bonuses to doctors for improving their immunisation uptake
  3. Monitoring immunisation targets and having immunisation days
  4. Attempted eradication of measles
  5. Schools refusing to take un-immunised children

While this worked well in Australia, one has to consider the composition of parents un-vacccinated children. They come in two types.

  1. Parents who are genuinely concerned that vaccination is dangerous
  2. Parents who couldn’t be arsed to vaccinate their kids.

I postulate that Australia had a great deal of parents in the second category. Unfortunately, I suspect New Zealand has a far smaller portion of parents in category 2 and a much higher spread of parents in category 1. Parents in category 1 are not going to be moved by any financial incentive (seen as “we’ll give you this small amount of money, if you let us poison your children”). They will not be persuaded by GPs with a vested financial interest, nor by nurses with a gung-ho “vaccinate anything that moves” attitude. Schools refusing to take children will just see these parents move their children to private schools or to a home-schooling environment (where, frankly, they will be unlikely to catch the childhood diseases they are not immunised against!). In short, New Zealand is unlikely to see the massive improvement Australia saw and the increase expenditure will be largely wasted.

Note: I have no hard data to support my conclusion, just my general experience. But it would be very advisable for the MoH to run a survey to determine the mix of parents who decline to immunise their children before copying Australia’s effort.

I also have deep concerns about the ethical nature of banning children from creche, primary and secondary schooling on the basis of their immunisation status. That goes for threatening to cut benefits as well. To me, it seems incredibly stupid to seriously harm children’s education and deepen their poverty levels in order to force people to have their children immunised. The consequence will be that those who opt out for conscientious reasons will suffer these harms, since they sincerely believe their children’s health will be seriously harmed by vaccination. These methods are therefore, in my opinion, completely inappropriate, regardless of the numbers of parents in the first category above.

You wouldn’t approve of a doctor who gave a person (of sound mind) an injection against their will. Why should we approve a government that tries the same thing?

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Related posts:

  1. Attack of the Vaccine Nazis
  2. Ethical Jab?
  3. Gardasil Update

3 Responses to “Incentives”

  • Actually the MoH has performed immunisation surveys that record reasons given for vaccination non-compliance. If you would like actual data here is a link to the Ministry of Health National Childhood Immunisation Coverage Survey 2005. Available as a pdf or word doc.

    http://www.moh.govt.nz/moh.nsf/indexmh/national-childhood-immunisation-survey-2005

    Here are some relevant quotes:

    “At the time of the survey 17.2% (n=269) children surveyed had missed one or more vaccinations, and 93% (n= 250) of the caregivers surveyed provided the main reason for the missed vaccination(s). ”

    “The top four most frequently identified reasons for missed immunisations were: concern about the risk associated with vaccination (25.2%; 19.4–31.0); use of a different immunisation schedule or vaccination undertaken overseas (19.1%; 13.4–24.7); a medical reason (although this did not distinguish between minor illness and a significant medical contraindication) (11.0%; 6.8–15.2); and belief that their child had been vaccinated but the records could not confirm this (8.1%; 4.7–11.6).”

    The remainder would probably fit under your “couldn’t be arsed” category.

    The sample numbers are small so these results should be taken as indicative only. This suggests though that of the vaccinated children, parents concerned for health reasons make up about 6% of the population. The implication is that the 91% coverage seen in Aussie is achievable here.

  • Thanks, Darcy

    I note that the survey only had a 17.2% non-compliance rate whereas New Zealand’s rate is closer to 25%. It would not surprise me if a large number of “conscientious objectors” simply refused to take part in the survey (the response rate to the survey was 84%).

    I still think an incentive plan would have a fairly low “bang for the buck” in reality. We do not have the massive levels of indifference seen in Australia.

  • Perhaps, I’m not convinced that’s a warranted assumption but, why not.

    It’s true that the difference between current vaccination levels and ideal levels is not as big a gulf as that seen in Australia. I do think however that those abstaining from vaccinations are reaping the benefits of living in a vaccinated community without contributing to it. If their actions only affected themselves I would feel differently but their refusal puts others at risk. While this scheme may not be perfectly suited to our situation surely something should be done to encourage higher compliance rates and keep them high?