Should the U.S. Restrict Welfare Benefits for Unvaccinated Children?

Australia has made significant strides in increasing vaccinations over the past 20 years, but with some use of controversial legislation. Dr. Tony Yang—a George Mason University’s College of Health and Human Services researcher—examined one Australian policy and its relevance, legality, and ethics for a similar program in the United States.

Recently published in JAMA, Yang’s study examined the “No Jab, No Pay” legislation, effective in January 2016, which only allowed families to be eligible for welfare benefits if their children were up to date on their vaccinations. It also prohibited objections to vaccinations other than those for medical reasons, such as for religious reasons.

According to the Australian government, within six months of the law’s effective date, 5,738 previously unvaccinated children in families receiving benefits were immunized and 187,695 children who were behind on the recommended vaccination schedule had caught up. Additionally, the government projects substantial savings over the next five years—nearly $400 million USD—as a result of this legislation, but a majority of these projected savings would be from benefits not paid out.

Yang cautions that the results of the Australian policy have not yet been systematically evaluated and that implementing a similar national program in the United States could face challenges. “Under U.S. law, state governments have typically enjoyed authority to require vaccinations for public health reasons. However, acceptability of such policy that requires vaccinations only for welfare recipients may come down to details of program design. This would include the accessibility and cost of the required vaccinations, how often payments are actually withheld, and how important a public health problem immunization coverage is among the subgroups affected.” Read more here.