The Australian government is jabbing deeper at the wallets of parents who don’t vaccinate their children.

The country already has a “No Jab, No Pay” policy but a tougher version took effect July 1. It cuts child benefit payments by AUD$28 every two weeks for each child who isn’t immunized.

The only exemptions are those approved by medical practitioners for health reasons. There are no conscientious or ideological opt-outs, which Canadian provinces allow.

Canada doesn’t have federal rules around vaccinations. Some provinces, including Ontario and New Brunswick, require proof of vaccination for school registration but many provinces only check for immunization, says Dr. Scott Halperin, a pediatric infectious specialist and director of the Canadian Center for Vaccinology at Dalhousie University.

“Parents who don’t immunize their children are putting their own kids at risk as well as the children of other people,” said Dan Tehan, Australia’s Minister for Social Services, in a statement.

Previously, parents with a taxable income of AUD$80,000 lost an end-of-year supplement for not vaccinating their children. But now, the penalty is taken out of each payment of roughly AUD$400, meant to serve as a “constant reminder for parents to keep their children’s immunization up to date.”

The rules make vaccines mandatory for school-aged children and allow for fines against child-care centres that admit unvaccinated children.

According to the Australian government, the policy introduced by Prime Minister Malcolm Turnbull in 2016 has resulted in 246,000 children being vaccinated. That has boosted the country’s overall rate from 90 per cent to 93 per cent.

But critics say “No Jab, No Pay” unfairly targets lower-income families who need help, not penalty.

Australia joins Italy and France in making a number of vaccines mandatory for children. Germany requires schools to report parents who haven’t vaccinated their children. States in the U.S. require up-to-date vaccinations for enrollment in schools.

There are no jurisdictions in the world which force vaccinations through the involvement of courts or child-welfare agencies, Halperin said, since there is no imminent risk to a child who is not vaccinated.

But Halperin says there is a case for tying vaccines to social welfare programs.

“Why do governments give social benefits? It’s part of a social contract where we say we are responsible for each other and we provide benefits based on that. Vaccines protect individuals but are also part of the social contract to protect others become some people don’t respond to vaccines or can’t have them for medical reasons or can’t get them when they’re too young,” he said.

“So, on that basis, vaccinations and social benefits are tied together.”

But Halperin says he prefers a “carrot” approach that rewards parents who do vaccinate with a bonus to their benefits payments, rather than penalizing those who don’t. He also would like to see improved education around vaccination, easier access for parents and a much improved tracking system.

If provinces were to tie vaccination to social benefits, Halperin says those programs must be carefully evaluated to make sure they resulted in increased immunization rates.

Some Canadian research has found that immunization is challenging in remote areas or among immigrant populations. As well, there is no electronic record of immunization in Canada and vaccine scheduling is complicated in early childhood. There are 14 immunizations recommended for children, some requiring boosters, and each province has its own recommended schedule.

According to UNICEF, Canada has the second-lowest rate of childhood vaccination among developed countries. While the exact rate is unclear, it’s generally accepted to be around 85 per cent for childhood vaccines in Canada. The World Health Organisation has a target of 90 to 95 per cent.

Halperin says he doesn’t believe rates are as low as international organizations suggest because they often rely on federal statistics when provincial ones are more accurate. He says vaccinations for infants and children are quite high but they tend to drop in adolescence when boosters are required.

There are concerns worldwide about vaccination rates, especially given outbreaks of measles, mumps and whooping cough that have been reported across North America and Europe, prompting health officials to issue warnings.

Halperin says vaccine complacency means diseases will return. Diptheria, for example, had been virtually eliminated, but when the Soviet Union dissolved, vaccinations fell apart in the new independent states. The disease made a swift comeback, with more than 100,000 cases that also spread to neighbouring countries. Several thousand people died.

“It’s easy to get complacent when we haven’t seen the disease. But remember, parents were lining up for the polio vaccine when it first came out. Whenever there is a scare of any kind, people are clamouring for a vaccine. The problem is that otherwise, prevention is not sexy.”

A report by the C.D. Howe Institute last year said only a tiny portion of Canadians – perhaps two per cent – hold anti-vaccine views. The researchers said complacency, costs associated with taking time off work, and difficulties in finding a healthcare provider, are among many reasons parents aren’t fully immunizing their kids.

“In addition, there appear to be significant misconceptions about the costs and benefits of immunization. Despite scientific evidence to the contrary, more and more parents are concerned about the risks of immunization than in the past.”

But the researchers said making immunization compulsory would be misguided and lead to further entrenched positions among parents with safety concerns. Instead, stricter voluntary policy measures, more reliance on public health nurses, electronic registries tracking vaccinations from birth to adulthood, and targeted interventions, including phone calls or emails to “fence-sitting parents” would have better results in raising vaccination rates, they said.

Halperin agrees that anti-vaxxers are a very small group and are “lost causes.” Instead, health authorities should focus on parents who simply forget, don’t get around to it, don’t have easy access or who need some further education.

Health Canada surveyed 1,029 Canadians and found that only five per cent of parents had “low trust” in vaccinations. In the results released in March, 48 per cent of Canadian parents and expecting parents said they have no doubts or concerns about vaccination. One in three said they have minor doubts or concerns, while six per cent said they have many doubts but still get their kids vaccinated.

One in 10 said they had “refused or delayed” some vaccines for their kids.

Those who expressed concerns said they worried about possible allergic reactions, side effects or toxic ingredients, and that they felt there was a lack of testing of vaccines.

According to the Public Health Agency of Canada (PHAC), coverage rates for vaccine-preventable diseases at age two vary from 72 per cent for Haemophilus influenza type B (hib) and 73 per cent for varicella (chicken pox) to 91 per cent for polio and 89 per cent for meningococcal C.