Vaccines and Universal Health Care

This last term in school, Ruth's class had an outbreak of chicken pox.  We received weekly emails from the school nurse informing us of this, and what symptoms to look for, and exhortations to keep sick kids home.

Australia strongly encourages vaccinations.  They withhold child benefits from the government unless parents comply with the vaccination regiment.  The benefits can be huge - reduced or free dental care (which is not typically covered by universal healthcare here), substantial discounts on daycare and precare/aftercare programs (In Australia you get the benefit at the time you use the service, as opposed to in the U.S. where you get tax relief when you file taxes), and standard deductions on your tax returns.  The total financial benefit could be as much as $15,000. 

Children with medical reasons to avoid vaccines are exempt from No Jab, No Pay.

There are still the anti-vaxxers around in Australia, and they aren't insignificant.  The latest statistic I could find was that only 88% of children in Melbourne are fully vaccinated, as defined by the National Immunisation Program (NIP).  More on them below.  Last winter there was an outbreak of whooping cough in Melbourne, and this past summer there was a measles outbreak.  Both occurred in hip, young suburbs.  Both were blamed on anti-vaxxers.

Ruth and Isaac were vaccinated for varicella in the U.S.  They got two injections - the initial one at age 1, and the booster at age 4.  They did not get sick.  Ruth has multiple friends whose parents are doctors, and who strongly support vaccination.  So why the outbreak?   The NIP has only put one varicella injection on its required list.  They offer the booster, but because it's not on the NIP list it's not paid for by Medicare.  If you want the booster, you pay for it yourself.  This might not discourage the parents of kids Ruth goes to school with, but because it's not on the NIP list, some doctors don't even offer it, and because of that, many parents don't even know it's an option.  Even Ruth's buddy whose mum is a gerontologist didn't know a second injection existed. 

The first injection gives 98% protection from chicken pox until, you guessed it, age 8.  After that, according to a CDC report, the protection goes down to about 80-85%, but can still prevent severe chicken pox by about 98%.

Why is only one injection on the required list?  I'm guessing they did a cost-benefit analysis at Medicare and decided the cost of jabbing twice would be more than treating the mild cases that could possibly erupt.  Or maybe they wanted to give parents the option to opt out of as many injections as they could without causing massive outbreaks and dangerously sick kids.  They're probably right on both counts, judging from our little school's sample.  About 40 kids at their school got chicken pox, and none that I heard of was hospitalised. 

On to another vaccine - this past week all the Year 7 students in my school were marched down to the school nurse to get their HPV boosters.  They got the first one in school at age 11, second one at age 12.  This is for boys and girls. 

For me and Joel, none of this is a problem.  We're pro-vaccine, and our kids are super-vaccinated by Australian standards.  But it does bring up some interesting ethical questions.  Some might be against vaccines but compelled to vaccinate their kids because of financial need.  Some might want the varicella booster and not be offered it, not because of some gag order, but because doctors who are refunded by Medicare for their services might not think to offer it to poorer patients, or just out of habit.