The new immunisation policies, No Jab No pay and No Jab No Play, were introduced in January 2016, 18 months ago, with the aim of improving immunisation rates. This is a valid goal and one I share as we know that vaccines have saved and continue to save many lives and are generally safe, with known common mild adverse events and some rarer more serious reactions. A medical exemption, on the basis or lowered immunity or a severe allergic reaction to a vaccine, is the only way to bypass the policies and are actually very hard to get, with very few children satisfying the criteria for a medical exemption. 

I am aware of the considerable social and financial impact on families by these policies through my clinical work in a weekly specialist immunisation clinic at RCH, Melbourne. As such many families are placing extreme pressure on GPs to provide unwarranted medical exemptions.

Families who may genuinely want to vaccinate their child but they have personally experienced an adverse event or are just too fearful of vaccines, without equal fear of the diseases as vaccines are now victims of their own success. What we need is fairer polices that are less punitive that remind and encourage all parents to vaccinate, whilst retaining non-medical exemptions but making them very hard to get! That is, an exemption signed every year by the families' GP stating their reasons not to vaccinate.

We know that with hard to get exemptions immunisation coverage rates go up, whilst still allowing a “pressure valve” for vaccine refusing parents so that they are not forced to go underground.

The last thing we need is GPs being forced to practice illegally or clusters of unvaccinated children in family day care settings, where vaccine preventable diseases such as chickenpox or whooping cough can spread easily. This only alienates these families further from the medical profession and places unvaccinated children at greater risk.

Doctors should only sign a valid exemption. There are very few genuine medical exemptions to vaccination. Vaccines save lives and are generally safe, with some side effects and very rarely more serious reactions. 

Some families unfortunately fear vaccines more than the diseases. This happens for a range of reasons – bad experiences with the system, mistrust, alternative beliefs. 
No policies will make them change. No Jab No Play effectively shuts out their children from enrolling children in childcare or pre-school. Some families are experiencing many difficulties.  No Jab NO Play is putting tremendous pressure on the system and enlivening activism. There are and have always been some doctors who are against vaccination in general. They will be the ones non-vaccinators will flock to when they have no other options.  

It would be better to have very strict and hard to reach exemptions for vaccine refusers so the policies don’t drive parents to these particular doctors and become even more disengaged with mainstream services.