Incentives, Penalties, and Vaccination.

This popped up on my FB feed yesterday: a proposal from the Australian government that certain child welfare payments should be withheld from parents who refuse to vaccinate their kids based on “conscientious objection”.

Parents who do not vaccinate their children will lose welfare payments of up to $2100 per child under a federal government policy set to be announced before the May budget.

Under changes that could save more than $50 million a year, Social Services Minister Scott Morrison is preparing to scrap a “conscientious objection” provision which allows anti-vaccination parents to still claim welfare benefits including childcare assistance and Family Tax Benefit A.

Fairfax Media understands the Family Tax Benefit A is worth up to $2100 per child.

What to make of the idea?

Well, I think that certain things can be taken more or less as read.  The first is that vaccination is a good thing, and is quite possibly a prima facie duty.  The second is that governments may, and perhaps must, encourage vaccination.  So it looks as though an argument in defence of the idea could be valid.  Measures to increase levels of vaccination are desirable; this is a measure that (if it works) would increase levels of vaccination; therefore this is desirable.  We’d have to do a bit of work to see whether the argument actually does work – formal validity won’t guarantee that – but in the meantime, the policy may be justified on the basis that it’s reasonable to believe that it would work.

But that is not, of course, the whole story.  Effectiveness is a necessary condition for a policy being justified, but it ain’t sufficient.  It’s likely that there’s more to say.

Notably, there’s a couple of questions to be asked about the justice of the policy.

In the first place, there’s something a bit iffy about cutting child benefits for this kind of reason.  This is because child benefits are directed at the child: they’re paid to the parents as a matter of pragmatism, but the parents are a proxy.  Therefore to cut the benefits (benefits of any sort, come to think of it) because of the parental decision will leave the child worse off than it might have been.  And presumably, the thought behind child benefit is that there’re certain things to which the child is entitled as a matter of right, and benefits help furnish those things.  That seems to put the child in a position of double jeopardy: granted that it’s already worse off than it would have been by dint of being more vulnerable to illness, to have a policy that would make it worse off still – perhaps even at the expense of some things to which it’s entitled – seems like it might be counterproductive at best.  But it might, at least indirectly, be targeting precisely the wrong people, and to that extent be unjust.

This injustice is compounded when we keep in mind that family welfare is (in many systems, at least: I’m not sure about Australia) means-tested anyway, which means that right from the start, the wealthier the household, the less incentivised they’d be by a cut on social security payments that they wouldn’t have got anyway.  I offer as a hypothesis that those most influential in pushing the anti-vax message are reasonably educated and well-off people, while a lack of education is likely to be a factor in being influenced.  Since a lack of education is correlated with lower income, and so a higher dependency on welfare, the policy is possibly open to the charge that it’s targeting precisely the wrong people on this front as well: that is, it’s targeting the families that’re more likely to be innocently caught up in the anti-vaccination nonsense than the bullshit artists who should know better than to propagate it.  (My hypothesis may be wrong, and probably requires more space than I can give it in a blog post; but it’s not obviously nuts.  And there’s no paradox about it being wealthy educated people who spread the message and poorer less educated people who receive it.  Someone might be all-things-considered educated while still having blind-spots, and so more likely to be convinced by woo; and, of course, some poorer people are well educated – but the correlation between poverty and poor education is hardly controversial.)

One slightly better option, suggested by the friend from whose FB feed I got this, is that insurance premia ought to be bumped up a little for those who sign the objection.  This wouldn’t have to be nearly as financially hard-hitting as cutting benefits, but it would aim to balance out the contribution that they make to the public health kitty against the extra risk they represent.  The extra cost would be less because it wouldn’t be punitive – only set to an increase in risk that is, we’d have to admit, not big.  It’s still not perfect, but it is better.  But, of course, it only works in a healthcare system where people have to buy an insurance policy of some sort.  In the UK, it’d be harder to enforce.

One other quick note: look at the phrasing in the sentence above.  The changes could save up to Aus$50 million.  That’s about £25 million, which isn’t a hell of a lot.  But the fact that it’s presented as a saving at all makes it look as though it isn’t really a public-health led policy after all, so much as an anti-welfare policy dressed up as being about public health.

  • Khalil Hassanally

    This seems very similar to the Bolsa Familia program which seems to have had enormous success in Brazil. Whilst a program like this can be seen as an infringement of autonomy at the same time charging people for the societal negative externalities they generate through individual choice is a field worth exploring. Your suggestion of insurance premiums seems fairer but as you say how would such a policy be implemented in the UK (perhaps a better ranking for the child when it comes to the choice of primary school?).

    With regards to your hypothesis of “wealthy educated people who spread the message and poorer less educated people who receive it”. Even if that is true (which I suspect it is) vaccination I suspect offers greater protection to lower socioeconomic groups who for reasons of over crowding, worse nutrition etc… are more susceptible to some of the disease being vaccinated against. I’d argue that from an epidemiological perspective it is perhaps sounder than you allow for. All things being equal when employing a non-random vaccination strategy aiming to vaccinate the higher risk demographic can still confer a herd immunity (http://cid.oxfordjournals.org/content/52/7/911.full).