Evidence map›Paper›PMID 39720421›Full record

ArticleThe Lancet regional health. Western Pacific2025

Impact of Australia's No Jab, No Pay policy on vaccination uptake - a before-after study in two national birth cohorts.

Frank Beard, Alexandra J Hendry, Heather F Gidding, Aditi Dey, Kristine Macartney, Julie Leask, Peter McIntyre

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Frank BeardNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Alexandra J HendryNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Heather F GiddingNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Aditi DeyNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Kristine MacartneyNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Julie LeaskNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.
Peter McIntyreNational Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, 2145, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Data on impact of financial penalties for non-vaccination are sparse. Australia has required full vaccination for government family assistance payment eligibility since 1998. In 2016, the No Jab, No Pay (NJNP) policy removed registered non-medical objection as exemption option and increased eligibility assessment to yearly. We aimed to examine NJNP impact on vaccine uptake in children. Methods: Individual-level Australian Immunisation Register data were used to assemble two-year-wide pre-/post-NJNP birth cohorts aged 1-<3 years, stratified by registered objection (yes/no) and vaccination status (zero-dose/partially vaccinated/fully vaccinated). At 5-<7 years, we measured odds ratios (ORs) and 95% confidence interval (CIs) for vaccination outcomes post-versus pre-NJNP and compared observed post-NJNP numbers with those expected if proportions pre-NJNP applied. Findings: Pre-NJNP of 562,316 children aged 1-<3 years, 92.1% were fully vaccinated, 4.9% partially vaccinated and 3.0% zero-dose; objection was registered for 1.1% overall (23.9% of zero-dose). Post-NJNP of 615,607 aged 1-<3 years, 92.7% were fully vaccinated, 4.7% partially vaccinated, 2.6% zero-dose; objection was registered for 1.5% overall (37.7% of zero-dose). By 5-<7 years of age, full vaccination was significantly higher post-than pre-NJNP in children with registered objection (zero-dose 14.6% versus 1.2% [OR 14.1; 95% CI 10.5-18.9]; partially vaccinated 41.7% versus 8.4% [OR 7.9; 95% CI 6.4-9.7]) and without objection (zero-dose 10.1% versus 4.9% [OR 2.2; 95% CI 2.0-2.4]; partially vaccinated 39.2% versus 34.5% [OR 1.2; 95% CI 1.1-1.3]). Post-NJNP we estimated 49,510 more children (3.7% with registered objection) to be fully vaccinated than expected. Odds of remaining zero-dose were 0.38 (95% CI 0.34-0.42) with versus 0.66 (0.63-0.70) without registered objection and fewer children (9,206, 1.5%) were persistently zero-dose post-than pre-NJNP (10,696, 1.9%). Interpretation: Full vaccination by age 5-<7 years increased post-NJNP irrespective of baseline vaccination/objection status. Relative increases were much higher among children with registered objection than without, but partially vaccinated children without objection largely accounted for numerical increases, suggesting increased eligibility assessment was more important than changes in exemption criteria. Funding: Australian Government Department of Health and Aged Care.

Indexed as

Childhood immunisationChildhood vaccinationFinancial sanctionsImmunisation coverageImmunisation mandatesNo Jab No PayParent attitudes and beliefsPublic health policy designVaccination policyVaccine hesitancyVaccine mandates

Identifiers

PMID39720421
PMCPMC11665672

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.