South Australian Public Health (Early Childhood Services and Immunisation) Amendment Bill

Committee Stage

In committee (resumed on motion).

Clause 1.

The Hon. S.G. WADE: I was wondering if I may come back to the question in relation to the extent to which these powers expand the powers of the public health officers. I think it is important to stress that the bill relates to vaccine-preventable diseases, whereas the current general health powers relate to controlled notifiable conditions. Not all vaccine-preventable diseases are controlled notifiable conditions.

When the committee last met, the Leader of the Opposition asked whether I could give him examples of some vaccine-preventable diseases that are not controlled notifiable conditions. In response to the Leader of the Opposition's questions, some examples of vaccine-preventable diseases that are not controlled notifiable conditions are pertussis, also known as whooping cough; mumps; varicella, also known as chickenpox; and rubella, also known as German measles.

For clarity, the bill provides specific powers to the Chief Public Health Officer, which allow the Chief Public Health Officer to exclude children in the event of an outbreak of vaccine-preventable disease occurring in an early childhood service. That extends the general powers of the Chief Public Health Officer which are applicable to controlled notifiable conditions. Under the SA Public Health Act, if a person has, or has been exposed to, a controlled notifiable condition and the Chief Public Health Officer considers that an order is reasonably necessary for the public health, then the Chief Public Health Officer has powers under section 73 of the South Australian Public Health Act 2011 to require a person to undergo an examination or test, and powers under section 75 of the act, such as to refrain from visiting a specified place.

These are general powers and are only applicable to controlled notifiable conditions. As I said, there are several vaccine-preventable diseases that are not controlled notifiable conditions. The bill provides specific and clear powers to the Chief Public Health Officer to take immediate action, which avoids both confusion and delay.

The Hon. K.J. MAHER: I think the minister has talked about this being, in his view, stage 1 and a stage 2 later on after some consultation. Can the minister outline when that consultation is due to commence, what the process will be and when that consultation will end?

The Hon. S.G. WADE: Like my Western Australian colleague, the Hon. Roger Cook, Deputy Premier of Western Australia, I think it is wise to engage the community as we shape a model that suits our state best. My expectation is that a discussion paper will be released in about a month's time. I have not discussed with my officers the time frames, but in the normal course of events, my expectation would be that the response time beyond that would be three to four weeks.

The Hon. C. BONAROS: Can the minister update the chamber as to the number of reported cases of measles, rubella and mumps in South Australia for 2019?

The Hon. S.G. WADE: I thank the honourable member for her question. I can advise the chamber that in 2019 in South Australia there have been two cases of confirmed measles, no cases of confirmed rubella and one case of confirmed mumps.

The Hon. C. BONAROS: Can the minister also confirm the percentage of children up to two years of age who are currently immunised against measles, mumps and rubella?

The Hon. S.G. WADE: I can advise the chamber that according to the annualised quarterly coverage data from the Australian Immunisation Register for March, June, September and December 2018, the coverage for South Australian children aged two years with MMR vaccine is 93.74 per cent. In that context, I would just mention that the national aspirational rate is 95 per cent, so we still fall short of that.

The Hon. C. BONAROS: What are the areas of underimmunisation in South Australia, generally speaking, and have we identified specific reasons for underimmunisation in those areas?

The Hon. S.G. WADE: I thank the honourable member for her question. The Australian Immunisation Register coverage reports for all assessed vaccines using the March, June, September and December 2018 rolling covering data indicate that there are eight areas in South Australia with coverage below 90 per cent in any of the assessed age groups—one year, two years and five years.

These areas are as follows: Adelaide City; Port Adelaide West; Murray and Mallee; Adelaide Hills; Outback, North and East; Fleurieu and Kangaroo Island; Burnside; and Campbelltown. The honourable member also asked whether I might like to suggest what the reasons might be. Three reasons have been identified as the key reasons for underimmunisation in South Australia. These are data management and reporting, vaccine hesitancy and vaccine access.

The Hon. C. BONAROS: This might fit into the answer, but have there been any specific assessments undertaken with respect to Indigenous communities in particular?

The Hon. S.G. WADE: SA Health undertakes a monthly review immunisation coverage for Aboriginal and Torres Strait Islander children to maximise immunisation coverage. SA Health undertakes data cleaning to ensure the Australian Immunisation Register accurately reflects administered vaccines and also works with immunisation providers to encourage timely vaccination. Aboriginal and Torres Strait Islander children are sent reminder postcards prior to immunisations being due and another postcard if the vaccinations are not administered.

The key reasons identified for true underimmunisation with respect to Indigenous communities is access to immunisation services and access to culturally appropriate immunisation services. I think it is appropriate to refer back to one of my previous answers. I think it is noteworthy that in the areas I identified as areas of underutilisation, whilst Outback, North and East was part of it, the Pitjantjatjara lands were not. In that regard, I can remember discussions with representatives of the Nganampa Health Council, who highlighted to me the pride that they have in their primary health program and, in particular, their immunisation program.

If I could share an anecdote, it was suggested to me by one of their medical officers that whenever a prime minister came onto the lands, they would check the immunisation rate in their home electorate and often they were below that on the lands. I think that highlights the value of primary health programs and the fact that in spite of the issues we raised, which included vaccine access—and I am sure there are challenges delivering a reliable supply of vaccines onto the land—the Nganampa Health Council has been able to maintain an effective program.

The Hon. C. BONAROS: In the 95 per cent target rate that we have talked about, there are eight areas that fall below. Can the minister also confirm if that applies to all of those or is that just in relation to the three that I raised—measles, mumps and rubella?

The Hon. S.G. WADE: If I could respond on that in two parts. First of all, the 95 per cent that I was referring to was the national aspirational rate. To respond to the honourable member's question in relation to underimmunisation, we use the below 90 per cent threshold. The state average is 93.74 for MMR. The 90 per cent in terms of immunisation is relating to all of the elements of the Australian Immunisation Register, which therefore relates to the NIP. I am advised that not all of the vaccines are measured in terms of coverage, but it is not limited just to MMR.

The Hon. C. BONAROS: Has the government undertaken any modelling as to how much a catch-up program is expected to cost and how many children would be expected to be included in a catch-up program?

The Hon. S.G. WADE: I must admit, I am not clear what the honourable member is referring to there. Each of the elements of the—

The Hon. C. BONAROS: Those children who are not up to date in their vaccinations.

The Hon. S.G. WADE: I will rely on my advisers on this. We often use the word 'catch-up rounds' for when we are introducing a new program; for example, meningococcal B. For this first year of the program, not only is it year 10, but it is also year 11 that are in the catch-up phase, and then I think, from next calendar year, it will only be available to year 10s. So there is that catch-up element as you establish a program.

If the honourable member is referring to a situation where the enrolment legislation might say—and I think this relates to the enrolment aspect rather than this (this is about outbreaks)—either a child that is vaccinated or is scheduled to get vaccinated, if you mean catch-up in that sense, that would, if you like, be a stage 2 issue, from my perspective. The point is made, no matter the nature of the catch-up round, if it is a catch-up element, if it is part of the National Immunisation Program, it will be funded through the National Immunisation Program for children.

The Hon. C. BONAROS: It was the phase 2 element that I was addressing in terms of the enrolments.

The Hon. S.G. WADE: Considering the bill relates to elements of the National Immunisation Program, the delivery of the vaccinations to children would be funded through the national program, as long as they have a Medicare card.

The Hon. C. BONAROS: I note the reasons that the minister gave earlier about the lower threshold and the fact that that applies in terms of outbreaks rather than the enrolment issue, but can the minister just clarify a little bit further for the record why it is that that lower threshold has actually been proposed, as opposed to the $30,000 threshold previously proposed by the Labor bill?

The Hon. S.G. WADE: The Labor bill and, for that matter, the Labor amendments talk about a higher threshold, and we certainly think that is worth discussing in the context of the stage 2 of the bill, which relates to exclusion and measures under that. But, in relation to this part of the bill, which is this stage, which relates primarily to the keeping of immunisation records and exclusion in the event of an outbreak, we think that the $2½ thousand is more appropriate.

The Hon. C. BONAROS: Given the importance of the issue that we are dealing with, has there been any recent moves on the part of this government or, indeed, others that the minister may know about, in terms of placing this on the COAG agenda in terms of its next meeting of health ministers or future meetings of health ministers?

The Hon. S.G. WADE: Immunisation legislation such as this is a state matter, so it is up to each state as to how they choose to legislate. I would like to advise that the Council of Australian Governments has:

…agreed the Health and Education Councils will develop options to implement a consistent national approach to increase immunisation rates in early childhood and care services, and advise COAG at its next meeting. This work will consider the desirability of excluding unvaccinated children who do not have a medical exemption from childcare centres and preschools. This work will also examine mitigation strategies to address potential adverse impacts for vulnerable children and families; providing information to parents about vaccination rates in early education and care services; and regulatory cost, data collection feasibility and privacy implications.

I am just getting the date of that. My understanding is that was a statement by COAG two or three years ago, but let me just clarify that for the council.

I do not have the date, but my understanding was that statement was made before I became a minister, so it predates March last year.

The Hon. T.A. FRANKS: Following on from the Hon. Connie Bonaros' question, in the minister's answer, which cited one of the areas where the aspirational targets were falling short, he stated that data management and reporting was a factor. Could he expand on that, please?

The Hon. S.G. WADE: I am advised that there are two particular risk areas there: one is the effectiveness of the vaccine provider to actually provide the relevant input, and perhaps organisational issues within the registry itself is the other.

The Hon. T.A. FRANKS: In the briefing I had with the minister and the departmental staff, it was stated that the provision and auditing of these immunisation records to be taken by early childhood services would be undertaken by the Education Standards Board. Could the minister please put on record how that will take place?

The Hon. S.G. WADE: Compliance with the collection of immunisation records will be monitored in conjunction with routine assessment of compliance with the Education and Early Childhood Services (Registration and Standards) Act 2011. This is assessed by the Education Standards Board, which takes a risk-based approach to determining the frequency of assessment. Services are assessed, on average, every two years. Compliance with the outbreak aspect of the policy will be monitored by the Communicable Disease Control Branch of SA Health.

The Hon. T.A. FRANKS: Just to clarify, the ongoing assessment and regular auditing will be done through Education provisions, and outbreaks will be treated as a Health matter. Why is Education and not Health undertaking those ongoing assessments and auditing?

The Hon. S.G. WADE: It seems efficacious, considering the Education Standards Board are already in there assessing the units, to include that. In this particular respect, we are talking about the maintenance of student records, basically.

The Hon. C. BONAROS: I cannot recall if I asked this directly. If I did, I did not quite catch the answer, so I am going to ask it again. Are there specific programs that the government is intending to implement to increase the rate of immunisation across the state?

The Hon. S.G. WADE: I thank the honourable member for her question. SA Health is working with the commonwealth Department of Health through the National Partnership Agreement on Essential Vaccines to increase vaccination coverage, including in Aboriginal children and in geographical areas with low immunisation coverage. I also hasten to add that the Marshall Liberal government introduced free influenza vaccines for under fives. That is a measure to try to increase vaccination rates.

Clause passed.

Clauses 2 and 3 passed.

Clause 4.

The Hon. K.J. MAHER: It may assist if I move, perhaps with your permission, the four amendments I have to clause 4 together. Amendment No. 2 is in effect the substantive amendment. Amendment No. 1 is consequential on amendment No. 2, and amendments Nos 3 and 4 are also consequential on amendment No. 2. With the indulgence of the committee, I would suggest I move all four amendments together and speak to them together.

The CHAIR: Please do.

The Hon. K.J. MAHER: I move:

Amendment No 1 [Maher–1]—

Page 4, after line 15 [clause 4, inserted section 96A]—After the present contents of inserted section 96A (now to be designated as subsection (1)) insert:

(2) For the purposes of this Part, a child meets the immunisation requirements if—

(a) an extract, or extracts, from the Australian Immunisation Register under the Australian Immunisation Register Act 2015 of the Commonwealth indicates that the immunisation status of the child is up to date; or

(b) a document of a kind approved by the Chief Public Health Officer indicates that the child meets the immunisation requirements within the meaning of the A New Tax System (Family Assistance) Act 1999 of the Commonwealth; or

(c) a certificate in writing issued by the Chief Public Health Officer indicates that the child meets the immunisation requirements.

Amendment No 2 [Maher–1]—

Page 4, after line 41—After inserted section 96B insert:

96BA—Prohibition on providing early childhood services to child not meeting immunisation requirements

(1) A person who provides an early childhood service must not enrol a child for the provision of the service and must suspend the existing enrolment of a child if—

(a) immunisation records relating to the child have not been provided to the person in accordance with section 96B(1); or

(b) the child does not, according to immunisation records provided in accordance with section 96B(1), meet the immunisation requirements.

Maximum penalty: $30,000.

(2) A person must not provide an early childhood service to a child if—

(a) immunisation records relating to the child have not been provided to the person in accordance with section 96B(1); or

(b) the child does not, according to immunisation records provided in accordance with section 96B(1), meet the immunisation requirements.

Maximum penalty: $30,000.

Amendment No 3 [Maher–1]—

Page 6, after line 21 [clause 4, inserted section 96D]—After inserted section 96D(5) insert:

(5a) For the avoidance of doubt, a child may be excluded from premises under this section irrespective of whether the child meets the immunisation requirements or not.

Amendment No 4 [Maher–1]—

Page 7, line 10 [clause 4, inserted section 96E(4), penalty clause]—Delete '$2,500' and insert '$30,000'

The first amendment, as I said, is consequential on the passage of the second amendment. It inserts the definition of what it means to meet the immunisation requirements for the purpose of the no jab no play offence brought about in amendment No. 2.

Amendment No. 2, which is the substantive amendment, makes it an offence for a child to attend an early childhood centre if they do not meet the immunisation requirements. The amendment makes this an actual no jab no play bill, rather than one that has very little effect, as we have discussed during the debate on clause 1.

Amendment No. 3 is consequential to amendment No. 2 and clarifies that a child may be excluded from early childhood premises by the Chief Public Health Officer, irrespective of whether they meet the immunisation requirements.

Amendment No. 4 is again consequential to amendment No. 2. This amendment increases the penalty for a breach of a condition of an exemption from $2,500 to $30,000, in line with the opposition amendments for the maximum penalty for breaching the no jab no play requirements under amendment No. 2.

The Hon. S.G. WADE: I thank the Leader for moving them en bloc because I think it is helpful to see them as a package. The simple choice before the chamber is whether the chamber is minded to the government's two-stage approach. We have been more economical than Western Australia. Western Australia is currently going through a three-stage approach. They have put out a consultation paper.

We think it is appropriate that just as Queensland has a different model to New South Wales, which has a different model to Victoria, and given that Western Australians are not willing to accept any of those models, it makes good sense for South Australia to look at its own model. As the Hon. Tammy Franks eloquently put at the second reading stage, we should make sure we maximise the public health benefit taking into account all factors, including the social determinants of health.

The Hon. C. BONAROS: I indicate for the record that SA-Best does not oppose the amendments in principle, insofar as what they try to achieve. However, I think in this instance, and given the discussions we have had, it is only fair that we give this government the benefit of the undertaking it has given in relation to the consultation process, bearing in mind that the ultimate benefits to be gained are for the wider community.

On that basis, we will not be supporting the amendments proposed by the Hon. Kyam Maher, but I make the point that that is not because we oppose in principle what he has proposed but rather because we think it is more appropriate that we allow the government to undertake its two-phase consultation process, for the reasons that the minister has already outlined.

The Hon. K.J. MAHER: A question to the Minister for Health and Wellbeing: if these amendments do not pass, would the minister concede that, in effect, the bill as it currently stands is not a no jab no play bill and that it could not at a later stage be characterised as no jab no play without these amendments?

The Hon. S.G. WADE: I think the honourable member is ignoring the earlier plea from the Hon. Tammy Franks that we should not descend into polemics. The Western Australian implementation of no jab no play is a three-step approach. They have done some public health audits and consultation on an enrolment model. We are doing exactly the same. It is a no jab no play policy, and we are getting on with the job.

The Hon. K.J. MAHER: Can the minister explain in what way this bill could at all be fairly characterised as no jab no play, in and of itself?

The Hon. S.G. WADE: It relates to children in early childhood services and their vaccination status.

The Hon. K.J. MAHER: In this bill, is there any sense at all that if a child is not immunised they cannot attend those centres?

The Hon. S.G. WADE: Yes. There are clear powers in the legislation that the Chief Public Health Officer can exclude people.

The Hon. J.A. DARLEY: I indicate that I accept the government's two-stage approach and will therefore not be accepting the opposition's amendments.

The Hon. T.A. FRANKS: I have some questions for the opposition in regard to their amendments. Which health and education groups or similar advocacy groups support the Labor amendments?

The Hon. K.J. MAHER: I do not have a full range of details in front of me, but I would repeat something that I said in an earlier contribution, namely, that there were—I think it was in 2017—consultations undertaken at the time.

The Hon. T.A. FRANKS: Since those consultations were undertaken, the Royal Australasian College of Physicians has raised some concerns. Has the opposition taken on board those particular concerns raised by the Royal Australasian College of Physicians with regard to access to early childhood education?

The Hon. K.J. MAHER: What has been taken into account are the consultations that have already occurred on this and, obviously, regimes that exist in other states and regimes that are about to commence in Western Australia.

The Hon. T.A. FRANKS: I will take that as a no. Is that the case?

The Hon. K.J. MAHER: Take it any way you want. I do not have any other information on it.

The Hon. T.A. FRANKS: Okay. What about the concerns raised by the SA Child Development Council? Have they been taken into consideration by the opposition?

The Hon. K.J. MAHER: I do not have anything to add to what I said before. There were previous consultations on a bill that was very similar to this, and of course there are regimes operating and coming into operation in other states.

The Hon. T.A. FRANKS: I thank the Leader of the Opposition but, as I noted in my concerns in my briefing on the previous bill, child protection concerns had certainly not been taken into consideration at that stage and were not involved or even thought of in the previous consultation process. Yet, we know that one of the main drivers of reform in child protection in this state was the terrible situation of Chloe Valentine. The only time Chloe had access to assistance, indeed to any of the agencies that potentially could have saved her life, was when she was involved in these early childhood services. That is the sort of child that we are talking about potentially being put into further isolation through a blunt instrument.

I did say that I would not be getting into polemics, and there are a lot of polemics in this debate. However, I will give you a new one. I will call this particular amendment a no shot no school amendment. It is not about no jab no play. This is not just play we are talking about here, it is actually a child's access to the full breadth, including education and early learning, that increasingly is delivered through our early childhood education services that we are talking about here. We are weighing up those particular child's rights, and the interests of that particular child, and so for that reason, on behalf of the Greens, I will not support the opposition amendments today.

I am disappointed that there was no response with regard to the quite significant concerns of the Royal Australasian College of Physicians and the SA Child Development Council, and I ask that child protection be very much part of any consultation process on these particular measures. Yes, they are somewhat emotive in the community, and certainly a lot of the polemics around no jab no pay is a way to punish some parents through punitive financial means, but no jab no play, no shot no school, is punishing the child, and I certainly cannot support that today.

The committee divided on the Hon. K.J. Maher's amendment No. 1:

Ayes 6

Noes 11

Majority 5

The Hon. K.J. Maher's amendments Nos 2 to 4 negatived; clause passed.

Title passed.

Bill reported without amendment.

Third Reading

The Hon. S.G. WADE (Minister for Health and Wellbeing) (16:01): I move:

That this bill be now read a third time.

Bill read a third time and passed.