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

Second Reading

Adjourned debate on second reading.

(Continued from 21 March 2019.)

The Hon. K.J. MAHER (Leader of the Opposition) (12:19): I rise to speak on the South Australian Public Health (Early Childhood Services and Immunisation) Amendment Bill, and indicate that I will be the lead speaker for the opposition. Today, we are not yet debating a no jab no play proposal from the government. It is interesting that those in the government have portrayed this bill as a first step to such a policy, because this legislation falls far short of that.

A real no jab no play policy is as simple as this: children must be age-appropriately immunised on a catch-up program, or exempted for medical reasons, to attend early childhood services. No jab no play has straightforward, important aims: improving immunisation coverage in Australia, reducing pockets of under-immunisation, and ultimately preventing and reducing morbidity and mortality because of vaccine-preventable diseases.

These laws are particularly important for our young people who cannot be vaccinated for medical reasons, to make sure that there is the required herd immunity around them to keep them safe. Eighteen months ago, Labor introduced a real no jab no play bill—a bill that did not shy away from taking a strong stand on protecting South Australian children from preventable diseases. We know that early childhood education is important. Every parent knows that. That is exactly why no jab no play is such an effective tool for ensuring our children are vaccinated.

It sends a message that parents should take vaccine-preventable diseases seriously and learn the facts about just how important it is to ensure their child is up to date with their injections under the National Immunisation Program. Unfortunately, our bill did not pass before the parliament was dissolved prior to the last election. In July 2018, the opposition reintroduced that bill in another place as a private members' bill. Time and again in the nine months since, the government has categorically shut down any debate on that bill.

This is not the first time we have seen the government delay action on immunisation policy. Firstly, they failed to match Labor's plan to introduce free flu jabs for kids ahead of last winter, only committing to a policy after Labor publicly called them to account. They then refused to implement Labor's fully costed plan to introduce free meningococcal B vaccines for kids, using delaying tactics for months, before finally admitting they should get around to implementing this critical reform.

The government is now saying they want to consult on no jab no play before doing anything real about it; however, oddly enough, that consultation has already happened. The former Labor government undertook consultation on the no jab no play in July 2017—almost two years ago. Consultation has already occurred where strong no jab no play laws already in place: New South Wales and Victoria, and from July, Western Australia.

It looks as though the Liberals will attempt to hide behind an unnecessary repetition of this process as a way of avoiding a strong stand on the issue. In reality, all they are doing is delaying an important public health reform and providing a platform for mistruths that those in the anti-vaccination community will spread.

Let us take a moment to reflect on the content of the government's bill before us as it currently stands. This bill requires early childcare providers to ask for the immunisation records of children, and in the event of a outbreak, can require the centre to provide the immunisation records they have to the Chief Public Health Officer. The government has failed to mention that this bill, with just with those standalone amendments, does not do any more than what already happens.

The opposition received confirmation in our briefing with the department that almost all childcare centres already collect immunisation records of their enrolled children. In fact the health department is already able to obtain records of immunisation of children in child care from the national immunisation register. In fact, the health department is not aware of any childcare centre that does not already collect immunisation information, even though that is a central element of the government's bill.

Under public health legislation, the Chief Public Health Officer already has the power to require that unvaccinated children need to stay home in the event of a preventable disease outbreak. And of course, in any event, this is too late. We should be enacting laws that prevent outbreaks, not try to address them afterwards. The opposition asked, given that there was not anything real that was changing, why this bill was necessary and if there was any urgency in enacting it. It became clear from the opposition briefings that there is no reason or urgency for requiring this legislation in its current form.

Without an actual no jab no play effect in the bill, this bill is just a delaying exercise in addressing what the real issue is. The reality is that South Australia has now fallen behind other states, both Labor and Liberal, when it comes to enacting a no jab no play policy in legislation. The Liberal commonwealth government has already taken steps to increase vaccination rates with their no jab no pay reforms, with parents missing out on the family tax benefit and the child care benefit if they do not vaccinate their children.

In fact, it was the then Liberal prime minister Malcolm Turnbull who called on all states to implement thorough no jab no play legislation to ensure that we kept our kids safe. Following that, the former state Labor government did exactly that: we heeded then prime minister Turnbull's call and introduced our bill to the chamber.

The federal government, the Victorian government, the New South Wales government and the Western Australian government know that the truth is that the more we increase our vaccination rate, the better we facilitate herd immunity, meaning that it is harder for preventable diseases to spread. For those children who are not vaccinated for legitimate medical reasons, their vaccinated peers will help protect them from contracting those preventable diseases. We also know that the myths of the anti-vaccination lobby are just not true. We have seen that recently confirmed in a major study that completely dismissed myths about vaccination somehow being linked to autism.

In countries around the world, we have also seen rates of measles—a totally vaccine-preventable disease—on the rise and extreme measures of containment of unvaccinated people having to take place in the United States. We should not be delaying the real issue. We should not be holding up implementing something in our state that has already been implemented in Victoria and New South Wales and is just about to be implemented in Western Australia.

We on this side are not buying what the anti-vaccination movement are selling. That is why Labor is going to try to fix this bill and actually enact some real change. The opposition will be introducing amendments that make this current bill a proper no jab no play law. Those amendments are consistent with legislation the former Labor government has introduced and are consistent with what is occurring right around Australia. We have an opportunity to strengthen this legislation to introduce a real no jab no play law that keeps kids safe, rather than perpetually delaying action on this issue. I commend to the chamber the amendments that will actually make this bill have some effect.

The Hon. C. BONAROS (12:27): I rise to speak on behalf of SA-Best in support of the second reading of the South Australian Public Health (Early Childhood Services and Immunisation) Amendment Bill 2019, which the government has stated is the first of two no jab no play bills that will be introduced to parliament. The bill before us encapsulates the first phase of the government's no jab no play policy, which aims to improve the ability to prevent and control outbreaks of vaccine-preventable diseases in early childhood services.

Most other states have the ability to exclude unimmunised children from an early childhood service when an outbreak is occurring. New South Wales, Victoria and Queensland have already enacted no jab no play legislation. Both New South Wales and Victoria require parents or caregivers to provide evidence that a child is fully vaccinated for age prior to enrolment in early childhood programs. Queensland legislation permits early childhood education and care services discretion regarding whether or not they will allow attendance of an unvaccinated or undervaccinated child.

Western Australia has recently commenced regulations to require caregivers to provide their child's Australian Immunisation Register statement upon enrolment in child care, kindergarten and school. This is the first step of Western Australia's proposed three-part process. The second part, which will require children to be fully vaccinated for age to be eligible for enrolment in child care and kindergarten, is currently undergoing consultation. The third part of the proposal will involve policy initiatives aimed at improving childhood vaccination coverage.

The Marshall government has stated that the second tranche of South Australian legislation will be introduced after public consultation and that it will deal with children being appropriately immunised in an immunisation catch-up program, or being exempt for medical reasons, in order to enrol in child care.

To that end, the government has committed to releasing a discussion paper on the matter shortly. Of course, there was, as we have heard, an earlier bill in the previous parliament, introduced on 27 September 2017 in this chamber by the then minister for health, Peter Malinauskas, which included both the catch-up program provisions and the provisions dealing with the containment of outbreaks of vaccine-preventable diseases.

That bill, as we know, was never debated and lapsed when parliament was prorogued. The former Labor government's bill was subsequently reintroduced in identical terms to its predecessor by the shadow minister for health, the Hon. Chris Picton, in the other place last year, where it has remained without debate since its introduction. The government has stated that the rationale for the carve-out of the immunisation catch-up program provisions—something we will deal with during the committee stage of the debate—in the bill before us is because of concerns raised by, as I understand it, the Royal College of Physicians.

The college has, according to the government and to advice I have received, highlighted the importance of affordable and accessible early childhood education, and consequently is concerned about children missing out on early education because they are not immunised. I hope the minister is open to tabling any correspondence from the royal college to that effect, or any other information he is able to provide.

In addition to the carve-out of the catch-up program provisions, the government has also reduced the penalty for persons contravening section 96E, under the bill, which deals with exemptions from $30,000, as expressed in the previous Labor iteration of the bill, down to $2,500, and I would also be keen to hear the rationale for doing so. Labor has filed, as we know, amendments to reinstate the catch-up program provisions and to increase the aforementioned penalty to $30,000, as is the case in its bill.

I will have a number of questions at the committee stage of the bill, dealing with a number of issues centred around this bill, and I look forward to the responses that I hope to receive from both the government and the opposition, and the arguments surrounding their respective positions on the amendments recently filed.

It is important to note that this bill follows on from the federal government's no jab no pay bill, erroneously referred to by the minister in his second reading speech on this bill as no jab no play back in 2015. The no jab no pay bill was the federal government's attempt at improving vaccination coverage in Australia, by targeting parents in receipt of the Family Tax Benefit Part A supplement, with the effect that parents would no longer receive the supplement if they did not vaccinate their children.

As the mother of a toddler, I cannot emphasise enough the importance of immunising children against vaccine-preventable diseases to protect not only our own children but other children and some of the most vulnerable in our community, like pregnant women, the elderly and those whose immune systems are compromised. If I can say anything, it is probably that I took steps to, perhaps, overimmunise my own son to ensure that not only were we up to date with our immunisations but that we had any additional immunisations that were appropriate, given his age, because it is something in which I believe strongly.

What is happening in the United States and in the Eastern States of Australia should send a chill down the spines of parents in South Australia. Measles were declared eliminated in the US in 2000, but scattered outbreaks have occurred in recent years. As at the end of March, 314 individual cases were confirmed in 15 states alone. That is in just the first three months of 2019. New York has been particularly hard hit, with 153 confirmed cases in suburban Rockland County, which has taken the drastic and unprecedented step of declaring a state of emergency that bars children and adolescents who are not vaccinated against measles from public places: banning children from public places—playgrounds and shopping malls. What have we come to?

In England, there was a tripling of measles cases recorded between January and October last year, with 913 infections compared with 259 for the whole of 2017. The head of the UK's National Health Service, Simon Stevens, has blamed the increase on anti-vaxers and their proliferation on social media. Similarly, the number of measles infections across Europe tripled to 82,500 in 2018, compared to the previous year. The New South Wales health department has just issued its 15^th measles warning for the year. Sadly, an eight month old and an 11 month old—too young for the vaccine, with the first dose ordered for around 12 months of age—have recently contracted the disease from public areas.

Measles, as we know, is highly contagious and can live for around two hours on surfaces after an infected person has left the area. Measles can cause deafness and encephalitis that in turn can cause brain damage. Ultimately, and in the worst-case scenario, measles can lead to death. The decision to leave a child unvaccinated is not just a threat to them individually but also the so-called herd immunity, the resistance among any given population to a disease. Because measles is so contagious, between 93 per cent and 95 per cent of people in a community need to be vaccinated to achieve herd immunity.

Sadly, the spectre of British doctor Andrew Wakefield, drummed out of the British medical profession for his 1998 paper that made a link between the MMR (measles, mumps and rubella) vaccine and autism, still looms large over the vaccine info wars. The publication of a major study last month revealed no link between autism and the MMR vaccine, which protects not only against measles but also mumps and rubella.

The Statens Serum Institut looked at all Danish children born between 1999 and 2010, more than half a million in total. The Danish study shows the MMR vaccine does not increase the risk of autism or trigger autism in susceptible children and is not linked with clustering of autism cases following vaccination, further enforcing what the medical community has long been saying about preventative shots.

The fear is that myths spread by anti-vaxers over decades means that the conspiracy around MMR will be impossible to defeat. I appreciate that this is an extremely divisive and contentious argument. However, the media has also reported this week that the anti-vaxer movement is now targeting our four-legged friends, making astounding claims that vaccinating your pet pooch will give them autism, which is simply outrageous because, for one, we know that our four-legged pooches cannot develop autism.

In just a few taps on Instagram you will find yourself deep in the realm of anti-vax conspiracies, with hashtags like #vaccineskill. People are being bamboozled and misled. For parents, and for parents like me, it is becoming increasingly difficult to distinguish between fact and fiction. Last month, Facebook agreed to ban adverts with anti-vaccination content, while Instagram says it will also introduce controls. It is also incumbent upon governments and upon us as legislators to do what we can to correct the damage done and protect innocent lives.

The Department for Health and the medical community also need to cut through the fake news with evidence-based, easy to understand health advice for parents. I make no apology personally for supporting the vaccination of children and policies like the no jab no play policy; I support it wholeheartedly. That said, however, I fully accept and indeed expect that there will always be exceptions. We need to ensure that we provide appropriate exemptions for those who fall within those exceptions, especially where they are based on medical grounds or other similar and important grounds. With those words, I am pleased to be supporting the second reading of this bill.

The Hon. T.A. FRANKS (12:39): I rise on behalf of the Greens to support this bill. I note that a previous incarnation in a different form came before this council but never reached a vote. The Hon. Connie Bonaros has summed up many of the arguments that I would echo today. The area of vaccination is something that has become highly charged, and much of the information is often not based on fact. It is often used as a political football, however, where people raise concerns on public health grounds that we get the legislation right.

The Greens absolutely support improving and increasing our vaccination rights. We absolutely acknowledge that vaccination works. However, when we are talking about public health measures, public health should be what guides the debate and not dramatic polemics. I note the words of the Royal Australasian College of Physicians, who have highlighted the importance of affordable and accessible early childhood education and their concerns that lack of access to early childhood education is highly detrimental to those children, should it impact on them. The Greens are not supportive of punishing the child for the parent's behaviour. We are also highly cognisant of the social determinants of health, which include access to education.

I note further that the SA Child Development Council has provided in principle support for the measures, which focus on improving the immunisation coverage rate, recognising the complexities of the issues around no jab no play legislation and the potential impacts on the human rights of a child's right to both health and education. They have cautioned against a blunt tool being used as a policy instrument, which might violate some of the core principles of the United Nations Convention on the Rights of the Child.

I echo some of those concerns. On the previous incarnation of the Weatherill government's bill, I raised in briefings questions around the impact on child protection of that blunt instrument. I was told in those briefings that the government of the day, the previous Labor government, had not considered child protection implications. I echo again my concerns that, in order to effect a public health measure where we are punishing the parents, it is not the child who should be punished. The child has that right to education and to access early childhood services.

So I think we can come through this parliament with a debate, I hope, that moves away from the polemics around vaxers and anti-vaxers. I put on record a personal observation as well, not of my child, who is fully up to date—indeed, my arm hurts at the moment because I have just had the flu jab in the last hour, as most members of this council have—but my uncle, who died early because he contracted polio back when polio was, of course, much more common in our society. Polio has been largely eradicated, but my uncle suffered his entire life. His access to a full life was impeded by that polio. My grandmother, similarly, was part of advancing education around those who had had polio and their rights and opportunities.

I am firmly pro-vaccination. I understand the public health outcomes, but I am also very cautious when it comes to punishing children as a public health measure and restricting their rights to full participation in our society. I think the first stage of this bill is a very welcome measure, and I look forward to appropriate consultation. There will be the polemics, there will be the hysteria, but I would hope that this council, with the information that we will gain as that second range of consultation is undertaken, will actually be able to make informed decisions in this place based on public health information, not on political games.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (12:44): If there are no other further contributions, I would happy be happy to sum up the debate. I thank the Hon. Kyam Maher, the Hon. Connie Bonaros and the Hon. Tammy Franks for their contributions. If it is not inappropriate, I would just reflect on what I think is the maturity of this council. Yesterday, we discussed euthanasia in a very rational, respectful way. Today, we have affirmed that all the major groups in this parliament support vaccination.

Certainly in the past, I can recall this parliament having people who were very sceptical about measures such as immunisation, and I think it is a strong statement today that all of the major groups in this parliament are reaffirming their commitment to immunisation and, if you like, taking a stand against the anti-vax movement.

I certainly take the point that the Hon. Connie Bonaros made in terms of the responsibility of SA Health and public health authorities to give the community the information they need to stand against misinformation. It is true in relation to immunisation; it is true in so many other areas. We have to find a way of people having a trusted channel of information and make sure that we rigorously defend it. Even when, shall we say, it might be convenient for politicians to present information, public health clinicians need to be able to provide information so that the community can look after its own health. Again, let me celebrate the fact that I am delighted, as Minister for Health and Wellbeing, that this parliament stands committed against the anti-vax movement and to immunisation.

I will perhaps just pick up on a few points that were made in the second reading speeches. The Hon. Connie Bonaros asked me to table the letter from the Royal Australasian College of Physicians. I am more than happy to do that. I might give a footnote to it. The recommendation that they made to the government was that:

States and Territories in Australia with 'No Jab, No Play' policies urgently commission independent reviews of the effect of 'No Jab, No Play' on equity of access to early childhood education.

and secondly:

South Australia and other States and Territories do not implement 'No Jab, No Play' policies until reviews have been undertaken and published.

In that context, I made inquiries of those other three jurisdictions: Queensland, New South Wales and Victoria. I was informed that the Queensland jurisdiction was indeed undertaking a review, and I spoke to the Queensland minister and was able to learn of the outcomes of that review. It basically indicated that the Queensland early childhood sector was supportive of the legislation. I also made inquiries in relation to the other two jurisdictions, and my understanding is that New South Wales and Victoria are not planning reviews in the foreseeable future. I think one of the jurisdictions is planning a review next year, but we are not intending to wait for that.

In the context of that response, the government has decided to do a two-stage approach in terms of introducing a public health measure bill, which is this one, and introducing an enrolment bill, which is the second part of the no jab no play. In that regard, it is remarkably similar to the approach being taken by Western Australia. Earlier this year, the Western Australian Labor government strengthened its public health outbreak laws, and they are, as we speak, as the Hon. Connie Bonaros mentioned, undertaking a consultation.

In terms of the Hon. Connie Bonaros's comments about why the government bill has a $2,500 fine versus the $30,000 fine, it was in the context of the two-stage approach. In the context of an outbreak response, we thought a $2,500 maximum fine was appropriate. Of course, if we were going to an enrolment approach, it may well be appropriate to increase the fine.

In terms of the contribution by the Hon. Tammy Franks, I think the Hon. Tammy Franks very persuasively put the need to make sure that we have a model that is designed for South Australian circumstances and that makes the best interests of the child paramount. As the honourable member highlights, this legislation raises issues in child protection and it raises issues in relation to education. In that context, I would remind honourable members that none of the Australian models are the same.

One thing I think is quite distinctive about the Victorian legislation is how broad their exemptions are. The Hon. Connie Bonaros mentioned that she was keen for exemptions to be medically focused. The Victorian legislation I think has quite broad exemptions—for example, if the child is descended from an Aborigine or Torres Strait Islander; if the child is in the care of a parent who is the holder of a Health Care Card, a Pensioner Concession Card, Gold Card or White Card; or if the child was a child of a multiple birth.

There are a range of issues I think we need to consider, like what I think the Hon. Tammy Franks would call the public health drivers but also medical exemptions and the issues in terms of other social disadvantage. I acknowledge the Hon. Tammy Franks quite rightly used the words 'social determinants of health'. I suppose many of those do relate to social determinants of health. We need to make sure that we act in the best interests of children, primarily through maximising the immunisation coverage, but do so without a blunt instrument and instead use the best possible instrument to provide positive outcomes for children. I seek leave to table a letter from the Royal Australasian College of Physicians, dated 19 October.

Leave granted.

Bill read a second time.

Committee Stage

In committee.

Clause 1.

The Hon. K.J. MAHER: A question for the government: from the government's research, what proportion of childcare centres already take steps to collect immunisation records?

The Hon. S.G. WADE: We understand it is around 98.

The Hon. K.J. MAHER: Currently, can the Chief Public Health Officer require childcare centres to provide immunisation records?

The Hon. S.G. WADE: I think the issue here is not just the provision of information but the provision in a timely way. When an outbreak of a vaccine-preventable notifiable condition occurs in an early childhood centre, the services are asked by staff of the Communicable Disease Control Branch of SA Health to provide a list of children and staff who attend the service and their vaccination status. Most services currently comply with this request although not always in a timely fashion. The proposed legislation will improve timeliness and require services to comply. I would remind the honourable member that this element was in the 2017 bill.

The Hon. K.J. MAHER: I thank the minister for his response. Just so I am clear, I think the answer was that there is currently provision for the Chief Public Health Officer to require immunisation records to be provided; is that correct?

The Hon. S.G. WADE: Only when there is a notifiable condition that has been reported. This legislation does not wait for that: it requires records to be kept in anticipation of them being needed.

The Hon. K.J. MAHER: As it currently stands, can the Chief Public Health Officer exclude unvaccinated children from attending child care in the event of a preventable disease outbreak?

The Hon. S.G. WADE: This provision was in the 2017 Weatherill bill. The Chief Public Health Officer can currently exclude a child from an early childhood service if he or she has reasonable grounds to believe a person has, or has been exposed to, a controlled notifiable condition, and that a public health order is reasonably required in the interests of public health and that urgent action is required in the circumstances of the particular case.

The Hon. K.J. MAHER: In summarising—and I think this is correct, as the minister has explained—currently, 98 per cent of childcare centres already collect immunisation information and the Chief Public Health Officer can require a childcare centre to provide them, and the Chief Public Health Officer can then exclude unvaccinated children in the event of a preventable disease outbreak. So what are the actual new powers of the bill for the Chief Public Health Officer as a result?

The Hon. S.G. WADE: I think it is important to stress that the bill relates to vaccine-preventable diseases. The current powers relate to controlled notifiable conditions. Not all vaccine-preventable diseases are controlled notifiable conditions.

The Hon. K.J. MAHER: Can the minister give an example of some of those that he is talking about?

The Hon. S.G. WADE: If the Chair would prefer, we can take that question and bring back the answer when we next resume.

The CHAIR: Yes.

Progress reported; committee to sit again.

Sitting suspended from 12:58 to 14:15.