Majority acceptance of vaccination and mandates across the political spectrum in Australia
| Published date | 01 May 2020 |
| Date | 01 May 2020 |
| DOI | 10.1177/0263395719859457 |
| Subject Matter | Articles |
research-article2019
Article
Politics
2020, Vol. 40(2) 189 –206
Majority acceptance of
© The Author(s) 2019
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vaccination and mandates
https://doi.org/10.1177/0263395719859457
DOI: 10.1177/0263395719859457
journals.sagepub.com/home/pol
across the political spectrum
in Australia
David T Smith
The University of Sydney, Australia
Katie Attwell and Uwana Evers
The University of Western Australia, Australia
Abstract
The Australian government has recently introduced some of the strictest vaccination mandates in
the world. In light of international studies warning that public opposition to vaccination mandates
could undermine public consensus about the value of vaccination, we conduct an original study
of more than 1000 Australians on attitudes towards both vaccination and mandates. We find
that, in contrast to similar studies in the United States and the United Kingdom, support for both
vaccination and mandates is very high, with no significant opposition from any political subgroup.
Apart from attitudes towards vaccination itself, there appears to be no separate attitudinal
dimension that generates political opposition to vaccination mandates in Australia. This shows the
importance of national political context in debates about vaccination policy.
Keywords
political culture, public health, vaccination, vaccination mandates
Received: 22nd January 2019; Revised version received: 2nd May 2019; Accepted: 3rd June 2019
Introduction
Childhood vaccination is a contentious political issue in many wealthy democracies,
despite widespread acceptance of its benefits and necessity as a public health measure.
The phenomenon of ‘vaccine hesitancy’, wherein parents worry about vaccine ingredi-
ents and safety or believe that their children might not need vaccinations because they
live healthy lifestyles (Dube et al., 2013), is becoming a ubiquitous feature of life in high
income countries, with a recent 67-country study finding the lowest rates of vaccine
Corresponding author:
David T Smith, The United States Studies Centre, The University of Sydney, Institute Building (H03), City
Road, Sydney, NSW 2006, Australia.
Email: david.smith@sydney.edu.au
190
Politics 40(2)
confidence in Europe (Larson et al., 2016). Not all parents who are vaccine hesitant reject
vaccines; in fact, most of them still vaccinate. A smaller portion of hesitant parents
actively refuse some or all vaccines (Leask, 2011). Australia is a typical example of a
country where childhood vaccination generates a heated and polarising political dis-
course, even though most of the population appears to support it (Chow et al., 2017;
Leask, 2015a). Because very high levels of childhood vaccination coverage are needed to
sustain ‘community protection’ (Pickering et al., 2018) – a collective level of immunity
protecting individuals who for various reasons cannot be directly protected by their own
vaccination – even a small amount of opposition from parents can create risks for public
health, especially where non-vaccination is regionally clustered.1 The perceived threat
from non-vaccinating parents in Australia has led to regular outbursts of scorn and out-
rage, with one major newspaper calling non-vaccinators ‘baby killers’ and referring to
enclaves of low vaccination as ‘risky hippie hotbeds’ (Chambers, 2015; Harvey, 2015).
Many non-vaccinating parents, on the other hand, see the vaccinating mainstream as a
hostile and unhealthy mass that threatens their rights to make their own decisions about
their families (Attwell et al., 2018a). In this environment, vaccination researchers have
warned about the potential for antagonistic debates to alienate parents who may be hesi-
tant about vaccinating (Leask, 2015a).
Australia’s ‘No Jab, No Pay’ policy, which from 2016 made some family welfare pay-
ments contingent on full vaccination,2 is at the forefront of a global trend towards more
restrictive vaccination mandates, which have also been implemented recently in France,
Italy, and various American states (Attwell et al., 2018b; Opel et al., 2017). While vac-
cination mandates may be potent tools for raising vaccine coverage, some researchers
worry that government compulsion may cause a backlash, dividing opinions on political
lines and weakening the overall pro-vaccination consensus (Beard et al., 2017; Kahan,
2014; Kahan, 2013). This article seeks to establish and explain the dimensions of public
opinion towards vaccination and vaccination policy in the Australian context, paying
particular attention to whether there are fissures in political consensus that could be
further widened by restrictive vaccination mandates. To do so, we use original survey
data of over 1000 respondents from the University of Western Australia’s Values Project.
This fills significant gaps in political research on vaccination policy in Australia, where
so far there has been relatively little survey research on attitudes towards any aspect of
vaccination, and no systematic investigation into the relationship between attitudes to
vaccination and attitudes to vaccination policy. Research from the United States and the
United Kingdom suggests this is an important line of enquiry because both countries
display sharp drops in support for vaccine mandates compared with support for vaccina-
tion itself, and much more partisan political division in the former than the latter in the
American case.
We find quite a different picture in Australia, where support for the mandatory vaccina-
tion policy is much higher and highly correlated with support for vaccination itself. There
is little difference between supporters of various parties on either question, and little evi-
dence for attitudinal divisions informed by any other major social or demographic cleav-
age. While we have no claims to make about the efficacy or proportionality of the Australian
mandatory vaccination policy, our research indicates a highly stable consensus in opinion
about vaccination in Australia, opinion that is much more accommodating towards manda-
tory regimes than what is found in some other liberal democracies. This highlights the
importance of political context in the reception of policy responses to public health issues.
While most wealthy democracies face similar problems around vaccination, different
Smith et al.
191
dynamics of policy history, political culture, and political competition may create widely
varying perceptions about how these problems should be addressed.
This article proceeds as follows. We first review findings from US and UK literatures
on public attitudes towards vaccination and vaccination mandates, identifying areas in the
Australian context that require investigation. Then, we describe the survey data we have
collected and used, and the methods we have chosen to analyse it. We present the results
of this analysis, with the central findings that support for both vaccination and vaccina-
tion mandates are very high, without the divergences and inconsistencies found in the
United States and the United Kingdom. We conclude by discussing the implications for
both politics and policy in Australia.
Literature review
Almost all readily accessible research on public support for mandatory vaccination hails
from the United States, where state-level school entry mandates operate, but most permit
religious and/or personal belief exemptions. A consistent finding in American research is
that patterns of support for vaccines as a health measure are different from patterns of
support for government policies that compel citizens to vaccinate their children. While
support for the former is generally very high, support for the latter is usually lower, with
important consequences. As one recent study notes with regard to the removal of personal
belief exemptions for school entry mandates in that state, ‘Although California’s pre-
dominantly liberal populace generally tolerates assertive public health policies, a vocal
libertarian minority ardently opposes vaccination mandates’ (Mello et al., 2015). Kahan
(2014) has warned that vaccination advocates should keep vaccines and mandates sepa-
rate in order to avoid inflaming opposition to vaccines based in distrust of government
compulsion. In a large study, he finds that positive views of vaccines are very high across
political subgroups in the United States, and views of vaccines are not linked to any
broader issues around the politics of science or culture. However, this high affective ori-
entation towards vaccines ‘should not be expected to translate readily into support for
stricter vaccination mandates’. Attitudes towards vaccination mandates in Kahan’s (2013)
sample are politically polarised by broader attitudes towards government regulation, and
thus Kahan urges ‘extreme caution’ about campaigns to reduce or eliminate exemptions
to vaccination mandates, which risk polarising attitudes towards vaccination itself.
McCoy (2018) finds different social sources of support for two items in Pew surveys
conducted in the United States, one asking about vaccine safety and the other asking
about vaccine policy. While about 10% of respondents to a 2015 survey said they thought
vaccines were unsafe, more than 30% of respondents to a 2014 survey said they did not
believe parents should be required to vaccinate their children. McCoy suggests this diver-
gence could help explain...
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