Editorial: Cash for jabs money well spent

Paying people to act in their own best interests may seem like an odd way to organise social policy. But when the alternative is much more expensive, it can make good economic sense.

That is plainly the thinking behind the idea that parents should be offered cash incentives to have their children immunised against common preventable diseases - and conversely, financially penalised if, without good reason, they don't get their kids jabbed.

Parliament's health committee is batting the idea around after discovering on a fact-finding trip to Canberra that Australia has dramatically improved its childhood immunisation rates. More than 90 per cent of 2-year-olds are now fully immunised as compared to barely 50 per cent in 2000. Meanwhile, we are lagging at less than 80 per cent.

Australia's success has been attributed to a variety of strategies, among them a system of cash incentives paid at the end of prescribed courses: the parents of kids who are fully immunised at 18 months get a A$125 ($163) cash payment. Another payment is made when the child is 4, if the programme of vaccinations is up to date.

It's a good spend. The cost of treating a child who catches a disease such as measles or whooping cough can quickly run into four figures - much more if complications set in. When you factor in downstream effects - other kids get infected, parents have to take time off work, specialist or hospital care for serious cases - the arithmetic becomes even more persuasive.

It is important that such incentives are not misinterpreted as state coercion. Parents must always be allowed to take a principled and conscientious decision not to have their children immunised, though it's worth saying that they are getting a free ride anyway, since their children enjoy the protection of the so-called "herd immunity" conferred by others' compliance.

But anyone involved in community health care will confirm that most of those who do not make arrangements for their children are not driven by principle; they simply omit to act. Cash incentives that result in the children being placed in front of alert clinicians could have health-care spin-offs above and beyond immunisation.

The corollary - financially penalising those who do not comply - is more fraught since it does unavoidably smack of coercion. For both donkeys and human beings, carrots are always better than sticks as instruments of persuasion. In any case, a system of penalties would be extremely difficult to implement fairly.

The idea of withholding benefits from non-compliers has been suggested, but the discussion avoids the question of what penalty might be levied on non-beneficiaries. And docking benefits might be seen as unfairly discriminating against a sector of the community that is already struggling.

But poorer communities, including benefit-dependent families, are hugely over-represented in the morbidity and mortality statistics in the epidemics of measles and mumps and whooping cough that strike with unpredictable regularity.

Unpalatable though it may be, poor people get ill more often and more severely than middle-class ones. When their children fall ill from easily preventable disease, society, and not just their parents, must bear some of the blame.

Canny businesses have long offered seasonal flu jabs to their workforces, realising that the cost-benefit makes it a no-brainer. The cost of the shots is small change compared to the cost of absenteeism and having sick workers infect others.

The same goes for the wider community. Our immunisation rates are among the lowest for any developed country: last year's UNICEF State of the World's Children report rated New Zealand 33rd out of 35 developed countries. Any suggestion of steps we might take to improve compliance is worth exploring. We owe it to the kids.