Parents attitudes towards the No Jab No Play legislation in Western Australia: a mixed methods study

Abstract Introduction: Mandates provided a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. This research forms part of a broader study to explore the influence of the NJNPlay legislation on the decision to vaccinate; and the impact of the NJNPlay legislation in Western Australia, two years after its implementation. Methods: This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: 1) the influence of the NJNP legislation on decision to vaccinate; and 2) the financial and emotional impacts of NJNP legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. Results: Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [ p < 0.001] and emotional impacts [ p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes a) belief in the importance of vaccination and ease of access , b) individual and community protection , and c) vaccine effectiveness, safety and alternatives help understand how parents beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: a) lack of choice, pressure and coercion to vaccinate ; b) policy and community level stigma and discrimination ; c) financial and career impacts ; and d) loss of education opportunities. Conclusion: Parents’ appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However, for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.