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 Preventive Medicine 145 (2021) 106406

Contents lists available at ScienceDirect

Preventive Medicine
journal homepage: www.elsevier.com/locate/ypmed

Removing conscientious objection: The impact of ‘No Jab No Pay’ and ‘No
Jab No Play’ vaccine policies in Australia
Ang Li a, b, *, Mathew Toll c, d
a
Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
b
Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
c
Department of Sociology and Social Policy, School of Social and Political Science, Faculty of Arts and Social Science, The University of Sydney, Camperdown, NSW,
Australia
d
LCT Centre for Knowledge Building, Faculty of Arts and Social Science, The University of Sydney, Camperdown, NSW, Australia

A R T I C L E I N F O A B S T R A C T

Keywords: Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities
Immunisation coverage have been developing a range of strategies to improve childhood vaccination coverage. This study examines the
Conscientious objection effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia.
Vaccine refusal
Conscientious objection was removed from immunisation requirement exemptions for receipt of family assis­
Vaccine hesitancy
tance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these
Non-medical exemptions
Vaccination policy national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation
Financial sanctions Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between
Childcare entry requirements 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab
Immunisation mandates No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement
Interrupted time series policies tended to show more significant increases. However, policy responses were heterogeneous. The
improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income,
more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has
increased post removal of conscientious objection, the policies have disproportionally affected lower income
families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More
effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access
barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low
coverage, to better address areas with persistent non-compliance with accordant interventions.

1. Introduction effective vaccination policies to sustain high immunisation coverage.

Vaccination is among the most effective presentative measures
against infectious diseases (Andre et al., 2008). Having a sufficient
proportion of the population immunised is required to protect the
community through sustained control of vaccine preventable diseases.
Although the majority of Australian children are immunised, main­
taining high immunisation coverage is imperative to prevent trans­
mission of serious diseases and reduce the risk of local outbreaks
(Australian Institute of Health and Welfare, 2017). Australia’s national
target for childhood coverage is 95%.
With the emergence of global anti-vaccination movements and
recent increases in measles cases in Australia, it is important to have
Since the introduction of the National Immunisation Program (NIP) in
1997, childhood immunisation coverage has had substantial increases in
Australia. NIP provided free vaccines for eligible people, introduced
school-entry immunisation requirements, and offered parental financial
incentives for immunisation. Under the NIP, receipt of the Child Care
Benefit (CCB) and Family tax Benefit (FTB) part A supplement was
linked with childhood immunisation status (Ward et al., 2013).1
During the period when conscientious objection on philosophical or
religious grounds was a valid exemption from immunisation re­
quirements for family assistance payments and childcare enrolment, the
percentage of children with conscientious objection recorded an in­
crease from 0.23% in 1999 to 1.34% in 2015 (Department of Health,

* Corresponding author at: Faculty of Medicine and Health, Level 2 Charles Perkins Centre D17, The University of Sydney, NSW 2006, Australia.
E-mail address: a.li@sydney.edu.au (A. Li).
1
The CCB replaced previous the Childcare Assistance Rebate and Childcare Cash Rebate in 2000, and the FTB Part A supplement replaced Maternity Immunisation
Allowance that discontinued 2012.

https://doi.org/10.1016/j.ypmed.2020.106406
Received 18 May 2020; Received in revised form 22 December 2020; Accepted 29 December 2020
Available online 1 January 2021
0091-7435/© 2020 Elsevier Inc. All rights reserved.
A. Li and M. Toll
2018). Targeting vaccine objection, the Australian government intro­
duced the No Jab No Pay legislation, implemented in January 2016, that
abolished conscientious objection exemptions from immunisation re­
quirements, which was linked to the eligibility for the CCB, Child Care
Rebate (CCR) and FTB-A supplement (Parliament of Australia, 2015-
16).2 Only parents of children who are fully immunised on the childhood
schedule (see Department of Health (2019b)), on a recognised catch-up
schedule, or with approved medical exemptions (e.g. medical contra­
indications and natural immunity) can receive these payments.
Several state governments augmented the financial penalties with
childcare enrolment restrictions under No Jab No Play that applied to
approved and licensed childcare centres. In January 2016, Victoria
(VIC) prohibited enrolment of unvaccinated children in early childhood
services unless they had medical exemptions or on a 16-week grace
period for vulnerable families. Meanwhile, Queensland (QLD) allowed
childhood services discretion not to enrol unvaccinated children. New
South Wales (NSW), which previously required children to be fully
immunised or hold an approved exemption to be enrolled in childcare
services since January 2014, removed the exemption in January 2018.3
Legislation in the remaining states and territories has been less stringent.
A timeline of relevant immunisation policies is displayed in Fig. 1.
Evidence on the effectiveness of mandatory immunisation policies on
childhood vaccination uptake is limited and mixed (Dubé et al., 2015;
Omer et al., 2009; Sadaf et al., 2013; Hull et al., 2020). There is scarce
evidence on the effectiveness of mandatory immunisation in childcare
centres and for countries other than the United States (Lee and Robinson,
2016). Many previous Australian studies lack baseline measurement or
control groups (Ward et al., 2012). Adoption of punitive mandates can
have unintended negative effects (Leask and Danchin, 2017). Removal of
conscientious objection can lead to an increase in numbers of medical
exemption claims (MacDonald et al., 2018), reduced equity in childcare
access (Beard et al., 2017), and failure to target under-vaccinated groups
not registered as objectors (Leask and Danchin, 2017). Australia has
consistent geographic clustering of vaccine objection (Beard et al., 2016),
2
These payments altogether could add up to $AU 15,000 a year (Leask and
Danchin, 2017). The government expected savings of AU$508.3 millions over
five years (Parliament of Australia, 2015-16). Within the 6 month of the
introduction of the No Jab No Pay, 5738 children whose parents were receiving
childcare payments and claiming vaccination objection had their children
vaccinated; and 148,000 previously under-vaccinated children were up-to-date
with their vaccination (Commonwealth of Australia, 2016).
3 6
During 2016–18, an interim vaccination objection form from parents could
still be accepted for childcare enrolment.
2
Preventive Medicine 145 (2021) 106406
Fig. 1. Main immunisation policies around financial
penalties and childcare enrolment.
Notes: The No Jab No Pay policy abolishes the con­
scientious objection from immunisation requirements
for eligibility of certain government payments. The
No Jab No Play policy prevents children who are not
immunised from enrolling in childcare centres, not
allowing conscientious objection as valid exemption.
Documentation requirements are to provide a state­
ment of immunisation status for childcare enrolment.
NSW, VIC, QLD, SA, WA, ACT and TAS are states and
territories in Australia. Source: Respective Public
Health Acts, Public Health Regulations, and Health
Amendment Acts across different years in each state
and territory; and National Centre for Immunisation
Research and Surveillance (2019).
which increases risks of outbreaks with unvaccinated clusters in informal
childcare arrangements (Leask and Danchin, 2017).
The current study aims to examine the effectiveness of removing
conscientious objection that affects government rebates and childcare
enrolment on immunisation coverage in Australia. In specific, non-
medical exemptions were removed for government payments (national
No Jab No Pay) and childcare enrolment (state No Jab No Play). The impact
of these national and state-level policies, largely targeting vaccine refusal,
is evaluated using coverage data from the Australian Immunisation Reg­
ister (AIR) linked with regional data from the Australian Bureau of Sta­
tistics (ABS) at the statistical area level 3 (SA3). The study considers
coverage rates for the vaccines on the NIP Schedule including Diphtheria,
tetanus, pertussis (DTP), Polio, Haemophilus influenzae type b (HIB),
Hepatitis B (HEP), Measles, mumps, rubella (MMR), Pneumococcal,
Meningococcal, Varicella, and full vaccination at one, two and five years of
age.4 Policy response heterogeneity is also examined by area socioeco­
nomic status, median income, numbers of FBT-A recipients and baseline
pre-policy coverage, due to potential effect modifying factors (Beard et al.,
2016; Beard et al., 2017; Leask and Danchin, 2017; Toll and Li, 2020).
2. Method
Data on childhood immunisation coverage are from the AIR for the
period 2014–2018.5,6 The AIR is a national register that records vaccines
given to all ages in Australia. Children enrolled in Medicare are regis­
tered on the AIR, which constitutes a nearly complete population
(Department of Health, 2007). The data contain quarterly vaccination
rates at the SA3 level at the milestone ages of one (12–15 months), two
(24–27 months) and five (60–63 months), for DTP, Polio, HIB, HEP,
MMR, Pneumococcal, Meningococcal, Varicella and full vaccination.
4
Based on the NIP Schedule, DTP, Polio, HIB, HEP, Pneumococcal and fully
immunised (Pneumococcal included in December 2013) are assessed at one
year of age. DTP, Polio, HIB, HEP, MMR, Meningococcal, Varicella and fully
immunised (Meningococcal, and MMR dose 2 and Varicella dose 1 included in
December 2014, and DTP dose 4 included in March 2017) are assessed at two
years of age. DTP, Polio, MMR and fully immunised (MMR removed in
December 2017) are assessed at five years of age.
5
The Australian Childhood Immunisation Register (ACIR) that recorded
vaccinations given to children under the age of 7 was expanded to become the
Australian Immunisation Register (AIR) that records vaccinations given to
people of all ages in September 2016.
Data involve only information publicly available and therefore no ethics
review was required.
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table 1
Summary statistics for immunisation coverage and regional characteristics, 2014–18.
2014 2015 2016 2017 2018

Mean SD Mean SD Mean SD Mean SD Mean SD

DTP 1 year olds 0.917 0.031 0.930 0.028 0.943 0.024 0.947 0.024 0.945 0.025
DTP 2 year olds 0.952 0.022 0.954 0.022 0.961 0.020 0.927 0.029 0.931 0.028
DTP 5 year olds 0.927 0.030 0.931 0.030 0.938 0.028 0.944 0.028 0.947 0.026
Polio 1 year olds 0.917 0.031 0.930 0.028 0.942 0.024 0.946 0.025 0.945 0.025
Polio 2 year olds 0.952 0.022 0.954 0.022 0.961 0.020 0.964 0.020 0.965 0.020
Polio 5 year olds 0.927 0.030 0.931 0.030 0.938 0.028 0.944 0.027 0.947 0.026
HIB 1 year olds 0.916 0.031 0.929 0.028 0.940 0.025 0.945 0.025 0.943 0.025
HIB 2 year olds 0.941 0.026 0.945 0.025 0.953 0.022 0.954 0.023 0.956 0.023
HEP 1 year olds 0.914 0.031 0.929 0.028 0.942 0.024 0.947 0.025 0.944 0.025
HEP 2 year olds 0.948 0.024 0.951 0.024 0.959 0.021 0.963 0.021 0.964 0.021
MMR 2 year olds 0.934 0.035 0.912 0.031 0.930 0.027 0.935 0.027 0.934 0.028
MMR 5 year olds 0.926 0.030 0.931 0.030 0.939 0.029 0.956 0.025
Pneumococcal 2 year olds 0.914 0.031 0.927 0.028 0.940 0.025 0.943 0.025 0.950 0.027
Meningococcal 2 year olds 0.934 0.027 0.942 0.027 0.951 0.023 0.954 0.023 0.955 0.023
Varicella 2 year olds 0.902 0.034 0.913 0.030 0.929 0.027 0.929 0.027 0.926 0.029
Fully 1 year olds 0.909 0.032 0.923 0.029 0.935 0.026 0.940 0.026 0.939 0.026
Fully 2 year olds 0.916 0.038 0.894 0.036 0.915 0.030 0.906 0.032 0.909 0.032
Fully 5 year olds 0.922 0.031 0.926 0.031 0.931 0.030 0.939 0.029 0.946 0.026
Median age 38.573 4.584 38.707 4.699 38.848 4.826 38.997 4.884 38.848 4.791
Total fertility rate 1.965 0.329 1.916 0.324 1.876 0.311 1.864 0.311 1.885 0.313
IRSAD 999.246 68.382 999.342 68.633 999.320 68.559 999.362 68.454 999.474 68.550
Gini coefficient 0.463 0.051 0.461 0.048 0.463 0.048 0.463 0.049 0.462 0.048
Working age population (%) 65.789 4.581 65.523 4.665 65.193 4.797 64.940 4.868 65.226 4.773
Population density (,000) 2.502 6.461 2.540 6.546 2.595 6.655 1.016 1.415 1.041 1.448
Median income (,000) 49.517 8.200 49.953 8.229 50.167 8.070 48.275 7.900 47.884 7.784
No. FTB A (,000) 4.950 3.617 4.863 3.610 4.799 3.611 4.676 3.589 4.504 3.516
No. FTB B (,000) 4.282 3.139 4.241 3.158 3.947 3.034 3.695 2.878 3.571 2.828
No. people w/insurance (,000) 23.048 15.136 24.202 15.891 24.768 16.303 23.988 15.769 24.491 16.091
No. jobs for females (,000) 27.559 16.313 27.778 16.599 27.982 16.981 27.754 16.618 27.883 16.784
No. jobs for males (,000) 30.181 18.199 30.312 18.448 30.361 18.822 30.265 18.470 30.340 18.625
No. observations 3749 3759 3761 3760 3757
No. SA3s 319 319 321 320 321

Notes: There were a few changes in the antigens assessed for the coverage calculation at milestone ages (Department of Health, 2019a). In December 2013, Pneumococcal
for children aged 12–15 months was included. In December 2014, Meningococcal and dose 2 MMR and dose 1 varicella (MMRV) for children aged 24–27 months were
included. In March 2017, dose 4 DTP for children aged 24–27 months was included. In December 2017, dose 2 MMR for children aged 60–63 months was removed.

There were 358 SA3 regions covering Australia in 2016. SA3s
generally have a population between 30,000 to 130,000 people, closely
align with Local Government Areas, and represent areas with district
identity and similar socioeconomic characteristics (ABS, 2016a). Non-
spatial SA3s that cannot be mapped in each state or territory are
recorded with one coverage rate in each state or territory at each age
group without identification codes. These non-mapped SA3s are not
included in the main study but used for robustness checks. Coverage
rates for SA3s with fewer than 50 individuals, around 20 SA3s per
quarter per age group, were supressed and not included in the study.
Data on regional characteristics at the SA3 level were obtained from the
ABS and included variables for population, economy, income, educa­
tion, employment, health, and family.7 The regional data from the ABS
were matched with the coverage data from the AIR using SA3 identifi­
cation for SA3s with more than 50 individuals.
The analytical approach is based on an interrupted time series (ITS)
framework. ITS approaches account for pre-intervention trends and are
well-suited to studies of population-level interventions occurring at a
defined time point. A before and after or ITS method was applied to
compare changes in vaccination coverage before and after No Jab No
Pay. A difference-in-difference (DID) or controlled ITS method was
applied to compare the difference in the changes of vaccination
coverage across states and territories with state-level immunisation
policies of different degrees of stringency, that is, before and after No Jab
No Play and tightened documentation requirement policies.
7
Most measures used in the study are available from 2014 to 2018 and some
are only available until 2017, including median income, Gini coefficient, the
number of jobs, and the number of private insurance holders. These variables
are extrapolated to 2018 using a simple moving average method.
Generalised linear models with a binomial distribution and a logit
link function were used to explore the association of immunisation
coverage at each age group with policy indicators, adjusting for regional
sociodemographic characteristics, states and territories indicators,
quarter indicators, and national and state time trends. Standard errors
were adjusted for unspecified heteroscedasticity and within-SA3 corre­
lation over time. The specification is as follows:
(
Coverageijt = f Post year1t + Post year2t + Post year3t + Post year1t
/ /
× state territoryj + Post year2t × state territoryj + Post year3t
/ / /
× state territoryj + state territoryj × Tt + state territoryj
/
× Tt2 + Tt + Tt2 + state territoryj + quartert + Xijt
)
The unit of analysis is at the state-SA3-quarter level. The dependent
variables are childhood vaccination coverage rates of DTP, Polio, HEP,
HIB, Pneumococcal, Meningococcal, MMR, Varicella and full vaccination
for one, two- and five-year olds at SA3 i, state or territory j, and quarter t.
Linear and quadratic time terms control for secular trends shown in the
coverage rates at the national and state or territory level over time. State
or territory indicators control for time-invariant unobserved factors
common within states or territories, and quarter fixed affects account for
any seasonal variations. Estimates are expressed as average marginal
effects (AMEs). A series of robustness checks were performed on sample
selection and model specification (see Appendix B).
Several coefficients are of interest for policy evaluation. The co­
efficients on Post year1t, Post year2t, and Post year3t measure the change
in the level of coverage post-implementation of No Jab No Pay at the
national level in 2016, 2017 and 2018 compared to pre-policy
(2014–2015). The coefficients on Post year1t × state/territoryj, Post
year2t × state/territoryj, and Post year3t × state/territoryj measure the

3
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

difference in the change of coverage after implementation of national

and state policies between states and territories.
The regional sociodemographic covariates (Xijt) include proportions
of working age population aged 15–64, median age of usual residents,
total fertility rates, population density, median total income, Gini co­
efficient, numbers of FTB-A and FTB-B cases, numbers of jobs for males
and females, numbers of taxpayers with private health insurance, and
the Index of Relative Socio-economic Advantage and Disadvantage
(IRSAD) quintiles.8 IRSAD summarises information on income, educa­
tion, occupation, and dwelling conditions of people and households
within an area (ABS, 2016b).
Heterogeneity analyses were also performed according to potential
policy effect modifying variables. The model specification included in­
teractions of policy indicators (post year dummies and their interactions
with state dummies) and indicators for area socioeconomics, median
income, numbers of FBT-A recipients, and baseline coverage in 2014.

3. Results

3.1. Summary of coverage rates

The sample mean and standard deviation of SA3-level immunisation

coverage rates for one, two and five age groups and regional covariates
from 2014 to 2018 are reported in Table 1. The coverage rates have been
high across the country and have improved over time. There are sig­
nificant variations at the SA3-level with the full immunisation coverage
in 2014 ranging from 76.9% to 100%, 73.6% to 100%, and 77.5% to
100% for one, two and five years olds, although the variation in local
coverage rates has decreased over time. Regional factors reveal the
general social trends in Australia.
Fig. 2 shows changes in quarterly coverage rates for each state and
territory over time by age groups. Quarterly coverage rates are calculated
as the weighted mean of coverage rates at each quarter, in each state or
territory, and for each age group. Coverage for one year olds shows
different rates of change before and after 2016, coverage for two year olds
has been increasing at a decreasing rate since September–December 2014,
and coverage for five year olds was more linear over time. Coverage rates
in ACT and VIC were among the highest across the country.
Tables 2, 3 and 4 present the main policy effect estimates from
generalised linear models for the effect of No Jab No Pay, No Jab No Play,
and tightened documentation requirement policies related to removal of
conscientious objection on childhood vaccination coverage for various
vaccines at one (Table 2), two (Table 3) and five (Table 4) years of age,
respectively. The results for other covariates (see Table A2, A3 and A4),
overall policy effects at the national level (Table A1), and robustness
checks (Table B1) are reported in the Appendix. At the national level, there
have been significant increases in coverage, with the increase for one and
two years olds showing stabilisation in the third year post No Jab No Pay
and the increase for five years olds being more persistent (Table A1).

3.2. Vaccine coverage among one-year-old cohorts

Controlling for national and state time trends and state fixed effects,
compared to pre policy, No Jab No Pay and No Pay No Play in January 2016
were associated with increases in coverage across vaccines in VIC and QLD Fig. 2. Coverage rates of full vaccination among states and territories by age
by 2–4 percentage points, with QLD showing more significant increases. groups, 2014–18.
No Jab No Pay in January 2016 led to an increase in coverage in NSW by Notes: NSW, VIC, QLD, SA, WA, ACT and TAS are eight states and territories in
around 2 percentage points in 2016, 2.7 percentage points in 2017, and Australia. In December 2014, Meningococcal and dose 2 MMR and dose 1
varicella (MMRV) were included in the definition of fully immunised for the 2-
years-olds, and in March 2017, dose 4 DTP was included in the definition of
8
Logarithmic transformations are conducted for population density, median fully immunised for the 2-years-olds. These changes explained the drops in the
income, the number of FTB cases, the number of private insurance holders, and 2-year-olds coverage rates (Department of Health, 2019a).
the number of female and male jobs to adjust for the large scale across obser­
vations. The log of population density is constructed as the log of population
density plus one to adjust for less-than-one values. Median income is inflated to
2018 dollars using the Consumer Price Index from the ABS.

4
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table 2
Effects of immunisation policies on coverage for one year olds.
DTP Polio HIB HEP Pneumo Fully

VIC Post y1 vs pre 0.023** 0.022** 0.015 0.023** 0.053*** 0.013

(0.010) (0.010) (0.010) (0.010) (0.012) (0.010)
Post y2 vs pre 0.027** 0.025** 0.019 0.026** 0.051*** 0.015
(0.012) (0.012) (0.012) (0.012) (0.014) (0.012)
Post y3 vs pre 0.019 0.017 0.011 0.016 0.035** 0.004
(0.015) (0.015) (0.015) (0.016) (0.017) (0.016)
QLD Post y1 vs pre 0.033*** 0.032*** 0.025** 0.032*** 0.069*** 0.024**
(0.011) (0.011) (0.011) (0.011) (0.014) (0.011)
Post y2 vs pre 0.037*** 0.036*** 0.029** 0.034*** 0.067*** 0.026**
(0.013) (0.013) (0.013) (0.012) (0.015) (0.013)
Post y3 vs pre 0.036** 0.035** 0.028** 0.032** 0.062*** 0.026*
(0.015) (0.015) (0.014) (0.014) (0.017) (0.014)
NSW Post y1 vs pre 0.025** 0.024** 0.017* 0.025** 0.077*** 0.018*
(0.010) (0.010) (0.010) (0.010) (0.015) (0.011)
Post y2 vs pre 0.029** 0.028** 0.022* 0.029** 0.086*** 0.027**
(0.012) (0.012) (0.011) (0.011) (0.016) (0.012)
Post y3 vs pre 0.030** 0.029** 0.024* 0.029** 0.089*** 0.031**
(0.013) (0.013) (0.012) (0.012) (0.017) (0.013)
WA Post y1 vs pre 0.032** 0.030** 0.021 0.028** 0.069*** 0.018
(0.014) (0.014) (0.013) (0.013) (0.016) (0.013)
Post y2 vs pre 0.039** 0.038** 0.029* 0.036** 0.067*** 0.027*
(0.016) (0.016) (0.015) (0.016) (0.018) (0.015)
Post y3 vs pre 0.049*** 0.048*** 0.039** 0.045** 0.070*** 0.038**
(0.018) (0.018) (0.017) (0.018) (0.021) (0.017)
SA Post y1 vs pre 0.017* 0.016* 0.010 0.017* 0.048*** 0.009
(0.009) (0.009) (0.009) (0.009) (0.011) (0.010)
Post y2 vs pre 0.016 0.015 0.008 0.017 0.041*** 0.007
(0.012) (0.012) (0.012) (0.011) (0.013) (0.012)
Post y3 vs pre 0.007 0.007 − 0.002 0.004 0.026 − 0.001
(0.016) (0.016) (0.016) (0.016) (0.017) (0.016)
TAS Post y1 vs pre 0.021* 0.020 0.012 0.019 0.052*** 0.012
(0.012) (0.013) (0.012) (0.012) (0.015) (0.012)
Post y2 vs pre 0.013 0.011 0.003 0.009 0.043** 0.004
(0.015) (0.016) (0.015) (0.015) (0.018) (0.016)
Post y3 vs pre − 0.005 − 0.008 − 0.017 − 0.016 0.020 − 0.017
(0.023) (0.023) (0.023) (0.023) (0.026) (0.025)
NT Post y1 vs pre 0.032*** 0.030** 0.020* 0.014 0.057*** 0.016
(0.012) (0.012) (0.011) (0.011) (0.013) (0.010)
Post y2 vs pre 0.034* 0.032* 0.020 0.019 0.051*** 0.014
(0.018) (0.018) (0.019) (0.019) (0.020) (0.019)
Post y3 vs pre 0.027 0.023 0.009 0.012 0.038 0.003
(0.026) (0.025) (0.029) (0.032) (0.026) (0.026)
ACT Post y1 vs pre 0.017** 0.015* 0.012 0.018** 0.044*** 0.013
(0.008) (0.008) (0.008) (0.008) (0.010) (0.009)
Post y2 vs pre 0.009 0.008 0.001 0.011 0.033** − 0.001
(0.014) (0.014) (0.015) (0.015) (0.014) (0.017)
Post y3 vs pre 0.004 0.003 − 0.007 0.004 0.023 − 0.009
(0.022) (0.022) (0.027) (0.023) (0.021) (0.027)
Other covariates Yes Yes Yes Yes Yes Yes
States, quarters, trends Yes Yes Yes Yes Yes Yes

Notes: Generalised linear models with a logit link are estimated. AMEs and robust standard errors are reported. AMEs times 100% give percentage points. Significant at
***1%, **5% and *10%.

with the additional No Jab No Play in January 2018, around 3 percentage
points in 2018. No Jab No Pay and tightened documentation requirements
in 2016 led to a 2.7% increase in 2017 and a 3.8% increase in 2018 in full
vaccination for WA.9 Increases in other states have been less significant.
Coverage rates have significant upward time trends at the national
level that explains some of the increase in the coverage for one year olds
over time (coefficients not shown). The increasing time trends likely
reflect implementation of a series of government vaccination strategies
following the NIP such as state campaigns, reminder systems, financial
incentives for providers and parents, and broadened awareness of
vaccination among parents.
3.3. Vaccine coverage among two-years-old cohorts
Following No Jab No Pay and No Pay No Play in 2016, QLD had
significant increases in coverage in Polio, HIB and HEP by 0.7–0.9% in
2016 and 1.0–1.2% in 2017, more significant than the increases in VIC.
No Jab No Pay in 2016 was associated with increased coverage by
around 0.7% in 2016 and 1.2% in 2017 in NSW, and together with No
Jab No Play, by around 1.5% in 2018.10
3.4. Vaccine coverage among five-years-old cohorts
No Jab No Pay and No Jab No Play in QLD led to an increase in the full
vaccination by 0.8% in 2016, 2.5% in 2017, and 3.0% in 2018. These
two policies in VIC led to an increase in the full vaccination by 0.3%
(insignificant), 0.8% and 1.4% in 2016, 2017 and 2018 respectively. No
Jab No Pay was associated with a 0.3% (insignificant) increase in 2016
and a 0.7% increase in full vaccination for NSW, and the additional No

9
Note the increase in Pneumococcal was partially the artefact of its inclusion
for the coverage definition in December 2013.
10
Note that there were some changes in the coverage definition in DTP in
March 2017 and MMR, Varicella and Meningococcal in December 2014.

5
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table 3
Effects of immunisation policies on coverage for two years olds.
DTP Polio HIB HEP MMR Meningo Varicella Fully

VIC Post y1 vs pre 0.003 0.004* 0.005** 0.003 0.027*** 0.015** 0.031*** 0.026***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.006) (0.008) (0.004)
Post y2 vs pre − 0.036*** 0.005 0.002 0.003 0.034*** 0.014* 0.028*** 0.016***
(0.004) (0.003) (0.004) (0.004) (0.005) (0.008) (0.010) (0.005)
Post y3 vs pre − 0.038*** 0.005 0.001 0.003 0.027*** 0.015 0.023* 0.003
(0.007) (0.005) (0.006) (0.005) (0.007) (0.010) (0.012) (0.009)
QLD Post y1 vs pre 0.008*** 0.007*** 0.009*** 0.007*** 0.035*** 0.021*** 0.040*** 0.033***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.007) (0.008) (0.003)
Post y2 vs pre − 0.018*** 0.011*** 0.012*** 0.010*** 0.045*** 0.026*** 0.041*** 0.032***
(0.004) (0.004) (0.004) (0.004) (0.005) (0.008) (0.010) (0.005)
Post y3 vs pre − 0.018*** 0.008 0.009 0.008 0.041*** 0.023** 0.037*** 0.023***
(0.007) (0.006) (0.006) (0.006) (0.007) (0.010) (0.013) (0.008)
NSW Post y1 vs pre 0.006*** 0.007*** 0.006** 0.007*** 0.030*** 0.019*** 0.031*** 0.024***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.007) (0.007) (0.003)
Post y2 vs pre − 0.030*** 0.011*** 0.006 0.012*** 0.039*** 0.023*** 0.028*** 0.010*
(0.004) (0.004) (0.004) (0.003) (0.006) (0.008) (0.010) (0.006)
Post y3 vs pre − 0.027*** 0.014*** 0.009 0.016*** 0.039*** 0.023** 0.025** − 0.001
(0.007) (0.005) (0.006) (0.005) (0.008) (0.010) (0.012) (0.009)
WA Post y1 vs pre 0.004 0.006 0.006 0.003 0.030*** 0.032*** 0.034*** 0.032***
(0.003) (0.004) (0.004) (0.004) (0.005) (0.009) (0.009) (0.005)
Post y2 vs pre − 0.052*** 0.007 0.009 0.006 0.036*** 0.037*** 0.031*** 0.021***
(0.006) (0.006) (0.007) (0.006) (0.007) (0.012) (0.012) (0.007)
Post y3 vs pre − 0.047*** 0.010 0.014 0.007 0.033*** 0.038*** 0.026* 0.014
(0.010) (0.010) (0.010) (0.010) (0.011) (0.014) (0.015) (0.011)
SA Post y1 vs pre 0.002 0.001 0.003 0.002 0.033*** 0.021*** 0.030*** 0.043***
(0.003) (0.004) (0.004) (0.004) (0.005) (0.007) (0.008) (0.006)
Post y2 vs pre − 0.048*** − 0.002 − 0.007 − 0.003 0.029*** 0.018* 0.017 0.021**
(0.008) (0.007) (0.007) (0.006) (0.008) (0.010) (0.011) (0.010)
Post y3 vs pre − 0.054*** − 0.012 − 0.018* − 0.013 0.018* 0.014 0.007 0.003
(0.012) (0.012) (0.010) (0.011) (0.011) (0.013) (0.015) (0.015)
TAS Post y1 vs pre − 0.001 0.002 0.012** 0.002 0.038*** 0.016* 0.034** 0.038***
(0.005) (0.005) (0.005) (0.005) (0.010) (0.008) (0.014) (0.010)
Post y2 vs pre − 0.049*** − 0.001 0.006 − 0.003 0.041*** 0.011 0.027 0.024*
(0.008) (0.005) (0.006) (0.005) (0.011) (0.012) (0.018) (0.013)
Post y3 vs pre − 0.075*** − 0.011 − 0.011 − 0.014 0.019 − 0.009 − 0.003 − 0.013
(0.024) (0.011) (0.012) (0.012) (0.021) (0.018) (0.030) (0.023)
NT Post y1 vs pre 0.010* 0.010* 0.016** 0.007* 0.042*** 0.019 0.056*** 0.039***
(0.005) (0.005) (0.008) (0.004) (0.011) (0.013) (0.020) (0.012)
Post y2 vs pre − 0.046*** 0.007 0.017** − 0.002 0.053*** 0.021 0.067** 0.030
(0.012) (0.008) (0.009) (0.006) (0.014) (0.014) (0.028) (0.020)
Post y3 vs pre − 0.067*** − 0.001 0.017 − 0.014 0.046*** 0.019 0.074** 0.012
(0.020) (0.016) (0.013) (0.013) (0.016) (0.020) (0.032) (0.027)
ACT Post y1 vs pre 0.002 0.003 0.002 0.004 0.025*** 0.012 0.027** 0.023***
(0.004) (0.007) (0.007) (0.008) (0.006) (0.011) (0.011) (0.006)
Post y2 vs pre − 0.033*** 0.001 − 0.005 0.003 0.035*** 0.014 0.040** 0.029**
(0.011) (0.016) (0.016) (0.017) (0.013) (0.018) (0.018) (0.013)
Post y3 vs pre − 0.051* − 0.006 − 0.025 − 0.006 0.016 0.010 0.038* 0.008
(0.030) (0.030) (0.040) (0.033) (0.023) (0.024) (0.022) (0.024)
Other covariates Yes Yes Yes Yes Yes Yes Yes Yes
States, quarters, trends Yes Yes Yes Yes Yes Yes Yes Yes

Notes: Generalised linear models with a logit link are estimated. AMEs and robust standard errors are reported. AMEs times 100% give percentage points. Significant at
***1%, **5% and *10%.

Jab No Play was associated with a 1.2% increase in 2018.11No Jab No Pay
and tightened documentation requirements in SA and WA brought about
2–3% increases in coverage. In particular, the increase in full vaccina­
tion was largely driven by the improvement in MMR. Significant in­
creases in coverage were not observed in the remaining states.
3.5. Regional factors associated with full vaccination coverage
The proportion of working age population, median age of usual
residents, population density and Gini coefficient were negatively
associated with the full vaccination coverage, while the number of
taxpayers who report having private health insurance was positively
correlated with full vaccination coverage (see Tables A2-4). Moreover,
vaccination coverage significantly decreased as area socioeconomic
status increased for one, two and five years olds.
11
MMR was not assessed at five years old since December 2017.
3.6. Response heterogeneity
Considering the concentration of recorded objection in more
advantaged areas (Beard et al., 2016), the greater effects of the policies
on lower-income families (Leask and Danchin, 2017), and the persistent
geographic clusters of recorded objection (Beard et al., 2017), the policy
response likely varied. The policy response heterogeneity was therefore
examined according to area socioeconomics, median income, numbers
of FBT-A recipients, and baseline coverage.
Fig. 3 panel (a) examines the overall policy effects on the full vacci­
nation coverage by area socioeconomic status measured by the IRSAD.
The increase in coverage associated with the policies was smallest in the
highest IRSAD quintile (most affluent and educated) for one and five
years olds, and in the second IRSAD quintile for two year olds.12 Overall,
12
Note that the mean of full vaccination coverage rates was highest in the
second quintile. The difference in coverage changes across the quintiles are not
significant for one year olds.

6
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table 4 reported in Fig. 3 panel (c).15No Jab No Pay policy linked childhood
Effects of immunisation policies on coverage for five years olds. immunisation to FTB-A supplements (2016–17) and FTB-A (2018-cur­
DTP Polio MMR Fully rent). Thus, there may be an interaction effect between the policy and
the number of FBT-A cases on coverage. It shows that the effect of the
VIC Post y1 vs pre 0.004 0.005* 0.003 0.003
(0.003) (0.003) (0.003) (0.003) policies increased as more people on FTB-A were in the area for one, two
Post y2 vs pre 0.007* 0.007* 0.016*** 0.008* and five year old cohorts.
(0.004) (0.004) (0.004) (0.004) Fig. 3 panel (d) presents the policy responses separately for SA3s
Post y3 vs pre 0.009* 0.009** 0.014*** with baseline pre-policy annual coverage in 2014 below and above 90%.
(0.005) (0.005) (0.005)
QLD Post y1 vs pre 0.010*** 0.010*** 0.008** 0.008**
The largest proportion of low baseline coverage occurred in the highest
(0.003) (0.003) (0.004) (0.004) quintile of the IRSAD, followed by the fourth, third, first, and second
Post y2 vs pre 0.022*** 0.021*** 0.034*** 0.025*** quintiles. The increase in areas with baseline coverage above 90% was
(0.004) (0.004) (0.004) (0.004) larger than that in areas with baseline coverage below 90%, and the
Post y3 vs pre 0.022*** 0.023*** 0.030***
positive policy effects mostly occurred in areas with higher baseline
(0.005) (0.005) (0.005)
NSW Post y1 vs pre 0.003 0.003 0.002 0.003 coverage. That is, the increase in immunisation coverage has been
(0.003) (0.003) (0.003) (0.003) largely driven by SA3s with relatively higher baseline coverage, which
Post y2 vs pre 0.004 0.003 0.014*** 0.007* tend to be socioeconomically disadvantaged areas.
(0.004) (0.004) (0.004) (0.004)
Post y3 vs pre 0.005 0.004 0.012***
(0.005) (0.005) (0.004)
4. Discussion
WA Post y1 vs pre − 0.000 − 0.001 0.003 0.001
(0.004) (0.004) (0.005) (0.004) The present study examines the associated impact of removing con­
Post y2 vs pre − 0.001 − 0.001 0.019*** 0.004 scientious objection exemptions from children vaccination requirements
(0.006) (0.006) (0.006) (0.006)
for access to family assistance payments (No Jab No Pay in 2016),
Post y3 vs pre 0.002 0.001 0.011
(0.008) (0.008) (0.008) enrolment in childcare (No Jab No Play in VIC and QLD in 2016 and NSW
SA Post y1 vs pre 0.013*** 0.013*** 0.017*** 0.014*** in 2018), and tightened documentation requirements for childcare
(0.005) (0.005) (0.006) (0.005) enrolment (WA in 2016 and SA in 2017). Overall, the results indicate that
Post y2 vs pre 0.015** 0.014** 0.033*** 0.019*** removing philosophical or religious exemptions was associated with in­
(0.006) (0.006) (0.006) (0.006)
Post y3 vs pre 0.018** 0.017** 0.027***
creases in the vaccination coverage at one (approx. 2–4%), two (approx.
(0.008) (0.008) (0.008) 1–1.5%) and five (approx. 1–3.5%) years of age. There have been overall
TAS Post y1 vs pre 0.006 0.005 0.006 0.003 improvements in coverage associated with No Jab No Pay, and states that
(0.005) (0.006) (0.006) (0.006) implemented additional No Jab No Play and tightened documentation
Post y2 vs pre 0.001 − 0.000 0.006 − 0.001
requirement policies tended to show more significant increases.
(0.009) (0.009) (0.007) (0.010)
Post y3 vs pre 0.002 0.000 0.006 Similar to the order of magnitude in this study, studies in the United
(0.009) (0.010) (0.010) States examining the removal of nonmedical exemptions from school
NT Post y1 vs pre − 0.023* − 0.024* − 0.019 − 0.024* entry requirements in California found an increase of nearly 3% in
(0.013) (0.013) (0.015) (0.014) kindergartener vaccination coverage in the first year, and a slight
Post y2 vs pre − 0.029** − 0.032** − 0.009 − 0.023*
(0.012) (0.013) (0.018) (0.013)
decrease of 0.45% in the second year (Bednarczyk et al., 2019; Delam­
Post y3 vs pre − 0.059* − 0.064** − 0.044* ater et al., 2019). The stabilisation of post-implementation trends has
(0.031) (0.032) (0.026) also observed for the one and two years olds. The increase in the
ACT Post y1 vs pre − 0.001 − 0.001 − 0.001 − 0.004 coverage of five years olds was more persistent and largely driven by
(0.007) (0.008) (0.008) (0.007)
MMR, which has been one of the most controversial vaccines since a
Post y2 vs pre 0.003 0.003 0.017 0.005
(0.013) (0.014) (0.012) (0.012) fraudulent study linked MMR with autism.
Post y3 vs pre − 0.004 − 0.000 0.000 However, the policy response was heterogenous. The changes in
(0.022) (0.021) (0.019) immunisation coverage post removal of conscientious objection was
Other covariates Yes Yes Yes Yes greatest in areas that were more socioeconomically disadvantaged, more
States, quarters, trends Yes Yes Yes Yes
government benefit dependent, with lower median income, and with
Notes: Generalised linear models with a logit link are estimated. AMEs and higher baseline coverage. The policies disproportionally affected lower
robust standard errors are reported. AMEs times 100% give percentage points. income families who were less likely to be vaccine objectors (Leask and
Significant at ***1%, **5% and *10%. Danchin, 2017) and have less means to arrange other informal childcare
coverage rates were less responsive in more socioeconomically advan­ (Helps et al., 2018; Leask and Danchin, 2017). Contrastingly, the
taged areas. improvement in immunisation coverage was smallest in more socio­
Fig. 3 panel (b) shows the policy effects on the full vaccination economically advantaged areas with lower baseline coverage. Smaller
coverage by logarithmised SA3-level median total income.13 Consistent improvement in these areas indicates that low immunisation coverage
with the findings for IRSAD gradients, the policy effects generally has been persistent at some local areas.
decreased as the level of median income increased. While the increase in Non-immunising parents are broadly comprised of refusing and hes­
coverage following removal of conscientious objection was around 3 itant parents who tend to be socioeconomically advantaged and accept­
percentage points for areas with the lowest median income, the increase ing parents who experience access barriers (Pearce et al., 2015; Toll and
was nearly zero for areas with the highest median income.14 Similarly, Li, 2020). The results imply that the areas with large proportions of
the policy effects were insignificant in affluent areas. motivated or persistent vaccine objectors who are affluent tend to have
Policy effect estimates by the number of FTB-A recipients are more persistently low vaccination and be less responsive to the elimina­
tion of conscientious objection. However, the areas with largely accept­
ing parents whose access issues have not been improved by the policies
will also have smaller responsiveness, depending on the size of the policy
13
The mean median income is $AU 49,517 with a range of 34,457-92,416. nudge relative to the barriers they face. These results imply that targeted
14
Note that most policy estimates show significance for two and five years
olds.
15
The mean number of FTB-A recipients is 4950 with a range of 591–19,450.

7
A. Li and M. Toll
Fig. 3. Effects of immunisation policies on full vaccination coverage rates by subgroups.
Notes: Generalised linear models with a logit link for full immunisation at 1, 2 and 5 years olds are estimated. AMEs on the overall post policy indicators are
displayed. AMEs times 100% give percentage points.
strategies, accordant with different causes of under-vaccination, at the
national or local area level might be needed to reach persistent non-
compliers and reduce risks of local outbreaks.
The study contributes to the literature on the effectiveness of
mandatory immunisation policies, including financial sanctions and
childcare entry requirements. Australia is among the first few jurisdic­
tions implementing regulations that remove non-medical exemptions to
childhood immunisation requirements. With more countries moving
towards implementing vaccination mandates, evidence from Australia
can assist effective policy designs to achieve high vaccination coverage.
Currently, there is a paucity of evidence on mandatory immunisation in
high-income regions with relatively high baseline rates (MacDonald
et al., 2018). A recent systematic review identifies a gap in studies
around immunisation mandates for childcare entry (Lee and Robinson,
2016).
This study provides empirical evidence on the effectiveness of
removing conscientious objection exemptions from vaccination re­
quirements linked to receipt of family assistance payments and/or child­
care enrolment. The investigation of vaccination coverage was conducted
for a range of scheduled vaccines at one, two and five years of age across
areas implemented with the policies. One of the key caveats is that the
variation in policy effects needs to be considered when implementing
mandatory immunisation programs. Given vulnerable families often sup­
port vaccination (MacDonald et al., 2018) and many areas with low
coverage have been persistent, future immunisation programs can be more
16
In the robustness checks, results for Varicella and MMR using only data after 2015 confirm similar findings (see Appendix B).
8
Preventive Medicine 145 (2021) 106406
effective if efforts are put in place to diagnose causes of under-vaccination
in areas with low coverage and small policy responses, and tailor accordant
interventions for for groups or areas with persistent non-compliance.
The study has a few limitations. First, ITS approaches assume that
pre-existing trends continue unchanged without the intervention. The
availability of counterfactual controls for No Jab No Pay would provide
more robust causality inference. Second, while the specification controls
for national and state-level time trends and state and quarter fixed ef­
fects, there might be some time-varying smaller-scale effects such as
client reminder and recall systems, home visits, and campaigns that
cannot be separated out from the main policy effects. Third, the study
did not assess the effectiveness of the policies separately for parents who
are refusing, hesitant, or facing access barriers that require individual-
level data, which would inform more targeted strategies to improve
coverage. Fourth, there have been changes in coverage definitions, such
as the inclusion of Pneumococcal in December 2013, DTP in March
2017, and MMR and Varicella in December 2014. For these vaccines, the
coverage changes post definition revision are mixed with policy effects,
although the results using only post definition period and findings for
other vaccines are similar.16
5. Conclusion
There has been an improvement in immunisation coverage with
implementation of vaccine mandates that remove conscientious
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

objection from vaccination requirements for government payments and refusal and access barriers, and a diagnosis of causes for lack of response
childcare enrolment. Australia has a high childhood vaccination rate, and under-vaccination in areas with persistently low coverage.
compared globally, but community immunity is contingent on high
coverage to reduce transmission risks of vaccine-preventable diseases.
Results suggest removing conscientious objection is a policy lever that Declaration of Competing Interest
improves vaccine coverage. However, more effective strategies require
an investigation of differential policy effects on vaccine hesitancy, None.

Appendix A

Table A1
Effects of immunisation policies on coverage rates at the national level.

One year olds

DTP Polio HIB HEP Pneumo Fully

Post y1 vs pre 0.026** 0.025** 0.018* 0.025** 0.065*** 0.017*

(0.010) (0.010) (0.010) (0.010) (0.013) (0.010)
Post y2 vs pre 0.029** 0.028** 0.022* 0.028** 0.065*** 0.021*
(0.012) (0.012) (0.012) (0.011) (0.014) (0.012)
Post y3 vs pre 0.027** 0.026** 0.019 0.024* 0.059*** 0.019
(0.013) (0.013) (0.013) (0.013) (0.015) (0.013)

Two years olds

DTP Polio HIB HEP MMR Meningo Varicella Fully

Post y1 vs pre 0.005*** 0.005*** 0.007*** 0.005*** 0.031*** 0.020*** 0.034*** 0.030***
(0.002) (0.002) (0.002) (0.002) (0.003) (0.006) (0.007) (0.003)
Post y2 vs pre − 0.033*** 0.008*** 0.006* 0.007** 0.039*** 0.022*** 0.032*** 0.020***
(0.003) (0.003) (0.003) (0.003) (0.004) (0.008) (0.009) (0.005)
Post y3 vs pre − 0.034*** 0.006 0.004 0.006 0.033*** 0.020** 0.026** 0.008
(0.005) (0.004) (0.005) (0.004) (0.006) (0.009) (0.011) (0.007)

Five years olds

DTP Polio MMR Fully

Post y1 vs pre 0.005** 0.005** 0.005* 0.004*

(0.002) (0.002) (0.002) (0.002)
Post y2 vs pre 0.009*** 0.008*** 0.021*** 0.011***
(0.003) (0.003) (0.003) (0.003)
Post y3 vs pre 0.009** 0.009** 0.017***
(0.004) (0.004) (0.004)
Other covariates Yes Yes Yes Yes Yes Yes Yes Yes
States, quarters, trends Yes Yes Yes Yes Yes Yes Yes Yes
Notes: Generalised linear models with a logit link for full immunisation at 1, 2 and 5 years olds are estimated. AMEs on the overall post policy indicators are displayed.
AMEs times 100% give percentage points.

Table A2
Effects of immunisation policies on coverage rates for one year olds.

DTP Polio HIB HEP Pneumo Fully

VIC Post y1 vs pre 0.023** 0.022** 0.015 0.023** 0.053*** 0.013

(0.010) (0.010) (0.010) (0.010) (0.012) (0.010)
Post y2 vs pre 0.027** 0.025** 0.019 0.026** 0.051*** 0.015
(0.012) (0.012) (0.012) (0.012) (0.014) (0.012)
Post y3 vs pre 0.019 0.017 0.011 0.016 0.035** 0.004
(0.015) (0.015) (0.015) (0.016) (0.017) (0.016)
QLD Post y1 vs pre 0.033*** 0.032*** 0.025** 0.032*** 0.069*** 0.024**
(0.011) (0.011) (0.011) (0.011) (0.014) (0.011)
Post y2 vs pre 0.037*** 0.036*** 0.029** 0.034*** 0.067*** 0.026**
(0.013) (0.013) (0.013) (0.012) (0.015) (0.013)
Post y3 vs pre 0.036** 0.035** 0.028** 0.032** 0.062*** 0.026*
(0.015) (0.015) (0.014) (0.014) (0.017) (0.014)
NSW Post y1 vs pre 0.025** 0.024** 0.017* 0.025** 0.077*** 0.018*
(0.010) (0.010) (0.010) (0.010) (0.015) (0.011)
Post y2 vs pre 0.029** 0.028** 0.022* 0.029** 0.086*** 0.027**
(0.012) (0.012) (0.011) (0.011) (0.016) (0.012)
Post y3 vs pre 0.030** 0.029** 0.024* 0.029** 0.089*** 0.031**
(0.013) (0.013) (0.012) (0.012) (0.017) (0.013)
WA Post y1 vs pre 0.032** 0.030** 0.021 0.028** 0.069*** 0.018
(continued on next page)

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A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table A2 (continued )
DTP Polio HIB HEP Pneumo Fully

(0.014) (0.014) (0.013) (0.013) (0.016) (0.013)

Post y2 vs pre 0.039** 0.038** 0.029* 0.036** 0.067*** 0.027*
(0.016) (0.016) (0.015) (0.016) (0.018) (0.015)
Post y3 vs pre 0.049*** 0.048*** 0.039** 0.045** 0.070*** 0.038**
(0.018) (0.018) (0.017) (0.018) (0.021) (0.017)
SA Post y1 vs pre 0.017* 0.016* 0.010 0.017* 0.048*** 0.009
(0.009) (0.009) (0.009) (0.009) (0.011) (0.010)
Post y2 vs pre 0.016 0.015 0.008 0.017 0.041*** 0.007
(0.012) (0.012) (0.012) (0.011) (0.013) (0.012)
Post y3 vs pre 0.007 0.007 − 0.002 0.004 0.026 − 0.001
(0.016) (0.016) (0.016) (0.016) (0.017) (0.016)
TAS Post y1 vs pre 0.021* 0.020 0.012 0.019 0.052*** 0.012
(0.012) (0.013) (0.012) (0.012) (0.015) (0.012)
Post y2 vs pre 0.013 0.011 0.003 0.009 0.043** 0.004
(0.015) (0.016) (0.015) (0.015) (0.018) (0.016)
Post y3 vs pre − 0.005 − 0.008 − 0.017 − 0.016 0.020 − 0.017
(0.023) (0.023) (0.023) (0.023) (0.026) (0.025)
NT Post y1 vs pre 0.032*** 0.030** 0.020* 0.014 0.057*** 0.016
(0.012) (0.012) (0.011) (0.011) (0.013) (0.010)
Post y2 vs pre 0.034* 0.032* 0.020 0.019 0.051*** 0.014
(0.018) (0.018) (0.019) (0.019) (0.020) (0.019)
Post y3 vs pre 0.027 0.023 0.009 0.012 0.038 0.003
(0.026) (0.025) (0.029) (0.032) (0.026) (0.026)
ACT Post y1 vs pre 0.017** 0.015* 0.012 0.018** 0.044*** 0.013
(0.008) (0.008) (0.008) (0.008) (0.010) (0.009)
Post y2 vs pre 0.009 0.008 0.001 0.011 0.033** − 0.001
(0.014) (0.014) (0.015) (0.015) (0.014) (0.017)
Post y3 vs pre 0.004 0.003 − 0.007 0.004 0.023 − 0.009
(0.022) (0.022) (0.027) (0.023) (0.021) (0.027)
Working age population % − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002***
(0.001) (0.001) (0.001) (0.001) (0.001) (0.001)
Median age − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002***
(0.000) (0.000) (0.000) (0.000) (0.000) (0.000)
Total fertility rate − 0.006 − 0.006 − 0.005 − 0.005 − 0.005 − 0.003
(0.006) (0.006) (0.006) (0.006) (0.006) (0.006)
Log population density − 0.001*** − 0.001*** − 0.002*** − 0.002*** − 0.002*** − 0.002***
(0.000) (0.000) (0.000) (0.000) (0.000) (0.000)
Log median total income 0.009 0.009 0.013 0.009 0.015 0.015
(0.012) (0.012) (0.013) (0.012) (0.012) (0.013)
IRSAD Q2 − 0.004 − 0.004 − 0.004 − 0.004 − 0.004 − 0.003
(0.003) (0.003) (0.003) (0.003) (0.003) (0.003)
IRSAD Q3 − 0.012*** − 0.012*** − 0.012*** − 0.013*** − 0.012*** − 0.012***
(0.004) (0.004) (0.004) (0.004) (0.004) (0.004)
IRSAD Q4 − 0.013*** − 0.013*** − 0.014*** − 0.014*** − 0.014*** − 0.015***
(0.004) (0.004) (0.004) (0.004) (0.004) (0.005)
IRSAD highest quintile − 0.014** − 0.014** − 0.014** − 0.016*** − 0.015** − 0.017***
(0.006) (0.006) (0.006) (0.006) (0.006) (0.006)
Gini coefficient − 0.207*** − 0.206*** − 0.212*** − 0.211*** − 0.222*** − 0.241***
(0.037) (0.037) (0.037) (0.039) (0.038) (0.039)
Log no. people on FTB-A 0.005 0.005 0.002 0.003 − 0.001 − 0.001
(0.021) (0.021) (0.021) (0.021) (0.021) (0.022)
Log no. people on FTB-B − 0.026 − 0.026 − 0.024 − 0.023 − 0.021 − 0.022
(0.020) (0.020) (0.020) (0.020) (0.020) (0.021)
Log no. insurance holders 0.029*** 0.029*** 0.027*** 0.028*** 0.025*** 0.026***
(0.008) (0.008) (0.008) (0.008) (0.008) (0.008)
Log no. jobs for females − 0.007 − 0.007 − 0.001 − 0.007 0.001 0.006
(0.018) (0.019) (0.019) (0.020) (0.019) (0.020)
Log no. jobs for males − 0.002 − 0.002 − 0.005 − 0.002 − 0.005 − 0.009
(0.018) (0.018) (0.018) (0.019) (0.019) (0.020)
Notes: Generalised linear models with a logit link are estimated. AME and robust standard error are reported. Significant at ***1%, **5% and *10%. The models with
and without allowing different slopes before and after 2016 had similar results.

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A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table A3
Effects of immunisation policies on coverage rates for two years olds.

DTP Polio HIB HEP MMR Meningo Varicella Fully

VIC Post y1 vs pre 0.003 0.004* 0.005** 0.003 0.027*** 0.015** 0.031*** 0.026***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.006) (0.008) (0.004)
Post y2 vs pre − 0.036*** 0.005 0.002 0.003 0.034*** 0.014* 0.028*** 0.016***
(0.004) (0.003) (0.004) (0.004) (0.005) (0.008) (0.010) (0.005)
Post y3 vs pre − 0.038*** 0.005 0.001 0.003 0.027*** 0.015 0.023* 0.003
(0.007) (0.005) (0.006) (0.005) (0.007) (0.010) (0.012) (0.009)
QLD Post y1 vs pre 0.008*** 0.007*** 0.009*** 0.007*** 0.035*** 0.021*** 0.040*** 0.033***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.007) (0.008) (0.003)
Post y2 vs pre − 0.018*** 0.011*** 0.012*** 0.010*** 0.045*** 0.026*** 0.041*** 0.032***
(0.004) (0.004) (0.004) (0.004) (0.005) (0.008) (0.010) (0.005)
Post y3 vs pre − 0.018*** 0.008 0.009 0.008 0.041*** 0.023** 0.037*** 0.023***
(0.007) (0.006) (0.006) (0.006) (0.007) (0.010) (0.013) (0.008)
NSW Post y1 vs pre 0.006*** 0.007*** 0.006** 0.007*** 0.030*** 0.019*** 0.031*** 0.024***
(0.002) (0.002) (0.002) (0.002) (0.004) (0.007) (0.007) (0.003)
Post y2 vs pre − 0.030*** 0.011*** 0.006 0.012*** 0.039*** 0.023*** 0.028*** 0.010*
(0.004) (0.004) (0.004) (0.003) (0.006) (0.008) (0.010) (0.006)
Post y3 vs pre − 0.027*** 0.014*** 0.009 0.016*** 0.039*** 0.023** 0.025** − 0.001
(0.007) (0.005) (0.006) (0.005) (0.008) (0.010) (0.012) (0.009)
WA Post y1 vs pre 0.004 0.006 0.006 0.003 0.030*** 0.032*** 0.034*** 0.032***
(0.003) (0.004) (0.004) (0.004) (0.005) (0.009) (0.009) (0.005)
Post y2 vs pre − 0.052*** 0.007 0.009 0.006 0.036*** 0.037*** 0.031*** 0.021***
(0.006) (0.006) (0.007) (0.006) (0.007) (0.012) (0.012) (0.007)
Post y3 vs pre − 0.047*** 0.010 0.014 0.007 0.033*** 0.038*** 0.026* 0.014
(0.010) (0.010) (0.010) (0.010) (0.011) (0.014) (0.015) (0.011)
SA Post y1 vs pre 0.002 0.001 0.003 0.002 0.033*** 0.021*** 0.030*** 0.043***
(0.003) (0.004) (0.004) (0.004) (0.005) (0.007) (0.008) (0.006)
Post y2 vs pre − 0.048*** − 0.002 − 0.007 − 0.003 0.029*** 0.018* 0.017 0.021**
(0.008) (0.007) (0.007) (0.006) (0.008) (0.010) (0.011) (0.010)
Post y3 vs pre − 0.054*** − 0.012 − 0.018* − 0.013 0.018* 0.014 0.007 0.003
(0.012) (0.012) (0.010) (0.011) (0.011) (0.013) (0.015) (0.015)
TAS Post y1 vs pre − 0.001 0.002 0.012** 0.002 0.038*** 0.016* 0.034** 0.038***
(0.005) (0.005) (0.005) (0.005) (0.010) (0.008) (0.014) (0.010)
Post y2 vs pre − 0.049*** − 0.001 0.006 − 0.003 0.041*** 0.011 0.027 0.024*
(0.008) (0.005) (0.006) (0.005) (0.011) (0.012) (0.018) (0.013)
Post y3 vs pre − 0.075*** − 0.011 − 0.011 − 0.014 0.019 − 0.009 − 0.003 − 0.013
(0.024) (0.011) (0.012) (0.012) (0.021) (0.018) (0.030) (0.023)
NT Post y1 vs pre 0.010* 0.010* 0.016** 0.007* 0.042*** 0.019 0.056*** 0.039***
(0.005) (0.005) (0.008) (0.004) (0.011) (0.013) (0.020) (0.012)
Post y2 vs pre − 0.046*** 0.007 0.017** − 0.002 0.053*** 0.021 0.067** 0.030
(0.012) (0.008) (0.009) (0.006) (0.014) (0.014) (0.028) (0.020)
Post y3 vs pre − 0.067*** − 0.001 0.017 − 0.014 0.046*** 0.019 0.074** 0.012
(0.020) (0.016) (0.013) (0.013) (0.016) (0.020) (0.032) (0.027)
ACT Post y1 vs pre 0.002 0.003 0.002 0.004 0.025*** 0.012 0.027** 0.023***
(0.004) (0.007) (0.007) (0.008) (0.006) (0.011) (0.011) (0.006)
Post y2 vs pre − 0.033*** 0.001 − 0.005 0.003 0.035*** 0.014 0.040** 0.029**
(0.011) (0.016) (0.016) (0.017) (0.013) (0.018) (0.018) (0.013)
Post y3 vs pre − 0.051* − 0.006 − 0.025 − 0.006 0.016 0.010 0.038* 0.008
(0.030) (0.030) (0.040) (0.033) (0.023) (0.024) (0.022) (0.024)
Working age pop % − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.003***
(0.001) (0.000) (0.001) (0.000) (0.001) (0.001) (0.001) (0.001)
Median age − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002***
(0.000) (0.000) (0.000) (0.000) (0.000) (0.000) (0.000) (0.001)
Total fertility rate 0.001 0.002 0.006 0.002 0.003 0.007 0.001 0.007
(0.005) (0.005) (0.005) (0.005) (0.006) (0.006) (0.006) (0.007)
Log population density − 0.002*** − 0.001*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.002*** − 0.003***
(0.000) (0.000) (0.000) (0.000) (0.000) (0.000) (0.000) (0.001)
Log median income 0.004 0.020** 0.011 0.020** − 0.002 0.012 − 0.004 − 0.002
(0.011) (0.009) (0.011) (0.010) (0.013) (0.010) (0.013) (0.014)
IRSAD Q2 − 0.005** − 0.005*** − 0.006*** − 0.006*** − 0.005* − 0.006*** − 0.004 − 0.005
(0.002) (0.002) (0.002) (0.002) (0.003) (0.002) (0.003) (0.003)
IRSAD Q3 − 0.013*** − 0.013*** − 0.014*** − 0.014*** − 0.014*** − 0.016*** − 0.013*** − 0.013***
(0.003) (0.003) (0.003) (0.003) (0.004) (0.003) (0.004) (0.004)
IRSAD Q4 − 0.015*** − 0.015*** − 0.017*** − 0.016*** − 0.017*** − 0.019*** − 0.015*** − 0.018***
(0.004) (0.003) (0.004) (0.004) (0.005) (0.004) (0.005) (0.005)
IRSAD highest quintile − 0.018*** − 0.017*** − 0.019*** − 0.019*** − 0.018*** − 0.022*** − 0.015** − 0.019***
(continued on next page)

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A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table A3 (continued )
DTP Polio HIB HEP MMR Meningo Varicella Fully

(0.006) (0.005) (0.005) (0.005) (0.006) (0.005) (0.006) (0.007)

Gini coefficient − 0.212*** − 0.153*** − 0.207*** − 0.163*** − 0.284*** − 0.202*** − 0.277*** − 0.338***
(0.033) (0.029) (0.034) (0.031) (0.038) (0.036) (0.038) (0.040)
Log no. FTB A − 0.021 − 0.016 − 0.029 − 0.007 − 0.023 − 0.031* − 0.016 − 0.016
(0.019) (0.017) (0.018) (0.017) (0.022) (0.018) (0.022) (0.024)
Log no. FTB B − 0.002 0.000 0.007 − 0.008 − 0.003 0.010 − 0.008 − 0.017
(0.018) (0.016) (0.017) (0.016) (0.021) (0.017) (0.020) (0.022)
Log no. insurance 0.022*** 0.014** 0.018*** 0.015** 0.029*** 0.021*** 0.034*** 0.032***
(0.007) (0.006) (0.007) (0.006) (0.008) (0.007) (0.009) (0.009)
Log no. jobs, females − 0.001 0.001 0.011 − 0.005 0.002 0.017 − 0.007 0.015
(0.016) (0.015) (0.017) (0.016) (0.020) (0.018) (0.019) (0.021)
Log no. jobs, males 0.001 − 0.001 − 0.008 0.004 − 0.006 − 0.019 − 0.004 − 0.015
(0.016) (0.015) (0.017) (0.016) (0.019) (0.018) (0.019) (0.021)
Notes: Generalised linear models with a logit link are estimated. AMEs and robust standard errors are reported. Significant at ***1% **5% and *10%.

Table A4
Effects of immunisation policies on coverage rates for five years olds.

DTP Polio MMR Fully

VIC Post y1 vs pre 0.004 0.005* 0.003 0.003

(0.003) (0.003) (0.003) (0.003)
Post y2 vs pre 0.007* 0.007* 0.016*** 0.008*
(0.004) (0.004) (0.004) (0.004)
Post y3 vs pre 0.009* 0.009** 0.014***
(0.005) (0.005) (0.005)
QLD Post y1 vs pre 0.010*** 0.010*** 0.008** 0.008**
(0.003) (0.003) (0.004) (0.004)
Post y2 vs pre 0.022*** 0.021*** 0.034*** 0.025***
(0.004) (0.004) (0.004) (0.004)
Post y3 vs pre 0.022*** 0.023*** 0.030***
(0.005) (0.005) (0.005)
NSW Post y1 vs pre 0.003 0.003 0.002 0.003
(0.003) (0.003) (0.003) (0.003)
Post y2 vs pre 0.004 0.003 0.014*** 0.007*
(0.004) (0.004) (0.004) (0.004)
Post y3 vs pre 0.005 0.004 0.012***
(0.005) (0.005) (0.004)
WA Post y1 vs pre − 0.000 − 0.001 0.003 0.001
(0.004) (0.004) (0.005) (0.004)
Post y2 vs pre − 0.001 − 0.001 0.019*** 0.004
(0.006) (0.006) (0.006) (0.006)
Post y3 vs pre 0.002 0.001 0.011
(0.008) (0.008) (0.008)
SA Post y1 vs pre 0.013*** 0.013*** 0.017*** 0.014***
(0.005) (0.005) (0.006) (0.005)
Post y2 vs pre 0.015** 0.014** 0.033*** 0.019***
(0.006) (0.006) (0.006) (0.006)
Post y3 vs pre 0.018** 0.017** 0.027***
(0.008) (0.008) (0.008)
TAS Post y1 vs pre 0.006 0.005 0.006 0.003
(0.005) (0.006) (0.006) (0.006)
Post y2 vs pre 0.001 − 0.000 0.006 − 0.001
(0.009) (0.009) (0.007) (0.010)
Post y3 vs pre 0.002 0.000 0.006
(0.009) (0.010) (0.010)
NT Post y1 vs pre − 0.023* − 0.024* − 0.019 − 0.024*
(0.013) (0.013) (0.015) (0.014)
Post y2 vs pre − 0.029** − 0.032** − 0.009 − 0.023*
(0.012) (0.013) (0.018) (0.013)
Post y3 vs pre − 0.059* − 0.064** − 0.044*
(0.031) (0.032) (0.026)
ACT Post y1 vs pre − 0.001 − 0.001 − 0.001 − 0.004
(0.007) (0.008) (0.008) (0.007)
Post y2 vs pre 0.003 0.003 0.017 0.005
(continued on next page)

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A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table A4 (continued )
DTP Polio MMR Fully

(0.013) (0.014) (0.012) (0.012)

Post y3 vs pre − 0.004 − 0.000 0.000
(0.022) (0.021) (0.019)
Working age pop % − 0.003*** − 0.003*** − 0.002*** − 0.003***
(0.001) (0.001) (0.001) (0.001)
Median age − 0.002*** − 0.003*** − 0.002*** − 0.002***
(0.000) (0.000) (0.000) (0.000)
Total fertility rate − 0.001 − 0.001 0.003 0.001
(0.007) (0.007) (0.007) (0.007)
Log population density − 0.002*** − 0.002*** − 0.002*** − 0.003***
(0.001) (0.001) (0.001) (0.001)
Log median income 0.003 0.002 0.009 0.004
(0.013) (0.013) (0.015) (0.014)
IRSAD Q2 − 0.004 − 0.004 − 0.003 − 0.004
(0.003) (0.003) (0.003) (0.003)
IRSAD Q3 − 0.014*** − 0.014*** − 0.015*** − 0.014***
(0.004) (0.004) (0.004) (0.004)
IRSAD Q4 − 0.017*** − 0.017*** − 0.018*** − 0.017***
(0.005) (0.005) (0.005) (0.005)
IRSAD highest quintile − 0.019*** − 0.019*** − 0.022*** − 0.020***
(0.007) (0.007) (0.007) (0.007)
Gini coefficient − 0.248*** − 0.243*** − 0.230*** − 0.260***
(0.044) (0.044) (0.045) (0.046)
Log no. FTB A − 0.032 − 0.028 − 0.016 − 0.029
(0.024) (0.024) (0.026) (0.024)
Log no. FTB B 0.013 0.010 − 0.003 0.009
(0.022) (0.022) (0.024) (0.022)
Log no. insurance 0.024*** 0.025*** 0.023*** 0.024***
(0.009) (0.009) (0.009) (0.009)
Log no. jobs, females − 0.017 − 0.019 − 0.015 − 0.008
(0.023) (0.023) (0.024) (0.025)
Log no. jobs, males 0.008 0.009 0.008 0.002
(0.022) (0.022) (0.023) (0.024)
Notes: Generalised linear models with a logit link are estimated. AMEs and robust standard errors are reported. Significant at ***1%, **5% and *10%. The
models with and without quadratic trends had similar results.

Appendix B

A series of sensitivity checks are performed to check the robustness of the model specification (Table B1). First, the estimation is applied to a sample
containing non-mapped SA3s (column (1)). For this specification, regional variables are not included because these SA3s with no identification codes
cannot be matched with the ABS data. Second, the estimation is limited to a sample of SA3s observed consistently for 20 quarters from January 2014 to
December 2018 to check the influence of areas with small population (column (2)). Third, the interaction between post-policy indicators, state or
territory indicators, and linear trends are included to allow for changes in trends during post-implementation period for different states and territories
(column (3)). Fourth, state or territory-level time trends are replaced with SA3-level time trends to allow time trends to vary for different SA3s (column
(4)). Fifth, a fixed effect regression is modelled to remove time-invariant unobserved heterogeneity among SA3s (column (5)). Estimations using these
specifications produce similar results.
Sixth, the coverage for MMR at two years of age is modelled using the data starting from January 2015 and April 2015 respectively, after the
coverage measure amendment in September–December 2014, to obviate the effect of definition changes (column (6)). The estimates are slightly
smaller using April 2015 and onwards. Seventh, weights derived from the synthetic control method are applied to states and territories at different age
groups to test the effect of No Jab No Play in VIC (column (7)), NSW (column (8)) and QLD (column (9)) using counterfactual controls with similar pre-
intervention characteristics. This approach allows identification of a combination of control units that most closely resembles implemented units. SA,
WA, TAS, NT and ACT without No Jab No Play in place are adopted as the donor pool for the evaluation of No Jab No Play for VIC and QLD in 2016 and
for NSW in 2018. Regional factors, age-appropriate population, and coverage rates over the pre-intervention period are used as predictor variables.
Similarly, the results show that NSW, VIC and QLD have extended policy effects at five years of age. An estimation using NT as the control unit for
tightened documentation requirements in WA and SA shows that there is no significant difference between WA or SA and NT, except that SA has larger
increases than NT for the five-year-old cohorts (results not shown).

13
 A. Li and M. Toll
Table B1
Robustness checks on effects of immunisation policies on full vaccination coverage rates.

(1) (2) (3) (4)

1 year 2 years 5 years 1 year 2 years 5 years 1 year 2 years 5 years 1 year 2 years 5 years

Post y1 vs pre NSW 0.017* 0.022*** 0.002 0.017 0.022*** 0.004 − 0.002 0.005*** 0.002 0.019* 0.022*** 0.001
(0.010) (0.003) (0.002) (0.011) (0.003) (0.003) (0.002) (0.001) (0.003) (0.011) (0.003) (0.002)
VIC 0.010 0.024*** 0.000 0.010 0.025*** 0.003 − 0.004* 0.006*** 0.002 0.013 0.024*** 0.000
(0.009) (0.003) (0.002) (0.009) (0.004) (0.003) (0.002) (0.001) (0.004) (0.010) (0.004) (0.003)
QLD 0.021** 0.030*** 0.005* 0.023** 0.032*** 0.009*** 0.002 0.007*** 0.007 0.024** 0.032*** 0.006
(0.010) (0.003) (0.003) (0.010) (0.003) (0.003) (0.003) (0.001) (0.004) (0.010) (0.003) (0.003)
SA 0.007 0.039*** 0.012** 0.005 0.042*** 0.013** − 0.008 0.015*** 0.011 0.009 0.041*** 0.012**
(0.009) (0.006) (0.005) (0.010) (0.006) (0.005) (0.006) (0.001) (0.007) (0.009) (0.006) (0.005)
WA 0.014 0.030*** − 0.003 0.014 0.029*** 0.001 − 0.008*** 0.007*** − 0.001 0.018 0.030*** − 0.003
(0.011) (0.003) (0.003) (0.012) (0.005) (0.004) (0.003) (0.002) (0.004) (0.013) (0.005) (0.004)
TAS 0.007 0.037*** 0.001 0.006 0.039*** 0.006 − 0.003 0.015*** 0.006 0.014 0.036*** 0.002
(0.012) (0.011) (0.006) (0.013) (0.007) (0.004) (0.008) (0.003) (0.005) (0.012) (0.009) (0.006)
NT 0.012 0.036*** − 0.026* 0.019* 0.042*** − 0.035*** − 0.006 0.006*** − 0.038* 0.018* 0.039*** − 0.026
(0.010) (0.010) (0.015) (0.011) (0.012) (0.012) (0.008) (0.002) (0.021) (0.010) (0.011) (0.017)
ACT 0.011 0.020*** − 0.009 0.014 0.017*** − 0.004 0.003 0.005 − 0.004 0.013 0.020*** − 0.008
(0.009) (0.006) (0.006) (0.010) (0.005) (0.007) (0.005) (0.004) (0.009) (0.009) (0.005) (0.007)
Post y2 vs pre NSW 0.024** 0.008 0.003 0.025** 0.007 0.007* 0.005* 0.003** − 0.012 0.027** 0.007 0.005
(0.011) (0.005) (0.003) (0.012) (0.005) (0.004) (0.003) (0.001) (0.008) (0.012) (0.005) (0.004)
VIC 0.012 0.013*** 0.004 0.011 0.014** 0.008* 0.007** 0.004*** − 0.032** 0.015 0.011** 0.005
(0.011) (0.005) (0.004) (0.011) (0.005) (0.004) (0.003) (0.001) (0.014) (0.012) (0.005) (0.004)
QLD 0.021* 0.027*** 0.021*** 0.024* 0.029*** 0.025*** 0.010*** 0.006*** 0.027*** 0.026** 0.028*** 0.022***
(0.012) (0.005) (0.004) (0.013) (0.006) (0.004) (0.004) (0.001) (0.005) (0.012) (0.005) (0.004)
14

SA 0.005 0.015 0.015*** 0.004 0.020** 0.019*** 0.006 0.009*** 0.012 0.008 0.015 0.016**
(0.011) (0.010) (0.006) (0.012) (0.010) (0.007) (0.004) (0.002) (0.011) (0.012) (0.010) (0.006)
WA 0.019 0.017*** − 0.006 0.021 0.018** 0.004 − 0.000 0.004** − 0.033** 0.027* 0.016** − 0.000
(0.014) (0.006) (0.005) (0.015) (0.007) (0.006) (0.005) (0.002) (0.016) (0.015) (0.007) (0.006)
TAS − 0.003 0.019 − 0.004 0.000 0.023* 0.006 − 0.012 0.014*** − 0.054** 0.007 0.017 − 0.002
(0.016) (0.013) (0.010) (0.017) (0.012) (0.009) (0.024) (0.002) (0.025) (0.016) (0.012) (0.009)
NT 0.008 0.022 − 0.028** 0.029 0.030 − 0.038** 0.007 − 0.002 − 0.089 0.022 0.025 − 0.024
(0.018) (0.018) (0.014) (0.021) (0.023) (0.019) (0.009) (0.006) (0.070) (0.018) (0.020) (0.017)
ACT − 0.006 0.025* − 0.006 0.006 0.015* 0.005 0.005 0.009 − 0.052* − 0.000 0.023* 0.001
(0.018) (0.013) (0.012) (0.017) (0.009) (0.012) (0.006) (0.006) (0.030) (0.017) (0.012) (0.012)
Post y3 vs pre NSW 0.027** − 0.005 0.007* 0.028** − 0.005 0.013*** 0.023*** 0.013*** 0.022*** 0.030** − 0.007 0.011***
(0.012) (0.009) (0.004) (0.013) (0.009) (0.004) (0.002) (0.002) (0.007) (0.013) (0.009) (0.004)
VIC − 0.002 − 0.003 0.009** − 0.004 0.001 0.015*** 0.005 0.015*** 0.020*** 0.002 − 0.004 0.012**
(0.015) (0.009) (0.004) (0.014) (0.009) (0.005) (0.007) (0.002) (0.007) (0.015) (0.009) (0.005)
QLD 0.020 0.016* 0.024*** 0.024* 0.020** 0.030*** 0.018*** 0.017*** 0.019* 0.025* 0.017** 0.028***
(0.014) (0.009) (0.005) (0.014) (0.008) (0.005) (0.005) (0.001) (0.011) (0.014) (0.008) (0.005)
SA − 0.004 − 0.008 0.021*** − 0.001 0.004 0.027*** 0.014** 0.024*** 0.013 − 0.003 − 0.005 0.024***
(0.015) (0.016) (0.008) (0.016) (0.015) (0.008) (0.006) (0.003) (0.021) (0.016) (0.016) (0.008)

Preventive Medicine 145 (2021) 106406

WA 0.024 0.004 − 0.003 0.032* 0.009 0.011 0.022*** 0.019*** 0.014 0.036** 0.008 0.007
(0.016) (0.011) (0.008) (0.017) (0.011) (0.008) (0.005) (0.002) (0.016) (0.017) (0.011) (0.008)
TAS − 0.027 − 0.024 0.002 − 0.016 − 0.011 0.009 0.008 0.021*** 0.025 − 0.013 − 0.025 0.005
(0.025) (0.024) (0.011) (0.029) (0.027) (0.008) (0.029) (0.002) (0.015) (0.025) (0.025) (0.010)
NT − 0.008 − 0.001 − 0.053* 0.033 0.016 − 0.060*** 0.020*** 0.012* − 0.227 0.014 0.006 − 0.046
(0.027) (0.027) (0.029) (0.022) (0.031) (0.019) (0.005) (0.006) (0.157) (0.024) (0.027) (0.033)
ACT − 0.017 − 0.000 − 0.018 0.007 − 0.012 0.001 0.017*** 0.010 0.024 − 0.010 − 0.002 − 0.003
(0.030) (0.025) (0.023) (0.023) (0.023) (0.019) (0.003) (0.011) (0.020) (0.027) (0.024) (0.019)
Covariates Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
A. Li and M. Toll Preventive Medicine 145 (2021) 106406

Table B1
Robustness checks on effects of immunisation policies on full vaccination coverage rates (cont.)

(5) (6) (7) (8) (9)

1 year 2 years 5 years Jan 2015- Apr 2015- 1 year 2 years 5 years 1 year 2 years 5 years 1 year 2 years 5 years

Post y1 vs pre NSW 0.022** 0.024*** 0.004* 0.032*** 0.019*** 0.020 0.025*** 0.004
(0.009) (0.003) (0.003) (0.006) (0.005) (0.014) (0.004) (0.003)
VIC 0.018* 0.025*** 0.002 0.028*** 0.017** 0.026 0.024*** 0.005
(0.010) (0.004) (0.003) (0.009) (0.008) (0.016) (0.005) (0.004)
QLD 0.027*** 0.033*** 0.007** 0.035*** 0.018** 0.012 0.032*** 0.003
(0.009) (0.003) (0.003) (0.010) (0.009) (0.014) (0.004) (0.004)
SA 0.012 0.047*** 0.013** 0.025** 0.007 0.022 0.043*** 0.017*** 0.010 0.044*** 0.014*** − 0.001 0.042*** 0.010*
(0.010) (0.006) (0.005) (0.011) (0.009) (0.015) (0.006) (0.006) (0.012) (0.006) (0.005) (0.013) (0.006) (0.006)
WA 0.019* 0.031*** − 0.002 0.034*** 0.023* 0.035* 0.032*** 0.006 0.019 0.034*** 0.001 0.003 0.028*** − 0.007
(0.010) (0.004) (0.004) (0.013) (0.013) (0.021) (0.006) (0.006) (0.017) (0.006) (0.004) (0.016) (0.006) (0.004)
TAS 0.016 0.042*** 0.003 0.032* 0.023 0.024 0.038*** 0.005 0.013 0.040*** 0.004 0.002 0.038*** − 0.000
(0.013) (0.012) (0.007) (0.018) (0.016) (0.017) (0.011) (0.006) (0.015) (0.011) (0.006) (0.015) (0.011) (0.006)
NT 0.017* 0.038*** − 0.027 0.063*** 0.066** 0.031* 0.041*** − 0.024* 0.019 0.043*** − 0.025* 0.005 0.037*** − 0.029**
(0.009) (0.012) (0.017) (0.024) (0.026) (0.016) (0.012) (0.013) (0.013) (0.014) (0.015) (0.013) (0.012) (0.012)
ACT 0.024** 0.023*** − 0.003 0.050* 0.048* 0.024* 0.022*** − 0.001 0.015 0.026*** − 0.003 0.003 0.020*** − 0.011
(0.011) (0.005) (0.007) (0.027) (0.026) (0.014) (0.007) (0.008) (0.011) (0.007) (0.008) (0.011) (0.007) (0.008)
Post y2 vs pre NSW 0.035*** 0.009 0.010 0.056*** 0.034*** 0.026 0.012* 0.008*
(0.012) (0.007) (0.006) (0.010) (0.010) (0.016) (0.007) (0.004)
VIC 0.024* 0.013* 0.006 0.048*** 0.027** 0.027 0.013* 0.011**
(0.013) (0.007) (0.006) (0.013) (0.013) (0.019) (0.007) (0.005)
QLD 0.033*** 0.030*** 0.023*** 0.059*** 0.031** 0.013 0.031*** 0.019***
(0.013) (0.007) (0.005) (0.015) (0.014) (0.016) (0.007) (0.005)
SA 0.016 0.019* 0.018** 0.031* − 0.001 0.020 0.019* 0.023*** 0.006 0.023** 0.019*** − 0.006 0.020* 0.012*
(0.013) (0.011) (0.008) (0.016) (0.014) (0.018) (0.011) (0.007) (0.015) (0.011) (0.007) (0.016) (0.011) (0.007)
WA 0.032** 0.015* 0.000 0.058*** 0.037* 0.044* 0.020** 0.009 0.027 0.025*** 0.005 0.011 0.018** − 0.006
(0.014) (0.008) (0.008) (0.018) (0.019) (0.024) (0.009) (0.007) (0.020) (0.008) (0.007) (0.019) (0.009) (0.007)
TAS 0.013 0.021* − 0.002 0.045** 0.030 0.017 0.023* 0.003 0.004 0.026** 0.000 − 0.009 0.023* − 0.006
(0.016) (0.013) (0.011) (0.021) (0.021) (0.021) (0.013) (0.010) (0.019) (0.013) (0.010) (0.019) (0.013) (0.010)
NT 0.022 0.019 − 0.025 0.090*** 0.090*** 0.028 0.034 − 0.024* 0.015 0.037 − 0.024* 0.002 0.029 − 0.030**
(0.017) (0.024) (0.016) (0.025) (0.029) (0.025) (0.022) (0.013) (0.021) (0.023) (0.014) (0.021) (0.020) (0.012)
ACT 0.016 0.028** 0.006 0.075* 0.069* 0.011 0.027* 0.008 − 0.001 0.031** 0.006 − 0.014 0.026* − 0.005
(0.019) (0.013) (0.013) (0.041) (0.038) (0.020) (0.014) (0.013) (0.019) (0.014) (0.012) (0.020) (0.014) (0.013)
Post y3 vs pre NSW 0.042*** − 0.004 0.015* 0.077*** 0.047*** 0.026 − 0.000 0.013***
(0.014) (0.010) (0.008) (0.013) (0.014) (0.017) (0.011) (0.005)
VIC 0.017 − 0.001 0.011 0.062*** 0.034** 0.014 0.001 0.018***
(0.016) (0.011) (0.008) (0.015) (0.016) (0.023) (0.012) (0.006)
QLD 0.035** 0.020* 0.029*** 0.077*** 0.041** 0.011 0.023** 0.022***
(0.015) (0.010) (0.007) (0.017) (0.017) (0.018) (0.010) (0.006)
SA 0.010 − 0.000 0.024** 0.047** 0.008 0.010 0.001 0.031*** − 0.007 0.005 0.028*** − 0.017 0.003 0.018**
(0.016) (0.016) (0.011) (0.018) (0.018) (0.021) (0.018) (0.009) (0.019) (0.016) (0.008) (0.020) (0.017) (0.009)
WA 0.044** 0.005 0.005 0.080*** 0.049** 0.052** 0.013 0.018* 0.034 0.017 0.013 0.020 0.011 − 0.001
(0.018) (0.012) (0.010) (0.022) (0.023) (0.026) (0.014) (0.009) (0.021) (0.012) (0.008) (0.021) (0.013) (0.009)
TAS 0.000 − 0.017 0.002 0.050* 0.024 − 0.005 − 0.013 0.010 − 0.022 − 0.011 0.008 − 0.035 − 0.012 − 0.001
(0.021) (0.020) (0.013) (0.029) (0.032) (0.031) (0.023) (0.010) (0.029) (0.023) (0.011) (0.031) (0.024) (0.011)
NT 0.009 − 0.005 − 0.042* 0.104*** 0.093*** 0.017 0.015 − 0.046* 0.003 0.019 − 0.046 − 0.014 0.011 − 0.058**
(0.022) (0.031) (0.023) (0.026) (0.030) (0.031) (0.029) (0.027) (0.028) (0.030) (0.028) (0.029) (0.028) (0.025)
ACT 0.012 0.007 0.004 0.073 0.057 0.001 0.006 0.006 − 0.014 0.010 0.002 − 0.024 0.006 − 0.010
(0.027) (0.023) (0.020) (0.047) (0.045) (0.030) (0.025) (0.020) (0.030) (0.025) (0.019) (0.032) (0.025) (0.020)
Covariates Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Notes: Generalised linear models with a logit link are estimated. AMEs and robust standard errors are reported. AMEs times 100% give percentage points. Significant at
***1%, **5% and *10%.

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ever prominent,—slavery must go, or it must be restricted and kept
out of the territories. The country is in great commotion; state after
state fights out its battles and wheels into line. In border states,
especially, political revolutions are taking place. The gospel of
Liberty is taking the place of the hard political doctrines of pro-
slavery Democracy. Mr. Blaine has to fire at long range, so efficiently
has the work been done at home, but it is cheering to see the
beacons lighted along the coast of Maine, and to know that the
bonfires are lighted all over the state. Men have already been trained
and gone forth to do yeoman service in other states. The Washburns
are in Illinois, Wisconsin, and Minnesota, while Israel Washburn, Jr.,
has just been elected governor of the home state.
In 1860 Mr. Blaine is elected speaker of the House, although his
colleague, William T. Johnson, of Augusta, was speaker the year
before. The singular popularity of the man is thus demonstrated, as
he takes the chair, escorted to it by his defeated competitor; his
words are few but in the best of taste. Mr. Blaine said,—
“Gentlemen of the House of Representatives:
“I accept the position you assign me with a due
appreciation, I trust, of the honor it confers and the
responsibility it imposes. In presiding over your
deliberations it shall be my faithful endeavor to administer
the parliamentary rules in such manner that the rights of
minorities shall be protected, the constitutional will of
majorities enforced, and the common weal effectively
promoted. In this labor I am sure I shall not look in vain for
your forbearance as well as your cordial co-operation. I
am ready, gentlemen, to proceed with the business of the
House.”
He is in a position of power and influence now; he is in the third
office of the state. His ability will be tested; great presence of mind,
quickness of decision, tact, and skill are needful. But he is ready and
at his ease. He has the knowledge requisite, and experience seems
born of the man. He fits wherever placed. He must know each
member, and he knows them; he must be just, and fair, and
honorable, and he is all of these by virtue of a broad, generous
nature.
Mr. Blaine is speaker of the House of Representatives of the state of
Maine, not because of any one good quality,—he is excelled in
single qualities by many another,—but because of a large
combination of good qualities, and these, cultivated to a high degree.
This it is that wins; many a face is beautiful in some one or more of
its features, but so distorted in others that the effect is bad, and
beauty, which is the harmonious blending of many lines upon the
canvas or features on the face, is lost. Character is the restoration of
moral order in the individual; let this be broken by some defect,
omission, or failure, some secret or overt act, and the harmony is
lost, and a once fair character is marred.
Thus it is not so much the symmetry as the large and splendid
combination of talents and genius which make him what he is. He
simply does his best, and keeps himself at his best all the time. He
anticipates every occasion, and has forces in reserve all the time,
and they are brought forward, if his tactics are not known, very
unexpectedly. The most telling points in all his earlier speeches are
not brought out at first, and when they do appear you wonder why he
did not produce them before, and this very wonder increases its
power on you. This is rather a necessity, it would seem, because
there is point and pith, and power all through.
A great year of destiny is before the nation; a mighty, conquering
battle-year. Slavery refuses any concessions, and Liberty loves itself
too well to be compromised. The great convention of Republicans in
the old wigwam in Chicago is an event of so great importance that all
minor events dwindle before it. James G. Blaine is there.
Excitement is at the highest pitch. The tone and temper of the North
is felt and feared. The old Democratic party is shattered into
fragments. It has several wings, but no body. The Union seems on
the verge of dissolution. But strong men, tried and true, who cannot
be brow-beaten and crushed; men who have not been deceived or
intimidated, or despoiled of their convictions since the Whig party
sold out to Slavery in 1852; men who have waited eighteen long,
eventful years for the iron to get hot enough to strike, are there; there
in their power; there, not to become demoralized, and drop their
guns and run, but to stand firm and strong in a mighty phalanx, and
do tremendous battle for tremendous right against tremendous
wrong.
William H. Seward is the choice of men, but Abraham Lincoln is the
choice of God. He has been fitting and training him for half a century,
much as he trained Moses, the great leader and emancipator of his
ancient people. They try in vain to elect their man. The way is
hedged up; ballot after ballot is taken, but it cannot be done. Finally,
the moment comes, and “honest old Abe” is crowned by the hand of
a remarkable Providence, and God’s will is done.
Men shake their heads, but high yonder on his throne the King does
his thinking. All is clear to him. Well-nigh a century of prayer is to be
answered.
Mr. Blaine’s description of the sessions and impressions at Chicago,
make the great, inspiring scenes live before the imagination, and
show how his broad, eager mind took it all in.
Ten of the Maine delegation were for Seward, and six for Lincoln. A
meeting was called, and an effort made by the Seward men to win
the Lincoln delegates to their side. Wm. H. Evarts was then in his
prime, and was called in to make the speech. He spoke for forty-five
minutes, and his speech, it was said, was “a string of pearls.” Mr.
Blaine stood just behind him, and though greatly delighted with the
beauty and brilliancy of the address, remained a firm Lincoln man to
the end.
He had no vote then, but he had a voice and a pen. From that time
he was a great admirer and friend of Mr. Evarts. This convention
greatly enlarged Mr. Blaine’s knowledge of men and acquaintance
with them.
The party in the four years since Frémont and Dayton had been
nominated at Philadelphia, under the goading provocations of
Buchanan’s administration, the frequent exhibition of the horns and
hoofs of Slavery, and the unwearied agitation in congress, and in
every state, county, and town of the North, the East, and the West,
had made a sturdy, constant, determined growth, a development of
back-bone, and a kindling of nerve that imparted courage and sent
joy to the heart.
It brought into the life of Mr. Blaine, more than ever, the life and
grandeur, the power and greatness of the party to which he had
wedded his destiny, giving his hand and his heart. He was in
complete sympathy with every principle and every measure. No man
living more fully, and clearly, and strongly, represents the ideas and
purposes of the men then at the front,—the leading men to whom
was entrusted the guidance and responsibility, for he himself was
then at the front,—than does he.
He is, and has been, right through, the defender and conservator of
all that was dear, and precious, and grand, then. Few men did more
to help elect Mr. Lincoln, or to make his administration a power in the
North. He was under fire constantly, but then he was firing constantly
himself, and doing execution that told every hour for the nation’s
good.
The North was surely aroused as never before, on fire with a great
and mighty excitement that rolled in waves and billows from ocean to
lake, and lake to gulf. There was no general on the side of Slavery
that could command all the forces. It had come to be in fact a house
divided against itself. Their convention at Charleston was broken up,
and Mr. Douglas nominated at Baltimore, and two other candidates,
Breckenridge and Bell, elsewhere. The serpent seemed stinging
itself to death. But in the great party of the North there is a solid
front, no waver along the entire line. They simply fight their great
political battle after the true American style of the Fathers, in a most
just and righteous manner, and for a cause most just and righteous.
Mr. Blaine was on the stump, as he had been the year before,
making speeches that the people loved to hear. The campaign
usually closed in Maine in September, when the state officers were
elected, and as the convention in Chicago was held in May, they had
but three months to do the work that other states did in five months.
Owing to the illness of his old friend and business partner, he edited
the Kennebec Journal for five or six months during the summer and
autumn of 1860, so that he was back upon his old ground during the
great campaign, sitting at the same desk.
The people loved him, and he loved them. “Send us Blaine,” would
come from all over the state. “We must have him, we will have him.”
And he would go. It seemed as if he would go farther, do more, and
get back quicker than any other man, and seemingly remember
everybody.
Ex-Gov. Anson P. Morrill, his old political friend and neighbor says, “I
would go out and address perhaps an acre of people, and be
introduced to a lot of them, and like enough, in six months or a year,
along would come a man and say, ‘How are you? Don’t you know
me?’ and I would say ‘No,’ and then the man would turn and go off;
but Blaine would know him as soon as he saw him coming, and say,
‘Hello,’ and call him by name right off.
“There,” he said, and he laid his gold-bowed spectacles on the table,
and continued, “a little better than a year ago he was in here, and we
sat at this table, and the spectacles laid there, and he took them up
and said, as he looked at them closely, ‘If those are not the very
same gold-bowed spectacles you bought in Philadelphia in 1856.’
“‘Why, how do you know?’ I asked in surprise.
“‘Why I was with you, and you bought them at such a place on such
a street.’
“And that,” said the governor, “was twenty-six years before. Now did
you ever hear of anything like that? I didn’t. Why, I’d even forgotten
that he was there. I tell you that beat me; and I asked him ‘what
made you think of it now?’
“‘O, I don’t know,’ said Mr. Blaine, ‘I just happened to see them lying
there, and thought of it.’
“Well, it must be a good thing for you to remember things that way.”
“And he simply replied, without any boasting, or in a way to make his
honored friend feel that he felt his superior faculty in the least,—
“‘O, yes, it is, at times.’”
Gov. A. P. Morrill is a fine sample of a real down-east Yankee, of the
old style; a man of sterling worth and integrity, and of the hardest of
common sense, and takes a special pride in Mr. Blaine, as he was at
one time of great assistance to him in a political way.
“The first time I saw Blaine,” he said, “was the night before my
inauguration; he called at my hotel and wanted a copy of my
address. He was simply a young man then, very pleasant in his
manner. But how he has grown. Yes, that is the secret of it; he has
been a growing man ever since, and so he has come right up and
gone right along.”
His own re-election to the legislature is a minor matter in the
campaign of ’60, in comparison with the election of Mr. Lincoln
president. As this state votes earlier than many of the others, the
effort is to roll up a large majority, and have great gains, so as to
carry moral power with it, and thus encourage other states who are
standing with them in the contest.
It is interesting to note the position of parties or presidential
candidates at this time. Mr. Lincoln would prohibit by law the
extension of slavery. This was exactly the position of the candidate
with him for vice-president, the Hon. Hannibal Hamlin, a strong friend
of Mr. Blaine.
Mr. Hamlin had originally been a Democrat of the Andrew Jackson
type, but when the Missouri Compromise, which prohibited the
extension of slavery, was repealed, he entered the Republican party
at its formation, and as candidate for governor in Maine in 1856, was
a powerful factor in breaking down the Democratic party.
Mr. Breckenridge would extend slavery by law, and was of course
the slave-holders candidate. Douglas, the candidate of the Northern
Democrats, would not interfere; simply do nothing to procure for
slavery other portions of the fair domain of Liberty to despoil. This, of
course made him unpopular in the South, where the demand was for
more states to conquer for our “peculiar institution.” The cry of the
Douglas Democrats,—and they counted their wide-awakes by the
thousand, who marched with torch and drum,—“The Constitution as
it is, and the Union as it was.” The Bell and Everett faction were
simply for saving the Union without telling how.
What a field these four great armies, each with its chosen leader,
occupied, and each conducting a hot, fierce campaign, determined
to win, and determined to believe they would win. Slavery was the
great disturbing element. It was all a question of how to deal with this
monster.
Mr. Lincoln was elected, and Blaine was again on the winning side.
But Mr. Blaine had another great interest in the political campaign of
this year. A Mr. Morse, of Bath, had been in congress from another
part of the third Maine district, in which Augusta is located, and it was
thought time for a change, and Gov. A. P. Morrill wanted Blaine to
run, but Morse was a strong man and Blaine was young, and a new
man comparatively, and though he was speaker of the House of
Representatives, he thought it not prudent at that time to subject
himself to such a test. “Fools rush in where Angels fear to tread.”
Mr. Blaine was in a good position, and growing rapidly, and so he
urged the strong and sagacious governor to try it himself, and Blaine
went into the campaign and helped achieve the victory,—for victory it
was by seven thousand majority.
Mr. Blaine, it would seem, who possessed an instinct for journalism
so wonderful and fine, possessed one equally well-developed for
politics. He well-knew that his rapid promotion would awaken
jealousies, prejudice, and envy, and also that he needed and must
have time to grow. There was one at least in the state legislature
who had been in congress, and he did not wish to “advance
backward,” as the colored servant of the rebel General Buckner
called it.
Mr. Blaine is a man of caution and carefulness, because he is a man
of great thoughtfulness and deliberation. When he has thought a
subject through, and it is settled, and he feels just right, he is ready,
and his courage rises, and so he moves with great power and
determination. If the action seems rash to any, it is because they are
not informed upon a subject upon which he is conversant.
Mr. Blaine had seen his man nominated at Chicago, and
triumphantly elected over a stupendous, well-organized, and
desperate opposition. He himself is returned to the legislature. His
friend, Ex-Gov. A. P. Morrill, is secured for congress, and Israel
Washburn, Jr., a grand Republican, elected governor over the man
who felt and learned to fear the power of Mr. Blaine in the legislature
the year before, Ephraim K. Smart. But, notwithstanding all of these
triumphs, and the prospective cleansing and regeneration of the
country, the present condition is most appalling.
Secession is the chief topic throughout the South, and in every
debating society in every college, and in every lyceum in every town
or city, the question is being discussed with the greatest warmth,
“Can a Southern state secede?” or “Can the government coerce a
state?” The old doctrine of state rights and state sovereignty is the
form of the topic in other quarters.
With many the question was clear on the asking of it; with others the
constitutional powers of self-preservation, of self-existence, and self-
perpetuation had to be presented with the arguments and the
acumen of a statesman. Perhaps Mr. Blaine, as an editor, never
dealt with a question in a more masterly way. It was the question of
the hour continually forcing itself upon attention.
It was the constant assertion of the Southern press that they would.
They believed all sorts of unkind things about the great and kindly
Lincoln. The fact is, the South had never before been defeated in a
contest for the presidency when slavery was involved in the issue.
This was their pet and idol. They would guard it at all hazards.
Fanaticism they regarded as the animus of the anti-slavery
movement, and an abolitionist to them was a malefactor.
A grave responsibility now was on those who “broke down the
adjustments of 1820, and of 1850.” But the year was closing, and the
glare of a contest more fierce than that through which we had
passed, was on the nation. It seemed inevitable. They had grown so
narrow, intolerant, and cruel, that the light of present political truth
did not penetrate them.
“Southern statesmen of the highest rank,” said Mr. Blaine, “looked
upon British emancipation in the West Indies as designedly hostile to
the prosperity and safety of their own section, and as a plot for the
ultimate destruction of the Republic.” They were suspicious, and
filled with alarm; and it was needless, as the action of Mr. Lincoln in
proclaiming emancipation was only when, in the second year of the
war, it was necessary.
The era of peace seems breaking with the hand of cruel war. It was
night to them, but a glorious day to us.
We close this chapter with this fresh, new poem of the time, by
Whittier.
At a time when it was rumored that armed men were drilling by the
thousands in Virginia and Maryland, for the invasion of Washington
before February, so as to prevent the announcement in congress of
Lincoln’s election, in the same issue of the Kennebec Journal, was a
poem by John G. Whittier, closing with these lines:—

“The crisis presses on us; face to face with us it stands,

With solemn lips of question, like the sphinx in Egypt’s
sands!
This day we fashion Destiny, our web of Fate we spin;
This day for all hereafter choose we holiness or sin;
Even now from starry Gerizim, or Ebal’s cloudy crown,
We call the dews of blessing, or the bolts of cursing down.

“By all for which the Martyrs bore their agony and shame;
By all the warning words of truth with which the prophets
came;
By the future which awaits us; by all the hopes which cast
Their faint and trembling beams across the blackness of the
Past;
And in the awful name of Him who for earth’s freedom died;
Oh, ye people! Oh, my brothers! let us choose the righteous
side.

“So shall the Northern pioneer go joyful on his way,

To wed Penobscot’s waters to San Francisco’s bay;
To make the rugged places smooth, and sow the vales of
grain,
And bear, with Liberty and Law, the Bible in his train;
The mighty West shall bless the earth, and sea shall answer
sea,
A mountain unto mountain calls, ‘Praise God, for we are
free!’”
 VIII.
SPEAKER OF THE MAINE LEGISLATURE.

O one read the signs of the times with a clearer

understanding of their significance, all through the winter
and spring of 1861, than the Speaker of the House of
Representatives in the Legislature of Maine. The great
duties that devolved upon him filled his mind with every important
matter, but the overshadowing interests were all national,—the
present and future of the country. They had become accustomed to
threats and fears; this had grown to be the normal condition of the
public mind. But the short, sharp question “What is the latest from
Charleston, Richmond” and other points of prominence and activity
in the South, showed how squarely up to the times people of the
North were living; how loyal and zealous for the nation the masses
were.
It was a higher compliment, in times so great in their demands for
the profoundest deliberations of the best minds, to be put at the
head, as the leader in positions of greatest power in the House.
Known and acknowledged worth could have been the only argument
for an action so personal to the honor of the state and its power in
the Union, and helpfulness to the nation in an emergency imminent
with danger.
This man of one and thirty is lifted over the heads of old and
respected citizens of soundest integrity. Is it an experiment, or do
they know their man? The state has called to the helm a man who
has been ten years in the congress of the United States; a man of
largest experience and profoundest wisdom, nearly twice the age of
the young speaker. But no mistake is made. He read in his youth
books that Governor Morrill is reading to-day at the age of eighty-
one; he has been a college-graduate for nearly fourteen years, and
has won his present distinction upon the floor of the house where he
now presides.
His duties are manifold. He must preside over the deliberations of
the House, be a good parliamentarian, prompt and accurate in his
decisions, as well as fair and impartial. He is dealing with freemen
and citizens, and representatives of the people of the entire state. He
must know every member, not by name, and face, and location in the
House, but in characteristics and accomplishments, all the great
interests of the state, as a whole, of its different sections, and in its
Federal relations, so that he may wisely appoint the twenty-one
important committees. He must know the business, education,
experience, residence, and political principles of every member, so
that he may know just who to appoint on banks and banking, on
agriculture, military, pensions, manufactures, library, the judiciary, the
militia, education, etc.
There are one hundred and forty-four members, twenty-three of
whom are Democrats, and he must use them all. He must select two
chairmen for each committee, and choose six or eight others to act
with them, putting some of the more valuable men on several
committees,—all must be treated with honor and fairness.
What did those one hundred and forty-four men see in James G.
Blaine, away back in the stormy, perilous times of 1861, that led
them to select him for that high and honorable position? He had not
been a citizen of Maine six years, and had been in political life,
officially, only two years. It was the man they saw, strong and
splendid, just the man for the hour. They felt, instinctively, they could
trust him; they knew him to be loyal and true, and capable, by the
testimony of all their senses. He was quick and keen, and life itself in
all of energy and endeavor; a born leader of men.
He had no wealthy and influential friend by his side, no one to say I
have known him from childhood, and can recommend him as worthy
of all honor, and all praise. He brought with him simply the name his
mother gave him, with no prefix and no affix. He lived in no mansion,
rode in no carriage, was attended by no courtiers in livery; he had no
returns to make, no promises to give. The whole of him sat before
them,—a refined and courteous gentleman, an elegant gentleman.
They could not mistake the powerful combination. They saw and felt
its worth, and so the great party which had just come into power in
the nation by electing its first president, honors itself by honoring
him.
His short-cut words of acceptance are uttered. The senate and the
new governor, Israel Washburn, Jr., are informed that the House is
organized, and they proceed to business with energy and despatch.
But the great war for the Union is coming. The peace convention
called by Virginia amounts to nothing. Mr. Crittenden’s resolutions
are futile, though most conventions adopt them in Philadelphia and
elsewhere. Southern states are actually seceding.
Mr. Lincoln is choosing and announcing his cabinet, with Seward as
his Premier, but treason is rampant in the South, holding high
carnival in state capitals, and even in the halls of congress. Mr.
Lincoln is on his way to Washington. He reaches Philadelphia on
Feb. 22d, at seven o’clock; is escorted to Independence Hall, where
Theodore Cuyler, in whose office Mr. Blaine read law, receives him
with an address of welcome, to which Mr. Lincoln replied, and “raised
the national flag which had been adjusted in true man-of-war style,
amid the cheers of a great multitude, and the cheers were repeated
until men were hoarse.”
While these patriotic cheers were resounding through the old halls of
Independence, the traitorous secretaries of the navy and of war were
sending vessels to southern ports and forts. Thirty-three officers,
among whom was Albert Sidney Johnson, abandon their regiments
of the regular army in Texas, and join the rebels. But Lincoln is
inaugurated, and the most pacific measures employed, but all of no
avail; determined, desperate men are ruling the destiny of the South.
The South was in no condition of want at this time, but rather in a
condition of prosperity, and its proud, haughty spirit seemed rather
born of luxury and extravagance.
Mr. Blaine has shown that she had increased in ten years before the
war three thousand millions of dollars, and this not from over-
valuation of slaves, but from cultivation of the land by new and
valuable appliances of agriculture. One state alone,—Georgia,—had
increased in wealth three hundred millions of dollars. But South
Carolina had commenced in October,—before Mr. Lincoln’s election
even,—her correspondence upon the subject of secession. No
wonder she was ready in the April following to inaugurate the war of
the Rebellion.
Mr. Blaine’s life could not be put into the nation, nor the life of any
strong, true man, at a time when it would be more valuable than now.
Men were men in earnest. They rose to par, and some, by a
mathematical process which redoubles energy and intensifies life,
are cubed or squared or lifted to the hundredth power; a premium is
on them; they are invaluable.
The governor issues his call for ten thousand men from Maine. Will
Mr. Blaine go? Mr. Garfield is in the state senate of Ohio, and
president of a college, but he drops all at once, and is soon at the
front with his regiment. His stay is short, however. Elected to
congress, by advice of President Lincoln he lays aside the dress of a
major-general on Saturday to enter the national House of
Representatives, a congressman in citizen’s dress, the following
Monday.
What will Mr. Blaine do? He is speaker of the House, and that gives
his name a power in the state. He is wielding a powerful pen as
editor of the leading daily paper at Portland. Few men in the state
have more influence; some must stay; the state must be aroused
and electrified; an immense work of organization is to be done. It is a
less conspicuous, more quiet home-work, but it is of the utmost
importance.
He stays, while many, like Garfield, go to return to do the
statesman’s work and make available the resources of the nation,
and strengthen the hands of the brave men at the front.
This was a work of vast importance in the conduct of the war. It was
power that was felt by both governor and president, by army and
navy. Mr. Blaine was on terms of intimacy with the governor of his
state,—a firm supporter of a faithful man. Very soon he was
instrumental in raising two regiments, and rallied thousands more to
the standard of the Union.
He became at this time chairman of the Republican State Central
Committee, and continued in this position for twenty years. He
planned every campaign, selected the speakers, fixed dates and
places for them, and so arranged all details, that no man of his ever
disappointed an audience. He knows the time of departure and
arrival of every train. He must do his part to see that the legislature
continues Republican, that the governor and his council are
Republican, that congressmen and senators of the United States are
Republican, and that the war-power of the state is not broken.
The great question for him to aid largely in settling is the worth of the
state of Maine to the nation. She must have governors that are in full
sympathy with the president; congressmen and senators that uphold
his administration.
In North’s History of Augusta, a valuable work of nearly a thousand
pages, it is recorded of Mr. Blaine that “probably no man in Maine
exerted a more powerful influence on the patriotic course pursued
than he. Ever active, always watchful, never faltering, he inspired
confidence in the cause of the Union in its darkest days.”
At the close of the first session of the legislature over which Mr.
Blaine presided, the leading Democrat in the House, a Mr. Gould,
from Thomaston, arose after remarks of great pathos and
tenderness, and presented this resolution:—
“Resolved, That the thanks of this House are presented to
the Hon. James G. Blaine, for the marked ability, the
urbanity and impartiality with which he has presided over
its deliberations, and for the uniform amenity of his
personal intercourse with its members.”
He bore testimony to the “marvelous despatch with which the formal
parts of the business had been done, and so the session greatly
shortened.”
The resolution was adopted by a unanimous vote, and Mr. Blaine
said,—
“Gentlemen of the House of Representatives:
“You will accept my most grateful acknowledgments for
the very cordial manner in which you have signified your
approbation of my course as your presiding officer. I beg in
return to witness to the dignity, the diligence, and the
ability with which you have severally discharged your
representative trusts. We met, many of us, as strangers;
may I not hope that we all part as friends, and parting,
may we bear to our homes the recollection of duties
faithfully performed, and the consciousness of having
done something to promote the prosperity and welfare of
our honored state. I bid you farewell.”
This was on the 18th of March, and on the 22d of April, the war
having broken out, they were assembled again in extra session, Mr.
Blaine in the chair. In three days and a half provisions were made for
raising troops and money for the war, and legislation pertaining to
militia-laws was enacted, etc. The wildest rumors filled the air. The
country seemed transformed at once into a turbulent sea, but men
did not lose their reckoning. Latitude and longitude were things too
deeply fixed and broadly marked to be unseen or ignored. The storm
blew from a single quarter. Its long gathering had made it black and
fierce. It struck the gallant ship of state. She was reeling with the
shock of war.
Never did the beauty and worth of federal states appear to better
advantage than when the impoverished and plundered government
called on them for aid. It was the parent’s call upon her children for
defence against their own misguided sisters. Never was mechanism
more finely adjusted, or power more equally balanced, than in the
Republic. Very distinct and separate are head and feet and hands,
eyes and ears, yet nothing is more perfect in its unity.
It is much the same with the great union of states. They are
separated far, and quite distinct in varied interests, but one in
powerful unity. But the time had come to show the strength of that
unity. All there was of the great mind and heart and life of Mr. Blaine
was given to the nation in holiest exercise of all his powers.
While eighty thousand of the foe are opposing thirty-five thousand of
our troops at Manassas Junction, and Colonel Ellsworth is losing his
life at Alexandria; while Stephen A. Douglas is delivering in early
June his last eloquent words, straight and heroic for the nation; while
the bankers of Boston, New York, and Philadelphia are casting one
hundred and fifty millions of dollars into the national treasury at
Washington, and the brave General Lyon with eight thousand men is
routing twenty-three thousand of the enemy in Missouri, at the cost
of his life,—while all the activities of that first summer of war are
going on, Mr. Blaine is facing a political storm of great severity, as
general-in-chief in the campaign that places Israel Washburn, Jr.,
again in the gubernatorial chair of the state, and keeps the reins of
government in Republican hands.
It has been a question often debated whether the nation is most
indebted to her warriors or her statesmen. There can be no
hesitation in deciding, where the mere question of life is considered,
or the hardships of camp and march and field are included in the
account. And yet Lincoln, nor Garfield wore a uniform when the
bullet struck.
No one thinks their patriotism less intense, or that of cabinet, or
senators and members of the house, or governors and council, or
members of legislatures less ardent in their love of country, and zeal
for the honor of her imperilled cause. At such times all true hearts
are one, and the blood that throbs in hands and heart and feet is all
the same.
Mr. Blaine was re-elected to his accustomed place in the legislature
of the state. The terrific war rages on. The demand for troops
increases,—is indeed quadrupled,—and the state must be brought
up to her quota by methods the wisest and best. And again and
again the clarion voice of the speaker of the House rings over the
state with no uncertain sound. Companies and regiments are
formed, and these must be filled. The fires burning so brightly, must
burn brighter. Intense love must be intensified. The news of terrible
battles thrills over the state almost daily. The romance of war is over.
Its gilt edge is gone. It is hard, desperate, bloody work. Their sons
and brothers and fathers are falling by the score and hundred at the
front. The bloody work has been done at Ball’s Bluff and Port Royal.
Sons of Maine are in Libby Prison and at Belle Isle.
The hard, serious question is discussed in every home. It fills the
dreams of yeomanry,—“Shall I go?” “Can I go?” All that is sacred in
business and religion in home and country is the question. Men are
lifted by appeals almost divine in eloquence, above any petty
consideration, to the grave question of the nation’s life and destiny.
Their names go down by scores and hundreds. Regiments and
brigades seem born in a day. They come from all ranks and
conditions,—from pulpit and press, from farm and shop, from bank
and office, and store and halls of state,—and are transformed in an
hour from citizens to soldiers, and march away to the front. Steamer
and car swarm with them.
The music dies away down the river, and they are gone,—gone
perhaps forever. Good-byes are cherished in heart of hearts, and
kisses from mother, father, lover, friend, are carried away like
cameos of thought, the sacred things of memory.
In the autumn we find Mr. Blaine in Washington, probably for the first
time, but not in official relations to the government. He must have a
nearer view of the great scenes being enacted. He must know the
men who are wielding the nation’s power, and put his finger on the
pulse of war, and gather material for the more intense activity his
work at home assumes. He must see the great-hearted Lincoln, and
shake his hand, and give him cheer.
Fessenden, Hamlin, and Morrill are there, for congress is in session
in a city fortified, and its streets patrolled by soldiers. Andrew
Johnson is the only senator present from eleven seceded states.
Breckenridge, mortified by the vote of his state, and the rebuke and
the castigation the dead Douglas had given him in the early spring,
was present from Kentucky; and Lane and Pomeroy were in their
seats from the new, free state of Kansas, as her first senators. And
the two Union senators were there,—Messrs. Willy and Carlisle,—
from the western portion of seceded Virginia. Only five free states
had other than Republican senators. Bright, Breckenridge, and Polk
were expelled.
Chase, and Cameron, and Seward had entered the cabinet, but an
impressive array of talent remained in the senate, to be studied by
our rising young statesman to best advantage. Charles Sumner and
Henry Wilson were there from Massachusetts; Zachariah Chandler,
and Bingham, of Michigan; Wilkinson of Minnesota; John P. Hale and
Daniel Clark, of New Hampshire; Benjamin F. Wade and John
Sherman, of Ohio; Wilmot and Cowan, of Pennsylvania; James R.
Doolittle and Timothy O. Hone, of Wisconsin. Jacob Collamore,
formerly in General Taylor’s cabinet, a ripe, scholarly man, was a
senator from Vermont, and Simmons and Anthony, from Rhode
Island.
On his first visit to the National Capital, Mr. Blaine could not fail to
visit the House where he himself was destined to have a career so
famous and honorable alike to himself, his state, and the nation.
There was his friend, Anson P. Morrill, who had desired him to take
the nomination to congress the present session, rather than himself,
and Galusha A. Grow, from his native state, a member of the
convention which has just nominated him for the presidency, and of
the committee notifying of the same, was then in the chair to be
reserved for him as speaker of that house. Thaddeus Stevens,
fearless, able, of intrepid spirit and strong character, the best hater of
slavery on the continent, hating even those who did not hate it, was
the natural leader of the House, assuming his place by common
consent. He attracted Mr. Blaine’s special attention.
John Hickman and Edward McPherson were with him from
Pennsylvania; and from New York there were Reuben E. Fenton,
experienced and strong in public affairs, Elbridge G. Spaulding, the
financier, William A. Wheeler, since vice-president, secretary
Seward’s friend and confidant, Theodore Pomeroy.
“The ablest and most brilliant man of the delegation,” says Mr.
Blaine, “was Roscoe Conkling. He had been elected to the preceding
congress when but twenty-nine years of age, and had exhibited a
readiness and elegance in debate that placed him at once in the
front rank. His command of language was remarkable. In affluent
and exhuberant diction Mr. Conkling was never surpassed in either
branch of congress, unless, perhaps, by Rufus Choate.”
Massachusetts had a strong delegation, headed by Henry L. Dawes,
and with him were A. H. Rice, since governor of the state, Elliott,
Alley, and William Appleton. Missouri sent Blair and Rollins, from the
battle-field. Crittenden, who had been six times elected to the
senate, in two cabinets, appointed to the supreme bench, was then
in the house, seeking with Charles A. Wickliffe, to save Kentucky to
the Union, against the treasonable conspiracies of Breckenridge.
With Crittenden and Wickliffe strong for the Union, were Robert
Mallory, James S. Jackson, and William H. Wadsworth, keeping up
the almost even balance of power in their state. Gilman Marston was
there from New Hampshire, soon to become conspicuous in the
field. Justin S. Morrill from Vermont, Frederick A. Pike, and the
brother of senator Fessenden from Maine, in company with Ex-Gov.
Anson P. Morrill. Illinois, Ohio, and Indiana had strong men there
also, as did Iowa and Minnesota.
Elihu B. Washburn, Owen Lovejoy, William A. Richardson, and John
A. Logan, represented the state of Lincoln and Grant; Schuyler
Colfax, George W. Julian, Albert G. Porter, Wm. McKee Dunn, and
Daniel W. Voorhees, were there from Indiana; and from the state of
Garfield, Bingham, Shellabarger, Horton, and Ashley. Pendleton,
Vallandigham, and S. S. Cox were on the Democratic side.
It must have been the dawn of an era of new inspirations and of
fresh aspirations, to look in upon such a body of men, only a few of
the leaders of whom we have mentioned.
Anson P. Morrill had written him, six months before he let anyone
else into the secret, that he should not run again for congress. His
business required his attention, having extensive woolen mills some