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From Informed Consent to Informed Compliance: Population health

From Informed Consent to Informed Compliance: Population health. Kevin Dew. Immunisation and informed consent. Issues Science and advocacy Public health as a moral authority Rationality and Irrationality Public health perceptions and public perceptions Institutional arrangements

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From Informed Consent to Informed Compliance: Population health

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  1. From Informed Consent to Informed Compliance:Population health Kevin Dew

  2. Immunisation and informed consent • Issues • Science and advocacy • Public health as a moral authority • Rationality and Irrationality • Public health perceptions and public perceptions • Institutional arrangements there is no well-developed set of ethical principles or a framework that informs decision-making of doctors working in public health

  3. Vaccination resistance and rationality • Compulsory vaccination

  4. Vaccination resistance and rationality • Vaccine critical groups • Hobson-West, P. (2007) 'Trusting blindly can be the biggest risk of all': organised resistance to childhood vaccination in the UK, Sociology of Health & Illness, 29, 2, 198-215

  5. Reason and advocacy • One can enter an argument prepared to be moved by reasoning or “the force of the better argument” (Habermas)

  6. Alternative public health • Utilitarian • Risk averse • Realistic hedonism • Purism • Holism • Dew. K, and Carroll, P. Public Health and CAM perspectives: An exploration of overlap, contrast and dissonance. In Researching Complementary and Alternative Medicine, J. Adams, ed. Abingdon and New York, Routledge (2007) 117-132.

  7. Immunisation and science • 1984/5 measles epidemic • 1997 measles epidemic • We estimate that 45,000 New Zealand children will be hit by the Measles epidemic this year. Of these, four thousand will have ear infections, pneumonia or diarrhoea. Approximately nine hundred will be hospitalized. Thirty will suffer brain inflammation. Up to nine will be left with permanent brain damage. At least four will die. You have a choice. Talk to your doctor about free immunisation and remove the risk of Measles forever. Or pray your child doesn’t join the dots. Measles. It’s not a pretty picture.

  8. Immunisation and academic freedom • Meningococcal meningitis campaign 2004 • Academic Freedom Dew, K. Academic freedom and its limits. In Challenging Science: Issues for New Zealand Society in the 21st Century. K. Dew and R. Fitzgerald eds. Palmerston North, Dunmore Press (2004) 187-204. • Politics or Science?

  9. Informed consent and public health Lag between health officials and the public • Typhoid vaccination • Polio virus and SV40 • Meningococcal meningitis A 1987 Day, Alison (2008) Child immunization: reactions and responses to New Zealand government policy 1920-1990. PhD thesis (history), University of Auckland.

  10. Some conclusions • To be informed is to be highly educated and resourced • Vaccination campaigns are about politics, paradigms, values and advocacy • Public need to have more involvement • At a policy level, not just an individual level

  11. Immunisation Technical Forum • changes to the immunisation schedule • changes to the immunisation handbook • Advise on the use of vaccines Expertise • Paediatrics • Delivery of services (primary care providers) • Microbiology • Adult infectious diseases • Maori perspective

  12. New institutions? • Advise on vaccination schedule • Determine responsibility for informed consent • Have oversight of programme delivery • Assess publicly funded vaccination programmes

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