From Informed Consent to Informed Compliance: Population health

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From Informed Consent to Informed
CompliancePopulation health

• Kevin Dew

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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

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Vaccination resistance and rationality

• Compulsory vaccination

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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

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Reason and advocacy

• One can enter an argument prepared to be moved by
  reasoning or the force of the better argument
  (Habermas)

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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.

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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 doesnt join the
  dots. Measles. Its not a pretty picture.

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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?

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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.

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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

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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

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New institutions?

• Advise on vaccination schedule
• Determine responsibility for informed consent
• Have oversight of programme delivery
• Assess publicly funded vaccination programmes