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标题：Another Look at the Human Papillomavirus Vaccine Experience in Canada
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作者：Catherine L. Mah ; Raisa B. Deber ; Astrid Guttmann 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：10
页码：1850-1857
DOI：10.2105/AJPH.2011.300205
语种：English
出版社：American Public Health Association
摘要：Policy debates about immunization frequently focus on classic trade-offs between individual versus collective well-being. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal—rather than a public—matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse. ONE OF THE TRIUMPHS OF public health has been the ability to prevent communicable diseases with a corresponding impact on population health through immunization.^{1 , 2} This success has led to many governments enacting policies for the public administration, public financing, and sometimes, public delivery of immunization programs to ensure that necessary vaccines are made available.² Collective action is usually justified on the basis of the phenomenon of herd immunity, which can halt person-to-person disease transmission via attainment of a threshold proportion of immune persons in a community.³ Yet, immunization is also a highly personal matter. A biological pharmaceutical agent (the vaccine) is administered to an individual, who makes a choice to assume the vaccine's benefits as well as any potential risks, and the overall benefit of herd immunity is threatened without sufficient buy-in by individual participants. Mandatory immunization, which is usually established on the grounds of herd immunity, further heightens the tension between the individual and the collective: through regulation, governing authorities compel individuals to take on personal risk, as a current investment for their own and for others’ future benefit. We examined the state of public good arguments in immunization policy processes through a qualitative analysis of the Canadian experience with the world's first vaccine against human papillomavirus (HPV), Merck's Gardasil. We demonstrate how arguments for the public health benefits of collective immunization programs can dissipate in the presence of policy framing that emphasizes the personal, rather than the public, dimensions of immunization.