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Canadian Journal of Public Health

, Volume 99, Issue 3, pp 192–194 | Cite as

What’s Public? What’s Private?

Policy Trade-offs and the Debate Over Mandatory Annual Influenza Vaccination for Health Care Workers
  • Catherine L. MahEmail author
Commentary

Abstract

Policy decisions about public health services differ from those for personal health services. Both require trade-offs between such policy goals as liberty, security, efficiency, and equity. In public health, however, decisions about who will approve, pay for, and deliver services are often accompanied by decisions on when and how to compel individual behaviour. Policy becomes complex because different stakeholders interpret evidence differently: stakeholders may assign different weights to policy goals and may even define the same goals differently. In the debate over mandatory annual influenza vaccination for health care workers, for example, proponents as well as opponents of mandatory vaccination may convey arguments in security terms. Those in favour of mandatory vaccination emphasize subclinical infections and duty of care (public security) while those opposed emphasize risk of adverse events (personal security). Proponents assert less worker absenteeism (efficiency) while opponents stress coercion and alternate personal infection control measures (liberty and individual rights/responsibilities). Consequently, stakeholders talk past each other. Determining the place of mandatory influenza vaccination for health care workers thus demands reconciling policy trade-offs and clarifying the underlying disputes hidden in the language of the policy debate.

Key words

Public policy health personnel legislation immunization public health practice 

Résumé

Les décisions concernant l’orientation des services de santé publique diffèrent de celles qui portent sur les services de santé individuelle. Les deux nécessitent des compromis entre les objectifs visés, que ce soit la liberté, la sécurité, l’efficacité ou l’équité. En santé publique toutefois, quand on a décidé qui doit approuver, payer et fournir les services, il faut souvent décider en plus quand et comment imposer des comportements individuels. Les politiques de santé publique sont donc plus complexes, car les différents intervenants interprètent les données différemment: ils n’accordent pas nécessairement la même importance à chaque objectif stratégique et peuvent même définir autrement des objectifs identiques. Dans le débat sur l’imposition ou non du vaccin antigrippal annuel aux travailleurs de la santé, par exemple, les partisans et les adversaires de la vaccination obligatoire peuvent invoquer la sécurité dans leurs arguments. Ceux qui sont pour la vaccination obligatoire insistent sur les infections subcliniques et le devoir de diligence (la sécurité publique), tandis que ceux qui sont contre insistent plutôt sur le risque d’effets secondaires (la sécurité personnelle). Les partisans préconisent une diminution de l’absentéisme chez les travailleurs (l’efficacité), tandis que les adversaires mettent en garde contre la coercition et préfèrent d’autres mesures personnelles de contrôle des infections (liberté et droits/responsabilités individuels). On assiste par conséquent à un dialogue de sourds. Si l’on veut déterminer l’importance à accorder à la vaccination antigrippale obligatoire des travailleurs de la santé, il faut donc concilier les compromis stratégiques et clarifier les différends qui se cachent sous les mots utilisés dans le débat d’orientation des politiques.

Mots clés

politiques publiques personnel médical et paramédical lois immunisation pratiques de santé publique 

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Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  1. 1.Department of Health Policy, Management and Evaluation, Health Sciences BuildingUniversity of TorontoTorontoCanada

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