scholarly journals Immunisation and the Law: Slippery Slope to a Healthy Society

2006 ◽  
Vol 37 (1) ◽  
pp. 93 ◽  
Author(s):  
Jessica Kerr
Keyword(s):  
Public Health Intervention ◽  
Informed Choice ◽  
Parental Choice ◽  
School Entry ◽  
Policy Makers ◽  
Population Immunity ◽  
Parental Autonomy ◽  
Coverage Rates ◽  
Immunisation Policy ◽  
Public Opposition

The immunisation of children against communicable diseases is a crucial public health intervention. Yet the understandable prioritisation of parental autonomy within New Zealand immunisation policy has contributed to consistently unsatisfactory coverage rates, in both absolute and comparative terms. If our immunisation law could be strengthened to eliminate ‘passive’ non-immunisation without fatally undermining parental choice, the goals of ‘population immunity’ might be achievable. Of the three reform options explored by this paper, two are rejected as unworkable. The first, a universal mandatory immunisation requirement, might be justifiable in principle but would encounter prohibitive public opposition. The second, an ‘informed choice’ requirement limited to beneficiaries, is unprincipled and potentially ineffective. The recommended option is more moderate and equitable. Creating a presumption in favour of immunisation at the point of school-entry would shift the legal focus from ‘informed consent’ to United States-style ‘informed refusal’. The degree of effort required to invoke a statutory exemption to immunisation would depend upon the extent to which policy-makers were satisfied that only parents implacably and legitimately opposed to immunisation were invoking it. Barring a dramatic increase in the size of the anti-immunisation lobby, it is suggested that an informed refusal requirement could successfully eliminate passive non-immunisation, thereby potentially achieving population immunity while substantially preserving parental autonomy.

scholarly journals Immunisation and the law : slippery slope to a healthy society

2021 ◽  
Author(s):  
◽  
Jessica Dorothy Kerr
Keyword(s):  
New Zealand ◽  
Public Health Intervention ◽  
Individual Choice ◽  
Policy Makers ◽  
Population Immunity ◽  
Point Of Entry ◽  
Decision Making Capacity ◽  
Opt Out ◽  
Parental Autonomy ◽  
Coverage Rates

<p>The immunisation of children against communicable diseases is a crucial public health intervention with both individual and collective outcomes. Current New Zealand immunisation policy prioritises parental autonomy, but has not succeeded in actively targeting all of the factors that prevent parents from ever making informed immunisation decisions. Consequently, our coverage rates are unsatisfactory both in absolute (by reference to the goal of 'population immunity') and relative terms. In order to have a realistic chance of meeting the Ministry of Health's optimistic coverage targets, it is necessary to consider whether New Zealand's comparatively weak immunisation law could be strengthened to eliminate the phenomenon of 'passive' non-immunisation without fatally undermining the decision-making capacity of parents. If this is not possible, then either the goal of population immunity or the prioritisation of individual choice must be abandoned. Of the three options for law reform explored by this paper, two are thought to be unworkable because they would, or should, be perceived as failing to achieve the delicate balance between individual freedom and public good. These are, first, a universal mandatory immunisation requirement, which may be justifiable in principle but would almost certainly encounter prohibitive public opposition; and, secondly, a targeted law that would require beneficiaries to make active decisions about immunisation, and (it is submitted) represents an unwarranted misuse of the vulnerability of those dependent upon taxpayer support. The reform option recommended is more moderate and more equitable. Creating a legal presumption in favour of immunisation, at the point of entry into primary school, would shift New Zealand from its current paradigm of 'informed consent' - whereby parents must actively opt in to immunisation - to a United States-style model that required parents who wished to opt out of immunisation to undergo a 'informed refusal' process. The stringency of this process would depend upon the degree to which policy-makers were satisfied that only those parents whose deeply held convictions prevented them from being open to persuasion were attempting to invoke it. Unless the size of the anti-immunisation lobby significantly increases, it is suggested that an informed refusal requirement could successfully tackle the problem of passive non-immunisation, thereby discharging the State's responsibility to further the interest of all New Zealanders in achieving and maintaining population immunity levels.</p>

scholarly journals Immunisation and the law : slippery slope to a healthy society

2021 ◽  
Author(s):  
◽  
Jessica Dorothy Kerr
Keyword(s):  
New Zealand ◽  
Public Health Intervention ◽  
Individual Choice ◽  
Policy Makers ◽  
Population Immunity ◽  
Point Of Entry ◽  
Decision Making Capacity ◽  
Opt Out ◽  
Parental Autonomy ◽  
Coverage Rates

<p>The immunisation of children against communicable diseases is a crucial public health intervention with both individual and collective outcomes. Current New Zealand immunisation policy prioritises parental autonomy, but has not succeeded in actively targeting all of the factors that prevent parents from ever making informed immunisation decisions. Consequently, our coverage rates are unsatisfactory both in absolute (by reference to the goal of 'population immunity') and relative terms. In order to have a realistic chance of meeting the Ministry of Health's optimistic coverage targets, it is necessary to consider whether New Zealand's comparatively weak immunisation law could be strengthened to eliminate the phenomenon of 'passive' non-immunisation without fatally undermining the decision-making capacity of parents. If this is not possible, then either the goal of population immunity or the prioritisation of individual choice must be abandoned. Of the three options for law reform explored by this paper, two are thought to be unworkable because they would, or should, be perceived as failing to achieve the delicate balance between individual freedom and public good. These are, first, a universal mandatory immunisation requirement, which may be justifiable in principle but would almost certainly encounter prohibitive public opposition; and, secondly, a targeted law that would require beneficiaries to make active decisions about immunisation, and (it is submitted) represents an unwarranted misuse of the vulnerability of those dependent upon taxpayer support. The reform option recommended is more moderate and more equitable. Creating a legal presumption in favour of immunisation, at the point of entry into primary school, would shift New Zealand from its current paradigm of 'informed consent' - whereby parents must actively opt in to immunisation - to a United States-style model that required parents who wished to opt out of immunisation to undergo a 'informed refusal' process. The stringency of this process would depend upon the degree to which policy-makers were satisfied that only those parents whose deeply held convictions prevented them from being open to persuasion were attempting to invoke it. Unless the size of the anti-immunisation lobby significantly increases, it is suggested that an informed refusal requirement could successfully tackle the problem of passive non-immunisation, thereby discharging the State's responsibility to further the interest of all New Zealanders in achieving and maintaining population immunity levels.</p>

Self-governing schools, parental choice, and the need to protect the public interest

2017 ◽  
Vol 99 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Edward B. Fiske ◽  
Helen F. Ladd
Keyword(s):  
New Zealand ◽  
School Choice ◽  
The Netherlands ◽  
Public Interest ◽  
Lessons Learned ◽  
Parental Choice ◽  
Policy Makers ◽  
The Public ◽  
Voucher Programs ◽  
The U.S

As policy makers call for the dramatic expansion of school choice and voucher programs across the U.S., it becomes all the more important for educators and advocates to consider lessons learned in countries – such as the Netherlands, New Zealand, and England – that have already gone down this path. Efforts to promote choice and school self-governance have shown clear benefits for individual students and families, but they have had troubling consequences for the broader public.

scholarly journals Multi-scale Data Sharing in the Life Sciences: Some Lessons for Policy Makers

2009 ◽  
Vol 4 (3) ◽  
pp. 71-82 ◽  
Author(s):  
Graham Pryor
Keyword(s):  
Data Sharing ◽  
Life Sciences ◽  
Informed Choice ◽  
Final Report ◽  
Policy Makers ◽  
Multi Scale ◽  
Produce Change ◽  
University Of Edinburgh ◽  
The University ◽  
Scale Data

Drawing on the final report on a recent series of case studies in the life sciences at the University of Edinburgh, this paper explores the attitudes and perceptions of researchers towards data sharing and contrasts these with the policies of the major research funders. Notwithstanding economic, technical and cultural inhibitors, the general ethos in the Life Sciences is one of support to the principle of data sharing. However, this position is subject to a complex range of qualifications, not least the crucial need for sharing through collaboration. The kind of generic vision for data sharing that is currently promoted by national agencies is judged to be neither productive nor effective.  Only close engagement with research practitioners in the identification of bottom-up strategies that preserve the exercise of informed choice - a fundamental and persistent element of scientific research - will produce change on a national scale.

scholarly journals Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Philip J Turk ◽  
Shih-Hsiung Chou ◽  
Marc A Kowalkowski ◽  
Pooja P Palmer ◽  
Jennifer S Priem ◽  
...  
Keyword(s):  
Public Health ◽  
North Carolina ◽  
Public Health Intervention ◽  
Sir Model ◽  
Health Intervention ◽  
Disease Spread ◽  
Local Context ◽  
Imperfect Detection ◽  
Policy Makers ◽  
Spatial Differences

BACKGROUND Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. OBJECTIVE The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. METHODS Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. RESULTS Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 – the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. CONCLUSIONS Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak.

scholarly journals Designing tailored interventions to address barriers to vaccination

2021 ◽  
Vol 47 (3) ◽  
pp. 166-169
Author(s):  
Katrine Habersaat ◽  
Noni E MacDonald ◽  
Ève Ève Dubé
Keyword(s):  
Implementation Process ◽  
Vaccine Uptake ◽  
World Health ◽  
Regional Office ◽  
Policy Makers ◽  
Root Cause ◽  
Planning Framework ◽  
Health Organization ◽  
Coverage Rates ◽  
The Impact

Despite efforts to promote vaccination and make vaccination services easily accessible, vaccination coverage rates remain below the target rate for many vaccines in various jurisdictions. The Tailoring Immunization Programmes (TIP) approach was developed by the World Health Organization Regional Office for Europe to support efforts of countries to achieve high and equitable vaccination uptake. In this Canadian Vaccination Evidence Resource and Exchange Centre (CANVax) series, we present key insights from the TIP planning framework to assist vaccine program planners, policy makers and vaccine providers to identify the interventions that will lead to increased vaccine uptake. The TIP is a phased approach that involves the following: 1) a clear diagnosis of the root cause of low vaccination; 2) an intervention based on this understanding; and 3) an evaluation of the implementation process and the impact of the interventions. At the provider-patient level, the approaches and insights of the TIP planning framework could inform vaccination consultation by emphasizing the importance of engaging with and listening to the patients and caregivers, and responding to their needs.

scholarly journals Lethal Over the Counter Cardioselective Drugs: Urgent Call For Policy Makers

2021 ◽  
Vol 1 (3) ◽  
pp. 47-49
Author(s):  
Joud M. Kossai Enabi ◽  
Abdulmohsen A. Alhumayn ◽  
Hisham Alomari ◽  
Yousef Ibrahim S. Alawad ◽  
Sharafaldeen Bin Nafisah
Keyword(s):  
Public Health ◽  
Saudi Arabia ◽  
Public Health Intervention ◽  
Over The Counter ◽  
Policy Makers ◽  
Suicidal Intent ◽  
Mortality And Morbidity ◽  
Common Presentation ◽  
Life Threatening ◽  
Shed Light

Drug overdose is a common presentation in emergency departments, and overdose of cardioselective agents warrants special attention, given its association with high mortality and morbidity. This study reports a case of cardioselective overdose with suicidal intent. We shed light on the accessibility in Saudi Arabia of these life-threatening drugs, and explore the nature of public health intervention to reduce to reduce the risk of misuse.    

How environmental certification can affect the value of organizations? The case of Forest Stewardship Council certification

2020 ◽  
Vol 22 (4) ◽  
pp. 531-543
Author(s):  
M.E. Sansalvador ◽  
J.M. Brotons
Keyword(s):  
Financial Performance ◽  
Forest Certification ◽  
Forest Stewardship Council ◽  
Environmental Certification ◽  
Business Policy ◽  
Policy Makers ◽  
Business Valuation ◽  
Environmentally Responsible ◽  
Forest Stewardship ◽  
Public Opposition

Forest certification appeared in the 1990's as a way to deal with forest deterioration. Currently, however, public opposition can limit its effectiveness. Business policy makers should analyze how Forest Stewardship Council (FSC) certification can affect the value of companies. Yet, the relation between financial performance and forest certification systems is a subject which has not been explored to a great extent, and the measures used for evaluating financial performance in published studies are not based on business valuation. In this study, Spanish companies with FSC certification are valuated under the premises of implementation and non-implementation of FSC certification. Given the uncertainty inherent in the second option, the use of fuzzy mathematics has been considered a suitable tool. According to the results obtained, it can be concluded that regardless of size or business sector, FSC certification is effective in increasing the value of companies. The pap er offers economic arguments for managers to become more environmentally responsible.

scholarly journals Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study

10.2196/19353 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e19353
Author(s):  
Philip J Turk ◽  
Shih-Hsiung Chou ◽  
Marc A Kowalkowski ◽  
Pooja P Palmer ◽  
Jennifer S Priem ◽  
...  
Keyword(s):  
Public Health ◽  
North Carolina ◽  
Public Health Intervention ◽  
Sir Model ◽  
Health Intervention ◽  
Disease Spread ◽  
Local Context ◽  
Imperfect Detection ◽  
Policy Makers ◽  
Spatial Differences

Background Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. Objective The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. Methods Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. Results Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 – the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. Conclusions Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak.

scholarly journals Pension multi-pillarisation in Italy: actors, ‘institutional gates’ and the ‘new politics’ of funded pensions

2018 ◽  
Vol 24 (1) ◽  
pp. 73-89 ◽  
Author(s):  
Matteo Jessoula
Keyword(s):  
Universal Coverage ◽  
Occupational Pension ◽  
Economic Sectors ◽  
Policy Makers ◽  
Adverse Conditions ◽  
New Politics ◽  
Comprehensive Plan ◽  
Funded Pensions ◽  
Path Dependent ◽  
Coverage Rates

A latecomer to supplementary funded pension provision, Italy’s multi-pillarisation plan was launched in the 1990s under extremely adverse conditions. Supplementary schemes were expected to achieve universal coverage relying primarily on second pillar occupational pension funds. Twenty-five years after its launch, the comprehensive plan can hardly be called successful with respect to both coverage and the relative importance of second and third pillar institutions. Extreme variation in coverage rates between occupational categories and across economic sectors suggests, however, that these developments cannot be merely interpreted as a consequence of institutional resilience and path-dependent dynamics. The article applies an ‘actor-centred institutionalist’ framework to respond to three main questions. What explains the still limited coverage of supplementary pillars in Italy? What factors account for the prominent role played by third pillar pension schemes in contrast to policy-makers’ original intentions? Which factors allow us to understand the significant variation in coverage across both occupational categories and economic sectors?

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