How do you enact public health policy change? Key informants and perfect political storms, help.
Michael Beeler, a fellow from the CIHR, spoke about Canada's 2001 decision to enter into a pre-purchase agreement to acquire the influenza vaccine for the entire Canadian population. Canada was the first country in the world to do this.
Michael Beeler, a fellow from the CIHR, spoke about Canada's 2001 decision to enter into a pre-purchase agreement to acquire the influenza vaccine for the entire Canadian population. Canada was the first country in the world to do this.
This was an interesting policy decision, as he said, because at the time in Canada there was no demand for this. And yet, the government was willing to spend $35-million for the procurement of vaccines and for the facilities to store them. This decision was not done as a response to an emergency, there was no precedent in the world for this, and yet the government was preparing to vaccinate the entire Canadian population within four months. The procurement, as he said, was based entirely on hypothetical models.
He explained the policy analysis 'problem stream': the policy didn't arise because of a large scale public emergency. In fact, he said, it was a very minor incident in 1997 of avian flu in Hong Kong that caught the attention of decision makers in public health agencies. Further, he noted that the global community was talking about pandemic preparedness at international conferences. Of note, some very senior Canadian officials were key delegates at these conferences.
What was notable, he said, was that these discussions were all amongst the policy community; there was no effort to engage the public. This example shows that it's possible to effect policy change if you lobby / involve key decision makers, even absent of public attention. Health Canada was willing to put together numbers and take them to key decision makers. Evidence did not play a strong role in creating this policy, but precautionary principle did: As it was explained by policy makers, catastrophic costs would be incurred if we didn't have a large scale vaccination program.
What was notable, he said, was that these discussions were all amongst the policy community; there was no effort to engage the public. This example shows that it's possible to effect policy change if you lobby / involve key decision makers, even absent of public attention. Health Canada was willing to put together numbers and take them to key decision makers. Evidence did not play a strong role in creating this policy, but precautionary principle did: As it was explained by policy makers, catastrophic costs would be incurred if we didn't have a large scale vaccination program.
To do this, public health agencies and the five largest pharmaceutical companies in Canada came together. There was overwhelming consensus among the agencies about the policy and pharma was willing to finance the huge cost.
He then explained what happened on political scene: there was significant pressure on the federal government to increase health care spending, based on years of budget surplus. Also, there was pressure to give to the 'have not' provinces more, notably Quebec. Policy advocates hired a former minister as a key lobbyist. And, the interests of the governing party - the Liberals - featured prominently.
As Beeler said, we won't really know the behind closed doors conversations as to how this policy was enacted, but we can surmise.
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