TAILIEUCHUNG - Informed choice and immunisation programmes

Similar patterns are seen when the US, Canada, and Sweden are compared on numerous social de- velopment and population health indicators [14,15]. Sweden fares the best, the US the worse, and Canada comes up the middle. These findings indicate that political and economic forces play a strong role in population health. Population health theory and re- search in Canada and elsewhere however, focus on a number of mid-level “social determinants of health” with little recognition of the role political and eco- nomic forces play in the quality of these health deter- minants [16–19]. Before considering these forces, a brief overview of various conceptualisations of social determinants of health is provided | women s health u p d a t e Informed choice and immunisation programmes The school-based phase of the HPV human papillomavirus immunisation programme that will provide Gardasil vaccine for girls from 12 years old is about to start. Given the debate on the failure of informed consent processes with the MeNZB immunisation programme and a troubling start to the national HPV immunisation programme launched in September last year it is timely to raise concerns about the fate of informed choice and consent in the school-based phase of the programme. Christy Parker looks at some of the ethical issues surrounding mass immunisation programmes targeting children and young people and argues that the principles of informed choice and consent must not be compromised by population health objectives. During the last 50 years mass immunisation programmes have been effective in protecting people against infectious diseases alongside other public health measures. However while successful these programmes have remained controversial often with fierce debate over both the context and their implementation Verweij Dawson 2004 . There are two major groups of ethical issues which cause controversy. The first relate to the development introduction and availability of new vaccines. There is much debate about the principles that should be applied in deciding which programmes are funded about how these decisions are made and by whom Verweij Dawson 2004 . The role of pharmaceutical companies who stand to make millions or even billions in decisions about national vaccination programmes is particularly contentious. Broader debates about the safety and efficacy of vaccines also continue to be very active. The second major group of ethical issues and the ones which are the focus of this article concern the implementation of vaccination programmes the means used to achieve high vaccination uptake and the information and communication processes involved Verweij Dawson 2004 . When extraordinarily high

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