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      Between individualism and social solidarity in vaccination policy: the case of the 2013 OPV campaign in Israel

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      1 , , 2 , 2
      Israel Journal of Health Policy Research
      BioMed Central

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          Abstract

          Background

          During the summer of 2013, after samples of poliomyelitis virus were found in sewage, Israel launched an intensive national oral polio vaccine (OPV) campaign. The clinical objective of the campaign was rather clear. With not a single case of infantile paralysis and with a population already highly protected with IPV (a dead version of the vaccine), the goal was to foster collective immunity so that risk populations could also be protected. This, however, entailed a rather unusual issue: how to persuade parents whose children already received an IPV to re-vaccinate their children, now with a live yet attenuated version of the virus that was excluded from the national vaccination program in 2004. The challenge therefore was a call for social solidarity - asking parents to vaccinate their children mainly for the sake of protecting unknown at risk populations and to take part in the larger global goals of the polio eradication program. This challenge stands at the core of our investigation. We see the OPV campaign of summer 2013 as a good case study of the tension between individualism and social solidarity in seeking the cooperation of the public.

          Methods

          We draw on a qualitative study that included participant observation, document reviews and interviews with policy-makers, parents, journalists, public health experts and community leaders. These data were analyzed in order to unravel the ways in which self-interest, community and solidarity were conceived by different agents during the vaccination campaign.

          Results

          The family as a metaphor for social solidarity was the main discursive item in the public campaign. Tensions, dissonances and inconsistencies were found between different registers and agencies as to what is at stake and what is required.

          Conclusions

          We discuss the ethical and social implications of our findings in order to better understand how persuasion was used in the current case and for its future role in similar events, within and outside Israel, when global efforts to eradicate polio are ongoing.

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          Most cited references19

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          Glocommodification: How the Global Consumes the Local - McDonald’s in Israel

          Uri Ram (2016)
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            Ethics and infectious disease.

            Bioethics apparently suffers from a misdistribution of research resources analogous to the '10/90' divide in medical research. Though infectious disease should be recognized as a topic of primary importance for bioethics, the general topic of infectious disease has received relatively little attention from the discipline of bioethics in comparison with things like abortion, euthanasia, genetics, cloning, stem cell research, and so on. The fact that the historical and potential future consequences of infectious diseases are almost unrivalled is one reason that the topic of infectious disease warrants more attention from bioethicists. The 'Black Death' eliminated one third of the European population during the 14th Century; the 1989 flu killed between 20 and 100 million people; and, in the 20th Century smallpox killed perhaps three times more people than all the wars of that period. In the contemporary world, epidemics (AIDS, multi-drug resistant turberculosis, and newly emerging infectious diseases such as SARS) continue to have dramatic consequences. A second reason why the topic of infectious disease deserves further attention is that it raises difficult ethical questions of its own. While infected individuals can threaten the health of other individuals and society as a whole, for example, public health care measures such as surveillance, isolation, and quarantine can require the infringement of widely accepted basic human rights and liberties. An important and difficult ethical question asks how to strike a balance between the utilitarian aim of promoting public health, on the one hand, and libertarian aims of protecting privacy and freedom of movement, on the other, in contexts involving diseases that are--to varying degrees--contagious, deadly, or otherwise dangerous. Third, since their burden is most heavily shouldered by the poor (in developing countries), infectious diseases involve issues of justice--which should be a central concern of ethics. I conclude by providing sociological and historical explanations of why the topic of infectious disease has not already received more attention from bioethicists.
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              Intensified environmental surveillance supporting the response to wild poliovirus type 1 silent circulation in Israel, 2013.

              An emergency response was triggered by recovery of wild poliovirus type 1 (WPV1) of the South Asia (SOAS) lineage from sewage in southern Israel in April 2013 during routine environmental surveillance. Public health risk assessment necessitated intensification of environmental surveillance in order to facilitate countrywide monitoring of WPV1-SOAS circulation. This involved increasing sampling frequency and broadening the geographical area, for better coverage of the population at risk, as well as modifying sewage testing algorithms to accommodate a newly developed WPV1-SOAS-specific quantitative real-time RT-PCR assay for screening of RNA extracted directly from sewage concentrates, in addition to standard virus isolation. Intensified surveillance in 74 sites across Israel between 1 February and 31 August 2013 documented a sustained high viral load of WPV1-SOAS in sewage samples from six Bedouin settlements and two cities with Jewish and Arab populations in the South district. Lower viral loads and intermittent detection were documented in sampling sites representing 14 mixed communities in three of the five health districts in central and northern Israel. Environmental surveillance plays a fundamental role in routine monitoring of WPV circulation in polio-free countries. The rapid assay specific for the circulating strain facilitated implementation of intensified surveillance and informed the public health response and decision-making.
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                Author and article information

                Contributors
                hagaiboas@gmail.com
                anatros@bgu.ac.il
                nadavd@bgu.ac.il
                Journal
                Isr J Health Policy Res
                Isr J Health Policy Res
                Israel Journal of Health Policy Research
                BioMed Central (London )
                2045-4015
                21 December 2016
                21 December 2016
                2016
                : 5
                : 64
                Affiliations
                [1 ]The Edmond J. Safra Center for Ethics, Tel Aviv University, Tel Aviv, Israel
                [2 ]The Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
                Author information
                http://orcid.org/0000-0001-8201-1886
                Article
                119
                10.1186/s13584-016-0119-y
                5178071
                b75ad869-77ae-4a9b-af63-98c201b294cc
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 November 2015
                : 22 November 2016
                Funding
                Funded by: montreal health equity research consortium
                Award ID: 115214
                Award Recipient :
                Categories
                Original Research Article
                Custom metadata
                © The Author(s) 2016

                Economics of health & social care
                Economics of health & social care

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