Governing Immunization in Canada

Modern immunization’s role in health systems is threefold: it is simultaneously a pharmaceutical product, a personal health care intervention, and a public health measure, each constituting a distinct, yet overlapping set of governance arrangements. This thesis examines immunization policy change and governance at the federal-provincial interface over the last decade (1997-2008) in Canada, situated against broader trends in public policy and public health. The research is based upon a case study design and a discursive approach to policy analysis, using documentary sources, supplemented with archival information, direct observations, and decision-maker informants. Over time, structures and instruments used to deal with immunization at the federal-provincial interface have undergone adaptation. New decision-making structures include the Public Health Agency of Canada and the Pan-Canadian Public Health Network; new instruments include the National Immunization Strategy, accompanied by targeted federal funding. Consistent with other sectors, however, the decade also witnessed an ongoing emphasis on fiscal prudence, risk-based regulation, and informal networks to accomplish policy goals. This thesis concludes that effective federal governance and lasting policy change for immunization requires resolution of two major tensions in the policy ideas underlying national processes. First, the interpretation of federal authority over matters of national concern remains ambiguous. While the National Immunization Strategy reflected dominant ideas around equitable access to vaccines and a broad conception of the federal sharing community, persistent gaps, particularly linking national-level decisions, financing, and delivery, have reinforced the existing notion of the appropriate degree of federal influence for immunization, rather than expanding it. Second, an increasing focus on personal security dimensions of immunization amid structural changes intended to address public security concerns is in tension with a situation that predisposes the state to avoid an unjust application of compulsory measures rather than to protect from harm those individuals who consent freely to immunization. Immunization in Canada requires a new paradigm that expands the notion of the state’s role in prevention as it applies to immunization, that addresses specific needs for protection in the life of the individual, and that reasserts the importance of strong, substantive, and sustained federal contributions to matters of national concern.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2010

Author dc:creator

• Mah, Catherine Ling

Advisor dc:contributor.advisor

• Deber, Raisa Berlin

• public health
• public policy
• immunization
• Canada

Statement dc:rights

• Attribution-NonCommercial-NoDerivs 2.5 Canada

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nc-nd/2.5/ca/

Language dc:language.iso

en_ca

Handle dc:identifier.uri

http://hdl.handle.net/1807/19058

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/19058