A FRAMEWORK TO GUIDE POLICYMAKERS ON THE USE OF SCIENCE TO INFORM PUBLIC HEALTH POLICY AND LAW: IMMUNISATION AS A CASE STUDY BY ALEXANDER SEBASTIAN PISHIEF A thesis submitted to Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Laws Victoria University of Wellington (2019) Contents I INTRODUCTION .......................................................................................................... 1 II THE INTERFACE BETWEEN SCIENCE, SOCIETY, POLICY AND LAW ........ 8 A Science and the Public Health Policy Process ............................................................... 9 B Post-normal Policymaking ........................................................................................... 12 C Blurring Science and Values Arguments ..................................................................... 13 D Separating Science and Values—A Brief Introduction to the Framework .................. 14 III ISSUES WITH USING SCIENCE TO INFORM POLICY ..................................... 15 A An Emotive Public ....................................................................................................... 16 1 False Balance .......................................................................................................... 16 2 Abundance of, and Accessibility to, Information ................................................... 17 3 Knee-jerk Reactions Leading to Unnecessary Regulation ...................................... 19 B Uncertainty and Risk .................................................................................................... 22 1 The Precautionary Principle .................................................................................... 23 2 Consensus of Risk ................................................................................................... 26 3 Imposing Risk and Outrage Factors ........................................................................ 28 4 Status Quo Bias ....................................................................................................... 28 C Misuse of Science ........................................................................................................ 30 1 Misinformation and Creating Doubt ....................................................................... 31 2 Junk or Pseudoscience ............................................................................................ 32 D The “Post-world” ......................................................................................................... 34 E Not Deferring to the Authority of Science ................................................................... 37 F Capacity to Understand the Evidence .......................................................................... 40 1 The Science Advisory System and the Policymaker............................................... 41 2 The Information Deficit Model ............................................................................... 42 IV VACCINE HESITANCY, BARRIERS, POLICY AND THE TREATY ................ 45 A Common Global Problems Behind Vaccine Hesitancy ............................................... 47 1 Links to Disease ...................................................................................................... 48 2 Religious Beliefs ..................................................................................................... 50 3 Distrust of Government and Medicine .................................................................... 52 B Barriers to Immunisation in New Zealand ................................................................... 53 1 Family Characteristics ............................................................................................ 55 2 Healthcare System-associated Factors .................................................................... 58 C Immunisation Policy .................................................................................................... 61 D The Treaty of Waitangi ................................................................................................ 63 V DEVELOPING A DECISION-MAKING FRAMEWORK ..................................... 65 A Why it is Important for Policymakers to Understand Immunisation Coverage ........... 66 B Policy Options to Increase Immunisation Coverage .................................................... 69 1 Compulsory Immunisation ...................................................................................... 69 2 Linking Beneficiary Payments to Immunisation Status .......................................... 70 3 Compulsory Immunisation of Healthcare Workers ................................................ 70 4 Non-coercive Policy Measures ............................................................................... 71 5 Restricting Anti-vaccination Propaganda ............................................................... 71 C The Framework ............................................................................................................ 72 D Stage One—Science ..................................................................................................... 72 1 The Nature of the Scientific Evidence .................................................................... 73 2 The Usefulness of the Scientific Evidence ............................................................. 74 E Stage Two—Values ..................................................................................................... 74 1 What are Values? .................................................................................................... 75 2 Competing Interpretations of Values ...................................................................... 76 3 Making Use of the Courts’ Interpretations of Values ............................................. 77 4 Rights and Freedoms and the Bill of Rights Act 1990............................................ 78 5 Approach to Values using Legal Standards ............................................................ 80 F Stage Three—Justified Limitation ............................................................................... 82 1 R v Hansen .............................................................................................................. 82 G Striking a Balance ........................................................................................................ 82 H General Applicability to Health-related Policy Decisions ........................................... 85 I Beyond the Scope......................................................................................................... 85 VI STAGE ONE: SCIENCE AND IMMUNISATION POLICY .................................. 86 A The Gatekeeper ............................................................................................................ 86 1 Evidence and the Scientific Method ....................................................................... 87 2 Generally Accepted Science ................................................................................... 91 3 Publication and Peer-Review .................................................................................. 94 4 Bias and Conflict of Interest ................................................................................... 95 B Applicability ................................................................................................................ 96 1 Cost/Benefit ............................................................................................................ 96 2 Relevance ................................................................................................................ 97 VII STAGE TWO: VALUES AND IMMUNISATION POLICY ................................... 99 A Public Health as a Community Value ........................................................................ 100 1 Vaccination as a Civic Duty ................................................................................. 101 2 The Good Samaritan ............................................................................................. 103 3 Prevention is Better than Cure .............................................................................. 103 B Making Decisions for Children .................................................................................. 104 1 Informed Consent.................................................................................................. 107 2 Best Interests of the Child ..................................................................................... 111 C Bodily Integrity .......................................................................................................... 114 1 Medical and Scientific Experimentation ............................................................... 115 2 Medical Treatment ................................................................................................ 119 3 Freedom of Choice ................................................................................................ 122 D Privacy .................................................................................................................... 124 1 Religion ................................................................................................................. 124 2 Freedom of Expression ......................................................................................... 126 E Equality ...................................................................................................................