台灣人類乳突病毒疫苗補助政策之利益關係團體分析

Abstract

目的：子宮頸癌為國人第二大婦癌，是性行為感染人類乳突病毒(HPV)所致，自2007年預防性HPV疫苗上市以來，衛生署國健局便開始評估補助全國國中女性接種疫苗的政策可行性。本研究欲探討政策評估期，影響國內HPV疫苗政策的核心決策機構，讓關切此議題的利益團體了解自身於政策決策的相對地位與表態；透過本研究在政策施行前提出整合利益團體的策略與態度，以及施行同時可以有的配套建議。 方法：此研究使用健康政策分析之利益關係團體分析法，以半結構式深度訪談國內關切疫苗補助政策的22位機構代表，以逐字稿為本，文本資料為輔，量化歸納利益關係團體的政策理解度、影響力、表態、領導意願、利益強度與互動關係的相對位置；再以質性分析法歸納出各機構的期望政策走向和策略現況。 結果：具有高影響力與高利益強度的機構共有11個，類別為：中央政府與立法機構、地方衛生單位與立法機構、部分非營利與倡議組織、疫苗製造商與國際衛生與醫療組織，絕對支持政策施行者佔多數，反對政策的機構以關心婦女健康議題的立法機構代表和長期倡議婦女健康之婦運團體為主。科學界與醫學界擁有高利益強度和中度影響力，媒體和商業集團與教育單位具有低影響力和低利益關係。政策表態以支持政策為眾，機構無論同意政策施行與否，預測政策有施行之趨勢，並以安全性、長期保護效力和成本效益作為支持或反對政策的辨證基礎。不同機構均採取了不同程度的策略行動，中央決策體系為被動接受策略的機構，藥廠、非營利組織和婦運團體為最積極倡議的機構。 結論：政府於政策評估期能囊括不同利益取向與影響力機構的意見，充分研究為基礎，避免施政遭遇阻力或被動為藥廠驅動，展現決策者中立卻有領導意願的能力；並應體認精英決策制度已不適用於婦女健康議題，需要同步加入性別影響評估。政府宜將性別平等的性教育、抹片與疫苗政策三管齊下，建立新興防癌疫苗的政策決策制度，重整公部門和促進產官學溝通的管道，方能達成利益機構均期望能降低子宮頸癌死亡率之遠景。

Background: Cervical cancer is the second leading cancer for females in Taiwan. The introduction of HPV vaccine stirred considerable debate on the feasibility of applying universal HPV vaccine program to middle school girls. This research identified the key stakeholders concerning HPV vaccine policies in Taiwan during health policy assessment stage in the policy analysis cycle by mapping the relative power position, attitude and influence of each stakeholder. Methods: Using stakeholder analysis in health policy analysis, a semi-structured qualitative interview with 22 institution representatives relative to the HPV vaccine policy is conducted. Verbatim and published documents are used to quantify stakeholders’ knowledge, influence, attitude, leadership, interest and coalition relative to each institution involved in the policy decision process; policy outcome and strategic approaches were then compiled qualitatively based on contents of the interviews. Results: Eleven institutions were considered of high influence and high interest categorized as below: central government and legislative institutions, local DoH’s and legislative institutions, the majority of NGOs and advocacy groups concerning HPV vaccine, pharmaceuticals, international organizations. Professionals in public health, medicine and vaccinology have high interest and low influence; the media, business cooperates and educational institutions have low influence and low interest in the policy. Main concerns in policy implementation include vaccine safety, protection efficacy, and cost-effectiveness of the policy. Each institution adopts varying strategies while advocating. Conclusion: While in the policy evaluation phase, the government should show commitment to HPV vaccine policy by getting all parties of different interests involved and map out an influence-power grid to aid in decision making. The government should acknowledge that Elitism policy-making is not suitable for women’s health policy; the government has the responsibility to promote gender awareness in sex education, annual smears and HPV vaccine jointly, and at the same time, establish new policy decision making strategies in the advent of new vaccines entering the market. By transparency in communication and combining efforts from the government, industry and academia, HPV vaccine policy could potentially benefit all stakeholders and ultimately reduce cervical cancer mortality in the long run.