Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Health Policy Plan. 2012 Aug;27(5):374-83. doi: 10.1093/heapol/czr056. Epub 2011 Aug 22.
The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes. The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand's poultry industry is large and principally an export economy, Vietnam's and Indonesia's are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy. With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.
本研究旨在分析东南亚三个国家（泰国、印度尼西亚和越南）目前在防控禽流感和人感染流感大流行方面的政策。通过分析家禽疫苗接种政策，来探讨该地区防控甲型 H5N1 流感的更广泛政策。通过分析奥司他韦等稀缺区域资源的抗流感药物储备政策，来探讨人感染流感大流行的防备政策。本研究应用了几种政策分析理论，分析了三国案例研究中关于家禽疫苗接种和储备抗病毒药物的使用的争论。我们对新兴主题进行了跨案例比较分析。研究发现，虽然印度尼西亚和越南引入了家禽疫苗接种计划，但泰国拒绝了这种政策方法。相比之下，三国都采取了类似的战略政策，为防范大流行做准备。在高致病性禽流感方面，经济因素至关重要。虽然泰国的家禽养殖业规模庞大，主要是出口经济，但越南和印度尼西亚的家禽养殖业则是为了满足国内消费。在泰国引入家禽疫苗接种政策可能会威胁到其贸易潜力，并对其经济产生重大影响。相比之下，越南和印度尼西亚国内的利益相关者则不太关心国际贸易，而更关心维持国内家禽业的健康。由于该地区某些国家的甲型 H5N1 已呈地方性流行，这些政策差异引发了人们对政策的区域一致性以及对既定总体目标（根除或缓解）的追求的质疑。此外，虽然经济因素在指导农业部门政策制定方面至关重要，但人们对该地区农业部门政策与公共卫生部门政策之间是否具有一致性提出了疑问。
