Policy Relating to Hepatitis B in New Zealand 1970-2005

Abstract

Hepatitis B emerged as a significant public health problem in New Zealand in the early 1980s. Initially seen as an infectious threat to transfusion recipients and an occupational hazard for health care workers, epidemiological studies revealed the unexpectedly high prevalence of the disease, particularly among Maori children, who were found to be at higher risk of developing chronic hepatitis B and its longterm complications. Despite these findings, however, factors other than scientific research influenced policy makers. The Health Department was reluctant to acknowledge that New Zealand, unlike other Western countries, had a high prevalence of a ‘third world’ disease. An effective vaccine was available from late 1982, but in an era of increasing fiscal constraints, the Health Department cited its high cost as a barrier to state-funded immunisation. From the mid-1980s community-based health activists and prominent Maori, rather than public health officials, drove the hepatitis B policy agenda. Individual policy players proved more influential than central policy advisors; nevertheless, in the absence of a comprehensive control strategy, attempts at hepatitis B prevention faltered. Despite the introduction of universal childhood hepatitis B immunisation in 1990, vaccine uptake was persistently poor, particularly among ‘high risk’ children. Equally, a three-year screening programme to identify and follow up hepatitis B carriers, introduced in 1999 in spite of strong opposition from official advisors, reached less than half of its targeted population. Adopting a chronological approach and drawing on archival sources and oral history interviews, this thesis examines the factors that shaped the formation of hepatitis B policy in New Zealand from 1970, when the first test for hepatitis B provided the means of protecting the blood supply, to 2005 when policy makers finally took a firm stand on the management of hepatitis B infected health care workers. It considers the debates around the introduction of hepatitis B immunisation and screening policies and locates the individuals and issues that influenced those debates within an international context.