Fredrik Bragesjö

Dilemmas of a vitalizing vaccine market: lessons from the MMR vaccine/autism debate.

A number of issues related to vaccines and vaccinations in society are discussed in this paper. Our purpose is to merge an analysis of some recent changes in the vaccine market with social science research on the relationship between citizens and authorities. The article has two empirical parts. The first shows how the vaccine market, which for many years has had immense financial problems, nowadays seems to becoming economically vitalized, mostly due to the production of new and profitable vaccines. However prosperous the future may appear, certain reactions from the public regarding vaccination initiatives offer insight into inherent problems of vaccine policies in many Western countries. In the second part of the article, these problems are exemplified with the recent controversy over the MMR (measles, mumps, and rubella) vaccine. We conclude that in spite of the improving profit-margins, the vaccine market remains vulnerable and insecure. Vaccines are permeated by society, even more so than pharmaceutics that are used to cure or alleviate illnesses. Radical changes in financial conditions with promises of a more profitable market will not, we argue, solve other even more fundamental problems.

A Framework for Future Studies of Personalised Medicine: Affordance, Travelling, and Governance of Expertise

Through individualised genomic knowledge and the digital tools of telemedicine, personalised treatments may be able to solve the “irresolvable” conflict between the evidence-based and person-centred medicine movements. The aim of this chapter is to offer a framework for future work concerning these developments. As indispensable human elements are often rendered invisible with these technologies, expertise is critical. Furthermore, it is important to consider the unpredictable and transformative effects of materialities and, consequently, how expertise travels. The pursuit of analytical work without acceptance of the general and often abstract polarisation between evidence and persons in internal medical debates requires acknowledgement of both the distribution of expertise and influence (e.g., the governance of expertise). Finally, hybrids of humans and non-humans are ubiquitous but require scrutiny. That is, the affordance of technologies that embody, enclose and translate expertise in new forms has reconfiguring effects on the roles of experts and physician-patient relationships.

Back to basics: Governing antibacterial resistance by means of mundane technoscience and accountability relations in a context of risk

In 2006, a sudden spread of a strain of a multi-resistant bacterium (Klebsiella pneumonia ESBL) arose inside of the Swedish university hospital in Uppsala. Measures of risk management were taken immediately to fight the bacteria spread in order to stop what soon developed into an epidemic. Officers at the hospital initiated a system of accountability relations, in this article analysed through a model developed by Neyland and Woolgar. We show how the introduction of mundane technoscientific procedures was closely related to efforts of making them understandable, recognisable, relevant and necessary to the actors involved. One and a half year later, the hospital declared the measures taken a success. Abeneficial change of behaviour and practices among the employees, patients and visitors had occurred. Furthermore, the prescription of antibiotics had decreased and become more appropriate and additional rooms with their own sanitary facilities were available. Although succeeding in halting the epidemic, both the implementation and above all the sustainability of the accountability system proved exceedingly exigent. However, to uphold an adequate practice and behaviour in the long run, the system needs constant management and monitoring. Well aware of this difficulty, the officers had the intention of creating a new, self-supporting culture. So far, the ambition of achieving consistent and persistent norms and a new culture seems to have failed. Our conclusions are ofrelevance for understanding how systems of accountability may be used in risk management.