Risk governance for infectious diseases: exploring the feasibility and added value of the IRGC-framework for Dutch infectious disease control

摘要

The quality of the Dutch system for control of infectious diseases is considered to be high. However, sometimes (e.g. during the Mexican flu and HPV vaccination in 2009, during the Q-fever outbreak from 2008 to 2011) the system encounters problems in terms of perceived effectiveness and public acceptance. This raises the question: Are other governance arrangements available that could contribute to a higher effectiveness and acceptance of infectious disease control? If so, how feasible are these arrangements in the light of the high time pressure in the case of an emergent outbreak of infectious diseases? In this paper, we explore the feasibility and added value of the International Risk Governance Council (IRGC)-framework. This framework aims to improve risk governance by tailoring the risk governance approach to the specific characteristics of the risk (the IRGC distinguishes between simple, complex, uncertain and ambiguous risks). Two recent infectious disease episodes - Q-fever and Schmallenberg virus (SBV) - were analysed. The actual risk governance approach was compared with a hypothesized situation, in which the IRGC-framework would have been applied. Data were collected by means of a review of literature, policy documents, newspaper articles and interviews with risk assessors and risk managers. This exploratory study revealed that Dutch infectious disease control incorporates many elements of the IRGC-approach, although some of these elements are used in an intuitive rather than in an explicit manner. Few elements are lacking. Incorporation of these elements (e.g. concern assessment) would have been both feasible and useful during the Q-fever epidemic (ambiguous risk), but not during the SBV outbreak (uncertain risk). We expect that primarily in cases of ambiguous infectious disease risks an explicit risk characterization and the further incorporation of concern assessment could strengthen Dutch infectious disease control. To assess whether a risk is (becoming) ambiguous remains a challenge to be operationalized.