| Summary: | 碩士 === 國立臺灣大學 === 政治學研究所 === 102 === The success of Taiwan’s infectious disease control and eradication, as well as its hepatitis B prevention program, have been highly praised around the world. This success has been ascribed to the effective immunization structure – from the central government to local public health bureaus – that relies on good governance and cooperation to fulfill the goal of disease control. However, in the late 1990s, local governments started to promote their own vaccine policies, while the central government lagged behind and made no progress. What factors changed the well-functioning “central decision and local execution” hierarchy system? How did the local governments, which are considered as holding a lower level of professionalism, gain the justification to decide immunization policies? This research explains how local governments were willing and able to step in to handle immunization policy, and through two case studies –Varicella and Pneumococcal Conjugate Vaccine – explains the Co-optive Relationship between central and local government.
The research shows that the change in the immunization system after democratization could be described as “central delegated, central regained the power, and regulated delegation”. Since the late 1990s, the local governments and legislators actively promoted their own free vaccine policies in the name of “fighting for the welfare of children”, “protecting the rights of vulnerable groups”, and “reducing families’ expenses”. While the action of the central government was restrained by the budget, local governments reshaped the images of the vaccines, from being associated with disease prevention focusing on herd immunity and shifting to welfare orientation focusing on fairness and justice. However, the central government indicated that the lesser governance and lower professionalism of local governments caused the mismanagement of resources and waste. Through the revision of Law on the Control of Communicable Diseases in 2009, the role of a professional decision system was assured, allowing the central government to regain the power of vaccine selection and policy elevation, while the policy direction of local governments has been regulated, and have the margin of providing welfare policy. From interviews and content analysis, I found that the policy image of the immunization policy has changed from professionalism to both welfare and professionalism, which is the key factor to how local governments were willing and able to step into the competition of policy venue. However, the HPV policies that are promoted by various local governments could sway the stability of image and venue, and could possibly change the role and meaning of vaccination in infectious disease control.
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