Revisiting the pharmaceuticalisation of pandemic influenza using Lukes' framework of power.

The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes' three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark - two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country's pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes' framework over the 'countervailing powers' framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry and the WHO also exerted power by enabling and constraining experts' decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes' sense, since it rested on keeping latent the tension between many individuals' health interests and the state's interests in protecting social and economic functioning.