消除疫苗疑云

Why is the same vaccine accepted in one part of the world and rejected in another? Heidi Larson tells Fiona Fleck why communicating the benefits versus the risks of vaccination is just part of the battle to gain public confidence in vaccines.

Q1: HOW CAN MEDICAL ANTHROPOLOGISTS HELP?

A: As anthropologists， we seek to understand what drives human behaviour and the method of study we most commonly use is “participant observation”， that is embedding yourself in the community often during the course of field work. Sometimes it’s about paying attention to small details that can reveal the underlying issues that are generating concerns.

Q2: FOR EXAMPLE?

A: Before the polio vaccine boycott in northern Nigeria， we already saw pockets of resistance to the oral polio vaccine in Uttar Pradesh in northern India， although there was never a state-wide political boycott. Rumours were circulating in the Indian state that vaccines sterilize recipients， but when we sat down and talked with the women from these communities， we found that their concerns were different. They didn’t want their children to be vaccinated by people from Delhi or other places outside their region because if there was a problem they wouldn’t know who to turn to and they didn’t want their children vaccinated by men. You can have all the communications in the world about the vaccine safety， but these will never change such concerns and， ultimately， people’s behaviour. When you launch a vaccination campaign， communities already have their own approach to health care and we need to understand this because， in a sense， we are trying to displace it.

Q3: HOW DID YOU GET INVOLVED IN THE SAGE WORKING GROUP ON VACCINE HESITANCY?

A: The group was formed in 2012. It’s a positive step in response to an issue that has been brewing over the last decade. The biggest game changer was the polio vaccination boycott in northern Nigeria in 2003. After that， more serious consideration was given in the public health community to what had been thought of as marginal and alternative views on vaccination.

Q4: WHAT DOES THE SAGE GROUP DO?

A: The working group is preparing the background material for a SAGE review of the problem. That includes defining vaccine hesitancy and its scope and it includes doing a systematic review of all the available literature on vaccine hesitancy and， based on this， preparing an analysis of the main determinants. The working group has also been asked by SAGE to identify and evaluate existing activities and strategies aimed at addressing vaccine hesitancy. The working group draws on the expertise of its 10 members as well as other relevant experts and people who have been faced with vaccine refusal. The terms of reference are quite similar to the goals of the Vaccine Confidence Project at the London School of Hygiene Tropical Medicine that started in 2010.

Q5: AND WHAT ARE THE DETERMINANTS OF VACCINE HESITANCY AND REFUSAL?

A: There are three main groups. First， the individual reasons related to personal belief systems or community-level belief systems. These may include everything from religious to philosophical notions， and are held primarily by people who reject artificial means of triggering an immune response or believe in alternative forms of medicine， such as homeopathy. Second， there are contextual factors， such as wars， conflicts and other external circumstances that make vaccine refusal more likely. Third， there are vaccine-specific issues， for example public concerns over an adverse event or a piece of research – sometimes faulty research， such as on the measles， mumps and rubella (MMR) vaccine by Andrew Wakefield in the United Kingdom – or over research that has been misunderstood.

http://www.who.int/bulletin/volumes/92/2/14-030214/en/index.html

針對部分國家地區禁用疫苗的問題，人類學家應發揮專業優勢了解驅動這一行為的原因。目前，SAGE工作小組正與這些專業人士就2003年尼日利亞北部爆發的疫苗抵制運動和印度北方邦抵制口服脊髓灰質疫苗（OPV）運動顯現出的問題尋找積極應對舉措。經分析發現，以下三類因素是抵制疫苗運動的罪魁禍首。第一，與個人信仰和社會信仰有關的個人原因。這些可能包括所有宗教和哲學觀念。受這些觀念影響的人們拒絕任何引起免疫反應的人工方式，他們希望用順勢療法替代藥物。第二，環境因素，如戰爭、沖突和其他可能導致拒絕疫苗的外部環境因素。第三，疫苗相關問題因素，如公眾擔憂疫苗會起反作用，或研究報告出錯，或研究報告遭到誤解等等。