強制接種疫苗有個大問題，值得注意

In 1904, the Brazilian city of Rio de Janeiro shook with violence as citizens rioted. Property was destroyed, dozens were wounded, and 30 people lost their lives as the population rose up against a perceived common enemy: a mandatory vaccine for smallpox.

1904年，巴西里約熱內盧市發(fā)生騷亂，民眾暴力沖突，財產(chǎn)被毀，數(shù)十人受傷，30人喪生。隨之人們又增加了一個對抗的公敵：一種強制性的天花疫苗。

To impoverished citizens who already had little trust in government authorities, it was a final straw. The response was extreme, but it serves as a reminder of how much public healthcare relies on winning the 'hearts and minds' of the community.

對于已經(jīng)對政府當局缺乏信任的貧困公民來說，這是壓垮他們的最后一根稻草。人們的反應是極端的，但它提醒人們，公共醫(yī)療在多大程度上依賴于贏得社區(qū)的“民心”。

Public vaccination programs are often a careful balance of carrot versus the stick. We'd all like to feel like we have absolute freedom over our own bodies, but some things are just too risky to leave up to individual discretion.

公共疫苗接種項目往往是胡蘿卜和大棒之間的一種謹慎的平衡。我們都喜歡對自己的身體有絕對的自由，但有些事情太冒險了，不能讓個人自由決定。

As vaccine-preventable diseases surge, governments around the world are putting down the carrots and bringing out bigger sticks in the form of mandatory vaccinations. The programs seem to be working, but a recent report points out it isn't without cost.

隨著疫苗可預防疾病的激增，世界各國政府都在放下胡蘿卜，拿出更大的大棒，強制接種疫苗。這些計劃似乎正在發(fā)揮作用，但最近的一份報告指出，并非沒有成本。

New Zealand Medical Association researchers Mary Nowlan, Esther Willing, and Nikki Turner have summarised a review of the literature on factors that influence vaccination coverage in New Zealand.

新西蘭醫(yī)學協(xié)會的研究人員MaryNowlan、Estherwill和Nikki Turner總結了影響新西蘭疫苗接種覆蓋率因素的文獻綜述。

They report that while mandatory programs are marginally effective, they risk further isolating disenfranchised parts of the community, making it even harder to eradicate potential hotspots of disease.

他們報告說，盡管強制性項目收效甚微，但它們有可能進一步孤立社區(qū)中被剝奪權利的部分，使根除潛在的疾病熱點變得更加困難。

Keeping communicable diseases under control is something of a team effort. When around 95 percent of a population is effectively immune to a pathogen, the chance that the disease will easily spread becomes remote.

控制傳染病是一個團隊的努力。當95%的人口對病原體有效免疫時，這種疾病很容易傳播的機會就變得很渺茫。

Despite this, there are inevitably individuals who can't acquire immunity, due to medical conditions or other factors. Because of this, it's a health authority's job to convince every other individual that it's their responsibility to defend their body through vaccines as much as possible.

盡管如此，還是不可避免地會有一些人因為身體狀況或其他因素而無法獲得免疫力。正因為如此，衛(wèi)生當局的工作就是說服每個人，他們有責任盡可能多地通過疫苗來保護自己的身體。
There are many ways authorities can do this. Communicating the science and facts on sanitation, hygiene, and immunisation is effective when we trust the source.

當局有很多方法可以做到這一點。當我們相信衛(wèi)生、衛(wèi)生和免疫的來源時，交流有關衛(wèi)生、衛(wèi)生和免疫的科學和事實是有效的。

Unfortunately, changes in how we communicate have helped create pockets of confusion, misinformation, and most importantly, mistrust.

不幸的是，我們交流方式的改變導致了混亂、誤傳，最重要的是，不信任。

For sectors of the community dealing with a history of broken trust, the usual public service announcements on immunisation schedules simply won't cut it, the researchers say.

研究人員說，對于社區(qū)中有信任破裂歷史的部門來說，通常在免疫接種時間表上公布的公共服務公告根本無法解決這個問題。

"Vaccination policies that ignore social and ethnic sensitivities risk lacking public support even when they have a strong evidence base," the team writes.

“忽視社會和種族敏感性的疫苗接種政策缺乏公眾支持，即使它們有很強的證據(jù)基礎。”研究小組寫道。

This isn't always as simple as a staunch opposition to vaccinating. Many parents are simply delaying vaccination schedules as life's other challenges take priority.

這并不總是像堅決反對接種疫苗那么簡單。許多父母只是簡單地推遲了疫苗接種計劃，因為生活中的其他挑戰(zhàn)占據(jù)了首位。

"Since 2017, inequity in coverage has been increasing especially in timeliness of delivery at the six-month mark, and particularly for children of Māori ethnicity and children living with socioeconomic deprivation."

“自2017年以來，覆蓋面的不平等現(xiàn)象不斷增加，尤其是在6個月大的時候，對少數(shù)民族兒童和社會經(jīng)濟貧困兒童而言更是如此。”

With opposition to vaccines on the rise and the usual communication measures failing, governments are increasingly turning to fines or other punitive measures to push vaccination rates back up.

隨著反對接種疫苗的呼聲越來越高，而通常的溝通措施也失敗了，各國政府越來越多地轉向罰款或其他懲罰性措施，以推高疫苗接種率。
A choice between a jab and a fine is enough to motivate many parents into visiting their nearest medical clinic.

在注射和罰款之間做出選擇，足以激勵許多父母去最近的診所就診。

That might nudge up the vaccination rates, but it might not be enough to hit the golden 95 percent mark across all demographics that keeps pathogens at bay. And for some community sectors, perceptions of autonomy and equity make all the difference when it comes to acting.

這可能會推高疫苗接種率，但這可能還不足以達到95%的黃金指標，在所有人口統(tǒng)計數(shù)據(jù)中都能將病原體擋在門外。對一些社區(qū)部門來說，自治和公平的觀念在行動方面起著至關重要的作用。

For those facing money challenges, a financial penalty could lose its impact. If they're unable to pay the fine, there's not only less incentive to vaccinate, there's added animosity and mistrust.

對于那些面臨金錢挑戰(zhàn)的人來說，罰款可能會失去它的影響。如果他們無力支付罰款，不僅接種疫苗的積極性會減少，還會增加敵意和不信任。

"Accumulative and negative effect on the family's wellbeing could lead to further hardship and social exclusion," the researchers write.

“對家庭健康的累積和負面影響可能導致進一步的困難和社會排斥。”研究人員寫道。

Mandatory vaccinations also cost a lot in resources, chasing up penalties often for little gain.

強制接種疫苗也需要大量的資源，往往收效甚微。

If facts and fines won't move people, though, what will? The researchers emphasise the importance of having healthcare workers who identify with a community and are able to build trust.

如果事實和罰款都不能打動人們，那還有什么能呢?研究人員強調了讓醫(yī)療工作者認同一個社區(qū)并能夠建立信任的重要性。

"Vaccination advocates with similar backgrounds to the target population can help to increase trust and acceptance," they write.

他們寫道：“與目標人群背景相似的疫苗接種倡導者，可以幫助增加信任和接受度。”

There's no simple, one-size-fits-all solution when it comes to convincing parents to immunise their families.

在說服父母給他們的家庭接種疫苗上，沒有一個簡單、一刀切的解決方案。

Vaccination is an emotional topic that polarises populations – but when the consequences are a matter of life and death, sometimes we need to ditch the stick and hold out a hand instead.

疫苗接種是一個情緒化的話題，它使人群兩極分化，但當后果是生死攸關時，有時我們需要丟掉棍子，轉而伸出援助之手。

This research will be published in the New Zealand Medical Journal.

這項研究將發(fā)表在《新西蘭醫(yī)學雜志》上。