强制接种疫苗有个大问题，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，巴西里约热内卢市发生骚乱，民众暴力冲突，财产被毁，数十人受伤，30人丧生。随之人们又增加了一个对抗的公敌：一种强制性的天花疫苗。

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.

对于已经对政府当局缺乏信任的贫困公民来说，这是压垮他们的最后一根稻草。人们的反应是极端的，但它提醒人们，公共医疗在多大程度上依赖于赢得社区的“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.

公共疫苗接种项目往往是胡萝卜和大棒之间的一种谨慎的平衡。我们都喜欢对自己的身体有绝对的自由，但有些事情太冒险了，不能让个人自由决定。

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.

随着疫苗可预防疾病的激增，世界各国政府都在放下胡萝卜，拿出更大的大棒，强制接种疫苗。这些计划似乎正在发挥作用，但最近的一份报告指出，并非没有成本。

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.

新西兰医学协会的研究人员MaryNowlan、Estherwill和Nikki Turner总结了影响新西兰疫苗接种覆盖率因素的文献综述。

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.

他们报告说，尽管强制性项目收效甚微，但它们有可能进一步孤立社区中被剥夺权利的部分，使根除潜在的疾病热点变得更加困难。

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.

控制传染病是一个团队的努力。当95%的人口对病原体有效免疫时，这种疾病很容易传播的机会就变得很渺茫。

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.

尽管如此，还是不可避免地会有一些人因为身体状况或其他因素而无法获得免疫力。正因为如此，卫生当局的工作就是说服每个人，他们有责任尽可能多地通过疫苗来保护自己的身体。
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.

当局有很多方法可以做到这一点。当我们相信卫生、卫生和免疫的来源时，交流有关卫生、卫生和免疫的科学和事实是有效的。

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

不幸的是，我们交流方式的改变导致了混乱、误传，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.

研究人员说，对于社区中有信任破裂历史的部门来说，通常在免疫接种时间表上公布的公共服务公告根本无法解决这个问题。

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

“忽视社会和种族敏感性的疫苗接种政策缺乏公众支持，即使它们有很强的证据基础。”研究小组写道。

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.

这并不总是像坚决反对接种疫苗那么简单。许多父母只是简单地推迟了疫苗接种计划，因为生活中的其他挑战占据了首位。

"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年以来，覆盖面的不平等现象不断增加，尤其是在6个月大的时候，对少数民族儿童和社会经济贫困儿童而言更是如此。”

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.

随着反对接种疫苗的呼声越来越高，而通常的沟通措施也失败了，各国政府越来越多地转向罚款或其他惩罚性措施，以推高疫苗接种率。
A choice between a jab and a fine is enough to motivate many parents into visiting their nearest medical clinic.

在注射和罚款之间做出选择，足以激励许多父母去最近的诊所就诊。

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.

这可能会推高疫苗接种率，但这可能还不足以达到95%的黄金指标，在所有人口统计数据中都能将病原体挡在门外。对一些社区部门来说，自治和公平的观念在行动方面起着至关重要的作用。

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.

对于那些面临金钱挑战的人来说，罚款可能会失去它的影响。如果他们无力支付罚款，不仅接种疫苗的积极性会减少，还会增加敌意和不信任。

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

“对家庭健康的累积和负面影响可能导致进一步的困难和社会排斥。”研究人员写道。

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

强制接种疫苗也需要大量的资源，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.

如果事实和罚款都不能打动人们，那还有什么能呢?研究人员强调了让医疗工作者认同一个社区并能够建立信任的重要性。

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

他们写道：“与目标人群背景相似的疫苗接种倡导者，可以帮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.

在说服父母给他们的家庭接种疫苗上，没有一个简单、一刀切的解决方案。

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.

疫苗接种是一个情绪化的话题，它使人群两极分化，但当后果是生死攸关时，有时我们需要丢掉棍子，转而伸出援助之手。

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

这项研究将发表在《新西兰医学杂志》上。