Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Lancet. 2011 Aug 6;378(9790):526-35. doi: 10.1016/S0140-6736(11)60678-8. Epub 2011 Jun 12.
Vaccines--often lauded as one of the greatest public health interventions--are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk-benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.
疫苗——常被誉为最伟大的公共卫生干预措施之一——正在失去公众的信任。一些疫苗专家将这种信心的下降称为危机。我们讨论了导致公众对疫苗越来越质疑的一些不断变化的全球环境特征，并概述了公众信任的一些具体决定因素。公众对疫苗接种的决策不仅受科学和经济证据的驱动，还受心理、社会文化和政治因素的混合驱动，所有这些因素都需要政策制定者和其他决策者理解并考虑在内。公众对疫苗的信任度差异很大，建立信任度取决于对疫苗和疫苗风险的看法、历史经验、宗教或政治派别以及社会经济地位的理解。尽管提供有关疫苗风险效益比的准确、基于科学的证据至关重要，但这不足以弥补当前公众对疫苗的信心水平与确保充分和持续疫苗接种覆盖率所需的信任水平之间的差距。我们呼吁开展更多研究，不仅要研究公众信任的个别决定因素，还要研究哪些因素组合最有可能维持公众信任。疫苗界在推出新疫苗时，要求疫苗功效和安全性以及技术和操作可行性方面具有严格的证据，但在要求同样严格的研究以了解影响公众对疫苗信任的心理、社会和政治因素方面一直疏忽大意。
