Geelen Els, van Vliet Hans, de Hoogh Pieter, Horstman Klasien
Dep. Health, Ethics and Society, Research School Public Health and Primary Care (Caphri), Faculty Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
Soc Sci Med. 2016 Mar;153:12-9. doi: 10.1016/j.socscimed.2016.01.051. Epub 2016 Feb 2.
In the context of international public debates on vaccination the National Institute for Public Health and the Environment (RIVM), the Dutch public health body responsible for the National Immunization Programme (NIP), fears that the high vaccination rate of children in the Netherlands obscures the many doubts and criticisms parents may have about vaccination. The question arises as to how the robustness of this vaccination rate and the resilience of the NIP can be assessed. To answer this question, we explore the vaccination practices and relationships between professionals and parents using qualitative methods. Drawing on Hirschman's concepts of exit, voice and loyalty, we distinguish between two different approaches to vaccination: one which enforces parental loyalty to the vaccination programme, and one which allows for voice. The analysis shows that due to their lack of voice in the main vaccination setting, parents' considerations are unknown and insight into their loyalty is lacking. We argue that the Dutch vaccination programme is caught between the insecurity of enforced parental loyalty to the NIP and the insecurity of enabling parental voice and negotiating space. We conclude that to increase the resilience of the NIP, experimenting with voice and exit is inevitable.
在国际上关于疫苗接种的公开辩论背景下，负责国家免疫规划（NIP）的荷兰公共卫生机构——国家公共卫生和环境研究所（RIVM）担心，荷兰儿童的高疫苗接种率掩盖了父母对疫苗接种可能存在的诸多疑问和批评。问题在于如何评估这一疫苗接种率的稳健性以及国家免疫规划的恢复力。为回答这个问题，我们运用定性方法探究疫苗接种实践以及专业人员与父母之间的关系。借鉴赫希曼的退出、发声和忠诚概念，我们区分了两种不同的疫苗接种方式：一种是强制父母对疫苗接种计划保持忠诚，另一种是允许父母发声。分析表明，由于父母在主要疫苗接种环境中缺乏发声渠道，他们的顾虑不为人知，对其忠诚度也缺乏了解。我们认为，荷兰的疫苗接种计划陷入了两难境地，一方面是强制父母对国家免疫规划保持忠诚所带来的不安全感，另一方面是让父母发声并给予协商空间所带来的不安全感。我们得出结论，为提高国家免疫规划的恢复力，尝试发声和退出是不可避免的。
