Boas Hagai, Rosenthal Anat, Davidovitch Nadav
The Edmond J. Safra Center for Ethics, Tel Aviv University, Tel Aviv, Israel.
The Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
Isr J Health Policy Res. 2016 Dec 21;5:64. doi: 10.1186/s13584-016-0119-y. eCollection 2016.
During the summer of 2013, after samples of poliomyelitis virus were found in sewage, Israel launched an intensive national oral polio vaccine (OPV) campaign. The clinical objective of the campaign was rather clear. With not a single case of infantile paralysis and with a population already highly protected with IPV (a dead version of the vaccine), the goal was to foster collective immunity so that risk populations could also be protected. This, however, entailed a rather unusual issue: how to persuade parents whose children already received an IPV to re-vaccinate their children, now with a live yet attenuated version of the virus that was excluded from the national vaccination program in 2004. The challenge therefore was a call for social solidarity - asking parents to vaccinate their children mainly for the sake of protecting unknown at risk populations and to take part in the larger global goals of the polio eradication program. This challenge stands at the core of our investigation. We see the OPV campaign of summer 2013 as a good case study of the tension between individualism and social solidarity in seeking the cooperation of the public.
We draw on a qualitative study that included participant observation, document reviews and interviews with policy-makers, parents, journalists, public health experts and community leaders. These data were analyzed in order to unravel the ways in which self-interest, community and solidarity were conceived by different agents during the vaccination campaign.
The family as a metaphor for social solidarity was the main discursive item in the public campaign. Tensions, dissonances and inconsistencies were found between different registers and agencies as to what is at stake and what is required.
We discuss the ethical and social implications of our findings in order to better understand how persuasion was used in the current case and for its future role in similar events, within and outside Israel, when global efforts to eradicate polio are ongoing.
2013年夏天，在污水中发现脊髓灰质炎病毒样本后，以色列发起了一场全国性的强化口服脊髓灰质炎疫苗（OPV）接种运动。该运动的临床目标相当明确。由于当时没有一例小儿麻痹症病例，且该国人口已经通过接种灭活脊髓灰质炎疫苗（IPV）获得了高度保护，所以目标是建立群体免疫，以便也能保护高危人群。然而，这带来了一个相当特殊的问题：如何说服那些孩子已经接种过IPV的家长，让他们现在用一种活病毒但已减毒的疫苗再次为孩子接种，而这种疫苗在2004年被排除在国家疫苗接种计划之外。因此，这一挑战是呼吁社会团结——要求家长主要为了保护未知的高危人群而给孩子接种疫苗，并参与到根除脊髓灰质炎计划的更大全球目标中。这一挑战是我们调查的核心。我们将2013年夏天的OPV接种运动视为在寻求公众合作时个人主义与社会团结之间紧张关系的一个很好的案例研究。
我们借鉴了一项定性研究，该研究包括参与观察、文件审查以及对政策制定者、家长、记者、公共卫生专家和社区领袖的访谈。对这些数据进行分析，以揭示在疫苗接种运动期间不同行为主体对自身利益、社区和团结的理解方式。
将家庭作为社会团结的隐喻是公众运动中的主要话语内容。在不同的记录和机构之间，就利害关系和所需措施存在紧张关系、不一致和不协调之处。
我们讨论了研究结果的伦理和社会影响，以便更好地理解在当前案例中如何运用劝导手段，以及在全球根除脊髓灰质炎努力持续进行的情况下，劝导手段在以色列国内外类似事件中的未来作用。
