A wakeup call

2015年，CNN运行Astoryabout 500 parents arrested in Pakistan for polio vaccine refusal. To most of us practicing in this environment, the episode was a wakeup call on the ramifications of omitting to educate, and convince, every parent to vaccinate their children on each patient contact. If physicians failed to engage every household in making this decision, will they then be arrested?

我们经常假设接种疫苗的好处是固有的知识。甚至高度识字的人群也有一定比例的疫苗拒绝，尽管由于不同的担忧。这充分证明需要在公众中灌输疫苗接种益处。缺乏这些努力，要责怪公众不知道的任何行动（尤其是识字率较低的地方）是不公平的。尽管受过教育，但有些人仍然可能不会选择接种疫苗。这是因为知识不相等。但是，如果没有知识，我们不能努力改变信念。

甚至高度识字的人群也有一定比例的疫苗拒绝，尽管由于不同的担忧。这充分证明需要在公众中灌输疫苗接种益处。

海蒂·拉尔森（Heidi Larson）在疫苗拒绝或疫苗犹豫不决方面有大量工作，并且该问题已突出显示这里,这里, and这里。关于如何促进公众接受疫苗接收的有价值的建议。

Eventually all of those arrested in Pakistan received bail on pledging to vaccinate their children. One would assume, however, that drastic measures such as these would be necessary only as a last resort and after every stone has been turned to educate the public on the pros of vaccination. Not so. Sadly, this is one area where vaccination programs in resource-limited tropical and sub-tropical countries falter.

我们为什么还在挣扎？

Most governments would wager that their immunization plans run as perfectly orchestrated programs. That may be true of the logistics, but is not the case with vaccine awareness. Most programs do not set aside budgets for education and awareness. As most mobilized funding comes from international agencies like GAVI, and very little local funds are generated – despite which many funding gaps remain – advocacy is frequently side-lined in favor of operational budgets. The immediate priority for many immunization programs is to invest in delivery mechanisms, but not the final step: actually making sure children receive the vaccines.

同样，人们会假设国家应该能够在没有巨大的倡导预算的情况下进行教育，对吗？似乎是什么资金，完成的。如果没有在国际议程中搁置钱来完成工作，那就不会发生。

即使搁置了钱，也必须有政治意愿才能通过免疫和宣传运动。由于资金和资源的滥用，许多资源有限的国家继续处于经济增长不良的恶性循环中。对目标的政治承诺是覆盖这一目标并确保适当使用资金的唯一方法。

即使搁置了钱，也必须有政治意愿才能通过免疫和宣传运动。

Another generally held view among public health officials is that vaccinators should be able to educate and convince parents to vaccinate. This again is an imbalanced view, as vaccinators who are supposed to cover 15 households everyday cannot be relied upon to deliver all components of a vaccination program. Many programs already have limited resources and inadequate workforce. Vaccinator mobility and security are also significant hurdles to delivery of vaccines to willing parents.

A harmonized approach

Many vaccination programs focus predominantly on delivery infrastructure, and while this is an important aspect of vaccines, including supply chains, and door-to-door delivery, we have been told that you can lead a horse to water, but cannot make him drink. Or can you? There are proven techniques to increase acceptance of vaccines among the community. One way is by conditional cash transfers (CCTs), but many more have been advocated and tried in different situations. But there is always another mountain to climb…in areas where CCTs have been successfully used, vaccine stocks have often run out!
因此，需要的是一种统一的教育和交付方法，以及一个没有另一个人就无法生存的计划的认可。

Vaccines are the most potent weapons we have against infections. While we strive to develop more and better vaccines, we also need to ensure that communities are engaged and invested in making vaccination programs successful. If we want to go far, we have to travel together.