The Epidemiology of Truth: A multi-method ethnography of HPV vaccine hesitancy in the Republic of Ireland

人们普遍认为疫苗接种是现代医学最重大的突破之一。世卫组织报告称，麻疹疫苗自推出以来挽救了约1710万人的生命，从本世纪初的54.6万人减少到2014年的11.49万人（世卫组织2015年）。自19世纪詹纳（Jenner）和帕斯卡尔（Pascale）的工作以来，在医学上疫苗接种取得成功的同时，也出现了疫苗耐药性的文化。正如Wolfe（2002）在他们对19世纪反疫苗运动的研究中所记载的那样，英国议会于1853年通过了《疫苗接种法案》，规定所有婴儿在出生后的头三个月必须接种疫苗，违者处以罚款或监禁。法律的通过引发了暴力骚乱，同时反疫苗运动也掀起了激烈的运动。正如伍尔夫总结的那样，他们的评论“这种反对从第一次接种疫苗开始，没有停止，可能永远不会……（它）不会离开我们，单靠武力也无法治愈。”机构与民众、信息实践、个人权利之间的关系是疫苗接种的核心。正如Berezin和deads所说，“接种疫苗是一种社会行为，也是一种医疗行为”。当代的关注不仅反映了公民、医疗保健和国家之间的关系，而且今天也深深涉及到信息实践和社会动态的变化，这些变化混乱地构成了疫苗接种的社会性。人乳头瘤病毒（HPV）疫苗尤其如此，它涉及一系列独特的交叉问题。HPV是世界上最普遍的性传播感染（STIs）之一。虽然在许多情况下它仍然没有症状，但16型和18型HPV会导致一系列癌症（宫颈癌、肛门癌、口咽癌、阴道癌和阴茎癌）和生殖器疣。仅在美国，就有7900万人感染了这种疾病，每年还会有1400万人新感染。同样，每年也有4000例hpv相关癌症的诊断（德克萨斯州卫生与公众服务委员会2016年）。HPV疫苗最近在全球引起了公众的高度关注。另一个引人注目的案例发生在2008年，当时德克萨斯州州长里克·佩里（Rick Perry）试图强制要求学龄女孩接种gardasil疫苗。社会保守派担心该疫苗使性滥交合法化并鼓励了性滥交，而与疫苗制造商关系密切的证据引发了对公司利益的进一步批评（Eggen 2011）。这些担忧并非德州或美国独有。Pop（2016）强调了罗马尼亚与HPV疫苗关系中的纯洁和腐败，同时注意到国家HPV疫苗接种运动的失败。正如她所说，“HPV疫苗让一些父母感到不安，这是其他疫苗无法做到的”（同上，第564页）。她强调，“在年轻女孩的生活中唤起性传播感染的可能性与她们所代表的纯真相矛盾”（同上，第568页）。对副作用的担忧也很重要；日本于2015年撤回了接种HPV疫苗的建议（Morimoto等人，2015年），而在丹麦，HPV疫苗覆盖率从1998-2000年的80%下降到2017年的17% （Skortstengaard， Thamsborg和Lynge， 2017年）。在其他情况下，更多的局部社会差异也在起作用——研究重点是美国各种族之间hpv疫苗接种率的差异（Burdette et al.2016; Galbraith et al.2016）。这些研究强调了对“基于文化的替代理论框架”的持续需求（Galbraith et al. 2016, p.123）。

It is widely remarked that vaccination is one of the most significant breakthroughs inmodern medicine. The WHO reports that the Measles vaccine saved an estimated 17.1million lives since its introduction, with 546,000 measles-related deaths at the beginningof the century to 114,900 by 2014 (WHO 2015). Alongside the success of vaccination inmedicine since the work of Jenner and Pascale in the 19th century, there has been aculture of vaccine resistance. As Wolfe (2002) documents in their study of the 19thcentury anti-vaccination movements, the UK parliament passed passing the VaccinationAct of 1853 which making immunisation mandatory for all infants in the first threemonths of life, with penalties of fine or imprisonment for non-compliance. Violent riotsfollowed the passage of the law, alongside spirited campaigning by anti-vaccinationmovements. As Woolfe conclude their review 'this opposition began with the firstvaccinations, has not ceased, and probably never will... [it] will not leave us and cannotbe cured by force alone'. The relationship between institutions and the populace,information practises, personal rights goes to the heart of vaccination. As Berezin andEads state 'vaccination is a social as well as a medical act'.Contemporary concerns not only echo those of the relationship between citizenry,healthcare and the state, but today deeply involved in shifting informational practisesand social dynamics which messily constitute the sociality of vaccination.This is particularly the case with the Human Papillomavirus (HPV) vaccine, whichinvolves a unique range of intersectional problems. HPV is one of the most widespreadsexually transmitted infections (STIs) in the world. Whilst in many cases it remainssymptomless, Type 16 and 18 HPV is responsible for a range of cancers (cervical, anal,oropharyngeal, vaginal and penile) and genital warts. In the US alone, 79 million areinfected with the disease and a further 14 million new infections occur each year. thereare likewise 4,000 diagnoses of HPV-related cancer made per year (Texas Health andHuman Services Commission 2016). The HPV vaccine has been subject to recentglobal spikes in public concern. Another high profile case One of the most high profileinstances can be found in 2008, when Texas state governor Rick Perry attempted tomandate vaccination using Gardrasil for school-age girls. Social conservatives voicedconcerns that the vaccine legitimated and encouraged sexual promiscuity, whereasevidence of a close relationship with the vaccine manufacturer brought about furthercriticism of corporate interests (Eggen 2011). These concerns are not unique to Texasor the US. Pop (2016) highlights narratives of purity and corruption in Romanianrelationships to the HPV vaccine, whilst noting the failures of national HPV vaccinationcampaigns. As she puts it, 'the HPV vaccine made some parents uneasy in ways thatno other vaccine did' (ibid, p.564) highlighting that 'to evoke the possibility of STIs in thelives of young girls was to contradict the innocence they represented' (ibid, p.568).Concerns over side effects are also significant; Japan withdrew its recommendation tovaccinate for HPV in 2015 (Morimoto et al. 2015), whereas in Denmark rates of HPVvaccine coverage have dropped as low as 17% in 2017, down from 80% full coverage in1998-2000 (Skortstengaard, Thamsborg and Lynge 2017). In other contexts, more localised social disparities are at work - with research focusing on divergences in HPVvaccination rates between ethnic groups in the US (Burdette et al. 2016; Galbraith et al.2016). Such studies highlight the ongoing need for 'alternative theoretical frameworksgrounded in culture' (Galbraith et al. 2016, p.123).