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，自引入麻疹疫苗以来，估计挽救了1710万人的生命，本世纪初与麻疹相关的死亡人数为54.6万人，到2014年为11.49万人(世卫组织2015年)。自19世纪詹纳和帕斯卡尔的工作以来，疫苗接种在医学上取得了成功，同时也出现了疫苗耐药性的培养。正如Wolfe(2002)在他们对19世纪反疫苗运动的研究中所述，英国议会通过了1853年的《疫苗法案》，该法案强制要求所有出生后三个月的婴儿接种疫苗，违反者将受到罚款或监禁的处罚。这项法律通过后，伴随着反疫苗运动的激烈运动，发生了暴力骚乱。正如伍尔夫总结他们的回顾时所说的那样，“这种反对始于第一次疫苗接种，并没有停止，很可能永远也不会……[它]不会离开我们，也不能仅靠武力来治愈”。机构和民众之间的关系、信息实践和个人权利是疫苗接种的核心。正如Berezin和Eads所说，接种疫苗既是一种社会行为，也是一种医疗行为。当代的担忧不仅呼应了公民、医疗保健和国家之间的关系，而且深入参与了信息实践的变化和社会动态，这错综复杂地构成了疫苗接种的社会性。人类乳头瘤病毒(HPV)疫苗尤其如此，它涉及一系列独特的交叉问题。人乳头瘤病毒是世界上最普遍的性传播感染(STI)之一。虽然在许多情况下它仍然没有症状，但16型和18型HPV导致了一系列癌症(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，每年还会新增1400万人。同样，每年有4000例HPV相关癌症的诊断(德克萨斯州卫生与人类服务委员会2016年)。最近，HPV疫苗受到了全球公众关注的激增。另一个备受瞩目的案例最引人注目的案例之一发生在2008年，当时德克萨斯州州长里克·佩里试图使用Gardrasil为学龄女孩接种疫苗。社会保守派表示担心，疫苗使性乱行为合法化并鼓励性行为，而与疫苗制造商密切关系的证据带来了对企业利益的进一步批评(Eggen 2011)。这些担忧并不是德克萨斯或美国独有的。POP(2016)强调了罗马人与HPV疫苗关系中的纯洁和腐败，同时指出了全国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，这是其他疫苗都没有做到的”(同上，第564页)，强调指出，“在年轻女孩的生活中引起性传播感染的可能性与她们所代表的清白相矛盾”(同上，第568页)。对副作用的担忧也很重要；日本在2015年撤回了对HPV接种疫苗的建议(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)。在其他背景下，更局部性的社会差异正在发挥作用--研究重点是美国不同种族群体之间HPV疫苗接种率的差异(BurDette等人)。2016年；Galbraith等人2016年)。这类研究突出了对“植根于文化的替代理论框架”的持续需求(Galbraith等人)。2016，第123页)。

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).