预防接种异常反应：风险的社会扩大和社会管理

Addressing the issue of adverse events following immunization (AEFI) is a critical challenge for vaccination across the globe. The rare cases of AEFI can possibly lead to huge negative consequences and broad impact to the society, even impeding the national immunization program (NIP) in a country. Up to 2010, 19 countries and regions in the world have established AEFI no-fault compensation systems. However, the AEFI compensation policy systems in China are relatively inadequately designed. Our research team found in previous studies that due to the lack of well-organized responsibility sharing and social management mechanism for AEFI, most of the AEFI risks were passively undertaken by individuals and their families; as a response, many of these individuals and families effected by AEFI took contentious actions, which resulted in various forms of social conflicts. It is thus important to bring in a perspective of social management of risk in AEFI research and policy making. Existing research on AEFI in China has been paid little attention on the implementation of AEFI related policies, particularly from the perspectives of individuals and families affected by AEFI. We lack critical knowledge of how the attitudes and beliefs of individuals and families affected by AEFI may influence public opinion and policy implementation. Some studies have touched upon issues of public opinion disposal and risk communication in emergent vaccination cases, but not the routine AEFI risk management (for example, the AEFI compensation policy or social security systems). In this project, two key questions will be addressed: 1) The specific mechanisms and processes of the amplification of AEFI risk. Specifically, how would the negative information of the very few AEFI cases get spread and have impact on the cognition and behavior of the public, which may lead to the amplification of social risk of AEFI? 2) How to develop a risk-sharing mechanism to ensure the rights of the disadvantaged groups (AEFI-affected individuals and families) to be protected by reasonable compensation? The project will be focused on the following four parts: 1) Critical analysis of the current AEFI policies; 2) Patterns of attitudes, beliefs and risks taking behaviors of the AEFI-affected individuals and families; 3) The mechanism of the amplification of AEFI risk; 4) The possible integration of the AEFI compensation policy with other social security policies. This research will adopt a combination of quantitative and qualitative methods, including survey research, in-depth interviews, case studies and content analysis. The proposed study will be conducted between January 2014 and December 2017.

预防接种异常反应（AEFI）是公共卫生领域预防接种工作的难点问题。它是最典型的小概率、高危害风险。本项目组前期研究发现，由于缺乏良好运作的社会分担和管理机制，当前AEFI风险常被受影响者个体承担，并转化为卫生机构和政府的风险，形成个人、政府、社会三方皆输的局面。本研究结合国内外AEFI风险研究现状，提出从社会风险管理视角研究AEFI管理制度中的风险管控和补偿政策问题，以政策周期理论框架为指导对现行制度设计中可能存在的社会风险误区进行分析。研究拟综合运用文献、访谈、问卷调查、案例等研究方法收集数据，对阐明AEFI风险被放大的具体机制，揭示极个别风险事件如何播散从而对公众的认知和行为产生影响的路径有重要意义。研究将调查AEFI受影响者（家庭）的群体特征和风险负担，为探索制定低概率无过错政策风险的社会分担机制奠定基础，为AEFI补偿制度与现行社会保障体系的接轨、AEFI事件补充干预手段提供思路。

本项目组前期研究发现，由于缺乏良好运作的社会分担和管理机制，当前预防接种异常反应（AEFI）风险常被受影响者个体承担，并转化为卫生机构和政府的风险，形成个人、政府、社会三方皆输的局面。本研究综合运用文献、访谈、问卷调查、案例等研究方法收集数据，对阐明AEFI风险被放大的具体机制，揭示极个别风险事件如何播散从而对公众的认知和行为产生影响的路径有重要意义。本研究结合国内外AEFI风险研究现状，提出从社会风险管理视角研究AEFI管理制度中的风险管控和补偿政策问题。本研究认为 1。当前中国社会的”反身现代性”已经日益明显，社会公众对于传统权威的认同和服从正在降低。在中国的预防接种事业得到极大发展，疫苗研发生产等可及性问题已经基本解决的今天，中国的预防接种政策必须符合当前的社会变化趋势，及时进行治理理念的调整。不同群体（农民工，高知家庭，大学生，中学生等）存在很大的认知及行为分化。2。AEFI病例规模及合理补偿所需资金应该进行科学测算，以便配备充足合理的补偿资金。3。AEFI风险发生后，会对极少数家庭造成重大伤害，引发一系列且长时期（往往终身）的困境，且家庭都有非经济性情感诉求，而当前AEFI风险治理政策是各部门分割一次性现金的解决思路，AEFI补偿制度与现行社会保障体系不接轨，造成问题长期得不到解决，困境家庭只能诉诸于放大矛盾的激化方式求得解决。4。预防接种风险事件可以通过政府不当反应（包括过度反应）与媒体的传播对预防接种行为及信任度造成全国性影响，并且这种影响往往是长期的。而各相关方通常采取自保方法来规避风险，加强管理及减少接种，不利于我国的疾病控制及公众健康意识的提高。本研究同时提出一系列具体的政策建议。