當國家變得富裕時，孩子們可能會失去疫苗

當國家變得富裕時，孩子們可能會失去疫苗

You'd think that as a poor country grows wealthier, more of its children would get vaccinated for preventable diseases such as polio, measles and pneumonia.

你可能會認為，隨著一個貧窮的國家變得更加富裕，更多的兒童會接種小兒麻痹癥、麻疹和肺炎等可預防疾病的疫苗。

But a review published in Nature this month offers a different perspective.

但本月發(fā)表在《自然》雜志上的一篇綜述發(fā)表了不同的觀點。

"The countries that are really poor get a lot of support for the vaccinations. The countries that are really rich can afford to pay for the vaccines anyway," says Beate Kampmann, director of the Vaccine Centre at the London School of Hygiene & Tropical Medicine and author of the review.

“那些非常貧窮的國家得到了很多疫苗接種的支持，真正富裕的國家無論如何都有能力購買疫苗。”倫敦衛(wèi)生與熱帶醫(yī)學學院疫苗中心主任貝亞卡普曼說，他也是這篇綜述的作者。

But, she says, "the middle-income countries are in a tricky situation because they don't qualify for support, yet they don't necessarily have the financial resources and stability to purchase the vaccines."

但是，她說，“中等收入國家的情況很棘手，因為他們沒有資格獲得支持，但他們不一定有財力和穩(wěn)定性來購買疫苗。”

Adrien, director of strategy and performance at Gavi, the Vaccine Alliance, agrees: "More and more vulnerable populations live in middle-income countries." Gavi, an international nonprofit that helps buy and distribute vaccines, projects that 70% of the world's under-immunized children will live in middle-income countries by 2030.

疫苗聯(lián)盟Gavi的戰(zhàn)略和績效主任阿德里安表示同意:“越來越多的弱勢群體生活在中等收入國家。”全球疫苗和免疫聯(lián)盟(Gavi)是一家?guī)椭徺I和分發(fā)疫苗的國際非營利組織。該組織預計，到2030年，全球70%的未接種免疫的兒童將生活在中等收入國家。

Brazil, India, Indonesia and Nigeria were among the 10 countries with the most children who lacked basic vaccinations in 2018 — for example, shots to prevent diphtheria, tetanus and pertussis by age 1.

巴西、印度、印度尼西亞和尼日利亞是2018年缺乏基本疫苗的兒童最多的10個國家之一——例如，在1歲之前接種預防白喉、破傷風和百日咳的疫苗。

Each of those countries meets the World Bank's definition of a middle-income country: an average annual income (known as the gross national income, or GNI, per capita) between $1,026 and $12,375. In Nigeria alone, 3 million kids are undervaccinated. That's 15% of the world's total of children who lack key vaccinations.

這些國家中的每一個都符合世界銀行對中等收入國家的定義：平均年收入(稱為人均國民總收入)在1，026美元至12，375美元之間。僅在尼日利亞，就有300萬兒童接種疫苗不足。這是世界上缺少關鍵疫苗的兒童總數(shù)的15%。

By contrast, vaccination rates can be high in poor countries, according to global health researchers. Rwanda, for instance, despite having a GNI of $780 per person, now has a near-universal coverage rate for childhood vaccines, on par with some of the wealthiest countries.

相比之下，根據(jù)全球衛(wèi)生研究人員的說法，貧窮國家的疫苗接種率可能很高。例如，盡管盧旺達的國民收入指數(shù)(GNI)為每人780美元，但現(xiàn)在兒童疫苗的覆蓋率已接近全球水平，與一些最富裕的國家相當。

But in general, once a country reaches a GNI per capita threshold over $1,580 for three years, support from Gavi tapers off. And despite their improved fortunes, countries don't always choose to fund childhood vaccines.

但總體而言，一旦一個國家達到三年人均國民總收入超過1580美元的門檻，全球疫苗和免疫聯(lián)盟的支持就會逐漸減少。盡管這些國家的財富有所增加，但它們并不總是選擇資助兒童接種疫苗。

Angola is among the middle-income countries with the lowest vaccination rates. Diamonds and oil have helped propel the country out of low-income status, and its president is a billionaire. Yet an estimated 30% to 40% of children there did not receive basic vaccines in 2018.

安哥拉是疫苗接種率最低的中等收入國家之一。鉆石和石油幫助該國擺脫了低收入狀態(tài)，該國總統(tǒng)是億萬富翁。然而，據(jù)估計，2018年有30%到40%的兒童沒有接種基本疫苗。

The lag in vaccination rates is caused by any number of reasons. "There's a whole list of middle-income countries, and they're not all the same," says Kampmann.

疫苗接種率的滯后是由許多原因造成的。坎普曼說:“中等收入國家的名單很多，但它們并不完全相同。

For example, Sam Agbo, former chief of child survival and development for UNICEF Angola, says Angola's leadership does not fully fund immunization programs. Agbo blames a political system that he says is mired in corruption, financial mismanagement and lots of debt.

例如，聯(lián)合國兒童基金會安哥拉兒童生存與發(fā)展項目前負責人阿格博說，安哥拉領導層沒有為免疫項目提供全部資金。阿格博將其歸咎于深陷腐敗、金融管理不善和大量債務的政治體制。

So it's hard to increase the health care budget. "Primary health care is not sexy," he says. "People are interested in building hospitals and specialized centers rather than investing in preventive care."

所以增加醫(yī)療預算是很困難的。“初級衛(wèi)生保健并不吸引人，”他說。“人們對建立醫(yī)院和專業(yè)中心感興趣，而不是對投資預防保健感興趣。”