
2015年8月7日,多哥洛美的一个孩子正在接种乙型肝炎疫苗。
A child receives a hepatitis B vaccine in Lomé, Togo, on 7 August 2015.
由小罗伯特·F·肯尼迪大力推崇的争议性疫苗试验已获几内亚比绍批准。丹麦研究人员计划对数千名新生儿推迟接种乙型肝炎疫苗。一项将从部分非洲新生儿中暂停接种乙型肝炎疫苗的争议性研究试验,本周获得了继续推进的批准。
Controversial vaccine trial touted by RFK Jr gets go-ahead in Guinea-Bissau Recommended dose of hepatitis B vaccine will be withheld from thousands of newborns by Danish researchers A controversial research trial that will withhold hepatitis B vaccines from some African newborns was given approval to move forward this week.
这项试验是小罗伯特·F·肯尼迪疫苗理念的核心内容。他是美国卫生与公众服务部(HHS)的部长,也是一位长期反对疫苗的人士。
It is a central part of the vaccine vision for Robert F Kennedy Jr the secretary of the US Department of Health and Human Services (HHS) and a longtime vaccine opponent.
在上个月的一场反疫苗会议上,肯尼迪赞扬了这项试验的丹麦研究人员,并称赞美国支持的关于新生儿乙型肝炎的研究,称其体现了特朗普政府在疫苗问题上的议程——包括大幅削减疫苗推荐,并对疫苗的安全性和有效性提出质疑。
At an anti-vaccine conference last month, Kennedy praised the Danish researchers behind the trial and touted US-supported research on hepatitis B in newborns as exemplifying the Trump administration’s agenda for vaccines, which has included slashing vaccine recommendations and casting doubt on the safety and effectiveness of shots.
费城儿童医院的传染病医生保罗·奥菲特表示:“肯尼迪希望我们在这个国家不再使用出生时接种的疫苗剂量。这就是他的目标。”奥菲特补充说,由于存在严重的伦理问题,肯尼迪永远不可能在美国开展这项试验。“他正在利用一个发展中国家……难道是因为非洲儿童比这里的儿童更容易被牺牲吗?”丹麦研究人员计划在几内亚比绍招募1.4万名婴儿参与试验,其中一半婴儿在出生时接种乙型肝炎疫苗,另一半则在出生后的前六周内暂停接种。
Kennedy “wants to make it so we don’t use a birth dose here in this country,” said Paul Offit, an infectious disease physician at Children’s Hospital of Philadelphia. “That’s the goal.”Kennedy would never be able to do the trial in the US because of its significant ethical concerns, Offit added. “He’s taking advantage of a developing country … Is it because children in Africa are more expendable than children here?”Danish researchers plan to enroll 14,000 infants in Guinea-Bissau in the trial, giving the hepatitis B vaccine to half of the babies at birth and withholding it from the others for the first six weeks of life.
本周,研究人员所属的南丹麦大学伦理委员会投票决定推进该试验。几内亚比绍的官员也批准了该项目。此前,该国卫生部长金欣·南托特曾表示,由于今年早些时候引发的国际争议,该项目已被暂停。
An ethics committee at the researchers’ home institution of the University of Southern Denmark voted this week to proceed with the trial, and officials in Guinea-Bissau have also greenlit the project, which the health minister, Quinhin Nantote, initially said was suspended after international uproar earlier this year.
斯蒂格·博尔森·汉森是该研究的创始成员之一,也是向丹麦委员会提交该研究的两位评审员之一。周五,他因抗议该研究中存在的重大伦理问题而辞去小组职务。
Stig Børsen Hansen, a founding member who was one of two reviewers who presented the study to the Danish committee, resigned from the group in protest on Friday, citing major ethical issues with the study.
汉森表示:“你们现在正在将新生儿纳入一场抽奖,以验证一个假设。”那些被随机选中无法获得疫苗出生剂量的儿童——也就是“输掉抽奖”的孩子们——在他们出生后的最初几天里,面临着感染乙型肝炎的风险,而这种感染可能对其造成不可逆转的终身损害。汉森指出:“他们在参与一个研究项目的过程中感染了乙型肝炎”,这意味着他们的感染实际上“是有意为之的”。该委员会的其他三名成员也相继辞职以示抗议。
“You are now enrolling newborns in a lottery to test a hypothesis,” Hansen said. The children who are randomly selected not to receive the birth dose of the vaccine, those who “lost the lottery”, face in their earliest days the risk of contracting hepatitis B, which can cause irreversible lifelong damage. “They contract hepatitis B in the context of being part of a research project,” Hansen said, which made their infection happen, in effect, “by design”. Three other members of the committee have also resigned in protest.
据报道,美国疾病控制与预防中心(CDC)已在今年的预算中为该项目预留了160万美元,并将由亿万富翁活动家比尔·阿克曼共同创立的珀尔辛格广场基金会以及蓝钟基金会提供的私人资金进行配套。
The US Centers for Disease Control and Prevention (CDC) has reportedly set aside $1.6m in this year’s budget for the project, and it will be matched with private funding from the Pershing Square Foundation, which was co-founded by the billionaire activist Bill Ackman, and the Bluebell Foundation.
CDC、丹麦研究人员、珀尔辛格广场基金会以及Nantote方面均未回应《卫报》关于此次试验的提问。
The CDC, the Danish researchers, Pershing Square and Nantote have not responded to the Guardian’s questions about this trial.
周四,CIDRAP News首次报道了该试验已获得丹麦伦理委员会批准的消息。此次披露了更新后的方案细节,这也是首次公开相关信息。
The news that the trial was approved by the Denmark ethics committee was first reported on Thursday by CIDRAP News This is the first time details of the updated protocol have been disclosed.
根据向《卫报》提供的细节,几内亚比绍的研究方案自今年1月发布以来已经发生了变化。研究人员现在将在母亲分娩前对她们进行乙型肝炎检测。检测呈阳性的母亲所生的婴儿将获得疫苗,并且不会被纳入试验。但检测呈阴性的母亲所生的婴儿则可能被纳入试验。新的方案尚未向公众公开。
The Guinea-Bissau study protocol has changed since it was posted in January, according to details shared with the Guardian. The researchers will now test mothers for hepatitis B before they give birth. The babies of mothers who test positive will be given the vaccine and will not be included in the trial. But the babies of mothers whose tests are negative may be enrolled. The new protocol has not been shared publicly.
在以往的研究中,感染乙型肝炎的儿童中有一半是在出生后因社区接触而感染的。“这种病毒可以通过日常接触传播,”奥菲特说道。它可以在物体表面存活长达七天,并且通过共用洗脸巾、牙刷和指甲剪而感染。此外,乙型肝炎检测存在5%的假阴性率,这可能会让分娩时的父母错误地认为自己没有感染该病毒。
In previous research, half of children who contracted hepatitis B did so after birth, through community exposures. “This virus can be transmitted casually,” Offit said. It can live on surfaces for up to seven days, and it can be acquired by sharing washcloths, toothbrushes and fingernail clippers. In addition, the hepatitis B test has a 5% false negative rate, which could provide false assurance that a birthing parent does not have the virus.
数十年的研究清楚地表明,接种疫苗将带来益处,因此将部分儿童置于接种组,而另一些儿童置于未接种组是不公平的,丹麦奥胡斯大学的统计学与药物计量学教授亨里克·斯托夫林说道。根据《赫尔辛基宣言》,国际医学研究必须获得主办国和赞助国伦理委员会的批准。
Decades of research make it clear that the vaccine would be beneficial, which means it would be unfair to place some children in the vaccinated group and some children in the unvaccinated group, said Henrik Støvring, a professor of statistics and pharmacometrics at Aarhus University in Denmark According to the Helsinki declaration, international medical research must be approved by ethics committees in both the host and sponsor countries.
丹麦南部大学的丹麦研究伦理委员会此前从未考虑过医学研究,但为了对这项研究进行投票,他们修改了规则。尽管具有专业知识的委员会成员反对批准该研究,但多数成员还是决定推进该项目。
The Danish research ethics committee at the University of Southern Denmark had never considered medical studies before, but it changed the rules in order to vote on this one. While committee members with expertise argued against approving it, the majority ruled to move forward.
“将这样的研究提交给这样一个委员会,是非常罕见的,”斯托夫林说道。丹麦的国家伦理委员会负责监督医学研究,但由于这项研究不会在丹麦进行,因此超出了他们的管辖范围。
“It’s very unusual to bring this into a committee like that,” Støvring said. The national ethics committee in Denmark oversees medical research, but this study was outside of their purview because it won’t take place in Denmark.
然而,“我不明白为什么不能在丹麦进行这项试验,”斯托夫林说道。事实上,有几个条件使丹麦成为更合适的地点。在丹麦,除非母亲病毒检测呈阳性,否则通常不会给新生儿接种乙型肝炎疫苗,而丹麦对所有孕妇都会进行病毒检测。
Yet “I don’t see why you couldn’t do it in Denmark,” Støvring said of the trial. In fact, several conditions make it a better location. The hepatitis B vaccine is not usually given to newborns in Denmark unless the mother is positive for the virus, for which all pregnant people are tested in Denmark.
几内亚比绍的乙型肝炎发病率位居世界前列,约18%的成年人携带该病毒。虽然病毒可能在出生时由母亲传染给婴儿,但也可能通过其他父母、亲属、兄弟姐妹或看护人传播。在出生第一年内感染乙型肝炎的儿童,出现严重后果(包括慢性感染和肝癌)的风险显著更高。
Guinea-Bissau has some of the highest rates of hepatitis B in the world, with about 18% of adults carrying the virus. While it may be transmitted from mother to child during birth, it could also be transmitted from another parent, relatives, siblings or caregivers. Children who are infected with hepatitis B in the first year of life are significantly more likely to develop severe outcomes, including chronic infection and liver cancer.
由丹麦研究人员彼得·阿比(Peter Aaby)和克里斯汀·斯塔贝尔·本(Christine Stabell Benn)主导的班迪姆健康项目(Bandim Health Project)已在几内亚比绍运作数十年,并与该国卫生系统紧密融合。至少有一位高级官员——现任公共卫生部长——直到去年12月仍同时担任班迪姆项目的职务。
The Bandim Health Project, run by Danish researchers Peter Aaby and Christine Stabell Benn, has operated in Guinea-Bissau for decades and is closely enmeshed in the country’s health system. At least one top official, the current director of public health, held a dual appointment with Bandim as recently as December.
在最近的一场反疫苗会议上,肯尼迪称赞了这些丹麦研究人员,称他们为“疫苗研究的众神”。肯尼迪声称,他们此前进行的一项研究表明,接种疫苗后,“可能会出现大规模伤害和灾难性伤害,而这些伤害就隐藏在明处”。但他并未提及,同一研究团队的另一项后续研究并未发现任何影响。
Kennedy praised the Danish researchers at a recent anti-vaccine conference, calling them “the deities of vaccine research”. Kennedy claimed that a prior study they conducted indicated that after vaccination, “you can have mass injuries, and catastrophic injuries, and they’re hiding in plain sight.”He did not mention that another follow-up study from the same researchers found no effects at all.
这项研究将聚焦于疫苗接种与死亡率,以及皮肤疾病和神经发育问题等健康结果。斯托夫林(Støvring)表示:“这项试验的主要问题是,它针对一些众所周知的严重疾病,而这些疾病正是该疫苗可以预防的。但他们接下来想要研究的却是一些高度推测性的内容——尤其是在世卫组织及其他机构明确建议应在出生时立即接种该疫苗的情况下。”
This study will focus on vaccination and mortality, as well as outcomes such as skin conditions and neurodevelopmental conditions. “The main problem of this trial is that you have some very well-known bad diseases that you can protect with this vaccine,” Støvring said. “And what they then want to study is something highly speculative – in a situation where WHO and others are saying that you should give this vaccine at birth, period.”
在周四的一次简报会上,曾反对该试验的非洲疾控中心(Africa CDC)一名官员在被问及这项研究时表示,美国与几内亚比绍之间正在“持续讨论”,更多细节将很快公布。几内亚比绍原计划于2027年开始为所有新生儿接种乙型肝炎疫苗,但已将这一计划推迟至2028年。
When asked about the study in a Thursday briefing, an official with the Africa CDC, which has opposed the trial, said there were “ongoing discussions” between the US and Guinea-Bissau and more details would be shared shortly. Guinea-Bissau planned to begin vaccinating all newborns against hepatitis B in 2027, but they pushed the campaign back to 2028.
奥菲特表示,肯尼迪和丹麦研究人员“利用标准护理措施实施过程中的延迟,对这些儿童造成了不必要的风险”。“这真是令人发指的行为。如此不道德且残忍的做法。”
Kennedy and the Danish researchers were “taking advantage of that delay in practicing standard care to put these children at risk unnecessarily”, Offit said. “What a terrible thing to do. What a horribly unethical and cruel thing to do.”