当国家变得富裕时，孩子们可能会失去疫苗

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.

你可能会认为，随着一个贫穷的国家变得更加富裕，更多的儿童会接种小儿麻痹症、麻疹和肺炎等可预防疾病的疫苗。

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

但本月发表在《自然》杂志上的一篇综述发表了不同的观点。

"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.

“那些非常贫穷的国家得到了很多疫苗接种的支持，真正富裕的国家无论如何都有能力购买疫苗。”伦敦卫生与热带医学学院疫苗中心主任贝亚卡普曼说，他也是这篇综述的作者。

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，她说，“中等收入国家的情况很棘手，因为他们没有资格获得支持，但他们不一定有财力和稳定性来购买疫苗。”

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.

疫苗联盟Gavi的战略和绩效主任阿德里安表示同意:“越来越多的弱势群体生活在中等收入国家。”全球疫苗和免疫联盟(Gavi)是一家帮助购买和分发疫苗的国际非营利组织。该组织预计，到2030年，全球70%的未接种免疫的儿童将生活在中等收入国家。

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、印度尼西亚和尼日利亚是2018年缺乏基本疫苗的儿童最多的10个国家之一——例如，在1岁之前接种预防白喉、破伤风和百日咳的疫苗。

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.

这些国家中的每一个都符合世界银行对中等收入国家的定义：平均年收入(称为人均国民总收入)在1，026美元至12，375美元之间。仅在尼日利亚，就有300万儿童接种疫苗不足。这是世界上缺少关键疫苗的儿童总数的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，根据全球卫生研究人员的说法，贫穷国家的疫苗接种率可能很高。例如，尽管卢旺达的国民收入指数(GNI)为每人780美元，但现在儿童疫苗的覆盖率已接近全球水平，与一些最富裕的国家相当。

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.

但总体而言，一旦一个国家达到三年人均国民总收入超过1580美元的门槛，全球疫苗和免疫联盟的支持就会逐渐减少。尽管这些国家的财富有所增加，但它们并不总是选择资助儿童接种疫苗。

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.

安哥拉是疫苗接种率最低的中等收入国家之一。钻石和石油帮助该国摆脱了低收入状态，该国总统是亿万富翁。然而，据估计，2018年有30%到40%的儿童没有接种基本疫苗。

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.

疫苗接种率的滞后是由许多原因造成的。坎普曼说:“中等收入国家的名单很多，但它们并不完全相同。

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，联合国儿童基金会安哥拉儿童生存与发展项目前负责人阿格博说，安哥拉领导层没有为免疫项目提供全部资金。阿格博将其归咎于深陷腐败、金融管理不善和大量债务的政治体制。

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."

所以增加医疗预算是很困难的。“初级卫生保健并不吸引人，”他说。“人们对建立医院和专业中心感兴趣，而不是对投资预防保健感兴趣。”