跨國、跨媒介的健康議題傳散與輿論探討：以 HPV 疫苗為例

2006 年人類乳突病毒(HPV)疫苗問世,至今超過 80 個國家納入國家疫苗接種計畫(NIP)、約 30 個國家採取公費接種。臺灣則在 2006 年末核准 HPV 疫苗上市,由各地方政府自行編列預算推動施打,直到今年 11 月將納為國家政策,統一補助國中青少女接種。施打 HPV 疫苗的安全性、有效性、副作用與政策制定的爭議等在國外的新聞、社群網站上已被大眾廣泛討論,並引發許多研究在探討閱聽眾對此些議題的態度認知。相較之下,儘管 HPV 疫苗在國內已推動十一年,可能因為由各地方政府補助施打,沒有全臺統一政策,且施打至今未有明顯爭議事件產生的緣故,雖有相關研究卻未引起重視和討論。在 2018 年 11 月即將全國性統一補助國中青少女接種前,本研究希望透過蒐集國內主流媒體及線上社群的相關言論,借鏡國外的相關研究,觀察、分析、來了解 HPV 疫苗跨媒體的傳散情形、及其引起的輿論意見,讓政府得以在政策施行前,對輿論部分做更多的解釋與資訊揭露,媒體則能在旁發揮監督與傳播功能。為了瞭解這個問題,首先探討國外的新聞、社群訊息如何在國內線上社群上被再製並傳遞?再來國內在主流媒體與線上社群如何討論 HPV 疫苗?討論主題有哪些? 以不同平台如傳統主流媒體、線上社群作為媒介,被傳遞的訊息類型、討論方式又如何反映出媒介的特性?最後則是在社群訊息中,哪些議題事件有較多的討論? 討論的立場又是什麼? 本研究將以自動化文字探勘輔助文本分析方法進行分析,如抽取國外傳遞到國內的案例、採用主題探勘模型找出 HPV 疫苗的討論主題、比較不同主題的平台差異,以及哪些主題觸動較多討論。再進一步透過人工文本分析的方式了解這些討論背後可能的脈絡與動機。研究結果發現,國外傳遞到國內的事件有研討會與期刊發表、政策執行以及副作用案例。其中副作用例子成為臺灣媒體後續報導上的借鏡素材,也是立法院凍結全面接種預算的原因之一。在國內的 18 個主題分類中,社群平台與主流媒體在主題上有顯著差異。進一步分析篇數較多的九個主題,其中主題一「預防觀念、問答集」彙整社群訊息討論問題,包含「該不該打疫苗?去哪打?打幾價?」; 跨平台資訊傳遞如主題三「雲林縣疫苗施打」有同篇報導在社群平台發佈後,當天或隔天再轉傳到主流媒體報導的情形;也有如主題十六「抹片加疫苗雙重防癌」, 雖然主流媒體與社群平台皆有類似資訊,但都沒有重複。最後觀察輿論發現,討論集中在主題一「預防觀念、問答集」,分成藝人在社群分享並邀請閱聽人按讚轉貼、個人的接種經驗分享討論,以及是否該接種的討論中,年輕女性與產後婦女都擔心接種後的效果,前者是因發生過性行為,後者則因醫院推薦接種。另外,全面接種的資訊在討論中引起明顯的反彈,原因為疫苗的副作用,以及公費接種有圖利廠商嫌疑。

關鍵字

HPV 疫苗；子宮頸癌疫苗；全面接種；主題模型；社群輿論分析

並列摘要

Ever since its introduction in 2006, the Human Papillomavirus (HPV) vaccine has been included in the National Vaccination Program (NIP) in more than 80 countries and is publicly funded among 30 countries. In Taiwan, HPV vaccine was officially approved in late 2006 but has been budgeted and promoted by individual municipalities only. Recently, the government has decided to roll out a new policy in November 2018 to make it a nationally-funded vaccine for all female students in Grade 7. The discussions and controversies regarding the vaccine's safety, effectiveness, and side effects have been widely debated on public media and called for research upon public attitudes toward relevant policies in many countries. However, there has been little attention to the public responses toward the upcoming national vaccine program in Taiwan despite the presence and local promotion of the HPV vaccine within the past 11 years. This research uncovers and examines the dissemination of HPV vaccine-relevant information across major media and online communities through collecting and analyzing news articles and corresponding comments. The overarching objective is to assist the government, the media, and other involved actors in understanding public attitudes, identifying potential concerns, and responding accordingly to emerging discussions through policy communication or adjustment in a timely and effective manner. The research first discusses how foreign news and social media information are reproduced and transmitted in domestic coverage and online discussions. Second, the research investigates how the HPV vaccine is discussed in mainstream paper media and online communities in Taiwan and identifies important topics of such discussions. Next, it dives into the characteristics among different media platforms (i.e., traditional paper media and social platforms). These differences are revealed in the types of information that are spread across and the ways the audience discuss the various topics. Finally, popular events and topics that trigger more discussions, as well as the stances in them, are highlighted and analyzed. This study adopts text-mining and content analysis methods. For example, it extracts important international HPV vaccine side-effect cases that appear in domestic discussions and uses topic models to induce major topics. Finally, qualitative context analysis is conducted to sort out the contexts and motivations beneath the debates. The study found that the types of foreign information that enters domestic media platforms include academic publications, policy implementations, and side-effect cases. For example, reported cases of side effects not only became key issues followed up by domestic media coverage but also contributed to the budget freeze of the national HPV vaccination program. Furthermore, among the 18 identified topics, there are noticeable differences in what and how they are being discussed between social platforms and the mainstream paper media. The topic surrounding the vaccination program in Yunlin County, for example, showed the cross-platform information transmission of the same coverage from social platforms to paper media with a time lag of 1 to 2 days. There are also examples, such as the topic regarding the combination of Pap test and HPV vaccine, that yield similar but non-repetitive information. Among all disscussions, the “FAQ” topic, which covers the eligibility, benefits, and procedures of the vaccination, is the most popular one. It can be further divided into three categories: information shared by celebrities, personal experiences, and discussions of whether to vaccinate or not. Teenage girls and postpartum women are especially worried about the efficacy of the vaccine due to preceding sexual behavior and hospital recommendations respectively. Finally, the opposing and questioning opinions toward the national HPV vaccination program in the discussion are mainly derived from the unresolved side effects and unclear secret profits potentially benefitting the pharmaceutical companies.