COVID-19中的香港長者與照顧者: 以照護的邏輯修繕「疫苗決策」

Abstract

2019新型冠狀病毒（COVID-19）對全球公共衛生帶來了巨大挑戰，挑戰之一是COVID-19的疫苗接種。在香港，即便政府擁有充足的疫苗量供應，香港民眾的疫苗接種意願仍一度持續低迷，其中長者的接種率是所有年齡族群中最低的。2021年12月底，香港遭遇了本地最嚴重的一次新冠病毒爆發。在重症以及死亡率的人群中，70歲以上長者所面臨風險最高。

長者在COVID-19面前的高風險性，以及疫苗接種面前的謹慎，引起了公共衛生領域學者的關注，開展在香港本土的新冠疫苗猶豫相關研究，大多採用量性調查的方式獲取資料，其局限在於無法細緻地得知特定族群的特殊經驗，從而了解研究對象的具體認知及其社會脈絡；更重要的是，鮮少研究探討照顧者在其中的作用。本研究以「照護的邏輯」作為研究理論框架，並且以「拼貼式民族誌」作為本研究的研究方法，試圖探討香港長者以及長者照顧者在長者新冠疫苗接種行為背後的決策脈絡。本研究關注不同生活方式之長者及其照顧者，在疫情之下所感受到的日常壓力，以及在對長者疫苗接種進行決策時的思考脈絡，並且試圖以疫情中的疫苗決策為主軸，勾勒不同受訪者疫苗接種經驗背後的家庭、醫療社會、政策圖景。我將使用田野筆記（包含訪談招募、與受訪者對話、田野觀察過程中研究者的發現與自我反思）、半結構性訪談內容、相關網路文章、媒體報導等多方內容作為本研究的研究資料進行分析，藉以完成此研究。

研究發現，在香港照顧者對長者新冠疫苗進行決策的行為背後，折射出香港特殊的地緣政治角色，並且以交錯複雜的方式對香港的政策方向、民眾的公權力信任產生影響。這些看似宏大的議題，透過新冠疫苗在長者以及照顧者的生活中變得具體，並且與他們的照顧歷程相互交織。在這複雜的時空脈絡下，照顧者的信任度、不確定感始終貫穿著他們的照顧與接種歷程。疫情與防疫政策打破他們原有的照顧生活，而照顧者卻從中以其強大的能動性以及「照護的邏輯」修繕著他們被打破的生活穩定性——接種或不接種，在此重新成為修繕照護邏輯的新工具。

Since December 2019, the COVID-19 pandemic has enormous global health challenges. One of the challenges has been the vaccination against COVID-19. In Hong Kong, despite sufficient vaccine supply from the government, the vaccination rate among the general public once remained very low, particularly among the elderly population. In late December 2021, the highly contagious Omicron variant of COVID-19 was discovered in Hong Kong, resulting in the most severe outbreak of COVID-19 in the region to date, with infection and mortality rates reaching their highest levels during the pandemic. Among those at the highest risk of infection and death are individuals aged 70 and above.

The high risk faced by the elderly population in the face of COVID-19, as well as their cautious attitude towards vaccination, has attracted scholars’ attention in the public health field. Several studies on vaccine hesitancy related to COVID-19 have been conducted in Hong Kong, mainly using quantitative survey methods to collect data. However, these studies have limitations in their ability to obtain detailed information on the specific experiences of certain groups to understand their particular cognitive and social contexts. Moreover, few studies have explored the role of caregivers in vaccination decision-making.

This study employs the theoretical framework of “the logic of care” and the research method of “Patchwork Ethnography” to explore the decision-making contexts behind the vaccination behaviors of elderly individuals and their caregivers in Hong Kong., this study aims to explore the daily stress experienced by elders and their caregivers with different lifestyles during the COVID-19 pandemic and the decision-making context regarding vaccine administration for elders. The study also attempts to outline the family, healthcare, and policy landscapes behind the vaccination experiences of different interviewees in the context of the pandemic. I analyzed data from various sources in the study, including field notes (developed from recruitment interviews, conversations with interviewees, researcher observations, and reflections during fieldwork), semi-structured interview content, related online articles, and media reports, to complete the research.

Research findings indicate that, in the context of the COVID-19 pandemic in Hong Kong, the vaccination-decision-making process of elderly individuals and their caregivers exhibits the manifestation of Hong Kong’s distinctive geopolitical role. This intricate interplay between geopolitical dynamics and the vaccination decision-making process exerts multifaceted influences on the policy orientation and public trust in governmental authority within the Hong Kong context. These grand and abstract issues become tangible through the COVID-19 vaccine’s impact on the lives of the elders and their family caregivers, intertwining with their caregiving journey. Within this complex temporal and spatial context, caregivers’ trust and uncertainty permeate their caregiving and vaccination experiences. The pandemic and the implemented preventive measures disrupt their pre-existing daily caring life. While caregivers and elders, with their agency, actively repair the stability of their daily life by embracing vaccination or deciding against it.