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議題背景：

美國疾病管制與預防中心（Centers for Disease Control and Prevention, CDC）將於本週（9/18-19）召開免疫實務諮詢委員會（Advisory Committee On Immunization Practices, ACIP），為期兩天的會議將討論常規疫苗與新冠疫苗的流行病學更新、疫苗有效性、安全性更新與經濟分析等議題。在新冠疫苗的議程中，討論方向可能指涉25名兒童死亡案例與施打疫苗有關。由於議題涉及兒童安全、防疫政策與公共衛生措施，引起國外媒體的高度關注，甚至可能造成公眾對疫苗接種的擔憂，需要充足科學資訊的刻畫。

相關連結：

ACIP會議資訊

目前國內的新冠疫情如何？過去曾施打新冠疫苗或是確診過，還需要打新的疫苗嗎？台灣有疫苗安全的監測機制嗎？台灣科技媒體中心邀請專家提供觀點，說明民眾應如何看待疫苗與死亡案例的相關性。

專家怎麼說？

2025年09月16日

國立中山大學公共衛生學系教授／台北市公共衛生師公會理事長 翁瑞宏

一、目前疫情與疫苗接種必要性

目前我國COVID-19疫情屬低度流行，但未完全結束。根據疾管署資料，9月初一週 (9/2-9/8) 新增16例重症與2例死亡，多為高齡或慢性病患。今年（2025）目前累計1,652例重症與381例死亡（統計至9月17日），其中超過八成並未接種最新的JN.1疫苗，凸顯疫苗在降低風險上的重要性。由於病毒持續變異，過去感染或舊疫苗的保護力會減弱，因此即使曾接種或確診，仍建議補打新疫苗，尤其對長者與慢性病患者，可有效降低重症與死亡風險。

 二、疫苗與死亡因果性的流行病學解讀

判斷疫苗是否導致死亡，不能單憑個案或直覺，需系統性分析。臨床與解剖調查可確認直接死因，但不足以認定疫苗為觸發因素。真正的因果判斷需比較接種者與未接種者，在相同條件下的死亡率；若接種組死亡率顯著升高，才可能顯示疫苗存在風險，否則不支持因果關係。解讀時應遵循因果判定原則，包括時序性、生物合理性、一致性與劑量反應關係等。換言之，個案死亡能揭示死因，但需依大規模研究與監測數據判斷疫苗因果性。

 三、臺灣的監測制度

我國已建立疫苗接種後不良事件通報與受害救濟制度，由專家審查因果並提供補償。以COVID-19疫苗為例，從2021年至今近8,000件申請案中，僅約3%認定與疫苗有因果關係；死亡案例多與原有疾病相關，僅少數與特殊副作用相關，如腺病毒疫苗血栓合併血小板減少症。數據顯示臺灣監測與補償制度完整透明，可提供公平資訊並與國際經驗對照。

 四、避免民眾對疫苗不信任的資訊與論述

要降低民眾的不信任，關鍵在於透明資訊、誠信溝通與制度保障。應公開不良事件與背景死亡率比較，清楚說明疫苗效益與風險；以生活化、同理心語言解釋數據，讓民眾感受到政府理解疑慮；善用專業醫師、公衛師與學者說明，避免誤導或謠言；透過補償與監測機制，讓民眾知道「若出問題，有管道可求助」。結合透明數據、專業解釋、同理溝通與制度保障，才能逐步化解疑慮，鞏固社會對疫苗的信任。

2025年09月18日

國立台灣大學公共衛生學院健康行為與社區科學研究所副教授 官晨怡

據華盛頓郵報所獲得的政府內部消息指出，川普政府的衛生官員將在今明（18日，美東時間10:00；19日，美東時間08:30）兩天舉行的聯邦疾病管制與預防中心「預防接種諮詢委員會（ACIP）」上，提出一項「新冠疫苗與美國國內25名兒童死亡之關聯性」討論議案。

ACIP已經是美國疾管中心行之有年的疫苗審議制度。每年ACIP會舉行3次例行會議，並在需要時加開額外會議。會議中檢視最新科學資料，邀請不同民間組織或個人發言，公開討論各類疫苗政策，最後由委員投票做出推薦疫苗與否的決定。根據疫苗猶豫研究的文獻累積，透明公開地回應公眾疑慮，有助於增加社會對疫苗的信心。事實上，在2020、2021年新冠全球大流行期間， ACIP針對新冠疫苗可能的效果及安全性進行數次公開討論與聽證，每場歷時3-5小時，甚至更長，此種馬拉松式的討論，展現回應民眾疑慮的誠意，讓新冠疫苗於2020年12月開始在美國接種，隨後迅速推廣至全球，拯救眾多生命。

然而，即將於今明兩天發生的疫苗審查會議極具爭議，其令人擔憂之處源於近幾個月來「以恢復公眾信任為名」發生的一連串政治事件。一向具鮮明反疫苗色彩的衛生部長，在今年6月底一次解任了全體17名ACIP委員，並宣稱ACIP成員所涉及的醫療利益衝突是破壞人們對於疫苗信任的關鍵，並隨即任命了新的委員，包含數名疫苗懷疑論者。此外，衛生部長更發表了和前疾管中心主任相互矛盾的專欄文章。上月底現任疾管中心主任也因拒絕背書某項疫苗政策被解任，尤有甚者，衛生部長在缺乏有力證據情況下主導撤回特定健康狀況民眾的的接種建議()。在如此氛圍中，對於即將到來「預防接種諮詢委員會」會議上會發生什麼，人們充滿疑惑與擔心。

簡言之，公開透明的討論有助於民眾疫苗信心的建立，但在此同時，相關研究也再再指出被政治化的疫苗資訊傳遞與討論是疫苗猶豫形成的主因之一，為此，美國即將發生的疫苗討論，帶有諸多不確定性，需要謹慎檢視。

2025年09月18日

國家衛生研究院感染症與疫苗研究所副研究員級主治醫師 齊嘉鈺

2020至2024年間，COVID-19疫苗挽救了全球大約250萬生命，尤其是對60歲以上的長者，預防重症與死亡的效果非常明顯。病毒隨著時間不斷演化，疫苗接種的對象和強制性在國際上就出現非常多的討論，甚至是爭辯。有學者強調疫苗除了能減少重症，也可能降低長新冠、心血管與認知併發症的風險；若醫護無法常規接種，恐將增加傳染給免疫低下患者的風險等等。相對的，也有學者反駁，認為目前很多疫苗效益的分析結果是來自觀察性研究，存在殘餘偏差、混雜因子，因此需要隨機臨床試驗（RCT）提供可靠的加強針保護效益結論。

無論如何，對於感染後可能惡化為重症的高風險族群，專家仍一致建議應該接種疫苗提高保護力。

以英國為例，自2023年後，疫苗已不再提供全民接種，而是針對高風險群體，今年疫苗接種與免疫聯合委員會（Joint Committee on Vaccination and Immunisation, JCVI）建議並已被政府與英國國民健保署採納，建議對以下族群優先施打疫苗：75歲以上成人、安養院長者住民、≥6 個月以上具有嚴重免疫抑制者。接種以春、秋兩季為主，採用針對最新流行株的單價mRNA疫苗。

新冠疫苗保護力

新冠疫情在2025年雖然比過去最嚴峻的高峰期緩和，但病毒還是持續在社區中流行，尤其在秋冬季仍會增加住院和死亡的風險。依據近期的觀察，感染後雖然多數傾向輕症，但是高齡長者和免疫抑制的族群一旦感染，住院與死亡的風險仍然很高。而過去打過疫苗或是經由自然感染所誘發的保護力都會隨時間下降，對病毒感染和傳播的保護效益只有維持大約3至6個月，對重症的保護雖然比較持久但也一樣會隨時間減弱。新的疫苗會針對最新的流行變異株設計，能在秋冬季再次強化免疫力，幫助降低重症與死亡的風險，尤其對75歲以上和免疫力低下的人來說特別重要。所以即使以前打過疫苗或確診過，高風險族群仍然建議要打新的疫苗。

 兒童感染與疫苗施打的影響

2025年9月1日英國衛生安全局在更新的《Green Book – COVID-19章節》中提到，多數兒童感染後為無症狀或輕症，在Omicron變異株流行之後更是如此。重症住院很少見，死亡更罕見。

根據研究報告顯示，25 歲以下，特別是男性，接種mRNA疫苗後發生心肌炎、心包膜炎的報告率比較高，但是基本上都是在接種後幾天內發生；多數為輕症，恢復情況也都很好。其他少見的通報症狀有：短暫、非嚴重的月經量變化、注射部位局部腫脹、蕁麻疹等。

由於兒童重症極少見，因此，英國政府2025年更新兒童的疫苗接種建議，對臨床高風險族群，例如：≥6個月以上具有嚴重慢性疾病、免疫缺陷、唐氏症的兒童仍建議接種追加劑。

孕婦感染與疫苗施打的影響

研究發現孕期間感染相較於同齡非孕婦，重症風險會升高，包括：需要住加護病房、使用侵入性呼吸器或是葉克膜的機會增加，且與肥胖、糖尿病、35歲以上等因子相關；Omicron變異株的嚴重度雖然比之前Delta變異株低，但是未接種疫苗的孕婦重症風險仍高於已接種者。基於上述風險，過去孕婦也被英國政府列為臨床風險族群，在季節性疫苗計畫中優先考量接種，目標在於降低母親重症與不良妊娠，如早產、死胎的發生。

英國藥物及保健產品管理局（Medicines and Healthcare Products Regulatory Agency，簡稱MHRA）與 衛生安全局（UK Health Security Agency，簡稱UKHSA）免疫接種部所設置的UK Vaccine in Pregnancy監測計畫合作，持續對懷孕婦女接種疫苗進行監測，至目前都未發現孕期接種新冠疫苗有安全性特別疑慮；WHO、美國、加拿大、歐盟等監管機構也在持續檢視。美國已有超過10萬名孕婦接種，大多為mRNA疫苗，也都未見安全性顧慮。因此Pfizer/Moderna（mRNA）疫苗是為孕婦接種的首選，mRNA也未在乳汁中偵測到；相反地，可在乳汁中偵測到保護性抗體，因此對嬰兒可能有被動保護，所以授乳期的媽媽也可接種疫苗。

 真正「不能打疫苗」的情形其實很少見。目前建議施打新冠疫苗「相對禁忌」的人，應避免「同一疫苗品項」，包括：對前一劑 COVID-19 疫苗曾發生「過敏性休克（anaphylaxis）」、對疫苗成分已知嚴重過敏（特別是 mRNA疫苗的PEG成分）、接種第一劑後發生「心肌炎／心包膜炎」。正在明顯發燒、當下疑似或是確診COVID-19正在感染期，則建議先緩一緩，待康復後再打。

參考資料來源：

1. Pappas, G. et.al. (2025) An Evidence-Based Approach to Covid-19 Vaccination. New England Journal of Medicine. doi: 10.1056/NEJMc2507760

2. Gandhi, M. (2025) COVID-19 Vaccination Saved Lives and This Matters in 2025. JAMA Health Forum. 6(7), e252237. doi: 10.1001/jamahealthforum.2025.2237

3.  英國衛生安全局 Guidance－The safety of COVID-19 vaccines when given in pregnancy.

September 16, 2025  

Ruey-Hong Weng, Professor, Department of Public Health, Chung-Shan Medical University / Chairman, Taipei Public Health Specialists Association

1. Current COVID-19 Situation and the Necessity of Vaccination 

Currently, the COVID-19 epidemic in Taiwan is at a low level of transmission, but it has not yet been entirely eradicated. According to Taiwan Centers for Disease Control data, during the first week of September (9/2–9/8), there were 16 new severe cases and two deaths, mainly among the elderly or patients with chronic illnesses. So far this year (2025), there have been a total of 1,652 severe cases and 381 deaths (statistics as of September 17), with over 80% of these individuals not having received the latest JN.1 vaccine. Such highlights the importance of vaccination in reducing risk. Because the virus continues to mutate, protection from past infections or older vaccines diminishes over time. Therefore, even those who have been previously vaccinated or infected are still advised to receive the new vaccine booster, especially the elderly and those with chronic conditions, as it can effectively reduce the risk of severe illness and death.

2. Epidemiological Interpretation of Vaccine-Related Death Causality 

Determining whether a vaccine causes death cannot be based solely on individual cases or intuition; it requires systematic analysis. Clinical and autopsy investigations can confirm the immediate cause of death, but are insufficient to establish the vaccine as a proximate cause. Accurate causal inference/assessment requires comparing mortality rates between vaccinated and unvaccinated groups in comparable populations. If the death rate in the vaccinated group is significantly higher, this may indicate a vaccine-related risk; otherwise, a causal relationship is not supported. Interpretation should follow principles of causal inference, including temporality, biological plausibility, consistency, and dose-response relationships. In other words, while individual deaths can reveal causes of death, vaccine causality must be assessed based on large-scale studies and surveillance data.

3. Taiwan’s monitoring system

Taiwan maintains an adverse-event reporting and injury compensation program, with expert panels assessing the causality of injuries. For COVID-19 vaccines, of nearly 8,000 applications since 2021, about 3% were determined to have a causal link to vaccination. Most deaths were attributable to pre-existing conditions; a small number were associated with rare events such as vaccine-induced immune thrombotic thrombocytopenia (VITT) following adenoviral-vector vaccines. The system is comprehensive and transparent, enabling fair communication and international comparison.

4. Communicating to sustain public trust in vaccines

Trust depends on transparent data, candid communication, and institutional safeguards. Authorities should publish adverse-event data alongside baseline mortality rates and clearly explain benefits and risks in accessible, empathetic language. Clinicians, public-health specialists, and experts should communicate findings to counter misinformation. Compensation and monitoring mechanisms should be visible so people know where to seek help if problems arise. Combining transparent data, expert explanation, empathetic communication, and system-level protections can strengthen public confidence.

September 18, 2025

Chen-I Kuan, Associate Professor, Institute of Health Behavior and Community Sciences, College of Public Health, National Taiwan University

According to information obtained by The Washington Post from internal government sources, officials within the Trump administration are expected to raise a motion concerning the “potential association between COVID-19 vaccines and the deaths of 25 children in the United States” at the upcoming meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), scheduled for September 18 (10:00 a.m. EST) and September 19 (8:30 a.m. EST).

The ACIP has long served as an established review mechanism within the CDC’s vaccine governance structure. It convenes three regular meetings annually and, when necessary, calls additional sessions. At these meetings, the committee examines the latest scientific data, invites input from civil society organizations and individuals, and deliberates publicly on matters of vaccine policy. Decisions are ultimately made through committee votes, which determine whether specific vaccines are recommended. Literature on vaccine hesitancy underscores that transparent and open responses to public concerns are crucial for strengthening societal trust in immunization. Indeed, during the height of the COVID-19 pandemic in 2020 and 2021, the ACIP held multiple hearings on the efficacy and safety of COVID-19 vaccines. These “marathon-style” discussions, each lasting three to five hours or longer, were seen as a demonstration of the government’s willingness to address public concerns, facilitating the rollout of the COVID-19 vaccine in December 2020 and its rapid global dissemination, which ultimately saved countless lives.

The forthcoming ACIP meeting, however, has already sparked controversy. Concerns arise from a series of politically charged events in recent months, ostensibly carried out in the name of “restoring public trust.” Notably, the Secretary of Health, who has consistently signaled strong anti-vaccine positions, dismissed all 17 ACIP members in late June, claiming that conflicts of interest within the committee were the primary barrier to public trust. Several new appointees included prominent vaccine skeptics. Moreover, the Secretary has published a statement contradicting with that of a former CDC director. The current CDC director was dismissed last month after refusing to endorse a contested vaccine policy. More alarmingly, the Secretary unilaterally revoked certain vaccine recommendations for individuals with specific health conditions, despite a lack of compelling scientific evidence. Against this backdrop, uncertainty and apprehension now surround the impending ACIP proceedings.

In sum, while transparent and inclusive discussion is indispensable for fostering public confidence in vaccines, research consistently demonstrates that the politicization of vaccine information and deliberation is one of the key drivers of vaccine hesitancy. The forthcoming deliberations within the United States therefore carry significant uncertainty and warrant close scrutiny.

September 18, 2025  

Chia-Yu Chi, Associate Research Fellow and Attending Physician, Institute of Infectious Diseases and Vaccinology, National Health Research Institutes

Between 2020 and 2024, COVID-19 vaccination saved an estimated 2.5 million lives worldwide, with especially strong effects in preventing severe disease and death among adults aged ≥60 years. As the virus has evolved, debates have emerged over target populations and vaccination mandates. Some experts emphasize that vaccines may also lower risks of long COVID, cardiovascular complications, and cognitive sequelae, and that irregular uptake among healthcare workers could increase transmission to immunocompromised patients. Others note that many benefit estimates come from observational studies subject to residual bias and confounding, arguing that randomized controlled trials (RCTs) are needed to more precisely quantify booster effectiveness.

Despite these debates, experts agree that high-risk groups should be prioritized for vaccination.

UK experience. Since 2023, the United Kingdom has limited vaccination to high-risk groups. In 2025, the Joint Committee on Vaccination and Immunisation (JCVI)—with adoption by the government and the National Health Service (NHS)—recommended priority vaccination for: (1) adults ≥75 years; (2) residents of care homes for older adults; and (3) individuals aged ≥6 months with severe immunosuppression. Vaccination is offered mainly in spring and autumn, using monovalent mRNA vaccines updated to circulating variants.

COVID-19 Vaccine Protection

Although COVID-19 activity is milder in 2025 than at prior peaks, the virus continues to circulate, and hospitalizations and deaths still rise in the fall and winter. Most infections are mild, but older adults and people who are immunocompromised remain at elevated risk of severe outcomes. Protection from prior vaccination or infection against infection and transmission typically wanes within approximately 3–6 months; protection against severe disease is more durable but also declines. Updated vaccines matched to circulating variants can restore immunity ahead of the fall and winter and reduce the risks of severe illness and death. This is especially important for adults aged 75 and older and those who are immunocompromised. Accordingly, high-risk groups are advised to receive updated boosters even after previous vaccination or infection.

Impact of COVID-19 Infection and Vaccination in Children

On September 1, 2025, the UK Health Security Agency updated the COVID-19 chapter in the Green Book, noting that most children who become infected experience asymptomatic or mild cases, especially following the spread of the Omicron variant. Severe hospitalizations are rare, and deaths are even more uncommon.

According to research reports, individuals aged 25 and under—particularly males—have a higher reported rate of myocarditis and pericarditis after receiving mRNA vaccines. However, these cases generally occur within a few days after vaccination; most are mild and recover well. Other rare reported symptoms include temporary, non-severe changes in menstrual flow, localized swelling at the injection site, and hives.

Because severe illness in children is extremely rare, the UK government updated its vaccination recommendations for children in 2025. Booster doses are still advised for clinically high-risk groups, such as children aged six months and older with severe chronic illnesses, immunodeficiencies, or Down syndrome with immunosuppressed condition.

Impact of Infection and Vaccination on Pregnant Women

Pregnant individuals face higher risks of severe COVID-19 than non-pregnant peers, including increased ICU admission, invasive ventilation, and ECMO, with additional risks associated with obesity, diabetes, and age ≥35 years. Although Omicron tends to be less severe than Delta, unvaccinated pregnant people remain at higher risk than those vaccinated. The UK therefore prioritizes pregnant individuals in seasonal programs to reduce severe maternal illness and adverse outcomes (e.g., preterm birth, stillbirth). The Medicines and Healthcare products Regulatory Agency (MHRA) and UKHSA jointly run the UK Vaccine in Pregnancy surveillance program; to date, no safety signals specific to pregnancy have emerged. Regulators in the WHO, United States, Canada, and the European Union report similar findings. In the United States, more than 100,000 pregnant individuals—mostly receiving mRNA vaccines—have been vaccinated without identified safety concerns. Pfizer-BioNTech and Moderna mRNA vaccines are preferred in pregnancy. mRNA of vaccine strain is not detected in breast milk, whereas protective antibodies are, suggesting potential passive infant protection; breastfeeding is compatible with vaccination.

Contraindications

True contraindications are rare. People should avoid the same vaccine product if they experienced: (1) anaphylaxis to a prior dose; (2) a known severe allergy to a vaccine component (e.g., PEG in mRNA vaccines); or (3) myocarditis/pericarditis after a prior dose. Those with a high fever or active COVID-19 infection should defer vaccination until recovery.