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To Have a Healthy School Year, Ensure Everyone Has Access to Immunizations_我的网站

昨夜星辰

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As physicians who care for children and families, our mission is to keep our patients healthy and help them thrive.

With many students heading back to school soon (and some having already started classes), we know all too well what it’s like for families to navigate this changing season – and importantly, to try to stay healthy. Along with the excitement and energy that each new school year brings, this is also a time of exposure to all the viruses that we typically see during the colder months. This year, that includes colds, the flu, respiratory syncytial virus (or RSV) and COVID-19.

As families prepare for the year ahead, it’s important that children’s immune systems are also prepared to detect and resist viruses so that they can stay healthy and thrive. Just like how software updates to your phone or computer keep things in working order, vaccines help your body’s immune system work better. We also know that when everyone can access recommended immunizations on time, it stops preventable diseases from spreading through our communities.

Vaccines are one of the greatest medical advances in history. Thanks to widespread immunization, we have eradicated or controlled many diseases that once caused pain, suffering and even death for countless children – from smallpox and polio to tetanus and measles. Plus, when children stay healthy and free of such debilitating diseases, they can succeed by staying in school and safely participating in activities like sports and other after-school programs. This continuity helps improve children’s social and emotional development and their entire quality of life.

Unfortunately, parents must currently try to find guidance about their child’s health in a sea of mis- and disinformation. In the age of social media, misinformation about many topics is rampant, and vaccines are no exception. We encourage everyone to seek information from a trusted source, like their family physician or pediatrician – the same way that we work together with parents to offer guidance on other important topics like healthy nutrition, injury prevention and so much more.

At that same time, we do need better ways to talk about vaccines, along with ways to help parents identify accurate sources of information that they can trust. We must also ensure that vaccines are widely available, easy to find and affordable to everyone.

Right now, the U.S. is lagging behind. In 2022, only 45.9% of children received a flu shot, down from 53.1% in 2019, according to data from the Centers for Disease Control and Prevention. This is compounded by research that showed a two-year decline in children receiving routine vaccinations during the COVID-19 pandemic.

Also concerning is CDC research showing that 8% of children had not had a well-child checkup within the last year – and that 6% didn’t have a doctor’s visit at all. A recent UNICEF report also shows 67 million children across the world missed out on one or more vaccinations over the last three years. These children are missing opportunities for immunizations as well as vital guidance on mental health, nutrition and other areas of child health and development.

These statistics are even more reason for parents, physicians and policymakers to ramp up vaccine education and ensure that children and their families can access vaccines and other routine medical care.

As physicians who care for families and who watch children grow up over many years, pediatricians and family physicians are well-positioned to help patients and their parents navigate challenges in getting vaccines. In addition to helping overcome barriers like lack of insurance or transportation, we can also serve as sources of accurate information. We can be a backstop against the rampant misinformation parents encounter in social media and a sounding board for their questions.

But physicians cannot do this alone. Policymakers must recognize the need to help families who qualify stay enrolled in Medicaid and to protect programs like the Children’s Health Insurance Program, which offers coverage for those who might not be eligible for Medicaid. We must expand the number of hospitals and clinicians who participate in the federally funded Vaccines for Children program, which today offers vaccines to nearly half the nation’s children. This program is critical because it helps ensure vaccine and health equity. And we must also ensure that physicians have the support they need to continue physically storing, administering and counseling families on vaccines.

In the end, we all share a collective responsibility to safeguard the health of our nation’s children and the health of the public. As your doctors, we know that we are all healthier when everyone is vaccinated.

。　　微软联合创始人比尔·盖茨周三（8月26日）在个人网站 Gates Notes 刊出近6000字长文，称人工智能将带来“人类历史上最动荡的时期之一”，并写下“目前没有方案”来缓冲这场转型。同一天，他在西雅图办公室接受采访时说，按现在的速度，“净负面结果的概率非常高”。　　长文标题是《我们现在对人工智能做出的选择至关重要》。盖茨写：人工智能“要么成为有史以来最大的平等器，要么成为最糟的不公来源”。

B | 他还列了三条已经同时出现的风险：大量工作岗位永久消失、作恶门槛下降、儿童成长与人际关系被替代。政府是否立法、税怎么改、哪些岗位留给人，目前都没有拍板。

C | 　　盖茨改口：三年前说“可管理”，现在说岗位会少一大块　　三年前，盖茨曾写过，人工智能带来的就业冲击会“颠簸”，但过渡仍“可管理”，技术会帮人把活干得更有效率。周三对 Semafor 他说，自己处在一种震惊里：“我差不多是第一个站出来说‘这太疯狂了，这太荒唐了’的人。”“我被沉默震聋了。”　　他对 Axios 说，好事走得偏慢，除了机器人，“坏事已经近在眼前”。按当前路线，净负面结果的概率非常高。他同时说，自己认识的业内人士几乎都在担心；对 GeekWire，他补了一句：他所认识的人里，“基本上除了埃隆，人人都担心”。

D | 　　长文把就业冲击写成结构性问题，而不是一轮经济周期里的失业。盖茨引用1933年美国大萧条时约25%的失业率作对照，写明人工智能“未必到这个水平”，但冲击“不会随着经济周期消失”。白领里，客服、软件工程、律师助理会先被替换；蓝领一侧，他写“很多美国人没意识到灵巧机器人进步有多快”，建筑和酒店业的部分体力活，到本十年末可能开始和人对打。没有干预的情况下，新创造的岗位会“远少于”今天的就业总量。转型会在大约十年里完成，而不是几代人。　　他对 Semafor 说，多数职业里，人最终会“远远不如做这份工作的人工智能”。他问，岗位消失之后的反弹会有多大：“会让数据中心那档事看起来像小事。

E | ”基金会解决不了社保缺口。他说，政府规模大约是全部慈善的20倍；盖茨基金会一年约100亿美元，“远远不够”。回应不能是“行业自己搞定”。　　三条风险已经并排写进同一篇长文　　第一条是工作。盖茨写，最危险的是入门级和中间层级岗位，新岗位大多要求要学很多年才能掌握的技能。

F | 他特别点到年轻人：入门岗位先没，再就业的台阶跟着变窄。等待“人已经被挤走或就业不足”再动手，会太晚。

G | 　　第二条是作恶能力下降。诈骗、深度伪造、虚假信息、监控，会先进入日常生活。

H | 网络攻击的资源门槛在下降，医院和电网这类基础设施被点名为薄弱点。生物一侧，他写人工智能会加快药物和疫苗，也会让设计致命新疾病变得更容易，“正面能力和危险能力很难拆开”。对 GeekWire，他把过去业内口头划过的警戒线又数了一遍：更容易做生物武器、更容易发动网络攻击、做出让人情感依赖的机器、抹掉大量岗位、技术本身失控。“我们正在越过每一条线。”　　第三条是孩子和关系。长文引用斯坦福与卡内基梅隆一项超过1100人的研究：用人工智能伴侣越重，自我报告的幸福感越差。盖茨写，自己小时候花力气学社交、交朋友，“如果当时就有人工智能伴侣，我怀疑自己不会下同样的功夫”。他还提到，初步调查显示，用得越重，批判性思维越弱，年轻群体更明显。　　他把这几类风险说成“黄灯或红灯已经在闪”。他批评现行自愿安全安排：阈值是什么、越过之后做什么，“整套东西在我看来空空如也”。

I | 若一直没有红线和后果，“我们回头看，会把现在当成风暴眼里的片刻”。有人拿出可信的全球减速方案，他写自己“多半会支持”，但“不认为这会发生”。地缘和政治力量太大。　　他提出三件事：新机构、给人留岗、向代币和机器人征税　　第一件是建新机构。盖茨写，现有机构不是为一种同时碰到就业、安全、卫生、能源和选举的技术设计的。

J | 他要国内新设能跨部门定优先级的机构，国际上要有一个组织，零件分别来自核检查、民航规则和臭氧层条约。这是倡议，不是已经成立的机构。对 Axios，他评美国两党：“两边对这件事都谈不上懂，也谈不上认真想过。

K | ”对 GeekWire，他问“白宫这边该找谁谈”。华盛顿的立法日程没有因此改写。　　第二件是“人类保留”（Human Reserved）岗位：机器已经能干，社会仍决定留给人。比喻是自然保护区——地可以盖楼修路，但选择不盖，因为失去的东西太大。例子包括儿童看护、陪审，以及告知“你得了不治之症”。他写：“技术上没有理由做不到。但不该这么做。”照料失智父亲的护工，被他写成“无法被替代的人的工作”。教育和医疗不要全面禁止人工智能，而是岗位受保护、人继续掌舵、工具给人用。

L | 保留可以分两种：一种永远由人做；一种是临时保护转行困难的人，比如职业生涯后段的制造业工人。极端情形下，他告诉 Axios，起初可以想象把约40%的岗位划给人，“这是我能想到的上限”。具体划哪些、怎么执行，长文写明“必须公开讨论”。各国进度可以不同，可以分年、分十年推进，而不是第二天全部替换。这些都还不是法律。　　第三件是税。盖茨主张对人工智能代币（模型把文本和其他数据切成的计费单位）和机器人征税，用来减弱“用机器替人”的财务激励，并给再培训和安全网筹资。现行税制是：雇人要缴工资税，买机器人通常可以当作经营开支抵扣。“税制在推你用机器换人。”他对 Axios 说，这等于“我这辈子见过的最大一次税制改动”，又碰上“我这辈子见过的最分裂的政治”。机器人税他九年前就提过，当时被广泛搁置，现在仍坚持。他承认这不“经济最优”，但创新加速后，社会付得起一点效率损失，用来把人留在岗位上。税率、税基、谁征、钱怎么分，长文没有给出法案文本。　　盖茨基金会仍按既定的20年计划往下花剩余约2000亿美元，还剩19年，并会把人工智能用到卫生、农业和教育项目里。他同时说，慈善填不上国家层面的安全网。模型公司“不是政策的人”，对外谈自家产品的负面时“有一点回避”。行业自己解决不了这件事。　　已经发出的是警告，还没有落地的是规则　　盖茨把这篇长文写成系列的第一篇，后续还要单独写生物风险。70岁的他说，自己三十多岁时觉得五六十岁的人什么都不懂，现在由他来发这种警告“有点怪”，但“我非常担心。一对一谈话时，他们也是”。