千年以來，人類不斷遭遇各種疫病的侵襲，流行速度更勝戰火蔓延，影響整體人類重大，然而隨著醫學知識的進步與衛生環境的改善，許多傳染病已經受到控制乃至根絕，但是生活周遭仍然面臨諸多威脅生命健康的潛藏危機，如果稍有疏失或不慎，傳染病不僅對於人體造成傷害，甚至恐將危害社會、經濟和政治層面，而近年的SARS、H1N1等流行病毒皆造成全球恐慌。 防疫工作重點在於及早掌握疫情趨勢以利制定相關因應政策，目前各國對於傳染病的掌握主要透過層層監測系統與歷史平均，藉以判斷該年特定傳染病流行與散佈程度。這些方法受到各種人為與環境因素影響，導致推估疫情成效有限之外，同時所得資料無法直接反應未來疫情，因此導致各國相關單位逐漸嘗試其他預測方法。 近年應用預測市場機制預測疫情模式引起公衛領域的重視，相關學術期刊與著名雜誌相繼介紹此一新興模式，同時肯定其在預測傳染病方面的成效與貢獻，而美國和台灣政府部門先後透過此項機制改善現有防疫體系的不足。那麼，預測市場用以預測疫情的成效是否確實如同其在眾多領域取得的成效一樣出眾？鑑於前述問題，本研究分別透過質化與量化的方式發掘公衛、醫學或流病學等其他領域對於「傳染病預測市場」是否能夠成為有效的預測機制或是成為常規的參考方法，結果證實使用的疾管局人員與參與的專業醫事人員認為「傳染病預測市場」確實可以應用於我國疫情預測的層面，但是兩者意見具有程度的差異。 / For centuries, the spread of various diseases damage countless human beings, which surpass wars in the world. Those diseases not only endanger people’s life, but also invade the other dimensions, including society, economic and politics. With the advancement of medical knowledge and the improvement of public health, many infectious diseases have been brought under control and even eradicated. But humans still face and experience threats from pandemic viruses such as SARS and H1N1 constantly. Epidemic prevention work focuses on understanding the variation of situation as soon as possible. Then governments can set up suitable decisions and policies based on epidemic situation. Though the monitoring system and the historical average are the mainstream to control the trends of infections for related departments, scientists believe that the two methods are subject to humans and environmental factors. In other words, it is difficult to draw effective information and direct response of the future trends from present methods. And it leads to national units gradually try other epidemic forecasting methods. In recent years, using prediction markets to predict flu causes the attention of public health. Thus academic journals and well-known magazines not only introduce this application but approve its effectiveness and contribution in predicting infectious diseases. The departments of US and Taiwan have tried to improve the deficiencies of the existing prevention system through prediction markets. Is this application really as successful as PM in many issues and fields? To response the question, this research intends to through qualitative and quantitative ways respectively to explore the evaluations on Epidemic Prediction Markets behind public health, medical, epidemiology, etc. The result confirms that CDC staff and health workers identify the feasibility of Epidemic Prediction Markets, but with the degree of variation.

近年來大量學術研究已經證實，自然資源對於國家發展眾多層面具有負面影響。過去的大部分研究關注的重點集中於自然資源對於經濟發展、政治體制、制度質量、以及內戰方面，鮮少研究涉及到其對疾病傳播的影響。進入二十一世紀之後人類社會更頻繁地被大規模的傳染疾病困擾。那些自然資源相對豐裕的地區，也正是被傳染疾病頻繁影響並造成大規模傷害的地區。瘧疾就是其中一種分布最廣且對公共健康造成巨大威脅的傳染病。這篇文章旨在研究自然資源對於瘧疾傳播的影響。通過所有國家從2000至2014年時間序列橫截面數據分析，結果證實自然資源豐裕程度以及依賴程度都會導致更多的瘧疾發病數以及更高的死亡數。 / A lot of researchers have proved that natural resources have adverse effects on the development outcomes. Most of the past researches focus on the effects of natural resources on economic growth, political regime, institutional quality, and civil war. An interesting phenomenon is that countries with rich in natural resources are also those affected frequently by contagious diseases. Malaria is one of the widest spread diseases that poses a major threat to public health. This paper aims to analyze the effects of natural resource abundance and natural resource dependence on the spread of malaria. By using the time-series, cross-sectional data of all countries from 2000 to 2014, the result shows that there is a resource curse on the contagious diseases. Both natural resource abundance and natural resource dependence lead to more confirmed cases and deaths from malaria. The effects on the incidence rate and death rate need further analysis.

【研究緣起與問題】2003年春季，SARS在全球造成一陣轟動，同時也重創全球的經濟，如今SARS會不會再來？政府如何因應？政府如何監測疫情？如何防治疫情？如果SARS等新興及再浮現感染症 （Emerging and Re-emerging Infectious Diseases）出現時，負責全國傳染病防治任務的行政院衛生署疾病管制局是如何作好全國傳染病防治工作呢？中央及地方主管機關之溝通，如何共同消除指責與誤會，發揮團隊精神，如何共同作好全國傳染病防疫任務，爭取公眾對政府之瞭解並加以支持，同時防止任何可能之攻擊，才是全民之福祉。故以「全國傳染病通報系統」的績效，其所仰賴之溝通通路之問題研究，是本研究的動機。了解「傳染病通報管理系統(WEB版)」最大的問題及新興傳染病（如SARS）防治通報的問題及「傳染病通報管理系統」最需要改進之的地方，是本研究的目的。 【研究方法與資料】本研究採取量化與質化並重的方法，以網路問卷方式的進行問卷調查，問卷對象為全國使用傳染病通報管理系統之相關人員，問卷問題內容的設計主要的型式含有開放式問卷（Open –Ended Question）、封閉式問卷（Close-Ended Question）及混合型問卷（Mixed Question）三種。同時以九十二年針對新興傳染病SARS期間為例，深度訪談當時任職於中央與地方負責傳染病防治權責具代表性者五位主管進行訪談，瞭解受訪者對新興傳染病如SARS防治的問題及「傳染病通報管理系統」最需要改進之的地方，以彌補問卷調查法無法深入瞭解到問題之缺點。 【研究結論與建議】 一、根據筆者初步研究經問卷的實證調查之後，從問卷分析資料顯示，使用者使用電腦的時間愈久，對以新版為溝通工具滿意度愈低；而愈瞭解通報系統的使用者，其以新版為溝通工具滿意度愈高，愈滿意新版改進之電腦網路溝通效果。顯示新版的通報系統在設計的操作介面與程序上，沒有人性化，作業內容繁多、需輸入的項目、資料太繁瑣、版面太繁瑣等，反而徒增使用者的困擾；而愈瞭解通報系統的使用者，其對新版的滿意度越高，表示對於使用者在操作上的教育訓練仍須加強，才能發揮新版通報系統的成效。 二、從敘述統計分析中發現： 受訪者對「訊息異動通知作業流程滿意」的使用滿意度的平均數最高，平均數為2.8095表示：較為滿意。「通報作業流程滿意嗎」的使用滿意度的平均數最低，平均數為2.3934，受訪者表示：較為滿意。以新版為溝通工具整體溝通滿意情形，平均數為2.558滿意。 三、開放式問卷分析資料顯示，花太多時間、速度太慢、網路的頻寬過窄又不穩定或無法登錄、作業內容繁多、作業流程問題、資訊管理問題及功能增添與建議等部分。 四、根據筆者初步研究深度訪談之後，彙整中央主管機關及地方主管機關的訪談核心二部分的問題與建議。 五、研究建議： 綜合問卷調查及深度訪談結果，提出政策層面、組織溝通層面、管理層面、實務操作層面等之建議。 【關鍵字】傳染病通報系統、嚴重急性呼吸道症候群(severe acute respiratory syndrome, SARS)、組織溝通、溝通通路、行政院衛生署疾病管制局 / 【Background and Issues】 In the spring of 2003, SARS outbreaks devastated the whole world; they also heavily damaged the world economy. Will SARS come back? How can governments manage it? How can government monitor the epidemics? How can we control the infection? When emerging and re-emerging infectious diseases such as SARS appear, how can the Center for Disease Control of the Department of Health, an organization in charge of national disease control, plan and execute measures for the control of communicable diseases? Effective communication between the central and the local competent authorities to remove together blames and misunderstanding, to develop team spirit, to attain jointly the goal of disease control, to solicit understanding and support of the public to the government, and to prevent any likely attack are some of the considerations in improving the welfare of the public. The reason of the present study was to understand, through the achievements thus far of the National Communicable Disease Reporting System, issues involved in the communication channels. The purposes of the study were to understand the major problems of the Communicable Disease Reporting and Management System (the Web version), issues involved in the reporting of emerging infectious diseases, and areas of the Communicable Disease Reporting and Management System where improvement was most urgently needed. 【Method and Materials】 Both the quantitative and qualitative methods were used. Questionnaire interview was conducted through the web to persons using the Communicable Disease Reporting and Management System throughout the country. The questionnaire contained open-end questions, closed-end questions and questions of mixed types. At the same time, to understand in depth areas not properly covered by the questionnaire interview, five key persons responsible for disease control at the time of the SARS outbreaks in 2003 at the central and the local levels were interviewed to understand their attitudes toward the control of emerging infectious diseases such as SARS, and the improvement most urgently needed for the Communicable Disease Reporting and Management System. 【Results and Recommendations】 1. Preliminary findings from analysis of the questionnaire interview showed that users became less satisfied with the new version communication means the longer they were in use of computers. Users who knew more about the use of the reporting system were more satisfied with the new communication means, were at the same time, more satisfied with the communication effects of the improved version. These facts suggested that the new reporting system was less user-friendly in the designing of interface and procedures. The system required more work, more detailed inputs, and thus added additional burdens on the part of the users. The more the users understood the reporting system, their satisfaction was higher, indicating that, for the new version reporting system to function in full, training of the users in the use of the system should be strengthened. 2. From the descriptive analysis, it was found that the average score of user satisfaction on the “information change reporting procedures” was as high as 2.8095, suggesting that the users were fairly satisfied. The satisfaction score on “reporting procedures” was the lowest at 2.3934. The overall satisfaction score on the use of the new version as a communication means was 2.558. 3. Findings from the open-end questions gave the following recommendations: taking too much time, too slow, frequency of the web too narrow, unstable, and unable to load, too detailed, issues related to operational procedures, issues related to information management and additional functions, etc. 4. By analysis of the in-depth interview, some issues were raised and recommendations made to the central and the local competent authorities. 5. Through questionnaire survey and in-depth interview, some recommendations concerning policies, organizational communication, management and practical operation were made. 【Key Words】 Communicable Disease Reporting System, SARS (Severe Acute Respiratory Syndrome), organizational communication, communication channels, Center for Disease Control, the Department of Health

本論文運用史學、統計與GIS繪圖法，自表至裏，自應用至體制，再至緣由，論述1895～1945年50年間臺灣預防接種史之開展、歷程與引發原因。論證臺灣人用疫苗發展歷史超過百年；日治時期臺灣住民已廣泛接種多量疫苗；臺灣諸免疫界變革不可忽視日本人事體制。 全文首先以法定之傳染病為例，論證疫苗在臺灣民間應用之普遍。首先論述最早在臺灣實施，作為全民接種開始，且採皮上切種之天花種痘，其官方制度演變、於民間推展方法、技術變革與臺日差距（少），以及從統計面所見之臺灣高接種率（社會高免疫力）、低天花感染率和死亡率，和1900年代一遇疫情風聲，即立刻實行臨時接種或擴大定期接種之防疫定制。其次論述血清型疾病預防注射。如1900年鼠疫接種，是臺灣最早由官方執行較大規模針式＼侵入性皮下預防注射之始。但1904年後因花費金額高、人體副作用大而少在臺灣實施。再如霍亂，1902年臺灣已應用霍亂血清，1916年較大規模實施＼實驗，1919～1920年國際霍亂大流行更極力推廣，兩年間，每年各有百餘萬人接種，是各地臺灣人普遍認識和接種預防注射針之始。1918～1920年流行性感冒，確切菌種和傳染原因等等均未知；但當第二波疫情較集中且嚴重時，官方已鼓勵配合副致死病因如肺炎球菌等，實施預防注射，與今日流感疫苗類似。其後，對霍亂或流感使用預防接種之防疫法，終日治結束均為常例。又如流行性腦脊髓膜炎，自1917年臺灣出現購買疫苗案例後，該疫苗自1920年代起即大量應用，1930年代後之接種人數更屢以十萬或百萬為單位。而臺灣1935年前所謂流行性腦炎或腦炎，常是指流行性腦脊髓膜炎；流行性腦炎或腦炎預防接種，實際指流行性腦脊髓膜炎接種。以上各種疫苗大量應用，至約1920年代已形成官方一遇疫情即立刻接種地積極、強力防疫定制，亦影響臺灣該等傳染病感染率和患者死亡率，以及官民對上述傳染病恐懼態度轉變。 繼應用面，本文次論人事、體制之制度面發展。首先，臺灣在1902～1905年，先後出現在臺灣設置血清藥院聲音、鼓勵細菌血清學研究、設置牛疫血清作業所、起議在臺實施全新生兒種痘和創設中央科學研究所。1916年開始製販血清疫苗，擇製本島常見菌種、強調「賣捌」非「販賣」，此後製品種類陸續增加。臺製疫苗亦供應沖繩和中國等等臺灣以外地區。1922年起，臺灣不再製造牛疫血清，改由朝鮮提供防疫之常備用品；1939年士林廠房完工，臺灣開始製造乾燥和精緻血清疫苗。另就中央衛生部人事和業績比較，細菌血清類研究和專任人力常多居各研究單位之首，1920年代達高峰；1930年代研究比重雖看似降低，然其負責人員數量、製劑內容和販賣數量，卻更深刻且快速進展，故臺灣中央一直重視免疫醫學或細菌學研究。而使臺灣於各階段發生細菌學興起、開始製販血清疫苗、研製機構體制和製品製程改變原因，首先，使細菌學、免疫學和血清研製機構在臺展開，首須歸因後藤新平和高木友枝等臺灣首長個人意識，以及其背後穩固之內務省衛生局（行政）、傳染病研究所（技術）和眾議會（審議）等人事資源和總體意向，並因人際網絡使臺灣得參酌美國作法。1916年臺灣開始製販血清疫苗，源自1914年傳研移管；擇製某類型製劑且限定專賣，則為前期人事派系延續和檢定制度便宜之計。傳承人事脈絡與社會局勢，再配合新發地政治社會需求，使1920年代後期起中央研究所人事漸變化，來自地方者再回歸地方，中央日益學術、大學化。最極致表現是1936～1939年中央研究所成為臺北帝大附屬和東大傳研化。此外，臺灣與海外各血清疫苗單位有連絡互通；臺灣是日本諸外地中最早大量製販各種血清疫苗者；也是日本國境內，極少數可以帝大附屬研究所之姿製販血清疫苗者。 / The dissertation aims to use historical data a long with GIS methods to explore the vaccination prevention to certain infectious diseases in colonial Taiwan (1895 – 1945). The smallpox vaccination was the earliest vaccination has been practiced in Taiwan. The change of polices and influstructure in cowpox manufacture revealed how the vaccination adminstration transformed and shaped local society. With the cowpox vaccine popularized, the immunity was gained as well as the low infection and mortality rate after 1910s implied its effectiveness. Secondly, the plague vaccination in 1900~1904 was the first big-scale preventive injection by the Taiwan official, but rarely injected after 1904 due to the high cost and side effects. following that, the cholera serum was often used in scale in 1916 which 3 million people received injecttion during 1919~1920, a period of cholera pandemic. One effective that cholera imunizationleft was that Taiwanese strated to accept needle injection a way of vaccinated prevention. The pandemic influenza invaded Taiwan in 1918~1921but the etiology was unknown currently. As the second wave of the epidemic occurred, the authorities began to pay attention and encouraged people to take injection from indirect causes of death such as pneumococcal. This injection strategy was applied in the whole Japanese ruled era. The epidemic cerebrospinal meningitis, since its vaccination reported in 1917, was larger implemented in the 1920s, then greatly practiced after the 1930s. Furthermore, the epidemic encephalitis or encephalitis named after Taiwan before 1935 usually referred to the epidemic cerebrospinal meningitis. Therefore, the epidemic encephalitis or encephalitis vaccination actually meant the meningococcal meningitis vaccination. In general, most implementation of vaccination appeared around 1916 progressed in 1920s and prevalently practiced after the 1930s. The police of vaccination brought down the infection and mortality rate in Taiwan a long withthe attitude of acceptance to immunization injection among people. Furthermore, Taiwan set up a professional animal serum factory and established the Central Science Institute of Taiwan Governor in 1903. In 1916, Taiwan started to make and sell serums and vaccines to the public which indicated the vaccination were already prevalent among Taiwanese. The govenemnt monopolized the sale of vaccines and the products could however offer to China and other places. In 1939, Taiwan went a step further to manufacture the dried vaccine, toxoid, and anatoxin. The phenomenon above implied various meanings. First, the promotion of bacteriology, immunology and serum in Taiwan were based on personal commitment by Gotou Shinpei (1857-1929) and Takagi Tomoe (1858-1943). With their connection to the Bureau of Sanitation of the Ministry of Interior, the Institute of Infectious Diseases (Kitazato Shibasaburou, 1853-1931), and House of Representatives, their works might link to the Rockefeller Institute which brought strong trust to the developing of bacteriology. In 1916 the attempt to produce and sell vaccine was a side-effect deriving from the domentic friction of the Institute of Infectious Diseases in 1914. It caused by the struggle of the administrative and resources, the dispute of practical and academic, and maturates of the bacteriology; lead to the essentially open to the serums and vaccines market in Japan and its foreign lands, included Taiwan. Taiwan closed to the faction of Kitazato. Soon after, the great spread of infectious diseases in 1918-1921 bright the emergency to apply and manufacture of biologics in 1920s in Japan and all of its territories. Taken the impact, the Central Research Institute of Taiwan Governor changed its infrastructure and products in the 1930s. It is worth noting that the Central Research Institute of Taiwan Governor and the Taiwan Medical Specialized School became branches of the (Taipei and Tokyo) Imperial University in 1936-1939, for the necessity of dried vaccine, toxoid, and anatoxin.