Greenpeace activists campaign against the excessive use of antibiotics in livestock farming John Macdougall/Getty Images

和国际货币基金组织一起解决抗生素耐药性

伦敦—本月是联合国抗生素耐药性(AMR)高级别会议召开一周年,该联合国会议由英国的独立AMR评估帮助组织。对我来说,去年的这个时刻令人无比光荣。因为我是AMR评估主席,也因为我的团队和英国总医务官萨利·戴维斯(Sally Davies)。

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去年的高级别会议决议,成员国代表将在两年后再次开会评估进展情况——因此,下一次会议是在2018年9月。会议还号召成立一个机构间协调小组,在两年的时间里指导遏制AMR的工作。小组由我负责召集,由非常有责任心的人士领导。在更广的范围上,国家和国际层面的决策者也开始将更多注意力集中在AMR的威胁上。

事实上,联合国高级别会议举行后,G20也做出了崇高的遏制AMR 承诺。在7月的G20德国汉堡峰会上,各国政府同意成立“研发合作中心”,着手逐步停止将抗生素应用于农业。农业生产上使用抗生素促进牲畜生长。

英国AMR评估建议增加20亿美元的AMR初期研究经费,因此,建立研发中心的措施非常值得欢迎。但限制在农业中使用抗生素的协议意义更加重大。在过去,G20主要成员国一致拒绝做出这样的承诺。而在作为联合国高级别会议基础的文件中,农业也没有提及,原因是担心因此导致最终协议胎死腹中。

联合国和G20所迈出的步伐令人鼓舞。但遏制AMR的斗争远远没有结束,反而可能才刚刚开始。放眼未来,最大的挑战之一在于个体国家和多边组织,比如联合国自身。我们如何确定政府和机构会兑现自己的豪言壮语?

首先,我们可以着眼于经济学和公共卫生的交叉互动。国际机构有很多方式可以撬动经济政策杠杆,大大降低传染病暴发的概率,提高脆弱国家对这一风险的抵抗力。

在我看来,国际货币基金组织(IMF)应该起到领导作用。彼得·桑兹(Peter Sands)和他的同事们在2016年5月的《柳叶刀》杂志上所发表的研究表明,传染病爆发会造成巨大的经济成本,但它们很少甚至没有作为评估宏观经济风险的因素被考虑到。IMF已经有了针对各国经济健康的定期评估,金融市场分析对此非常重视。为了经济健康,也为了公共卫生,IMF同样可以在追踪各国AMR进展方面做出出色表现。

十年多前,欧盟便已经宣布将禁止将抗生素用于促进牲畜生长。但除了偶尔有调查记者关注此事,还有谁真正深入到各成员国,调查这一目标的进展情况?

在英国,我的AMR评估同僚和我们的建议所引起的政府反应引线深刻,特别是在减少抗生素处方、防止住院传染和将农业中的抗生素用量限制在50毫克/千克牲畜水平方面。

在过去的一年中,我在一些积极研究AMR威胁问题的英国大学发表公开演讲。们鼓励我比过去更多地去会见一些该问题的学术研究者。但通过提问听众,我意识到很少有人了解政府的政策反应。这可能只是因为我的听众们不了解情况;但我对此有所怀疑。更有可能的情况是政府没有兑现它的承诺。

IMF是非常理想的解决问题者,它可以将该问题列为其常规经济评估的一部分。它的经济分析对于不太富裕的国家价值更高,在这些国家,防止传染病暴发可以对长期经济增长起到直接提振作用。

在联合国高级别会议迎来一周年之际,我的最后一项担忧是决策者仍然没有批准旨在鼓励开发新药和新诊断方法的市场进入奖励经费。这些创新将是防止和发现AMR的关键,而刺激这些创新的激励机制正日益被视为正确的方法。在这方面,IMF也能够提供非常宝贵的建议。

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