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预防下一场传染病

锡拉丘兹—最近埃博拉寨卡等疾病的爆发证明,我们需要在传染病爆发之前就有所预见并遏制。但致命疾病巨大的多样性、顽固性和传染性也以最突出的方式证明了遏制和预防是多么困难。

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对我们的准备工作来说,一个威胁是连通性。拜便利的国际旅行所赐,近几年来,登革热、基孔肯亚病和寨卡病毒都能搭顺风车自东而西,在美洲和加勒比地区造成大规模爆发。另一个威胁比较陈词滥调:钱没有谈拢。不管什么原因,事实是,只要人类不能组织起集体全面的防御,传染病就会继续作乱——并带来灾难性后果。

制定有效的预防和遏制战略——在生化上做好准备——是降低全球传播威胁的最佳方法。准备工作需要各个机构和出资人之间的协调,构建能够迅速部署和推广疫苗、药品和协议的网络,从而限制疾病的传播。简言之,为下一场传染病做好准备不但意味着构建全球能力,要需要为它掏钱。

至少在概念上是如此。生化准备的现实则要复杂得多。首先,缺少专用资金阻碍了长期预防战略在许多国家的部署;世界银行的新报告发现只有包括美国在内的六个国家,认真对待传染病威胁。与此同时,由于实验室和诊所的不足,世界许多地区的公共卫生官员,难以有效应对疾病啊播发情况。更有许多出资机构,包括政府和非政府组织,通常只提供一年的资金,从而无从实现长期规划。

多年来,科学家、医生和公民社会行动方都对缺乏可靠、有效和制度化的传染病预防投资表示关注。令人失望的是,在他们提出这些关注的同时,遏制人类有意为之的生化袭击的军事拨款却保持在巨额水平。但是,尽管有目的、罪恶的传染病暴发可能造成严重伤害,可能性相对来说却非常低。相反,自然发生的传染病爆发时不时就会发生,且代价更加高昂,即使它们并不具备引起轰动的生化恐怖主义的“恐慌因子”。

不久前,我们这些参与过传染病爆发的预防工作人,对于准备工作能够得到需要的资源这一点,曾经有过更强的信心。但在许多地方,预算停滞不前甚至被削减。这是令人震惊的短视,因为与响应相比,预防的成本要低得多。比如,建设医疗和实验基础设施、提供辨别和预防培训以阻止最近在西非爆发的埃博拉病毒,需要付出多大成本?具体的数字很难计算,但我丝毫不怀疑它要比遏制埃博拉的成本低数十亿美元。准备工作是物有所值的。

敲响警报的不只是缺乏资金;对现成资金如何使用的限制也是个问题。拨款被限定在具体的用途上,导致项目无法实现其目标,这样的情况绝非罕见。比如,出资者可能允许修葺现有实验室,但不允许建设新实验室;或者资金可以用于支持采购诊断机器,但不能用于培训这些机器的操作员。在许多发展中国家,社区甚至无法拥有能用来测试、监控和存放危险病原体的实体建筑。缺乏远见的资金管理完全忽视大格局中的关键要素,导致资金得不到很好利用。

除了这些挑战之外,还有为工作人员发薪水和确保可靠的电力和其他基本服务方面的困难,此外,很显然预防疾病爆发还需要国际援助组织的广泛参与。但目前的情况是,繁琐的支出规则和金融承诺的不足正在束缚致力于下一场严重的疾病爆发的人员的手脚。

科学家和公共卫生专家在遏制致命传染病这场竞赛中面临着数量惊人的险阻。要想克服这些险阻,我们需要重新定义疾病准备工作,从响应立场转为预防方针。用于准备工作的资金必须多层次配置,以产生必要的效果。对如何支出资金的限制,应该予以放松。资金源必须敞开,从而让多年期的准备工作成为可能。医疗服务提供者和一线响应人员必须接受适当的培训。长期方案,比如建立和连通生化检测系统等,应该予以扩大和强化,让全世界公共卫生专业人员能够追踪和报告人类和动物疫情,共同规划防御方案。

公共卫生是全球安全的重要一环。不再预防传染病爆发方面做出适当的投资将让我们所有人都面临风险,不管下一次爆发的是什么传染病、什么时候爆发。

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