A girl seriously affected with cholera Albert Gonzalez Farran/Getty Images

消灭霍乱路线图

日内瓦—“请问洗手间在哪?”每当我访问霍乱爆发地区,这常常是我问的第一个问题。更多时候,我获得的回答是“我们没有洗手间。哪里方便就在哪里解决。”

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霍乱这个古老的病种,如今已经成为贫穷病。它本身不具有地理区别,但主要在卫生设施落后的脆弱社区传播。

携带霍乱弧菌的洪水进入到饮用水水源,然后被毫无戒心的旅行者传播,或进入用未处理过的污水进行灌溉的家庭,被摄入人体后栖息于小肠,引发严重腹泻和脱水

那些从未亲眼目睹霍乱影响的幸运儿,可能会认为这无非是有一种肠胃病。但如果不迅速进行治疗,霍乱可能会在几个小时内夺走成年人或儿童的生命。每年,霍乱都会导致大约95,000人死亡;其中许多是儿童。

今年,无精打采、双目无神的待治疗霍乱患者的形象出现在世界各国。这种疾病以前所未有的速度在也门传播,4月份以来已造成2,000多人死亡索马里南苏丹海地和其他许多撒哈拉以南非洲和亚洲国家也发生了霍乱疫情爆发。

但关于最近的致命霍乱疫情的最令人悲哀的事实是每个人的死亡其实都是可以避免的。世界早已掌握了有效控制霍乱的知识和工具,但现有资源与必要的全球承诺不相匹配。

因此,多元化的技术合作网络——全球霍乱控制任务小组(Global Task Force on Cholera Control)至关重要。《消灭霍乱——2030年全球路线图》(Ending Cholera – A Global Roadmap to 2030)强调要转向积极预防方针,制定了在未来十年让霍乱致死人数减少90%的目标。如果能得到全面实施,该计划将帮助多达20个国家在相同的时间框架内根除霍乱传播。该路线图基于三个支柱——早期监测、集中预防以及国家和合作伙伴间的合作——为消灭作为公共卫生威胁的霍乱提供了非常具体的路径。

一旦霍乱在一个社区内爆发,就会日益难以控制。因此,很重要的一点是,即使没有报告病例,也不能将它遗忘。包括了水、下水道设施和卫生(所谓的WASH服务)投资在内的多部门方针能够将霍乱控制在未萌发状态。用口服霍乱疫苗进行预防和快速治疗手段(如口服补水剂和静脉注射)也能起到同样的作用。

改善WASH基础设施是最有效的预防方法,尽管在资源匮乏国家落实这些服务需要时间。因此,路线图还鼓励在霍乱高发地区预防性地大量配置口服疫苗。疫苗能够立刻起作用,在三年内防止霍乱爆发,为实施长期解决方案争取时间。

口服霍乱疫苗可以通过世界卫生组织在Gavi即疫苗联盟的支持下维持的全球储备获得。自2013年该计划成立以来,已有超过1,500剂疫苗分配给18个国家。明年,疫苗储备将增加到2,500万剂以上,而成立之初只有两百万剂。

要在2030年前消灭作为卫生威胁的霍乱——这是全球合作伙伴和世卫组织最新做出的承诺——需要来自受霍乱影响的国家、技术合作伙伴和国际捐赠者的持续合作和致力。考虑到如今全世界每年仍有数百万人有可能沾染霍乱,这一目标似乎非常艰巨。但在城市化、气候变化和其他因素有可能让传染风险进一步加剧的情况下,我们必须实现这一目标。路线图让它成为可能。

实施路线图计划将是饱受霍乱反复爆发的国家性价比最高的解决方案。这也是急需行动起来的原因之一。但对国际社会来说,采纳这一战略也是一件正确的事。政府有确保所有人都不会遭遇可预防死亡的道德义务。这也是世界卫生组织的义务,因此,我们将努力帮助世界实现我们所制定的雄心勃勃的目标。

我们拥有战胜霍乱所需要的工具。现在,我们又有了计划,没有任何借口不把计划和工具落到实处。

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