Why the WHO's Emergency Declaration for Ebola Is a Big Deal
为什么世界卫生组织紧急发布埃博拉是个严重问题
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2019-08-11 18:24
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The World Health Organization last week drew global attention to a nearly year-old outbreak of Ebola in the Democratic Republic of the Congo (DRC), calling it a “public health emergency of international concern.” The designation signals a public health risk to other countries and indicates that a coordinated international response might be needed. The agency based its decision in part on the first confirmed case of Ebola in Goma, a DRC city of nearly two million people on the country’s eastern border with Rwanda. That shift raises the risk that the disease could spread internationally.

上周世界卫生组织在刚果民主共和国告知全球需关注近期爆发的埃博拉疫情,称之为“全球关注的社会卫生紧急事件”。这个名称向其他国家传递了健康风险信号,并且表示需要协调的国际应对措施。该机构的此决定部分是因为在戈马确诊的第一例埃博拉病例,戈马是一个拥有近两百万人的刚果民主共和城市,其东边与卢旺达接壤,这种情况大大提高了疾病在全球传播的风险。

This Ebola outbreak is the second worst on record, with roughly 2,500 documented cases of people with Ebola virus disease and about 1,700 deaths so far. The situation has been compounded by deadly violence against health care workers and mistrust of outside medical authorities. In recommending the emergency declaration, a WHO committee emphasized “disappointment about delays in funding,” as well as the need to protect people’s livelihoods by “keeping transport routes and borders open.” A coordinated response to the outbreak is under way, including distribution of a new vaccine, but the committee says more work is needed to help people and communities affected by Ebola.

埃博拉的爆发是有史以来第二严重事件,据粗略统计有2500人感染埃博拉病毒并超过1700人死亡。由于对卫生保健人员的致命暴力和外部医疗局的不信任,这种情况更加恶化。由于发布紧急声明的建议,世界卫生组织的会议上阐述了“对拖延资金感到很失望”,同时也提出了需要“通过保持传送路线以及国境的开放”来保持人们生活。协同措施正在进行中,包括新疫苗的投放,但是会议认为应该将更多精力放在帮助那些被埃博拉感染的人群和组织上。

Chandy John, president of the American Society of Tropical Medicine and Hygiene, is an infectious disease expert who has not studied Ebola specifically, but has studied outbreaks of other infectious diseases, including malaria. Scientific Americanspoke with him about what the emergency declaration aims to accomplish, as well as the biggest challenges in turning the tide against the current outbreak.

美国热带卫医学与卫生组织的主席查恩.约翰是一名传染病专家,但是他的以前研究不是针对于埃博拉,而是一些其他爆发的传染病,包括疟疾。科学美国人(科普杂志)跟他谈论了有关这次紧急声明的目的以及为扭转最近疫情爆发最大的挑战。

[An edited excerpt of the conversation follows.]

谈话编辑摘录如下

What is the WHO hoping to achieve with this emergency declaration about the outbreak?

世界卫生组织想通过疫情的紧急声明达到什么目的?

There has been a coordinated international response, mostly organized by the WHO, but they’ve noticed that despite numerous recommendations for increased resources, the global community hasn’t contributed what they feel is necessary for this outbreak. An announcement like this puts it front and center that there is a need for a coordinated international response. And it’s a crisis, so both the coordination and the balance of resources that are needed are higher than for usual public health problems. And hopefully, that means that more resources will then be devoted to it.

国际各方大部分在WHO的组织下都做出了协调一致的应对,但是他们提到,不管上交了多少关于增加补给的建议,全球组织并没有给他们提供必要的疫情资源。也有相似的公告提出了全球协同应对的必要性,并将放在前列和中心。这是一次危机,所以所需资源的协调和平衡要优先于普通社会卫生问题。这意味着未来有更大希望投放更多资源。

When you say resources, are we talking about money, staff, vaccines or all of the above?

提到的资源是我们所说的资金、人力、疫苗还是全部?

Money, for sure, but their real problem is with security and with health workers being killed. So, we need countries contributing to a United Nations presence there that could provide security to health workers that are at risk, as well as the ability to deploy more vaccine, the ability to make more vaccine, and funds for local health workers. So yes, it’s all of the above.

资金是确实需要的,但是他们真正的问题是安全性降低和医务人员的死亡。所以我们需要各国家来建立一个联合国的存在,可以保护处在危险中的医务人员提供安全,并且部署、制作更多地疫苗,为当地的医务工作者提供资金。是的,我们需要全部。

Do you think this type of declaration by the WHO will have an impact on the outbreak in terms of those measures?

就那些措施来说,你认为WHO发布的这类声明对疫情爆发有影响吗?

Yeah, I think that everybody believes it will. There have been calls for this from a number of groups prior to this. This designation has not been used very often. But a lot of groups felt that we really needed to move ahead to this, partially because people feel that once the outbreak is declared as a PHEIC [Public Health Emergency of International Concern], countries are more likely to step up on contributing resources. So I hope that happens.

对,我认为所有人都觉得有。在此之前已经有很多团体打来有关这些的电话了。这个称呼(全球需注意的社会卫生事件)用的不多,但是很多团体认为我们需要在此之前行动起来,部分原因来自群众,人们认为一旦PHEIC(全球关注的社会卫生紧急事件)发布疫情爆发,国家就很有可能会挺身而出来提供资源。所以我希望这可以发生。

Can you talk about what we might do to stem the violence against health care workers and whether this declaration could help?

为了阻止对于社会卫生人员的暴行我们应该做些什么?发布的声明对于这些有用吗?

The groups or forces on the ground—it doesn’t necessarily need to be armed forces—can provide security to health workers so they don’t feel that their lives are at risk when they go into these communities. That’s one thing. But another is getting groups to talk about what’s happening there and understanding the social science of the situation: what the fears are, why people are doing this.

军队是没必要的,但是有地面部队和团体可以保护医疗人员的安全,所以当医务人员去到那些区域时不会担心他们的人身安全有危险。这是一件事,还有一件事是让队伍们知道到底发生了什么事,并且了解现在的社会科学情况,害怕什么?为什么人们会这么做?

Is there mistrust of both the public health response and of the vaccine being administered?

人们对于社会卫生应对措施和疫苗的接种有怀疑态度吗?

There’s suspicion of health workers, and in some areas, there is suspicion of vaccines. But by and large, as the vaccine has been given out, it has mostly been accepted. So now, it’s more a question of supply than fear of vaccination. Merck, which makes the vaccine, is committed to doubling the supply by 2020. But it still may not be enough for all who need it. There is also a second vaccine by Johnson & Johnson that they would like to study, but so far that hasn’t been approved for study in the DRC. It’s new, and it doesn’t have the same track record as the other one, so they would be studying the vaccine and its efficacy. But in the long term, if we could use it and see that if it was efficacious, that might be part of the solution. The amount of the current vaccine that can be supplied is in the hundreds of thousands of doses. And that will work for certain vaccination strategies, but for broader vaccination strategies, you might need more than that. Because the supply has been relatively constrained, they’ve been using an adjusted smaller dose that seems to still give an adequate response. So, that’s one of the ways in which they’ve been kind of extending the vaccine.

对卫生人员人们是有怀疑的,在一些地方对接种疫苗也持有怀疑。但是总体上来说,当疫苗发放了大部分还是愿意接受的。所以现在的问题是疫苗的供给而不是对疫苗的恐惧。墨客公司是一家制作疫苗的公司,该公司承诺到2020年会将供应翻倍。但是这依然供不应求。还有约翰森&约翰森公司生产的第二种疫苗,他们喜欢做研究,但是他们的研究还没有被DRC认可。这是全新的并且以前没有任何相似的记录,所以他们一直研究疫苗和其效益。但是就长远来说,如果我们可以使用它并且看到了它的效果,那这将会解决一部分问题。可以提供的现有的疫苗的总量是数以百计数以千计的。这对某些疫苗接种策略是有用的,但对于国外疫苗接种策略,这些是不够的。因为供应相对有限,他们用调整过得小剂量疫苗才能提供足量的疫苗,所以这是一种扩大疫苗投放的方法。

Can you say more about the tipping point that prompted the emergency declaration?

能否介绍一下促使紧急声明宣布的临界点?

There’s one particular area which is the epicenter of the outbreak—46 percent of cases in the last three weeks have been reported from there and it seems to be continuing there. The fact that they haven’t been able to get it under control in that area was a factor. But I think the person who traveled to Goma, and then was in Goma and ill, is kind of front and center of the WHO’s report on the emergency declaration. That would seem to be the biggest thing that may have pushed towards this.

有一个特殊的区域是疫情的震中,在过去的三周内有46%的病例都属于那边,并且数量还在上升。事实上,那片区域没有控制住疫情。我认为那些去戈马旅游并且染病的人才是WHO紧急公告的重点。这是一件应该放在首列最重要的事件。

How concerned should we be about Ebola outbreaks spreading internationally?

我们应该如何关注埃博拉的全球传播?

During the previous outbreak, cases were transmitted internationally and caused a panic. In the U.S., it cost in the billions of dollars for a very small number of cases in 2014. It’s potentially a plane ride away. And I don’t mean that in a scaremongering way, but just to say that diseases now know no borders. What’s happening in the DRC matters to the U.S. for the health of our citizenry. And that’s a reason why we really need to dedicate U.S. dollars to this effort.

在之前疫情的爆发,染病者已经被传送并且造成了一定的恐慌。在2014年,美国花费了百万美元来控制小部分疫情。有可能是乘飞机离开,我不是在恐吓,只是说现在疾病不分国界。对于城市健康来说,在刚果发生的事对美国很重要。所以这也是我们真的需要美国提供资金来应对的原因。

Are there other steps that should be taken to stem the outbreak?

还有哪些其他方法来阻止疫情爆发?

I think a lot of it is extension of what’s being done already and doing it in additional areas. Part of it is investigating what’s happening in the communities, how people understand the disease, how people understand the role of health care workers, the screening at cross-border areas. I also think that there are things on-site that need to be investigated, such as how to prevent infections that are transmitted in hospitals, because people go to the hospital and perceive that they just die there. That’s part of why people are suspicious of health care workers—they’re typically from outside, they’re coming in and working at these places where people go to die. Also, are there ways that the extremely restricting protective gear can be altered, and yet leave health care workers safe? Because it’s basically like being in a spacesuit in extremely hot weather on land—it’s very difficult to stay in that protective gear for a long period of time.

我认为很多都是那些已经在做的事情的延伸,并在其他领域进行。一部分是来研究发生了什么、人们怎么了解这种疾病、人们怎么理解医疗人员的角色以及跨国区域的筛选。我还认为在现场的东西也需要研究,比如怎么样防止院内感染,因为人们去了医院才发现自己只会死在那里。这也是人们怀疑医疗人员的一部分原因,他们来自外地,他们来了之后,在会有人死去的地方工作。同时有没有办法可以替换极其受限的防护装备,并且能保护医疗人员的安全?因为这基本上就像在极其炎热的大陆天气下穿着太空服,在那种防护装备下是很难待很长时间的。

ABOUT THE AUTHOR(S)

关于作者

Tanya Lewis

谭雅.刘易斯

Tanya Lewis is an associate editor at Scientific American who covers health and medicine.

谭雅.刘易斯是科学美国人健康医学的副主编。

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