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来源:经济学家    作者:经济学家   时间:2013-01-16 11:02   点击: 次  

Science and Technology,Eradicating polio,Late? Or never?

A plan to wipe out polio by the end of next year is in trouble

HUBRIS is always dangerous. In 1977 smallpox was eradicated and—an accidental infection in a British laboratory a year later aside—that claim has stood the test of time. Having eliminated one viral disease, the authorities decided they ought to be able to get rid of another: polio. That, though, proved a tougher opponent. The World Health Organisation's original target, set in 1988—a polio-free world by 2000—proved illusory.
骄傲自满通常是危险的行为。 1977年,人类宣称消灭了天花(若将一年后英国实验室发生的一次偶然天花感染排除在外的话),这份声明经历了时间的考验。 在消灭了一种病毒疾病后,权威专家们认为他们有能力再消灭另一种病毒:脊髓灰质炎病毒。 但实践证明,脊髓灰质炎是个难以应付的对手。 世界卫生组织于1988年定下的原始目标——到2000年实现全世界无脊髓灰质炎——被证明是天方夜谭。

The latest deadline set by the Global Polio Eradication Initiative (GPEI), the multinational body charged with dealing with the disease, is next year. On July 20th, though, Sir Liam Donaldson, once England's chief medical officer and now the chairman of an independent watchdog committee that scrutinises the GPEI's activities, published a report which says this deadline, too, is at risk.
全球根除脊髓灰质炎行动小组(GPEI)是负责消灭该疾病的跨国机构,它将消灭脊髓灰质炎的最后期限定为明年。 但7月20日,利亚姆·唐纳森发布的一份报告指出这个最后期限也正面临风险,利亚姆·唐纳森是英国前首席医疗官,现任负责审查"全球根除脊髓灰质炎行动"活动的独立监督委员会主席。

In truth, the GPEI has not done badly. The number of cases of polio is a mere 1% of what it was in 1988. But that number has hardly budged for several years. Squeezing the last few cases out of existence has proved far harder than expected.
事实上,全球根除脊髓灰质炎行动一直成绩卓著。 目前,脊髓灰质炎的病例数量仅为1988年的1%。 而且在数年间,该数字几乎都未发生变化。 要想根除最后的少量残存病例证明比预期更难。

Polio poses a particular challenge to countries with unstable politics and weak health systems. To contain outbreaks, surveillance must be vigilant: the virus usually lurks silently, paralysing just one carrier in 200. Moreover, the vaccine is delicate and must be kept cool. And immunisation requires repeated vaccinations.
在政治动荡和卫生系统薄弱的国家,消除脊髓灰质炎将面临很严峻的挑战。 为控制疾病爆发,必须在疫情监测上提高警惕:此种病毒通常悄无声息地潜伏于人体内,每200名病毒携带者中仅有1名会遭受此病毒侵袭。 此外,由于病毒疫苗的敏感特性使其必须在低温下保存。 并且要想实现免疫还需要反复接种。

Today polio is endemic in only four countries: Afghanistan, India, Nigeria and Pakistan. It has, however, re-emerged in several others. Each endemic country has its own particular problems. In Afghanistan the GPEI has failed to stop transmission in 13 war-ridden southern districts. Most of India is free of the disease, but the states of Uttar Pradesh and Bihar continue to struggle. In 2003 and 2004 Nigeria was gripped by rumours that polio vaccine would sterilise children and infect them with HIV. And although in Pakistan the incidence of polio dropped tenfold between 1995 and 2000, conflict, poor sanitation and a mobile population helped the number of cases jump by 62% last year.
目前脊髓灰质炎仅在四个国家流行:阿富汗、印度、尼日利亚和巴基斯坦。 但此病在其它几个国家也曾死灰复燃。 每个疾病流行的国家都有自己特殊的问题。 在战火纷飞的13个阿富汗南部地区,全球根除脊髓灰质炎行动没能够阻止疫情的传播。 印度大部分地区都未出现该病疫情,但北方邦州和比哈尔邦州仍在与该疾病抗争。 2003年和2004年,尼日利亚坊间盛传脊髓灰质炎疫苗会使儿童绝育并让他们感染艾滋病毒。 尽管巴基斯坦的脊髓灰质炎发病率在1995年到2000年间降低了10倍,但战争冲突、恶劣的卫生条件和人口的流动使病例数量在去年激增了62% 。

In 2010 the GPEI adopted a new strategy, with the goal of stopping transmission by the end of 2012. If no cases are seen for three years after that, the disease will be certified as eradicated. One priority of this new strategy is to work carefully with local leaders, to win support for immunisation.
2010年,全球根除脊髓灰质炎行动通过了一项新策略,其目标是到2012年底阻止脊髓灰质炎的传播。 如果接下来的三年内无病例发生,那就证明该疾病被彻底根除了。 这项新策略的首要任务是寻求与疫情当地领导人的紧密合作,赢得他们对免疫行动的支持。

In Asia, where polio cases are concentrated in just a few places, the GPEI has tailored plans for each of them. For example, better co-ordination between Afghanistan and Pakistan would help manage cross-border transmission. In Africa, where the virus now roams across a broad swathe of countries, the GPEI would scale up activity in places such as Angola, Chad, Guinea and Mali where polio has reappeared in recent years. The response to new outbreaks would be swifter and stronger; the administration of vaccines, broader. A new, more effective oral vaccine will help.
在亚洲,脊髓灰质炎仅集中在少数几个地区,全球根除脊髓灰质炎行动已经为它们量身定制了几套方案。 例如,阿富汗与巴基斯坦的通力合作有助于控制疫情的跨境传播。 在非洲,病毒目前在众多国家肆虐,近年来,脊髓灰质炎在安哥拉、乍得、几内亚与马里等国家死灰复燃,全球根除脊髓灰质炎行动将扩大对它们的救治规模。 对新疫情爆发的反应将更加快速而有效,并且疫苗的投放范围将更为广泛。 一种新型更为有效的口服疫苗也将对疫情防治有所帮助。

Sir Liam's committee was itself a product of this new strategy, and now it is fulfilling its remit by pointing out where other components are going wrong. Though India has made gains, elections interrupted progress in Nigeria. Pakistan's emergency action plan seems to have had little effect—the country has recorded 54 cases this year, double the number in the first half of 2010.
利亚姆负责的委员会本身就是这项新策略的产物,他们要履行的职责是指出根除脊髓灰质炎行动计划中的错漏之处。 尽管印度在脊髓灰质炎防治方面取得成效,但尼日利亚的大选阻断了该病所取得的进展。 巴基斯坦的紧急行动计划似乎也成效甚微——该国今年已经发生了54宗病例,比2010年上半年增加一倍。

Countries with resurgent polio are struggling as well. Chad, for example, has been slow to implement a strong plan of action. The original strategy for the Democratic Republic of the Congo was to concentrate vaccination in three provinces. However, transmission is now more widespread, so a broader campaign might prove necessary.
脊髓灰质炎复发的国家也面临同样的困境。 例如乍得迟迟未付诸实施强有力的行动计划。 刚果民主共和国原先的策略是将免疫计划集中在三个省。 然而现在疾病传播反而更加广泛了,因此可能需要在更大范围内与该疾病抗争。

More than $8 billion has been spent to date, with more than $1 billion of that coming from the Bill & Melinda Gates Foundation. Mr and Mrs Gates hope their investment will pay a big dividend. A recent paper estimated that eliminating polio would bring a net benefit of between $40 billion and $50 billion over the period from 1988 to 2035. But that assumed eradication by 2012.
迄今为止,各国已经投入了80多亿美元对抗脊髓灰质炎,其中有十几亿美元资金来自于比尔·盖茨和梅林达·盖茨基金会。 盖茨夫妇希望他们的投资会带来很大成效。 一份最近的报告估计从1988年到2035年间消除脊髓灰质炎将带来400亿到500亿美元的净收益。 但其前提是到2012年要将脊髓灰质炎彻底根除。

Donald Henderson, the doctor who led the campaign to rid the world of smallpox, predicts that even if polio is deemed eradicated, vaccination will have to continue, just in case. That will drive up costs. For now the GPEI is resolute. But the eradication campaign cannot last for ever.
唐纳德·亨德森医生曾领导消灭全世界天花的斗争,他预测即使有天脊髓灰质炎被消灭了,免疫工作仍要继续以确保万无一失。 但这将推高行动计划的成本。 目前全球根除脊髓灰质炎的行动是坚决的, 但病毒消灭战役不可能永无休止地进行下去。



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