爲了共同的未來 我們需要向世衛組織投資

Epidemics and pandemics are like earthquakes. Tragic, inevitable and unpredictable. It starts as a random event. A virus jumps species from a bird, bat, or other animal to “Patient Zero” – who passes it on to other human beings. More likely than not, over the course of this century we will face an influenza pandemic similar to the one in 1918 that killed 50m people.

流行病和流行病疫情就像地震一樣：悲慘、不可避免而且不可預測。它起源於一個隨機事件。一種病毒跨越物種界限，從一隻鳥、一隻蝙蝠或其他動物跳到“零號病人”身上，接着這個人再把病毒傳到其他人身上。在本世紀，我們很有可能會經歷一次類似於1918年那樣的流感疫情，當年的疫情曾導致5000萬人死亡。

President Barack Obama’s first chief of staff, Rahm Emanuel, said in the wake of the global economic meltdown that “you never let a serious crisis go to waste”. Crises are opportunities to learn. They point to measures that will prevent the collapse of institutions when they are under extreme pressure.

美國總統巴拉克•奧巴馬(Barack Obama)的首任幕僚長拉姆•伊曼紐爾(Rahm Emanuel)曾在全球經濟危機過後表示，“你絕不能讓一場嚴重的危機白白浪費”。危機也是機遇，我們可以從中吸取教訓。它們會揭示一些有助於防止機構在極端壓力下崩潰的措施。

While the focus is understandably on responding to the Ebola crisis, it is equally important that it serves as a wake-up call with respect to inadequacies that threaten not just tragedy on an unprecedented scale but the basic security of the US and other wealthy nations. As with climate change, no part of the world can insulate itself from the consequences of epidemic and pandemic.

在世人不難理解地專注於應對埃博拉疫情之際，同樣重要的是，這場疫情應讓人們警醒，各種不足之處不僅可能帶來規模空前的悲劇，還會危及美國和其他富國的基本安全。就像氣候變化一樣，全球任何一個角落都無法擺脫流行病的影響。

The report of the Global Health 2035 commission, which I co-chaired, points up three crucial lessons.

“全球健康2035”(Global Health 2035)委員會的報告提出了3點重要教訓。我擔任該委員會的聯合主席。

First, collective action must be taken to build strong health systems in every corner of the globe. In west Africa, Ebola was a “stress test” on national health systems, and in Sierra Leone, Liberia and Guinea the systems could not cope. There were too few trained health professionals; there was also too little equipment and too few supplies, and too little capacity for public health surveillance and control.

第一，必須採取集體行動在全球所有地區建立強大的衛生體系。在西非，埃博拉是針對各國衛生體系的一場“壓力測試”。塞拉利昂、利比里亞和幾內亞的衛生體系應付不了這場疫情。受過訓練的專業醫護人士太少；設備和物資太少，公共衛生監測和控制能力也太弱。

Nigeria’s containment of the virus after the first case was diagnosed in July is instructive. Its success, hailed by the World Health Organisation as a piece of “world class epidemiological detective work”, is explained by its aggressive, co-ordinated surveillance and control response. It already had a polio surveillance system, with skilled outbreak specialists who were quickly put to work tackling Ebola. Every country needs this kind of system. Prevention is cheaper than cure and leads to better outcomes.

在首例埃博拉患者今年7月被確診後，尼日利亞對埃博拉病毒的防控具有指導意義。強有力而協調的監控迴應是該國防控成功的原因，世界衛生組織(WHO)稱讚其爲“世界級的流行病學偵探工作”。尼日利亞已建立小兒麻痹監測體系，擁有有技能的疫情專家，能夠依靠他們來對付埃博拉疫情。每個國家都需要這種體系。防範的代價低於治療，而且會取得更好的結果。

Building these systems takes time and money. Our research, conducted with an international team of economists and health experts, and published last year in the medical journal The Lancet, suggests that the price of this “systems strengthening” would be about $30bn a year for the next two decades. The good news is that we have the financing to pay for this through a combination of aid and domestic spending. The cost represents well under 1 per cent of the additional gross domestic product that will be available to low- and lower-middle-income countries due to increased GDP growth over the next 20 years.

建立這些體系需要時間和金錢。我們的研究表明，未來20年，“加強體系”的成本爲每年約300億美元。這項研究由一個由經濟學家和衛生專家組成的國際團隊開展，去年發表在醫學雜誌《柳葉刀》(The Lancet)上。好消息是，通過援助和國內支出，我們可以籌措這筆資金。其成本遠遠低於中低收入國家未來20年國內生產總值(GDP)增量的1%。

The second lesson is that the lack of investment in public health is a global emergency. The WHO’s slow response to Ebola was not surprising, given its recent staff cuts. For that, we all share the blame. Since 1994, the WHO’s regular budget has declined steadily in real terms. Even before the Ebola crisis, it struggled to fund basic functions. The entire budget for influenza was just $7·7m in 2013 – less than a third of what New York City alone devotes to preparing for public health emergencies.

第二個教訓是，公共衛生投資匱乏是一項全球性緊急事件。鑑於世界衛生組織最近的裁員，該組織對埃博拉疫情的緩慢迴應並不令人意外。對此，我們都要承擔責任。自1994年以來，世界衛生組織的經常預算按實際價值計算一直穩步下滑。甚至在埃博拉疫情爆發之前，該組織就連維持基本職能都捉襟見肘。2013年，該組織針對流行病疫情的預算總額爲770萬美元，不到紐約市公共衛生緊急事件預算的三分之一。

It takes just one infected airline passenger to introduce an infection into a country. We need the WHO more than ever. It alone has the mandate and legitimacy to serve as a health protection agency for all countries, Rich and poor. Starving it of funds is reckless.

一位受病毒感染的航空旅客就能把疾病帶入一個國家。我們比任何時候都更需要世界衛生組織。該組織具備成爲所有國家（窮國和富國）的衛生保護機構的授權和合法性。任由它資金匱乏是魯莽的。

The third lesson concerns scientific innovation. When it comes to discovering and developing medicines, vaccines and diagnostic tests, we have been largely ignoring the infectious diseases that disproportionately kill the world’s poor. Consequently, we still have no medicines or vaccine for Ebola. All we can do is provide basic life support, such as fluids and blood pressure treatment . For prevention, we have to rely on old-fashioned measures such as quarantine.

第三個教訓與科學創新有關。就發現和開發藥物、疫苗和診斷測試而言，我們基本忽視了那些導致大量窮人死亡的傳染病。其後果是，我們還沒有針對埃博拉病毒的藥物或疫苗。我們所能做的是提供基本的生命支持，例如補液和血壓控制。至於預防，我們不得不依賴老式的隔離等措施。

Margaret Chan, WHO’s director-general, has explained the reason for this neglect. Doctors were “empty-handed”, she said, because “a profit-driven industry does not invest in products for markets that cannot pay”. Ebola affects poor African nations, so drug companies see no profit in working on it. No society will allow companies to reap huge profits when disease is spreading rapidly.

世界衛生組織總幹事陳馮富珍(Margaret Chan)解釋了這種忽視的原因。她表示，醫生們“兩手空空”，因爲“一個由利潤驅動的行業不會爲付不起錢的市場投資開發產品”。埃博拉病毒影響的是非洲窮國，因此製藥企業認爲在這方面投入是不會帶來任何利潤的。任何一個社會都不會允許企業在疾病快速蔓延時獲得巨大利潤。

Rich governments and donors need to step up. Investing several billion dollars a year, less than 0.01 per cent of global GDP, could be decisive in preventing tragedy on the scale of world war.

富有的政府和捐贈者需要加快腳步。每年投資幾十億美元（不到全球GDP的0.01%）有望在防止世界大戰規模的悲劇方面發揮決定性作用。

Some issues are more important than recessions and elections. Ebola is a tragedy. Let us hope that it will also be a spur to taking the necessary steps to prevent the far greater one that is nearly inevitable on the current policy trajectory. The next Ebola is just around the corner.

有些問題比經濟衰退和選舉更重要。埃博拉疫情是一場悲劇。讓我們希望它也將促使我們採取必要舉措，防範那些規模大得多、按照目前政策軌道近乎不可避免的悲劇。下一個埃博拉距離我們並不遠。