为了共同的未来 我们需要向世卫组织投资

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样：悲惨、不可避免而且不可预测。它起源于一个随机事件。一种病毒跨越物种界限，从一只鸟、一只蝙蝠或其他动物跳到“零号病人”身上，接着这个人再把病毒传到其他人身上。在本世纪，我们很有可能会经历一次类似于1918年那样的流感疫情，当年的疫情曾导致5000万人死亡。

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.

美国总统巴拉克•奥巴马(Barack Obama)的首任幕僚长拉姆•伊曼纽尔(Rahm Emanuel)曾在全球经济危机过后表示，“你绝不能让一场严重的危机白白浪费”。危机也是机遇，我们可以从中吸取教训。它们会揭示一些有助于防止机构在极端压力下崩溃的措施。

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.

在世人不难理解地专注于应对埃博拉疫情之际，同样重要的是，这场疫情应让人们警醒，各种不足之处不仅可能带来规模空前的悲剧，还会危及美国和其他富国的基本安全。就像气候变化一样，全球任何一个角落都无法摆脱流行病的影响。

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)委员会的报告提出了3点重要教训。我担任该委员会的联合主席。

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，必须采取集体行动在全球所有地区建立强大的卫生体系。在西非，埃博拉是针对各国卫生体系的一场“压力测试”。塞拉利昂、利比里亚和几内亚的卫生体系应付不了这场疫情。受过训练的专业医护人士太少；设备和物资太少，公共卫生监测和控制能力也太弱。

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月被确诊后，尼日利亚对埃博拉病毒的防控具有指导意义。强有力而协调的监控回应是该国防控成功的原因，世界卫生组织(WHO)称赞其为“世界级的流行病学侦探工作”。尼日利亚已建立小儿麻痹监测体系，拥有有技能的疫情专家，能够依靠他们来对付埃博拉疫情。每个国家都需要这种体系。防范的代价低于治疗，而且会取得更好的结果。

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.

建立这些体系需要时间和金钱。我们的研究表明，未来20年，“加强体系”的成本为每年约300亿美元。这项研究由一个由经济学家和卫生专家组成的国际团队开展，去年发表在医学杂志《柳叶刀》(The Lancet)上。好消息是，通过援助和国内支出，我们可以筹措这笔资金。其成本远远低于中低收入国家未来20年国内生产总值(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.

第二个教训是，公共卫生投资匮乏是一项全球性紧急事件。鉴于世界卫生组织最近的裁员，该组织对埃博拉疫情的缓慢回应并不令人意外。对此，我们都要承担责任。自1994年以来，世界卫生组织的经常预算按实际价值计算一直稳步下滑。甚至在埃博拉疫情爆发之前，该组织就连维持基本职能都捉襟见肘。2013年，该组织针对流行病疫情的预算总额为770万美元，不到纽约市公共卫生紧急事件预算的三分之一。

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带入一个国家。我们比任何时候都更需要世界卫生组织。该组织具备成为所有国家（穷国和富国）的卫生保护机构的授权和合法性。任由它资金匮乏是鲁莽的。

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.

第三个教训与科学创新有关。就发现和开发药物、疫苗和诊断测试而言，我们基本忽视了那些导致大量穷人死亡的传染病。其后果是，我们还没有针对埃博拉病毒的药物或疫苗。我们所能做的是提供基本的生命支持，例如补液和血压控制。至于预防，我们不得不依赖老式的隔离等措施。

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.

世界卫生组织总干事陈冯富珍(Margaret Chan)解释了这种忽视的原因。她表示，医生们“两手空空”，因为“一个由利润驱动的行业不会为付不起钱的市场投资开发产品”。埃博拉病毒影响的是非洲穷国，因此制药企业认为在这方面投入是不会带来任何利润的。任何一个社会都不会允许企业在疾病快速蔓延时获得巨大利润。

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.

富有的政府和捐赠者需要加快脚步。每年投资几十亿美元（不到全球GDP的0.01%）有望在防止世界大战规模的悲剧方面发挥决定性作用。

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.

有些问题比经济衰退和选举更重要。埃博拉疫情是一场悲剧。让我们希望它也将促使我们采取必要举措，防范那些规模大得多、按照目前政策轨道近乎不可避免的悲剧。下一个埃博拉距离我们并不远。