陈冯富珍博士在伦敦卫生和热带医学院：妇女与科学讲座系列的演讲（中英对照）

英文版：From crisis to sustainable development- lessons from the Ebola outbreak.doc 

中文版：摆脱危机，走向可持续发展：从埃博拉疫情中得出的经验教训.doc 

From Crisis to Sustainable Development: Lessons from the Ebola Outbreak

摆脱危机，走向可持续发展：从埃博拉疫情中得出的经验教训

 

London School of Hygiene and Tropical Medicine. Women in Science Lecture Series

伦敦卫生和热带医学院：妇女与科学讲座系列

 

Dr Margaret Chan, Director-General of the World Health Organization

世界卫生组织总干事 陈冯富珍博士

 

10 March 2015

2015年3月10日

 

My good friends at the London School of Tropical Medicine and Hygiene, colleagues in public health, ladies and gentlemen,

 

伦敦卫生和热带医学院的朋友们、公共卫生界的同事们、女士们、先生们，

 

The outbreak of Ebola virus disease that ravaged parts of West Africa in 2014 is the largest, longest, most severe, and most complex in the nearly four-decade history of this disease.

 

在埃博拉病毒病将近40年的历史上，2014年肆虐于西非部分地区的疫情是规模最大、历时最长、最严重和最复杂的一次。

 

To date, nearly 24,000 cases and nearly 10,000 deaths have been reported in Guinea, Liberia, and Sierra Leone. This sum is an order of magnitude higher than the 2,400 cases reported in all 24 previous Ebola outbreaks combined.

 

迄今为止，在几内亚、利比里亚和塞拉利昂共报告了2.4万起病例，将近1万人死亡。这一数量级高出了以往全部24次疫情总计报告的2400起病例。

 

A look at the factors that made last year’s outbreak so difficult and so devastating is important. That experience yields a number of lessons that need to be acted on with the utmost urgency.

 

必须审视一下，是哪些因素导致了去年的疫情如此棘手，破坏力如此巨大。我们从中可得出一些需要刻不容缓地采取行动的经验教训。

 

Constant mutation and adaptation are the survival mechanisms of the microbial world. Changes in the way humanity inhabits the planet have given viruses and bacteria multiple new opportunities to exploit. New diseases are now emerging at an unprecedented rate. No one expects this trend to end.

 

不断的变异和适应是微生物世界的生存机制。地球上人居方式的变化，带给病毒和细菌许多可利用的新机会。新的疾病正以前所未有的速度出现。很难指望这一趋势将会中止。

 

Moreover, in a world of radically increased interdependence, international travel, and trade, there is no such thing as a local outbreak anymore.

 

此外，在一个相互依存关系、国际旅行和国际贸易迅猛增长的世界上，再不会有地方局部疫情一类事情。

 

Recent large outbreaks, just since the start of this century, have shattered a number of assumptions about the world’s vulnerability to new and re-emerging diseases, like Ebola.

 

最近这次本世纪以来的疫情大暴发，打破了在世界面对新的和再度出现的疾病，例如埃博拉的脆弱性问题上，人们的种种想当然。

 

As the century began, most experts believed that the exotic pathogens that cause so much misery in the developing world would never threaten wealthy countries, with their high standards of living and well-developed health systems.

 

随着本世纪的发端，大多数专家都认为，在发展中世界造成巨大痛苦的外来病原体再不会威胁到富裕国家，因为后者确立了很高的生活标准和发达的卫生系统。

 

Then came the SARS outbreak of 2003, a disease that took its heaviest toll on wealthy urban areas. SARS spread most efficiently in sophisticated hospital settings.

 

随后暴发了2003年的严重急性呼吸道综合征疫情（SARS），富裕的城市地区首当其冲。严重急性呼吸道综合征在高端医院环境下传播最迅速。

 

Scientists also assumed that threats could be predicted. When the virus that caused the 2009 influenza pandemic emerged in the Americas, attention was almost exclusively focused on the H5N1 avian influenza virus circulating in Asia as the most likely cause of the next pandemic.

 

科学家还认为，各种威胁是可以预测的。2009年，美洲出现导致流感大流行的病毒时，焦点几乎完全集中在亚洲传播的H5N1禽流感病毒上，它被视为下一次流感大流行的最有可能的原因。

 

Scientists assumed that the most likely breeding ground for new diseases was in the forests of Africa and the teeming cities of Asia. Then came the Middle East Respiratory Syndrome, or MERS, which emerged in the Kingdom of Saudi Arabia in 2012. No one expected that an arid desert environment, and camels instead of chickens, would give rise to a new disease.

 

科学家曾认为，非洲的森林和亚洲的拥挤城市是新的疾病最有可能的滋生地。然后，2012年，在沙特阿拉伯王国出现了中东呼吸系统综合症，或MERS。没人预料到干旱的沙漠环境和骆驼，而不是鸡，将引发新的疾病。

 

Like these other outbreaks, Ebola in West Africa delivered a number of surprises. Understanding these surprises brings lessons that can help the world prepare for similar events in the future. They are certain to come.

 

如同其它这些疫情一样，西非的埃博拉带来了一系列意外。剖析这些意外，将得出教训，有助于世界防备今后的类似事件。新的事件一定会不期而至。

 

Ladies and gentlemen,

 

女士们、先生们，

 

The first surprise was the appearance of Ebola in a new geographical area.

 

第一个意外是埃博拉出现在新的地理区域。

 

Ebola, which first emerged in 1976, has shown an historical pattern of surfacing at irregular intervals, usually in remote rural areas, then going into hiding in some unknown reservoir in the forests, but always in the same parts of equatorial Africa.

 

埃博拉始见于1976年，显示了一种时隐时现的历史格局，通常发生在边远的农村，然后匿藏于森林中一些不为人知的宿主那里，但始终出没在赤道非洲的同一些地区。

 

Nothing from past experience prepared the world for last year’s arrival of the virus in West Africa.

 

以往的经验，完全没能帮助世界准备停当，应对去年在西非出现的病毒。

 

To understand that event, we need to look at the state of health care in the three countries, the assumptions that drove the early response, and the cultural traditions that fed rapid spread.

 

为理解这次事件，我们需要考察一番这三个国家的卫生保健状况，驱动初期应对的种种假设，以及导致迅速传播的文化传统。

 

Prior to 2014, Ebola was considered a rare disease. The only control tools available date back to the Middle Ages: early detection, isolation, infection control, and quarantine.

 

在2014年之前，据认为埃博拉是一种罕见病。仅有的控制手段可追溯到中世纪：早期发现、禁止接触、感染控制和隔离。

 

The largest previous outbreak, which occurred in Uganda in 2000, infected 425 people. With cases currently in the tens of thousands, the failure to develop vaccines and treatments has far more glaring consequences.

 

以往最大规模的疫情，是2000年出现在乌干达。有425人受到感染。而目前，面对成千上万个病例，疫苗研制和治疗方面的失败导致了远为触目惊心的后果。

 

Guinea, Liberia, and Sierra Leone are among the poorest countries in the world. At the start of the outbreak, all three had only recently emerged from years of civil war and unrest that left basic health infrastructures damaged or destroyed and created a cohort of young adults with little or no education.

 

几内亚、利比里亚和塞拉利昂属于世界上最贫穷的几个国家。疫情初起时，所有这三个国家刚刚摆脱了多年的内战和动乱，基本卫生基础设施遭受损毁，一代青年人很少或完全没有受过教育。

 

Before the outbreak, the three countries had only one to two doctors available to treat nearly 100,000 people. For comparison, Spain has 370 and the US has 245. That meager workforce was further diminished as more than 800 health care workers contracted the disease and nearly 500 died.

 

在疫情暴发之前，这三个国家只有一两个医生可投入对将近10万人的治疗工作。相形之下，西班牙为370名，美国为245名。这一薄弱的人力，因为800名卫生保健工作者染病，近500人死亡而进一步崩解。

 

This is the first big lesson. Well-functioning health systems need to be in place before a health crisis strikes. The best way to keep an outbreak from becoming an international threat is to stop it quickly at source.

 

这是第一个重大教训。应在卫生危机袭来之前，建立运转良好的卫生系统。防止疫情演化为国际威胁的最好方式，是在源头迅速制止它。

 

Doing so requires a surveillance system that can pick up early signals of unusual disease events, response teams that can track and investigate cases, and laboratory services to support the investigation.

 

要想做到这一点，需要建立可早期发现异常疾病事件迹象的监测系统、追踪和调查病例的应对小组，以及支持调查工作的实验室服务。

 

Of the 194 countries that are Member States of WHO, only 64, that is, less than a third, have these core capacities for outbreak alert and response in place. That is a shocking indictment of the state of global preparedness.

 

在世卫组织的194个会员国中，只有64个国家，即不到三分之一，具备此类进行疫情警报和应对的核心能力。这就揭示了全球防备状况的惊人败像。

 

The virus affected an additional six countries in two groups. The US, Spain, and the UK reported cases, but their well-developed health systems gave the virus no chance to establish a foothold.

 

病毒影响了分为两组的另外六个国家。美国、西班牙和英国报告了病例，但它们发达的卫生系统阻断了病毒立足的机会。

 

Senegal, Nigeria, and Mali had weak health systems but a high level of alert and preparedness, and treated the first imported cases as a national emergency. With support from their partners, all three countries defeated Ebola with very little, if any, onward transmission.

 

塞内加尔、尼日利亚和马里卫生系统薄弱，但高度戒备，严防死守，作为国家应急行动治疗了头一批病例。所有这三个国家，在其伙伴支持下，埃博拉疫情得以平息，很少向外界传播。