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）

Ladies and gentlemen,

女士们、先生们，

We learn more about the world’s vulnerability to emerging and re-emerging diseases when we look at how the outbreak started and subsequently spread.

看一看疫情如何暴发，随后又如何传播，我们就会更清楚世界面对正在出现和再度出现的疾病的脆弱性。

Retrospective studies identify 26 December 2013 as the start of the outbreak, when an 18-month old boy living in a small village in Guinea’s Forest Zone fell ill and died two days later.

回溯性研究确认疫情是在2013年12月26日发生的，当时，在几内亚林区的一处小村庄，有一名18个月大的男婴染病，两天之后死亡。

Much of the surrounding forest has been destroyed by foreign mining and timber operations. Some evidence suggests that disruption of the ancient forest ecology brought potentially infected wild animals, and the bat species thought to harbor the virus, into closer contact with human settlements.

周遭的森林大部分毁于外国的采矿和伐木活动。一些证据表明，对古老森林生态的破坏导致了可能受到感染的野生动物，以及据认为是病毒宿主的蝙蝠物种与人类定居点的更密切接触。

Prior to symptom onset, the child was seen playing in his backyard near a hollow tree heavily infested with bats. This tells us something about the perils of environmental degradation.

这名男婴在发病之前，有人看到他曾在家中后院一棵空心树旁玩耍，树上有大批蝙蝠栖息。这就向我们透露了关于环境恶化后果的一些信息。

From that initial case, the virus spread quickly, with fatal results, to other family members and the midwives, faith healers, and hospital staff who treated them, and then on to new villages as people travelled to attend funerals and then returned home.

从最初的这一病例开始，造成致命结果的病毒迅速传播给其他家庭成员、接生者、巫术医师和医务人员，随着人们前来参加葬礼，事后返回自家，又蔓延到其它村庄。

The virus crept into the capital, Conakry, on 1 February and then fanned out further from the hospital where the patient was treated and died. No one knew this was Ebola. No one took any precautions.

2月1日，病毒潜入首都科纳克里，随后从有患者接受治疗和死亡的医院向外扩散。没人知道这是埃博拉。没人采取任何防范措施。

A disease that killed so many so quickly did not go unnoticed. However, lack of capacity meant that the disease was first misdiagnosed as cholera and then later as Lassa fever, two of the many common infectious diseases that mimic the early symptoms of Ebola.

以如此之快的速度，杀人如此之多的疾病并非没有受到注意。但由于缺乏能力，这一疾病最初被误诊为霍乱，后又被误诊为拉沙热，它们是酷似埃博拉早期症状的许多普通传染病中的两种。

When the causative agent was finally identified on 21 March, the Ebola virus had been circulating, undetected and uncontained, in Guinea for nearly three months.

在3月21日最后确定病原体时，埃博拉病毒已在几内亚传播了近三个月，未被察觉，不受控制。

By then, the virus was firmly entrenched. A few scattered cases had already been imported into Liberia and Sierra Leone, but this spread, too, was silent and not detected until too late.

此时，病毒已经站稳脚跟。零星的几起病例流入了利比里亚和塞拉利昂，但这一传播也是悄无声息的，等到发现时，为时已晚。

WHO had an investigative team on the ground in Guinea within days after the diagnosis was confirmed. But countries and their international partners, including WHO, underestimated the situation. We thought we knew Ebola. Knew how it behaved. Knew the course the disease would take. Knew how to control it.

在确诊后的几天内，世卫组织就派出一个调查组到达现场。但这几个国家和它们的国际伙伴，包括世卫组织，都低估了局面的严重性。我们自以为了解埃博拉，了解它的行为方式，了解这一疾病的演化轨迹，了解如何控制它。

This is another important lesson. Expect the unexpected. Never trust a virus to behave as it has in the past, especially when introduced into a new setting, with new opportunities to exploit.

这是另一个重大教训。需要防患于未然。永不相信病毒会重复过去的行为方式，特别是当它们进入新的环境，有新的机会可资利用时。

The newness of Ebola added to the problems created by weak health systems. The three countries were poorly prepared for this unexpected and unfamiliar disease at every level.

埃博拉的异常之处加剧了卫生系统薄弱所产生的种种问题。这三个国家在各级都对这一意外和陌生的疾病准备不足。

Clinicians had never managed cases. No laboratory had ever diagnosed a patient specimen. No government had ever witnessed the social and economic upheaval that can accompany an outbreak of this disease. Populations could not understand what hit them or why.

临床医生从未治疗过任何病例。没有一个实验室诊断过患者标本。没有一个国家的政府目睹过伴随这种疫情爆发而来的社会和经济动荡。民众无法理解他们的遭遇和原因。

The virus exploited exceptionally high population mobility across exceptionally porous borders, with the three countries persistently re-infecting each other. Populations readily cross borders, but response teams do not.

病毒借助漏洞百出的边境上频繁的人口流动，导致这三个国家持续的反复传染。人口跨境非常容易，但反应小组却不能随意进出。

Throughout its history, Ebola had been largely a disease affecting remote rural areas where sparse populations created a natural barrier against explosive spread. In West Africa, the virus exploited urban environments and conditions in crowded slums.

此前，埃博拉在其全部历史上，始终是主要影响边远农村地区的一种疾病，那里人烟稀少，形成了阻挡爆炸性传播的天然屏障。在西非，城市环境和拥挤贫民窟的条件给予病毒可乘之机。

But above all, the virus exploited West Africa’s deep-seated cultural traditions. Funeral and burial rites involving close contact with highly infectious corpses were the most dangerous of these traditions, and they proved highly resistant to change.

但首先，病毒是利用了西非根深蒂固的文化传统。殡葬仪式涉及与高传染性尸体的密切接触，是这些传统中最危险的，而且顽固地拒绝改变。

In Liberia and Sierra Leone, where burial rites are reinforced by a number of secret societies, some mourners bathe in or anoint others with rinse water from the washing of corpses.

在利比里亚和塞拉利昂，一些秘密会社强化了这类下葬仪式，吊唁者会在清洗尸体的水中洗浴或用这样的水涂洗他人。

In the face of early and persistent denial that Ebola was real, health messages issued to the public repeatedly emphasized that the disease was deadly, and had no vaccine, treatment, or cure. While intended to promote protective behaviors, these messages backfired.

一反早期坚持否定埃博拉真实性的说法，向公众发出的健康信息反复强调这一疾病是致命的，没有疫苗，难以治疗或不可治愈。尽管这些信息的本意是倡导防护行为，但产生了事与愿违的结果。

If Western medicine had nothing to offer, families preferred to rely on traditional healers or care for loved ones in homes, thus giving the virus more opportunities to exploit.

西药既然不起作用，家人宁可依赖巫师或在家里照料亲人，这就给了病毒更多肆虐机会。

Ebola preyed on another deep-seated cultural trait: compassion. In West Africa, the virus spread through the networks that bind societies together in a culture that stresses compassionate care for the ill and ceremonial care for their bodies if they die.

埃博拉得以戕害生命的另一个深层文化特点是：同情心。在西非，一种强调关爱病者并在其死后对尸体进行礼仪性处理的文化将社会凝聚在一起，病毒就是通过这样的网络传播开来。

Apart from the need to invest in health systems, this is the second biggest lesson. The outbreak will never be brought to an end in the absence of full community engagement and cooperation. To this day, communities in Guinea and Sierra Leone continue to hide patients in homes, conduct secret unsafe burials at night, and refuse to cooperate with contact tracing teams.

除了需要投资于卫生系统外，这是第二个重大教训。没有社区的充分参与和合作，疫情将永无止境。时至今日，几内亚和塞拉利昂的社区仍继续在家中藏匿患者，夜晚举行秘密和不安全的葬礼，并拒绝与追踪接触情况的小组合作。

Yet another lesson concerns the importance of creating incentives for the development of medical products for diseases that primarily affect the poor and thus have little market appeal.

还有一个教训，事关必须制定措施，激励研制某些医疗产品，这些产品作用于主要影响穷人的疾病，因此没有什么市场吸引力。

Ebola has been known for nearly 40 years. Yet clinicians were left empty-handed, with no vaccines, treatments, or cures. I believe this lesson is already shaping events.

埃博拉为人所知已有近四十年。但临床医生对其束手无策，没有疫苗，难以治疗或不可治愈。我认为这一教训已经在发生影响。

WHO has worked hard with industry to correct the R&D failure. New rapid diagnostic tests are coming on the market. Several promising drugs, including ZMapp, are currently undergoing clinical trials. The first phase III clinical trial of a vaccine began in Guinea over the weekend.

世卫组织与业界共同奋斗，以纠正研发方面的失败。新型快速诊断检测法正在进入市场。几个前景光明的药物，包括ZMapp，目前正在进行临床试验。一种疫苗的第一次三期临床试验已于周末在几内亚开始。

Ladies and gentlemen,

女士们，先生们，

A review committee convened under the International Health Regulations to assess the response to the 2009 influenza pandemic concluded that the world was ill-prepared to cope with a severe and sustained disease event. Ebola was both.

为评价对2009年流感大流行的应对行动，根据《国际卫生条例》召集了一个审查委员会。该委员会得出以下结论：世界应对严重和持续性疾病事件的准备不足。埃博拉就具备这两种特性。

When the outbreak peaked in the last quarter of 2014, everyone was overwhelmed. We had too little of everything.

当疫情在2014年最后一个季度达到高峰时，大家都一筹莫展。我们缺少所有的一切。

Not enough treatment beds, laboratories, isolation wards, and ambulances. Not enough doctors and nurses, epidemiologists, logisticians, and burial teams. Not enough personal protective equipment, body bags, and space in cemeteries.

没有足够的治疗床位、实验室、隔离室和救护车。没有足够的医生和护士、流行病学家、后勤人员和安葬小组。没有足够的个人防护装备、收尸袋和墓地。

The world must never again find itself in such a position. Ebola has been a wake-up call, not just for Africa, but for the world. In my view, three changes will do the most to improve the world’s collective defense against the infectious disease threat.

世界绝不能再陷入如此境地。埃博拉敲响了警钟，不仅是对非洲，而且是对全世界。我认为，有三个变革可以大大改善世界对传染性疾病威胁的集体防卫。

First, invest in building resilient communities and well-performing health systems that integrate public health and primary health care. Ideally, health systems should aim for universal health coverage, so the poor are not left behind. This requires new thinking and a new approach to health development.

第一，投资于建设具有适应能力的社区和运转良好的卫生系统，以整合公共卫生与初级卫生保健。理想的情况是，卫生系统以全民健康覆盖为目标，不使穷人求告无门。这需要新的思维和新的卫生发展方针。

Second, develop the systems, capacities, and financing mechanisms needed to build surge capacity for responding to outbreaks and humanitarian emergencies.

第二，发展建立扩增能力的必要系统、能力和筹资机制，以应对疫情和人道主义突发事件。

Third, create incentives for R&D for new medical products for diseases that primarily affect the poor. A fair and just world should not let people die for what boils down to market failure and poverty.

第三，制定激励措施，推动针对主要影响穷人的疾病，研发新的医疗产品。一个公平和公正的世界不应听任人们因市场失灵和贫穷而死亡。

These three things also fit well with the coming agenda for sustainable development that seeks to distribute the benefits of economic growth more evenly and respects our planet’s fragile resources.

这三件事也符合即将出台的可持续发展议程，此项议程寻求更平均地分配经济增长红利，并爱惜我们星球脆弱的资源。

From the health perspective, the greatest need is to have health systems in place that can withstand future shocks, whether these come from climate change or a runaway virus.

从卫生角度看，最大的需要是建立可承受未来冲击的卫生系统，无论冲击是来自气候变化，还是来自失控的病毒。

Doing so is not a luxury. It is the best insurance policy for the future and the best way to cement the tremendous gains in health made since the start of this century.

这样做并不是一种奢侈。它是对未来的优质保单，是巩固自本世纪开始以来在卫生方面取得的巨大进步的最佳途径。

Thank you.

谢谢大家。