加強(qiáng)全球重大傳染病的防控合作

文/馬克·吉特（Mark Jit） 譯/張佳藝

相信我們都同意防治重大傳染病需要強(qiáng)大的全球合作。

I believe anyone in the world agrees that solid global cooperation is necessary to prevent and control major infectious diseases.

傳染病防治過程的經(jīng)濟(jì)效益與重大影響，可以通過多角度來思考。從定義上來說，“外在影響”是指由一方帶來（造成）的好處（損失），將會(huì)由另外一方承擔(dān)?！皫恚ㄔ斐桑┖锰帲〒p失）”的一方，可以是個(gè)人、集體，也可以是國家。在傳染病領(lǐng)域，外在影響更多的是國家層面。比如國家A存在某種傳染病，若治理好（如全民接種疫苗）將造福國家A本身；若未治理好，可能會(huì)將疾病傳播至國家B境內(nèi)，從而給兩國都帶來負(fù)面的影響。特別在全球疫情大流行背景之下，疫情的治理并不是獨(dú)善其身之事，需考慮到本國做法對(duì)鄰國和世界帶來的影響。

The global cooperation in the prevention and control of major infectious diseases has many perspectives for consideration. The term “externality” is the cost or benefit born by a party due to another party producing or consuming something. The party can be a person, an organization, or even a country. Here in the field of infectious diseases, the party is a country. Supposed there is an infectious disease if country A takes action (e.g., starting a vaccination program), there is a positive that both countries A and country B will benefit. On the other hand, if country A stops non-pharmaceutical interventions, the negative externality is that disease incidence in country B increases due to more infected travelers from country A. Therefore, no country can decide or only concern for itself in the prevention and control due to the externalities in the actions, especially during the global epidemic. Accordingly, every country should consider the impact of its efforts on other states or even the entire world.

世衛(wèi)組織明確“國際公共衛(wèi)生緊急事件”

世界衛(wèi)生組織提出國際公共衛(wèi)生緊急事件（PHEIC），意味著當(dāng)疾病的傳染程度已經(jīng)對(duì)全球帶來重大影響時(shí)，可將其列為PHEIC。世界衛(wèi)生組織共六次宣布PHEIC，2009年甲型H1N1流感，2014年野生型脊髓灰質(zhì)炎，2014年西非埃博拉疫情，2016年巴西寨卡病毒，2019年剛果（金）埃博拉疫情，2020年新冠肺炎疫情。

Public health emergencies of international concern

The World Health Organization (WHO) introduced the Public Health Emergencies of International Concern (PHEIC), meaning an extraordinary event is determined to constitute a public health risk to other states through the international spread of disease and to require a coordinated global response potentially. The WHO declared PHEIC 6 times: H1N1pdm09 in 2009, Polio and Ebola in 2014, Zika in 2016, Ebola again in 2019, and SARS-CoV-2 (COVID–19) in 2020.

我們應(yīng)該思考，如何在國家內(nèi)控制好外在影響？首先是做好對(duì)疾病的研究和了解。若一個(gè)國家對(duì)某種疾病的認(rèn)識(shí)更加深刻，并將知識(shí)傳播至全球各地，這將使他國受益。其次是疫苗，通過疫苗的接種減少國家之間傳染病的傳播。最后，通過旅行限制以控制疫情。在新冠肺炎疫情暴發(fā)初期，基本上所有國家均采取旅行限制作為控制本國疫情的手段。當(dāng)然疫情防控需要所有國家盡最大努力，僅單個(gè)國家實(shí)行禁令并不能有效控制新冠肺炎疫情。不同國家的旅行限制政策不同，一些旅行限制對(duì)阻止病毒擴(kuò)散非常關(guān)鍵。旅行限制對(duì)經(jīng)濟(jì)的影響是不容忽視的，據(jù)統(tǒng)計(jì)，全球GDP因旅行減少導(dǎo)致了1.8%的衰退，經(jīng)濟(jì)增長和旅行限制兩者之間需要平衡，以保證控制疫情同時(shí)不會(huì)對(duì)全球經(jīng)濟(jì)帶來太過沉重的打擊。

We should deliberate on the control of externalities within the country. The first domain is research and knowledge generation. A country generating knowledge of diseases and spreading the means of control worldwide definitely benefit other countries. The second one is vaccination. One country’s vaccination affects what happens in other countries by reducing inter-country transmission. The third one is travel policies. In the early stage of COVID–19, many countries adopted travel restrictions to control the epidemic. All countries have their shares of responsibility for preventing and controlling the epidemic rather than placing hopes on a particular country. Travel restrictions vary from country to country. Some limits are crucial to stop the exportation of infected cases or viruses. However, we cannot ignore the impact of travel restrictions on the economy. According to statistics, global GDP has declined by 1.8% due to the tourism reduction. Therefore, it is necessary to find the balance between economic growth and travel restrictions to control the epidemic to a certain extent while not hitting the global economy too hard.

需要更多更透明的全球協(xié)作與信息共享

新冠肺炎疫情暴發(fā)時(shí)，中國很快公布了新冠病毒的基因序列，這種信息共享同樣也幫助了世界上其他國家。除此之外，不同國家就新冠病毒發(fā)表的研究成果、論文，同樣是種信息共享，迅速造福全球。

Share information to promote global cooperation

When COVID–19 broke out, China identified and published the genome sequence of the corona virus soon. Besides, the research results and papers published by different countries on COVID–19 are also a kind of information sharing, which will rapidly benefit the whole world. In this respect, it’s evident that China and the US have made significant contributions. Moreover, the strong collaboration among China, the UK, the US, and other countries have shared research results.

世界衛(wèi)生組織于2020年宣布了一項(xiàng)名為SOLIDARITY的大型全球試驗(yàn)，以確定是否有治療這種新型冠狀病毒感染的方法；于2021年進(jìn)入SOLIDARITY PLUS試驗(yàn)階段。該試驗(yàn)代表了世界衛(wèi)生組織成員國之間最大規(guī)模的全球合作，涉及52個(gè)國家和地區(qū)、600多家醫(yī)院的數(shù)千名研究人員（SOLIDARITY PLUS試驗(yàn)階段）。

The WHO organized a great global trial to find the treatment of COVID–19 in 2020. This trial entered the Solidarity PLUS trial phase in 2021, representing the most extensive international collaboration among the WHO Member States, covering 52 countries/regions and thousands of researchers over 600 hospitals. There is a critical issue in global partnership, that is, support for a patent waiver. In order to better defeat the COVID–19, many countries have generously shared their research results rather than protect the patent. They waived monopolies for COVID–19 medical tools.

事實(shí)上，在全球合作的過程中有一個(gè)非常關(guān)鍵的問題——支持專利豁免。為了更好戰(zhàn)勝新冠肺炎疫情，許多國家放棄了對(duì)于新冠研究成果的專利保護(hù)，慷慨地分享其研究成果，避免新冠研究科研方面出現(xiàn)壟斷。如前所述，中國及時(shí)共享了新冠病毒的基因序列和相關(guān)案例分析，對(duì)于全球合作嚴(yán)控新冠肺炎疫情發(fā)揮了至關(guān)重要的作用。我們應(yīng)該從新冠肺炎疫情中收獲更多經(jīng)驗(yàn)：應(yīng)對(duì)全球性緊急公共衛(wèi)生事件，需要更多、更透明的全球信息共享與全球協(xié)作。

As mentioned above, China’s timely sharing of the genetic sequences and case studies played a critical role in the global collaboration to control the epidemic. There is a lot to be learned from COVID–19: When dealing with PHEIC, more needs to be done to build on current research collaborations and extend knowledge sharing.

馬克·吉特（英國），倫敦健康與熱帶病醫(yī)學(xué)院特邀專家

推動(dòng)全球疫苗公平分配

疫苗接種是新冠肺炎疫情防控最為關(guān)鍵的環(huán)節(jié)，新冠肺炎疫苗實(shí)施計(jì)劃（COVAX）是由全球疫苗免疫聯(lián)盟、世界衛(wèi)生組織和流行病預(yù)防創(chuàng)新聯(lián)盟共同提出并牽頭進(jìn)行的全球項(xiàng)目，旨在實(shí)現(xiàn)全球新冠肺炎疫苗公平分配。全球有許多國家參與了該項(xiàng)目，參與的經(jīng)濟(jì)體可分為自費(fèi)經(jīng)濟(jì)體和受資助經(jīng)濟(jì)體。當(dāng)然，在推進(jìn)COVAX過程中，仍會(huì)遇到一些困難，有國家選擇不參加，或者對(duì)COVAX項(xiàng)目的推行持有不同的意見。需要提及，全球包括歐洲國家、北美國家在內(nèi)的很多國家，可為本國居民提供足夠的疫苗，但與此同時(shí)也有很多國家沒有足夠的疫苗供應(yīng)。疫苗供應(yīng)的不平等、不均衡仍然是無法忽略的關(guān)鍵因素。中國在全球疫苗共享方面做得非常好——目前為止，美國和英國在全球疫苗捐贈(zèng)方面遠(yuǎn)遠(yuǎn)落后于中國。全民注射疫苗對(duì)于防控新冠肺炎疫情至關(guān)重要，全球疫苗公平分配也會(huì)帶來經(jīng)濟(jì)收益，比如歐盟、美國、中國均可從全球疫苗拓展的過程中受益。

Achieve equity in vaccine distribution globally

Vaccination is the most critical aspect of the prevention and control of COVID–19. COVAX Facility, a global program jointly proposed and led by Global Alliance for Vaccines and Immunization (GAVI), WHO, and Coalition for Epidemic Preparedness Innovations (CEPI), is an international collaboration to achieve equity in vaccine distribution globally. Many countries around the world are involved in COVAX. The participating economies can be divided into self-financing participants and funded economies. In the process of promoting COVAX, there are still some difficulties. Some countries choose not to participate, or they hold different views on the implementation. Many countries, including Europe and North America, have managed to procure sufficient doses and given them to large proportions of the population. But there are also many parts of the world where the countries are unable to afford these vaccines. The inequity and imbalance of vaccine supply are still crucial factors that we cannot ignore. However, China is now a leading country in terms of vaccine sharing. The US and the UK are lagging in terms of being able to donate or exports vaccines. Vaccination is crucial to the prevention and control of COVID–19, and global vaccine equity benefits the economic recovery in the world. For instance, the European Union, the US, and China can benefit from global vaccine sharing.

總之，需要各個(gè)國家意識(shí)到新冠肺炎是全球性疾病，需要考慮到本國可能對(duì)其他國家?guī)淼耐庠谟绊?。若某一個(gè)國家沒有做好防控，將影響到其他國家的利益。新冠肺炎疫情體現(xiàn)了全球合作的弱點(diǎn)和優(yōu)點(diǎn)，疾病防控的全球合作是非常關(guān)鍵的，我們要?jiǎng)訂T所有可能的力量控制疫情，直至最后完全消滅病毒。

In conclusion, actions taken by countries during the epidemic of emerging infectious diseases such as COVID–19 imposed externalities on other countries. Any country’s failure in prevention and control will affect the benefits of other countries. COVID–19 shows both successes and weaknesses in international cooperation, yet global cooperation in disease prevention and control is critical. All possible forces are supposed to be mobilized to control the epidemic until the virus is eliminated.