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。
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。
来源：WHO
心译翻译工作室
