加强全球重大传染病的防控合作

文/马克·吉特（Mark Jit） 译/张佳艺

相信我们都同意防治重大传染病需要强大的全球合作。

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

传染病防治过程的经济效益与重大影响，可以通过多角度来思考。从定义上来说，“外在影响”是指由一方带来（造成）的好处（损失），将会由另外一方承担。“带来（造成）好处（损失）”的一方，可以是个人、集体，也可以是国家。在传染病领域，外在影响更多的是国家层面。比如国家A存在某种传染病，若治理好（如全民接种疫苗）将造福国家A本身；若未治理好，可能会将疾病传播至国家B境内，从而给两国都带来负面的影响。特别在全球疫情大流行背景之下，疫情的治理并不是独善其身之事，需考虑到本国做法对邻国和世界带来的影响。

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.

世卫组织明确“国际公共卫生紧急事件”

世界卫生组织提出国际公共卫生紧急事件（PHEIC），意味着当疾病的传染程度已经对全球带来重大影响时，可将其列为PHEIC。世界卫生组织共六次宣布PHEIC，2009年甲型H1N1流感，2014年野生型脊髓灰质炎，2014年西非埃博拉疫情，2016年巴西寨卡病毒，2019年刚果（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.

我们应该思考，如何在国家内控制好外在影响？首先是做好对疾病的研究和了解。若一个国家对某种疾病的认识更加深刻，并将知识传播至全球各地，这将使他国受益。其次是疫苗，通过疫苗的接种减少国家之间传染病的传播。最后，通过旅行限制以控制疫情。在新冠肺炎疫情暴发初期，基本上所有国家均采取旅行限制作为控制本国疫情的手段。当然疫情防控需要所有国家尽最大努力，仅单个国家实行禁令并不能有效控制新冠肺炎疫情。不同国家的旅行限制政策不同，一些旅行限制对阻止病毒扩散非常关键。旅行限制对经济的影响是不容忽视的，据统计，全球GDP因旅行减少导致了1.8%的衰退，经济增长和旅行限制两者之间需要平衡，以保证控制疫情同时不会对全球经济带来太过沉重的打击。

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协作与信息共享

新冠肺炎疫情暴发时，中国很快公布了新冠病毒的基因序列，这种信息共享同样也帮助了世界上其他国家。除此之外，不同国家就新冠病毒发表的研究成果、论文，同样是种信息共享，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.

世界卫生组织于2020年宣布了一项名为SOLIDARITY的大型全球试验，以确定是否有治疗这种新型冠状病毒感染的方法；于2021年进入SOLIDARITY PLUS试验阶段。该试验代表了世界卫生组织成员国之间最大规模的全球合作，涉及52个国家和地区、600多家医院的数千名研究人员（SOLIDARITY PLUS试验阶段）。

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.

事实上，在全球合作的过程中有一个非常关键的问题——支持专利豁免。为了更好战胜新冠肺炎疫情，许多国家放弃了对于新冠研究成果的专利保护，慷慨地分享其研究成果，避免新冠研究科研方面出现垄断。如前所述，中国及时共享了新冠病毒的基因序列和相关案例分析，对于全球合作严控新冠肺炎疫情发挥了至关重要的作用。我们应该从新冠肺炎疫情中收获更多经验：应对全球性紧急公共卫生事件，需要更多、更透明的全球信息共享与全球协作。

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.

马克·吉特（英国），伦敦健康与热带病医学院特邀专家

推动全球疫苗公平分配

疫苗接种是新冠肺炎疫情防控最为关键的环节，新冠肺炎疫苗实施计划（COVAX）是由全球疫苗免疫联盟、世界卫生组织和流行病预防创新联盟共同提出并牵头进行的全球项目，旨在实现全球新冠肺炎疫苗公平分配。全球有许多国家参与了该项目，参与的经济体可分为自费经济体和受资助经济体。当然，在推进COVAX过程中，仍会遇到一些困难，有国家选择不参加，或者对COVAX项目的推行持有不同的意见。需要提及，全球包括欧洲国家、北美国家在内的很多国家，可为本国居民提供足够的疫苗，但与此同时也有很多国家没有足够的疫苗供应。疫苗供应的不平等、不均衡仍然是无法忽略的关键因素。中国在全球疫苗共享方面做得非常好——目前为止，美国和英国在全球疫苗捐赠方面远远落后于中国。全民注射疫苗对于防控新冠肺炎疫情至关重要，全球疫苗公平分配也会带来经济收益，比如欧盟、美国、中国均可从全球疫苗拓展的过程中受益。

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.

总之，需要各个国家意识到新冠肺炎是全球性疾病，需要考虑到本国可能对其他国家带来的外在影响。若某一个国家没有做好防控，将影响到其他国家的利益。新冠肺炎疫情体现了全球合作的弱点和优点，疾病防控的全球合作是非常关键的，我们要动员所有可能的力量控制疫情，直至最后完全消灭病毒。

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.