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关于《国际卫生条例》在埃博拉疫情应对中的作用问题审查委员会上的开幕词

2015-09-07    来源:WHO    【      美国外教 在线口语培训

Opening Remarks at the Review Committee on the Role of the International Health Regulations in the Ebola Outbreak and Response
在关于《国际卫生条例》在埃博拉疫情和应对中的作用问题审查委员会上的开幕词

Dr Margaret Chan, Director-General of the World Health Organization
世卫组织总干事 陈冯富珍博士

Geneva, Switzerland
瑞士 日内瓦

24 August 2015
2015年8月24日

Mr Chair, distinguished members of the Review Committee, ladies and gentlemen,
主席先生,尊敬的审查委员会各位成员,女士们、先生们:

Good morning, and a very warm welcome to Geneva. Thank you for giving us your time and your expertise.
上午好!非常欢迎大家来到日内瓦。谢谢你们拿出时间并凭借专门技能前来参会。

You are asked to provide a critical review of how the International Health Regulations performed during the outbreak of Ebola virus disease in West Africa.
你们受邀对《国际卫生条例》在西非埃博拉病毒病疫情期间的实施情况开展严格审查。

The review takes place at a time of nearly universal agreement that the international response to the outbreak was inadequate. When the number of cases in Guinea, Liberia, and Sierra Leone began to increase exponentially, all responders, including WHO, were overwhelmed.
这次审查是在几乎普遍认为对这次疫情的国际反应不够充分的时刻进行的。当几内亚、利比里亚和塞拉利昂的病例数量开始呈几何级数上升时,包括世卫组织在内的所有应对方都不堪负重。

Since Ebola first emerged in 1976, WHO and its partners have responded to 22 previous outbreaks of this disease. Even the largest were contained within four to six months.
自从埃博拉于1976年首次出现以来,世卫组织及其伙伴对该病以往出现的22次疫情做出了应对。即使是最大的疫情也在四至六个月内得到控制。

In West Africa, WHO, and many others, were late in recognizing the potential of the outbreak to grow so explosively. Some warning signals were missed. Why?
这次在西非,世卫组织和许多其它方面很晚才意识到本次疫情可能会如此急剧上升。错失了一些预警信号。这是为什么?

Our challenge now is to look for improvements that leave the world better prepared for the next inevitable outbreak.
我们现在的挑战是找到改进办法,使这个世界在下一次不可避免的疫情面前做出更好准备。

Managing the global regime for controlling the international spread of disease is a central and historical responsibility of the World Health Organization. We need to pinpoint the reasons why the response fell short. We need to learn the lessons. We need to put in place corrective strategies just as quickly as possible.
为控制疾病的国际传播而掌管全球制度,这是世界卫生组织的一项历史性核心责任。我们需要确定这次反应功亏一篑的原因所在。我们需要汲取经验教训。我们需要尽快提出纠正策略。

The IHR is a principal instrument for doing so. These regulations are the only internationally-agreed set of rules governing the timely and effective response to outbreaks of infectious diseases and other public health emergencies.
《国际卫生条例》是实现这一目标的一个主要工具。这些条例仅仅是国际商定的一套规则,对及时有效应对传染病疫情和其它突发公共卫生事件作了规定。

If its legally-binding obligations on States Parties are not being met, change is urgently needed. If WHO is not exercising its full authority under the regulations, change is urgently needed.
当缔约国没有履行其法定义务时,就迫切需要作出改变。当世卫组织不能履行条例规定的所有权限时,就迫切需要作出改变。

Your job is not an easy one. Emerging and re-emerging infectious diseases have become a much larger menace under the unique conditions of the 21st century, with its unprecedented volume and speed of international travel and the radically increased interdependence among nations.
你们的任务并非轻而易举。新出现和再现的传染病在21世纪这种特定条件下已经变得更具威胁性,国际旅行的数量和速度达到了前所未有的程度,各国之间的相互依存关系大大加深。

Every day, nearly 100,000 flights carry 8.6 million passengers and $17.5 billion of goods to their destinations.
每天约有10万个航班运载着860万乘客,另有价值175亿的货物被运往其目的地。

The dynamics of virus spread in West Africa had many exceptional features. But it would be a mistake to forget that many other countries also have extremely weak health systems and infrastructures, a history of conflict and civil unrest, highly mobile populations, and entrenched high-risk cultural practices.
该病毒在西非的传播态势具有多个很不寻常的特点。但忽略以下情况也是不对的:许多国家的卫生系统和基础设施也极为薄弱,冲突和内乱历史、人口流动性大并且一些高度危险性文化做法根深蒂固。

Ebola in West Africa was the largest, longest, and most deadly event in the nearly four-decade history of this disease. But it was not a worst-case scenario.
西非埃博拉是该病近40年历史上最大规模、最为漫长、最为致命的事件。而这还不是最坏情况。

Preparedness for the future means preparedness for a very severe disease that spreads via the airborne route or can be transmitted during the incubation period, before an infected person shows tell-tale signs of illness.
对将来做出防备就意味着对一种十分严重的疾病做出准备,这种疾病可以通过空气传播方式蔓延开来,或者在感染者出现种种患病体征之前在潜伏期就能引起传播。

Ladies and gentlemen,
女士们、先生们,

As you undertake this review, you have the views and recommendations of three expert groups as guidance.
在你们开展审查时,三个专家小组提出的意见和建议对你们会有所指导。

First, the review committee that assessed IHR performance during the 2009 influenza pandemic. Second, the review committee that looked at IHR core capacities. And most recently, the report of the Ebola interim assessment panel, chaired by Dame Barbara Stocking. These expert groups have identified three main weaknesses in the performance of the IHR.
首先是对2009年流感大流行期间《国际卫生条例》的实施情况作出评估的审查委员会。其次是对《国际卫生条例》核心能力作过审视的审查委员会。还有最近由Barbara Stocking夫人主持的埃博拉中期评估小组提出的报告。这些专家小组提出了在实施《国际卫生条例》方面存在的三个主要弱点。

First, compliance with the obligation to build core capacities for event detection and response has been dismal. Eight years after the IHR entered into force, fewer than a third of WHO Member States meet the minimum requirements for core capacities to implement the IHR.
首先,在根据要求建设事件发现和应对核心能力方面不尽人意。《国际卫生条例》生效八年以来,尚不足三分之一的世卫组织会员国达到了实施《国际卫生条例》核心能力的最低要求。

Why? Is this because health security is not a priority for governments and the international community? Is this because SARS was contained within less than four months, and the long-dreaded influenza pandemic turned out to be so mild? Did everyone relax?
这是为什么呢?是由于卫生安全不是政府和国际社会的工作重点?是否因为SARS在不到四个月的时间内得到了控制,长期以来令人担惊受怕的流感大流行到头来是这样温和?是否所有人都松了懈?

Or is it a matter of not having sufficient financial and human resources? As you know, the IHR wording, that “States Parties shall utilize existing national structures and resources to meet their core capacity requirements,” places resource responsibilities squarely on the shoulders of individual governments.
或者是否因为没有足够的资金和人力资源?正如你们所知道的那样,《国际卫生条例》“缔约国应当利用现有的国家机构和资源,满足核心能力要求”这一措词明确将资源责任放在了各个国家政府的身上。

Are the minimum requirements set out in the IHR too demanding? Should we lower the bar? Surely not.
是不是《国际卫生条例》阐明的最低要求过高?我们是否需要降低这些限制性规定?当然不是。

But perhaps we should change our whole approach to the way progress is supported and monitored.
然而我们可能需要改变用来支持和监测进展的整个工作方式。

I have heard broad agreement that the practice of relying on self-assessments needs to be replaced with a more rigorous and objective mechanism. You may want to further explore options for doing so.
我听到的多数一致意见是,依靠自我评估的做法需要由更加强有力的目标机制来替换。你们可以就这样做的可选方案进一步进行探讨。

Many factors have been cited as contributing to this poor compliance with core capacities.
人们提到了多个造成这种没有很好的遵守核心能力要求的促成因素。

In a number of countries, implementation of the IHR is regarded as the sole responsibility of ministries of health, with very little engagement from other relevant ministries, such as those responsible for finance, trade, tourism, agriculture, and animal health.
多个国家将《国际卫生条例》的实施仅仅视为卫生部的责任,极少会涉及到其它相关部门,比如负责财政、贸易、旅游、农业和动物卫生的部门。

National focal points often have limited authority and very little access to a country’s true power base. Misunderstanding of the IHR as a rigid, legal process further constrains compliance.
国家归口单位的权限往往十分有限,极少可以接近国家的真正权力基础。将《国际卫生条例》误解为一种僵硬的法律程序,这进一步限制了其遵守程度。

Ladies and gentlemen,
女士们、先生们,

At the very least, the Ebola outbreak in West Africa provides dramatic proof of the importance of having minimum capacities and infrastructures in place before a severe disease becomes established in a population.
至少这次西非埃博拉疫情给人们带来了大量证据,以此证明当某种严重疾病在人群中扎下根之前具备最低限度的能力和基础设施十分重要。

Ebola in Guinea, Liberia, and Sierra Leone was an extreme stress test that saw the virtual collapse of health services.
在几内亚、利比里亚和塞拉利昂发生的埃博拉是一次极端强度测试,这使人看到了卫生服务几近崩溃的一面。

The national responses in Nigeria, Senegal, and Mali show the good results possible when health officials are on high alert and the health system is well-prepared. But overall, national and international responses show how far the world is from achieving global health security. Overall, these experiences provide a stunning example of all that was missing, all that can go wrong.
尼日利亚、塞内加尔和马里作出的国家性反应表明,当卫生官员处于高度戒备,卫生系统作出良好准备时就可能取得良好结果。但总体而言,国家和国际应对情况表明,这个世界离实现全球健康保障的距离有多远。总之,这些经验用例证很好地说明了所缺失的一切,可能会出错的一切。

The IHR call for national capacity “to detect events involving disease or death above expected levels for the particular time and place in all areas within the territory”.
《国际卫生条例》要求具备“发现领土内所有地区与特定时间和地点发生的超过预期水平的涉及疾病或死亡的事件”的国家能力。

But how can countries that routinely experience deaths from diseases like malaria, Lassa fever, yellow fever, typhoid fever, dengue, and cholera recognize an unusual event in the midst of all this background noise from difficult and demanding diseases?
而面临困难和棘手疾病这类背景噪音时,平常遇有因疟疾、拉沙热、黄热病、伤寒、登革热和霍乱等疾病造成的死亡的国家如何才能看到不寻常事件?

Maybe this is another truly fundamental problem that keeps the IHR from working as intended.
也许这是另一个真正使《国际卫生条例》无法按照预想情况正常运转的根本性问题。

The Ebola virus circulated in Guinea for three months, undetected, off every radar screen, with no alarms sounding, misdiagnosed as cholera, then thought to be Lassa fever.
埃博拉病毒在没有被发现的情况下在几内亚流行了三个月,它没有出现在雷达防线上,没有发出警报,被误诊为霍乱,又想到了拉沙热。

Even in Sierra Leone, where health officials were on high alert, the virus spread undetected for at least a month, sparking numerous chains of transmission that rapidly multiplied.
塞拉利昂的卫生官员保持着高度警惕,即便如此该病毒在没有被发现的情况下至少传播了一个月,触发了多个很快成倍数增长的传播链。

The earliest cases to reach the health system were managed as gastroenteritis, again with a diagnosis of cholera presumed.
最早抵达卫生系统的病例按照胃肠炎做了处置,又一次被假定诊断为霍乱。

Within six weeks, three hotspots of intense virus transmission were firmly established.
病毒严重传播的三个热点在六个星期之内就稳稳的扎下根来。

As we learned, cases at the start of an outbreak, when containment has the best chance of success, will be missed in the absence of sensitive surveillance, rapid laboratory support, and good information systems shared by the public health and clinical sectors. If the two arms of the health system are not talking or sharing information to raise awareness and take rapid action, we have seen what can happen
正如我们所学到的,在疫情之初对病例实施控制就有很大的可能取得成功,在缺少敏感性监测系统,没有快速实验室支持和由公共卫生和临床部门共享的良好信息系统的情况下就会错失这些病例。当卫生系统的这两个部门不能够以提高认识和采取快速行动为目的而相互交流并分享信息,我们已经看到了可能会出现什么情况。

As I always say, what gets measured gets done. What can’t be seen can’t be measured or managed.
我总在说,能衡量,始能执行。无法看到的东西就不能得到衡量或者处理。

As we learned, when new cases occur that cannot be linked to a known chain of transmission, an outbreak is out of control.
正如我们所学到的,当病例的发生不能与已知传播链建立联系时,疫情就会失控。

Ladies and gentlemen,
女士们、先生们,

As a second weakness, many countries imposed measures, such as restrictions on travel or trade, that went well beyond the temporary recommendations issued by the Emergency Committee last August.
第二个弱点就是许多国家采取了旅行或者贸易限制等措施,这大大超出了去年八月突发事件委员会发布的临时建议。

These measures isolated the three countries and vastly increased economic hardship for some of the world’s poorest people. All three ran short of food and fuel.
这些措施使这三个国家与外界隔绝,大大增加了世界上最为贫穷的一部分人的经济困难。三个国家都缺少食物和燃料。

Just as important, travel restrictions, including the many airlines that suspended flights to West Africa, impeded the arrival of desperately needed response teams and equipment.
同样重要的是,这些旅行限制,包括许多航空公司暂停了前往西非的航班,使前往灾区的急需应对团队和设备遭受了困难。

If countries are punished in this way, where is the incentive for rapid and transparent reporting?
如果国家受到这等惩罚,哪有动力作出快速且透明的疫情报告?

Whether and under what circumstances countries should be permitted to implement health measures beyond those recommended by WHO was a politically charged issue when the IHR were negotiated.
各国是否并且在何种情况下应当被准予在世卫组织提出的建议之外采取卫生措施,这是在《国际卫生条例》谈判过程中一个带有政治敏感性的问题。

At present, WHO does not have a mechanism for enforcing compliance with its recommended measures. This has to change.
目前,世卫组织并没有一种强行遵守其所提建议措施的机制。这必须做出改变。

A third weakness is the absence of a formal alert level of health risk other than the declaration of a public health emergency of international concern, or PHEIC. This is a recommendation from the Stocking report for you to consider.
第三个弱点就是除了宣布为国际关注的突发公共卫生事件之外,尚缺少一种针对卫生危险的正式警报等级。这是Stocking报告中提出的供你们审议的一项建议。

Establishing a formal intermediate level of alert of health risk would require an amendment to the IHR.
对卫生危险设立一个正式的过渡性警报等级就需要对《国际卫生条例》做出修订。

Another option is illustrated by the Emergency Committee convened to assess the MERS situation.
另一个选择方案由评估中东呼吸综合征疫情的突发事件委员会作了阐述。

Although many meetings under this Committee were held, none declared a PHEIC, yet their reports consistently set out advice aimed at reducing the number of cases and preventing further international spread.
尽管已经以该委员会名义召开了多次会议,但没有一次将其宣布为国际关注的突发公共卫生事件。而会议发表的报告一直在提出建议,目的是减少病例数并防止进一步出现国际传播。

Ladies and gentlemen,
女士们、先生们,

Some other recommendations from the expert groups would also require amendments. The IHR has provisions for making amendments. But as this is a matter of international law, the procedures are strict and they take time.
专家小组提出的其它一些建议也要求作出修订。《国际卫生条例》对修订问题作了规定。但由于这是一个国际法事项,因此操作过程十分严格且耗费时间。

In the best possible case, any amendments proposed now would take several years to come into force. Is this what you want? I defer to your suggestions.
最佳可能情况是,现在提出的任何修订都需要几年时间才能生效。这是否为你们的意愿?我听从你们的建议。

Other options can be used to move forward much more quickly. Nor are you in any way obliged to consider only those recommendations made by the three expert groups.
可以使用其它一些选择方案来大大加快行动步伐。没有要求你们仅仅考虑这三个专家小组提出的建议。

Let me also share with you what I have been hearing. Some analysts have argued that a risk approach to capacity development might support more rapid progress.
让我也与你们分享一下我的耳闻。有些分析人士认为,针对能力发展问题采取风险方式可能会有利于加快取得进展。

For example, we may need to be smarter in identifying where improved surveillance and response capacities are most badly needed.
比如,我们需要在确定最为需要改进监测和资源能力的问题上更加机警一些。

Systematic studies conducted over decades have shown that the emergence of new diseases follows a non-random global pattern.
几十年来开展的系统性研究已经表明,新疾病的出现会遵循一种非随机性全球模式。

From these studies, we also know that nearly 72% of all new human pathogens originate in wildlife, and most frequently at lower latitudes. Can mapping of geography, climate, and cultural behaviours pinpoint hotspots for the emergence of new diseases?
我们通过这些研究还了解到,在人身上发现的所有新病原几乎有72%源于野生动物,且常常发生在纬度较低地区。对地理、气候和文化行为进行制图就可以确定新疾病的发生?

Can we give the international community a list of priority countries ranked as likely to experience outbreaks? Some countries may see this as stigmatizing.
我们是否可以向国际社会提出一份可能出现疾病疫情的重点国家排序清单?有些国家可能会将此视为不够光彩。

In other words, not lower the bar for core capacities, but narrow the list of countries in urgent need of support.
换言之,不是去降低核心能力方面的限制性规定,而是缩小需要迫切得到支持的国家清单。

As WHO knows from its experience with vaccines for yellow fever and epidemic meningitis, the promise of assistance can be a powerful incentive for building surveillance and reporting capacity.
正如世卫组织从黄热病和流行性脑膜炎疫苗的经验中所了解的那样,援助承诺可能会成为监测和报告能力建设的一个强大吸引力。

The aftermath of the Ebola outbreak likely represents our best chance ever to transform the world’s response to epidemics and other health emergencies.
埃博拉疫情之后可能是我们有史以来对世界应对疫情和其它突发卫生事件作出变革的最佳机会。

The image of people dying on the grounds of overflowing hospitals should have left an indelible mark on the world’s collective conscience. This is also a window of political opportunity.
在人满为患的医院地上死去的病人景象给世界上的集体良知留下了不可磨灭的印记。这也是一个政治机遇窗口。

I ask you to be critical in your assessment, bold in your thinking, and far-reaching in your recommendations.
我请大家在开展评估时带有批判性,对问题的思考不失胆识,提出的建议具有深远意义。

I value your expertise, and your advice, and I wish you every success in your deliberations.
我珍视你们的专业评价和建议。祝你们的讨论取得圆满成功。

Thank you.
谢谢大家!



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