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流行病: 预防不足

经济学人2016.3.25

传染病导致的危机已经越来越常见,世界应该做好更周全的准备。

埃博拉危机让世界清醒地认识到,我们对于如此致命的疾病有多么的束手无策。细思恐极的是,当病毒在人声鼎沸的拉各斯肆虐时,多亏了一名医生的大无畏精神,疫情蔓延才得以中止,与此同时,拉各斯恰巧有技术能够追溯到所有与第一例病毒感染者接触的所有人。

这是一个新常态。新型传染病变得越来越普遍。随着地球上人口日益增加,大量的公路和航班提升了各个地区的通达性,再加上人与动物的接触越来越多,这样的情形不可避免。人类已知的1400个病原体中,有一半以上都源自动物宿主,包括猪、蝙蝠、鸡和其他禽类。

流行病与大混乱

当新的疫情爆发时,恐惧情绪传播的比病毒更快。政治家们做出各种合理或不合理的反映:禁止出行、检疫隔离和贸易封锁。航线暂停,旅行者们取消出游。埃博拉感染了超过3万人,致死1.1万人,疫情最严重的三个国家因此损失产值超20亿。SARS感染了8千人,致死800人,由于爆发在较发达地区,其造成的产值损失超过400亿。预测这些疾病导致的损失不容易,但最近一份关于全球健康危机的报告预计,潜在的流行病将导致每年约600亿的经济损失。

随着危机不断升级,对疾病的防御也应同样加强。美国国家医学研究院表示每年仅需投入45亿美金(相当于富有国家花在发展援助上的3%)在流行疾病防控上,世界便会变得安全许多。资金的投入将会用于加强公共卫生体系,提高研发部门在应对突发情况以及资金短缺的协调性。

在流行疾病的防控上注入更多的投资会带来更多的好处。每年仅在防治肺结核病上,全球GDP减少了120亿美金,而疟疾则耗费更多。若公共健康体系建立完善,将有利于防治肺结核等疾病,但首要的是去研制疫苗去防治现今极其罕见,但又被科学家们声称今后极易大流行的疾病,比如拉沙热,克里米亚刚果出血热,或者马尔堡。

若能更好地共享数据,那将会大有裨益。更为重要的是提供资金,还有当公司把疫苗或者药品推向市场时需审查责任人。即便是未来爆发可能性最高的流行病的防控疫苗,在处于初步发展与早期检测阶段时,也要耗费大约1.5亿美金。因此医药公司没有动力去投资开发未来可能都不会被使用的疫苗。对于这些公司,一旦疫情爆发,后期的疫苗测试也很难对付。医药行业花费了10亿美金在埃博拉上,同时承担了责任风险,然而从未获利。没有公司会愿意亏本第二次。为了鼓励医药公司在疫情时期充分发挥自己的作用,政府需要明确自己将会如何替他们分担责任。

自金融危机后,为了降低经济危机蔓延的风险,银行已被要求持有更多资本。全球每年共花去大约2万亿美金在防治疾病上面。在卫生安全上投资类似于购买保险,但是会取得更好的收益。

Pandemics_An ounce of prevention

《The economist》

2016.3.25

http://www.economist.com/news/science-and-technology/21576375-new-viruses-emerge-china-and-middle-east-world-poorly-prepared

Crises of infectious diseases are becoming more common. The world should be better prepared

ONE of the sobering lessons of the Ebola crisis was how ill-prepared the world was for such a deadly disease. It is terrifying to reflect on how the virus's advance was halted in the teeming city of Lagos thanks only to the heroism of a single doctor and because the place just happened to have the expertise needed to trace all of the first victim's contacts. Today the world is facing a worrying outbreak of Zika virus, adding to a growing list of diseases that includes SARS, MERS and bird flu.

This is the new normal. New infectious diseases are becoming more common. With more people on the planet, more roads and flights connecting everyone, and greater contact between humans and animals, this is only to be expected. Over half of the 1,400 known human pathogens have their origins in animals such as pigs, bats, chickens and other birds.

Pandemics and pandemonium

When a new outbreak occurs, fear spreads even more rapidly than the virus. Politicians respond, rationally or not, with travel bans, quarantines or trade blocks. Airlines ground flights. Travellers cancel trips. Ebola has infected almost 30,000 people, killed more than 11,000 and cost more than $2 billion in lost output in the three hardest-hit countries. SARS infected 8,000 and killed 800; because it hit richer places, it cost more than $40 billion. Predicting these losses is hard, but a recent report on global health risks puts the expected economic losses from potential pandemics at around $60 billion a year.

As the threat grows, so does the case for beefing up defences against disease. America's National Academy of Medicine suggests that just $4.5 billion a year (equivalent to about 3% of what rich countries spend on development aid) devoted to preparing for pandemics would make the world a lot safer. The money would strengthen public-health systems, improve co-ordination in an emergency and fund neglected areas of R&D.

Many of the investments to prepare for pandemics would bring broader benefits, too. Stronger public-health systems would help fight such diseases as tuberculosis, which reduces global GDP by $12 billion a year, and malaria, which takes an even bigger toll. But the priority should be to advance vaccines for diseases that are rare today, but which scientists know could easily become pandemics in the future: Lassa fever, say, Crimean Congo haemorrhagic fever or Marburg.

Better sharing of data would help

. More important is funding and a review of who has liability if firms rush vaccines or drugs to market. The initial development and early-stage testing of vaccines for the most likely future pandemics would cost roughly $150m each. Drug firms have little incentive to invest in a vaccine that may never be used. For these firms even later-stage testing when a pandemic breaks out is tricky. The drug industry spent $1 billion on Ebola and took on liability risk, yet never made a profit. The same companies may not be so willing next time. To encourage drug firms to play their full part during an emergency, governments need to set out how they will share the burden.

Since the financial crisis, banks have been required to hold more capital in order to lower the risk of economic contagion. The world spends about $2 trillion annually on defence. Investing in health security is a similar form of insurance, but one with better returns.