经济学人29:小儿麻痹症 扶轮社计划

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　　科技

　　Polio

　　小儿麻痹症

　　A Rotary¹ engine

　　扶轮社计划

　　Can a businessmen's club eradicate² polio from the world?

　　商人组织能否根除世界各地的小儿麻痹症？

　　IT IS a year since the last case of polio was diagnosed in India. That is not enough to pronounce the country polio-free-three clear years are the conventional period required for that to happen. But it is a good start. And if India really is clear, then what was once a global scourge³ will now be endemic to a mere⁴ three countries: Afghanistan, Nigeria and Pakistan. The number of people infected, meanwhile, has dropped from 350,000 in 1988 to 650 last year.

　　距印度最后一例小儿麻痹症患者被确诊到现在已经1年。那不足以宣布这个国家脱离了小儿麻痹症——人们习惯上将三年不出现小儿麻痹症病例作为一个国家宣布脱离小儿麻痹症的周期。但这已经是一个好的开始。如果印度摆脱了小儿麻痹症，那么曾经风靡全球的灾难在现在将仅存于三个国家：阿富汗、尼日利亚和巴基斯坦。于此同时，感染小儿麻痹症的人的数量已经从1988年的350,000降低到了去年的650.

　　All this is in large part thanks to the efforts of Rotary International. In 1985, after a successful pilot study in the Philippines, this businessmen's club cum global charity announced a plan to eradicate polio by vaccinating⁵ every child under five at risk of catching⁶ it. The estimate then was that it would cost $120m. Some $800m of Rotary money later (plus a lot from other sources), the virus is still out there, but its remaining hidey-holes tell their own story: where civil disorder⁷ is rife⁸, medicine is hard.

　　所有这一切很大程度上得益于扶轮国际。1985年，一个在菲律宾进行的初步研究成功之后，商人组织和全球慈善团体宣布了一项计划，这项计划通过给有患小儿麻痹症风险的五岁以下儿童接种疫苗来根除小儿麻痹症。预计这个计划将耗资一亿两千万美元。其后要花费扶轮社八亿美元（加上许多通过其他途径获得的钱），病毒仍然还会存在，但是那些剩余的隐藏的地点发出自己的心声：越是内乱盛行的地方，医疗就越发的困难。

　　On January 17th Rotary announced it had raised yet another $200m. The Bill & Melinda Gates Foundation will contribute a further $405m, and the pressure will thus be kept up. John Germ, one of Rotary's trustees, thinks that if all goes well 2016 might be the first year when no new cases are reported. That would, though, mean spending more than $1 billion a year between now and then.

　　1月17日，扶轮社宣布已经另外募集了两亿美元的资金。比尔及梅林达?盖茨基金会将另外捐献四亿零五百万美元，即便如此还是会有压力。扶轮社的理事之一约翰泽恩认为如果一切进行顺利，那么2016年可能是第一年没有新的病例被报道的一年。尽管那将意味着从此时到彼时每年要花费至少10亿美元。

　　The inspiration for Rotary's campaign against polio came from the eradication⁹ of smallpox¹⁰. Like polio, smallpox was a viral disease for which effective, easily administered vaccines¹² existed. And crucially, like polio, smallpox had only one animal host: Homo sapiens. In principle, then, extermination¹³ should be possible. The practice, however, has turned out rather different.

　　扶轮社遏制小儿麻痹症的启发来自天花的根除。和小儿麻痹症一样，天花是一种可以被存活的疫苗简单有效的治理的病毒性疾病。关键是天花像小儿麻痹症一样仅有一个动物寄主：人类。一般而言根除应该是可能的。然而时间证明却是恰恰相反的。

　　First, unlike smallpox, polio viruses can survive for long periods outside a host-for instance in sewage. Second, when the campaign began in earnest there were three main varieties of polio, each of which required a specially¹⁴ tailored vaccine¹¹. Focusing effort on one of these strains often led to the resurgence¹⁵ of another. Third, besides the inevitable¹⁶ difficulties of working in places that have poor medical infrastructure¹⁷, the campaign ran into some specific human problems. The most notorious of these was the rumour¹⁸, spread in 2003 by certain religious leaders in Nigeria, that the vaccine would sterilise girls and was part of an American plot to rid the world of Muslims. This helps explain why polio persists in Nigeria.

　　第一，与天花不同的是，小儿麻痹症病毒在寄主之外可以长时间的存活—例如在下水道。第二，当此项活动开始正儿八经的进展的时候已经存在三类主要的小儿麻痹症，每一类都需要一种特别定做的疫苗。集中对其中一类小儿麻痹症下功夫经常会导致另一类病毒的死灰复燃。第三，除了这些不可避免的医疗设备落后的工作困难之外，此项活动偶尔还会遇到人类问题。其中最臭名昭著的就是在2003年尼日利亚的某一宗教领导人散布的谣言，谣言称疫苗将会使女孩绝育并且是一个消灭世界上伊斯兰教徒的美国阴谋的一部分。这帮助解释了尼日利亚的小儿麻痹症得不到遏制的原因。

　　That polio can actually be eradicated¹⁹ is suggested by the elimination²⁰, in 1999, of one of the three strains. Whether the resources needed to do so might be better spent elsewhere, though, is a matter of debate. Some would prefer to see a shift to policies that improve overall health, including investing in decent sanitation²¹ and clean water.

　　1999年，三类小儿麻痹症之一的消除证明了小儿麻痹症实际上可以根除。但是根治小儿麻痹所需要的资源财力是否可以在别处更好的支配是一个值得讨论的问题。一些人更希望看到一个改善全民健康的政策的转变，包括像样的环境卫生和干净的水。

　　The response to that is that if you remove the specific pressure on polio it will simply bounce back. Moreover, in practice, a synthesis between the two positions is emerging. According to Mr Germ there is already a debate within Rotary about what to do next. Providing clean water and improving maternal²² and child health are popular options.

　　对于此观点的回应是如果你对小儿麻痹症疏忽大意它将会轻易的恢复活力。此外，实际上两种立场已经显现出达成一致的势头。据泽恩先生说，早就已经在扶轮社内部召开了关于接下来该怎么做的讨论会。提供干净的水和改善母婴健康是符合大众的选择。

　　One thing everyone wants to avoid, though, is what happened after smallpox was eliminated. Then, the infrastructure of health workers and clinics that had been created to detect and fight the disease was allowed to evaporate. Had it been used instead to focus on polio, that illness, too, might have been vanquished²³ by now.

　　不过，每个人都想避免的一件事是天花被消除以后发生的事。此外，已经制造的用于检测和治疗疾病的保健人员和诊所的医疗设施是可以消除疾病的。至于这些设备是否也已经用于治疗小儿麻痹症这样的疾病到目前为止可能已经可行了。

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