通常針對疫情地區中斷往來的時候,都會導致醫療物資和人員的移動更困難甚至不可能。也就是 Trump 最近的名言,cure cannot be worse than the problem itself. 但是建議各國阻斷交通往來的話,通常死傷的人命更多,也常常如書中例子所言,反而導致跟疫情絲毫無關的人無端喪命。除此之外,研究也顯示,交通阻隔尤其是道路的阻斷,往往對疫情的防範沒有什麼作用,反而讓醫療物資和人員的移動平添困難。
WHO 針對的是全球衛生,也為了考慮經濟不發達地區往往疫情爆發的時候更不容易得到救助。如果做了先例建議阻斷交通和貿易,將來各國隱匿疫情的動機就更高,長遠來說對世人健康的風險隱患更危險。
回到剛剛的話題,如果這本書的例子改變,變成會傳染的疾病,那麼 WHO 會建議中斷交通往來嗎?其實 WHO 2014 年早就針對傳染性的流感發表過相關的研究:結論也是完全公開的:
The results of our systematic review indicate that overall travel restrictions have only limited effectiveness in the prevention of influenza spread, particularly in those high transmissibility scenarios in which R0 is at least 1.9 (Box 2). The effect size varied according to the extent and timeliness of the restrictions, the size of the epidemic, strain transmissibility, the heterogeneity of the travel patterns, the geographical source and the urban density of international travel hubs. Only extensive travel restrictions – i.e. over 90% – had any meaningful effect on reducing the magnitude of epidemics. In isolation, travel restrictions might delay the spread and peak of pandemics by a few weeks or months but we found no evidence that they would contain influenza within a defined geographical area.
Often, in the context of pandemic preparedness and response, travel restrictions – especially at points of entry – have intuitive appeal to policy-makers because they demonstrate that a tangible attempt is being made to prevent the ingress of a novel virus or prevent onward spread. However, such an attempt is not always effective.
WHO continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks.
In general, evidence shows that restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions. Furthermore, restrictions may interrupt needed aid and technical support, may disrupt businesses, and may have negative social and economic effects on the affected countries. However, in certain circumstances, measures that restrict the movement of people may prove temporarily useful, such as in settings with few international connections and limited response capacities.
那麼,在中國本土疫情大致趨緩,改為小心防範境外輸入病例的現在,WHO 依然維持不實施交通或是貿易管制的建議,是「WHO 二月收了中國的好處淡化疫情」嗎?如果依照這個邏輯,是不是 WHO 現在四月份反過來「收了歐美的好處淡化疫情」?他們到底是草菅人命,還是有科學的判斷?
那麼,回到最一開始,大家罵很兇的譚德塞和 WHO 的決策。到底他們發佈的建議「請世界各國不要限制與疫情地區的交通」,有沒有道理呢?依照你的看法,以下哪一選項比較接近事實呢?
WHO 先被中國、繼而被歐美收買了,政治因素干擾了他們的專業判斷,讓全世界都增加被感染的風險。
WHO 的科學家們都是草包,完全不懂防疫和公共衛生。他們做的研究都是狗屁,還不如政治人物和鍵盤群眾的無上智慧。畢竟我們有谷歌,什麼都查得到。
其實 WHO 確實是秉持科學原則在推動防疫建議,反而是罵 WHO 的政治人物想趁機撈取政治資本,藉由疫病的恐懼,驅使義和團式的群眾隨之起舞。他們才是想用政治因素干擾專業的科學防疫。