比尔·盖茨：拜访社会最底层的人

任何时候有人问我为什么相信脊髓灰质炎（脊灰）有可能被根除，我都会跟他们讲我2010年印度之行的故事。在那次行程中，我拜访了这个国家最底层的一群人——穆萨哈尔人（Musahar）。

如今，印度已不再有脊灰。但不到十年前，全世界超过半数的脊灰病例都来自印度。当时许多卫生专家都说，印度将是地球上最后一个消灭脊灰的国家，因为那里出生率高、环境卫生差、人口密度大，这些都给了脊灰兴旺发展的机会。

那么印度是如何消灭这种疾病的呢？（点击文末“阅读原文”观看一段VR视频）

你可以在比哈尔邦偏远的戈西河沼泽地带找到答案。这里居住着印度最贫穷、最不被重视的穆萨哈尔人。2010年，给穆萨哈尔人及其他住在偏远、高危地区的人接种疫苗，是印度在消除这一致残疾病的漫长征程中需要克服的最大障碍之一。没有被国家免疫规划覆盖的孩子达数千人，这使脊灰得以继续传播。

印度政府为此采取了全力让每一个孩子都接种疫苗的行动，采用新的测绘工具，确保没有一户人家被遗漏。他们部署了超过200万名疫苗接种员，覆盖了全国的各个角落，包括我拜访过的穆萨哈尔人的村庄，那里曾经常由于戈西河发大水而难以接近（当时有张照片非常鼓舞人心：疫苗接种员在没腰的水中艰难前行，将脊灰疫苗带到偏远的村庄）。

2014年，印度实现了消灭脊灰的目标，这说明哪怕是在最复杂的情况下，这种致人瘫痪的疾病也是可以被击败的。有了与甚至是最偏远社区的新联系，卫生工作者正在为那里的孩子提供除脊灰疫苗以外更多的东西。他们继续同当地社区合作，改善其他重要卫生服务的送达情况，包括孕产妇和新生儿保健，以及针对麻疹和其他可预防疾病的免疫接种。

印度的经验继续鼓舞着全世界消灭脊灰的最后战役，目前只有三个国家还存在这种疾病：阿富汗、巴基斯坦和尼日利亚。根据最新的数字，2017年全球只有21例确认的野生脊灰感染病例——这是自1988年发起全球消灭脊灰行动以来（当时每年有35万病例）的最低数字。

这是一项不可思议的成就，但现在还不是骄傲自满的时候。不论世界上任何地方存在脊灰威胁，它都是对我们所有人的威胁。因此，全世界比以往任何时候都需要继续支持数百万疫苗接种员，他们正不知疲倦地想要完成自己的工作。他们的梦想——也是我的梦想——是看到脊灰被彻底击败的那一天。

Meeting the Musahar

Whenever someone asks me why I believe it’s possible to eradicate polio, I tell them about my 2010 trip to India to visit one of the country’s lowest castes—the Musahar. 

Today, India is polio free. But less than a decade ago, more than half the world’s cases of polio could be found in India. At the time, many health experts said that India would be the last place on Earth to stop polio because its high birth rate, poor sanitation, and population density allowed the disease to flourish. 

So how did they wipe out the disease?

The answer can be found in the remote marshlands of the Kosi River in the Indian state of Bihar. The region is home to one of the poorest, most underserved castes in India, the Musahar. In 2010, vaccinating the Musahar and other people living in remote, high-risk areas was one of the biggest obstacles India faced in its long campaign to end the paralyzing disease. Thousands of children were being missed during the national immunization drives, allowing the disease to continue to spread. 

In response, the Indian government launched an all-out effort to reach every child, employing new mapping tools to ensure that no family was missed. They deployed more than 2 million vaccinators who covered every speck of the country, including the Musahar village I visited, which was often inaccessible because of flooding from the Kosi River. (One of the most inspiring photographs of that time was an image of polio workers wading waste deep in water to reach remote villages with the polio vaccine.) 

By 2014, India achieved its goal of being polio free, proving that the paralyzing disease could be defeated in the most complicated circumstances. With new ties to even the remotest communities, health workers are providing children with much more than the polio vaccine. They continue to work with local communities to improve the delivery of other critical health services, including maternal and newborn care, as well as vaccinations for measles and other preventable diseases. 

India’s experience continues to be an inspiration for the world’s final push to wipe out polio in the three countries where it endures: Afghanistan, Pakistan, and Nigeria. Based on the latest figures, in 2017, there were just 21 identified cases of wild poliovirus in the world—the lowest number ever—down from 350,000 cases per year when the global polio eradication effort launched in 1988. 

That’s an incredible achievement. But now is no time for complacency. If polio a threat anywhere in the world, it is a threat to us all. That’s why it’s more important than ever for the world to continue to support the millions of vaccinators who are working tirelessly to finish the job. Their dream, as is mine, is to see the day that polio is defeated.