这本书教给我许多关于西班牙流感的事 | 盖茨书评

My dad’s mom, Lillian Gates, was lucky to have survived the 1918 influenza pandemic. Unlike COVID-19, which is hitting older people the hardest, the influenza pandemic caused the highest mortality among people in their twenties. The most vulnerable of all were pregnant women. In 1918, my grandmother was 27 and pregnant with my dad’s older sister. She was living in Bremerton, WA, which suffered big losses from influenza because it had a big Navy shipyard and sailors coming from all over the world.

我的祖母莉莲·盖茨（Lillian Gates）在1918年的流感大流行中幸运地活了下来。不同于对老年人影响最大的新冠肺炎，当年的流感疫情在20多岁的年轻人群体中造成了最多的死亡，而其中最脆弱的是孕妇。那一年我祖母27岁，怀着我父亲的姐姐。她住在华盛顿州的布雷默顿市，那里因为有一个大型的海军造船厂和来自世界各地的水手，所以遭受了流感的重创。

Then as now people isolated themselves at home, streets were empty, and industry shut down. Doctors and nurses were incredibly heroic, putting their own lives at risk and working themselves to the bone. The best parts of human nature were frequently on display—but so were acts of ignorance, greed, and fear of the “other.”

就像今天一样，那时的人们在家自我隔离，街道空无一人，企业停工停产。医生和护士们英勇无比，冒着生命危险拼命工作。人性中最美好的部分经常被展现出来，但无知、贪婪和对“他人”的恐惧也随处可见。

To refresh my memory about the realities and lessons of that devastating pandemic, I recently reread The Great Influenza (2004), by John M. Barry. He does a great job of showing just how profoundly that pandemic affected not just billions of families like mine but also the entire flow of history.

为了刷新我对于那场毁灭性疫情的现实和教训的认识，我最近重读了约翰·巴里（John M. Barry）的《大流感》（2004年出版）。他出色地展示了大流行如何深刻地影响了数十亿像我家这样的家庭，以及整个的历史发展。

《大流感:最致命瘟疫的史诗(特别纪念版)》

[美]约翰·M.巴里 著

上海科技教育出版社 2020年3月版

Barry speculates that if not for the pandemic, World War II might never have erupted. In 1918, when President Woodrow Wilson was in the midst of negotiating with his British and French counterparts the treaty to end World War I, he got a violent case of the flu. He survived, but he was never the same again, physically or mentally. Previously, Wilson had insisted that the treaty must represent “peace without victory” and would not give in to the harsh terms French President Georges Clemenceau wanted to impose on the Germans. But after getting the flu, Wilson “yielded to Clemenceau everything of significance Clemenceau wanted,” Barry writes.

巴里推测，如果不是因为大流行，第二次世界大战可能永远不会爆发。1918年，当伍德罗·威尔逊（Woodrow Wilson）总统与英法两国盟友就结束第一次世界大战的条约进行谈判时，他得了严重的流感。他活了下来，但自那以后无论从身体上还是精神上，他都像变了个人。此前，威尔逊坚称该条约必须代表“无胜利的和平”，不会向法国总统乔治·克里孟梭（Georges Clemenceau）想强加给德国人的苛刻条件让步。但在得了流感之后，巴里写道，威尔逊“向克里孟梭屈服了，并答应了他想要的一切”。

No one can know for sure what effect the flu really had on Wilson, or what the effect of a gentler Treaty of Versailles might have been. But Barry is sure that Wilson’s illness contributed to the rise of Hitler: “Historians with virtual unanimity agree that the harshness toward Germany of the Paris peace treaty helped create the economic hardship, nationalistic reaction, and political chaos that fostered the rise of Adolf Hitler.”

没人知道流感对威尔逊究竟产生了什么影响，也没人知道温和版的《凡尔赛条约》可能产生什么影响。但巴里确信威尔逊的患病促成了希特勒的崛起：“历史学家几乎一致认为，《巴黎和约》对德国的苛刻条件催生了经济萧条、民族主义情绪和政治混乱，这些都助长了阿道夫·希特勒的崛起。”

When The Great Influenza first came out, I got a copy from Bill Foege, a good friend and public-health hero who helped to eradicate smallpox. I’m glad I read it. It’s one of several books that made it clear to me that the world needed to do a better job of preparing for novel pathogens. Writing roughly 16 years ago, Barry was clear and persuasive that “another pandemic not only can happen…. It almost certainly will happen.”

当《大流感》刚出版时，我从比尔·福吉（Bill Foege）那里拿了一本。他是我的朋友，也是公共卫生界的英雄，曾帮助根除了天花。我很高兴自己读了这本书。我读过的几本同类书籍让我明白，世界需要更好地为迎接新型病原体做准备。大约16年前，巴里在书中明确及有说服力地写道：“另一场大流行病不只是可以发生，而是几乎肯定会发生。”

I wasn’t the only one who took Barry’s admonition to heart. As ABC recently reported, “President George W. Bush was on vacation at his ranch in Crawford, Texas, when he began flipping through a … copy of a new book about the 1918 flu pandemic [given to him by Health Secretary Mike Leavitt]. He couldn’t put it down.” Bush and Leavitt then worked to pass a multi-billion-dollar pandemic-preparation bill.

我并不是唯一一个将巴里的告诫牢记于心的人。正如美国广播公司（ABC）最近报道的那样：“小布什（George W. Bush）总统在得克萨斯州克劳福德的牧场度假时，翻阅了一本有关1918年流感大流行的新书（卫生部长迈克·莱维特（Mike Leavitt）给了他这本书）。他爱不释手。”小布什和莱维特随后努力通过了一项耗资数十亿美元的大流行应变法案。

So what are the big lessons from the 1918 influenza pandemic?

我们从1918年流感大流行得到了哪些重要教训呢？

First and foremost, leadership matters, and President Wilson failed to provide it. “Wilson did nothing about influenza in the military but express concern about shipping troops to Europe,” writes Barry. “He did even less for civilians…. There is no indication that he … so much as inquired of anyone in the civilian arm of the government as to its efforts to fight the disease.”

首先，领导力很重要，威尔逊总统就没有做到这一点。巴里写道：“威尔逊对军队中的流感并未采取任何措施，只是对向欧洲运送军队表示担忧。” “他为平民所做的事甚至更少……没有任何迹象表明，他曾向民政部门的官员询问过任何关于民间抗击疫情的进展。”

Fortunately, scientific leaders like Army Surgeon General William Gorgas stepped up. And so did some, but by no means all, governors and mayors. In St. Louis, for example, the city mobilized quickly and staged effective responses that saved many lives. In Philadelphia, in contrast, the mayor ignored the advice of experts that he should cancel a massive parade in support of the war effort. A few days later, the bodies started piling up. “Undertakers, themselves sick, were overwhelmed. They had no place to put bodies…. Undertakers’ work areas were overflowing, they stacked caskets in halls, in their living quarters,” writes Barry.

幸运的是，像陆军外科医生威廉·戈格斯（William Gorgas）将军这样的科学界领袖站了出来。一些（但非全部）州长和市长也站了出来，例如圣路易斯市迅速行动，采取了有效的应对措施，挽救了许多生命。与之相反的是，费城市长无视专家的建议，没有取消支持战争的大规模游行。几天以后，尸横遍野。“殡仪馆的人忙得不可开交，甚至连他们自己也生了病，尸体无处存放……殡仪馆的工作区域人满为患，他们把棺材堆在大厅里、堆在他们的生活区。”巴里写道。

“

In 1918, America’s political leaders sugarcoated bad news to avoid panicking the public.

1918年，美国的政治领导人给坏消息裹上了糖衣，以避免引起公众恐慌。

”

Second, truth matters. In 1918, America’s political leaders—even health commissioners—sugarcoated bad news to avoid panicking the public. That greatly undermined their authority when citizens saw friends and neighbors dying in great numbers. Barry concludes that “those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.”

第二，真相很重要。1918年，美国的政治领导人——甚至是卫生官员——都给坏消息裹上了糖衣，以避免引起公众恐慌。当市民看到朋友和邻居大批死亡时，当权者的权威急剧下降。巴里总结道：“当权者必须保住公众的信任。要做到这一点就不得扭曲任何事实，不得文过饰非，不得试图操纵他人。”

Third, philanthropy has an important role to play. In fact, things could have been much worse if not for the gifts of John D. Rockefeller, Johns Hopkins, and many other donors whose names were never put on buildings. These gifts fundamentally transformed American science and medicine in the late 19th and early 20th century, giving the country hundreds of thousands of well-trained professionals to treat those who fell ill from influenza and guide the public-health response.

第三，让慈善事业发挥重要作用。事实上，如果没有来自约翰·洛克菲勒（John D. Rockefeller）、约翰斯·霍普金斯（Johns Hopkins）和许多未曾在建筑物上留名的捐赠者的慷慨捐助，情况可能会更糟。这些捐助从根本上改变了19世纪末20世纪初美国的科学和医学，为这个国家提供了成千上万受过良好培训的专业人员，他们对流感病患进行救治，以及指导公共卫生应对工作。

Fourth, pandemics are humbling. Despite the brilliant work at the Rockefeller Institute, Johns Hopkins University, and other institutions, doctors never had the benefit of effective antiviral medications or a vaccine. In fact, it was not until 1933 that scientists confirmed that it was a virus, rather than a bacterium, that caused the influenza pandemic. 

第四，流行病让人感到卑微。尽管洛克菲勒研究所、约翰斯·霍普金斯大学和其他机构做了杰出的工作，医生却从未受益于有效的抗病毒药物或疫苗。事实上，直到1933年，科学家们才证实了引起流感大流行的是病毒而不是细菌。

This time around, we have many more tools at our disposal for creating effective vaccines and therapeutics. But the science is still slower than any of us would like, and putting an end to this pandemic will require more than just great science. It will also take a lot of political will, especially encouraging social distancing and making sure that laboratory miracles spread as far and wide as the virus itself.

这一次，我们有更多的工具可用于研发有效的疫苗和治疗方法。但科学发展的速度仍然比我们希望的慢，而且结束这场大流行需要的也不只是伟大的科学。我们还需要强大的政治意愿，尤其是要鼓励社交距离，以及确保在实验室诞生的奇迹能像病毒本身一样广泛传播。

When Melinda and I first started learning about childhood vaccines, we were appalled to learn that it often took decades for a new vaccine to be put to widespread use in the developing world. So even before we have all the tools we need to defeat COVID-19, my colleagues at the Gates Foundation, Gavi, and many other organizations are working to raise the money, organize the institutions, and develop a global plan of action for distributing them around the globe. In 1918, the world just didn’t have the systems to do that. Melinda and I are deeply committed to making sure we will this time around.

当我和梅琳达刚开始了解儿童疫苗时，我们惊讶地发现，要在发展中国家普及一种新疫苗往往需要几十年的时间。因此，在我们拥有战胜新冠病毒所需的所有工具之前，我在盖茨基金会、全球疫苗免疫联盟（Gavi）和许多其他组织的同事们，正在努力筹集资金，组织多方机构，以及制定一项全球行动计划，以便在全球范围内分配这些工具。1918年，世界上还没有可以完成这些的系统。我和梅琳达都致力于确保我们在这一次能够做到。