巴基斯坦根除脊髓灰质炎的最后一英里，乐观与决心并存 | 盖茨笔记

Earlier this year, I made my first trip ever to Pakistan to learn more about the country’s incredible efforts to wipe out polio.

今年早些时候，我首次访问巴基斯坦，以求进一步了解该国为根除脊髓灰质炎所做的非凡努力。

At the time of my visit in February, Pakistan had gone more than a year without a single child being paralyzed by the crippling disease. This was a huge achievement made possible by the skill and dedication of the polio program’s leadership and its more than 300,000 polio workers. Their energy and enthusiasm reminded me of what I saw in India and Nigeria when those countries were traveling the final mile to eliminate polio within their borders.

在我2月到访的时候，巴基斯坦已经有一年多的时间没有一个儿童因这种致残疾病而瘫痪了。这是一项伟大的成就，归功于消灭脊髓灰质炎计划的领导以及30多万名脊灰工作者的专业技能和奉献精神。他们的精力和热情让我想起了我在印度和尼日利亚看到的情景，当时这两个国家为实现消灭脊灰的目标正在进行最后一英里的冲刺。

But the last mile is often the toughest. The gains made against this highly contagious disease are often fragile.

但最后一英里往往是最艰难的。抗击这种高传染性疾病过程中取得的成果往往很脆弱。

In recent weeks, the world received a sobering reminder of this fact when three new cases of wild poliovirus were detected in Pakistan: 12 and 15-month-old boys, and a two-year-old girl all living in the same district in Khyber Pukhtunkhwa Province, Pakistan, near the border with Afghanistan. (Pakistan and Afghanistan are the only two countries where the wild poliovirus has not been eliminated.) 

最近几周，巴基斯坦发现了三例新的野生脊灰病毒病例，这让世界对上述事实有了更为清醒的认识：三例新病例分别为12和15个月大的男孩，以及一个两岁的女孩，他们都生活在巴基斯坦与阿富汗接壤的开伯尔·普什图省的同一地区。（巴基斯坦和阿富汗是仅有的两个尚未根除野生脊灰病毒的国家。）

It is heartbreaking to see these three children paralyzed by a preventable virus that has been eliminated in nearly every part of the world. (The government of Pakistan is providing rehabilitation services and other support to help the children and their families.)

看到这三名儿童因一种可预防的病毒而瘫痪，这实在令人心碎，这种病毒已经几乎在世界各地绝迹。（巴基斯坦政府正在为这几名儿童和他们的家庭提供康复服务和其他支持，以帮助他们走出困境。）

At the same time, the emergence of these new cases was not entirely unexpected given the challenges of wiping out the virus in one of the most challenging places on Earth. The border region between Pakistan and Afghanistan, where the cases were detected, struggles with insecurity and misinformation that can sometimes prevent vaccinators from reaching every child who needs the polio vaccine.

与此同时，鉴于这是要在地球上最具挑战性的地区完成根除病毒的艰巨任务，因此，出现这些新病例也并非完全出乎意料。在发现这些病例的巴基斯坦和阿富汗边境地区，不安全感和错误信息有时会阻碍疫苗接种工作者接触到每一个需要脊灰疫苗的儿童。

When I learned about the new cases, I was disappointed. But I was also heartened by the response of Pakistan’s polio program. Despite having every reason to be frustrated, Dr. Shahzad Baig, who runs Pakistan’s National Emergency Operations Center for polio, said his team was not deterred. “This strengthens our resolve to reach every child with the polio vaccine,” he said.

当我得知有新病例出现时，我感到很失望。但我也被巴基斯坦消灭脊髓灰质炎计划的应对措施所鼓舞。尽管的确有理由感到沮丧，但巴基斯坦国家脊灰紧急行动中心的沙赫扎德·拜格博士表示，他的团队并没有被吓倒。“这增强了我们为每个儿童接种脊灰疫苗的决心，”他说。

After what I saw during my visit to Pakistan, I shouldn’t have been surprised by the team’s unfailing confidence. The polio workers are driven and detail oriented. They understand that running effective polio vaccination drives is not about getting one thing right. It’s about getting everything right that’s necessary to ensure all children get vaccinated.

访问巴基斯坦期间的所见让我不该对该团队始终如一的信心感到惊讶。这些脊灰工作者干劲十足且注重细节。他们明白，开展有效的脊灰疫苗接种活动并不只是要单纯做好一件事，而是意味着要做好一切相关必要的工作，以确保所有儿童都能接种疫苗。

In Pakistan, that has meant training 300,000 frontline workers who walk from house to house to vaccinate over 43 million children under the age of five; creating detailed maps for those teams to use to ensure no child is missed; running public information campaigns to inform communities about the risks of polio and the benefits of vaccination; organizing security to protect vaccinators; and building strong supply chains so vaccines are available across the country.

在巴基斯坦，这意味着要培训30万名一线工作人员，他们要挨家挨户为4300多万名五岁以下儿童接种疫苗；为团队绘制详细的地图，以确保不遗漏任何一名儿童；开展宣传活动，让社区了解脊髓灰质炎的风险和接种疫苗的益处；组织安保工作以保护接种人员；并建立强大的供应链，使疫苗在全国各地都可获得。

In between vaccination drives, Pakistan’s polio surveillance workers are constantly hunting for signs of acute flaccid paralysis in children and testing the environment for the presence of the virus.  Pakistan currently has the largest environmental surveillance network in the world. From tiny villages to larger cities and urban areas, Pakistan’s system has the capacity to find the poliovirus wherever it exists.

在疫苗接种活动的间隙，巴基斯坦的脊灰监测人员一直不断地在寻找儿童急性弛缓性麻痹的迹象，并测试环境中是否存在该病毒。巴基斯坦目前拥有世界上最大规模的环境监测网络。从小村庄到大城市和城区，巴基斯坦的系统有能力在病毒存在的任何地方找到它。

The nerve center for all this work is the National Polio Emergency Operations Center, which was a highlight of my visit. A wall of screens in a control room displayed real-time information about vaccinations, security, and supplies, as well as detailed maps following the movements of polio workers. This data helps the team see where they need to make improvements to the vaccination programs to ensure they reach all the children. You probably know I have an insatiable appetite for data, especially health data. So, it should be no surprise I lingered here for longer than planned to look at all the information and learn from the polio experts who are as passionate about data as I am.

所有这些工作的“神经中枢”是巴基斯坦国家脊灰紧急行动中心，它是我此行的重点。控制室里的一面屏幕墙显示了有关疫苗接种、安全和供应的实时信息，以及追踪脊灰工作人员行动的详细地图。这些数据有助于团队了解他们需要在哪些方面改进疫苗接种计划，以确保疫苗接种覆盖所有儿童。你可能知道我对数据，尤其是健康数据有着一种永不满足的了解欲。因此，我在此处逗留了比原计划要长的时间，了解所有信息，并向和我一样热衷于数据的脊灰专家们学习。

What was also remarkable to see is how Pakistan has continued to build community support for its polio activities by integrating them with other essential health programs, like routine immunization programs. During the pandemic, polio workers used their deep knowledge of local communities to reach out to families to raise awareness of COVID-19, teach them how to protect themselves with handwashing and mask wearing, and encourage people to get vaccinated.

同样令人瞩目的是，巴基斯坦通过将脊灰活动与其他基本卫生计划（如常规免疫接种计划）相结合来持续为脊灰活动争取社区支持。在新冠大流行期间，脊灰工作者利用他们对当地社区的深入了解来帮助居民提高对新冠肺炎的认识，教他们如何通过洗手和戴口罩来保护自己，并鼓励人们接种疫苗。

Polio workers constantly battle rumors and misinformation about the polio vaccines. But by engaging openly with the public’s questions they’re making headway against this challenge.

脊灰工作者不断与有关脊灰疫苗的谣言和错误信息作斗争。通过公开回答公众提问，他们在应对上述挑战方面取得了进展。

I got a glimpse of part of this effort at a national immunization call center where doctors and other health workers respond to tens of thousands of queries every month from the public about immunization, including polio. If families hear a rumor about the polio vaccine, they can call for free and ask about it. Pakistan has reduced the number of vaccine refusals and I believe that the work of this call center is one of the key reasons why. The call center was set up to support polio inquiries, but due to the success of the program, the call center expanded its services to answer questions about COVID-19 vaccines and all other vaccines.

我在一个国家免疫呼叫中心瞥见了这份努力的一部分，在那里，医生和其他卫生工作者每个月都要回答数以万计的公众关于免疫（包括脊髓灰质炎）的问题。如果哪个家庭听到关于脊灰疫苗的谣言，他们可以拨打免费电话咨询。在巴基斯坦，拒绝接种疫苗的人数已明显减少，我相信这个呼叫中心所做的工作是关键原因之一。该呼叫中心是为了支持脊灰咨询而设立的，并由于该计划的成功，其服务范围已扩展到回答有关新冠疫苗和其他所有疫苗的问题。

Pakistan’s polio effort also benefits from the strong support it receives from the very top of its government. I recently had an opportunity to speak with Pakistan’s new Prime Minister, Shehbaz Sharif, and it was clear that his administration is actively engaged in stopping transmission for good.

巴基斯坦抗击脊灰的努力也受益于其政府最高层的大力支持。最近，我有机会与巴基斯坦新任总理夏巴兹·谢里夫交谈，很明显，他的政府正积极致力于永久阻断脊灰病毒传播。

“The fact is, we’ve never been closer to ending polio and it’s critical that the world doesn’t lose sight of this goal.”

“事实是，我们从未如此接近于根除脊髓灰质炎，至关重要的是，世界不能忘记这一目标。”

Even with the three new polio cases in Pakistan, the virus is still circulating at very low levels and the world has an historic opportunity to make sure this virus never paralyzes a child again. The fact is, we’ve never been closer to ending polio and it’s critical that the world doesn’t lose sight of this goal.

尽管巴基斯坦新出现了三例脊灰病例，但是该病毒的传播水平很低，而世界正面临着一个历史性的机会来确保这种病毒永远不会再让儿童瘫痪。事实上，我们从未像现在这样接近于根除脊髓灰质炎，至关重要的是，世界不能忘记这一目标。

The last mile to end polio, of course, will be challenging. And that’s why it’s important that the world keep up its support for the polio programs in Pakistan and Afghanistan, so they don’t travel it alone.

当然，根除脊髓灰质炎的最后一英里将充满挑战。这就是为什么世界继续支持巴基斯坦和阿富汗的脊灰计划如此重要，这样他们就不会孤军奋战了。

I look forward to keeping you posted on their progress in the months ahead.

我期待在未来几个月向你们分享更多关于他们终结脊灰的进展。