新冠疫情专刊 | 研究：“这次疫情暴发将成为导火索”
Sharing the latest articles of the UNESCO Courier with you.
与您第一时间分享联合国教科文《信使》杂志的最新文章。
COVID-19疫情加剧了气候紧急状况，财富分配不均，社区、国家和地区之间的分歧，同时造成了所谓自二战以来最严重的全球危机。在全球进入COVID-19疫情紧急状态后，许多女性的呼吁都未被我们所听到。因此，教科文组织《信使》杂志在本年度第三期杂志（7-9月刊）以“一个全新的世界，源自女性的构想”为主题邀请全球的女性发出自己的声音，以帮助我们了解这场全球性的危机正在如何影响着我们的社会，又将带来什么后果：我们可以从中吸取什么教训？危机之后的世界又会是什么样子？
Adding to the climate emergency, unequal distribution of wealth, and ever-deepening divides between communities, nations and regions, COVID-19 has created what some are calling the gravest global crisis since World War II. The next issue of the UNESCO Courier, under the theme of “A Whole New World, Reimagined by Women” will give voice only to women, many of whom have gone unheard since the start of the COVID emergency, to help understand how this crisis is affecting our societies and explore the possible consequences: What are the first lessons we can draw? How will the world look like after?
“在这场危机中，女性仍是无名英雄”
“Women are the unsung heroes of this crisis”
娜塔莉·斯特鲁布 - 伍尔加夫特（Nathalie Strub-Wourgaft）是2020年4月成立的 COVID-19临床研究联盟的发起者之一。该联盟汇聚了30多个国家的科学家、医生、捐助方和决策者，致力于加快资源匮乏国家对于这种疾病的研究。娜塔莉认为研究工作必须针对这些国家的具体需求来展开。
Nathalie Strub-Wourgaft is one of the initiators of the COVID-19 Clinical Research Coalition, launched in April 2020. It brings together scientists, physicians, donors and policymakers from over thirty countries, to accelerate research on the disease in resource-poor nations. She argues that research must be specifically adapted to the needs of these countries.
娜塔莉·斯特鲁布 - 伍尔加夫特（位于瑞士日内瓦的独立研究机构“被忽视疾病药物研发倡议”被忽视热带疾病部门主任） 接受采访
Director of Neglected Tropical Diseases at the Drugs for Neglected Diseases initiative (DNDi), an independent research organization based in Geneva, Switzerland.
01
是什么促使您们决定创建COVID-19临床研究联盟？
What motivated the creation of the COVID-19 Clinical Research Coalition?
娜塔莉·斯特鲁布 - 伍尔加夫特：到3月中旬时，关于冠状病毒的临床研究已经开展得相当活跃了，但主要集中在富裕国家，同时也是大多数感染者所在的国家。而南方国家，不论是在非洲、亚洲还是拉丁美洲，却迟迟没有任何开展临床试验的计划，这让我们当中不少人深感忧心。虽然当时这些地区的病例数量还不算多，但预测显示疫情将会升级，尤其是在非洲。南北方国家的研究工作显然进展不均衡，这就是我们成立联盟的起因。埃博拉病毒引发的那场公共卫生危机依然令人记忆犹新，当时出现了许多研究项目，但不同项目之间缺乏协调，也没有实现信息共享。我们一定要避免重蹈覆辙。
Nathalie Strub-Wourgaft: Clinical research on the coronavirus was already very active by mid-March – but it was concentrated in rich countries, where the majority of infected people were also located. There were a number of us who were concerned that no clinical trials were planned in countries in the South, whether in Africa, Asia or Latin America. There were still only a few cases there, but projections predicted that the epidemic would escalate, particularly in Africa. There was a clear imbalance between North and South in research. That is why we launched the Coalition. We still had in mind what happened at the time of the health crisis with the Ebola virus. A multitude of research projects had emerged at that time, but there was no co-ordination and no sharing of information between these different projects. It was necessary to avoid repeating those mistakes.
COVID-19是一种新型疾病，一切都必须从零开始——要制定新的治疗方案，要分析样本，要生成临床影像。研究与疫情同步展开。研究必须快速推进，但同时也要避免重复，以便尽快找到一些基本问题的答案，比如说，如何避免死亡？如何避免住院？如何保护自己？哪些人属于高危群体？要在这些问题上取得进展，需要具备强大的分析能力，也就是需要汇总信息和数据。
As COVID-19 was a new disease, everything had to be done from scratch – new protocols had to be invented, samples had to be described, clinical images had to be created. The research developed in parallel with epidemiology. It was necessary to go very quickly, but it was also necessary to avoid duplication in order to provide rapid answers to basic questions – how to avoid fatalities, how to avoid hospitalization, how to protect oneself, who were the risk groups? To make progress on these issues, however, a high level of analytical power is needed, which means bringing together information and data.
02
为什么需要针对资源匮乏国家开展专项研究？
Why is it necessary to develop specific research for countries with low resources?
娜塔莉·斯特鲁布 - 伍尔加夫特：北方国家制定的治疗方案在南方国家并不适用，即便仅仅是因为不同地区出现的合并症不同。例如在非洲，疟疾、结核病和艾滋病毒的感染率很高，而在欧洲却不是这样。更何况，各国的卫生系统也不同。工业化国家的医院在收治大量重症患者方面已然显得左支右绌，力有不逮。那些没有配备人工呼吸机的医院又会是怎样一番景象呢？就治疗方法而言，某些目前显现出可喜疗效的疗法均为可注射分子疗法，而这需要训练有素的医护人员来实施。假如没有这样的人员，那就必须另寻其他治疗方案。
Nathalie Strub-Wourgaft: The therapeutic propositions that could be developed in the North are not applicable as such in the South – if only because comorbidities are not the same from one region to another. In Africa, for example, malaria, tuberculosis, or HIV are widespread, which is not the case in Europe. Moreover, health systems are different. In industrialized countries, hospitals have had difficulty coping with the influx of patients with severe forms of the disease. What about those not equipped with artificial respirators? As far as treatments are concerned, the molecules that are showing some promising results today are injectable molecules, and therefore require trained hospital staff. If this personnel is not available, other therapeutic solutions must be found.
此外，目前还不清楚世界各地的病毒是否相同，未来可能会发生地域变异。最后，靠社会科学来解决的问题同样还取决于地域环境——德里的封禁措施与法国农村的措施必然不同。管控措施的影响以及民众对于管控措施的接受程度，各个地区也不尽相同。由此可见，研究工作一定不能脱离实际背景，绝不能把在工业化国家取得的科研成果复制到世界各地。研究必须以相关国家的优先事项为指引。
In addition, it is unclear whether the virus is the same everywhere. It would appear there are geographical variants. Finally, the problems addressed by the social sciences also depend on the regional context – lockdown is not the same in Delhi as it is in a rural area in France. The impact of this confinement and its acceptability by the population varies from one region to another. Therefore, in research, the notion of context is essential. You cannot conduct scientific research in industrialized countries and apply it everywhere else. Research must be guided by the priorities of countries.
03
如此严重的公共卫生危机能否提高人们对联合开展研究的必要性的认识？
Could a health crisis of this magnitude raise awareness of the need to federate research efforts?
娜塔莉·斯特鲁布 - 伍尔加夫特：这是肯定的。我们需要在摸索治疗方法和临床诊断方面联手努力。主要捐助方应商定优先事项，这是危机应对工作中必不可少的一环。此时此刻，全球卫生问题与我们所有人都息息相关。这是前所未有的局面，即便是埃博拉危机最终也被认定为非洲问题，可见事态之严重。面对这种新的病毒，我们别无选择，只有戮力同心。世界卫生组织（世卫组织）将首个临床试验命名为“团结”，其寓意深远。
Nathalie Strub-Wourgaft: Absolutely. We need to federate efforts in terms of identifying treatments, and diagnoses. It is necessary for the major donors to agree on priorities, which is absolutely essential in the response. We are at a time in history when we are all concerned by a global health problem. This is a totally new situation. Even the Ebola crisis was finally identified as an African problem. This new virus leaves us no choice but to work together. The fact that the World Health Organization (WHO) has named its first clinical trial “Solidarity” is not insignificant.
04
研究管理工作是否已经开始转好？
Are we witnessing the beginnings of a better governance of research efforts?
娜塔莉·斯特鲁布 - 伍尔加夫特：现在要作出判断还为时尚早。这方面的意愿是有的，而且与以往相比，研究界内部的协作也有改善。现在还不能奢谈更好的管理，但我们正在朝着这个目标迈进。另一方面，关于冠状病毒病的临床试验现已开展近千次之多，这意味着还没有形成真正意义上的国际合作。
Nathalie Strub-Wourgaft: It is still a little early to say. The will is there, and we have better collaboration among the research community than in the past. We cannot yet talk about better governance, but we are getting closer to it. At the same time, nearly a thousand different clinical trials have been launched on COVID-19 – which means that internationally, there is no real collaboration.
这场公共卫生危机造成的影响暂时还难以估量，但危机将是一个转折点。我们正在确立一种新的工作方法，目前仍有许多工作要做。我们正在努力将获取问题纳入研究项目，这是我们现阶段的主要成果之一。以“被忽视疾病药物研发倡议”为例，我们目前正在开展一项临床试验，探索今后可以大规模供患者使用的分子疗法。这项工作看似浅显，但往往很难做到。
This health crisis will be a tipping point, although it is still difficult to measure its impact. We are in the process of building a new way of working, but much remains to be done. One of the achievements is that today, we are trying to integrate the issue of access into research projects. At DNDi, for example, we are currently working on a clinical trial. We are looking at molecules that will be made available to populations, and will be accessible on a large scale. It seems obvious, but this hasn't always been the case.
05
能否谈谈在这场公共卫生危机中取得的突破？
Could we talk about a breakthrough in this health crisis?
娜塔莉·斯特鲁布 - 伍尔加夫特：这场危机将成为时代的分水岭。数百万人感染，数十万人死亡，如果这都不是分水岭，那还能是什么？要说不是，那就是在矢口否认我们的亲身经历。在研究这种疾病方面，我们已经错过了一些时间，但与以往相比还不算太糟糕。埃博拉病毒是一个转折点，而冠状病毒病将成为导火索。不可否认，这场危机是一次教训。有些人数年来一直在试图敲响警钟，比如比尔·盖茨（Bill Gates），他早在多年前就曾警告过未来可能会暴发一场大流行疾病。有些人曾建议世卫组织成员国根据当前研究领域的当务之急，拿出国家预算的0.1%用于开展研究。我们现在必须听取这些意见。
Nathalie Strub-Wourgaft: There will be a before and an after. How could it be otherwise when the infections can be counted in millions, the deaths in hundreds of thousands? If this is not the case, it means that we are in denial about what we have just experienced. Time has been lost in research on this disease, but less than in the past. Ebola was a turning point. COVID-19 will be a detonator. This crisis is undeniably a lesson. Some people have been trying to sound the alarm for several years – like Bill Gates, who warned of a pandemic many years ago. Some had suggested that WHO member countries should devote 0.1 per cent of their budgets to research, according to priorities defined by the research imperatives of the day. Those voices must now be heard.
新冠疫情专刊 | 一个全新的世界，源自女性的构想
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