美教授：特朗普预算草案置美国人民的健康于不顾

在美国总统特朗普的新预算草案中，所有用于国内外公共卫生防疫和医学研究的资源几乎都被大幅削减了。其中，美国疾病控制与预防中心的预算被砍掉了12亿美元（17%）。而不幸的是，眼下正是一个各类传染病更容易在国际上肆虐的时代。

虽然大多数国会议员认为这个草案肯定会被国会毙掉，但对它进行仔细研究后，我们也能从中一窥特朗普政府的政策和行政取向。为了将美国的国防预算提高10%，特朗普完全忽视了这个国家面临的最大的安全隐患——一场能杀死数百万人的瘟疫。

在最近我与马克•奥尔沙克合著的《最致命的敌人：我们与杀人细菌的战争》（Deadliest Enemy: Our War Against Killer Germs）一书中，我们详细列出了美国和全球面临的最紧迫的公共卫生隐患，比如埃博拉病毒和由蚊虫传播的寨卡病毒等，以及用炭疽或是经过基因加工的天花病毒等实施的生化恐怖袭击。然而针对这些威胁，我们能给出的防治方案仅有那么三五个。

首当其冲的威胁，是一场全世界范围的致命流感大爆发，其威力或许不亚于1918年到1919年的那次西班牙流感——这似乎有点像末日恐怖电影里的情节。我们在书中还想象了H7N9病毒的一个变种肆虐全球的情景，而这一幕果真已经成了笼罩在东南亚国家头上的阴影。

我们对下一次流感疫情的大爆发依然毫无准备。我们目前的疫苗是基于20世纪40年代的技术，很多人就算接种了疫苗，在病毒来袭时也无济于事。另外，以全球极其有限的流感疫苗生产能力，在疫情爆发的头6至9个月里，全球人口中最多也就只有一小部分能接种到疫苗。

我们面临的第二大威胁是抗生素的耐药性。这是一场缓慢移动的海啸，可能最多几十年，人类就会重回瘟疫频发的黑暗时代，一个小伤口就能要了人的命，肺结核也会再度成为绝症。最近，一项针对抗生素耐药性的综合研究发现，到2050年，死于耐药菌感染的人可能要比死于癌症和糖尿病的人加起来还要多。

忽视传染病对人类和动物健康的威胁，是一种极端愚蠢的做法。对于美国来说，一种致死的病毒或细菌肆虐全美所造成的后果，要远比任何军事袭击、恐怖袭击乃至核攻击都更加严重。美国的立法者不应该浪费时间和精力去讨论特朗普政府预算草案的细节，而应是应该在2018财年的联邦预算中，根据重要性对政府支出进行排序，以扼杀新型传染病对美国造成致命影响的可能。因此，美国非但不能削减疾病防治中心和国家卫生研究院（NIH）的预算，相反还要增加对这两个部门的拨款，投入大量资源用于研发能够改变整个游戏规则的流感疫苗，在国际上大力宣扬对人和动物滥用抗生素的害处，并且支持新型抗菌剂的研发。

这些预算的分配不仅仅关乎党派政治，更关乎一个国家的生死存亡。

本文作者Michael T. Osterholm是明尼苏达大学传染病研究与政策中心的主任、终身教授。著有《最致命的敌人：我们与杀人细菌的战争》（Deadliest Enemy: Our War Against Killer Germs）一书。（财富中文网）

译者：朴成奎

President Donald Trump’s new budget proposes drastically cutting resources in virtually all aspects of domestic and international public health preparedness and medical research. The proposed budget includes a $1.2 billion cut to the Centers for Disease Control and Prevention (CDC), a 17% reduction. Unfortunately, this comes at a time when infectious diseases are significantly more capable of wreaking international havoc.

While most lawmakers view the budget as “dead on arrival,” the detailed breakdown offers a window into the policies and priorities of the Trump administration as it prepares for what could be a contentious bipartisan debate. In a move to increase the U.S. defense budget by 10%, Trump has lost sight of the greatest national security threat of them all: a disease outbreak killing millions of people.

In Deadliest Enemy: Our War Against Killer Germs, a book I recently co-authored with Mark Olshaker, we laid out a crisis agenda of the most pressing challenges to national and global health security. Solutions to huge lurking regional threats such as Ebola, mosquito-borne illnesses like Zika, and bioterrorism from anthrax or a genetically engineered smallpox virus are only three, four, and five on our list.

The number one threat—a worldwide lethal influenza outbreak equal to or greater than the 1918–19 Spanish flu pandemic—would literally read like the outline for an apocalyptic horror film. And the H7N9 strain we chose for an imagined but scientifically plausible scenario in our book is currently percolating to the surface in Southeast Asia.

We remain woefully unprepared for next influenza pandemic. Our current vaccines are based on 1940s technology that leaves many unprotected even when vaccinated. Furthermore, our extremely limited global capacity to make an influenza vaccine means only a small percentage of the world’s population would have access to the vaccine in the first six to nine months of a pandemic.

Our number two threat—antimicrobial resistance—is a slow-moving tsunami that within decades could bring us back to the infectious Dark Ages, when a simple scrape could kill and untreatable tuberculosis was rampant. A recent comprehensive study on the future impact of antimicrobial resistance concluded that by 2050, more people worldwide will die from these resistant infections than from cancer and diabetes combined.

It is beyond foolish to neglect the danger of infectious diseases on human and animal health. The threat of a killer virus or bacteria wreaking havoc in the U.S. is far greater than any military or terrorist assault, including the explosion of an atom bomb. Instead of wasting their time and energy debating the specifics of the Trump administration’s proposed budget, American lawmakers should determine what to prioritize in the 2018 federal budget that can help the U.S. limit the deadly impact of emerging infectious diseases. This includes increasing, not cutting, the CDC and National Institutes of Health (NIH) allocations, putting serious resources into a game-changing influenza vaccine, and promoting an international effort to combat profligate antibiotic use in humans and animals and to support research and development for new antimicrobial agents.

The allocation of these funds is not just about partisan politics, but national security on the most existential level.

Michael T. Osterholm is Regents Professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is co-author of Deadliest Enemy: Our War Against Killer Germs.