对话 | 疫情下的联合国专家声音：从危机响应到城市韧性

 本期主题 | 城市韧性 (Urban Resilience)

本期嘉宾 | Mr S. Ananthakrishnan

新型冠状病毒现已在许多国家蔓延，感染了全世界数以万计的人。世卫组织最初将其名称暂定为2019-nCoV，后正式命名为COVID-19（Coronavirus Disease 2019），已在国际上被广泛应用。

世卫组织强调“必须不受出于种族、年龄、族裔或任何其他身份歧视地享有健康权，反歧视和平等要求各国逐步采取措施，纠正任何歧视性的法律、惯例或政策”。世卫组织宣布以COVID-19作为正式名称的同时，媒体报道称“因2019年12月以来暴发的病毒源于武汉市，已导致对中国人和其他东亚人种的偏见、仇外情绪和种族主义情绪的增加”。因此我们需要明白，命名的后果不仅与健康有关，还可能引发对某些人群或国家的偏见。

海外华人圈在社交媒体上发起的反歧视运动

（图片来自于网络）

世卫组织于2005年3月成立健康问题社会决定因素委员会（CSDH），以支持各国和全球卫生合作伙伴，助其解决导致疾病和健康不平等的社会因素。使国家易受传染病流行影响的主要社会因素包括贫困、文盲、性别不平等和快速城市化。减少对传染病的歧视和污名化，重点关注包括妇女和儿童在内的最弱势群体，具有至关重要的意义，更有助于最大限度地减少和预防包括埃博拉、寨卡、SARS和COVID-19在内的传染病的进一步传播。

Coronavirus has spread in many countries, infecting millions of people all over the world. The World Health Organisation (WHO) initially assigned it the temporary designation of 2019-nCoV, and now officially it is called COVID-19 (Coronavirus Disease 2019), which I think is being adopted internationally.

WHO emphasizes that “The right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity or any other status. Non-discrimination and equality requires states to take steps to redress any discriminatory law, practice or policy.” When COVID-19 has been declared by WHO, it has been reported in the media that “the outbreak of the virus in December 2019, which originated in the city of Wuhan has led to increased prejudice, xenophobia, and racism against Chinese and other people of East Asian descent”. So it is important to understand that the consequences are not only related to health, but also can trigger prejudice against certain people or countries.

A Commission on Social Determinants of Health (CSDH) was established by WHO in March 2005 to support countries and global health partners to help address the social factors leading to illness and health inequality. The major social determinants that make countries vulnerable to infectious disease epidemics include poverty, illiteracy, gender inequality, and rapid urbanization. Reducing discrimination and stigmatization with regard to the infectious diseases and focusing on the most vulnerable groups especially women and children are of crucial importance and can be instrumental in minimizing and preventing further spread of communicable diseases including Ebola, Zika, SARS and COVID-19.

国际公共卫生紧急事件（PHEIC）是世卫组织对“通过疾病的国际传播对其他国家构成公共卫生风险，以及可能需要采取协调一致的国际应对措施的不同寻常事件”的正式声明。世卫组织内一个由国际专家组成的紧急委员会（EC）依据《国际卫生条例（2005）》公布该声明，而此版条例是在2002/2003年SARS暴发后制定的。

国际公共卫生紧急事件的影响包括：1）在政府层面，各国卫生部长必须加强与世卫组织成员国之间的协调与合作；2）加强入境点的监测措施，提升公众意识；3）制定区域防备计划。

正如我们所知，世卫组织已向据信有较高病毒暴发风险的地区派遣专家，在病例管理、监测和早期检测等领域给予协助。通过向工作人员提供试剂、检测设备和培训，努力提高国家实验室病毒检测能力。与此同时，世卫组织还向各国提供了必要的个人防护设备。由于COVID-19全球感染人数已超9万人，唯有持续的国际合作行动才能有效遏制这一流行病继续蔓延。

A Public Health Emergency of International Concern (PHEIC) is a formal declaration by the WHO of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response". The declaration is publicized by an Emergency Committee (EC) of WHO made up of international experts operating under the International Health Regulations (IHR) 2005, which was developed following the SARS outbreak of 2002/2003.

The implications of the PHEIC are: a) at the governmental level, the health ministers of the countries will have to strengthen coordination and cooperation among WHO Member States, b) to enhance surveillance measures at points of entry, increase public awareness efforts, and c) to develop a regional preparedness plan.

As we know, WHO has dispatched experts to countries believed to be at higher risk of an outbreak of coronavirus to assist in areas including case management, surveillance and early detection. WHO is also working to increase the capacity of national laboratories to detect COVID-19 by supplying reagents, testing equipment and training for staff. Essential personal protective equipment has also been dispatched by WHO to various countries. As COVID-19 has affected over 90000 people globally, only sustained international efforts can check this pandemic. 

可持续发展目标（SDG） 3：“确保健康的生活方式，促进各年龄段人群的福祉”。在这一目标下，3.d提到要加强各国，特别是发展中国家早期预警、降低风险，以及管理国家和全球健康风险的能力。联合国可以协助和协调国际救援和治疗行动，并确保各国在病毒研究方面的合作，以找到疫苗和药物等治疗方法。

正如世卫组织总干事谭德塞所说，“中国正在采取‘强有力的措施’来阻止疫情的蔓延，而世界其他国家应努力防止疫情进一步扩散并加以控制”。恐惧和谣言可能比我们正在与之斗争的COVID-19更可怕，重要的是要聚焦有关病毒的事实及其对公众带来的风险。让公民参与和了解情况是及其重要的，联合国可以在国际上发挥关键作用。

The Sustainable Development Goals (SDG) 3: “Ensure healthy lives and promote wellbeing for all at all ages”. Under this goal, target 3.d mentions the strengthening of the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks. UN can assist in coordinating international relief and treatment efforts as well in securing cooperation among counties in research against virus to find cures such as vaccinations and medicines.

As the Director of WHO Tedros Adhanom Ghebreyesus recently said, “While China was taking ‘strong measures’ to stop the outbreak from spreading, the rest of the world should work on preventing a further spread and controlling it”. Fear and misinformation can be more harmful than COVID-19 that we are fighting against — it’s important to focus on the facts about the virus and the risk to the public. Engaging and informing the public is important and the UN can play a key role internationally. 

正如在任何人道主义危机中一样，应对公共卫生灾难应采取无缝衔接的方式，既要应对危机造成的当前形势，又要开始早日恢复进程。早期恢复是一种“通过增进协调，侧重于提升适应能力、重建或加强应对能力，从而致力于解决而不是加剧长期存在的问题的灾害应对办法”。例如，许多国家的卫生系统和公共卫生状况不佳，新的公共卫生危机还是会因此出现。

因此，我们必须制定一套具体的纲领性行动计划，例如为卫生部门人员提供培训，建全稳固现有卫生系统，并通过增进在恢复响应中发挥重要作用的社会团体参与来提升公众意识。简而言之，在应对当前危机的同时，我们还应在社区层面和卫生部门自身建立一个健全的系统，为预防未来危机的复发做好准备。

Just like in any humanitarian crisis, public health disasters should be addressed in a seamless manner by tackling the immediate situation arising out of the crisis as well by beginning the process of early recovery. Early Recovery is both an “approach to disaster response which, through enhanced coordination, focuses on strengthening resilience, re-building or strengthening capacity, and contributing to solving rather than exacerbating long standing problems”; for example health systems and public hygiene are in bad shape in many countries, and new public health crisis emerges also because of this.

Hence, we have to contribute to a set of specific programmatic actions, for example training the health sector personnel, make the health sector robust, as well as awareness raising among the public by engaging the communities that are important in every recovery response. In short, while we are addressing the crisis immediately, we should also prepare for preventing a relapse or an occurrence of future crisis by creating a robust system in the communities and the health system itself.

许多国家的卫生系统和经济将受到影响，并且我们看到它们已经受到了影响。随着新冠肺炎在50多个国家被确诊，经济学家正在逐步降低他们对全球经济增长值的预测。

据英国海外发展研究院（ODI）称，疫情对人口健康和人员流动的即时影响最直接体现在确诊的冠状病毒传播，以及航班取消和旅行禁令。新冠肺炎从一开始的传染病（epidemic）变为现在的全球流行病（pandemic），意味着它已经跨越了多国边界。鉴于流行病对所有个体和行业带来的巨大冲击，各国亟需以卫生部门为重点，开展紧急和大规模响应行动。全球各国，特别是卫生服务水平较低地区，需要实施一系列与卫生有关的政策和信息宣传运动，以遏制病毒的传播。长远看来，在欧洲和北美国家，预期的卫生人员短缺问题将不得不通过宽松的移民政策和提高工资来解决。

世卫组织指出，为了降低疫情影响，保护卫生相关人力资源，并确保疫情期间及后续卫生服务的连续性，我们需要更强大的卫生系统。为未受疫情影响的人群提供基本的人力及医疗资源具有同等重要的意义。如我们所见，所有的力量都投入到了紧急情况应对中，这往往导致对基本和常规卫生服务的忽视。具有讽刺意味的是，无法得到及时治疗的一些其他疾病的死亡率可能会因此上升。因此，城市医疗系统需要有效平衡急救护理和正常医疗服务供给。

各国还必须考虑由此引发的潜在经济影响和溢出效应。海外发展研究院（ODI）的脆弱性指数可以通过贸易、投资和人员流动等指标检测一个国家易受病毒侵害的程度。财政资源有限、卫生系统薄弱的国家弹性较差，也更容易受到冲击。强有力的城市经济和充足的卫生服务资金将是应对危机和复苏的必要条件。许多捐助国提供的紧急救济资金应用于解决疫情传播问题。我认为ODI也应更多地关注健康及疾病传播预防等因素。

As pointed out by WHO, in order to mitigate the impact of epidemics, protect the health workforce and ensure continuity of health services during and after them, stronger health systems are needed. It is also important to maintain staff, efforts, and medical supplies to others not affected by the crisis. As we have seen, all efforts shift to respond to the emergency. This often leads to the neglect of basic and regular essential health services. Ironically, mortality rates of other diseases for which people could not get treatment may rise. Hence a balanced approach to emergency care and normal health services in cities will be useful.

Countries must also examine the potential economic fall-out and spill-overs effects. ODI’s vulnerability index can examine a country’s direct exposure to the virus through trade, investment, and movement of people. Countries with constrained fiscal resources and weak health systems are less resilient and more vulnerable. Strong urban economy and funding of health services to look after the crisis and recovery will be necessary. Emergency relief funds that are provided by many donor counties should be channeled to address the spread of COVID-19. ODI should also focus more on health and prevention of the spread of Coronavirus.

城市在面对传染病方面，既有挑战，也有机遇。由于各种原因，城市化加速了传染病的出现和传播。新的传染病可能从不受城市环境影响的自然界（如鸟类）中产生，然后扩散到城市中心区，从而加快传播速度。由于城市人口密度大，这些来自野生动物的人畜共患病会迅速传播，禽流感和冠状病毒就是其中的例子。在较贫穷国家，许多大城市还有卫生条件低下的生活区，如贫民窟。居住在贫民窟的人们更容易感染疾病，因为那里生活环境拥挤，几乎没有洁净的水源和卫生设施。基于统计数据的研究表明，“传染病最容易出现在快速城市化的发展中国家，特别是印度、中国东部和非洲南部”。

与此同时，城市间的人口流动很容易使这些疾病“全球化”。如2000年代初香港暴发的非典疫情，不仅应归咎于人口密度，还因其拥有高人口流动性。因此，目前就COVID-19对旅客采取的限制措施是可以理解的。我们还需谨记，疾病及其传播方式的多样性和复杂性意味着“即使是准备最充分、基础设施最清洁的城市也有疫情暴发的风险”。

另一方面，城市也为同时向更多人快速提供卫生服务创造了可能性，如感染监测、检测、受感人群治疗以及疾病传播预防。公民参与的城市规划和持续监督可以成为改善城市人口健康和减少传染病负担的有力工具。由于集聚效应，规模经济将成为可能。研究结果表明，人口密度低的国家和城市在实现卫生服务等设施覆盖方面面临着更高的负担。它们需要更多的人均资源来实现可持续发展目标。如针对孕产妇保健或艾滋病护理，需要更多的资源投入来帮助居住分散的人群。高城市密度有其自身优势，因为在那里资源更容易共享。

There are challenges and opportunities when it comes to cities and infectious diseases. Urbanisation drives up the emergence and spreading of infectious diseases due to various reasons. New infectious diseases can emerge from nature, for example from birds, independent of the urban context and then will spill over to urban centres from where the spread becomes speedy. These zoonotic diseases from wildlife can spread quickly due to human population density in cities. Avian flu and coronavirus are among the examples. In poorer countries many of the large cities also have unhygienic living conditions such as in slums. People are more susceptible to diseases in slums with very little access to clean water and sanitation and crowded living conditions. Studies based on statistical data say that “the greatest risk of infectious disease emergence is in the rapidly urbanising developing nations, in particular India, eastern China and southern Africa.” 

Of course, traveling from one city to another can easily “globalize” such diseases. An example is the SARS outbreak in Hong Kong in the early 2000s was blamed not only on density but also on the high rate of people traveling into and out of the city. Hence the measures put in place for travellers in connection with COVID-19 is quite understandable. We should also keep in mind that the variety and complex nature of diseases and methods of transmission “mean that even the best prepared city with the cleanest infrastructure can still be vulnerable to outbreaks”.

On the other hand, cities also offer possibilities for quick delivery of health services to many people at the same time, detection of infections, monitoring and treating of affected people, and prevention of the spread of the diseases. City planning with the engagement of the population, and continuous monitoring can be powerful tools to improve the health of the urban populations as well as decrease the burden of communicable diseases. Economy of scale will be possible due to agglomeration. Research findings indicate that countries and cities with low population densities face higher burdens to achieve coverage of facilities like health services. They also require more resources per capita to achieve the SDG targets. For example, maternal health or HIV care, more resources will be required in reaching people living apart or in a less dense manner. Urban density can be good because resources are more easily shared.

良好的城市治理可以使城市人口在国家和全球各级政策的制定和执行方面发挥更大的作用。自上而下的管理方式，即公民被视为治疗或严厉措施（但旨在防止疾病的传播）的被动接受者，将使人们产生抵触情绪，即使它的出发点是善意的。开放的环境与参与式氛围将有助于提升居民接纳度，从而减少恐慌。专家指出，在感染COVID-19的人群中，冠状病毒引起的呼吸系统疾病发生率较低。然而，仍有必要为最坏的情况做好准备，需要提高城市人口对该病的认知，并鼓励宣传勤洗手等简单而实用的措施。

在塞拉利昂——一个卫生系统薄弱的国家，一项社区层面以社会动员和社区参与为导向的实用应对策略，在病例检测和抑制埃博拉传播方面发挥了有效作用。2014-2015年间由中国资助开展的一项研究详细描述了该案例。

试点社区埃博拉感染病例检测、调查和管理的实操流程图

（详情可见：

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974705/）

There needs to be an emphasis on good urban governance through which urban populations can play a greater role in the formulation and implementation of policies at the national and global levels. A top down approach where by citizens are treated as passive recipients of cures or measures considered as harsh, intended to prevent the spread of diseases will make people resist even well intended measures. Openness and engagement of the community will create acceptance. There is no need to panic. It is pointed out by experts that of contracting COVID-19, the respiratory illness caused by the coronavirus remains low. However, there is a need for being prepared for the worst case scenario and hence the raising the awareness of the urban populations about the disease as well about simple and practical measures like washing one’s hands as often as possible.

In Sierra Leone, the community-based strategy of social mobilization and community engagement was effective in case detection and reducing the extent of Ebola transmission in a country with weak health system. This is described in a study funded by China, a practical community-based response strategy to interrupt Ebola transmission in Sierra Leone, the study was conducted during 2014–2015. (Please found details: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974705/)

到目前为止所采取的遏制病毒蔓延的措施是令人印象深刻的——从我所了解到的情况来看，武汉和整个省份被封锁，与疫情区有接触的人员得到隔离，政府动员人们参与抗疫等方式非常值得称赞。我不确定它是否可以在其他国家复制，但从中吸取的教训相当有用。城市中涌现的志愿者工作同样值得称道，让世界了解到如何积极动员社区和城市居民参与到抗疫工作中。如果疫情不再持续扩散到武汉以外地区，这本身就是一个重要标志，将给人以乐观和积极恢复的信心。

The measures taken so far to halt the virus epidemic are very impressive and amazed – from what I gather, the way how Wuhan and the whole province has been immediately quarantined as well as the way people are mobilized treated are indeed very praiseworthy.  I am not sure if it can be replicated in other counties, but the lessons learned can be very useful. The commendable volunteering work happening in the cities in China is also to be noted. It would be important for the world to know how the communities and city dwellers are being actively engaged in addressing this situation. If there is no further spread of the infection beyond Wuhan, it will be an indicator itself and gives room of optimism and recovery. 

地方当局和医学界必须解决可能存在于社区中的怀疑、不信任和犬儒主义。卫生系统不应被视为一种“控制和惩罚”的工具。基于医疗从业人员和权威人士在人们心目中长期树立的形象，赢得病人的信任将会是一个非常困难的任务。但是，医学教育系统、医院和医生自身可以采取措施来解决恐惧和不信任等问题。即使是在隔离的情况下，或者发生入侵行为时，也需要强有力的证据来证明所提出的方案能够达到预期目的的可能性。在没有具体证据的情况下，应根据合理的实质性论据作出决定，并尽可能从类似的情况中获得证据支撑。任何限制行为都必须以科学证据为基础，而不是以武断、不合理或歧视性的方式强加于民众。具体做法可参见世卫组织关于《传染病暴发中伦理问题的管理指南（2016）》。我们是在与人打交道，而不是机器，所以这是一个关于公众与医疗卫生系统建立有效沟通的问题，当局必须与民众密切合作，以防止疾病的传播。

The local authorities and the medical community must address the real sense of suspicion, distrust, and cynicism that are probably embedded in the community. The health system should not be seen as a “control and punish” instrument. That’s why earning a patient’s trust is a very difficult task given the fact that how the medical practitioners and authorities  are perceived . But medical education systems, hospitals, and physicians themselves can take steps to address this issue of fear and distrust. Even in a situation of quarantine, or an intrusive action, there is greater need for robust evidence for what is being proposed is likely to achieve its desired aim. When specific evidence is not available, decisions should be based on reasoned, substantive arguments and informed by evidence from analogous situations, to the extent possible. Any restrictions must be based on scientific evidence and not imposed in an arbitrary, unreasonable, or discriminatory manner. In this context, one can mention, WHO’s Guidance for Managing Ethical Issues in Infectious Disease Outbreaks (2016). We are dealing with people, not machines, so it’s a question of people being able to communicate with medical and health systems, and the authorities must work closely with people to prevent the spread of the disease.

我认为读者可以对不同国家如何应对这类疾病有一个比较性的理解。如贵校的学生可以接触到世界各地不同的学生群体，因此可以在交流实践案例、经验和想法的过程中进一步增进社群之间的沟通。我们应该利用社交媒介互通信息，了解各国面对疫情已采取了哪些步骤，哪些是有用的，以及如何进一步推进这些措施。创建一个由学生和年轻人组成的国际虚拟网络，为他们交流成功经验、良好范例以及困难挑战提供平台，以此在抗击疫情方面建立全球团结。

长远来看，我们应该以新冠肺炎疫情为鉴，在流行病应对措施及预防方面开展广泛的国际研究。从性别、年龄、社会地位等不同维度看待此议题也至关重要，疾病如何影响人，某些人群（老年人、妇女）是否更易感，原因为何？基于此，我们应该研究对待特定人群的特殊方法，并把它作为我们学习、研究、理解、分析和互相交流的重点。

My immediate recommendation will be for the audience to have a comparative understanding of how disease like this has been tackled in different countries. Like students in your university can be able to reach out for different student communities across the world, so that there could be a better communication among communities in exchanging practices, experience and ideas.  We should use electronic media to communicate with each other, to find out what steps have been taken and what are useful, and how it can be done further. Creating an international virtual network of students and young people to exchange success stories and good examples as well as about the difficulties can build global solidarity in fighting this pandemic.

In the longer run, I would feel that we should think of doing international research to find out lessons learned from this disease and how the world can address and prevent such epidemics in the future. It will also be important to look from the gender, age and social status dimensions, how the disease affects people, is certain population (elderly people, woman) more vulnerable in facing the disease, and why so? Therefore, we should look into the specificity of how we can fix certain population. And this is what I think we should be able to study, research, understand, at the same time analyse and inform each other.

We should have optimistic approach to fight the disease and we can end well with optimism just like what we have done with other diseases in the past.

-End-

• 对话 | 疫情下的国际专家声音：健康城市源于健康社区 

• 对话 | 疫情下的环境科学专家在行动：模型预测与科学辟谣 

  
  

  
  

西交利物浦城市与环境校级研究中心

XJTLU-Urban and Environmental Studies 

University Research Centre

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