But the most influential Eastern European signatory was the First Lady of Georgia, a country whose estimated 2,700 HIV-infected people account for just 0.018% of the regional total.	但东欧签名者中影响力最大的要数格鲁吉亚第一夫人，而该国的爱滋病感染者数量（2700名）仅占整个地区的0. 018%。


Judging by their governments’ indifference, the remaining 99.982% of the HIV-infected people in Eastern Europe – and all those they place at risk of harm – can just rot.	有鉴于各国政府的不作为，剩下的那99. 982%东欧感染者——以及所有那些可能被他们危害的人——都只好自生自灭了。


Eastern Europe’s Tito Option	东欧的铁托选择


LONDON – Success stories in what the European Union calls “the neighborhood” have been hard to come by. First Georgia, then Ukraine, and most recently Moldova have all been big EU hopes.	伦敦——


That summit comes at an auspicious time, as the EU reviews its European Neighborhood Policy (launched in 2004) and the Eastern Partnership (launched in 2009), ahead of a second grand summit in Budapest under the Hungarian EU presidency in May 2011.	在欧盟称为“邻国”的国家中，成功的故事十分鲜见。 开始是格鲁吉亚，后来是乌克兰，还有最近的摩尔多瓦，这些国家欧盟都寄予厚望。


But France has dragged its feet on easing visa requirements for Ukrainians, and EU negotiators are frustrated with the total lack of progress towards a Deep Free Trade Agreement, which they blame, rightly, on the Ukrainian “oligarchs” who have returned to power since Viktor Yanukovych became President in February.	但每次都以失望告终。 对欧盟来说不幸的是，今年与乌克兰的年度峰会（11月22日）很可能展示这种失败。


One problem has long been the lack of enthusiasm on the EU side for further expansion into the region.	这一峰会来的正是时候，欧盟正在回顾其《欧洲邻国政策》（2004年启动）和《东方伙伴》（2009年启动），2011年5月匈牙利轮值欧盟后将举行第二次大型峰会。


More recently, the EU has also had to face the reality of competing with Russia in what President Dmitri Medvedev calls Russia’s “sphere of privileged interests.” Increasingly, however, the problem is with Eastern Europe’s states themselves.	但法国在放松乌克兰签证要求方面磨磨蹭蹭，欧盟谈判者对于达成《深度自由贸易协定》毫无进展十分沮丧，他们将其归咎于维克托·亚努科维奇2月当选总统使得乌克兰回到了“寡头政权”时代。


First, these are new states whose sovereignty was often contested at their birth in 1991, and that have remained weak.	欧盟对这一地区缺乏进一步扩张的热情，这一直是一个问题。


Their independence was a result of the USSR’s collapse, and, while some had national revolutions, in most Soviet elites and political culture remained entrenched.	最近，欧盟还需要面对现实，在俄罗斯总统德米特里·梅德韦杰夫所谓的俄“特殊利益范围”内与其竞争。


Corruption is rife, state capture by powerful vested interests is the norm, and institutional effectiveness and capacity for reform are weak.	但东欧问题不断涌现。


Second, they have the economies of weak states.	首先，这些国家都是新生国家，其主权自1991年诞生以来就陷入争夺，并且一直孱弱。


With the crucial exception of energy-rich Azerbaijan, they have few natural resources or high-value manufactures, and have large agricultural sectors.	它们的独立源于苏联的解体，并且虽然一些国家发生了革命，大多数前苏联地区社会精英和政治文化仍然根深蒂固。


They also depend on economic rents or Russian derivatives rather than adding value themselves – Ukraine makes profits from gas transit, Belarus from oil refining.	腐败横行，强大的既得利益者把持国家，改革的机构效率和能力十分虚弱。


Many sell raw materials or base products – Ukrainian steel, for example – where export competitiveness depends less on product quality than on global commodity prices.	第二，它们拥有弱国的经济。 除了富有能源的阿塞拜疆，它们没有自然资源和高价值制造业，但拥有庞大的农业部门。


The two economies in the region that appear most successful – Belarus and Azerbaijan – are the furthest from the EU model. Their good fortune is not due to their domestic policies, but to hydrocarbons in Azerbaijan’s case and, in Belarus, to Russian subsidies.	它们还依赖经济租金或俄罗斯金融衍生品，却不提升自身价值——乌克兰以倒卖石油赚钱，白俄罗斯以精炼石油赚钱。


The emulation effect that spurred Central European reform in the 1990’s is not working farther east.	许多国家销售原材料或基本产品——例如乌克兰钢铁——所以出口竞争力依赖于全球商品价格而非产品质量。


Unlike the EU accession candidates of the 1990’s, the states of Eastern Europe and the Caucasus have little incentive or capacity to adopt the Union’s body of law, the acquis communautaire, and move up the value chain.	这一地区看起来最成功的两个经济体——白俄罗斯和阿塞拜疆——与欧盟模式大相径庭。 它们的好运不是因为国内政策，阿塞拜疆是由于碳氢化合物，白俄罗斯是由于俄罗斯补助金。


Third, although they would no doubt protest loudly at such a description, states like Ukraine are better thought of as balancers rather than joiners.	第三，虽然乌克兰一类的国家无疑会对这种说法大声抗议，但它们更适合作为平衡器而非参与者。


Playing a game of balance between Russia and the West allows the elite to remain in power, and to preserve the oligarchical economy in an otherwise harmful equilibrium of semi-reform.	在俄罗斯和西方之间玩平衡游戏，使得精英能保有权利，维持寡头经济，而非进入有害的半改革平衡状态。


Indeed, local leaders are modern-day Titos, unable or unwilling to join either Europe or Russia.	确实，当地领导人就像现代的铁托，不能或不想加入欧洲或俄罗斯。


But both Russia and the West are sufficiently interested that they feed the game of balance with enough resources to enable local leaders to fend off rivals and excuse their own lack of reform.	但俄罗斯和西方都对其十分感兴趣，它们在平衡游戏上投入许多资源，足够让当地领导人击败对手，并且找到不进行改革的借口


Some are reluctant balancers.	有些国家不愿意当平衡器。


Moldova’s current government, the Alliance for European Integration, might be a lot more pro-European if it had not seen how Russia treated supposedly pro-Western governments in Georgia and Ukraine before it.	摩尔多瓦的现任政府，欧洲一体化联盟若不是见证了俄罗斯之前如何对待所谓亲西方的格鲁吉亚和乌克兰政府的话，将更加亲近欧洲。


Some play the game with relish – ironically, Belarus’s President Aleksander Lukashenka is suddenly something of a regional role model in this regard.	一些国家却狂热地扮演着这个角色——讽刺的是，白俄罗斯总统亚历山大·卢卡申科在这方面突然成为了地区性的楷模。


The increasing role of other powers in the region – Iran and Turkey, but China above all – gives local leaders even more wriggle room, particularly because, as Lukashenka said in characteristically unguarded fashion during a visit to Beijing, “China’s investment has never had any political strings attached.”	其他势力在这一地区影响渐盛——伊朗和土耳其，但最多的还是中国——使得当地领导人有了更多的转圜空间，特别是因为，就像卢卡申科在访问北京时口无遮拦地说，“中国的投资从未附加任何政治条件。 ”


Fourth, elements of the “Beijing Consensus” are increasingly entering the region by the back door.	第四，“北京共识”的元素不断从后门进入这一地区。


As Yanukovych’s Ukraine rolls back democratic reforms, Foreign Minister Kostiantyn Gryshchenko says that Ukraine should “use all that is best from China’s experience,” particularly “the ability to think and act strategically” – which is, of course, easier in countries where the government faces no opposition.	当亚努科维奇的乌克兰政府取消民主改革时，外交部长康斯坦丁·格里先科说乌克兰应该“吸取中国经验的精华”，特别是“策略性思考和行动的能力”——当然这在政府毫无反对的国家更加容易。


The EU can continue muddle along with its one-size-fits-all policy of “enlargement-lite” in the region.	欧盟可以继续用其一体适用的“扩张之石”政策在该地区搅混水。


Or it can work harder to turn balancers into joiners.	或者它可以更加努力，让平衡器变成参与者。


There are genuine prospects for changing the incentive structure in small states like Moldova, particularly if the EU can help build up long-term institutional capacities.	在如摩尔多瓦一类的小国，确实有希望改变刺激结构，特别是在欧盟可以帮助建立长期制度能力的情况下。


But, elsewhere in the region, the Union should recognize the reality of each individual game of balance, and work within the limits of what is possible in order to promote EU interests.	但在这一地区的其他国家，欧盟应该认识到每一个独立的平衡游戏的现实，并在可能的限度内推动欧盟的利益。


First, the EU should work to Finlandize Ukraine, whose foreign policy, like Tito’s, is now officially “non-aligned.”	首先，欧盟应该努力让乌克兰“芬兰化”，乌克兰的外交政策和铁托一样，官方说法是“不结盟”。


NATO expansion is off the table.	北约扩张不用再谈。


Yanukovych has leaned towards Russia in the short term, but has already reached the point that he needs other powers to balance Russia.	亚努科维奇在短期内已经向俄罗斯倾斜，但也已经达到了需要其他势力来平衡俄罗斯的程度。


The EU can accept Ukraine’s foreign-policy constraints, while concentrating on helping it transform its economic and social structures, and preserving its democracy.	欧盟可以接受乌克兰的外交政策限制，而集中帮助它改造经济和社会结构，并维护其民主。


A second strategy is to Serbianize Georgia.	第二条策略是“塞尔维亚化”格鲁吉亚。


Like Serbia and Kosovo, Georgia should be encouraged, if not to forget about its rebel provinces, then to abandon the kind of manifest-destiny politics that subordinates everything to the recovery of sacred lands, leaving the country free to concentrate on internal reform.	与塞尔维亚和科索沃一样，如果没有忘记格鲁吉亚叛乱的省份，应该鼓励格鲁吉亚放弃那种上天注定，一切为恢复圣地服务的政治，让国家自己集中精力进行内部改革。


Finally, the EU should work to Francoize Belarus.	最后，欧盟应该努力“弗朗哥化”白俄罗斯。


Like Spain in the dictator’s final years, a political opening is unlikely.	像独裁末期的西班牙，政治开放不太可能。


But the Belarusian economic model cannot survive, with the trade deficit forecast to exceed $7 billion (14% of GDP) this year.	但白俄罗斯的经济模式不可能维持，今年其贸易赤字预期超过70亿美元（14%的GDP）。


Belarus cannot borrow enough to cover this.	白俄罗斯如何借贷都无法解决这个问题。


As with Spain under Franco, Belarus’s economy will change before Lukashenka does, laying the basis for rapid development once he is gone.	就像在弗朗哥治下的西班牙，白俄罗斯的经济在卢卡申科做出改变前就会改变，为他离开后的快速发展打下基础。


East Timor’s Example	东帝汶的范例


MANILA -- East Timor, now known as Timor-Leste, is the world’s newest democracy.	东帝汶，现在更名为东帝汶民主共和国（Timor-Leste），是世界上最年轻的民主国家。


It may have a population of less than one million, but it has a proud, heroic history and a rich culture built up over centuries of diverse ethnic and colonial influences.	虽然它的人口不到一百万，但却拥有着令人自豪的、英勇的历史和数个世纪以来在多种族和殖民主义影响下的丰富文化积淀。


The island attracted Chinese and Malay traders in the fifteenth century.	这个岛屿在15世纪时就吸引了中国和马来的商旅。


The Portuguese arrived not long after, and stayed 400 years.	不久以后葡萄牙人到来并一待就是400年。


Now it is attracting attention as an example of United Nations-led nation-building.	现今它正作为联合国主导下的国家建设样本而令世人瞩目。


The UN Integrated Mission in Timor-Leste (UNMIT), headed by Atul Khare, consists of a civilian staff of 1,568, of which 334 are volunteers, and a police commissioner, Rodolfo Tor, with 1,623 police personnel from 39 countries.	由Atul Khare领导的联合国东帝汶综合特派团（UNMIT）包括1568名文职成员（其中有334名志愿者）、一位警察专员Rodolfo Tor和来自39个国家的1623名警务人员。


UNMIT’s main job is a difficult one: bringing about national reconciliation.	UNMIT有一项艰巨的重任：实现民族和解。


While peaceful parliamentary elections were held on June 30, an atmosphere of apprehension has prevailed ever since.	虽然在6月30日已经进行了和平的议会选举，但一种令人后怕的气氛却自此挥之不去。


Neither the former ruling party, Fretilin, nor the newly formed CNRT, led by Xanana Gusmão, the hero of the resistance to Indonesia’s occupation, won an outright majority.	前执政党Fretilin和由抵抗印尼占领的英雄Xanana Gusmão领导的新组建的CNRT 都没有获得压倒性多数。


At first, the UN, like many Timorese, including José Ramos-Horta, the country’s Nobel Laureate president who won election last May, had hoped that a national unity government could be formed.	起初，联合国与许多东帝汶人（包括在去年5月大选中获胜的该国总统、诺贝尔奖得主José Ramos-Horta）一样都希望能够组成一个民族团结政府。


But a month-long attempt to broker an inclusive government failed.	但为期一个月的努力却以失败告终。


So, in August, Ramos-Horta ended the deadlock by swearing in Gusmão, a long-term political ally and former president, as prime minister.	因此在8月份，Ramos-Horta通过任命其长期政治盟友、前总统Gusmão为总理从而结束了这一僵局。


Gusmão had forged a coalition with three other centre-left parties.	Gusmão与其他三个中—左派政党结成了联盟。


Together they won a narrow 51% majority of the popular vote, giving them 37 of the 65 seats in parliament.	他们共同以51%的多数票险胜，赢得了65个议会席位中的37个。


Gusmão’s main rival, Mari Alkatiri, Fretilin’s leader and a former prime minister, denounced Ramos-Horta’s decision.	Gusmão的主要竞争对手，Fretilin的党魁、一位前部长Mari Alkatiri谴责了Ramos-Horta的决定。


Fretilin, he said, would not cooperate with an “illegal and unconstitutional” government.	他说Fretilin不会与一个“非法和反宪法”的政府合作。


The constitution is open to interpretation, and he argues that Fretilin, which won the largest share of the vote (29%), should have been asked first to form a government – even a minority one.	对宪法的解释没有定论。 他认为作为赢得最多票数的独立政党（29%），Fretilin应该首先被要求组建政府—即使是一个少数派政府。


Fretilin at first sought to fight the decision through non-violent means.	Fretilin起初试图以非暴力方式反击这一决定。


But some of its supporters began venting their anger on the streets.	但它的一些支持者却开始走上街头泄愤。


Groups of angry marauding young men armed with stones and slingshots ran amok, setting up roadblocks and torching buildings.	成群的年轻人怒气冲冲、四处劫掠，他们手持石块和弹弓，设置路障并焚烧房屋。


But this did not last long, thanks to both the UN and the democratic processes it is helping to nurture.	但由于有了联合国及其培育的民主进程，这种情况并未持续很长时间。


Of course, Timor Leste has been in something of a political limbo since last year, when clashes between rival factions in the security forces led to a brief breakdown of law and order.	当然，自从去年以来，东帝汶就处于政局不稳的状态。 安全部队的对立派别之间发生冲突导致该国进入短暂的法律与秩序崩溃状态。


But with security now mainly in the hands of UN police and Australian and New Zealand peacekeepers, the political process is being given a chance to work itself out.	但随着联合国警察和澳大利亚及新西兰的维和部队接管安全事务，该国的政治进程又重现生机。


Gusmão will now need to prove himself at the head of an inexperienced government.	Gusmão需要在一个缺乏经验的政府面前证明自己的能力。


One big test will be whether the estimated 100,000 displaced people, amounting to 10% of the population, many living in tent camps, feel safe enough to return home.	一个巨大的考验将会是看占总人口10%的、大多居住在帐篷里的10万流离失所的人是否有足够的安全感重回家园。


If Fretilin persists in its decision to obstruct the government, instability will persist.	如果Fretilin坚持其妨碍政府的决策，那么不稳定的状态仍将持续。


This is where the Association of Southeast Asian Nations (ASEAN) can help.	而这正是东盟(ASEAN)可以介入的时机。


At the top of the agenda at ASEAN’s Leaders Summit in Singapore this month is the adoption of a Charter to embody its “One Vision, One identity, One Community” concept for Southeast Asia.	这个月在新加坡举行的东盟领导人峰会的首要议题是通过一部《宪章》来体现东南亚“同一愿景、同一身份、同一社会”的理念。


Timor-Leste is still only an observer in the ASEAN family, but it appears able to grasp – far better than Myanmar, an ASEAN member state – the need for a rules-based ASEAN that stands for democratic governance even in the most difficult of circumstances.	虽然东帝汶只是东盟大家庭的观察员国，但它似乎远比缅甸—这个东盟的成员国—更能领会对一个基于规则的东盟的需要。 这样的东盟即使在最困难的情况下也会坚持民主治理。


Indeed, the Timorese people have consistently shown that what they want from their government is openness, dialogue, and majority voting under the rule of law.	的确，东帝汶人民已经矢志不渝地表明他们需要从政府那里获得公开、对话和法制下的多数票选。


Myanmar’s people want the same, but their country is being pushed towards collapse by years of political and economic crisis, and might well become ASEAN’s pariah, like Africa’s Zimbabwe.	缅甸人民同样需要这些，但他们的国家正被多年的政治与经济危机推向崩溃的边缘，并很可能成为东盟的弃儿，就如同非洲的津巴布韦。


That should stand as a warning to Timor Leste’s clashing factions, lest any of them conclude that repression and dictatorship are the best solution.	这对于东帝汶的各冲突派别应该是一记警钟，除非他们认为镇压和独裁是最佳的解决方案。


Dying to Live	向死而生


FREETOWN, SIERRA LEONE – I was a young medical officer working at the Emergency Unit of the Ola During Children’s Hospital in Sierra Leone when I advised the mother of a child with severe malaria to tell a blatant lie.	弗里敦，塞拉利昂—我曾经是塞拉利昂奥拉都灵儿童医院（Ola During Children’s Hospital）急诊中心的一位年轻卫生官员，在此期间，我曾经建议一位重症疟疾患儿的母亲撒一个弥天大谎。


Her daughter Mariama needed a life-saving blood transfusion.	她的女儿玛利亚玛（Mariama）需要输血救命。


But her mother had no money to pay for the screening tests and to compensate the blood donor.	但她母亲没钱给她做筛查和补偿献血者。


I had seen many children die while their parents frantically sought the necessary funds.	我目睹许多儿童在父母亲发疯似地筹集必要的资金时死去。


Determined to save Mariama’s life, I told her mother to go home and announce the death of her daughter.	我决心拯救玛利亚玛的生命，我让她母亲回去宣布女儿已死。


I knew this would provoke the sympathy of her relatives, and they would scrape together their meager resources to ensure a proper funeral.	我知道这将激发她的亲戚的同情，他们会从不多的储蓄中凑出一笔钱来保证一个体面的葬礼。


The mother agreed, and when she returned six hours later, she threw enough money on the table to cover all of Mariama’s care: a blood transfusion and treatment for malaria and worm infestation.	母亲同意了，六小时后她回到医院，拿来了足够完成玛利亚玛疗程的钱：输血并治疗疟疾和寄生虫感染。


A few days later, I discharged the still weak but recovering four-year-old from the hospital.	几天后，我让这位尽管仍然十分虚弱但已开始恢复的四岁儿童出院了。


Though Mariama’s illness did not move her relatives to action, her death did.	玛利亚玛的病情没有让她的亲戚们采取行动，她的死让他们采取了行动。


The same thing happened, on a much larger scale, during the Ebola epidemic in West Africa.	同样的事情在西非埃博拉疫情爆发期间以更大的规模再次发生。


It is believed that the epidemic first took hold in the forested regions of Guinea in December 2013, then gradually spread into Sierra Leone and Liberia.	据信，埃博拉爆发最开始是是在2013年12月的几内亚森林地区，然后逐渐传播到塞拉利昂和利比里亚。


The international community watched as the disease ravaged the three countries, decimating villages, wiping out entire families, and bringing economies to a standstill.	国际社会眼睁睁看着埃博拉席卷三国，摧毁村庄，无数家庭灭门，经济陷入停顿。


But, at the start, it attracted little attention.	但是，一开始，埃博拉并没有吸引多少关注。


The international community was content to ignore the truth, until the epidemic had become so widespread that they no longer could.	国际社会心安理得地忽视真相，直到疫情达到他们无法再视而不见的地步。


By then, however, it was too late to avert a major catastrophe.	但是，那时已经无法阻止一场大灾难了。


We are still learning the full extent of the Ebola disaster in West Africa.	我们仍在领教西非埃博拉疫情的厉害。


For fear of catching the disease, schools were closed, with students and teachers staying at home.	由于害怕得病，学校关门大吉，学生和教师只能呆在家中。


Indeed, many workers stayed home as well, causing restaurants, bars, and hotels to cease functioning and the economy to grind to a halt.	事实上，许多工人也只能呆在家中，导致餐厅、酒吧和饭店停业，经济陷入停滞。


Half of all private-sector jobs were lost.	私人部门就业岗位减少了一半。


Farmers’ self-isolation led to a 30% drop in agricultural output.	农民的自我孤立导致农作物减产30%。


People’s social lives stalled as well.	人们的社交生活也陷入了停顿。


A curfew was imposed in many districts, and long-distance travel was discouraged.	许多地区实施了宵禁，长途旅行成为众矢之的。


In several towns, accepting a visitor into your home meant the risk of a heavy fine.	在一些城镇，收留访客可能遭到重罚。


Nonetheless, the disease spread into urban areas and, like a wildfire, engulfed the three countries and spilled into others.	尽管如此，埃博拉仍然蔓延到城市地区，并且如野火般吞噬了三国并进入其他国家。


To date, more than 8,500 infections and 3,500 deaths have been reported just in Sierra Leone.	到目前为止，光是塞拉利昂便报告了8,500多例感染和3,500例死亡。


The health sector has perhaps been the hardest hit.	卫生部门也许是受打击最大的地方。


The death of more than 220 health-care workers left only 3.4 skilled health personnel for every 10,000 citizens.	220多名医护人员死亡意味着每10,000公民只有3. 4名熟练医护人员为他们服务。


As fear of Ebola mounted, many citizens stopped using health services, reflected in a 23% drop in births in hospitals or clinics, a 21% drop in children receiving basic immunization, and a 39% drop in children treated for malaria.	随着埃博拉恐慌的升级，许多公民不再就医，这反映在医院和诊所出生儿童人数下降23%、接受基础免疫儿童人数下降21%、疟疾就诊儿童人数下降39%。


As a result, these countries experienced a resurgence in vaccine-preventable diseases, malaria, maternal and child deaths, and acute malnutrition.	结果，这些国家开始出现疫苗可防疾病、疟疾、母婴死亡和急性营养不良重新抬头。


In this sense, the worst may be yet to come.	从这个角度讲，最坏的时候还没有到来。


But Sierra Leone is picking up the pieces, and has embarked on a two-year recovery plan.	但塞拉利昂正在重新站起来，实施了一个两年恢复计划。


The first priority is to get the number of Ebola cases to zero and keep it there.	第一个重点是将埃博拉病例减到零并永远保持。


This means changing the conditions that allowed it to spread so rapidly in the first place.	这意味着改变让一开始让埃博拉得以如此迅速地蔓延的环境。


The first step is to rebuild the health-care system.	第一步是重建卫生体系。


The plan demands the restoration of health-care services in 40 hospitals and 1,300 primary health-care facilities across the country, so that children and mothers can receive free essential care, vaccinations, and treatment for diseases like tuberculosis, HIV/AIDS, and malaria.	这一计划要求重建全国40家医院和1,300家初级医疗机构的医疗服务，以使儿童和母亲能够获得免费的基本医疗、疫苗和结核病、艾滋病和疟疾等疾病的治疗。


Moreover, in order to bolster safety – and restore confidence – in the health-care system, the plan calls for better infection-control practices and training for a new cadre of skilled workers.	此外，为了加强卫生体系的安全——以及重塑信心——该计划呼吁采取更好的传染病控制实践、训练新一代熟练工人骨干。


And it includes closer cooperation with community groups, which should be engaged in disease surveillance and response.	它还包括加强与社会组织间的合作，社会组织应该参与疾病防控和响应。


The post-Ebola recovery will not be quick, easy, or cheap.	后埃博拉时期的恢复绝不可能是迅速、容易、便宜的。


In Sierra Leone alone, it is expected to cost $1.3 billion – $896.2 million of which has yet to be procured.	光是在塞拉利昂，据估计就要耗费13亿美元——其中8亿9,620万美元仍是缺口状态。


To close that gap, we need help from our African partners and the broader international community.	要弥补这一缺口，我们需要来自我们的非洲伙伴和更广大的国际社会的帮助。


Many years ago, without the help of a lie, Mariama would have died.	多年前，要不是一个谎言，玛利亚玛已经死了。


Today, we do not need lies.	如今，我们不需要撒谎。


We need genuine engagement, open communication, and mutual accountability, at the local, national, regional, and global levels.	我们需要真正的参与、开放的沟通和互相问责——在地方、国家、地区和全球层面都是如此。


We have already seen how a lack of essential health-care services can devastate a country, taking thousands of lives and shattering many more.	我们已经看到，缺乏基本卫生服务如何毁掉一个国家、夺走成千上万人生命并摧毁跟多人的生活。


We came together as a country to beat Ebola, and we are committed to prevent future epidemics.	我们全国上下众志成城击败了埃博拉，我们决心预防未来传染病。


With ongoing international support, we will do just that.	只要有不断的国际支持，我们就能做到。


Ebola and Innovation	埃博拉与创新


BOSTON – Lives are not all that have been lost in the ongoing Ebola crisis.	波士顿—在仍在肆虐的埃博拉危机中，损失的不仅仅是生命。


In recent discussions about how to combat the virus, the methodical rigor of science and medicine has given way to hyperbolic politics and public hysteria.	在关于如何对抗这一病毒的最新讨论中，科学和医学的系统严密性不敌夸张的政治和公共歇斯底里。


To be sure, informed, data-driven public policy to manage the current outbreak must remain a top priority.	诚然，用了解情况、数据驱动的公共政策管理当前的大爆发仍必须成为最高优先项。


But it is equally important to take stock of the epidemic’s lessons and to ensure that we are prepared for the emergence of other diseases.	但同样重要的是评估这场传染病的教训并确保我们做好准备抗击其他疾病的出现。


Two major lessons should be learned from the current Ebola outbreak.	我们必须从最近的埃博拉大爆发中汲取两大教训。


First, the fight against a single disease must not come at the expense of strengthening an entire health-care system.	首先，与一种疾病的斗争绝不能以牺牲整体医疗体系的强度为代价。


Countries with fragile health systems may be able to tackle a given ailment with the help of NGOs and foreign governments, but they are likely to be dangerously unprepared when confronted with unexpected outbreaks of new diseases.	医疗体系分散的国家也许可以在非政府组织和外国政府的帮助下处理某些小病，但当面临意料之外的新疾病的爆发时，可能出现非常危险的毫无准备的情况。


In Liberia, for example, the prevalence of malaria in children under the age of five declined from 66% in 2005 to below 32% in 2011.	比如，在利比里亚，五岁以下儿童疟疾患病率从2005年的66%下降到了2011年的32%以下。


Nonetheless, when the Ebola virus entered Liberia from neighboring Guinea earlier this year, the country’s health-care infrastructure was quickly overwhelmed.	尽管如此，当今年早些时候埃博拉病毒从相邻的几内亚进入利比里亚时，该国的卫生基础设施马上就被摧毁。


More than 2,000 Liberians have died of the disease, and the virus remains rampant.	2,000多利比里亚人因埃博拉丧生，并且埃博拉至今仍在肆虐。


Similarly, unless they strengthen the health-care system as a whole, other countries that have performed well in some areas – say, the fight against Ebola – could still face large death tolls and long-term economic turmoil.	类似地，除非提高整体医疗体系水平，否则在某些领域——比如对抗埃博拉——表现出色的其他国家也仍可能面临巨大的伤亡数字和长期经济动乱。


The second lesson that the Ebola epidemic holds concerns major gaps in our ability to develop new methods and technologies to fight the virus and other diseases like it.	埃博拉所带来的第二个教训是我们在开发新方法和技术对抗埃博拉病毒和其他类似疾病方面存在巨大缺口。


Our policies and approaches have too often been reactive, not proactive.	我们的政策和方法常常是响应式的，而非前瞻性的。


As a result, affordable and easy-to-use protective equipment for frontline health-care workers and point-of-care tests that are quick, reliable, robust, and cost-effective have been hard to find.	结果，一线医护人员很难找到平价易用的保护性设备和迅速、可靠、鲁棒、高性价比的现场检测。


The public and non-profit sectors should support innovations that are not only focused on solving immediate problems, but that also address potential future challenges.	公共和非盈利部门应该支持不仅关注解决眼下的问题、还能应对潜在未来挑战的创新。


The United States Agency for International Development, the White House Office of Science and Technology, the Centers for Disease Control and Prevention, and the Department of Defense have declared Ebola a “Grand Challenge for Development” and have launched an effort to sponsor practical, cost-effective innovations to treat and prevent it.	美国国际开发署（Agency for International Development）、白宫科学与技术办公室（White House Office of Science and Technology）、疾病控制与预防中心（Centers for Disease Control and Prevention）以及国防部宣布埃博拉为“重大发展挑战”并启动了支持务实、高性价比的治疗和预防方法的计划。


This is an important step in the right direction, but such efforts need to start well before an outbreak if they are to have a significant impact.	这是迈向正确方向的重要一步，但这些措施要想起到很大作用，应该在爆发前很久就开始。


New technologies require time to be tested before they can be deployed in the field, and scaling up to large-scale production is a major challenge for any new invention.	在可进行田野实验前，新技术需要时间检验，而对于任何新发明，扩展到大规模生产也是重大挑战。


The Ebola crisis has shown that we need to think about developing our ability to innovate at the most basic level.	埃博拉危机表明，我们需要思考如何发展我们在最基础层面的创新能力。


Just as health-care systems in the developing world need to be strengthened, we also need to build up our capacity to develop new solutions for similar challenges when they arise.	正如发展中世界的医疗体系需要强化，我们也需要建设我们在类似挑战出现时开发新解决办法的能力。


Engineering schools often fail to provide students with knowledge or understanding of the challenges faced by those outside of the developed world. Medical students and public-health professionals sometimes study or do internships in places where the disease burden is high; but a minuscule number of similar opportunities are available to engineers and technologists.	工学院常常不能授予学生关于发达世界之外的人所面临的挑战的知识和理解���医学生和公共卫生教授有时会在疾病负担沉重的地方从事研究或参加研讨班；


As a result, talented scientists and engineers are often grossly unaware of problems that need to be solved, and even those that might be motivated to do so are unlikely to apply their training to address new and emerging threats.	但工程师和技术专家获得类似机会的情况甚少。 结果，天才科学家和工程师常常完全没有意识到需要解决的问题，即使是被动员起来这样做的科学家和工程师，也无法将他们受到的训练应用于新出现的威胁。


Developing technology takes time and commitment.	开发技术需要时间和努力。


In addition to promoting awareness of global challenges in science and engineering schools, and providing opportunities for students to start addressing them in the field, we need to establish mechanisms that will foster and sustain the ideas that this process brings forward.	除了在理工科推广对全球挑战的认识、为学生提供从现场开始解决问题的机会外，我们还需要建立培养和维持推动这一过程前进的机制。


By creating research grants that do not expire as soon as an outbreak is under control, we would substantially increase our portfolio of solutions to manage the next epidemic better.	我们需要建立不会因为爆发被控制住就马上被撤销的研究项目，这能够极大地丰富我们更好地管理下一次传染病暴发的办法。


When faced with the next Ebola-like challenge, our ability to meet it will depend on the strength of local institutions and our ability to develop the right tools with which to fight it.	在面临下一场埃博拉式的挑战时，我们的应对能力取决于地方机构的强度和我们开发正确的斗争工具的能力。


There is no telling how many lives may depend on the steps we take now.	我们现在所采取的步骤可能挽救无数生命。


Ebola and Inequality	埃博拉和不平等性


NEW YORK – The Ebola crisis reminds us, once again, of the downside of globalization.	纽约—埃博拉危机再次提醒我们全球化的弊端。


Not only good things – like principles of social justice and gender equality – cross borders more easily than ever before; so do malign influences like environmental problems and disease.	不仅好东西——如社会正义和性别平等原则——比以前更加容易跨国传播； 环境问题和疾病等恶劣影响也是如此。


The crisis also reminds us of the importance of government and civil society.	埃博拉危机还提醒我们政府和公民社会的重要性。


We do not turn to the private sector to control the spread of a disease like Ebola.	我们不会转向私人部门以求控制埃博拉这样的疾病的传播。


Rather, we turn to institutions – the Centers for Disease Control and Prevention (CDC) in the United States, the World Health Organization (WHO), and Médecins Sans Frontières, the remarkable group of doctors and nurses who risk their lives to save those of others in poor countries around the world.	反之，我们会转向美国疾病控制和预防中心（Centers for Disease Control and Prevention，CDC）、世界卫生组织（WHO）和无国界医生（Médecins Sans Frontières，该组织的医生和护士们以身犯险拯救全世界贫穷国家的人）等机构。


Even right-wing fanatics who want to dismantle government institutions turn to them when facing a crisis like that caused by Ebola.	即使是欲铲除政府机构而后快的狂热右翼，在面临埃博拉这样的危机时也会转向机构。


Governments may not do a perfect job in addressing such crises, but one of the reasons that they have not done as well as we would hope is that we have underfunded the relevant agencies at the national and global level.	政府在解决这些危机方面也许做得并不完美，但它们之所以不能做到像我们所希望的那样出色，一个原因是我们没有为国家和全球层面的相关机构提供充足的资金。


The Ebola episode holds further lessons.	埃博拉危机的教训不仅于此。


One reason that the disease spread so rapidly in Liberia and Sierra Leone is that both are war-ravaged countries, where a large proportion of the population is malnourished and the health-care system has been devastated.	埃博拉在利比里亚和塞拉利昂传播得如此迅速，一个原因是这两个国家都饱受战争蹂躏，很大一部分人口营养不良，医疗体系也被摧毁殆尽。


Moreover, where the private sector does play an essential role – vaccine development – it has little incentive to devote resources to diseases that afflict the poor or poor countries.	此外，在私人部门确实起着关键作用的领域——疫苗研发，也找不到激励促使资源用于影响穷人或穷国的疾病。


It is only when advanced countries are threatened that there is sufficient impetus to invest in vaccines to confront diseases like Ebola.	直到当发达国家受到威胁时，才有足够的动力投资于对抗埃博拉这样的疾病的疫苗。


This is not so much a criticism of the private sector; after all, drug companies are not in business out of the goodness of their hearts, and there is no money in preventing or curing the diseases of the poor.	这并不是对私人部门的批评； 毕竟，制药公司并不是慈善企业，也没有钱被用于预防和治疗穷人的疾病。


Rather, what the Ebola crisis calls into question is our reliance on the private sector to do the things that governments perform best.	相反，埃博拉危机引起的问题是我们依靠私人部门去做政府表现最好的事情。


Indeed, it appears that with more public funding, an Ebola vaccine could have been developed years ago.	事实上，也许如果有更多的公共资金，埃博拉疫苗在多年前就早已被开发出来了。


America’s failures in this regard have drawn particular attention – so much so that some African countries are treating visitors from the US with special precautions.	美国在这方面的失败引起了特别关注——以至于一些非洲国家用特别措施对待来自美国的访客。


But this just echoes a more fundamental problem: America’s largely private health-care system is failing.	但这只是一个更为基本的问题的回声：以私人为主的美国医疗体系正在破产。


True, at the top end, the US has some of the world’s leading hospitals, research universities, and advanced medical centers.	诚然，在顶端，美国拥有世界领先的医院、研究型大学和高等医学中心。


But, though the US spends more per capita and as a percentage of its GDP on medical care than any other country, its health outcomes are truly disappointing.	但是，尽管美国人均医疗支出占GDP之比高于其他任何一个国家，其健康结果着实令人失望。


American male life expectancy at birth is the worst of 17 high-income countries – almost four years shorter than in Switzerland, Australia, and Japan.	美国出生男性预期寿命是17个高收入国家中最低的——比瑞士、澳大利亚和日本低四年。


And it is the second worst for women, more than five years below life expectancy in Japan.	美国女性排名倒数第二，日本女性出生预期寿命低五年多。


Other health metrics are equally disappointing, with data indicating poorer health outcomes for Americans throughout their lives.	其他健康指标也同样令人失望，数据表明，美国人终其一生的健康结果都比其他发达国家差。


And, for at least three decades, matters have been getting worse.	此外，在过去三十年中，情况每况愈下。


Many factors contribute to America’s health lag, with lessons that are relevant for other countries as well.	许多因素导致了美国在健康方面的落后，其中的教训可供其他国家借鉴。


For starters, access to medicine matters.	首先，能够就医很重要。


With the US among the few advanced countries that does not recognize access as a basic human right, and more reliant than others on the private sector, it is no surprise that many Americans do not get the medicines they need.	美国是极少数不承认有病可医属于基本人权的发达国家之一，比其他发达国家更加依靠私人部门，因此毫不奇怪许多美国人得不到他们所需要的医药。


Though the Patient Protection and Affordable Care Act (Obamacare) has improved matters, health-insurance coverage remains weak, with almost half of the 50 US states refusing to expand Medicaid, the health-care financing program for America’s poor.	尽管患者保护和平价医疗法（Patient Protection and Affordable Care Act，即奥巴马医保）改善了这一问题，但健康保险覆盖率仍然很低，美国50个州中有近一半拒绝扩大美国穷人医疗融资计划——医疗补助（Medicaid）。


Moreover, the US has one of the highest rates of childhood poverty among the advanced countries (which was especially true before austerity policies dramatically increased poverty in several European countries), and lack of nutrition and health care in childhood has lifelong effects.	此外，美国是儿童贫困率最高的发达国家之一（在紧缩政策大幅增加了某些欧洲国家的贫困率之前，这一情况更加触目惊心），而在儿时缺乏营养和医疗会造成终身影响。


Meanwhile, America’s gun laws contribute to the highest incidence of violent deaths among advanced countries, and its dependence on the automobile underpins a high rate of highway fatalities.	与此同时，美国的枪支法律导致其称为发达国家中暴力致死事件最多的一个，而其对汽车的依赖则导致了高速公路致命事故率的高企。


America’s outsize inequality, too, is a critical factor in its health lag, especially combined with the factors mentioned above.	美国严重的不平等性也是其健康落后的关键因素，特别是其与上述因素形成了共同作用。


With more poverty, more childhood poverty, more people without access to health care, decent housing, and education, and more people facing food insecurity (often consuming cheap foods that contribute to obesity), it is no surprise that US health outcomes are bad.	更多的贫困、更多的儿童贫困、更多的得不到医药、体面住房和教育的人、更多的面临食品不安全（常常消费导致肥胖的廉价食品）的人，考虑到这些情况，毫不奇怪美国健康结果如此糟糕。


But health outcomes are also worse in the US than elsewhere for those with higher incomes and insurance coverage.	但美国收入较高、有医保覆盖的人口的健康结果也比其他发达国家糟糕。


Perhaps this, too, is related to higher inequality than in other advanced countries.	也许这也与其不平等性高于其他发达国家有关。


Health, we know, is related to stress.	我们知道，健康与压力有关。


Those striving to climb the ladder of success know the consequences of failure.	挣扎着在成功阶梯上向上攀爬的人明白失败的后果。


In the US, the rungs of the ladder are farther apart than elsewhere, and the distance from the top to the bottom is greater.	在美国，阶梯各级之间的差异远远大于其他发达国家，顶端和底端的距离更是无比遥远。


That means more anxiety, which translates into poorer health.	这意味着更多的焦虑，从而导致更糟糕的健康。


Good health is a blessing.	好健康是一项福祉。


But how countries structure their health-care system – and their society – makes a huge difference in terms of outcomes.	但国家如何构建医疗体系——以及社会——能够造成结果的巨大差异。


America and the world pay a high price for excessive reliance on market forces and an insufficient attention to broader values, including equality and social justice.	美国和世界因为过度依赖市场力量、对包括平等和社会正义在内的更广泛的价值关注不足而付出了高昂代价。


Ebola in America	埃博拉在美国


NEW YORK – Until Thomas Eric Duncan brought Ebola into the United States, the disease was largely dismissed as an exotic pestilence of concern mainly to impoverished West Africa, and those who dared to volunteer there.	纽约——直到托马斯·埃里克·邓肯将埃博拉病毒带回美国前，这种疾病被视为在贫困非洲和胆敢付非工作的志愿者中传播的异国瘟疫而基本不受重视。


And its transmission to two nurses responsible for Duncan’s care – likely resulting from several breaches of medical protocol – has focused intense scrutiny on US preparedness for a possible outbreak.	而两名负责照顾邓肯的护士感染病毒——可能因为违反了几项医疗规定——导致人们不得不认真审视美国是否为可能的疫情爆发做好了准备。


President Barack Obama even announced last week the appointment of an “Ebola Czar” to manage the detection, isolation, and control of the virus in the US.	美国总统奥巴马甚至在上周宣布任命“埃博拉沙皇”来负责管理病毒在美国的检测、隔离和控制。


Medical and public health experts had been assuring the public that there was little cause for fear.	医疗和公共卫生专家一直在向公众保证没有理由产生恐慌情绪。


The Centers for Disease Control and Prevention (CDC) and other health agencies were working behind the scenes, painstakingly tracing anyone who may have come into contact with Duncan and quarantining those who might transmit the disease.	疾病控制与预防中心（CDC）和其他医疗卫生机构一直在幕后工作，煞费苦心地跟踪任何曾与邓肯接触者并对可能的传播者进行隔离。


Transmission in the US was nearly impossible, owing to the strength of the US health system, it was thought.	人们想当然地以为由于美国医疗系统的实力雄厚，病毒在美国传播几乎是不可能的。


But, as recent events have illustrated, robust health agencies should not be taken for granted.	但最近发生的事件表明，强有力的卫生部门并非理所当然。


In fact, over the past decade, the government has slashed budgets at several top health agencies, including the CDC, the National Institutes of Health (NIH), and state and local health departments.	事实上，过去10年来，政府削减了几家顶级医疗卫生机构的预算，其中包括疾病预防控制中心、美国国立卫生研究院（NIH）以及州和地方的卫生部门。


Between 2005 and 2012, for example, the CDC lost 17% of its funding, and officials recently reported that funding allocated for Ebola-type health emergencies is $1 billion less than it was in 2003.	比方说从2005到2012年，疾病预防控制中心失去了17%的资金支持，不久前有官员称划拨给埃博拉型突发公共卫生事件的预算比2003年减少了10亿美元。


The challenges faced at the state and local levels may be even greater.	州和地方一级所面临的挑战可能更为严峻。


Some 23% of local health departments reported that public health preparedness programs were reduced or even eliminated in 2011, while a further 15% reported similar cuts in 2012.	2011年约23%的地方卫生部门反映公共卫生应急计划数量锐减甚至消失。 还有15%反映2012年也有过类似的削减开支。


In 2014 alone, the Hospital Preparedness Program, which links regional hospitals with local health departments to prepare for potential public health emergencies, suffered $100 million in budget cuts.	仅2014年一年，连接地区医院与地方医疗卫生部门、为潜在公共卫生突发事件做准备的医院应急计划就蒙受了1亿美元的预算损失。


These reductions have already left their mark.	上述开支削减已经烙下了印记。


The Hospital Preparedness Program was designed specifically to train health personnel on disease containment in the setting of unforeseen epidemics, such as Ebola.	医院应急计划专门负责培训医务人员在埃博拉等不可预知的流行病毒爆发期间开展疾控工作。


Had it been adequately funded, perhaps the two nurses now infected would still be healthy.	如果该项目资金充足，或许那两名护士就不会感染病毒。


The NIH, which funds important advances in our understanding and treatment of diseases like Ebola, has also suffered cutbacks.	推动我们对埃博拉等疾病理解和治疗重大进步的美国国立卫生研究院同样也被削减了预算。


Its budget has stagnated for most of the past decade, except for years when it was dramatically reduced, such as in 2013.	该院预算过去10年来停步不前甚至像2013年那样遭到大幅削减。


This has forced productive research laboratories to close, putting potentially life-saving research – like that on an Ebola vaccine – on the back burner.	成绩斐然的实验室因此被迫关闭，导致像埃博拉疫苗这样有可能挽救生命的研究被搁置一边。


One explanation for the drastic budget cuts of recent years is that public health institutions usually operate with little fanfare and out of the public eye.	近年来预算大幅削减的一项理由是公共卫生机构通常默默无闻，很难进入公众视线。


At their best, they prevent disease without a trace, leaving little visible evidence of their crucial function.	即便工作做得再好，他们也只是无声无息地预防疾病爆发，很难拿出发挥重要作用的证据。


Hence, funding for public health has been a tough sell in good economic times, and is one of the first targets for retrenchment.	因此，即使在经济景气时也很难说服政府增加公共卫生经费，而在困难时期却首先遭到削减。


But global health emergencies like the current Ebola epidemic highlight the folly of these fiscal priorities.	但像埃博拉疫情这样的全球性公共卫生事件凸显出上述财政优先顺序的愚蠢。


Though we may not lean too heavily on our health infrastructure typically, its importance becomes all too apparent when disease and death come knocking at our door.	虽然不能太过依赖我们的健康基础设施，但在疾病和死亡来袭时其重要性才变得更为明显。


Indeed, though the threat of a serious Ebola outbreak in the US remains minimal, that is no reason for complacency.	事实上，尽管埃博拉病毒在美大规模爆发的可能性依然很小，但我们绝无理由因此而自满。


As the number of cases in West Africa rises, so does the potential for outbreaks outside of that context.	随着西非患病人数的增加，也增加了西非以外地区疫情爆发的危险。


And when members of the international community cannot contain the epidemic, the richest and most powerful actor, namely the US, has an obligation to step in and try to do so.	当国际社会无法控制疫情时，最富裕也最强大的国家美国有义务接过责任、勇于承担。


But budget cuts have damaged America’s ability to fulfill this obligation, and thus may cost more than policymakers bargained for.	但预算削减损害了美国履行义务的能力，由此付出的代价可能超过决策者的预见。


In late September, Obama committed $88 million and 3,000 troops to support the fight against Ebola in Liberia.	9月下旬，奥巴马拨款8，800万美元，并部署3，000人的部队支持利比亚的抗击埃博拉病毒之战。


But his decision came only after the epidemic had been smoldering for many months, with 6,000 Ebola cases confirmed and many more believed to be undetected.	但他是在疫情已经酝酿了几个月后才做出的这项决定，经过确诊的埃博拉病例达到6，000起，而且有不少病例尚未被发现。


Had CDC funding been at an appropriate level, US support – in the form of highly trained public health professionals, rather than ground troops – might have been deployed much earlier and been more effective.	如果疾控中心的资金维持在正常水平，美国就可能提前派出训练有素的公共卫生人员而非作战部队，抗击埃博拉的效果也会更加明显。


Ironically, the CDC and its leadership have come under intense scrutiny over the mishandling of Duncan’s care and the Ebola transmissions that resulted from it.	讽刺的是，疾控中心及其领导人由于对邓肯救护失措以及由此导致的病毒传播已经在接受严格的审查。


However, had the same lawmakers who are now deriding the CDC listened to pleas for more support and warnings of the consequences of poor funding over the past several years, perhaps the US would not be in the situation in which it finds itself today.	但如果现在嘲笑疾控中心的立法者过去几年注意到CDC的求助和资金不足的后果警示，也许今天美国就不会发生这样的事件。


The guiding principle of public health is to prevent disease before it strikes, and this requires long-term investment in institutions that can protect us.	公共健康的指导原则是在疾病爆发前加以预防，而这就需要对保护我们的机构进行长期投资。


Our collective health and wellbeing are evidence of such institutions’ effectiveness.	我们整体的健康和幸福就是这些机构有效工作的证据。


Fortunately, the Ebola outbreak is unlikely to expose Americans fully to the poor fiscal choices of the past decade.	幸运的是，埃博拉病毒的爆发不太可能彻底暴露美国10年来财政政策的错误。


But the disease’s sudden appearance on the global scene serves as a stark reminder of what can happen if we do not remain vigilant.	但这种疾病突然出现就是在警示人们丧失警惕会带来什么样的后果。


The next epidemic could be just around the corner.	下一次疫情也许就在不久以后。


We must ensure that we are fully prepared.	我们必须充分做好准备。


Fighting Ebola on All Fronts	全线抗击埃博拉病毒


PARIS – Judging by the media coverage in the United States and Europe of the Ebola outbreak in West Africa, one might conclude that conditions in the affected countries are gradually improving.	巴黎——从欧美媒体对西非埃博拉疫情的报导上，人们可能认为受影响国家的状况正在逐步改善。


But, though the epidemic is no longer a front-page story, the virus is far from being contained.	但虽然疫情已不再占据头版头条，但病毒离完全控制还相去甚远。


On the contrary, it remains a serious global health threat.	相反 ，埃博拉疫情依然对全球健康构成严重的威胁。


I recently traveled to Conakry, the capital of Guinea, together with French President François Hollande, and then visited Macenta, a rural district in the country’s forest region, close to where the outbreak began.	不久前我随法国总统奥朗德出访几内亚首都科纳克里，之后访问了林区的马森塔，那里的农村临近疫情最初的爆发地。


In both places, I witnessed firsthand the virus’s devastating impact: suffering, fear, despair, and, ultimately, death.	在上述两地我亲眼目睹了病毒的破坏性影响：痛苦、恐惧、绝望、最后以死亡结束。


Even the trivial has become weighted with meaning: no one shook hands.	就连琐碎小事也被赋予了特殊的涵义：这个地区的民众都不敢握手。


The truth is that the Ebola virus continues to spread – and quickly.	真相是埃博拉病毒继续传播——并且以很快的速度。


Granted, it has been contained in Liberia, but only in Liberia, and even there, there is no way to ensure that another outbreak will not occur.	诚然，病毒在利比亚已经得到控制——但也仅限于利比亚，并且就连在那里，也无法确保疫情不再次发生。


Ebola is spreading in ways that differ from what we have previously seen.	埃博拉传播的方式与我们之前目睹的不同。


The virus does not spread as rapidly as many others, such as influenza, which in the past limited the scale of epidemics, particularly because outbreaks were confined to rural areas.	埃博拉不具备流感那样的传播速度，这一特点曾经限制了疫情的规模，使疫情主要集中在农村地区。


But this time, the virus has entered cities and towns, making it especially dangerous.	但此次病毒已经来到了城镇和城市，这大大增加了病毒的危险性。


High population density provides fertile ground for any virus, let alone Ebola.	密集的人口为一切病毒传播提供了肥沃的土壤，更不用说这次的埃博拉疫情。


West Africa’s treacherous combination of widespread poverty, scarce medical resources, and crowded urban areas can be devastatingly deadly.	西非普遍贫困、医疗资源稀缺、城市拥挤等危险组合带来的打击可能具有毁灭性。


Nearly 7,500 people are reported to have died from Ebola this year. More than 16,000 are reported to have been infected.	据报道今年有近 7,500人死于埃博拉，超过 16,000人遭到感染。


These are ballpark figures, and while they provide important information about the trajectory of the epidemic and the effectiveness of response efforts, officials warn that the real numbers are probably far higher.	这些还只是大概的数据，虽然上述信息大致反映了疫情状况及对策的有效性，官方警告这些可能远低于真正的数据。


Health is a global public good.	健康是一项全球性的公益事业。


In most countries, the right to health is enshrined in the constitution or legislation.	在多数国家，宪法或法律保障公民拥有健康权。


The right, according to the World Health Organization (WHO), includes “access to timely, acceptable, and affordable health care of appropriate quality.”	世卫组织定义健康权包括“能及时得到有一定质量、可以接受且负担得起的医疗救治。


But, in the case of viruses like Ebola, few states, if any, can issue such guarantees.	”但一旦涉及埃博拉，几乎没有任何国家能做出这样的保证。


From a moral point of view, it is incumbent upon the international community, with its institutions, authorities, resourceful businesses, and individuals – as well as its knowledge and wealth – to deploy the necessary means to stop the spread of Ebola.	从道德角度看，国际社会有责任利用掌握的机构、权威、财力雄厚的企业和个人——还有知识和财富——为阻止埃博拉病毒传播采取必要的措施。


The imperative is equally strong from a purely self-interested point of view.	即便从自利的角度必要性也同样强烈。


If the virus is not quickly contained, everyone – every country – will be at risk.	如果病毒得不到迅速控制，所有人——所有国家——都将会处在危险之中。


The good news is that Ebola can be contained.	好消息是埃博拉病毒可以得到遏制。


Eventually, it can be eradicated.	最终也可以彻底根除。


If we are to achieve this, however, the virus must be understood and diagnosed.	但要想做到这一点，必须��了解和诊断病毒为前提。


Its spread must be prevented, and treatment must be offered.	必须防止病毒进一步传播，并提供有效的治疗方式。


Though there is no clinically proven vaccine against Ebola, this could soon change.	虽然现在还没有经临床验证的治疗埃博拉的疫苗，但这种状况可能很快发生改变。


Since the outbreak of the virus in March, the Institut Pasteur, an independent, non-profit research organization, has worked to understand how the virus can be contained and what treatment can be offered.	今年3月埃博拉病毒爆发后，一家独立的非营利性研究机构巴斯德研究所一直致力于了解这种病毒并研究治疗方案。


Our researchers are tracking the spread of the virus to understand how epidemics evolve, and we are working to empower local scientific and medical personnel.	我们的研究人员通过追踪病毒传播了解疫情变化，我们正努力协助当地科研和医务人员开展抗击病毒的斗争。


We expect to have two vaccine agents ready for clinical trials in 2015.	我们预期2015年将有两种疫苗制剂进入临床试验阶段。


The Institut Pasteur’s Ebola Task Force is fighting the virus on the ground in West Africa and in the laboratory in France, studying the virus and how it spreads, and leaving no stone unturned to find a medical solution that will stop this outbreak and prevent new ones.	巴斯德研究所的 埃博拉工作组在西非和法国的实验室抗击埃博拉病毒，研究病毒及其传播方式，以求千方百计找到阻止疫情传播和预防新疫情爆发的解决方案。


Together with the WHO and non-governmental organizations including Médecins Sans Frontières and the Red Cross and Red Crescent, the Institut Pasteur is committed to fighting the virus and its causes.	巴斯德研究所携手世卫组织和无国界医生组织、红十字会及红新月会等非政府组织，为抗击病毒及其起源做出自己的贡献。


Countries around the world have pledged support, financial and otherwise, to tackle the most immediate concerns: helping affected people and communities.	世界各国承诺给予财政和其他支持以解决人们最担心的问题：为受灾民众和社区提供援助。


Many countries already contribute to research into the causes, spread, and treatment of the Ebola virus.	很多国家已经参与研究埃博拉病毒的成因、传播途径和治疗手段。


An international “coalition of the willing” has been established, and we call on all states, relevant organizations, interested businesses, and qualified individuals to join it.	我们已经成立国际“自愿联盟”，呼吁所有国家、相关机构、企业和有能力的个人积极加入。


Together, we can and will see the end of Ebola.	如果共同努力，我们迟早能看到消灭埃博拉的一天。


Ebola and Beyond	埃博拉病毒及更多


WASHINGTON, DC – The United States and Europe have grossly overreacted to a few isolated cases of the Ebola virus within their borders.	华盛顿——美国和欧洲面对各自境内出现的几起孤立的埃博拉感染个案反应严重过度。


These panicked responses are not just futile.	这些惊慌失措的反应还不仅仅是没有任何用处。


By violating basic scientific principles, they defy the fundamental ethical criterion for compulsory public-health action.	因为违反了基本科学原理，这些举措挑战了强制公共卫生行动的基本道德准则。


And when it comes to protecting citizens from Ebola – not to mention preventing similar global health crises from emerging in the future – these responses may well be counterproductive.	而且在保护民众免遭埃博拉感染（更不要说防止未来发生类似的全球性健康危机）的问题上——如此做法的效果可能适得其反。


The most egregious examples of overreach have occurred in the US, where the initial response entailed enhanced screening of travelers from Guinea, Liberia, and Sierra Leone.	过度反应最惊人的例子来自于美国，美国的第一反应是加强筛查来自几内亚、利比里亚和塞拉利昂的旅客。


More problematic, several states instituted mandatory 21-day quarantines for volunteer health workers returning to the US from Ebola-stricken countries.	更成问题的是，某些州甚至对从埃博拉受灾国返回美国的志愿医疗工作者强制执行为期21天的隔离检疫政策。


Fortunately, the political backlash against the quarantine orders quickly prompted some state governors to ease them.	幸运的是，隔离检疫令所引发的政治风波很快迫使某些州长放宽了这项政策。


It is time for developed countries to recognize that the best way to protect their citizens from Ebola is to help stop the spread of the virus in West Africa.	发达国家现在应当认识到保护民众免遭埃博拉病毒侵袭的最佳方法是协助阻止病毒在西非的传播。


This requires, first and foremost, a sustained “surge response” to Ebola in the three most affected countries.	而这首先需要在埃博拉肆虐最严重的三个国家长期执行“强化反应”政策。 上述反应政策必须得到充足（且大额的）资金支持；


Such a response must be underpinned by adequate (and considerable) funding; well-trained doctors, nurses, and community health workers; and improved local capacity for diagnosis, treatment, contact tracing, and the isolation of infected individuals.	派遣训练有素的医生、护士和社区卫生工作者； 并提高当地诊断、治疗、追踪接触者和隔离感染者的能力。


There is no time to waste.	时间已经非常紧迫。


Indeed, the dearth of bold leadership has already delayed an effective international response to the current Ebola outbreak for far too long, drastically increasing the costs of the crisis.	事实上，缺乏有勇气的领导人已经使国际社会针对当前埃博拉疫情的有效反应来得太迟，从而大大增加了这次危机所付出的代价。


Beyond stemming the spread of Ebola, the international community must apply the lessons of the current crisis to future potential health hazards, by developing a credible response that emphasizes early, robust, and evidence-based action.	除了阻止埃博拉蔓延，国际社会必须在未来可能的健康危险中吸取这次危机的教训，制定以证据为基础的有效可靠的早期举措。


To this end, three key initiatives should be launched.	为此必须落实三项主要政策。


First, the World Health Organization should commit to an emergency contingency fund that it could deploy for surge capacity as soon as it declares a “public health emergency of international concern.”	首先，世卫组织应当设立突发事件应急基金，一旦宣布为“国际关注的突发公共卫生事件”就可以启用。


Had such funding been available to mount a robust initial response when Ebola emerged, the WHO would have had a strong incentive to declare an international emergency in a timely manner.	假使在埃博拉病毒爆发时存在基金支持最初的应急反应，世卫组织极有可能及时将其定性为一场国际突发事件。


In fact, a WHO review committee recommended just such a fund, amounting to at least $100 million, in 2011.	事实上，世卫组织评审委员会曾于2011年提议设立这样的基金，当时的建议额度至少在1亿美元以上。


Though that would have been eminently affordable, representing less than 0.5% of international health assistance, the WHO failed to establish it.	虽然只占国际医疗援助不到0. 5%的数额在经济上完全可以承受，但世卫组织最终还是没能实现这一目标。


The folly of this decision is now painfully obvious, as is the fact that the contingency fund should be significantly larger – up to $500 million.	这项决策的愚蠢如今显而易见，同样显而易见的还有应当大幅追加应急基金金额至5亿美元。


The second pillar of an effective crisis-response strategy is an emergency reserve workforce – established by the WHO, in cooperation with national governments – comprising well-trained health professionals who are prepared for rapid deployment in low-resource settings.	有效危机应对策略的另一根支柱是由世卫组织牵头领导各国政府建立应急储备的医疗队伍，招募训练有素的医务人员，随时准备在资源稀缺的条件下实施快速部署。


This would provide countries with weak health-care systems – which are particularly susceptible to disease outbreaks – with the human resources they need to bring health crises quickly under control.	医疗保健体系薄弱（因此特别容易受到疫情爆发影响）的国家会因此得到必要的人力资源支持，从而迅速将医疗危机控制住。


Of course, such measures do not diminish countries’ responsibility for strengthening their health-care systems and safeguarding their populations.	当然，国家建设卫生保健系统和保护民众健康的责任并没有因此减弱。


That is why the last and most important step toward preventing future global health crises is the creation of an international health system fund to support national efforts to acquire the capacity both to respond effectively in emergencies and to deliver comprehensive health services in normal times.	因此防止未来爆发公共健康危机最后也最重要的步骤是设立国际卫生系统基金，以便在紧急状况下有效做出反应，并且在平时提供全面的医疗卫生服务。


Such a fund would fit into the International Health Regulations framework that was agreed to in 2005, and advance the cause of universal health care, based on the principle that all people have a right to health.	上述基金应隶属于2005年签署的国际医疗卫生条例框架，并且在民众健康权的基础上推进全民医疗保健服务。


Governments would also be expected to allocate adequate domestic funds to achieve these goals, with, for example, African heads of state fulfilling the 2001 Abuja Declaration’s pledge to allocate at least 15% of national budgets to the health sector.	政府还应当拨出充足的国内资金实现上述目标，比方说非洲国家首脑切实履行2001年阿布贾宣言承诺，拿出国家预算的至少15%投资公共卫生部门。


But, for lower-income countries, significant progress toward establishing strong health-care systems would be virtually impossible without support from a sustainable international fund.	但对于低收入国家来讲，如果没有国际基金的长期协助，建立强效医疗卫生系统几乎是不可能完成的任务。


Given that creating such a fund would entail a massive multi-billion dollar investment in lower-income countries, social mobilization is the key to generating the necessary political support.	鉴于设立上述基金需要在低收入国家投入数十亿美元的巨额资金，社会动员是争取必要政治支持的关键因素。


In this sense, the global response to AIDS – spurred by the US President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria – could serve as a useful model.	从这个意义上讲，对抗艾滋病的全球对策——包括美国总统针对艾滋病的应急计划和抗击艾滋病、肺结核及疟疾的全球基金——可以作为一种有效的模式发挥作用。


Beyond establishing strong health-care infrastructure, national governments will need to develop systems of accountability to deliver health services to their populations.	除建立健全的卫生保健基础设施外，各国政府还需要实行问责制，确保为民众提供健康服务。


This includes fair and transparent stewardship of resources, anti-corruption safeguards, tools for monitoring progress, civil-society engagement, and accountability for failures.	其中包括对资源进行公平、透明的管理、落实反腐败保障、对进度实施监控、促进民间社会参与和对失败进行问责。


To advance these objectives, an international coalition is pushing for a Framework Convention on Global Health, aimed at fostering good governance for health at the local, national, and global levels.	为了实现上述目标，某国际联盟正在推动签署全球医疗卫生框架公约，旨在促进地方、国家及全球范围内良性的健康监控。


The treaty, based on the principle of a right to health, would provide clear guidelines for the allocation of funding and other responsibilities.	基于健康权原则的这项公约将为资金及其他责任的分配提供明确的指导原则。


The West African Ebola epidemic should inspire a course correction on international health policy, reinforcing the need for rapid-response tools and strong health-care infrastructure.	西非爆发的埃博拉疫情应当促使国际医疗卫生政策做出修正，推动建立快速反应机制和高效的医疗卫生基础设施。


Establishing frameworks to provide scalable, sustainable funding to achieve these goals is a wise and affordable investment – one that is in everyone’s interest.	制定提供实现上述目标所需长期灵活投资的框架是一项明智高效、并且符合所有人利益的投资。


This is one humanitarian response that would provide vast benefits worldwide, now and in the future.	这项人道主义政策将使世界各国受益，无论是现在还是未来。


Development for the People	民众可以享受到的发展


NEW YORK – The Ebola epidemic in West Africa is destroying lives, decimating communities, and orphaning children at a rate not seen since the region’s brutal civil wars ended more than a decade ago.	纽约——自从10年前西非地区的残酷内战结束后，现在的埃博拉疫情夺走生命、摧毁社区、催生孤儿的速度可谓史无前例。 在利比亚，60%的市场目前已陷入瘫痪；


In Liberia, 60% of markets are now closed; in Sierra Leone, only one-fifth of the 10,000 HIV patients who are on anti-retroviral treatments are still receiving them; and Guinea’s government is reporting a $220 million financing gap because of the crisis.	在塞拉利昂，10，000名艾滋病毒感染者中仅有五分之一仍在接受抗逆转录病毒治疗； 几内亚政府报告危机造成高达2.


If the outbreak is not contained soon, most of the economic and social gains achieved since peace was restored in Liberia and Sierra Leone, and since Guinea’s democratic transition began, could be reversed.	2亿美元的资金缺口。 如果疫情无法迅速得到扭转，利比里亚和塞拉利昂恢复和平和几内亚民主转型开始后所取得的多数经济和社会成果均有可能毁于一旦。


All three countries remain fragile, divided, and, as the current crisis highlights, uniquely prone to shocks.	上述三个国家目前局势既分裂又脆弱，并且在这场危机中很容易出现震荡。


More broadly, the region’s current crisis should inspire reflection about how the world supports and advances development.	从更广义的角度看，目前这场地区危机理应激发人们对世界如何支持并推进发展这一课题的思考。


One important reason for these countries’ vulnerability is the consistent lack of investment in their populations, which has prevented ordinary citizens from reaping the benefits of economic growth.	上述国家面对危机束手无策的一个重要原因是对民众投资的长期欠缺，因此阻碍普通民众从经济增长中收获好处。


Indeed, while the economies of Guinea, Liberia, and Sierra Leone grew rapidly in the ten years prior to the Ebola outbreak – at average annual rates of 2.8%, 10%, and 8%, respectively – their populations have seen little improvement in their daily lives.	事实上，虽然几内亚、利比里亚和塞拉利昂经济在埃博拉病毒爆发前10年分别以2. 8%、10%和8%的年均增速快速增长，但其民众的日常生活却鲜有改善迹象。


More than 65% of foreign direct investment has gone toward mining and logging, which are notorious for generating little employment and concentrating wealth in the hands of a few.	超过65%的外国直接投资都流向了采掘和伐木业，上述行业一向因较少创造就业机会和导致财富向少数人集中而在人们的印象中臭名昭著。


Likewise, though health services in Liberia and Sierra Leone improved after their civil wars ended, quality and coverage have remained well below West African standards.	同样，虽然内战结束后利比里亚和塞拉利昂的医疗服务有所改善，但其质量和覆盖范围仍然远低于西非标准。


When Ebola struck, Liberia had only 120 doctors for its four million citizens.	埃博拉病毒来袭时，利比里亚4百万民众仅有区区120名医生。


Add to that sprawling urban slums – semi-governed, overcrowded, and poorly sanitized – and it is not surprising that these countries have struggled to contain the epidemic.	再加上管理松散、人满为患、清洁环境恶劣的庞大的城市贫民窟——上述国家一直拼命试图遏制疫情因此也就不足为怪。


The threat that Ebola poses in all three countries extends beyond health care.	埃博拉在上述三国造成的威胁都不仅局限在医疗领域。


Throughout the region, a history of conflict and a legacy of poor governance have fueled a deep distrust of governments and state institutions, as indicated in a 2012 Afrobarometer survey.	据2012年非洲民主动态调查显示，整个地区长期冲突和治理不善的传统导致对政府和国家机构的信任严重缺失。


Indeed, these countries’ lack of an established social contract has been the main obstacle to establishing political authority and effective governance.	事实上，这些国家公认社会契约的缺位一直是确立政治权威及有效治理的主要障碍。


Moreover, this environment has created fertile conditions for the spread of wild theories including that the government and aid workers are conspiring to infect citizens.	不仅如此，这种环境为谣言的传播创造了肥沃的土壤，其中包括政府和救援人员合谋让民众感染病毒。


Many people deny that the Ebola virus exists at all, claiming that their governments have invented it to raise additional funds – which they will never see – from the international community.	很多人根本不承认埃博拉病毒的存在，称政府为从国际社会筹集更多资金而凭空捏造了整个事件（筹集来的资金民众永远也不可能看到）。


Such doubts and fears are leading families to hide their dead and conduct funerals at night, with some communities going so far as to attack health workers.	这样的疑虑和恐惧导致家庭藏匿亡者及在夜间举行葬礼，某些社区甚至发展到袭击医疗工作者。


All of this is making it extremely difficult to halt the spread of the disease.	这一切都让阻止疾病蔓延的工作变得极为困难。


With a highly contagious and lethal virus devastating poor and fragmented societies that distrust their leaders, business as usual is not enough.	在这种具有高度传染性及致命性的病毒摧毁对领导人缺乏信任的分裂、贫困的社会之际，承袭原有做法无疑是远远不够的。


The only way to halt the current Ebola outbreak, and prevent similar epidemics, is to address the fundamental social and political vulnerabilities that have allowed the virus to flourish.	阻止当前埃博拉疫情并防止类似流行病的唯一途径是根治诱发病毒传播的最基本的社会和政治弱点。


The key is to place people at the center of development efforts, by increasing investments in health care, education, and other public services.	关键是要通过增加医疗、教育和其他公共服务投资将民众置于发展工作的核心位置。


At the same time, a strong effort must be made to bolster job creation.	同时必须竭尽全力创造更多就业机会。


With a reliable support structure and adequate economic opportunity, households – and, in turn, countries – become more resilient.	可靠的支撑结构和充分的经济机会可以增强家庭和国家的适应能力。


Those at the forefront of the fight against Ebola – including the United Nations Development Program – have been mobilizing communities against the disease, supporting medical teams, and helping survivors and families of the infected cope with the tragedy.	那些身处抗击埃博拉前沿的力量——包括联合国发展计划署——一直在动员社会群体对抗疾病并支持医疗团队，同时协助幸存者及感染患者家属面对这场悲剧。


While these efforts could not be more important, they must be backed by a longer-term strategy to strengthen these fragile countries’ defenses.	虽然上述工作的重要性已经无以复加，我们必须制定长期战略加强这些脆弱国家的防御能力。


Ebola will be defeated, but the vulnerabilities that this outbreak has exposed should spur a fundamental shift in focus among policymakers.	埃博拉病毒将被打败，但这场爆发所暴露出的问题应推动执政者从根本上转变工作重点。


The development approach that dominates global thinking today emphasizes economic growth and state-building over social progress.	今天主导全球思维的发展理念强调经济增长及政府建设高于社会进步。


But the only way to boost a society’s resilience and ability to trust impersonal institutions is to give the people who comprise it the tools – and confidence – they need to prosper.	但增强社会适应性和对机构信任度的唯一方法是将繁荣所需的相关工具和信心交给民众。


Diseases Without Borders	无国界疾病


DAVOS – Today’s world seems more risk-laden than ever.	达沃斯—当今世界风险似乎比以往任何时候都要大。


The increasingly visible effects of climate change, rising geopolitical tensions, state crisis and collapse, inadequate or unequal economic opportunities, and the spread of infectious diseases – to name just some of the highest-profile threats – have created an environment of great uncertainty.	气候变化的影响日益明显，地缘政治紧张局势日益升级，国家危机和崩溃频发，经济机会不充分也不平等，还有传染病的肆意蔓延——而这只是其中一些最严重的威胁——它们给我们带来了极大的不确定环境。


Will 2015 be the year when these risks come to a head, or the moment when world leaders come together to develop real strategies for mitigating them?	2015年，这些风险会有所消停吗？ 世界领导人的会晤能带来遏制它们的真正战略吗？


This week, I am joining leaders from the worlds of business, government, politics, the arts, and academia at the World Economic Forum in Davos, Switzerland, to discuss the risks that the world faces.	本周，我和全球商业、政府、政治、艺术和学术界领袖一道参加瑞士达沃斯世界经济论坛，讨论世界所面临的风险。


Of course, determining which challenges merit the most attention will not be easy.	当然，确定哪些挑战应该得到最多关注并非易事。


That is where the WEF’s annual Global Risks reports can help.	世界经济论坛的年度《全球风险》（Global Risks）报告能起到帮助作用。


Drawing on the perspectives of roughly 900 experts and decision-makers from around the world who participate in the WEF’s global risks-perception survey, this year’s report found that, for the first time in its ten-year history, economic risks are taking a backseat to environmental and geopolitical concerns.	该报告由全球大约900名专家和决策者参与世界经济论坛全球风险观点调查。 在今年的报告中，十年来第一次出现了环境和地缘政治担忧压倒经济风险的现象。


Specifically, participants rated interstate conflict with regional consequences as the top risk, in terms of likelihood, facing the world in 2015, with extreme weather events coming in second.	具体而言，与会者将有地区后果的国家间冲突列为2015年世界所面临的首要风险（按可能性排名），极端气候事件紧随其后。


The top risks in terms of impact were water crises and the spread of infectious diseases.	按影响排名的最高风险是水危机和传染病蔓延。


The point, of course, is not simply to highlight how much danger the world currently faces.	当然，这只是强调目前世界着多大的危险。


By illuminating experts’ top-rated risks, the report highlights important opportunities for action.	《全球风险报告》列出了专家最关注的风险，突出了重要的行动机会。


According to WEF founder Klaus Schwab, 2015 can be a “year of destiny for humankind.”	世界经济论坛创始人克劳斯·施瓦布（Klaus Schwab）指出，2015年可能是“人类命运之年”。


Indeed, if global leaders – from multilateral organizations, governments, the private sector, and civil-society groups – seize opportunities for closer cooperation, long-simmering risks can be cooled before they boil over.	事实上，如果全球领导人——不管是多边组织、政府、私人部门还是公民社会团体——能抓住机会加强合作，长期发酵的风险可以在形成不可收拾之势之前得到遏制。


One area where concerted, collaborative action can make a major difference is the spread of infectious diseases.	共同和合作行动可以带来重大差别的一个领域是传染病的蔓延。


During the meeting in Davos, officials will discuss the creation of a new global pandemic emergency facility that would enable countries to respond quickly to crises within their borders by providing them with the needed funds.	达沃斯会议期间，将讨论成立一个新的全球流行病紧急机制，通过向各国提供必要资金帮助它们快速响应国内危机。


To understand how badly the world needs this capacity, one need look no further than the ongoing Ebola pandemic, which has ravaged West African societies, claiming thousands of lives and upending many more.	世界急需这一能力，仍在西非社会肆虐、夺走数钱生命并且还将有大量人口因此丧生的埃博拉便是明证。


A rapid and determined response could have done much to contain the virus.	迅速、坚决的响应可以在很大程度上遏制病毒。


But the international response was delayed and inadequate.	但国际响应既迟缓，也不充分。


Indeed, six months into the crisis, just 30 medical-response teams were treating and caring for patients on the ground in Guinea, Liberia, and Sierra Leone.	事实上，在危机爆发的六个月中，只有30支医疗响应队在几内亚、利比里亚和塞拉利昂治疗和看护病患。


The shortage of health workers, facilities, and supplies prevented many people from receiving treatment, allowing the virus to spread further.	卫生工作人员、设备和供给的短缺让许多人无法得到治疗，让病毒进一步蔓延。


Fear of the disease’s seemingly inexorable spread hampered trade, business activity, and travel in the affected countries.	对埃博拉看似不可阻挡的蔓延之势的担忧妨碍了受影响国的贸易、商业活动和旅行。


In December, the World Bank downgraded its growth estimates for the formerly fast-growing economies of Guinea, Liberia, and Sierra Leone, which are now expected to lose $1.6 billion in income in 2015.	12月，世界银行将此前位居高速增长行列的几内亚、利比里亚和塞拉利昂的增长估计做了向下修正，2015年，这些国家预计将损失16亿美元收入。


In order to become better prepared to tackle future pandemics, the world must invest now in strengthening public-health systems, bolstering developing countries’ disease-prevention capacity, and establishing new and flexible financing instruments.	为了更好地做好准备以处理未来流行病，世界必须从现在开始投资于强化公共卫生体系、提高发展中国家的疾病预防能力，并创造灵活的新融资工具。


A global pandemic emergency facility could mobilize public and private resources and frontload financing, so that when a global health emergency arises, funding is in place to support an immediate response at scale.	全球流行病紧急机制可以动员公共和私人资源以及前置融资，从而在发生全球卫生紧急状况时，大规模快速响应所需要的资金支持已经就位。


As the Ebola crisis has demonstrated, passing the hat once a pandemic has taken hold is far too time-consuming and carries huge economic and, more important, human costs.	埃博拉危机表明，在流行病爆发后才开始组织行动太耗费时间，会造成巨大的经济和——更重要的——人力损失。


Such a global resource could underpin the development of a comprehensive strategy to address the next outbreak, including a plan for putting health workers and supplies on the ground quickly.	这一全球资源可以为发展全面战略应对下一次传染病暴发打下基础，包括快速派遣卫生工作者和供给的计划。


It could even provide a market signal for producers of vaccines and drugs.	它甚至可以为疫苗和药品生产商提供市场信号。


The WEF’s Global Risks report emphasizes the need for robust plans to face the threat of pandemics.	世界经济论坛《全球风险》报告强调，我们需要鲁棒的计划应对流行病威胁。


This is especially urgent in light of the rapid growth of cities and informal settlements – where infectious diseases can spread more easily – in developing countries. We need to start creating those plans now.	在发展中国家城市和非正式住所——在这些场所传染病传播起来更加容易——快速增长的背景下，这一需要尤其迫切。


After all, we do not know when the next pandemic will strike.	毕竟，我们不知道下一场流行病会在何时爆发。


We cannot eliminate global risk.	我们不可能消除全球风险。


We can, however, make our economies and societies more resilient and thus better equipped to minimize the impact of the threats we face.	但是，我们可以让我们的经济和社会拥有更强大的恢复力，从而更好地实现威胁影响的最小化。


In this sense, forward-thinking initiatives like the global pandemic emergency facility are crucial to making the world a safer place for all of us.	从这个角度讲，前瞻措施——如全球流行病紧急机制——是让世界变成我们所有人更安全的家园的关键。


Three Global Health Threats	三大全球健康危机


SAN FRANCISCO – The tragic Ebola outbreak in West Africa has underscored the imperative of strengthening health systems at both the national and global level.	旧金山—西非埃博拉大爆发是一场悲剧，它彰显出加强国家和全球层面医疗系统的紧迫性。


But, though Ebola has focused the world’s attention on systemic shortcomings, the goal must be to combat the abiding epidemics that are quietly inflicting suffering and death on populations worldwide.	但是，尽管埃博拉吸引了全世界对系统缺陷的关注，但目标必须放在消灭持久流行病上，这些疾病正在悄然在全世界人口中间传播痛苦和死亡。


Ebola has undoubtedly wrought tremendous agony.	毫无疑问，埃博拉制造了极大的痛苦。


But it is not the first – or the most devastating – pandemic the world has faced.	但它并不是世界所面临的第一场瘟疫——也不是最灾难性的瘟疫。


In fact, smallpox is the deadliest disease known to humanity; until Edward Jenner developed the vaccine in 1796, it was the leading cause of death in Europe.	事实上，人类已知最致命的疾病是天花； 直到1796年爱德华·詹纳（Edward Jenner）发明了天花疫苗前，它一直是欧洲的第一死亡原因。


Before its eradication in 1980, it killed an estimated 300-500 million people.	在1980年被消灭前，据估计天花总共造成3亿—5亿人死亡。


The Bubonic plague of the fourteenth century killed 75-100 million people – more than half of Europe’s population.	十四世纪的黑死病杀害了7,500万—1亿人，相当于欧洲人口的一大半。


Nearly 75 million people, or 3-5% of the world’s population, died in just a few months during the 1918 influenza pandemic – more than twice the number of people killed in World War I.	1918年流感大爆发夺走了近7,500万人的生命，或世界总人口的3—5%，比第一次世界大战的死亡人数还多出一倍多。


The world continues to grapple with HIV/AIDS, which has already caused more than 40 million deaths and infects a similar number of people today, with 95% of the epidemic’s victims living in developing countries. Only when HIV/AIDS began to gain traction in advanced countries were highly effective anti-retroviral therapies developed – therapy that most of the poor people suffering from the disease could not access or afford.	世界仍在与艾滋病作斗争，目前，艾滋病已经造成4,000多万人死亡和相近数字的感染者，其中95%的受害者生活在发展中国家，直到艾滋病开始在发达国家出现肆虐之势，高效的抗逆转录病毒疗法才被开发出来，但这一疗法大部分身患艾滋病的穷人是无法获得或承担的。


Similarly, the failure of governments, multilateral organizations, and NGOs to respond quickly enough to the Ebola outbreak reflects the fact that the disease has ravaged poor countries.	类似地，政府、多边组织和非政府组织对埃博拉爆发响应不及时反映出一个事实：这场疫情蹂躏的是穷国。


But, at a time of unprecedented global interconnectedness, everyone has a stake in ensuring that adequate health-care systems and structures are in place to address such a pandemic.	但是，在这个全球互联程度前所未有的时代，确保足够充实的医疗系统和存在解决类似疫情的结构事关每个人的利益。


Achieving this requires providing the needed investment; after all, effective national health systems and agile surveillance are the first lines of defense against outbreaks of disease.	实现这一点需要提供必需的投资； 毕竟，有效的国家卫生系统和密切的监控是抵御疾病暴发的第一道防线。


At this point, Ebola is not only a health crisis, but also a humanitarian, economic, and political crisis.	在这方面，埃博拉不仅是一场健康危机，也是一场人道主义、经济和政治危机。


To be sure, some progress has been made.	诚然，我们已经取得了一些进展。


The United Nations Mission for Ebola Emergency Response’s “70/70/60” plan – to isolate 70% of Ebola patients and ensure that 70% of burials are conducted safely within 60 days – has largely been implemented, reducing the number of new cases considerably.	联合国埃博拉紧急情况响应小组（Mission for Ebola Emergency Response）的“70/70/60”计划——隔离70%的埃博拉患者，确保70%的葬礼在60天内安全进行——大致上得到了很好的实施，显著降低了新病例。


But people are still suffering and dying – often owing to a lack of access to credible information or adequate treatment.	但人们仍在遭受病痛和死亡——原因往往是无法得到可信消息或充分治疗。


Of course, when it comes to safeguarding the health of populations, there is a fine line between protecting the public and impinging on individual rights.	当然，在捍卫人口健康的问题上，存在一条保护公众和侵犯个人权利的界线。


That is why all public-health interventions must focus first and foremost on scientific facts, and avoid emotional or panicked responses.	因此，所有公共卫生干预都必须首先聚焦于科学事实，并避免情绪或恐慌的反应。


In this context, the imposition of mandatory quarantines on travelers from Ebola-affected countries was an obvious policy failure – just as they were when authorities tried to contain the Black Death of 1350 in Europe or the Plague of London in 1665.	在此背景下，强制隔离来自埃博拉疫区国家的旅行者显然是政策失败——一如当局试图遏制1350年的欧洲黑死病和1665年伦敦疫情。


Instead of wasting time on fear-based strategies, the international community must leverage human and financial resources to ensure fact-based, concerted, collective action.	国际社会不应该把时间浪费在基于恐惧的战略上，而必须利用人力和金融资源确保基于事实的、紧密合作的集体行动。


Such a united approach is possible; indeed, it has happened before.	这一联合行动方针是可行的； 事实上，以前也实行过。


At the turn of the century, the establishment of institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Bill and Melinda Gates Foundation, and GAVI, the Vaccine Alliance, coincided with a renewed effort to improve global health.	在世纪之交时，抗艾滋病、结核病和疟疾全球基金（Mission for Ebola Emergency Response’s）、比尔和梅琳达·盖茨基金会（Bill and Melinda Gates Foundation）和疫苗联盟GAVI（GAVI, the Vaccine Alliance）一致打造了改善全球健康的新措施。


The UN’s commitment to the Millennium Development Goals – which included four health-related targets, covering nutrition, maternal and child health, and infectious diseases – reflected a political consensus to improve health worldwide.	联合国的千年发展目标（Millennium Development Goals）承诺——其中包括四个健康相关目标、覆盖了营养、母婴健康和传染病——体现了改善全球健康的政治共识。


This institutional architecture has facilitated considerable progress in many of these areas; for example, the under-five mortality rate has plummeted by 49% since 1990.	这一机构结构大大促进了这些领域中的进步； 比如，五岁以下儿童夭折率自1990年以来下降了49%。


But there is far more to be done.	但还有很多要做。


In regions like Southeast Asia and Sub-Saharan Africa, maternal and child health and infectious diseases remain priorities.	在东南亚和撒哈拉以南非洲等地区，母婴健康和传染病仍是当务之急。


In fact, the ten countries with the highest child mortality rates are all located in Sub-Saharan Africa; a baby born in West Africa is 30 times likelier to die before the age of five than one born in Western Europe.	事实上，十个儿童夭折率最高的国家全部位于撒哈拉以南非洲； 西非出生的婴儿，其在五岁前死去的概率是西欧出生的婴儿的30倍。


Even within countries, massive inequalities remain.	即使在国家内部，也存在巨大的不平等。


For example, there is a ten-fold difference in infant mortality between municipalities in the Mexican states of Guerrero and Nuevo León.	比如，墨西哥格雷罗州（Guerrero）和新莱昂州（Nuevo León）城市婴儿死亡率相差十倍之多。


Moreover, silent epidemics have taken hold, particularly in lower-income countries, as the combination of mega-trends like urbanization, population aging, obesity, sedentary lifestyles, smoking, and alcohol consumption has spurred the rise of chronic non-communicable diseases (NCDs).	此外，由于不少大趋势的共同作用——比如城市化、人口老龄化、肥胖、久坐、吸烟、饮酒等——导致慢性非传染性疾病的大幅增长，还存在着一些静默的流行病，特别是在收入较低的国家。


For adults in most countries, cancer, diabetes, and cardiovascular disease have become leading causes of disability and death.	对大部分国家的成年人来说，癌症、糖尿病和心血管疾病已成为致残和致死的主要原因。


Emerging infectious diseases like Ebola may be more compelling, but the health impact of chronic NCDs, not to mention their high and growing social and economic costs, is substantially larger.	新兴传染病（如埃博拉）也许更加紧迫，但慢性非传染性疾病的健康影响要大得多，更不用说它们所导致的高昂且不断增加的社会和经济成本了。


There is no time to waste.	没有时间可供浪费。


Policymakers must pursue aggressive action to curb the spread of risk factors like the consumption of tobacco, alcohol, and obesogenic foods.	决策者必须追求果断行动遏制烟草、酒精和致胖食物的消费等风险因素的传播。


The world is facing a three-prong health challenge: We must build sustainable national and global health systems that can respond quickly and effectively to crises like Ebola; eliminate or control infectious diseases; and address the quietly rising epidemic of chronic NCDs.	世界面临着三大健康挑战：我们必须构建可持续的国家和全球卫生体系以快速有效地响应埃博拉等违纪； 消灭或控制传染病；


To succeed on all three fronts, we need sustained investment in health infrastructure, management, and personnel.	并解决悄然兴起的慢性非传染性疾病的流行。 要在所有这三个方面取得成功，我们需要保持卫生基础设施、管理和人才的投资。


Equality is key.	平等性是关键。


This means improving access to health care and education.	这意味着改善医疗和教育的普及度。


But it also means addressing the deeper social inequities that extend beyond the public-health agenda.	但这也意味着解决超过公共卫生日程的更深层次的社会不平等。


In formulating the post-2015 development goals, world leaders must remember that health is a fundamental human right.	在制定2015年后发展目标时，世界领导人必须铭记，健康是基本人权。


The Ethics of Fighting Ebola	战埃博拉的伦理学


PRINCETON – It may, in the end, turn out to be fortunate that a handful of people in developed countries – four in the United States and one in Spain – have contracted Ebola.	普林斯顿—最后，我们也许会幸运地看到，一小撮发达国家人民——四个美国人和一个西班牙人——遏制了埃博拉。


Tragic as this was for Thomas Duncan, the only one of these patients who has died, if all of the more than 13,000 cases and nearly 5,000 deaths had occurred in Africa, Ebola would never have aroused nearly as much attention in rich countries.	唯一悲剧的是托马斯·邓肯（Thomas Duncan），他是这几个病人中唯一一个丧命的，虽然在非洲造成13,000多例病患和近5,000人死亡，但埃博拉在发达国家基本没有引起什么关注。


In this respect, Ebola is – or, rather, was – an example of what is sometimes referred to as the 90/10 rule: 90% of medical research is directed toward illnesses that comprise only 10% of the global burden of disease.	从这个角度看，埃博拉是——或者说曾经是——有时被称为90/10法则的一个例子：90%的医学研究被用于只占全球疾病负担10%的疾病。


The world has known about the deadly nature of the Ebola virus since 1976; but, because its victims were poor, pharmaceutical companies had no incentive to develop a vaccine.	世界从1976年就知道埃博拉病毒具有致命性； 但是，由于受害者都是穷人，制药公司没有动力研发疫苗。


Indeed, pharmaceutical companies could expect to earn more from a cure for male baldness.	事实上，制药公司治疗男性秃顶还能多赚一点儿。


Government research funds in affluent countries are also disproportionately targeted toward the diseases that kill these countries’ citizens, rather than toward diseases like malaria and diarrhea that are responsible for much greater loss of life.	丰裕国家的政府研究基金也往往集中精力针对导致本国公民死亡的疾病而不会关注致死人数更多的疟疾和痢疾。


But the tiny number of Ebola cases in rich countries – and the ensuing panic-inducing headlines and quarantine measures – have brought home the global nature of infectious disease today. Mass travel has made effective containment of epidemics extremely difficult.	但埃博拉在发达国家只是引起了几个病例——以及持续引发恐慌的新闻标题和隔离措施——就引起了对当今传染病全球性的重视。


The best defense against an infectious disease is to fight it where it originates, and that requires good health services.	对抗传染病的最佳防御是在发源地战胜它，而这要求良好的医疗服务。


Ebola appears to have been eradicated from Nigeria, in no small part because that country had a Gates Foundation-supported hospital with personnel trained and equipped to control infectious diseases.	埃博拉似乎已经被赶出了尼日利亚，这很大程度上要归功于尼日利亚拥有盖茨基金会（Gates Foundation）所支持的一家医院，该医院有受过训练的人手和设备控制疫情。


If, over the past decade or two, affluent countries had done more to assist Liberia, Sierra Leone, and Guinea, the current Ebola outbreak could have been minimized, if not prevented.	如果在过去一二十年里富裕国家对利比里亚、塞拉利昂和圭亚那予以更大的支持，当前的埃博拉大爆发即使不能预防也可以得到最大程度的遏制。


But now it is too late for that, and scientists are rushing to find both a vaccine and an effective treatment for Ebola.	但现在只能亡羊补牢了，科学家正在忙不迭寻找埃博拉疫苗和有效治疗方案。


What ethical considerations should guide them in their search?	在这方面，我们应该以怎样的伦理学作为指导？


The standard way to judge the efficacy of a vaccine is to conduct a trial in which those who could benefit are randomly assigned to two groups, one of which receives the potentially beneficial vaccine, while the other receives a substance with no active ingredients, known as a placebo.	判断疫苗效果的标准办法是设计实验，可能的受益者被随机分配给两个组别，一组接受可能有效的疫苗，另一组接受没有活性成分的替代品（称之为安慰剂）。


To avoid possible confounding factors, such as greater risk-taking by those who know they have been vaccinated, or the desire of those conducting the trial to show that the vaccine works, the study is “double blind”: Neither the subjects nor those administering the trial and collecting the data know who got the vaccine and who got the placebo.	为了避免可能的混淆因素，比如知道接受了疫苗的实验对象过度冒险或实验者渴望证明疫苗有效，研究必须是“双盲”的：实验对象、实验者和数据收集者都不知道谁得到疫苗，谁得到安慰剂。


Only an independent group examining the data sent in from the field has that information.	只有一个考察小组能够得到包含这些信息的数据。


Without such a trial, the appearance of efficacy may be an illusion, because other factors would have led to a lower rate of infection anyway.	如果不进行这样的实验，效果就有可能只是幻觉，因为可能是其他因素导致了低传染率。


Yet if a promising vaccine is available – and if safety trials in healthy human volunteers who are not at risk of infection demonstrate that it does no harm – to deny it to those who are tending to the sick and dying, at great risk to their own health, seems unethical.	但如果成功的疫苗可以获得——并且以没有传染风险的健康志愿者为对象的安全性实验证明它没有危害——那么不把它送到照顾患者和重症患者、自己也极有可能染上埃博拉的医护人员手中就是不道德的。


That question will soon need to be answered, because both the pharmaceutical giant GlaxoSmithKline (in conjunction with the US National Institute of Allergy and Infectious Diseases) and the Public Health Agency of Canada have candidate vaccines in development.	这一问题很快就会成为必须回答的问题，因为制药巨头葛兰素史克（与美国国家过敏和传染病研究所（US National Institute of Allergy and Infectious Diseases）一起）和加拿大公共卫生署（Public Health Agency of Canada）已经在研发备选疫苗。


At a recent World Health Organization meeting in Geneva, Ripley Ballou, the head of GlaxoSmithKline’s program to develop a vaccine, argued that a randomized controlled trial comparing a potential Ebola vaccine with a vaccine that protects against another virus would be the most ethical way to assess efficacy.	在最近的世界卫生组织日内瓦会议上，葛兰素史克公司疫苗研发团队主管里普雷·巴罗（Ripley Ballou）指出，比较潜在埃博拉疫苗和针对其他病毒的疫苗的随机控制实验是最符合伦理的效果评��方式。


Depending on the outcome, results could be available within three months, allowing production and distribution to go ahead with greater confidence.	基于实验结果，结果可以在三个月内获得，让人们以更大的信心进入生产和分销阶段。


Representatives of Médecins Sans Frontières (Doctors without Borders), which has more than 3,000 staff members combating Ebola in the most affected countries, strongly opposed giving placebos to anyone at high risk of contracting the disease.	无国界医生组织（Médecins Sans Frontières，其有3,000多名成员正在埃博拉最猖獗地区奋战）的代表强烈反对给埃博拉高风险人群使用安慰剂。


But Ballou appears to have persuaded many of the participants at the meeting that his proposal will save more lives in the long run.	但巴罗似乎说服了很多参会者，使他们认为他的方案在长期能够挽救更多生命。


If that is true, a randomized controlled trial could be the most ethical option.	果真如此的话，随机控制实验就是最符合伦理的选择。


When it comes to treatment, the situation is different.	在治疗问题上，情况有所不同。


In a letter published last month in The Lancet, doctors, scientists, and bioethicists from a wide range of countries – including Guinea, Ghana, Nigeria, and Senegal, as well as Britain, France, Hong Kong, and the United States – argued that a randomized trial is justified only when there is “equipoise,” or balance, between the two options offered.	在《柳叶刀》（The Lancet）上个月刊登的一封信中，来自多个国家和地区的医生、科学家和生物伦理学家——包括圭亚那、加纳、尼日利亚、塞内加尔以及英国、法国、中国香港和美国——指出随机试验只有在两组对象之间存在“均势”（平衡）的情况下才有效。


This can happen when doctors do not know whether a proposed treatment will do more harm than good, or when they are in doubt about which of two treatments is more likely to cure the patient.	医生不知道备选治疗是否弊大于弊时，或他们不清楚两种治疗哪种更有可能治愈患者时属于这种情况。


But, when facing a disease that kills up to 70% of those who are infected, and no accepted treatment yet exists, patients could reasonably refuse consent to a trial in which they might receive a placebo, rather than an experimental treatment that offers some hope of recovery.	但是，对于传染后致死率接近70%并且没有已被接受的现成治疗方法的埃博拉来说，患者可能理性地拒绝参与可能获得安慰剂的实验，还不如参与存在些许恢复希望的实验性治疗。


In such cases, it might be more ethical to monitor carefully the outcomes of different treatment centers now, before experimental treatments become available, and then compare these outcomes with those achieved by the same centers after experimental treatments are introduced.	在这种情形中，仔细监控眼下的不同治疗中心的结果，然后以相同治疗中心引入实验性治疗后所实现的结果作比较也许更符合道德。


Unlike in a randomized trial, no one would receive a placebo, and it should still be possible to detect which treatments are effective.	与随机实验不同，没人会得到安慰剂，并且仍有可能确定哪种治疗更加有效。


Turning the Page on Ebola	翻过埃博拉这一页


WASHINGTON, DC – The Ebola outbreak that began last year in Guinea, Sierra Leone, and Liberia, three of the four countries of the Mano River Union, is the most severe on record since the disease was first diagnosed in Central Africa in 1976.	华盛顿—去年始于马诺河联盟（Mano River Union）四国之三的几内亚、塞拉利昂和利比里亚的埃博拉是该疾病自1976年在中非首次确诊以来最严重的一次。


The impact of the epidemic has been devastating, calling into question our three countries’ significant socioeconomic progress in the aftermath of decades of conflict and instability.	埃博拉的影响是灾难性的，我们三国的在数十年冲突和动荡后所取得的重大社会经济进步岌岌可危。


The region has so far registered a total of 25,791 cases and 10,689 deaths – almost ten times the number of deaths from all other Ebola epidemics combined.	到目前为止，该地区报告25,791起病例，其中死亡病例10,689起——几乎是此前各次埃博拉爆发死亡人数的总和。


For 2014, the projected growth rates for our three countries were 4.5%-11.3%.	2014年，我们三国预计增长率为4. 5%—11.


These projections have now been reduced to 2.2% at best.	3%。 如今，预测值以下调到2.


In the absence of mitigation measures, a recession cannot be ruled out.	2%或以下。 如果没有遏制措施，衰退将是难以避免的。


The uncontrolled spread of the disease exposed the shortcomings of our national health care systems, as well as regional and global institutions’ weak capacity for coordination and effective response.	埃博拉的不受控蔓延暴露出我们的国民医疗体系的缺陷，也暴露出地区和全球机构协作和有效响应能力不足。


Simply put, we were ill prepared to cope with, much less prevent, an outbreak on this scale.	简言之，我们对于这种规模的大爆发应对准备不足，更不用说预防了。


We bear a collective responsibility for the thousands of lives lost to Ebola and the tens of thousands affected by the disease.	我们对于埃博拉影响地区因此丧生的数千条生命有着集体责任。


And, today, thanks to institutional improvement and adaptation, we are closer to winning the fight against Ebola.	如今，感谢机构改善和适应，我们距离战胜埃博拉又近了一步。


Although the disease has not been contained and eradicated throughout the region, its spread has slowed; now we have to start planning our recovery, which must include strengthening the national, regional, and international systems that protect our people’s lives and futures.	尽管埃博拉在该地区尚未得到遏制和根除，但其传播已经放慢； 现在，我们必须开始恢复计划，而这必须包括强化保护我们的人民的生命和未来的国家、地区和国际体系。


We, the presidents of the three affected countries, met in Conakry, Guinea, in February, joined by Côte d’Ivoire, to adopt a common strategy to end the epidemic and guide post-Ebola socioeconomic recovery.	作为三个受影响国的总统，2月份我们三人在几内亚科纳克里（Conakry）举行了会晤。 我们与科特迪瓦一道采取了一项共同战略消灭埃博拉和疫后经济社会恢复。


This meeting was followed by a donors meeting in Brussels at the beginning of March, and a meeting in Freetown, Sierra Leone, two weeks later to coordinate our technical committees.	这次会晤后，3月初布鲁塞尔举行了出资人会议，两周后，塞拉利昂弗里敦（Freetown）又举行了协调我们的技术委员会的会议。


We will continue to build on these efforts in Washington, DC, at the spring meetings of the International Monetary Fund and the World Bank.	我们将在华盛顿国际货币基金组织（IMF）和世界银行春季会议上继续这方面的努力。


We are determined to eradicate Ebola by exchanging information, sharing technical expertise, creating innovative and accessible community health systems, and intensifying public education strategies, including steps that can be shared in families, such as applied water, sanitation, and hygiene (WASH) standards.	我们决心通过交换信息、共享技术专业知识、建立创新性普及型社区医疗体系、加强公共教育战略等手段根除埃博拉，包括家庭可以共享的措施，如用水、环境卫生和预防卫生（WASH）标准。


Only then can investment by the private sector – the engine of employment and stable livelihoods – begin to recover.	惟其如此，私人部门投资——就业和稳定生活的引擎——才会开始恢复。


The spread of the Ebola virus has been facilitated by our countries’ shared history and culture, which has enabled the disease to cross borders easily and move quickly from remote rural areas to urban centers.	埃博拉病毒的传播因为我们三国的共同历史和文化变得更加方便——疾病轻易地跨境传播，迅速地从偏远农村地区向城市中心地区蔓延。


Unfortunately, the epidemic forced us to close some of our borders, preventing access to relatives and care.	不幸的是，埃博拉迫使我们关闭部分边境，这阻止了人们与亲人的接触和获得看护。


We want our infrastructure, health policies, and economic strengths to benefit people across borders through links – community support systems and development corridors – that encourage collaboration and job creation.	我们希望我们的基础设施、卫生政策和经济优势能够通过鼓励合作和就业创造的联系——社区支持系统和发展走廊——惠及各国人民。


And we ask our international partners to support a common economic stimulus plan, with an emphasis on practical solutions that can enhance growth and increase employment.	我们也呼吁我们的国际伙伴支持共同经济刺激计划，并以可以强化增长、增加就业的务实方案为重点。


Four elements are essential to our recovery effort.	对我们的恢复措施来说，四个要素至关重要。


The first component is the creation of resilient public health systems, which requires trained community health workers in order to expand coverage in rural areas.	首先是建立恢复力强的公共卫生体系，而这需要训练有素的社区卫生工作者以扩大农村地区覆盖面。


It also requires nationwide water and sanitation programs and well-equipped centers for the control of infectious diseases in each country.	这还需要每个国家建立全国性供水和环境卫生计划和设施良好的传染病控制中心。


Second, we need to focus on infrastructure, particularly roads and electricity and telecommunication networks.	其次，我们需要以基础设施为重点，特别是道路和电力和通讯网络。


We ask the African Development Bank to take the initiative in creating an infrastructure fund, an extension of the Mano River Initiative, launched in 2013, with the objective of furthering regional integration.	我们呼吁非洲开发银行成立一个基础设施基金、扩展2013年启动的马诺河计划（Mano River Initiative），以深化地区一体化为目标。


And we ask our partners to recognize that programs originally planned on a ten-year time horizon, must be implemented urgently.	我们还呼吁我们的伙伴国要认识到，最初以十年为着眼点的项目必须尽快实施。


Third, we need to support economic recovery by encouraging confidence within the private sector, which has been hit by rising costs in the region.	第三，我们需要通过鼓励私人部门的信心支持经济复苏。 私人部门信心因为该地区成本上升而大受打击。


Specifically, the region would benefit from grants to local entrepreneurs, concessional financing and loans to foreign investors, and budgetary support from the government.	具体而言，该地区可以从地方企业家补贴、外国投资者优惠融资和贷款、政府预算支持等措施中获益。


Finally, in line with the recommendation of the Commission for Africa, the United Nations, and the African Union, we ask for a total cancellation of our foreign debt.	最后，按照非洲委员会（Commission for Africa）、联合国和非洲联盟的建议，我们呼吁完全豁免我们的外债。


This would allow us to recover the fiscal flexibility we need to enable us to co-finance the reconstruction of our health systems.	这将使我们能够恢复财政灵活性，从而让我们能够共同出资重建我们的卫生体系。


We urge our international partners to support our economic recovery in the same spirit of cooperation, and with the same sense of urgency, that helped us fight the Ebola virus.	我们敦促我们的国际伙伴以与帮助我们对抗埃博拉病毒同样的合作精神、同样的紧迫感支持我们的经济复苏。


Together, we can build health care systems, infrastructure, and regional institutions that will be stronger than before the start of the epidemic.	齐心协力的我们能够建立比埃博拉疫情爆发前更加强大的医疗体系、基础设施和地区机构。


Together, we can build a lasting legacy of health and progress for our peoples.	齐心协力的我们能够为我们的人民留下持续的卫生和进步遗产。


Helping the ECB Cross the Rubicon	帮助欧洲央行下定决心


PARIS – Eurozone monetary officials are expected to make history when they gather for the European Central Bank’s next policy-setting meeting on January 22.	发自巴黎——在外界的预期中，欧元区货币政策官员将在1月22日召开的欧洲中央银行下一轮政策制定会议上齐聚一堂，共同创造一段历史。


Observers anticipate that ECB President Mario Draghi and his colleagues will finally cross the Rubicon and announce the launch of a large-scale program of quantitative easing (QE) – in other words, high-volume purchases of government bonds.	观察家们预计欧洲央行主席马里奥·德拉吉（Mario Draghi）及其同僚将最终下定决心，宣布启动一项大规模量化宽松政策——换言之，就是大规模采购各国政府债券。


Though the ECB has resisted QE for more than five years, even as other major central banks embraced it, Executive Board member Benoît Coeuré has already called it the “baseline option.”	虽然欧洲央行已经抵制了量化宽松政策达五年之久，即便其他各主要国家央行都采取了这一政策，但欧洲央行执行委员会成员伯努瓦·科赫（Benoît Coeuré）已经将其称之为“基准选项”。


On the face of it, the ECB has many reasons to launch QE.	在表面上看，欧洲央行拥有许多启动量化宽松的理由。


For two years, inflation has consistently failed to reach the 2% target.	近两年以来，欧元区的通胀一直未能达到2%的目标。


In November, the annual price growth was just 0.3%, while the recent collapse in oil prices will generate further downward pressure in the coming months.	在十一月，年度价格增幅为0. 3%，而最近的油价大跌将在未来几个月带来更进一步的下行压力。


Even more important, inflation expectations have started to de-anchor: forecasters and investors expect the undershooting of the target to persist over the medium term.	而更重要的是通胀预期已经开始动摇。 经济预测专家和投资者们都预期这种无法达到目标的状况将一直维持到中期。


Low inflation is already a serious obstacle to economic recovery and rebalancing within the eurozone.	低通胀已经成为了经济复苏及欧元区内部经济重新调整的一大严重阻碍。


Outright deflation would be an even more dangerous threat.	而彻底的通缩则会成为更加严重的威胁。


Moreover, financial markets consider QE so likely that the largest part of its bond-rate and exchange-rate consequences have already been priced in.	此外，金融市场在很大程度上认定量化宽松已经是板上钉钉的事情，以至于其中绝大多数的债券利率和汇率都已经提前出现了变动。


Should the ECB disappoint expectations, bond and foreign-exchange markets would confront an abrupt and damaging unwinding of positions: long-term interest rates would rise, stock markets would sink, and the exchange rate would appreciate.	一旦欧洲央行打破了这一预期，那么债券和外汇市场将面对一场突然且破坏性的破位：长期利率将上升，股票市场会下跌，汇率则会走高。


That is not what Europe needs as it struggles to achieve in a year the growth that the United States has already recorded in a single quarter.	这可不是欧洲所需要的东西，因为美国花费一个季度所取得的增长，前者需要努力整整一年才能实现。


Yet hesitations are palpable.	但对此的犹豫情绪也是明显存在的。


Jens Weidmann, the president of the German Bundesbank, remains openly skeptical.	德国央行行长简斯·魏德曼（Jens Weidmann）依旧公开质疑这项做法。


Though Weidmann does not deny the risk of deflation, he argues that the consequences of recent price data may be less serious than believed, while those of full-fledged QE could be more serious than assumed.	虽然魏德曼不否认通缩的危险，但他认为最近价格数据所体现出来的后果不会如想象中严重，而全面量化宽松的结果则会比预计的更加危险。


Several of his colleagues share his reservations.	他的几位同僚也同样对此持保留意见。


It is important to understand why there is still no agreement in Frankfurt on the best possible course of action.	这就很有必要去理解为何在法兰克福还未能就最佳的行动进程达成任何协议。


At a time when the US data seem to validate the Federal Reserve’s strategy, why is the ECB hesitating?	在美国的数据似乎已经验证了美联储的战略之时，为何欧洲央行依然踌躇不前？


Contrary to conventional wisdom, the issue is not one of pure doctrine.	与一般认识相反的是，这一事务并不单纯是理念之争。


Yes, the Bundesbank fiercely opposed the ECB’s conditional support of debt-distressed eurozone members and backed legal challenges to Draghi’s innovation, the outright monetary transactions (OMT) scheme.	没错，德国央行曾经激烈反对欧洲央行对高负债欧元区成员国的有条件支援，也支持了针对德拉吉创新举措——直接货币交易计划——的法律行动。


But German officials do not dispute the legitimacy of wholesale bond purchases for monetary-policy purposes, and that there can be circumstances that require QE.	但德国官员们并未质疑为实现货币政策目的而批量采购债券行为的合法性，而其中就有某些状况需要用到量化宽松。


Orthodoxy rules out providing ECB support to a particular country, because this would violate the separation between monetary and fiscal policy: The authority to commit public resources to the benefit of a particular country belongs exclusively to parliaments, not the central bank.	对欧盟条约的正统诠释反对欧洲央行向某一特定国家提供援助，因为这将破坏货币和财政政策两者的各自独立：为了某特定国家的利益而调拨公共资源的权限只属于议会，而非央行。


But a wholesale purchase of government bonds does not raise similar concerns.	但批量采购各国政府债券则不会产生类似的担忧。


Unlike in 2012, when the OMT was announced, the objective of QE is not to help governments keep market access.	与2012年宣布直接货币交易计划时不同，量化宽松的目标不是去帮助政府维护市场融资渠道。


In principle, QE has nothing to do with sovereign solvency.	在原则上，量化宽松与主权债务偿付能力无关。


It is a monetary instrument that the central bank must rely on when its policy interest rate has hit the zero lower bound and thus cannot be pushed lower.	它只是一个当央行政策利率已经触碰到“0”这一下限并因此无法继续压低的时候所必须采用的货币政策工具。


The debt level of the government is irrelevant to the decision to use it.	政府的负债水平与使用这一工具的决策是无关联的。


But, by lowering long-term interest rates, central-bank purchases of government debt can help contain government debt service.	但是通过压低长期利率，央行对政府债券的采购可以帮助维持政府债务体系的正常运行。


In this way, QE can keep solvent a government that otherwise would be insolvent – a nightmare scenario for a central bank.	借助这种方式，量化宽松可以让一个本该破产的政府——这对央行来说堪称一场噩梦——维持偿付能力。


Japan is a case in point.	对此日本就是一个很好的例子。


The Bank of Japan already holds government securities worth 40% of GDP, and it is committed to annual purchases worth 16% of GDP within the framework of Prime Minister Shinzo Abe’s economic revitalization agenda.	日本银行已经持有相当于该国GDP总额40%的政府债券，并承诺在首相安倍晋三的经济激活进程框架下每年购入相当于GDP总额16%的债券。


The mammoth size of the BOJ program implies that it has taken full control of the market for government paper.	日本银行采购方案的庞大金额意味着其已经完全控制了政府债券市场。


With annual purchases amounting to twice the deficit, it has become hard to speak of a “market” for government debt.	在这种相当于赤字两倍的年度采购行为之下，所谓的政府债券“市场”也基本上名存实亡。


In fact, the BOJ sets the price.	日本银行成为了事实上的价格制定者。


Such a situation can make the central bank hostage to the government’s behavior.	这种情况会令央行成为政府行为的人质。


The BOJ’s action is predicated on Abe’s commitment to restoring the sustainability of public finances once deflation has been defeated and the economy has returned to growth.	安倍承诺一旦遏制住通缩且经济恢复增长就要恢复公共财政的可持续性，而日本银行的对应行动也能因此推断出来。


Should Abe fail to deliver, the BOJ would be trapped.	一旦安倍无法兑现承诺，则日本银行必将陷入困境。


If it stopped buying government debt, it could trigger a sovereign crisis and reduce the value of its own portfolio (especially if it started selling the bonds on its balance sheet).	如果日本银行停止购买政府债券，就像引发一场主权危机并导致自身投资组合的价值受损（尤其当它开始出售自身资产负债表上的债券时）。


But continuing its purchases would tighten the government’s grip.	而持续收购只会不断强化政府对银行的控制。


Trust in the government is therefore vital for any central bank that embarks on QE.	因此对任何实施量化宽松的央行来说，对政府的信任非常重要。


This trust is missing in Europe.	而这种信任在欧洲早已失落了。


Despite an accumulation of legal texts and procedures, the EU fiscal framework lacks credibility and does not give the ECB confidence that governments will continue to pursue sustainability after its bond purchases shelter them from market pressure even further.	尽管不断添加各类法律文本和程序，欧盟的财政框架依然缺乏可信度，也未能给予欧洲央行信心，无法让后者觉得这些国家将在债券采购行动让其躲过了进一步市场压力后继续寻求财政可持续性。


Moreover, unlike its counterparts, the ECB does not face a single interlocutor, and none of the governments that hold it accountable is or feels in charge of the eurozone as a whole.	此外，跟其他央行不同，欧洲央行的谈判对手不止一个，也没有任何一个对其负责的政府事实上或让人感觉能掌控欧元区这个整体。


This is a deeply unfavorable situation, which explains why the ECB, once obsessed with the risk that governments would coalesce to assail its independence, has turned into the staunchest advocate of fiscal-policy coordination.	这是一个极为不利的情况，也解释了曾经担忧各国政府可能联合起来削弱其独立性风险的欧洲央行，为何会摇身一变成为了财政政策协作的最坚定倡导者。


Concern is therefore understandable.	这一担忧也因此是可以理解的。


But it does not diminish the need for bold unconventional action against deflation, and it should not prevent the ECB from launching QE.	但这并不能消除对大胆非常规反通缩手段的需求，也不应因此阻止欧洲央行启动量化宽松。


The parallel with Japan highlights the need for governments to behave responsibly, individually and collectively.	与日本的比较点出了政府以负责任，单独和集体的方式采取行动的必要性。


Europe’s elected national leaders have a large role to play, and they must not eschew their duties.	欧洲的民选国家领导人需要扮演极大的角色，也不应该回避自身的责任。


The more confidence they give to the ECB, the more effective QE will be.	他们给欧洲央行的信心越多，量化宽松策略就越有效。


Europe’s Trial by Crisis	欧洲的危机考验


BERLIN – Some 2,500 years ago, the ancient Greek philosopher Heraclitus concluded that war is the father of all things.	发自柏林——大约2500年前，古希腊哲学家赫拉克利特（Heraclitus）指出战争是一切事物之父。


He might have added that crisis is their mother.	如果能活到今天，他或许会再增添一句：危机是一切事物之母。


Fortunately, war between world powers is no longer a realistic option, owing to the threat of mutual nuclear destruction.	幸运的是，在相互核毁灭的威胁之下，大国强权之间的战争已经不再是一个现实的选项。


But major international crises, such as the current global financial crisis, remain with us – which might not be an entirely bad thing.	但大型的国际危机，比如当前的全球金融危机却依然伴随着我们——而这或许不完全是件坏事。


Just as in war, crises fundamentally disrupt the status quo, which means that they create an opportunity – without war’s destructive force – for change that in normal times is hardly possible.	正如战争那样，危机彻底打破了现状，这意味着新的改革机会得以产生——却不具备战争的那种破坏性——而这些机会在平时是很难有机会出现的。


To overcome a crisis requires doing things that previously were barely conceivable, let alone feasible.	克服危机需要做出一些原本无法想象的事，而不仅仅是可施行的方案。


That is what has happened to the European Union over the last three years, because the global financial crisis has not only shaken Europe to its foundations; it has assumed life-threatening proportions.	这就是欧盟过去3年来所发生的情况，因为全球金融危机不仅从根本上动摇了欧洲； 还有可能威胁到其生存。


Compared to the beginning of 2009, we are now dealing with a significantly different EU – one that has become divided between a vanguard of member states that form the eurozone and a rearguard, consisting of member states that remain outside it.	相比于2009年初，我们现在面对的是一个与过去差异巨大的欧盟——联盟分化成为一个组成欧元区的前锋成员国和一个尚未加入欧元区的后卫成员国。


The reason is not evil intent, but rather the pressure of the crisis.	出现这种情况的原因并非出自恶意，而是危机的压力所致。


If the euro is to survive, eurozone members must act, while other EU members with various levels of commitment to European integration remain on the fringe.	如果欧元想生存下来的话，欧元区成员国必须行动起来，而其他对欧洲一体化有不同程度承诺的成员国则依然处于边缘地位。


Indeed, almost all taboos that existed after the eruption of the crisis have now been abolished.	事实上，在危机爆发之后几乎所有的禁忌都被打破了。


Most were established at German instigation, but now they have been removed with the German government’s active support.	其中大多数当初都是在德国推动之下建立的，但如今却在德国政府的积极支持之下被废除。


It is an impressive list: national responsibility for bank rescues; the sanctity of the EU treaty’s proscription of bailouts for governments; rejection of European economic governance; the ban on direct government financing by the European Central Bank; refusal to support mutual liability for debt; and, finally, the transformation of the ECB from a copy of the old Bundesbank into a European Federal Reserve Bank based on the Anglo-Saxon model.	拒绝支持共同承担债务的决定； 最后，欧洲央行从旧的德意志银行的翻版转型成一个基于盅格鲁-萨克逊模式的欧洲联邦储备银行。


What remains is the rejection of Eurobonds, but that, too, will ultimately disappear.	剩下的就是对欧洲债券的抵制，但这也将最终消失。


The only question is whether that taboo will fall before or after next year’s German general election.	唯一的问题就是这项戒条究竟会在下一轮德国大选之前还是之后被打破。


The answer depends on the future course of the crisis.	而答案则取决于危机的未来进程。