经济学人23:疾病传播 细菌与金钱

 　　Books and Arts; Book Review;The spread of disease;Germs and money;

　　文艺；书评；疾病传播;细菌与金钱;
　　Where and when will the next pandemic emerge?
　　下一次大范围流行病将于何时在哪里爆发？
　　Contagion 1: How Commerce Has Spread Disease. By Mark Harrison.
　　《疫病蔓延：商业行为是如何传播疾病的》，马克·哈里森著。
　　Spillover: Animal Infections and the Next Human Pandemic. By David Quammen.
　　《溢出效应：动物传染病和下一场人类流行病》，大卫·奎曼著。
　　On October 2nd a British traveller, flying home to Glasgow from Afghanistan, began to feel ill. Within hours he was diagnosed with Crimean-Congo Haemorrhagic Fever, a virus nasty enough for him to be put onto a military transport aircraft for transfer to an isolation 2 hospital in London. Less than 24 hours later he was dead.
　　10月2号，一名英国旅行者从阿富汗乘飞机返回故乡格拉斯哥。在旅途中，他突然感到有些不适。几个小时以后他被诊断出患有克里米亚-刚果出血热——这种疾病的病毒特别危险，足以让他被送上一架军用运输机并转移到伦敦的一家隔离医院里。他没撑过24小时就病发身亡了。
　　This outbreak, on top of another death last month in Saudi Arabia from a previously 3 unknown virus, a cousin of the Severe Acute Respiratory Syndrome 4 (SARS), has set global health agencies on edge. Ten years ago the deaths of a couple of travellers from foreign parts might not have been news at all. But the fright of the SARS outbreak in 2003 has left a lasting 5 impression, and scientists and public-health officials now tend to see any putative 6 disease threat through its lens.
　　上个月，在沙特阿拉伯有一种此前未知的病毒（严重紧急呼吸综合症 （SARS）的类似病毒）导致一人死亡，再加上本次克里米亚-刚果出血热的爆发，这两起事件让全球各卫生机构紧张起来了。如果放在十年以前，从国外回来的几个旅行者暴毙可能根本算不上什么新闻。但对2003年 SARS 爆发的恐惧给人们留下了持久的印象，科学家和公共卫生官员如今往往对任何假定的疾病威胁都不敢轻忽。
　　It is refreshing 7, therefore, to take a wider look at the problem of infectious disease. Two recent books take very different approaches to the narrative 8 of bacteria and viruses, prions and protists that humanity has known for centuries and the brand new bugs 9 that, by opportunistic accident, hop 10 between species and start a new evolutionary 11 tussle 12. Mark Harrison, director of Oxford 13 University's Wellcome Unit for the History of Medicine, charts a chronological 14 path through the history of such diseases. David Quammen, an American science journalist, picks up the story of contemporary blights 15, exploring how the next pandemic will be detected.
　　因此，如果能从更广泛的角度来看待传染病的问题，的确让人耳目一新。最近有两本新书面世，采取了截然不同的方法来叙述人类发现于几个世纪以前的细菌、病毒、朊毒体和原生生物。两本书中还提到了一些全新的微生物——它们具有“机会致病性”，活跃在各个物种之间，并在进化方面引发了一场新的争论。马克·哈里森是牛津大学维尔康医学史研究所负责人，他针对历史上的此类疾病绘制了一张按时间顺序排列的进程图表。美国科学新闻记者大卫·奎门报道了当代枯萎病的情况，对人类会在什么时候发现下一次大范围流行病进行了研究。
　　“Quarantines have become tariffs 16 by another name,” Mr Harrison states at the beginning of “Contagion”, which moves with scholarly deliberateness from 12th-century Europe through to the globalised early 20th century, to demonstrate how modern-day quarantines evolved. Commerce was already associated with infection during the Black Death, though it would be hundreds of years before rats were singled out as its carrier, and the first quarantines followed soon after. When the plague reappeared in Britain and on the continent in the 1660s, European countries used tit-for-tat quarantines to keep out competitors, skim fees from merchants, reassure 17 trading partners and punish those who quarantined them.
　　《疫病蔓延》一书用学术性的从容笔调从12世纪的欧洲一直写到全球化的20世纪早期，展示了现代隔离检疫的发展过程。哈里森在书的开头写道：“隔离检疫已经成了另一种名义上的关税。”几百年前，在黑死病肆虐期间，人们曾经认为老鼠是唯一的带菌者——但当时的疾病感染已经和商业行为联系了起来，而且其后不久就实施了人类历史上首次隔离检疫。17世纪60年代，当英国乃至整个欧洲大陆再次出现这场瘟疫的时候，欧洲国家采取了针锋相对的隔离检疫措施来阻拦竞争对手、从商人手中捞取钱财、消除贸易伙伴的疑虑并且惩治那些曾经对欧洲实施隔离检疫的国家。
　　Mr Harrison follows the loosening of quarantines as the tides of free trade rose in the mid-19th century. A series of international conferences (and another bad bout 18 of plague) finally gave birth to the first international health regulations in 1907 with the object of smoothing out commerce. On both sides of the Atlantic, quarantine was increasingly replaced by better intelligence and proactive measures.
　　哈里森叙述道：19世纪中期，随着自由贸易浪潮的兴起，隔离检疫措施有了一些松动。一系列国际会议（以及另一场瘟疫的猛烈侵袭）最终促使各国在1907年制定了首批国际卫生规程，旨在解决商业贸易难题。大西洋两岸的国家逐渐采用更完善的疾病情报工作和主动防御措施来代替隔离检疫行为。
　　But current quarantine regulations are not immune to politicisation, and it is in making this point that Mr Harrison's book is most illuminating 19, though this forms a small part of the overall narrative. In defending “biosecurity”, governments have tended to react defensively to diseases like the H5N1 bird flu and mad-cow disease (or BSE), disrupting not just bilateral 20 trade but international markets as well. For instance in the 2009 swine-flu pandemic, Russia, China and others banned pork imports from North America and Mexico despite protests by the World Trade Organisation 21 and the European Union that there was no evidence the virus could travel in meat. Disease scares still provide an appealing cover for trade protectionism.
　　但现行的隔离检疫规程仍然难免要受到政治化的影响。尽管哈里森在通篇叙述中对此着墨不多，但正是对这一方面的论述让本书极具启发性。在保护“生物安全”的时候，各国政府对于 H5N1 禽流感和疯牛病（或称 BSE）等疾病往往采取防御性的反应，不仅中断了双边贸易，还给国际市场带来了负面影响。比如，2009年猪流感大范围肆虐的时候，俄罗斯、中国等国家曾经禁止从北美和墨西哥进口猪肉——尽管当时世界卫生组织和欧盟抗议称并没有证据表明猪流感病毒可以通过食用肉类传播。对疾病的恐慌仍然能够为贸易保护主义提供有利的掩护。
　　Mr Quammen's book, “Spillover”, is a scientific narrative rather than an historical one, focusing on zoonotic infections, those that pass from animals to humans. This category makes up nearly two-thirds of all human infectious diseases, including rabies, Ebola and malaria 22. The three most recent outbreaks—of SARS, bird flu and swine flu—indicate that the next pandemic is likely to be zoonotic in origin.
　　奎曼的《溢出效应》与其说是采取了历史性的叙述方式，不如说是从科学角度进行了描述。本书主要论述动物传染病在人类身上引发的感染。在所有人类传染疾病方面，这个范畴占了将近三分之二，其中包括狂犬病、埃博拉病毒和疟疾。历史上最近三次的传染病爆发（SARS、禽流感和猪流感）暗示下一场大范围流行病可能也会起源于动物传染病。
　　Mr Quammen analyses individual diseases, searching for patterns in their outbreaks. Most of the chapters focus on a single infection, and he ranges with ease over decades and continents, drawing upon years of interviews and field trips with scientists. Mr Quammen is a lively writer and a good detective, tracing diseases from their first appearance back to their origins—in some cases, still unsettled.
　　奎曼分析了一些疾病个例，从它们的爆发情况中寻找规律。本书大部分章节主要描写单一的某种疾病感染。凭借多年的探访经验以及和科学家们一起做的实地考察，奎曼游刃有余地涉及了几十年来各个大洲的感染情况。他是一位笔触生动的作家，也像是一名神探，从疾病首次出现时追溯到它们的爆发源头——某些疾病究竟起源于何处仍然悬而未决。
　　Familiar diseases are given a fresh gloss 23, while even the most devoted 24 hypochondriac will find some new ones to worry about. (Ever heard of parrot fever?) One of the most surprising chapters is on HIV, about which much has already been written. Mr Quammen traces the various strains of HIV back to the beginning of the 20th century, when the virus is likely to have moved from a chimpanzee into a human. With judicious 25 use of a fictional 26 narrative he then draws the story forward, bringing in some startling new evidence for how HIV was able to spread so widely.
　　奎曼对人们熟知的疾病进行了全新的阐述，即使是最坚定的疑病者看了这本书之后也会产生另外的焦虑（听说过鹦鹉热吗？）本书最让人惊奇的章节之一是关于 HIV 的——针对这种病毒已经出版了很多相关资料。奎曼将几种不同类型的 HIV 追溯到20世纪初：该病毒可能是在当时由黑猩猩传染给人类的。然后，他审慎而明智地采用一种小说般的叙述方式将故事向前推进，针对 HIV 如何能够如此广泛传播提出了一些惊人的新证据。
　　To his credit, Mr Quammen does not shy away from the lurid 27 question of the “next big one” that will be on readers' minds from the start. But he folds it into the story with due scientific rigour. From one disease to the next he asks, “Why hasn't this gone big?” In the case of SARS, for instance, the answer may be mostly sheer luck. Neither quarantines nor eradication 28 programmes, nor even disease detectives, will be enough to guard mankind against the next outbreak. But wise precautions may limit collateral 29 damage as humanity tries to stave off the next big one.
　　读者从一开始关心的就是“下一场大瘟疫”将在什么时候到来。值得赞扬的是，奎曼并没有回避这个耸人听闻的问题。但他用一种恰当的科学严谨性把这个问题融入了叙述之中。每谈到一种疾病，他都会问道：“为什么这种疾病没有大范围流行？”比如拿 SARS 来举例——答案可能通常被解读为纯粹的运气。不管是进行隔离检疫，还是实行病毒根除方案，抑或是派遣疾病调查员，都不足以帮助人类抵御下一次流行病的爆发。但如今人类正在试图延缓“下一场大瘟疫”的到来，此时采取理智的预防措施或许能减轻这场疫病的附带损害。