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醫藥論壇

作者:台大醫院小兒部李秉穎醫師

建立:2005.11.21

修改:2005.11.21

鳥兒無辜 何忍趕盡殺絕?

最近,台灣的鴿子開始挨餓,流浪鳥日漸增多,這些都是不必要恐慌的產物。到目前為止,台灣完全沒有H5N1這類高病原性禽流感,病毒是否會突變導致大流行則尚在未定之天。民眾在平靜無波的台灣,實在沒有理由驚懼不安。


一個很重要的觀念是:禽流感不會無中生有。待在家裡的禽鳥、在廣場漫遊的鴿子,都不可能憑空生出禽流感。萬一高病原性禽流感入侵台灣,那時才須特別注意禽鳥的帶病毒狀態,否則只是庸人自擾。就好比說,世界到處都有狂犬病,如果因而在狂犬病絕跡的台灣宣示禁止養狗,必定引來杞人憂天之譏。


規定學生每天量兩次體溫的作法,犯了無中可能生有的錯誤,在總統發言後總算得到矯正,但有些不必要的作法還持續進行。例如規定餵鴿子要罰錢,結果鴿子不明白牠們為何要挨餓,也不瞭解為何那些無知的人們還敢天天來拍合照。如果禁止餵鴿子的目的是要餓死牠們,何不抓起來殺掉?一旦牠們餓死,反而會引起鴿子疑似死於禽流感的恐慌。既不要牠們好好地生,也不讓牠們好好地死,此政策的效果只是虐待鴿子而已。每天去廣場看鴿子的人們,已經證實人不會因此得到禽流感。相關單位如果真的擔心,可以定期去監測鴿子糞便有無禽流感病毒,而不應將所有鴿子視為不存在兇案的嫌疑犯。


禽流感入侵台灣總要有管道,最近大陸走私鳥驗出H5N1禽流感即為台灣防疫問題的核心。在霍亂絕跡多年的台灣,今年突然出現兩個互不相關的霍亂病例,筆者推測很可能也跟大陸走私有關。要預防禽流感疫情,不是棄養無辜的鳥,也不是讓鴿子挨餓,而是落實檢疫工作、斷絕入侵管道。所有台灣民眾均應認清,走私是危及全民健康生命的惡行。


有議者認為防疫工作有做總比沒做好,這是錯誤的觀念。在沒有疫情之時執行很多規定,就好比沒有火災卻要消防隊到處灌水。禽流感恐慌不只傷害無辜的鳥兒,也讓雞鴨滯銷、股市下跌、流感病人拿不到克流感治療,這些被虛耗的社會成本,可部分歸咎於抱持著「有做總比沒做好」觀念的人們。

 

2005.11.12 國際期刊 Lancet相關評論

對於禽流感的恐懼是一把雙面刃

 

Editorial. Fear of avian influenza is a double-edged sword. Lancet 366(9499): 1751.

 

“To fear the worst oft cures the worst.” So wrote William Shakespeare in his Homeric love story Troilus and Cressida. This sentiment must have been uppermost in the minds of the hundreds of officials who gathered in Geneva on Nov 7–9 as they acknowledged the risk to human health of pandemic influenza, and broached an unprecedented consensus on how best to prepare.

Urgency marked the proceedings. A gloomy assurance by WHO Director-General Lee Jong-wook that no society would be left unscathed by pandemic influenza confirmed H5N1's status as a global priority. International organisations spelled out a grim forecast of the “incalculable human misery” that could result from a pandemic, and warned of the ineffectiveness of current preparations. On controlling the disease in birds, delegates from countries struggling with outbreaks pleaded for help to finance urgent control efforts. And unaffected nations in the path of migrating birds described with resignation their ill-preparedness to fend off the approaching threat.

In a demonstration of the singular spirit of cooperation nurtured by such fears, the conference ended with promises of action. Delegates pledged support to nations who need help developing preparedness plans; offered assistance in building surveillance capacity and responding to outbreaks in birds; promised to strengthen veterinary services and networks; and laid plans for accruing international drug stockpiles and advancing research into drug and vaccine production. A follow-up meeting at which these plans will be shored up with funds will be held in Beijing on Jan 17–18, 2006.

The extent of the consensus buoyed the Geneva meeting's organisers, who are optimistic about the capabilities of donors and technical agencies to streamline assistance to needy countries. But whereas fear has certainly helped focus international preparations for a worst-case scenario, Shakespeare's axiom is not so fitting when applied to the anxieties of individuals. So with international cooperation now bolstering preparedness plans, it is time for governments to tackle the prospect of inevitable civil unrest.

Even before a pandemic emerges, panic is a danger. The recent growth in momentum for action against avian influenza has been flanked by a rise in anxiety about the pandemic risk. These fears are perpetuated by politicians' misplaced instincts to withhold information instead of talking openly about the disease. And, worryingly, experience shows that widespread fear can lead to social and economic consequences as serious as the disease itself. In Thailand and China, for example, avian influenza has already damaged poultry sales and put these countries' residents off their food. Cambodia, one of the four countries to have confirmed human infections with H5N1, says a “psychosis” has gripped its population. And there have been numerous reports of individuals in rich countries—including doctors—stocking up on the antiviral drug oseltamivir (Tamiflu) in an effort to protect themselves against future disease.

Previous experience of outbreaks suggests that these examples are minor compared with what is likely to come. Intensified anxiety at the start of a pandemic could mean that people avoid travel, fear going to hospitals, or start riots in the streets. Patients will be stigmatised, and confidence in governments will be damaged or lost. But just as there is time to complete preparedness plans, there is still time to stem public anxiety. However, this can only be done by winning the public's trust—and for many governments, trust comes in short supply.

It is true that public assurances are difficult to muster when uncertainties abound and available scientific information is incomplete. But if governments are to avert widespread panic they must admit to uncertainty, act transparently, issue guidance on disease protection, and make sure new information is disseminated to the public as quickly as possible. These actions can be thought of as preparedness measures in themselves: people who trust their leaders will be more likely to adhere to health advice when a pandemic emerges.

Good communication also means responding to public concerns. And where public concern runs highest now is on the issue of limited drug stocks. Politicians are understandably fearful of public reactions to an admission that drug stocks are small and potentially inadequate. But this fear, a result of an over-reliance on pharmaceutical solutions to public-health threats, is misplaced. A WHO conference on outbreak communication concluded last year that information might be the only source of protection during a public-health emergency. Populations have a right to information that affects their lives—and without it, their worst fears are more likely to arise.

 

 

相關文章:

禽流感的正解與誤解
我們該如何看待禽流感的威脅
流感與疫苗
禽流感的危機
動物攜帶流感病毒之監測調查
禽流感是否會威脅我們? (2005.5.4)
防禽流感 大家別賞鳥 (2005.10.5)
禽流感反映著種族歧視的偏見 (2005.10.11)
恐禽流感大爆發 東南亞返國民眾自主管理10天一定要做 (2005.10.11)
誤解加恐慌 只怕要撲殺候鳥了 (2005.10.20)
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網站外觀改版:2003.10.01

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上次更新:2017年05月16日
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