在美國總統(tǒng)特朗普的新預(yù)算草案中，所有用于國內(nèi)外公共衛(wèi)生防疫和醫(yī)學(xué)研究的資源幾乎都被大幅削減了。其中，美國疾病控制與預(yù)防中心的預(yù)算被砍掉了12億美元（17%）。而不幸的是，眼下正是一個(gè)各類傳染病更容易在國際上肆虐的時(shí)代。

雖然大多數(shù)國會(huì)議員認(rèn)為這個(gè)草案肯定會(huì)被國會(huì)斃掉，但對(duì)它進(jìn)行仔細(xì)研究后，我們也能從中一窺特朗普政府的政策和行政取向。為了將美國的國防預(yù)算提高10%，特朗普完全忽視了這個(gè)國家面臨的最大的安全隱患——一場能殺死數(shù)百萬人的瘟疫。

在最近我與馬克?奧爾沙克合著的《最致命的敵人：我們與殺人細(xì)菌的戰(zhàn)爭》（Deadliest Enemy: Our War Against Killer Germs）一書中，我們?cè)敿?xì)列出了美國和全球面臨的最緊迫的公共衛(wèi)生隱患，比如埃博拉病毒和由蚊蟲傳播的寨卡病毒等，以及用炭疽或是經(jīng)過基因加工的天花病毒等實(shí)施的生化恐怖襲擊。然而針對(duì)這些威脅，我們能給出的防治方案僅有那么三五個(gè)。

首當(dāng)其沖的威脅，是一場全世界范圍的致命流感大爆發(fā)，其威力或許不亞于1918年到1919年的那次西班牙流感——這似乎有點(diǎn)像末日恐怖電影里的情節(jié)。我們?cè)跁羞€想象了H7N9病毒的一個(gè)變種肆虐全球的情景，而這一幕果真已經(jīng)成了籠罩在東南亞國家頭上的陰影。

我們對(duì)下一次流感疫情的大爆發(fā)依然毫無準(zhǔn)備。我們目前的疫苗是基于20世紀(jì)40年代的技術(shù)，很多人就算接種了疫苗，在病毒來襲時(shí)也無濟(jì)于事。另外，以全球極其有限的流感疫苗生產(chǎn)能力，在疫情爆發(fā)的頭6至9個(gè)月里，全球人口中最多也就只有一小部分能接種到疫苗。

我們面臨的第二大威脅是抗生素的耐藥性。這是一場緩慢移動(dòng)的海嘯，可能最多幾十年，人類就會(huì)重回瘟疫頻發(fā)的黑暗時(shí)代，一個(gè)小傷口就能要了人的命，肺結(jié)核也會(huì)再度成為絕癥。最近，一項(xiàng)針對(duì)抗生素耐藥性的綜合研究發(fā)現(xiàn)，到2050年，死于耐藥菌感染的人可能要比死于癌癥和糖尿病的人加起來還要多。

忽視傳染病對(duì)人類和動(dòng)物健康的威脅，是一種極端愚蠢的做法。對(duì)于美國來說，一種致死的病毒或細(xì)菌肆虐全美所造成的后果，要遠(yuǎn)比任何軍事襲擊、恐怖襲擊乃至核攻擊都更加嚴(yán)重。美國的立法者不應(yīng)該浪費(fèi)時(shí)間和精力去討論特朗普政府預(yù)算草案的細(xì)節(jié)，而應(yīng)是應(yīng)該在2018財(cái)年的聯(lián)邦預(yù)算中，根據(jù)重要性對(duì)政府支出進(jìn)行排序，以扼殺新型傳染病對(duì)美國造成致命影響的可能。因此，美國非但不能削減疾病防治中心和國家衛(wèi)生研究院（NIH）的預(yù)算，相反還要增加對(duì)這兩個(gè)部門的撥款，投入大量資源用于研發(fā)能夠改變整個(gè)游戲規(guī)則的流感疫苗，在國際上大力宣揚(yáng)對(duì)人和動(dòng)物濫用抗生素的害處，并且支持新型抗菌劑的研發(fā)。

這些預(yù)算的分配不僅僅關(guān)乎黨派政治，更關(guān)乎一個(gè)國家的生死存亡。

本文作者M(jìn)ichael T. Osterholm是明尼蘇達(dá)大學(xué)傳染病研究與政策中心的主任、終身教授。著有《最致命的敵人：我們與殺人細(xì)菌的戰(zhàn)爭》（Deadliest Enemy: Our War Against Killer Germs）一書。（財(cái)富中文網(wǎng)）

譯者：樸成奎

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

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

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

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

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

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

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

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

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