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[转载]学习讲话:保护我们治疗疟疾的最佳武器

(2011-04-01 16:35:43)
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疟疾、艾滋病、结核病是三大传染病

Protecting our best weapon in treating malaria

Dr Margaret Chan
Director-General of the World Health Organization

Statement at the launch of the Global Plan for Artemisinin Resistance Containment
Geneva, Switzerland
12 January 2011

Ladies and gentlemen,

The report we are launching today sets out a high-level plan to protect our most potent weapon in treating malaria, the artemisinins. These medicines are the key ingredient of artemisinin-based combination therapy, or ACTs.

ACTs are the gold standard. They are the most effective treatment for falciparum malaria, the most deadly form of malaria.

Combination therapy is a deliberate strategy to delay the development of drug resistance, which inevitably happens when any antimalarial drug is widely, and especially, unwisely used.

ACTs deliver a two-punch attack on the malaria parasite. By combining drugs with different mechanisms of action and different time spans of activity, ACTs increase the likelihood that any parasites not killed by one drug will be killed by the second one.

The usefulness of these therapies is now under threat.

Evidence of resistance to artemisinins was suspected on the Cambodia-Thailand border in 2008 and confirmed in 2009. Other suspected foci have been identified in the Greater Mekong subregion, but are not yet confirmed.

This part of the world is the historical epicentre for the emergence of drug-resistant malaria parasites. History tells us what to expect.

Over the past several decades, we have lost one front-line antimalarial after another as resistance has developed, become established, and then rapidly spread internationally, rendering these drugs useless.

Today, in launching this global plan, WHO, together with Roll Back Malaria partners, is attempting to break this historical pattern. We are calling on the international community to take advantage of an unprecedented window of opportunity.

The ambition is bold: to stop the emergence of artemisinin resistance dead in its tracks, at its source, and thus prevent, or at least significantly delay, further international spread.

This opportunity is unprecedented in the history of malaria control. Why now?

Thanks to a recent surge in research, we understand malaria, and the mechanisms of drug resistance, much better. Let me thank researchers in hundreds of institutes around the world, also in endemic countries.

Their work has made it possible for WHO to compile the largest collection of studies on antimalarial drug efficacy ever reviewed and standardized for analysis.

Vigilance is at an all-time high. In fact, intensive monitoring of therapeutic efficacy has been in place, with WHO support, on the Cambodia-Thailand border since 2001. A standardized research protocol has been developed to aid similar vigilance elsewhere.

Never before have the first subtle changes in parasite sensitivity been detected so early. Never before have the tools and strategies been in place to attempt to stop the emergence and spread of drug resistance at its source.

Never before have we had such a high level of commitment to make this happen, to stay one step of ahead of at least some of the setbacks that history has taught us to expect.

We believe that the plan has every good chance of success. Above all, the international community is duty bound to seize this opportunity. Too much is at stake if we fail.

It is no exaggeration for me to say that the consequences of wide-spread resistance to artemisinins would be catastrophic.

After decades of stagnation in malaria control, stepped up efforts are finally producing impressive results, including striking drops in transmission rates and deaths. These results are invigorating, adding to the growing momentum to reduce the huge burden of malaria, especially in sub-Saharan Africa.

The spread of resistance to artemisinins and the loss of ACTs could unravel these hard-won gains very quickly and undermine the conviction that malaria can be defeated.

A large number of endemic countries have nothing left to fall back on if the ACTs begin to fail. Most older antimalarials have been rendered useless by drug resistance. While a major effort is under way to develop new classes of antimalarials, no replacement products are on the immediate horizon.

The estimated yearly number of malaria cases, though declining, is still 223 million. Leaving such a large number of people with no effective treatment would be an unthinkable tragedy.

Ladies and gentlemen,

I have two further points.

First, the containment plan is not a side-track, not a diversion of resources and efforts. Basically, what is recommended to contain resistance is what needs to be done to control malaria in every endemic country.

We need to continue to reduce transmission, through either the scaled up use of treated bednets or increased indoor residual spraying of insecticides.

Countries need to stop handing out ACTs to every child with a fever. ACTs should be treated like precious, fragile commodities, dispensed only on the basis of a confirmed diagnostic test.

This is entirely feasible. Inexpensive, quality-assured rapid diagnostic tests are now available that can be used right down to the community level.

We need to ensure that every patient with confirmed malaria gets the best, quality-assured medicines. We need to do more to prevent the sale of counterfeit or substandard medicines. We need to stop the practice of peddlers selling individual pills instead of full treatment courses.

We need to ban the marketing of therapies containing only artemisinin, and thus lacking that two-punch power of combination therapies.

These practices must be prevented as they hasten the development of drug resistance. They also undermine good overall malaria control.

My second point is this. We are launching a global plan at the start of 2011, but this does not mean that aggressive action has not already taken place. On the contrary.

Containment efforts began immediately on the Cambodia-Thailand border at the end of 2008, even before resistance was confirmed. Household coverage with treated bednets is nearly 100%.

Health facilities have been set up to diagnose and treat malaria. Services are open 24 hours a day, free of charge, and stocked with quality-assured ACTs. Intensive monitoring of therapeutic efficacy continues.

What the global plan aims to do is add another safeguard by extending vigilance and preventive measures to all endemic countries.

The emergence of artemisinin resistance has been a wake-up call. It gives us another compelling reason to step up existing control measures with the greatest sense of urgency.

The global plan spells out clearly what needs to be done. It is my sincere wish that the international community will seize this unprecedented opportunity.

Thank you.

http://www.who.int/dg/speeches/2011/malaria_plan_20110112/en/index.html

 

保护我们治疗疟疾的最佳武器

世界卫生组织总干事
陈冯富珍博士

在全球控制青蒿素耐药性计划启动仪式上的讲话
瑞士日内瓦
2011年1月12日

女士们,先生们,

我们今天发表的报告为保护我们在治疗疟疾方面最有效的武器,即青蒿素,提出了一个高级别计划。此类药物是被称为ACTs的以青蒿素为基础的联合治疗的关键成分。

ACTs是黄金标准。它们是针对作为最致命形式疟疾的恶性疟疾的最有效治疗手段。

在广泛使用并尤其在不明智地使用之后,任何抗疟药物都不可避免地会出现耐药性。联合治疗是延迟形成耐药性的一种慎重战略。

ACTs对疟疾寄生虫实施双重打击。通过联合施用作用机制不同和药效时段不同的药物,ACTs加大了未被一种药物杀死的任何寄生虫被第二种药物杀死的可能性。

这种疗法的效用现在受到威胁。

2008年在柬埔寨与泰国交界处发现疑似青蒿素耐药性的证据,并在2009年得到确认。在大湄公河次区域发现了其它疑似疫源地,但尚未确认。

该地区是历史上出现耐药性疟疾寄生虫的中心地带。历史已告诉我们会发生什么事情。

在过去数十年间,随着耐药性出现、站住脚跟、然后迅速在国际上传播并从而使药物丧失效用,我们一次又一次地失去一线抗疟药物。

今天在启动这一全球计划时,世卫组织与遏制疟疾伙伴们一起,正在努力打破这种历史格局。我们呼吁国际社会利用前所未有的机会之窗。

我们雄心勃勃:要从根源上立刻制止青蒿素耐药性的出现,并从而制止或至少显著延缓进一步的国际传播。

这一机会在疟疾控制的历史中是前所未有的。为什么现在出现机会?

鉴于近期的大力研究,我们对疟疾和耐药性机制有更充分的了解。我希望感谢世界各地,包括疟疾流行国家中成百所研究机构中的研究人员。

他们的工作使世卫组织有可能编纂有史以来经过审评和进行标准化供分析使用的抗疟药物效力研究的最大规模汇编。

警戒程度从未象现在这样高。事实上,自2001年以来在世卫组织的支持下对柬埔寨与泰国交界处一直在大力监测治疗效果。制定了标准化的研究方案以便协助在其它地方开展类似的警戒。

以前从未如此早地发现寄生虫敏感性的最初细微变化。以前从未有过力图从根源上制止耐药性的出现和传播的手段和战略。

以前我们从未作出过如此高度的努力以便实现目标,提前防范历史教会我们预见到的至少某些失败。

我们相信这一计划成功的几率很高。最主要的是,国际社会有义务抓住这一机会。如果我们失败,涉及的利害关系太大。

我可以毫不夸张地说,青蒿素耐药性广泛传播的后果将是灾难性的。

疟疾控制工作在数十年中停滞不前,强化的努力现在终于产生了显著的成果,包括传播率和死亡人数大幅度下降。这些成果令人振奋,推动了减轻疟疾巨大负担的日益增长的动力,尤其是在南撒哈拉非洲。

青蒿素耐药性传播以及ACTs失效,可使艰苦奋斗赢得的这些成就很快消失并会影响可击败疟疾的信念。

如果ACTs开始失效,许多疟疾流行国家没有任何备用药物。耐药性已使多数较陈旧的抗疟药物失去效用。虽然正在加大努力研制新型抗疟药物,但没有近期可见的替代制品。

虽然每年疟疾病例的估计例数不断减少,但仍达到2.23亿例。如此大量的人不能得到有效治疗将是一个不可思议的悲剧。

女士们,先生们,

我还要讲两点。

首先,控制计划不是走旁道,不是分散资源和力量。基本上,为控制耐药性建议的工作也是每个疟疾流行国家中为控制疟疾所需要做的工作。

我们必须通过加强使用药物蚊帐或更多地进行室内杀虫剂滞留喷洒,继续减少传播。

各国必须停止向每个发烧的儿童分发ACTs。应当象对待珍贵和易碎的商品一样对待ACTs,并只在确定诊断化验结果的基础上施药

这是完全可行的。现在已有费用不高和质量有保证的快速诊断测试法,一直到社区级都可以使用。

我们必须确保确诊的每位疟疾患者得到有质量保证的最佳药物。我们必须更加努力制止假冒伪劣药品的销售。我们必须结束由小贩出售单片药物以取代全程治疗的做法。

我们必须禁止推销仅含青蒿素并因此缺少联合治疗双重打击力量的疗法。

必须制止这种做法,因为这种做法会加快耐药性的产生,也会破坏良好的整体疟疾控制。

我要说的第二点是,我们在2011年开始时启动全球计划,但这不是说尚未采取大力行动。正好相反。

2008年底在柬埔寨与泰国交界处立刻开始了控制工作,当时甚至还未确认出现耐药性。药物蚊帐的家庭普及率达到近100%。

建立了卫生设施以诊断和治疗疟疾。每天24小时提供免费服务,并备有质量获得保证的ACTs。正在继续密切监测治疗效果。

全球计划的目的是要把警戒和预防措施扩大到所有疟疾流行国家,从而增加又一层保护。

青蒿素耐药性的出现敲响了警钟。它为我们提供了具有说服力的又一个理由,促使我们以更大程度的紧迫感加强现有控制措施。

全球计划明确说明需要开展的工作。我真挚地希望国际社会把握这一前所未有的机遇。

谢谢

http://www.who.int/dg/speeches/2011/malaria_plan_20110112/zh/index.html

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