School of International and Public Affairs, The Earth Institute, Columbia University, New York, NY 10027, USA.
Philos Trans R Soc Lond B Biol Sci. 2013 Jun 24;368(1623):20120149. doi: 10.1098/rstb.2012.0149. Print 2013 Aug 5.
An infectious disease will be eradicated only if it is eliminated everywhere, including in the hardest-to-reach, most vaccine-wary communities. If eradication is successful, it promises a dividend in the form of avoided infections and vaccinations. However, success is never certain unless and until eradication is achieved, and claiming the dividend means bearing the possibly great risk of re-emergence. Economic analysis of eradication evaluates these risks and rewards relative to the alternative of 'optimal control', and also exposes the incentives for achieving and capitalizing on eradication. Eradication is a 'game', because some countries may be willing to eliminate the disease within their borders only if assured that all others will eliminate the disease within their borders. International financing is also a game, because each country would rather free ride than contribute. Finally, for diseases such as polio, capitalizing on eradication is a game, for should any country continue to vaccinate in the post-eradication era using the live-attenuated polio vaccine, the countries that stop vaccinating will be exposed to the risk of vaccine-derived polioviruses. In the framework developed in this paper, eradication is a seductive goal, its attainment fraught with peril.
只有在包括最难以到达和对疫苗最持怀疑态度的社区在内的所有地方消除传染病，才能将其消灭。如果消灭成功，将以避免感染和接种疫苗的形式带来红利。然而，除非消灭成功，否则成功永远不会确定，声称获得红利意味着承担重新出现的巨大风险。对消灭的经济分析评估了相对于“最佳控制”的替代方案的这些风险和回报，还揭示了实现和利用消灭的动机。消灭是一种“游戏”，因为一些国家可能愿意在其境内消灭这种疾病，前提是确保所有其他国家也在其境内消灭这种疾病。国际融资也是一种游戏，因为每个国家都宁愿搭便车而不愿出资。最后，对于脊髓灰质炎等疾病，利用消灭也是一种游戏，因为如果任何国家在消灭后继续使用减毒活脊髓灰质炎疫苗在接种疫苗，停止接种疫苗的国家将面临疫苗衍生脊髓灰质炎病毒的风险。在本文所制定的框架内，消灭是一个诱人的目标，其实现充满危险。
