Crawford R, Rutz D C, Evans D P
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Center for Humanitarian Emergencies, Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
Public Health. 2016 Dec;141:186-191. doi: 10.1016/j.puhe.2016.09.018. Epub 2016 Oct 22.
In late 2013, an Ebola outbreak quickly grew into an epidemic of extraordinary magnitude, killing more people than all previous Ebola outbreaks combined. Although the epidemic was unprecedented, the world had previously experienced several acute public health emergencies requiring global coordination. HIV/AIDS, SARS and H1N1 tested global response, and in each case coordination proved problematic, making the 2013-2015 Ebola epidemic no exception. The purpose of this project was to identify persistent vulnerabilities within global public health emergency response and to identify areas for future research and improvement.
Non-systematic review and qualitative interview study.
Using PubMed and Google, a comprehensive search of articles connected to the HIV/AIDS, SARS, H1N1 and Ebola responses was conducted. Then, 21 key responders involved in those emergencies, primarily from the US Centers for Disease Control and Prevention, participated in in-depth interviews. The content analysis and in-depth interview data were analysed using MAXQDA analysis software.
A number of issues emerged, including cultural and political clashes within relevant agencies and a lack of confidence in those agencies, policy barriers that hinder long-term international response, a shortage of personnel and resources, itemized funding streams that limit flexibility to direct resources, and challenges to deploying responders internationally.
The data suggest that the world remains ill prepared to handle sustained responses and global pandemics. The study identified major vulnerabilities persistent within US-led global public health response and offers recommendations for further focused research to fully understand why these challenges persist.
2013年末，埃博拉疫情迅速演变成一场规模空前的流行病，死亡人数超过此前所有埃博拉疫情死亡人数的总和。尽管此次疫情前所未有的严重，但世界此前也曾经历过几次需要全球协调应对的急性公共卫生突发事件。艾滋病毒/艾滋病、非典和甲型H1N1流感考验了全球应对能力，而且在每种情况下，协调都存在问题，2013 - 2015年的埃博拉疫情也不例外。本项目的目的是确定全球公共卫生应急响应中持续存在的薄弱环节，并确定未来研究和改进的领域。
非系统性综述和定性访谈研究。
利用PubMed和谷歌，全面检索与艾滋病毒/艾滋病、非典、甲型H1N1流感和埃博拉应对相关的文章。然后，21名主要来自美国疾病控制与预防中心、参与过这些突发事件应对的关键响应人员参加了深度访谈。使用MAXQDA分析软件对内容分析和深度访谈数据进行分析。
出现了一些问题，包括相关机构内部的文化和政治冲突以及对这些机构缺乏信心、阻碍长期国际应对的政策障碍、人员和资源短缺、限制资源调配灵活性的逐项资金流以及在国际上部署响应人员面临的挑战。
数据表明，世界在应对持续响应和全球大流行方面仍准备不足。该研究确定了美国主导的全球公共卫生应对中持续存在的主要薄弱环节，并为进一步有针对性的研究提供了建议，以全面了解这些挑战为何持续存在。
