Le Turnier P, Leport C, Martin P, Jadand C, Hoen B, Guégan J-F
Service des maladies infectieuses et tropicales, Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France; Centre d'investigation clinique unité d'investigation clinique 1413, institut national de la santé et de la recherche médicale, centre hospitalier universitaire de Nantes, Nantes, France.
IAME, UMR 1137, Inserm, université Paris Diderot, Paris, France; Unité de coordination du risque épidémique et biologique, Assistance publique-Hôpitaux de Paris, Paris, France.
Rev Epidemiol Sante Publique. 2020 Apr;68(2):133-136. doi: 10.1016/j.respe.2019.09.009. Epub 2019 Dec 18.
The social, economic and political consequences of emerging infectious disease (EID) may escape the sphere in which they first arise. In recent years, many EIDs have revealed the close links between human, animal and plant health, highlighting the need for multi-scale, multisectorial EID management. Human beings play a dual role in EID because they can promote their development through numerous human-environment interfaces and expanding international trade. On the other hand, their ability to analyze, interpret and act on the determinants of EID allows them to access the expertise necessary to control these EIDs. This expertise must be constantly adapted to remain relevant as the EID evolves, particularly in its virulence or transmission channels. Flexibility should become an inherent part of the expertise-based decision-making process even if it means going backwards. A certain degree of transparency and feedback to citizens is necessary for the acceptability of political decisions basing on expertise. A key step in the management of EID is the appropriate management of the early signal of infectious emergence. This step combines multidisciplinary skills allowing access to the best pathway for containing EID by implementing early countermeasures adapted to the situation. New digital technologies could significantly improve this early detection phase. Finally, experts have a fundamental role to play because they are located at the interface between operational actors and decision-makers, which allows multidirectional feedback, ideally in real time, between professional actors and decision makers. To combat current and future EIDs, expertise should be based on a multi-sectorial approach, promotion of collegiality and continuously adaptation to the evolving nature of EIDs.
新发传染病(EID)的社会、经济和政治后果可能会超出其最初出现的范围。近年来,许多新发传染病揭示了人类、动物和植物健康之间的紧密联系,凸显了进行多尺度、多部门新发传染病管理的必要性。人类在新发传染病中扮演着双重角色,因为他们能够通过众多的人类与环境的界面以及不断扩大的国际贸易来促进新发传染病的发展。另一方面,人类分析、解读新发传染病的决定因素并据此采取行动的能力,使他们能够获取控制这些新发传染病所需的专业知识。随着新发传染病的演变,尤其是在其毒力或传播途径方面,这种专业知识必须不断调整以保持相关性。灵活性应成为基于专业知识的决策过程的固有组成部分,即使这意味着要倒退。为了使基于专业知识的政治决策具有可接受性,向公民提供一定程度的透明度和反馈是必要的。新发传染病管理中的一个关键步骤是对传染病出现的早期信号进行适当管理。这一步骤需要综合多学科技能,以便通过实施适合具体情况的早期应对措施,找到控制新发传染病的最佳途径。新的数字技术可以显著改善这一早期检测阶段。最后,专家发挥着根本性作用,因为他们处于业务行为体和决策者之间的界面位置,这使得专业行为体和决策者之间能够进行多方向反馈,理想情况下是实时反馈。为了应对当前和未来的新发传染病,专业知识应基于多部门方法、促进共同合作并不断适应新发传染病不断演变的特性。