Farrugia A
Blood and Tissues Unit, Australian Therapeutic Goods Administration, Woden, ACT, Australia.
ISBT Sci Ser. 2006 Sep;1(1):25-32. doi: 10.1111/j.1751-2824.2006.00007.x. Epub 2006 Aug 15.
Globalization may be viewed as the growing interdependence of countries worldwide through the increasing volume and variety of cross-border transactions in goods and services, and also through the more rapid and widespread diffusion of technology. Globalization is not just an economic phenomenon, although it is frequently described as such, but includes commerce, disease and travel, and immigration, and as such it affects blood safety and supply in various ways. The relatively short travel times offered by modern aviation can result in the rapid spread of blood-borne pathogens before measures to counteract transmission can be put in place; this would have happened with SARS if the basic life cycle of the SARS virus did not include an asymptomatic viraemia. This risk can be amplified by ecological factors which effect the spread of these pathogens once they are transferred to a naïve ecosystem, as happened with West Nile virus (WNV) in North America. The rationalization and contraction of the plasma products industry may be viewed as one aspect of globalization imposed by the remorseless inevitability of the market; the effect of this development on the safety and supply of products has yet to be seen, but the oversight and assurance of a shrinking number of players will present particular challenges. Similarly, the monopolization of technology, through patent enforcement which puts access beyond the reach of developing countries, can have an effect on blood safety. The challenges presented to blood safety by globalization are heightening the tensions between the traditional focus on the product safety - zero-risk paradigm and the need to view the delivery of safe blood as an integrated process. As an illustration of this tension, donor deferral measures imposed by globalization-induced risks such as vCJD and WNV have resulted in the loss of the safest and most committed portion of the blood donor population in many Western countries, leading to an increased risk to safety and supply. It is only through an appreciation of the basic needs of transfusion medicine, including the enunciation of appropriate principles to manage, rather than eliminate, risks, that the challenges imposed by globalization may be overcome.
全球化可被视为全球各国之间日益增强的相互依存关系，这种关系通过货物和服务跨境交易的数量和种类不断增加，以及技术更迅速和广泛的传播得以体现。全球化不仅仅是一种经济现象，尽管它常常被如此描述，它还包括商业、疾病传播、旅行、移民等，因此它以各种方式影响血液安全和供应。现代航空提供的相对较短的旅行时间，可能导致血源性病原体在采取措施防止传播之前迅速传播；如果非典病毒的基本生命周期不包括无症状病毒血症，非典疫情就可能如此发展。一旦这些病原体转移到新的生态系统中，生态因素会加剧这种风险，就像西尼罗河病毒（WNV）在北美的情况一样。血浆制品行业的合理化和收缩，可被视为市场无情必然性所带来的全球化的一个方面；这一发展对产品安全和供应的影响尚有待观察，但对数量不断减少的参与者进行监督和保障将带来特殊挑战。同样，通过专利执法使技术垄断，导致发展中国家无法获得相关技术，这可能会对血液安全产生影响。全球化给血液安全带来的挑战，加剧了传统的产品安全零风险范式与将安全血液供应视为一个综合过程的需求之间的紧张关系。作为这种紧张关系的一个例证，全球化引发的风险（如变异克雅氏病和西尼罗河病毒）所导致的献血者延期措施，已造成许多西方国家最安全、最忠诚的献血人群流失，从而增加了安全和供应方面的风险。只有通过认识到输血医学的基本需求，包括阐明管理风险而非消除风险的适当原则，才能克服全球化带来的挑战。
