Coleman Mikaela, Khan Palwasha Y, Linde Lauren, Williams Phoebe C M, Marais Ben J
Sydney Infectious Diseases Institute (Sydney ID), University of Sydney, Sydney, New South Wales, Australia.
Institute of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University, Munich, Germany.
Curr Opin Pediatr. 2025 Apr 1;37(2):124-136. doi: 10.1097/MOP.0000000000001442. Epub 2025 Jan 29.
Life on earth, as we know it, is changing. The likelihood of more frequent pandemics and disease outbreaks is something that current global healthcare infrastructure is ill equipped to navigate. Human activity is forcing our planet into a new geologic epoch, the Anthropocene, which is typified by increased uncertainty resulting from human disruption of earth's life-giving ecosystems. Plagues and pandemics have always been unfortunate partners to periods of disruption, as they will be again if the frequency and severity of climate and conflict-mediated disasters increase in coming years. If we continue to exceed and degrade the planetary boundaries that protect human health, our children and their children will reap the consequences.
Scientists have defined nine 'safe operating' planetary boundaries for life in all its glorious diversity to thrive on planet earth. Recent evidence suggests that six of these nine boundaries have already been transgressed, but the potential implications for these transgressions upon child health is not well articulated. We highlight how contravention of these boundaries will impact infectious disease risk and humans' ability to survive and thrive. We reflect specifically on how paediatricians are called upon to speak up for the most vulnerable members of our species, young children and as yet unborn future generations.
Post COVID-19 initiatives to improve pandemic preparedness and response are certainly warranted, but pandemic prevention should include committed efforts not to exceed safe planetary boundaries. Willingly exceeding these boundaries has deep moral consequences that are poorly articulated by current ethical frameworks. Paediatricians are best placed to develop and champion the neglected 'third dimension' of medical ethics, recognizing the moral imperative to protect the long-term best interests of children and future generations.
综述目的：如我们所知，地球上的生命正在发生变化。当前全球医疗基础设施难以应对更频繁的大流行和疾病爆发的可能性。人类活动正迫使我们的星球进入一个新的地质时代——人类世，其特点是由于人类对地球赋予生命的生态系统的破坏而导致不确定性增加。瘟疫和大流行一直是动荡时期不幸的伴生物，如果未来几年气候和冲突引发的灾难的频率和严重程度增加，它们将再次出现。如果我们继续超越并破坏保护人类健康的地球边界，我们的子孙后代将自食其果。
最新发现：科学家们已经为地球上各种丰富多彩的生命定义了九个“安全运行”的地球边界。最近的证据表明，这九个边界中的六个已经被突破，但这些突破对儿童健康的潜在影响尚未得到充分阐明。我们强调违反这些边界将如何影响传染病风险以及人类生存和繁荣的能力。我们特别思考了儿科医生如何被要求为我们这个物种中最脆弱的成员——幼儿和尚未出生的后代发声。
总结：新冠疫情后为改善大流行防范和应对而采取的举措当然是有必要的，但大流行预防应包括致力于不超越安全的地球边界。自愿超越这些边界会带来深刻的道德后果，而当前的伦理框架对此阐述不足。儿科医生最有能力发展并倡导医学伦理学中被忽视的“第三个维度”，认识到保护儿童和后代长期最大利益的道德必要性。
