第69屆「世界衛生大會」（WHA）衛生福利部部長專文
全球衛生安全 – 臺灣不會缺席
資料來源：衛生福利部
2003年全球爆發嚴重急性呼吸道症候群(SARS)大流行，導致774名病患死亡，影響當年國際經貿、旅遊活動甚鉅，並造成重大經濟損失。近幾年來，新興傳染病如伊坡拉、中東呼吸症候群冠狀病毒感染症(MERS)持續對人類健康及生命安全造成威脅，且因交通運輸的便利而更加快速散播到全球各地。
中南美洲去年底爆發茲卡(Zika)疫情威脅全球，依據WHO2014年的統計數據指出，威脅全球的傳染病中，有17%是由病媒蚊引起的疾病，每年導致75萬人死亡，尤以登革熱在全球超過100個國家造成流行為甚，全球有四分之一的人口處在登革熱威脅中。臺灣去年的登革熱確定病例為43,419例，是自1987年以來最嚴重的一次，而傳播茲卡的病媒蚊與傳播登革熱的病媒蚊相同，所以臺灣亦面臨茲卡疫情的威脅。
我國深刻體認到傳染病無國界，因此，自2009年正式加入國際衛生條例(IHR 2005)機制，與WHO建立直接的對口單位後，即積極參與各項運作，與全球各國共同攜手面對公共衛生的威脅。同時提升我國疾病監測與應變量能，使我國具備符合IHR (2005)規範之基本核心能力，強化我國衛生安全。此外，為與全球共同對抗西非伊波拉疫情，臺灣在2014年捐贈10萬套個人防護裝備及100萬美元提供國際救援團隊第一線人員使用；並在過去一年間，舉辦四場國際訓練營，提升亞太及東南亞區域偵測與因應伊波拉、MERS、登革熱及茲卡等國際重大傳染病之防疫量能，計有14個國家的衛生防疫官員或實驗室專業人員參加，形成區域網絡，共同對抗疫病之爆發流行。
為因應蚊媒傳染病之威脅，我國擬定四大應變策略，包括醫療整備、境外防疫、邊境檢疫及病媒控制，以建構國內防疫網。然而除了相關病媒控制策略外，發展有效的疫苗及適切的臨床管理措施亦為防治蚊媒傳染病之最佳利器。此外，我國亦面臨流感大流行與季節性流感之威脅，特別是老年人族群感染流感病毒後，易導致併發症而住院。因此，為防範流感疫情發生，我國每年鼓勵國人施打季節性流感疫苗，提高疫苗接種完成率，以達到群體免疫效果。
臺灣與其他國家一樣，皆無法倖免於全球流感大流行之挑戰與威脅，為因應新型流感病毒肆虐，臺灣除了持續加強流感大流行因應整備計畫外，亦積極參與國際合作網絡，與國際分享流感病毒資訊及防治經驗。另為促進全球衛生安全、快速偵測及防範疫病爆發流行，美國與世界衛生組織(WHO)，世界動物組織(WOAH)及世界農糧組織(FAO)共同發起一項名為「全球衛生安全綱領」的夥伴關係，使全球各國能儘速符合IHR(2005)規範之基本核心能力要求，並藉此深化WOAH會員國落實「獸醫服務體系評估」(PVS)規範。臺灣亦依循此架構目標，推展人醫與獸醫疫病防治合作計畫，建構防疫一體的傳染病防治體系，對抗各項新浮現疫病之挑戰與威脅；同時進行整合資源、組織重整，成立國家蚊媒傳染病研究所，協助地方政府對抗疫病。
疾病無國界，星星之火足以燎原，一地的疫情控制不好即可能造成全球大流行，因此，維護全球衛生安全亟需全體人類共同努力，確保最佳量能因應公共衛生威脅與挑戰。臺灣將積極參與國際事務，持續推動雙邊及多邊合作計畫，協助亞太及東南亞鄰國提升該國基本應變能力，確保全球衛生安全不再因缺乏溝通及透明度而產生致命性盲點。
Taiwan’s International Participation is Vital to Ensuring Global Health Security
According to the WHO estimate released on April 21, 2004, a total of 774 lives were claimed in the SARS outbreak in 2003. Far beyond the nations where it claimed the most victims, SARS traumatized the world with vast economic disruptions, deeply impacting international trade and travel that year and in the nervous months that followed.
Yet such threats are far from over: emerging infectious diseases such as Ebola and MERS have followed. These are the threats we understand a little about – yet what we really have to fear are the threats we cannot name. Even as global health experts gather, new and unmapped outbreaks can spread rapidly across the globe. More rapidly than ever, arguably, as air travel statistics show that more people are flying, with more of the world than ever within a day’s travel.
Zika virus emerged in South America late last year, and has since swept across every continent, challenging disease control efforts worldwide. The World Health Organization in 2014 estimated that vector-borne diseases account for 17% of the global burden of all infectious diseases, killing up to 750,000 people each year. Dengue, the fastest-growing vector-borne disease, is endemic in more than 100 countries – with four out of ten people worldwide potentially at risk. Last year, Taiwan confirmed a total of 43,419 indigenous cases, which was one of the most severe dengue outbreaks since 1987. Since Zika virus is transmitted by the same mosquito species that transmits dengue virus, Taiwan also faces increased risk of a Zika virus outbreaks.
Because we know infectious diseases do not respect boundaries, Taiwan has fulfilled its International Health Regulations responsibilities since 2009, when we were officially included in the implementation framework. We have established an IHR Contact Point with WHO to enable regional and global responses to public health threats. We assessed and improved our surveillance and response capacities to meet the Annex 1B IHR core requirements in a timely manner. Taiwan closely monitors international trends to optimally promote and enhance health security. In response to Ebola in West Africa, we provided 100,000 sets of Personal Protective Equipment and donated US$1 million to international Ebola aid efforts in 2014. Since then, we organized four training workshops for Asia-Pacific and Southeast Asian health and laboratory workers to improve regional capacity to detect and respond to Ebola, MERS, dengue and Zika virus. Participants from 14 countries exchanged experiences and formed regional networks to address such public health threats.
Taiwan has expanded mosquito-related preparedness and response with four strategies: health system planning, prevention of Zika virus importation, border quarantine, and vector control measures. Yet better vector control, effective vaccines, and proper clinical management are still needed.
Our people also face pandemic and seasonal influenza threats. Previous outbreaks have demonstrated that seasonal influenza virus strains can pose major challenges to our health systems. Because the highest hospitalization rates are among senior citizens, we encourage annual seasonal influenza vaccination to achieve herd immunity.
As we continue to improve our influenza-related planning, we retain a global vision and work hard to maintain the widest possible international health networks. To bring together nations to promote global health security, prevent disease outbreaks, detect threats early and respond rapidly, the United States launched the Global Health Security Agenda with WHO, the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (WOAH). Its goals include consistent and widely supported standards like IHR, including the Performance of Veterinary Services Pathway and other health security frameworks. By adopting these frameworks, Taiwan promotes human medicine and veterinary collaborations and constructs a unified system for infectious disease control.
Nothing less than this multilateral and multi-sectoral approach is needed to fight infectious diseases. While we still hope for better alignment with the international community, we are reorganizing at home to pursue best policies and practices. We are establishing a national research institute for vector-borne diseases in southern Taiwan to integrate resources and assist local governments with prevention.
It is no news to this expert audience that a crisis anywhere easily and soon can become a problem everywhere. Global health demands that all populations have optimal capabilities to respond to such threats.
Taiwan will continue to pursue bilateral, multilateral and research cooperation. We can be relied on to assist our Asia-Pacific and Southeast Asian neighbors as they enhance their own response capacities. And for the reasons I have discussed, we will actively participate in international arenas.
Such participation ensures that global health security will never again have deadly blind spots due to blocked communication and a lack of transparency.