美国可能在本周失去麻疹消除状态。在美国遭遇35年来最严重的麻疹疫情之际，这一事件很可能坐实卫生部长小罗伯特·F·肯尼迪干预疫苗政策的政治遗产。
The United States could lose its measles elimination status this week, an event likely to cement health secretary Robert F. Kennedy Jr’s legacy of meddling in vaccine policies amid the worst outbreak of the virus in the US in 35 years.
如果美国失去无麻疹状态，它将加入加拿大以及数个欧洲和亚洲国家的行列，这些国家曾消除麻疹，但麻疹后来又卷土重来。
If the US loses its measles-free status, it would join Canada and several European and Asian nations that had eliminated the disease only for it to return.
“这是巨大的倒退，”保罗·奥菲特博士说。他是费城儿童医院疫苗教育中心主任、传染病科主治医师，也是肯尼迪的著名批评者。
“That is a tremendous step backwards,” said Dr Paul Offit, director of the Vaccine Education Center, an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, and a prominent critic of Kennedy.
一个由八名独立专家组成的小组将在华盛顿特区审议流行病学证据，该小组隶属于世界卫生组织（WHO）的区域分支机构泛美卫生组织（PAHO）。最终决定将由泛美卫生组织主任作出。
A panel of eight independent experts will consider the epidemiological evidence in Washington DC, part of a group called the Pan American Health Organization (PAHO), a regional branch of the World Health Organization (WHO). The PAHO director will make the final call.
“无论泛美卫生组织怎么说，麻疹现在已在美国地方性流行。麻疹已在美国站稳脚跟，”奥菲特说。“我们今年会看到它，明年也会看到它”，因为美国“大幅降低了”疫苗接种者的百分比。
“Independent of what PAHO says, measles is now endemic in the US. Measles has a foothold in the US,” said Offit. “We’re going to see it this year, we’re going to see it next year,” because the US “critically decreased the percentage” of people vaccinated.
根据约翰斯·霍普金斯大学国际疫苗获取中心追踪器的数据，美国正处于自1991年以来最严重的麻疹疫情之中，全国病例超过5400例。仅今年一年，宾夕法尼亚州已有六人死亡，纽约州一名儿童在选举日死亡，几天后威斯康星州一名婴儿死亡。美国几乎所有州都有活跃疫情。
The US is in the midst of its worst measles outbreak since 1991 with more than 5,400 cases nationally, according to the Johns Hopkins University International Vaccine Access Center tracker. Just this year, six people have died in Pennsylvania, a child died in New York on election day and an infant died in Wisconsin days later. Nearly every US state has an active outbreak.
麻疹被认为是医学已知最具传染性的疾病之一。绝大多数美国人给自己和孩子接种疫苗，但麻疹极强的传染性意味着，即便免疫水平仅小幅下降，也足以让它传播。每1000名感染者中有1至3人死亡，约五分之一的未接种疫苗感染者需要住院治疗。两剂麻疹、腮腺炎和风疹（MMR）疫苗对该病的有效性为97%。
Measles is considered one of the most infectious diseases known to medicine. The overwhelming majority of Americans vaccinate themselves and their children, but the sheer contagiousness of measles means even small dips in immunity allow it to spread. It kills one to three people per 1,000 people and hospitalizes about one-in-five unvaccinated people who are infected. Two doses of the measles, mumps and rubella (MMR) vaccine is 97% effective against the disease.
尽管消除状态是一项正式的公共卫生认定，但失去这一状态会对普通美国人产生切实影响。仅举一例，俄亥俄州克利夫兰市公共卫生主任戴维·马戈利乌斯博士就警告人们，要找到自己的麻疹疫苗接种证明，以防接触麻疹阳性患者。
Although elimination status is a formal public health designation, its loss has real effects on everyday Americans. In just one example, Dr David Margolius, the Cleveland, Ohio,director of public health, is warning people to find proof of their measles vaccination in the event they’re exposed to a measles-positive patient.
“现在是去找出那份证据的时候了，因为现在这是可能发生在你身上的真实日常生活事件，”马戈利乌斯说。他同时也是大城市健康联盟的当然理事。没有证明，患者将面临抽血做免疫学检测或21天隔离。
“Now is the time to go and find that evidence, because now this is a real day-to-day life thing that could happen to you,” said Margolius, who is also a director-at-large of the Big Cities Health Coalition. Without proof, patients face either an immunology blood draw or a 21-day quarantine.
克利夫兰卫生当局今年已经做了大量侦探工作，追踪在医院候诊室和电梯里接触过麻疹患者的人。
Cleveland health authorities have already done a tremendous amount of detective work this year to track down people exposed to measles patients in hospital waiting rooms and elevators.
“我们联系人们，对大多数人来说，包括我自己在内，我们都没有个人得过麻疹的经历，”他说。“他们生活里已经有各种事情要应付，现在又接到这个电话。”感染麻疹的人群类型也发生了变化。1963年疫苗首次获批时，麻疹被视为一种儿童疾病。大多数儿童在五岁前感染该病。
“We reach out to people and for most people, including myself, we have no personal experience with measles,” he said. “They’ve got everything else going on in their life, and now they’re getting this call.”The types of people who contract measles has also changed. In 1963, when the vaccine was first licensed, measles was considered a childhood disease. Most children contracted the disease by the age of five.
“现在你看到流行病学正在发生变化，”奥菲特说。宾夕法尼亚州三分之二的麻疹感染者是成年人，而研究人员对这一群体掌握的信息很少。甚至有母亲生下了感染麻疹的婴儿。“现在，你看到了我们以前完全没见过的情况——先天性麻疹。”消除状态可能丧失之际，正值特朗普政府处境不稳之时。共和党人刚刚在中期选举中遭遇历史性惨败。
“Now you’re seeing the epidemiology shift,” said Offit. Two-thirds of people infected with measles in Pennsylvania are adults, a group on which researchers have little information. Mothers have even given birth to babies with measles. “Now, you’re seeing something we just didn’t see at all – congenital measles.”The potential loss of elimination status comes at a tenuous moment for the Trump administration. Republicans just endured a historic drubbing in the midterm elections.
几位新的民主党医生和科学家预计将进入国会，他们承诺要追究肯尼迪的责任。与此同时，特朗普任命斯蒂芬·米勒为幕僚长，进一步强化了他对疫苗敌对立场的承诺。
Several new Democratic doctors and scientists are slated to come into Congress on promises to hold Kennedy accountable. At the same time, Trump has doubled down on his commitment to vaccine antagonism with the appointment of Stephen Miller as chief of staff.
“Stephen Miller 是我身边最坚定的 Maha 支持者，”Kennedy 在一份关于 Miller 任命的声明中表示，“是时候释放‘Kraken’了。”与此同时，美国疾病控制与预防中心（CDC）的应对能力因特朗普政府的干预而大幅受损。该机构损失了最高达三分之一的员工，Kennedy 干预了该机构关于麻疹死亡病例的报告，并散布了关于麻疹疫苗的错误信息。
“Next to me, Stephen Miller is the strongest Maha supporter in the administration,” Kennedy said in a statement about Miller’s appointment. “It’s time to unleash the Kraken.”Meanwhile, the capacity of the Centers for Disease Control and Prevention (CDC) to respond has been significantly hampered by the Trump administration. The agency has lost up to one-third of its staff, Kennedy has interfered in the agency’s reporting of measles deaths and has spread misinformation about the measles vaccines.
即便如此，Margolius 并未把所有责任都归于 Kennedy 的头上。疫苗犹豫情绪在特朗普上任前就已在上升，疫情期间的各种干扰也是真实存在的。
Even so, Margolius doesn’t lay all the blame at Kennedy’s feet. Vaccine hesitancy was increasing before Trump took office, and pandemic-era disruptions were real.
“有人将这归咎于我们的卫生部长，我当然认为他可以做得更多来帮助局势，而不是损害局势，但我认为病例数量在全球范围内正在上升，”他说，“即使在一个更亲公共卫生的政府下，这种情况也可能发生。”特朗普政府第二任期也推出了多项广泛变革，这些变革对全球根除麻疹的目标构成挑战。特朗普 2024 年的首批行动包括撤出世界卫生组织（WHO）和全球疫苗联盟（GAVI）。
“Some of the narrative has been to pin this on our health secretary, which certainly I think he could do much more to help the situation rather than hurting the situation, but I do think the case count is climbing everywhere,” he said. “This could happen even under a more pro-public health administration.”The second Trump administration also made broad changes that challenge measles elimination globally. Some of Trump’s first acts in 2024 included withdrawal from the World Health Organization (WHO) and the Global Vaccine Alliance (GAVI).
GAVI 为印度和马拉维等国家提供麻疹疫苗。据世界卫生组织统计，全球约有 95,000 例麻疹死亡，主要发生在五岁以下未接种疫苗的儿童中。
GAVI provides measles vaccines to nations such as India and Malawi. There are about 95,000 measles deaths globally, according to the World Health Organization, mostly in unvaccinated children under five years old.
在国内，共和党人还实施了历史上最大规模的联邦健康保险削减，预计这些变化将导致至 2034 年为止超过 1700 万人失去保险。这对像 Margolius 这样的人造成了挑战，他们在保险覆盖不稳定的情况下，仍努力为人们接种疫苗。
At home, Republicans also enacted the largest ever federal cut to health insurance, changes expected to result in more than 17 million people losing insurance through 2034. That has challenged people such as Margolius, who struggle to connect people with vaccines when their health insurance coverage is unstable.
“直到我们重新加入 WHO 并与全球各地的健康机构合作……这将继续发生，”Margolius 说。
“Until we can rejoin the WHO and cooperate with other health agencies all over the world ... This will continue,” said Margolius.