抗生素的抗藥菌-(完結篇)

抗生素的抗藥菌-(完結篇)-突顯出我們過度使用

全球共享的資源

《編按》

本文作者乃美國MIT(麻省理工學院) 著名著作教授。內容由抗生素之濫用談起到空氣汙染，兩件事表面上不相關，其實都是危害人類健康至鉅之事。兩件事皆與『人性』與『公德心』息息有關，更與『自私自利』脫不了干系。而任何嚴刑峻法無法遏制公害之盛行時，唯一良方只能依賴自私心的「約束」。

There are other modern commons that are less immediately visible, but remain at risk. The CDC lists 16 vaccine-preventable diseases children face — measles, mumps, whooping cough, and more. Vaccination against such illnesses doesn’t just protect the kid getting jabbed. When enough of any group is immune to a given illness, so-called herd immunity emerges. The disease agent can’t get enough of a foothold in a community to threaten those who haven’t been vaccinated (such as infants too young for the shots or people with compromised immune systems). Those who choose not to vaccinate exploit the communal immunity others’ shots produce.

還有其他現代公有事件的情形，雖非不那麼立即可見, 但仍有危險。CDC 列出了16種可預防的兒童所面臨的疾病疫苗-至少含麻疹、腮腺炎、百日咳等。針對這種疾病的疫苗接種，不僅能保護孩子的被感染。當足夠的任何群體對某種疾病有免疫時, 所謂群體免疫群就會出現。這種疾病的代理人，在社區中不能獲得足夠的安穩立足點，來威脅那些沒有接種疫苗的人 (比如嬰兒太小, 不能打疫苗針預防，或者免疫系統受損的人)。那些選擇不接種疫苗的人，會利用其他人的疫苗注射產生的免疫，來保護自己。

But that only works as long as vaccination rates remain high. Over the last two decades, objections to vaccination have spread, partly in response to a false claim of a vaccine-autism link published in 1998, and outbreaks of preventable illnesses have begun to recur. Here, the commons is the public’s willingness to accept vaccination; the exploitation lies in the use of others’ immunity to protect oneself without vaccination. The tragedy of this commons would come if herd immunity were to fail. If that happens, more and more people will fall ill needlessly. Some will die.

但須要疫苗接種比率居高不下, 這項工作才能奏效。在過去的二十多年來, 拒絕接種疫苗的意見已經擴散, 部分是因為1998年發表了，一項關於自閉症疫苗的錯誤說法, 另一因素為可預防疾病的暴發已經開始復發。在此，有利公共的想法是，大眾有接受疫苗接種的意願; 而佔別人便宜的目的，在於利用他人的免疫力來保護自己，而不接種疫苗。如果群組的免疫失敗, 這場公有的悲劇就會發生。如果發生這種情況, 越來越多的人會不必要地生病。有些人甚至會死。

THE ACTUAL experience of traditional commons suggests that, under the right circumstances, a commons can be remarkably robust. Garrett Hardin’s hypothetical villagers had unfettered access to the commons, much as doctors and farmers have been little deterred in their use of antibiotics. But access to the village green in historic England was never so unrestricted. Specified rights were clearly defined and explicitly allocated. There were rights of pasture — the allowance to run different kinds of livestock in specified numbers — and rights to fish, gather wood, cut sod, and so on, with each household’s share explicitly constrained.

傳統的共用資源的實際經驗表示, 在適當的情況下, 一件共用資源可以非常健壯有力。雖然醫生和農民在使用抗生素上，幾乎沒有受到什麼禁止威懾，但加勒特的假設性村民們，卻不受限制地進入了公共場所,。在歷史悠久的英格蘭, 進入鄉村綠地的機會從未如此不受限制。特定權利已被明白確定，並明確分配。過去有牧場的權利--准許在指定數量的情況下，經營不同種類牲畜--和捕魚權、採集木材、砍伐草皮等等, 但每個家庭的分配額都明白地受到限制。

Anyone reckless enough to take more than their share could face swift and rough correction. Just ask the rabbit-keepers of Charnwood forest in Leicestershire.

任何不計後果地取用，比他們應得的份額更多的人，可能面對迅速而粗暴概略的糾正。只要問一下，在萊斯特郡强伍森林的兔子飼養員就明白。

 Some of the wealthiest landowners around that commonly held woodland expanded their commercial rabbit operations, which led to the overgrazing of the best pasturage. The local villagers rioted and marched, advancing through the common and declaring that “all rabbits are vermin.” They dug up the warrens and killed and sold any rabbits they could catch. When this defense of traditional rights went to court, the rioters won.

一些在那共有的林地附近，最富有的土地擁有者，擴大了他們商業用途的養兔區域, 而導致最佳畜牧場的過度被放牧。因此當地村民舉行暴動和示威遊行, 通過共同共有土地, 並宣佈 『所有的兔子都是害蟲』。他們挖掘養兔場, 殺死並賣掉了任何他們能抓到的兔子。當這件衛護傳統權利的事件被告上法院時, 暴亂者卻贏了官司。

Long-lived commons were always regulated. Those who depended on them had to accept restraints on their freedom of action, and such agreements had to extend to all those with access to whatever was being protected. Contemporary global commons require the same: international regimes and broad agreements to preserve what individual nations cannot own but could wreck. Market-based responses can work in certain circumstances. It’s possible, sometimes, simply to privatize formerly public resources. That’s what happened when most English commons were “enclosed” and divvied up among local landowners, and it is the theory behind, for example, proposed responses to the traffic jams of a commonly shared free road that would impose toll payments that allow some drivers to rent access to private, open lanes.

長期居住的共同區總是一直被調控管制。那些依賴他們的人，必須接受對他們行動自由的限制, 這種協定必須擴展到所有「有機會正受到保護的公地」。當代全球公有物之要求也相同: 國際制度和廣泛的協定, 以維護任何個別國家不能擁有, 但可能破壞之處。基於市場的反應在某些情況下可以奏效。有時,把以前的公共資源私有化，是可能的,。這就是當大多數英國公地被『封閉』，並在當地地主之間瓜分的時候所發生的情形, 但背後有一個隱藏的理論, 例如, 對一條共用的免費道路的交通堵塞，而提出的應對措施, 這措施是強加收費, 而允許一些司機，能出進私人開放的車道(如美國收費的共用車道-Carpool lanes)。

WHATEVER ONE may feel about the justice or social consequences of such approaches — Harvard philosopher Michael Sandel’s “What Money Can’t Do” has made a powerful argument against such solutions — many crucial modern commons don’t readily privatize. Cash can encourage the building of more roads, but it’s difficult indeed to price microbial resistance. Enclosing the atmosphere or the ocean is impossible, so it will take some international form of regulatory constraint to slow or stop the accumulation of carbon in the world’s climate system. Herd immunity can’t readily be “owned.”

不管人們對這種應對措施的公正性，或社會後果有什麼看法--哈佛大學哲學家-邁克. 桑德爾的看法-『有金錢不能做的事』- 已經對這種解決辦法，提出了強而有力的争論--那就是，許多重要的現代公共資源並不輕易隨便私有化。有錢可以鼓勵興建更多的道路, 但病菌的抗藥性，確難以評估出其價格。要封閉大氣層或海洋是不可能的, 因此它將採取一些國際形式的監管限制, 以減緩或阻止碳在全球氣候系統中的積累。無法輕易地『擁有』群體的免疫力。

To ensure the long-term health of each of today’s commons — our shared systems of survival — the way we use them has to be constrained. How that regulation occurs can vary. A carbon tax, essentially putting a price on pollution, may be an effective way to address climate change. Preserving the antibiotic commons may likely require multiple approaches, from boosting support for research into new antimicrobial drugs and treatments, to negotiating international agreements restricting antibiotic use in agriculture and uncontrolled distribution of antibiotics to the public, to training doctors to avoid prescribing unneeded or ineffective drugs.

為了確保今天公用土地上，每一個人的長期健康--即我們共有的存活系統--, 我們使用它們的方式必須受到限制。如何規定，可能不盡相同。實質上是要對污染付出代價的碳『排放稅』,可能是解決氣候變化的一條有效途徑。而保存抗生素之共用性，可能需要多種對策, 從促進對新抗菌藥物和治療的研究支持, 到國際協定的磋商，以限制農業使用抗生素, 以及毫無控制地對大眾，分配使用抗生素, 到訓練醫生，避免不必要或不正確藥物的處方。

To save certain human goods, we must accept the idea of restricting some human choices.為了拯救某些人類產品, 我們必須接受，限制某些人類選擇的想法。

Such a commitment does not now exist at the center of American power. President Trump’s paint-by-numbers approach to rule-making — his order that federal agencies cut two regulations for every new one they issue — makes a mockery of the notion of regulatory goals to deal with crises within our physical and biological habitats. “America First” rhetoric is utterly at odds with the global nature of critical dangers. Microbes trade resistance from strain to strain and know no borders; winds blow to and from wherever they will; the same oceans lap against every shore. Nothing in the statements of the Trump administration or the Republican leadership in Congress suggests that the current American government recognizes such natural systems as inherently global and jointly held inheritances, in need of explicit care.

這種承諾現在並不存在於美國的權力中心。川普總統的「按照數字順序塗畫」，來制定規則-就是他下令聯邦機構，在他們提出的每一個新的問題中，删減兩條規定的做法，嘲弄了管理目標的概念，此概念提及對付我們的物質和生物生境中的危機處理。『美國第一』 的言辭完全與嚴重危險的全球性質相悖。病菌的抗藥性從應變到應變,且毫無忌憚地到處漫延; 傳染風向自如; 如同海洋拍打著每一個海岸。川普政府或國會中，共和黨領導階層的聲明，沒有任何東西表明, 目前的美國政府認為, 這種自然系統本質上是全球性，也是共同持有的遺產, 也需要明確的照顧。

Last fall, a woman in Reno died of a disease that until recently was easy to cure. That’s sad. But this death was not inevitable, if only America and nations around the world had acted on a problem that was understood more than 70 years ago. Given what we know now, how many more such tragedies are we willing to tolerate?

去年秋天, 雷諾市的一位婦女，死于一種直到最近才很容易治癒的疾病。真可悲。只要全世界的國，包括美國和其他國家，對一個70年多前，就已經理解的問題採取行動的話, 這一死亡事件就不是不可避免的。鑒於我們現在所知, 我們願意容忍更多的這樣悲劇？

Thomas Levenson is a professor of science writing at MIT and an Ideas columnist. His latest book is “The Hunt for Vulcan.”

湯瑪斯. 利文森是麻省理工學院的科學著作教授, 也是一位思想專欄作家。他最新的著作是『尋找火神』。

全文完

Justin Lai 編譯

12/17/2017