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Tare da Membobin Hukumar Lafiya ta Duniya (WHO) suna yin shawarwarin sabbin yarjejeniyoyin daidaita tsarin kula da cututtukan tare da kasafin kudin shekara-shekara. $ 31.5 biliyan, zai zama ma'ana a ɗauka cewa kowa ya fayyace mene ne ainihin annoba. Abin mamaki ba haka lamarin yake ba. Ko da yake kasashe za su kada kuri'a a cikin watanni biyu kan wani sabon zabe Yarjejeniyar annoba da kuma gyara ga Dokokin Kiwon Lafiya ta Duniya (IHR) don baiwa hukumar ta WHO cikakken ikon sarrafa cutar, babu wata ma'anar da aka amince da ita ta "cutar." Wani mataki na tsanani ake bukata? Yaya ya kamata ya yadu? Wane kashi na yawan jama'a dole ne su kasance cikin haɗari?
Barkewar iyakokin gama gari na sanyi ya dace da ma'anar annoba da yawa, kamar yadda maimaitawar Mutuwar Baƙar fata ta tsakiya. Yawancin yarjejeniyoyin ƙasa da ƙasa ana yin su ne a kusa da matsala mai ma'ana, amma duniya tana gab da saka hannun jarin dubun dubatar biliyoyin ba tare da ingantaccen tushe don hasashen farashi da fa'idodi ba. A takaice dai, babu wata cikakkiyar yarjejeniya kan abin da a zahiri Majalisar Lafiya ta Duniya ke yarda da shi.
Tarihin Cututtuka
Lokacin da muke magana a yanzu game da annoba, yawanci muna nufin yaduwar SARS-CoV-2 a duniya wanda ya fara a cikin 2019. Kalmar ta haifar da hotunan titunan da ba kowa da kuma kasuwannin da ke rufe, na fuskoki masu rufe fuska da kuma mutane masu shiru suna tsaye ƙafa 6. Wannan yana haifar da ma'anar gaggawar da masu tsara manufofin ke amsawa a halin yanzu ta hanyar ƙirar sabbin takaddun cutar. Takaddun rigakafin kamuwa da cuta da yawa, shirye-shirye da martani (PPPR) sun ba da shawarar cewa waɗannan manufofin muhimmin martani ne ta hanyar da'awar a 50% dama na wata cuta mai kama da Covid-19 a cikin shekaru 25 masu zuwa ko kuma batun farashin tattalin arzikin Covid-19 don tallafawa da'awar dawowa kan zuba jari. Wannan hanya tana da matsala yayin da ta kasa bambance tsakanin farashin kai tsaye na cutar da tasirin martanin da ba a saba gani ba.
Etymology na kalmar “cututtuka” ta fito ne daga tushen tsohuwar Girkanci dêmos (δῆμος, mutane, jama'a) tare da “annoba” da “cututtuka.” Prefix pan- (tsohon Girkanci πάν) gabaɗaya yana nufin duka ko kowane; don haka, annoba ta samo asali ne daga tsohuwar manufar Girkawa πάνδημος (na ko na dukan mutane, jama'a). Kalmar yawanci tana nufin cututtuka masu yaduwa, ko da yake wasu amfani da annoba na iya zama gama gari, misali magana game da “cututtukan kiba.” Abin da ya bambanta annoba (da annoba) daga cututtuka masu yawa shine cewa suna shafar adadi mai yawa na mutane a cikin ɗan gajeren lokaci kuma fiye da tsammanin al'ada. Abin da ya banbanta annoba da annoba a cikin zukatan mutane shi ne yaɗuwar ƙasa a kan iyakokin ƙasa.
Wasu daga cikin mafi munin annoba da aka rubuta a tarihi sun biyo bayan mamaye Turai na Amurkawa, suna kawo sabbin ƙwayoyin cuta zuwa yawan jama'a marasa ƙarfi. Irin waɗannan yanayi ba su wanzu a duniya ta yau da kullun. Sauran cututtuka masu lalacewa sun haifar da ƙwayoyin cuta kamar kwalara ko annoba, na biyun shine ke da alhakin Mutuwar Baƙar fata a karni na 14 wanda ya shafe watakila kashi uku na al'ummar Turai. Ingantattun tsaftar tsafta da kuma gano maganin rigakafi tun daga tushe ya rage barazanar kamuwa da cututtukan kwayan cuta, wanda ya zama babban tushen annoba.
Babban annoba ta ƙarshe da duniya ta fuskanta kafin Covid-19 ita ce mura ta Sipaniya ta 1918. Saboda haka, har zuwa annobar cutar ta Covid-19, “tsarin kamuwa da cutar” kusan a duk faɗin duniya ana nufin cutar mura. WHO ta buga na farko shirin cutar mura a cikin 1999, wanda ya motsa shi ta hanyar kamuwa da cututtukan ɗan adam na farko da aka yi rikodin tare da murar avian H5N1. An sabunta shirin sau da yawa, da lokaci na ƙarshe a cikin 2009 kuma ya bayyana da yawa "hanyoyin cutar." Waɗannan su ne ma'anar cutar kawai da WHO ta buga a cikin jagorar hukuma kuma ta keɓance ga mura.
Rikicin Murar Alade
Lokacin da WHO ta ayyana cutar ta H1N1 a matsayin annoba a shekara ta 2009, duk da cewa ba ta fi murar murar yanayi ta yau da kullun ba, wata takaddama ta barke a kan abin da ke bayyana "annoba." Yayin da shirin na WHO ya mayar da hankali kan yaduwar wani sabon nau'in mura ba tare da buƙatar ya zama mai tsanani ba, wani ma'anar a shafin yanar gizon WHO ya karanta tsawon shekaru shida: "Cutar cutar mura tana faruwa ne lokacin da sabuwar kwayar cutar mura ta bayyana wanda yawan bil'adama ba shi da rigakafi, wanda ya haifar da annoba da yawa a lokaci guda a duniya tare da adadi mai yawa na mutuwa."
A mayar da martani ga a tambaya ta wani dan jarida na CNN yana tambayar bukatar yanayin "mai girma" tsanani, an canza ma'anar cutar mura a shafin farko na WHO a watan Mayu 2009, tare da cire kalmar "tare da adadi mai yawa na mutuwa da rashin lafiya." Madadin haka, sabuwar ma'anar ta fayyace cewa "cututtukan na iya zama mai sauƙi ko mai tsanani a cikin rashin lafiya da mutuwa da suke haifarwa, kuma tsananin cutar na iya canzawa a tsawon wannan cutar."
Kodayake ma'anar akan gidan yanar gizon ba ta da wani tasiri mai amfani, gaskiyar cewa canjin ya faru jim kaɗan kafin ayyana muradin alade a matsayin annoba. tuhuma. A watan Maris na 2011, Majalisar Tarayyar Turai ta amince da wani kuduri game da kimanta yadda ake gudanar da cutar ta H1N1 a cikin 2009-2010 a Tarayyar Turai. The Ƙuduri "Ya bukaci WHO da ta sake fasalin ma'anar cutar, la'akari da ba kawai yaduwarta ba har ma da tsananinta."
Peter Doshi ya nuna a cikin wani 2009 labarin "Babban ma'anar cutar mura" wanda ma'anar farko a kan gidan yanar gizon WHO yana kwatanta babban ra'ayi game da annoba a matsayin bala'i a yanayi. Ya yi nuni da wani rubutu a gidan yanar gizon hukumar ta WHO, inda aka bayyana cewa ko da a yanayin da ya fi dacewa na kamuwa da cutar mura, zai haifar da mutuwar mutane sau 4 zuwa 30 fiye da mura na yanayi.
A lokaci guda kuma, WHO ta kuma danganta cutar mura ta Asiya ta 1957-1959 da kuma cutar Hong Kong ta 1968-1970 a matsayin annoba, ko da yake sun kasance. ba mai tsanani ba. Doshi ya kara da cewa "dole ne mu tuna da manufar "tsarin kamuwa da cutar," wanda aka yi la'akari da tunanin cewa cutar ta mura ta buƙaci mayar da martani daban-daban fiye da mura na shekara-shekara, na yanayi.
Wannan tashin hankali na dacewa da ma'anar ya kasance a yau. A gefe guda, ana bayyana cututtukan cututtuka a matsayin bala'i ko ma wani barazanar wanzuwa. A daya hannun kuma, an ambaci muradin alade a matsayin misali na annoba duk da haifar da ƙarancin mace-mace fiye da lokacin mura. Tare da mura na alade, cututtuka irin su SARS-1, MERS, Zika, da/ko Ebola ana yawan amfani da su azaman misalan don nuna haɓakar da ake gani hadarin annoba, ko da yake SARS-1, MERS, Da kuma Zika Kowannensu yana da kasa da mutuwar 1,000 da aka rubuta a duniya, har abada, kuma cutar ta Ebola ta keɓe a yankuna na tsakiya da yammacin Afirka.
Annoba ko PHEIC?
a wani daftarin farko na Yarjejeniyar Cutar Kwayar cuta, Kungiyar Tattaunawar Gwamnati (INB) ta gabatar da takamaiman takamaiman ma'anar cutar: "Yaduwan duniya na cuta ko bambance-bambancen da ke cutar da al'ummar bil'adama tare da iyaka ko rashin rigakafi ta hanyar ci gaba da haɓakawa daga mutum zuwa mutum, mamaye tsarin kiwon lafiya tare da matsananciyar cututtuka da babban mace-mace, da haifar da duk wani tasiri na zamantakewa da tattalin arziƙin duniya."
Wannan ma'anar ta fi takura fiye da yawancin ma'anar annoba, saboda tana buƙatar ƙwayoyin cuta don haifar da mummunar cututtuka da mace-mace da kuma yaduwa a duniya. Ana iya la'akari da wannan don tabbatar da matakan sa baki da ba a saba ba. Koyaya, INB ta yi watsi da ma'anar cutar ta a cikin sabon daftarin aiki na Yarjejeniyar Cutar Kwalara ba tare da maye gurbinsa ba.
An yi watsi da ma'anar INB, kuma ta musamman, ta bambanta da ma'anar da Bankin Duniya ke amfani da shi a cikin kafa daftarin aiki na Asusun Matsakaicin Kuɗi na PPPR (yanzu an san shi da Asusun Cutar Cutar). A can, ana ma'anar annoba a matsayin "cutar da ke faruwa a duniya, ko kuma a kan wani yanki mai faɗi sosai, ke ketare iyakokin ƙasa da ƙasa kuma yawanci tana shafar mutane da yawa." Sabon daftarin Yarjejeniyar Cutar A yanzu ya haɗa da ma'anar mai zuwa na "cutar cuta mai saurin kamuwa da cuta," wato "kowane cututtukan da aka gano don cutar da ɗan adam kuma shine: labari (ba a bayyana shi ba tukuna) ko kuma sananne (ciki har da bambance-bambancen sanannen pathogen), mai yuwuwa mai saurin yaɗuwa da / ko kuma mai saurin kamuwa da cuta tare da yuwuwar haifar da gaggawar lafiyar jama'a na damuwa na duniya." Bai yi ba zahiri dole ne a sanya kowa rashin lafiya.
Ba kamar kalmar annoba ba, an ayyana Gaggawar Kiwon Lafiyar Jama'a na Damuwa ta Duniya (PHEIC) a cikin IHR (2005) a matsayin "wani lamari mai ban mamaki wanda aka ƙaddara… don zama haɗarin lafiyar jama'a ga sauran jihohi ta hanyar yaduwar cutar ta duniya kuma mai yuwuwar buƙatar mayar da martani ta ƙasa da ƙasa." PHEICs ba su iyakance ga barkewar cututtuka ba amma suna iya kaiwa ga haɗarin lafiya daga gurɓataccen sinadari ko makaman nukiliya. Ana buƙatar ƙasashe membobin su sanar da WHO game da abubuwan da za su iya haifar da PHEIC, mai yiwuwa suna ƙayyade "m" da "mai yiwuwa" a cikin wasu mahallin da aka yarda gaba ɗaya.
Da zarar an yi faɗakarwa, za a kira kwamitin gaggawa na gaggawa a WHO don tuntuɓar Darakta-Janar game da ƙuduri da ƙare PHEIC tare da ba da shawarwari na wucin gadi ga Jihohin da abin ya shafa. Ko da yake kwamitin gaggawa ya tuntubi, ciki har da memba daga Jihohin da abin ya shafa, duk ikon yanke shawara ya ta'allaka ne ga Darakta-Janar kuma yana da ikon yin amfani da shawarwarin kwamitin. Wannan bangare na siyasa yana da mahimmanci, kamar yadda sabbin gyare-gyaren da aka tsara don IHR za su ba da shawarwarin WHO yayin PHEIC, kamar rufe iyakokin da alluran rigakafi na wajibi, daure wa kasashe membobi.
Bayyana annoba a matsayin yuwuwar PHEICs ya daidaita tattaunawar guda biyu da ke gudana don Yarjejeniyar Cutar Cutar da gyare-gyaren IHR. Masu suka da yawa sun yi iƙirarin cewa gyare-gyaren na IHR zai baiwa Darakta-Janar na WHO ikon ayyana barkewar cutar ba tare da izini ba. Duk da haka, Babban Darakta ya riga yana da ikon ayyana PHEIC a ƙarƙashin ƙa'idodin da ake dasu (ko da yake gyare-gyaren IHR na iya sa irin wannan sanarwar ta fi tasiri). A halin yanzu abin da aka gabatar gyara kar a ayyana annoba. Duk da yake yana da ma'ana don daidaita manufofin biyu, yana da mahimmanci a tuna cewa IHR sun fi girma a cikin iyakokin, kuma ba duka PHEICs ne annoba ba. Darakta Janar na WHO ya bayyana shida PHEICs don barkewar cututtuka a cikin shekaru goma da suka gabata, na baya-bayan nan shine Mpox (Biri) a cikin 2022.
Nauyin Cutar Cutar Kwalara
Covid-19 ita ce annobar cutar da aka fi samun adadin wadanda suka mutu tun bayan bullar cutar ta Spain. Lambar hukuma ta miliyan bakwai yana wakiltar daidai da kusan shekaru biyar na mace-mace daga tarin fuka, amma ya faru a cikin gungun tsofaffi masu nisa. Ganin cewa nauyin tarin fuka ya tsaya tsayin daka ko kuma yana raguwa kafin cutar ta Covid-19, kamar yadda kuma nauyin HIV/AIDS da zazzabin cizon sauro suke (a yanzu sun sake tashi), ba a saba kiran wadannan cututtuka a matsayin annoba ba.
Duk da haka, da Global Fund ya rubuta cewa waɗannan cututtuka guda uku “bai kamata a lakafta su a matsayin ‘kawai’ annoba ko annoba ba, annoba ce da aka yi fama da ita a ƙasashe masu arziki.” Wannan batu ne mai mahimmanci. Nauyin kowane nau'in cutar ba'a keɓe shi ta hanyar ilimin halittarsa kawai amma ta yanayin alƙaluma, tattalin arziƙi, da mahallin cibiyoyin da yake yaduwa. Idan waɗannan cututtukan na dogon lokaci su ne ainihin cututtukan cututtukan da suka fi girma a halin yanzu, to shin gaggawar mayar da martani a cikin 2024 shine mafi kyawun tsarin kula da su?
SARS-CoV-2 yana ƙara haɗarin mutuwa da cuta mai tsanani musamman ga mutane sama da 65 wanda ya zama wani yanki mai girma kuma mai girma na yawan jama'a a cikin ƙasashe masu arziki. Koyaya, matsakaicin shekarun a yankin kudu da hamadar sahara shine 18 shekaru kuma kashi uku ne kawai na al'ummar kasar 65 ko mazan. Don haka, tarin fuka, zazzabin cizon sauro, da HIV/AIDS, da ke shafar matasa masu yawa a waɗannan ƙasashe. m kiwon lafiya fifiko. An kuma dauki cutar kwalara a matsayin annoba a baya lokacin da ta shafi masu hannu da shuni kuma yanzu an manta da ita a kasashe masu tasowa da masu matsakaicin karfi. A halin yanzu kwayar cutar kwalara har yanzu yana haifar da barkewar cutar a wurare irin su Haiti inda mutane ke fama da rashin ruwa da tsaftar muhalli.
Samun wannan dama yana da mahimmanci. Ta hanyar mai da hankali kan cututtukan cututtukan da ba su da nauyi waɗanda ke shafar duniya baki ɗaya, gami da masu hannu da shuni, ba za mu iya jujjuya hankalinmu daga cututtuka masu nauyi da ke addabar jama'a masu karamin karfi ba. Wannan yana haifar da damuwa na gaskiya kuma ya bambanta maganganun da aka yi akan daidaito da aka yi amfani da su a cikin daftarin Yarjejeniyar Cutar. Don haka yana iya yin ma'ana a canza mayar da hankali daga annoba zuwa ga gaggawa na kiwon lafiya da ke damun duniya, wanda zai iya iyakance ga yanayin ƙasa, kamar yadda ya shafi cutar Ebola. Yin hakan na iya ba da damar tattara albarkatu daidai gwargwado ga haɗari da buƙatu, maimakon saka kuɗi da yawa, lokaci, da jarin zamantakewa a cikin wani ajandar shirye-shiryen balaguron balaguro wanda ke fafutukar ma ayyana manufofinsa.
Ci gaba da rikitar da manufar shirye-shiryen cutar sankara da PHEIC kawai yana haifar da rudani yayin da ya tona asirin hanyoyin siyasa. Idan WHO na son shawo kan duniya don yin shiri don barkewar annoba, da kwantar da hankulan fargabar yiwuwar yin amfani da alamar cutar ta hanyar wani sabon tsarin mulki, to suna buƙatar ba da haske kan abin da a zahiri suke magana akai.
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REPPARE (Sake kimanta Shirye-shiryen Cutar Kwayar cuta Da Ajandar Amsa) ya ƙunshi ƙungiyar darussan da yawa da Jami'ar Leeds ta kira.
Garrett W. Brown
Garrett Wallace Brown shine Shugaban Manufofin Lafiya na Duniya a Jami'ar Leeds. Shi ne Co-Jagoran na Sashen Bincike na Lafiya na Duniya kuma zai zama Darakta na sabuwar Cibiyar Haɗin gwiwar WHO don Tsarin Lafiya da Tsaron Lafiya. Binciken nasa ya mayar da hankali kan gudanar da harkokin kiwon lafiya na duniya, ba da kuɗaɗen kiwon lafiya, ƙarfafa tsarin kiwon lafiya, daidaiton lafiya, da ƙiyasin farashi da yuwuwar bayar da tallafi na shirye-shiryen rigakafin cutar da martani. Ya gudanar da manufofi da haɗin gwiwar bincike a cikin lafiyar duniya fiye da shekaru 25 kuma ya yi aiki tare da kungiyoyi masu zaman kansu, gwamnatoci a Afirka, DHSC, FCDO, Ofishin Majalisar Dinkin Duniya na Birtaniya, WHO, G7, da G20.
David Bell
David Bell likita ne na asibiti da lafiyar jama'a tare da PhD a cikin lafiyar jama'a da asali a cikin likitancin ciki, ƙirar ƙira da cututtukan cututtukan cututtuka. A baya can, ya kasance Darakta na Fasahar Kiwon Lafiya ta Duniya a Asusun Intellectual Ventures Global Good Fund a Amurka, Shugaban Shirin Malaria da Cutar Cutar Kwalara a Gidauniyar Innovative New Diagnostics (FIND) a Geneva, kuma ya yi aiki a kan cututtuka masu yaduwa da daidaita dabarun gano cutar zazzabin cizon sauro a Hukumar Lafiya ta Duniya. Ya yi aiki na tsawon shekaru 20 a fannin kimiyyar halittu da lafiyar jama'a na duniya, tare da wallafe-wallafe sama da 120. David yana zaune a Texas, Amurka.
Blagovesta Tacheva
Blagovesta Tacheva ƙwararren mai bincike ne na REPPARE a Makarantar Siyasa da Nazarin Duniya a Jami'ar Leeds. Tana da PhD a cikin Harkokin Ƙasashen Duniya tare da gwaninta a ƙirar cibiyoyi na duniya, dokokin kasa da kasa, 'yancin ɗan adam, da martanin jin kai. Kwanan nan, ta gudanar da bincike na hadin gwiwa na WHO game da shirye-shiryen cutar sankara da kiyasin farashin mayar da martani da yuwuwar samar da sabbin hanyoyin samar da kudade don saduwa da wani yanki na wannan kiyasin. Matsayinta a cikin ƙungiyar REPPARE shine ta bincika shirye-shiryen cibiyoyi na yanzu waɗanda ke da alaƙa da shirye-shiryen balaguron balaguro da ajandar mayar da martani da kuma tantance dacewarta ta la'akari da nauyin haɗari da aka gano, farashin dama da sadaukarwa ga wakilci / yanke shawara mai adalci.
Jean Merlin von Agris
Jean Merlin von Agris dalibi ne na REPPARE wanda ke samun tallafin PhD a Makarantar Siyasa da Nazarin Duniya a Jami'ar Leeds. Yana da digiri na biyu a fannin raya tattalin arziki tare da sha'awar ci gaban karkara na musamman. Kwanan nan, ya mai da hankali kan yin bincike kan iyaka da tasirin ayyukan da ba na magunguna ba yayin bala'in Covid-19. A cikin aikin REPPARE, Jean zai mai da hankali kan tantance zato da kuma ƙwaƙƙwaran tushen shaida da ke ƙunshe da shirye-shiryen balaguron bala'in duniya da ajandar mayar da martani, tare da mai da hankali musamman kan abubuwan da ke haifar da jin daɗi.
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