我國禽流感因應策略與危機管理

Abstract

台灣在公衛先賢的努力下，早早即脫離天花與瘧疾的毒害，其他霍亂、痢疾、狂犬病等雖無法完全斷除，其發生率之低也是近乎不見。此安逸局面於近十年來已變成近失守的情勢，流行性腦脊髓炎、登革熱、腸病毒、肺結核等捲土重來，且有站穩腳每年累犯之勢，尤其2003年的SARS更是橫掃全世界，重創台灣經濟、社會秩序與改變人心。是自然界的反撲?還是經濟文明的安逸享受，使我們失去警覺，失去謙卑，失去團結利他的胸懷?對應於SARS，禽流感病毒更是厲害幾百倍，歷史上的三次大流行死亡少則百萬，多則兩千萬，已非SARS之數百死亡可比；面對此強敵，我國相關防疫政策與措施始終師法WHO，然而我國防疫分級與WHO之分級顯著不同且複雜，因此興起比對雙方策略計畫措施之心。 雙方計畫比對下，在計畫的時間發展上我國腳步並不比WHO慢，但是以危機管理理論檢視雙方策略與計畫內容，則明顯顯示我國的計畫寬廣度不足以含蓋危機管理的三個階段(缺危機復原學習)，另各階段計畫內容偏向醫療，深入相關科技、硬體、技術面，但對社會整體面的溝通、衛教、心理照護、媒體合作等人文心理工作則相對缺乏或簡畧。相同情形也見於計畫演習準備，強調技巧硬體應用，漠視指揮、相關部門制度整合、大眾心理與媒體合作，整體計畫顯現有技術而無管理。故建議相關全國防疫、防災計畫之整合訂定以專案方式，指派高層官員(如行政院副院長、主秘、副主秘或政務委員)及其機要人員負責指揮整合所有部門，分工協調合作而成。規劃之準則規定應簡明，以利溝通與宣導。重視社會心理之溝通、引導與衛教；加強部門的合作協調；善用社團組織，開發社會人力資源；推行個人衛生(洗手、咳嗽禮節、生病戴口罩)、保護環境衛生成為生活習性；主動出擊，派出專家進行國際合作，獲取第一手疫情及防治資料，作為我國靈活快速因應基礎。

Under the efforts of predecessors in public health, the people of Taiwan have managed to avoid the devastating effects of smallpox and malaria in the past. Having yet to eradicate other diseases, such as cholera, dysentery, and rabies, their prevalence of virtually non-existent. However, this feeling of security is changing for the worse, encephalomyelitis, dengue fever, enterovirus and TB have not only returned but their effects have worsened. In 2003, SARS swept the world, and inflicted the economy, social order and even the humanity in Taiwan. Is it caused by our conflict with Mother Nature? Or is it down to the loss of awareness, humbleness and teamwork after being accustomed to economical and social pleasures. Compared with SARS, avian flu is much more harmful and damaging in its effects. History shows three major pandemics of avian flu cases, all of which caused millions of deaths where as SARS on the other hand caused hundreds, which makes avian flu a greater threat. The anti-epidemic measures taken in Taiwan exceeds in complexity when compared to the World Health Organization (WHO) when referring to its grading systems. To study this further I wish to contrast the anti-epidemic policies between these two parties. When comparing the times of completion, Taiwan was not slower in producing their own plan. However, when evaluating crisis management, it is evident that the Taiwan’s plan is not vast enough to cover all three stages of management. In addition, the plan of each stage is variable depending on the medication, medical related technology, hardware and instructions for patients, but other aspect such as psychological counseling, public communication and the cooperation of the media are lacking in Taiwan. Similar conclusions can be made when observing results from a trial run of the Taiwan model, which emphasizes on the use of technology, but neglects coordination, the integration of other departments and the cooperation of the media. This tells us that the government of Taiwan has enough technique in this issue but not enough administration. Therefore, I would suggest that the government constitutes a nation wide anti-epidemic or disaster prevention plan, available in the case of high-risk threats, and assign high-level officials and other confidential personnels to command and integrate all the departments for a more concise and efficient method of communication and guidance. The government should now focus on improving social-psychological communication, teaching good hygiene habits (such as the regular washing of hands and wearing a face mask when ill), encouraging volunteers to provide service for the community and lastly, sending specialists to lesser economically developed countries to help control the spread of infection but to also help prevent future epidemics.