Phantse kwiminyaka emibini edlulileyo, iCongress yacela i-National Academy of Sciences (NAS) ukuba ihlolisise idatha ekhoyo malunga nokhuseleko kunye nokusebenza kakuhle kwesitofu sokugonya i-anthrax (AVA). Ikomiti yadalwa yi-NAS Institute of Medicine (IOM) ukwenza oku, kwaye iqela ladibana kwiinyanga ezilishumi elinesixhenxe zokugqibela ukuphonononga lo mbandela onzima kunye neengxabano.
Ndizimase iintlanganiso ezininzi ezivulelekileyo, ndenza umboniso omenyiweyo, kwaye ndanikezela malunga namaphepha angama-300 olwazi oluxhasayo kwikomiti.
Ingxelo yeZiko leSizwe leNzululwazi Isitofu sokugonya i-Anthrax: Ngaba sikhuselekile? Ngaba iyasebenza? yakhutshwa ngo-Matshi 6. Ibanga ukuba luqulunqo olucokisekileyo lwazo zonke iinkcukacha ezikhoyo, zilinganiswe ngokuthembeka, kwaye zibandakanya inani leengcebiso kunye neengcamango zophando olongezelelweyo.
Yafikelela kwesiphi isigqibo ingxelo? Apha kulapho ifumana umdla khona.
Izigqibo zengxelo zixhomekeke ekungahoyweni kolwazi oluninzi olubalulekileyo, kwaye izindululo zalo zinika iSebe lezoKhuselo yonke into elinokuyifuna. Ingxelo ibonakala "iphothiwe" ukuxhasa inani lamanyathelo e-DOD, kwaye ibonelela ngezizathu ezifunekayo zokuqalisa kwakhona ugonyo olusisinyanzelo lwe-anthrax phezu kwezichaso zabaninzi kwiCongress.
Amazwi anamandla. Ndingazixhasa? Masihlole isiShwankathelo sesiGqeba esiLawulayo kwaye sibone ukuba ingxelo iphetha ngelithini malunga nokusebenza, ukhuseleko kunye neenkxalabo zokwenza isitofu sokugonya (esivale umzi-mveliso iminyaka emine, de ekugqibeleni yafumana imvume ye-FDA ngoJanuwari 2002). Iingcebiso ezininzi ebezingalindelekanga nazo ziyaphononongwa. Ndicatshulwe kumbhalo ongqindilili, ndasebenzisa izicaphulo.
UMSEBENZI
1. โNgenxa yokuba isitofu sokugonya sikhusela i-antigen ebalulekileyo kwisenzo setyhefu yebhaktiriya, i-AVA kufuneka isebenze ngokuchasene netyhefu ye-anthrax kuzo zonke iintlobo ezaziwayo ze-B. anthracis, kunye nakuzo naziphi na iintlobo ze-bioengineered ezinokubakho.
Le ntsomi iphindwa kaninzi zizithethi ezohlukeneyo ze-DOD kule minyaka mine idlulileyo, ukuxhasa inkqubo yokugonywa kogonyo lwe-anthrax. Nangona isenza ingqiqo, ingxelo iyachaswa yidatha, apho amawaka ezilwanyana ezigonyiweyo ziye zanikezela kumngeni kwiintlobo ezininzi ze-anthrax, ngaphandle kokuvelisa amanqanaba aphezulu e-antibody kwi-antigen yesitofu ekuthethwa ngaso, 'i-antigen ekhuselayo' okanye i-PA.
Ngaphezu koko, ayiwuhoyi umsebenzi kaPomerantsev et al eRashiya (epapashwe kupapasho lukaDisemba 1997 lwejenali yeVaccine), apho uhlobo lobunjineli be-anthrax luye lwasuswa i-antigen gene ye-PA. Kwafakwa enye ijini yecereolysin, nto leyo eyenza ukuba i-anthrax ixhathise kwisitofu sokugonya esisekwe kwi-PA njengesitofu sangoku sokugonya i-anthrax.
Ingaba ingxelo ye-IOM ijongane njani nolu lwazi? Yathi uphononongo lukaPomerantsev "lunempazamo" kuba i-anti-PA antibody titres yezilwanyana ezigonyiweyo ayizange inikwe. Le yingxoxo ekhethekileyo, kuba i-antibody titres kwiimpuku kunye neehagu zeguinea azibonisanga ukunxulumana nokuphila. Emva koko ingxelo ikhalazela ukuba kwasetyenziswa iihamster, kwaye โkuncinci okwaziwayo ngeehamster njengemodeli yezilwanyana.โ Uphononongo lwenziwa eRashiya, kwaye abantu baseRashiya abasebenzisa i-hamster njengemodeli yabo mhlawumbi banolwazi oluninzi malunga ne-hamsters kunye ne-anthrax.
UPomerantsev usebenza e-NIH ngoku, engekude ne-IOM. Ukuba iimpendulo kule mibuzo bezifunwa ngokwenene, uPomerantsev wayenokumenywa ukuba eze kuziphendula.
Le ngxelo ikwakhankanyile, kodwa ngoko nangoko ayihoywa, into yokuba iDOD yoyika ngolu hlobo lwe-anthrax yobunjineli, kangangokuba iye yafumana ikhontrakthi ne-Battelle Memorial Institute ukuba yenze uhlobo olufanayo lofuzo. (Jonga uMiller J kunye noBroad W. NYT ngoSeptemba 4, 2001, iphepha A1.) Kwaye ngubani owaziyo ukuba iPomerantsev idibanisa ntoni ngoku kwi-NIH?
Amabango e-IOM okuba isitofu sokugonya "kufuneka sisebenze" kuzo zonke iintlobo zeentlobo ezaziwayo kunye nazo zonke iintlobo ze-bioengineered ezinokubakho kufuneka zikhutshwe ngokukhawuleza njengethemba lokungakhathali.
2. "I-macaque kunye nomvundla yimizekelo yezilwanyana ezaneleyo zokuvavanya ukusebenza kwe-AVA ekuthinteleni i-anthrax yokuphefumla."
Iimodeli ezininzi zezilwanyana zisetyenzisiwe kuvavanyo lwe-anthrax. I-DOD ifumanise ukuba ngumvundla kuphela kunye nerhesus macaque ezibonisa ukugonyeka okuqinileyo emva kogonyo lwe anthrax. I-macaque, akumangalisi ukuba inesifo esisondeleyo kwi-pathologically kwinguqu yomntu ye-anthrax yokuphefumla. Itshimpanzi, nangona kunjalo, edla ngokujongwa isondele emntwini kune macaque, iba nesifo se anthrax esifana ngokusondeleyo neso kwiihagu neempuku.
I-DOD kudala ibango, ngaphandle kokukhankanya nayiphi na idatha yokuxhasa ibango, ngenxa yokuba i-anthrax ye-macaque ibonakala ngathi i-anthrax yomntu, ukuba i-macaque yeyona modeli yezilwanyana yokufunda ugonyo lokugonya. Kodwa ngenxa yokuba isifo sinokufana ne-pathologically ayithethi ukuba impendulo ye-immune ye-macaque kwisitofu sokugonya iyafana nempendulo yomntu. Ingxelo ye-IOM ayiphumeleli ngokupheleleyo ekuchazeni le ngqikelelo yomtsi.
Omnye umtsi uyalandela. Umvundla ukhula ngakumbi emva kokugonywa kwe anthrax kunempuku, impuku okanye iguinea pig. Iimacaques ziyabiza, kodwa imivundla inexabiso eliphantsi. Ke iDOD ifuna ukuqhuba amaphononongo okusebenza kogonyo kwimivundla, hayi iimacaques okanye iitshimpa. I-anthrax yomvundla ayifani ngokusondeleyo ne-anthrax yomntu.
I-IOM ibonelele nge-DOD nge-nugget yegolide efunwayo ukuxhasa imifuniselo yomvundla, ngokusekwe kwingxoxo elahlekisayo yokuba i-anthrax ye-macaque ijongeka njenge-anthrax yomntu, kwaye impendulo yomvundla kwi-AVA ibonakala ngathi yi-macaque immune response, ngoko ke imivundla ifana nabantu!
Siyazi ukuba imivundla ifumana ugonyo olululo kwisitofu sokugonya i-anthrax, kodwa owona mbuzo ngowokuba ngaba abantu bayalufumana ukhuseleko olululo? Buphi ubungqina bokuba imivundla ibonelela ngomzekelo omhle wokugonyeka komntu?
Ingxelo yokuba ezi zilwanyana ziyimizekelo emihle ebantwini iyahlukana kwimihlathi emininzi kamva. Ingxelo ye-IOM ithi, "Idatha evela kwizifundo zezilwanyana esele iphuhlisiwe ibonisa ukuba i-serological correlates yokugonywa komntu inokuphuhliswa kwiimodeli ezifanelekileyo zezilwanyana. Ikomiti iyawuncoma lo msebenzi kwaye ikhuthaza uphuhliso lwawo ngakumbi.โ
Oko kuthetha ukuthini ukuba okwangoku, akukho ndlela yokuthelekisa i-immunity eyenziwa zizilwanyana emva kokugonywa, kwi-immune response yabantu emva kokugonywa. Umgca ongezantsi: i-IOM inike iDOD imrimatur yayo yokusebenzisa imivundla, ngaphandle kobungqina obuxhasayo okanye ingqiqo, kuba ayibizi kakhulu kwaye inganikezela ngesigqibo esishiyiweyo esifunekayo.
3. โIkomiti ifumanisa ukuba ubungqina obukhoyo obuvela kwizifundo ezenziwa ngabantu kunye nezilwanyana kunye neengqikelelo ezifanelekileyo zesifaniso, bubonisa ukuba i-AVA njengoko inelayisensi sisitofu esisebenzayo sokukhusela abantu kwi-anthrax, kubandakanywa i-anthrax yokuphefumla, ebangelwa yiyo nayiphi na into eyaziwayo okanye ekholelekayo. iintlobo zobunjineli zeB. anthracis.โ
Apha ingxelo yenza amabango amaninzi avumayo kwi-DOD, kodwa engaxhaswanga bubungqina, kwisivakalisi esinye:
a) I-AVA iyasebenza ebantwini, nkqu nokuphefumla
b) Ukongezwa kwebinzana elithi "njengelayisenisi" kubonakala ngathi kumzamo wokulinganisa kwimeko yangoku kwiNkundla ye-Federal, ephawula ukuba ilayisenisi ye-AVA ayibandakanyi isibonakaliso (ukusetyenziswa okuvunyiweyo) ukuphefumla, okanye ukusetyenziswa kwemfazwe yebhayoloji. . Ukuba ijaji iyavuma, i-DOD iya kuthintelwa ekunyanzeni isitofu sokugonya i-anthrax kumajoni.
c) Isitofu sokugonya siya kusebenza kwiintlobo zemfuzo eyenziwe ngobunjineli.
Ngaphandle kwayo yonke le ngxelo igonyo malunga ne-PA, esona sithako sesitofu sokugonya, ngokucacileyo akukho ndlela yokwazi ukuba isitofu sokugonya siya kusebenza na ngokuchasene nohlobo lobunjineli lwe-anthrax: kuxhomekeke ukuba zenziwe njani na.
Incwadi ka-Ken Alibek ethi Biohazard ithi iintlobo ze-anthrax ezixhathisayo zinokwenzeka kwaye zaziphantsi kophuhliso kwindawo eyayisakuba yi-USSR. U-Alibek wayengomnye wabavavanyi bale ngxelo. Ngaba izinto ezazimxhalabisa zazishiyiwe, okanye wazilibala izinto awayezibhala kwiminyaka emi-3 eyadlulayo?
Ingxaki esemthethweni yomenzi wesitofu sokugonya, kodwa ingahoywa yi-FDA kugqatso lwayo lokufumana ilayisensi yesitofu sokugonya ukusikhusela kwi-DOD-ephuhliswe ngezixhobo ze-anthrax, ekhutshwe nguThixo kuphela owaziyo, kwaye nguThixo kuphela owaziyo ukuba kutheni (urhulumente wobumbano akanalo nofifi. ngubani obambe i-anthrax), kukuba akukho datha yomntu yokuxhasa ukusebenza kwesi sitofu sokugonya kulo naluphi na uhlobo lwe-anthrax ebantwini: hayi eye-anthrax yesikhumba, hayi eyokuphefumla. Kwaye phantsi kwemimiselo ekhoyo ngo-1970 xa isitofu sokugonya sasinelayisensi, kwaye sisekhona nanamhlanje, bekufuneka ube nalo datha ukuze ufumane ilayisenisi.
Ngaba bukho ubungqina obubambekayo bokusebenza? Hayi ncma. Isitofu sokugonya sisebenza kwezinye izilwanyana, kodwa hayi kwezinye. Isitofu esidala, esingazange sibe nalayisenisi ye-anthrax sisebenza ngokuyinxenye. Mhlawumbi nayo le yenza njalo, kodwa idatha yokubonisa oku ebantwini ayikho.
UKHUSELEKO
4. โIziganeko zasekuhlaleni, ngakumbi ububomvu, ukudumba, okanye amaqhuqhuva kwindawo yokutofaโฆzifana nezehlo eziqatshelwe emva kokufunyanwa kwezinye izitofu zokugonyaโฆโ
Yinyani, kodwa zenzeka ngesantya esiphezulu kakhulu kunezinye izitofu zokugonya. Kutheni le nto ingakhankanywanga kuShwankathelo?
5. โIziganeko zenkqubo, ezinjengomkhuhlane, i-malaise ne-myalgia, ziyafana nezehlo ezibonwa emva kokufunyanwa kwezinye izitofu ezisetyenziswa ngoku ngabantu abadala, kodwa azixhaphakanga kuneziganeko zasekuhlaleni.โ
Amaphononongo amaninzi anike ama-70-80% amazinga okuchaphazeleka kwengingqi, kunye nama-48% emilinganiselo yenkqubo yesitofu sokugonya i-anthrax. Ngaba i-48% ingaphantsi kakhulu kune-70%? Omabini la mazinga aphezulu kunezinye izitofu zokugonya.
6. "Kukho iiyantlukwano zesini kwiimpendulo zengingqi emva kokugonywa nge-AVA..."
Apha ingxelo izikhwenene impazamo yeenyaniso ezenziwe kuqala yiDOD. Idatha ekhoyo ibonisa ukuba amabhinqa anezinga eliphezulu leempendulo zengingqi kunye nenkqubo kunamadoda, nge-2-3 factor.
Iimpendulo zasekuhlaleni zithathwa njengezincinci, kwaye zihlala zisonjululwa. Kodwa ukusabela kwenkqubo okwenzeka emva kokugonywa kunokuba ziimpawu zezifo ezingapheliyo ezizayo. Ngoko ke, i-DOD ayifuni ukuvuma ukuba yintoni idatha yayo ibonisa malunga neempendulo zenkqubo, kwaye ngokukodwa ukuvuma ubukho bokungalingani phakathi kwesini. Ukuvuma umahluko wesini kwiindlela zokusabela kunokubangela ukuba abasetyhini bakhululwe ekugonyweni, into iDOD efuna ukuyiphepha kakhulu. (Elinye ityala lesitofu sokugonya i-anthrax esekwe kumahluko ngokwesini likwaphumela kwiinkundla zamatyala.)
7. "Idatha ekhoyo ilinganiselwe kodwa ayibonisi bungqina bubambekayo ngeli xesha ukuba abasebenzi abaye bafumana i-AVA baye baphakamisa iingozi zeziganeko zempilo ezizayo."
Yonke ireferensi ekhankanyiweyo ukuxhasa le nkcazo yayisiya kwi-DOD briefer, ngaphandle kokucaphula okuthathu kuthotho lwamaphepha ajonge abasebenzi baseFort Detrick abathi ngamnye wabo wafumana izitofu ezininzi ezahlukeneyo. Ingxaki ngala maphepha mathathu (ango-1958, 1965 kunye no-1974) kukuba uphando lwenziwa kuwo onke phambi kuka-1971. ke ngoko, isitofu sokugonya i-anthrax esifunyenwe phantse kuphela ngaba basebenzi baseDetrick yayisisitofu esahlukileyo sokugonya i-anthrax.
Ingxaki ngokusebenzisa izishwankathelo zeDOD kuphela kufuneka icace.
Le ngxelo iphephe ntoni ngokucokisekileyo ukuze ifikelele esi sigqibo singasentla?
a) Idatha yokuqala evela kuMkhosi waManzi yanikezelwa kwi-IOM kamsinya nje phambi kokuba ingxelo igqitywe. Uphononongo lweNavy lufumene amazinga aphezulu okukhubazeka kokuzalwa kwinzala egonyiweyo, ngokuchasene noomatiloshe abangagonywanga. Ingxelo ye-IOM igxininise ubunjani bokuqala bale datha kunye neminye imida kwi-database ye-Navy, kwaye ayizange ikhankanye isifundo kwiingcebiso zayo.
b) Uphononongo oluhlanu lwe-Gulf War syndrome lufumene unxulumano olubalulekileyo ngokwezibalo phakathi kwesitofu sokugonya i-anthrax, okanye izitofu ezininzi zokugonya ezinikezelwe kwi-Gulf War Syndrome, kunye nophuhliso lwe-Gulf War Syndrome. Akukho zifundo zikhoyo eziphikisa lo mbutho. Olu phononongo lwenziwa ngamaqela amahlanu ahlukeneyo abaphandi.
Oku kushiyiwe kakhulu, ngakumbi njengoko amaqela amathathu kwamahlanu aye afunda amagqala afumene i-AVA, isitofu sokugonya esifanayo esiphononongwayo; amanye amaphononongo amabini yayingamagqala aseBritani afumana isitofu esahlukileyo sokugonya i-anthrax. Iziphumo zazifana, nangona kunjalo. Ingxelo ye-IOM yaluthethelela njani olu qwalaselo?
Okokuqala, ithi amaphononongo eMfazwe yeGulf โawayilelwanga ukufunda iziphumo zokuvezwa kogonyo.โ Yimbudane leyo. Emva koko ingxelo iyayigxeka into yokuba ugonyo oluninzi lunikezelwe. Kodwa amanye amaphononongo aye ajonga umba wogonyo oluninzi, kwaye afumana iziphumo ezilungileyo. Oku kukuxelela ukuba ubuncinane esinye sesitofu sokugonya sinokubangela iingxaki, okanye ukuba ugonyo oluninzi ludibene ukubangela ukugula. Okokugqibela, ingxelo igxeka imfuno yokuxhomekeka kwiingxelo zakho zokuzivelela ngesitofu sokugonya. Kodwa ekubeni i-DOD ingazange ilubeke ugonyo kwiirekhodi zokudutyulwa kwamajoni ase-US, yonke into enokwenziwa ngabaphandi kukusebenzisa ingxelo yobuqu. Oko kukuthi, ngaphandle kokuba i-DOD ithathe isigqibo sokufumana iirekhodi zokugonywa kweMfazwe ye-Gulf elahlekileyo kwiminyaka elishumi eyadlulayo.
Ezi zizathu azikuthetheleli ukuphosa olu phando, oluye lwapapashwa kwiijenali zezonyango eziphezulu: I-Lancet, i-American Journal ye-Epidemiology, kunye ne-Occupational and Environmental Medicine.
Endaweni yoko, ingxelo ithi izifundo ze-DOD ezingapapashwanga, kwiimeko ezininzi ezenziwe ngoosonzululwazi basemkhosini abancinci abanamava amancinci kwi-epidemiology, kwaye engazange iphononongwe ngoontanga okanye ipapashwe, yayiyeyona mithombo "yeyona ikhoyo" yedatha kwi-AVA kunye neziphumo zempilo.
Idatha ekhoyo ibingayi kulinganiselwa ukuba i-IOM ikhethe ukuthathela ingqalelo izifundo zeMfazwe yeGulf, ezenziwe ngabasebenzi abanamava nabahlonitshwayo.
Ndinike ilungu ngalinye lekomiti uphononongo olupapashiweyo lwesitofu sokugonya i-anthrax olwenziwa kwiziko lomkhosi eNgilani ngo-2000. Kumajoni ali-100 athe avolontiya ukuba athathe isitofu sokugonya i-anthrax, ama-71% aye ayeka kuthotho lwesitofu sokugonya phambi kwedosi yawo yesine. Umbhali wayengaqinisekanga ukuba kutheni abaninzi abamkela idosi yokuqala besala iidosi zamva, kodwa izinga lokusabela elibi laliphezulu kakhulu, kwaye lithintele i-28% yabamkeli ekuphakamiseni okanye ukuqhuba ubuncinane iiyure ezingama-48 emva kogonyo. Eli phepha nalo alizange likhankanywe kwingxelo.
c) I-IOM yalile ukwenza izigqibo kwi-VAERS data (i-VAERS yinkqubo yokunika ingxelo yesiganeko esibi ngokuzithandela esonganyelwe yi-FDA kunye ne-CDC) okanye kwiKomiti yeeNgcali ze-Anthrax Vaccine (AVEC), eyasekwa yi-DHHS ngesicelo se-DOD, jonga ingxelo nganye ye-VAERS malunga nesitofu sokugonya i-anthrax. I-IOM ibonise ukuba idatha ye-VAERS kufuneka isetyenziswe ukuvelisa iingcamango malunga nemiphumo yokugonya, ekufuneka emva koko ivavanywe kusetyenziswa iindlela ezinobungqina bezibalo, ezingenayo i-VAERS.
Nangona kunjalo, i-VAERS kufuneka ifundwe ukuze kuveliswe iingcamango: yinjongo yayo leyo. I-FDA ikwenzile oku kwaye yafaka ulwazi kwisitofu sokugonya se-anthrax sangoku. I-IOM ikhetha ukuthetha ukuba akukho zimpawu zingapheliyo zixelwe kwi-VAERS ngenxa yesitofu sokugonya, ngelixa i-FDA iphawule ngokufanelekileyo ukuba ezinye iimpawu zixelwa rhoqo emva kogonyo ukuba zibandakanywe kwileyibhile yesitofu sokugonya.
Ukwala ukuqwalasela idatha ye-VAERS ngomnye umzekelo wendlela ingxelo ye-IOM ihoye ngayo ubungqina obunokukhokelela kwicala elingalunganga.
Inkqubo entsha yokuVelisa
8. "I-AVA ngoku iya kuveliswa yinkqubo yokuvelisa esanda kuqinisekiswa phantsi kolawulo olungqongqo, ngokweemfuno zangoku ze-FDA. Ngenxa yoko, imveliso yasemva kokulungiswa inesiqinisekiso esikhulu sokungaguquguquki kuneso senziwa ngexesha lokufumana iphepha-mvume lokuqala.โ
Ukuba ukungabikho kokuhambelana kubonakaliswe njengesizathu sokuba i-AVA ingabonisi ukhuseleko okanye ukusebenza kakuhle, oku kuya kuba ziindaba ezilungileyo. Ukusukela oko kungenjalo, sihlala sisebumnyameni malunga nokhuseleko lwesitofu sokugonya 'esitsha selayisenisi' kunye nokusebenza kwayo, kunye nendlela esithelekiseka ngayo nesitofu sokugonya esasinelayisensi yangaphambili.
Iimveliso ezininzi ze-AVA ebeziveliswe ngaphambili ziyahluka kugxininiso lwamalungu azo ngomlinganiselo wama-40 ukusuka kwiqashiso ukuya kwiqashiso: amanye amaqashiso ane-40 ephinda-phindwe kangangama-XNUMX yesithako esisebenzayo (PA) njengamanye.
Kunyaka ophelileyo, i-GAO yazisa iNkongolo ngotshintsho lokucoca kumenzi wesitofu sokugonya okukhokelele ekunyukeni okuphindwe nge-100 (ukwanda kweepesenti ezili-10,000) kwinqanaba le-PA kwisitofu sokugonya i-anthrax. Uluhlu lweenguqu zoluhlu lwaqala ngo-1990, kodwa aluzange lungeniswe kwi-FDA ukuze luvunywe. I-FDA yafunda kuphela ngolu tshintsho kwi-GAO ngo-2000, kwaye yaluvuma emva kweenyanga eziliqela kamva.
Ngandlela ithile, ingxelo ye-IOM iyasilela ukukhankanya ukonyuka okuphawulweyo kwamva nje kogonyo lwamandla, olunokuba yingcaciso yamazinga aphezulu okusabela axelwe emva kuka-1990.
Oku kushiyelelwe ngomdla, kuba isitofu sokugonya silinganiselwe kakhulu. Isitofu sokugonya i-anthrax sinokusebenza kwi-1/100 yethamo, okanye mhlawumbi sisebenze xa kuncitshiswa kakhulu. I-US iceba ukunciphisa uluhlu lwayo olukhoyo lwe-15 yezigidi zeedosi zokugonya i-smallpox ukuya kwi-1/5th yamandla ayo angoku: kutheni kungenjalo i-anthrax?
Kuya kuba luncedo ukufunda ukuba ukonyuka kwe-PA kunye nezinye iinxalenye zesitofu sokugonya, esinokuthi ngoku sibe sikhulu ngokuphindwe ngama-4,000 kunesitofu sokugonya se-anthrax esenziwa ngeminyaka yoo-1980, kuyaluchaphazela ukhuseleko lwesitofu kunye nokusebenza kakuhle.
Ingxelo ye-IOM ayiphumeleli ukuphakamisa naluphi na uphando malunga nokuba utshintsho lwamandla okugonywa kwe-anthrax luchaphazele ukhuseleko, ukusebenza kakuhle okanye idosi efanelekileyo, nangona kukho imfuneko ecacileyo yophando kule mimandla.
Izipho ezimangalisayo kwi-DOD zifunyenwe kwiNgxelo
9. "I-DOD kufuneka iqhubeke nokuxhasa iinzame ze-CDC zokufunda i-reactogenicity kunye ne-immunogenicity yendlela engenye yolawulo lwe-AVA kunye nenani elincitshisiweyo leedosi zokugonya."
Le yenye i-nugget IOM ephoswe kwi-DOD, efuna ukulungiswa kwelayisensi yesitofu ukuze kuvumeleke iinaliti ezinzulu, ze-intramuscular eziya kufihla ezinye zeempendulo zasekuhlaleni.
10. โIkomiti ayifumani sizathu senzululwazi sokuqhubeka nokusebenza kwe-AVEC ngendlela ekuyo ngoku. Uqwalaselo lwekomiti ye-IOM malunga ne-AVEC ayibonisi siphoso kumalungu e-AVEC okanye ukusebenza kwayo njengoko loo komiti isekwayo; kunoko, ikomiti ye-IOM ibona ukuba i-AVEC yenzelwe ukunikela ingqwalasela eyongezelelweyo kwiinkxalabo zokhuseleko malunga nokhuseleko lwe-AVA kunye nokuba idatha ayifuni ukuqhubeka ngqalelo ekhethekileyo ...
"I-DOD kufuneka ichithe i-AVEC ngendlela yayo yangoku kwaye endaweni yoko incedise i-FDA kunye ne-CDC ekusekeni ikomiti yeengcebiso ezizimeleyo ezijongene nokujonga yonke inkqubo yokuvavanya ukhuseleko lwesitofu."
a) Esi siphakamiso sasimangalisa kakhulu. Ukuphawula ngokuqhubekeka kobukho be-AVEC yindlela engaphaya koko ikomiti ye-IOM yayihlawuliswe ukuba iyenze. Kutheni le nto i-IOM igqithe izikhokelo zayo ukuza nale mpama kwi-AVEC? Ngaba kunokwenzeka ukuba i-AVEC yaqala ukuchonga iingxaki ngesitofu sokugonya?
I-AVEC inike iqela le-CDC eliphanda ngesitofu sokugonya i-anthrax uluhlu lweziphumo ezibi ekufuneka zijongwe kwizifundo ezifumana isitofu sokugonya i-anthrax. Ngaba ukuvunywa kwayo kweziphumo zogonyo olubi kuye kwayizuzisa i-AVEC i-coup de grace?
b) Kutheni i-IOM icele i-DOD ukuba incedise i-FDA kunye ne-CDC kuvavanyo lokhuseleko lwesitofu? Le ngcebiso inemvelaphi yayo kwindawo yokukhanya. Akukho nto kumqulu wekomiti enokuthi ithathwe njengokumema ingcebiso efana nale. Ngaba uluntu luyafuna ukuba iSebe lezoKhuselo lingene kwindawo yokugonya abantu?
'Umdla' we-DOD kukhuseleko lwesitofu ubonakaliswe koku kulandelayo:
a) ukunika amayeza okulinga amalungu omkhosi ngaphandle kwemvume enolwazi okanye ngolwazi olunganelanga
b) ukugcina izitofu zokugonya amashumi eminyaka phambi kokusetyenziswa, kunye nokubuyisela kwakhona izitofu eziphelelwe lixesha izihlandlo ezininzi ngaphandle kovavanyo olufanelekileyo.
c) ukuvelisa inzululwazi embi ukugquma indima yezitofu zayo zokugonya kunye nonyango kwizigulo ezifana neGulf War Syndrome.
Ukubonelela nge-DOD ngendawo kwitafile yokhuseleko lwesitofu kunokukhokelela kuphela ekubhidaniseni uvavanyo lokhuseleko lwabantu, kunye nomkhosi, izitofu zokugonya.
11. "Abasebenzi be-DOD basebenzise i-DMSS (iNkqubo yoKhuseleko lwezoNyango lwezoNyango) ukwenza uhlalutyo oluxabisekileyo ekuphenduleni iinkxalabo malunga nemiphumo yezempilo enokuthi idibaniswe nokugonywa kwe-AVA ...
"I-DOD kufuneka ixhase kwaye iqhubekisele phambili uphuhliso lwemithombo yedatha ye-DMSS kunye nabasebenzi beeyunithi eziya kuvumela ukuqhubeka ngokukhawuleza nangokucokisekileyo uhlalutyo lwezi datha, kubandakanywa kodwa kungaphelelanga kwintsebenziswano ecetywayo phakathi kwe-CDC kunye noMsebenzi woMkhosi wokuHlola."
Uvimba weenkcukacha we-DMSS unokuba sisixhobo esimangalisayo sokufunda iindidi ngeendidi zemiba yezonyango kwimisebenzi esebenzayo yamadoda nabasetyhini. Iqokelela idatha yokuxilonga kulo lonke utyelelo lwangaphandle kunye nokulaliswa esibhedlele kwe-servicemember nganye ngaphakathi kwezibonelelo zonyango lomkhosi. Ayifaki idatha kwi-VA okanye amaziko onyango angewona umkhosi.
Nangona kunjalo, kukho iingxaki ezinzulu nge-DMSS, ubuncinci malunga nesitofu sokugonya i-anthrax.
Xa izigidi ezithathu zabantu-iminyaka yabasebenzi abangagonyelwanga i-anthrax bafaniswa nama-500,000 eminyaka yomntu wabasebenzi abagonyiweyo, iziphumo zazingeyonyani. Kuye kwafumaniseka ukuba ukuba ubufumene naziphi na iidosi zesitofu sokugonya, ubumalunga nama-60% kuphela onokuchaza iindidi ezininzi zeengxaki zonyango kunokuba awuzange ugonywe. Ezi ziphumo bezibaluleke kakhulu ngokwezibalo.
Kuba i-DOD ingenakuza nengcaciso ebambekayo yezi ziphumo, nto leyo ethetha ukuba isitofu sokugonya i-anthrax sesona siphuculi sempilo saziwayo ngumntu, iziphumo zibangelwa zezi:
a) indlela yokusebenza yamanani eneziphene
b) uloyiko lwababoneleli bezonyango lokubhala izigulo kwabo bafumana olu gonyo 'lukhuselekileyo', eyona nto iphambili kukhuseleko lwebhayoloji yebhayoloji yeyeza lomkhosi, okanye
c) Uloyiko lwabafumana isitofu sogonyo lokuba iimpawu ezichazwe kwisitofu sokugonya zinokukhokelela ekuthatheni umhlala-phantsi ngokwenkani, ngoko ke bayakuphepha ukufuna uncedo lwezigulo, okanye bafune uncedo kwenye indawo.
Eli lisiseko sedatha ingxelo ye-IOM iqhwabela izandla.
Ngakolunye uhlangothi, i-database ye-DMSS iphakamisa ukuba isitofu sokugonya i-anthrax sinxulumene nomngcipheko okhulayo wesifo seswekile, umhlaza webele, i-asthma, isifo sikaCrohn, umhlaza we-thyroid kunye ne-multiple sclerosis. Ingxelo ye-IOM yavuma ukuba le mibutho ingaba yimiqondiso yobudlelwane obunokwenzeka, ngokukodwa kwisifo sikashukela, isifo sikaCrohn kunye ne-multiple sclerosis. Ezi zonke ziziphazamiso ze-autoimmune, eziziintlobo zeziphumo zexesha elide kwisitofu sokugonya esinokuqikelelwa, kuba izitofu zokugonya zisebenza njengezivuseleli zomzimba.
Ingxelo icebisa "ulandelelwano olongezelelweyo."
12. โI-DOD kufuneka iphuhlise iinkqubo zokwandisa amandla okubeka esweni ukwenzeka kweemeko zempilo eziqala mva ezinokunxulunyaniswa nokwamkelwa kwalo naluphi na ugonyo; idatha ephononongwe yikomiti ayicebisi imfuneko yeenzame ezikhethekileyo zolu hlobo lwe-AVA. โ
Ngoko nangona idatha kwiziphumo zexesha elide zilinganiselwe kakhulu, ngaphandle kweenkxalabo malunga nedatha yesiphene kunye nedatha ye-DMSS kwisifo seswekile, i-multiple sclerosis kunye ne-Crohn's Disease, ngaphandle kokwaliwa kweedosi zokugonya ezongezelelweyo ngabaninzi e-UK nase-US, kwaye ngaphandle kwamaphononongo amahlanu e-Gulf War Syndrome, ingxelo icebisa ngokuthe ngqo ngokuchasene nazo naziphi na iinzame ezikhethekileyo ekujongweni kokhuseleko lwesitofu se-AVA, kwaye ifuna ukuvala ikomiti enye echongiweyo ukwenza oku. Kakhulu ngombono "wolandelelwano olongezelelweyo."
Ngaba sifanele simangaliswe? Emva kwayo yonke loo nto, ubuncinci iiphaneli ezintathu zeengcali ezidlulileyo ezathi zayilwa ukuxoxa ngezigulo ezivela kumagqala eMfazwe yeGulf, kubandakanya nelinye elivela kwiZiko lezoNyango, licetyiswe ngesisa ngokuchasene nokwenza naluphi na uphando ngendima enokwenzeka yesitofu sokugonya i-anthrax kwizigulo zeMfazwe yeGulf.
Kusekho ulwazi oluthembekileyo olulinganiselweyo malunga neziphumo ze-dioxin (eyona tyhefu inamandla kwi-Agent Orange) ebantwini, kwiminyaka engamashumi amathathu emva kokuba i-US yayeka ukusebenzisa i-Agent Orange ngenxa yeenkxalabo zempilo.
Ukhe wazibona nini ngaphambili izazinzulu zicebisa ngokuchasene nophando olongezelelweyo? Kuphela kwiimeko ezimbini: xa umba uye wasonjululwa ngokungathandabuzekiyo, okanye xa umntu ezama ukufihla into ethile. Ngelishwa, le ngxelo yi-replay ye-tawdry tune endala. Iphaneli yeengcali ezibekekileyo idibana ukusombulula umbuzo onzima wesayensi. Kodwa yifunde ingxelo, kwaye inzululwazi yeyona nto ingekhoyo. Endaweni yoko, yipolitiki (kunye nokugquma) njengesiqhelo.
Incwadi ethi Science, Money and Politics: Political Triumph and Ethical Erosion ebhalwe nguDaniel Greenberg ibalisa ngembali yobuxoki nezenzo ezimanyumnyezi zezazinzulu eziye zayitshabalalisa imilinganiselo esisiseko senzululwazi kuluntu lwethu. Mhlawumbi umntu kufuneka ajonge ngaphaya kweGreenberg ukuze afunde ukuba kwenzeka njani iingxelo ezinje ngale.
Ukuvunywa kwe-IOM yinto eyayilindelwe yi-DOD ukuze iqalise kwakhona inkqubo yokugonywa okunyanzelekileyo, ngokutsho komenzi wesitofu sokugonya (ngoMatshi 7 NY Times, uSheryl Stolberg). Ngeebhiliyoni zeedola kumgca wokugonya i-biodefense yasemkhosini, kunye nesidingo sokubonakala ngathi sisenza into enentsingiselo malunga nesoyikiso se-bioterrorism, ngaba le ngxelo inokuthi ivelise esinye isigqibo?
Ukuba urhulumente unokuba netyala lokugula amajoni akhe, musa ukubamba umoya wakho ulinde isayensi exhaswa ngurhulumente eya kungqina oko.
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Nikela