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Updated: May 6, 2026

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谁的负担,谁的好处? 重新审视世卫组织关于扩大大规模阿齐思罗米辛注射的指导方针中的道德权衡

Maple Goh^1,2,3, A M Viens^4,5, Safura Abdool Karim^6,7

¹Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, United States of America.

|September 30, 2025

概括

大量服用亚齐思罗米可显著降低资源有限地区的儿童死亡率. 然而,由于对抗微生物药物耐药性的担忧,世界卫生组织的指导方针是谨慎的,需要修订伦理框架.

科学领域:

全球健康全球健康
传染病流行病学传染病流行病学
生物伦理学生物伦理学

背景情况:

大量服用阿齐思罗米 (MDAA) 的药物显示出在高负担,低资源环境中降低儿童死亡率的潜力.
目前世界卫生组织 (WHO) 的指导方针建议谨慎对待MDAA,因为有关抗菌素耐药性 (AMR) 的担忧.
世卫组织现有的指导方针不足以解决关键的伦理问题,如代际正义,公平的负担分担和健康的结构性决定因素.

研究的目的:

分析围绕MDAA减少儿童死亡率的伦理考虑.
为世卫组织关于MDAA的指导方针提出修订后的伦理框架.
倡导扩大MDAA干预的资格和改进监测.

主要方法:

对当前世卫组织关于MDAA的指导方针进行道德分析.
对MDAA对儿童死亡率和AMR的影响的证据的审查.
检查全球抗药性政策及其对低收入国家的影响.
制定一个平衡的伦理框架,整合上下文价值观.

主要成果:

目前世卫组织指导方针的伦理考虑不足,忽视了代际正义和公平的负担分担.
全球抗抗菌药物政策往往不成比例地负担低收入国家.
提出了修订后的伦理框架,强调正义,公平和社区投入.

结论:

经修订的世卫组织指南应根据特定背景的标准扩大MDAA资格.
实施需要强有力的死亡率和耐药性监测.
全球对可持续卫生系统和抗生素获取的投资对于公平的MDAA实施至关重要.

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