「五輪で沈黙は責任逃れ」　英医学誌 Lancet、WHOなどを批判

医学界で権威のある英医学雑誌ランセットが6月12日、東京五輪・パラリンピック開催の是非について、世界保健機関（WHO）などが沈黙していることは「責任逃れ」だとする論説を発表した。

新型コロナウイルス感染症の流行が続く中、開催のリスクや、リスクを管理する方法は、広く精査して承認を得る必要があるとし、今すぐ世界的な議論を始めるよう呼びかけた。

前回2016年のリオデジャネイロ五輪では、ジカウイルス感染症（ジカ熱）が問題となり、WHOが緊急委員会を開いてリスクを評価。米疾病対策センター（CDC）も当時の長官が「大会を中止または延期する公衆衛生上の理由はない」と表明した。

だが、東京のオリパラではこうした動きは出ていない。

同誌は「五輪に向けて世界的な話し合いが必要」という題の論説で、「WHOは開催するべきか言及を避けている」と指摘。CDCには、同誌が大会への態度を明らかにするよう何度か求めたが、応じていないことを明らかにした。

June 12, 2021 The lancet

We need a global conversation on the 2020 Olympic Games
　　https://doi.org/10.1016/S0140-6736(21)01293-9

With 6 weeks until the Tokyo 2020 Olympic Games begin, concerns over the safety of the Games amid the COVID-19 pandemic are intensifying.

Public health experts have expressed strong reservations about how well the risks are being mitigated in articles and before parliamentary committees.

The Olympic and Paralympic Games are now deeply unpopular in Japan: lengthy petitions have been signed, 10 000 volunteers have resigned, and several opinion polls have shown that most respondents thought the Games should be postponed or cancelled.

The International Olympic Committee (IOC) has the ultimate power to decide on the Games but has huge economic and reputational incentives to continue, as does the Japanese Government.

Both insist that the Games will go ahead safely.

Writing on June 4, Kaori Yamaguchi, executive member of the Japanese Olympic Committee, suggested that the decision is a fait accompli. “We have been cornered into a situation where we cannot even stop now. We are damned if we do, and damned if we do not.”

 Is Yamaguchi right? Are we sliding into a dangerous Games? And shouldn't all who have a stake also have a voice?

The Games are a global event, happening amid a global health crisis. Control and prevention of COVID-19, including vaccination, are highly variable worldwide. Although international spectators have been barred, 15 000 athletes from more than 200 countries will travel to Tokyo, as well as nearly 80 000 officials, journalists, and support staff.

Their vaccination is not mandatory and mixing could risk avoidable transmission of SARS-CoV-2, including emerging viral variants, seeding fresh outbreaks when attendees return home.

The Games might also adversely affect the COVID-19 situation within Japan, where case numbers are falling, but several regions remain under a state of emergency.

Japan's vaccination roll-out has been sluggish, with 3.4% of the population immunised.

As The Lancet goes to press, no final decision has been made on whether domestic fans can attend, but doctors are concerned about the pressure on health services.

The Tokyo Medical Practitioners Association, representing around 6000 primary care doctors, has written to Prime Minister Yoshihide Suga calling for the Games to be halted, saying that Tokyo's hospitals “have their hands full and have almost no spare capacity”.

The IOC has taken extraordinary measures to minimise the risk of transmission. The number of attendees has been halved. Participants have been given a stringent 60-page rule book for COVID-19, developed with WHO and public health experts: non-compliance could see expulsion from the Games. Two negative COVID-19 tests are required before departure for Japan as well as daily testing during the Games. Strict non-pharmaceutical interventions will be in place, and most events will take place outdoors. All possible places attendees might visit must be approved in advance, and use of public transport is barred.

Historically, the overall number of travellers to a host country changes little during the Games. Narita airport in Tokyo is receiving close to 100 000 international passengers per month. The IOC might well also point to events such as the European Football Championship. Matches are being played, with spectators, in the UK, which had 30,724 infections in the week of May 31 and rising, compared with Japan, which had fewer than 19 000.

Finally, the Olympic and Paralympic Games could encourage physical activity, provide a worldwide morale boost, and promote unity, showing how the global community can come together, after 18 traumatic and fractious months.

But has the global community come together? All nations have an interest in the COVID-19 pandemic and the safety of the Games, yet discussions have largely rested with the IOC and the Japanese Government.

Even Tokyo could not unilaterally cancel the Games without risking a multibillion dollar fine for breach of contract. The IOC, whose risk assessments are not publicly available, is the only one with the mandate to halt the Games. But the 2020 Games are not solely a sporting issue.

Global health organisations have been largely silent on whether the Games should proceed. WHO refuses to be drawn on whether they should go ahead. The ECDC(欧州疾病予防管理センター)  has told The Lancet it has not specifically performed or even discussed a risk evaluation for the Olympics.

In 2016, amid Zika, US CDC director Tom Frieden, declared there was no public health reason to cancel or delay the Rio Games. The CDC has not responded to several requests from The Lancet to clarify its stance on Tokyo 2020.

This silence is a deflection of responsibility. The risks of the Games, and how they are being managed, need wide scrutiny and approval. There needs to be a global conversation about the Games, and it needs to happen now.