【TED】为何疫苗总是姗姗来迟

Love English 2 2022-12-23

为何每次重大疾病侵袭人类时，我们的疫苗研制总是姗姗来迟？背后的原因是我们不愿看到，也是一直或被人忽视或被人有意隐瞒着。Seth Berkley 先生认为现在是我们都要了解并重视这个问题的时候了！

演讲者：Seth Berkley 塞斯·伯克利

演讲题目：The troubling reason why vaccines are made too late ... if they're made at all

The child's symptoms begin with mild fever, headache, muscle pains, followed by vomiting and diarrhea, then bleeding from the mouth, nose and gums. Death follows in the form of organ failure from low blood pressure.

小孩子的症状一开始有些发烧、头痛、肌肉酸痛，接着呕吐和腹泻，然后是嘴巴、鼻子、牙龈出血，因血压低带来的器官衰竭样貌伴随着死亡。

Sounds familiar? If you're thinking this is Ebola, actually, in this case, it's not. It's an extreme form of dengue fever, a mosquito-born disease which also does not have an effective therapy or a vaccine, and kills 22,000 people each year.

听起来很耳熟吗？如果你正想着这是“埃博拉病毒”的话，事实上这个案例并不是的；它是一种登革热的极端样态——一种蚊子所带来的疾病，这东西同样没有行得通的药方或是疫苗，而且每年夺走22,000条人命！

That is actually twice the number of people that have been killed by Ebola in the nearly four decades that we've known about it. As for measles, so much in the news recently, the death toll is actually tenfold higher. Yet for the last year, it has been Ebola that has stolen all of the headlines and the fear.

在我们已经知道登革热近四十年来那确实是丧命于埃博拉病毒人数的两倍。至于近来如此大量登上新闻的麻疹，死亡总计实际上高出十倍；然而去年一整年里“埃博拉”已经抢走所有的头条和恐惧。

Clearly, there is something deeply rooted about it, something which scares us and fascinates us more than other diseases. But what is it, exactly? Well, it's hard to acquire Ebola, but if you do, the risk of a horrible death is high. Why? Because right now, we don't have any effective therapy or vaccine available.

很清楚地有某种东西深植于其中，某种远比其他疾病还要吓人以及使我们着迷的东西。但是那到底是什么呢？要染上“埃博拉”是很难的，不过要是你染上了——不得好死的风险很高，为什么呢？因为此时我们没有任何行得通的药方或疫苗是可到手的，

And so, that's the clue. We may have it someday. So we rightfully fear Ebola, because it doesn't kill as many people as other diseases. In fact, it's much less transmissible than viruses such as flu or measles. We fear Ebola because of the fact that it kills us and we can't treat it. We fear the certain inevitability that comes with Ebola. Ebola has this inevitability that seems to defy modern medical science.

这就是线索了，我们也许到哪天会有药方、疫苗；所以我们理该害怕埃博拉病毒，它并没有如同其他疾病夺走了许多人命，事实上它比起流行感冒或是麻疹等病毒更不会转传出去，我们害怕埃博拉是因为它会夺走我们的性命而我们不能治好它的事实，我们惧怕伴随着埃博拉的必然无可幸免性，埃博拉有着看似否定现代医疗科学的无可幸免性。

But wait a second, why is that? We've known about Ebola since 1976. We've known what it's capable of. We've had ample opportunity to study it in the 24 outbreaks that have occurred. And in fact, we've actually had vaccine candidates available now for more than a decade. Why is that those vaccines are just going into clinical trials now?

不过慢着－那是为什么呢？我们自从1976年以来就知道埃博拉病毒了，我们知道它有什么能耐，我们早就有充分的机会在24个已经出现过伊波拉的爆发区来研究它，而且事实上我们确实已经有可到手的疫苗候选剂超过十年以上，为什么那些疫苗现在才正要进入临床测试呢？

This goes to the fundamental problem we have with vaccine development for infectious diseases. It goes something like this: The people most at risk for these diseases are also the ones least able to pay for vaccines. This leaves little in the way of market incentives for manufacturers to develop vaccines, unless there are large numbers of people who are at risk in wealthy countries. It's simply too commercially risky.

这要讲到我们在研发给传染性疾病用的疫苗现有的根本问题，要讲到像这些东西——“对这些疾病最有风险的人，同样也是最买不起疫苗的人！”，这留下很少的市场诱因给厂商来研发疫苗；除非在富裕的国家里有着一大堆人处于风险之下，研发疫苗绝对是商业上太冒风险的。

As for Ebola, there is absolutely no market at all, so the only reason we have two vaccines in late-stage clinical trials now, is actually because of a somewhat misguided fear. Ebola was relatively ignored until September 11 and the anthrax attacks, when all of a sudden, people perceived Ebola as, potentially, a bioterrorism weapon.

至于埃博拉病毒是绝对丝毫市场诱因也没有，所以我们现在会有两个在后段临床测试的疫苗，唯一的理由确实是因为某种被误导的恐惧。埃博拉病毒直到911和炭疽病攻击前相对之下是被轻忽的，但是突然间染上埃博拉病毒的人就如同潜在性生物恐怖攻击武器。

Why is it that the Ebola vaccine wasn't fully developed at this point? Well, partially, because it was really difficult-- or thought to be difficult -- to weaponize the virus, but mainly because of the financial risk in developing it. And this is really the point.

为什么埃博拉疫苗在这时候没有被完全地研发出来呢？有一部分是因为它确实很难，或是被想成很难－把病毒武器化，不过主要是因为要开发它的财务风险，而这真的就是关键。

The sad reality is, we develop vaccines not based upon the risk the pathogen poses to people, but on how economically risky it is to develop these vaccines. Vaccine development is expensive and complicated. It can cost hundreds of millions of dollars to take even a well-known antigen and turn it into a viable vaccine.

令人难过的现实就是我们研发疫苗不是基于病原体对人体造成的风险，却是基于研发这些疫苗经济上是如何冒风险的；疫苗的研发是既昂贵又繁琐的，它可以花到上亿美元把一个就算相当清楚的抗体转变成大有机会的疫苗。

Fortunately for diseases like Ebola, there are things we can do to remove some of these barriers. The first is to recognize when there's a complete market failure. In that case, if we want vaccines, we have to provide incentives or some type of subsidy. We also need to do a better job at being able to figure out which are the diseases that most threaten us.

幸好对类似于“埃博拉”的疾病来讲，有着我们能移除些许阻碍的事情可做。首先是认知到当那里市场完全失能的时候，在那个案例里如果我们想要疫苗，我们得提供诱因或是某类补助，我们同样需要在有办法弄清楚威胁我们最大的疾病有哪些这档事上做得更好；

By creating capabilities within countries, we then create the ability for those countries to create epidemiological and laboratory network swhich are capable of collecting and categorizing these pathogens. The data fromt hat then can be used to understand the geographic and genetic diversity, which then can be used to help us understand how these are being changed immunologically, and what type of reactions they promote.

透过在国与国之间催生多种本事，我们接着为那些国家催生能力来建立流行病学和实验室的网络，该网络有办法收集和归类这些病原体。从那里得来的资料稍后可以被用来理解地理和基因的歧异性，那些接着可以被用来帮助我们理解这些病原体是如何在免疫学上被更改了，以及它们会促发什么样的反应。

So these are the things that can be done, but to do this, if we want to deal with a complete market failure, we have to change the way we view and prevent infectious diseases. We have to stop waiting until we see evidence of a disease becoming a global threat before we consider it as one.

这些是可以被做到的事情，不过要做到－假使我们想要解决市场完全失能的话，我们得要改变我们看待以及防治传染病的方式，我们必须停止直到我们看见疾病之证据前的空等－早在我们认定之前形成全球威胁。

So, for Ebola, the paranoid fear of an infectious disease, followed by a few cases transported to wealthy countries, led the global community to come together, and with the work of dedicated vaccine companies, we now have these: Two Ebola vaccines in efficacy trials in the Ebola countries --and a pipeline of vaccines that are following behind.

所以拿埃博拉病毒来说，对一种传染病疑神疑鬼的惧怕、接下来极少数的病例被转送到富裕的国家去，导致全球社会来携手合作；而且有了尽职的疫苗公司在做事，我们现在有了这些东西－在出现埃博拉的国家中有了两种临床疗效试验中的伊波拉疫苗，以及源源不绝的疫苗紧接其后。

Every year, we spend billions of dollars, keeping a fleet of nuclear submarines permanently patrolling the oceans to protect us from a threat that almost certainly will never happen. And yet, we spend virtually nothing to prevent something as tangible and evolutionarily certain as epidemic infectious diseases.

每一年我们花费掉数十亿美元维持核子潜艇舰队不间断地巡防大洋，以保护我们远离几乎铁定永远不会发生的威胁，再加上我们实际上没花钱来避免某种碰得到的以及肯定会进化的流行传染病。

And make no mistake about it -- it's not a question of "if," but "when." These bugs are going to continue to evolve and they're going to threaten the world. And vaccines are our best defense. So if we want to be able to prevent epidemics like Ebola, we need to take on the risk of investing in vaccine development and in stockpile creation. And we need to view this, then, as the ultimate deterrent --something we make sure is available, but at the same time, praying we never have to use it.

而且别搞错了－这不是“会不会”而是“何时”的问题，这些病菌将会继续进化，而且它们将会威胁到全世界，而疫苗就是我们最佳的庇护。因此要是我们想要能够避免像伊波拉一般的传染病，我们必须冒投资在疫苗研发以及产生囤积的风险。我们必须正视这个然后当做终极遏制－我们要确保那是到手的东西，不过同一时间祈祷我们永远用不上它！

Thank you.

谢谢大家！