TED: Bill Gates The Next Outbreak -We're Not Ready

◆这是比尔盖茨2015年在Ebola爆发之后做的TED演讲。他认为在未来几十年里，如果有什么东西可以杀掉上千万人，那更可能是个有高度传染性的病毒，而不是战争；不是导弹，而是微生物。在全世界范围内，大家其实都投资不足，研究不到位，更没有足够的准备来应对突发传染病。

When I was a kid, the disaster we worried about most was a nuclear war. That's why we had a barrel like this down in our basement, filled with cans of food and water. When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel. 

Today the greatest risk of global catastrophe doesn't look like this. Instead, it looks like this. If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war. Not missiles, but microbes. Now, part of the reason for this is that we've invested a huge amount in nuclear deterrents. But we've actually invested very little in a system to stop an epidemic. We're not ready for the next epidemic. 

Let's look at Ebola. I'm sure all of you read about it in the newspaper, lots of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication. And as you look at what went on, the problem wasn't that there was a system that didn't work well enough, the problem was that we didn't have a system at all. In fact, there's some pretty obvious key missing pieces. 

We didn't have a group of epidemiologists ready to go, who would have gone, seen what the disease was, seen how far it had spread. The case reports came in on paper. It was very delayed before they were put online and they were extremely inaccurate. We didn't have a medical team ready to go. We didn't have a way of preparing people. Now, Médecins Sans Frontières did a great job orchestrating volunteers. But even so, we were far slower than we should have been getting the thousands of workers into these countries. And a large epidemic would require us to have hundreds of thousands of workers. There was no one there to look at treatment approaches. No one to look at the diagnostics. No one to figure out what tools should be used. As an example, we could have taken the blood of survivors, processed it, and put that plasma back in people to protect them. But that was never tried. 

So there was a lot that was missing. And these things are really a global failure. The WHO is funded to monitor epidemics, but not to do these things I talked about. Now, in the movies it's quite different. There's a group of handsome epidemiologists ready to go, they move in, they save the day, but that's just pure Hollywood. 

The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola Let's look at the progression of Ebola over this year. About 10,000 people died,  and nearly all were in the three West African countries. There's three reasons why it didn't spread more. The first is that there was a lot of heroic work by the health workers. They found the people and they prevented more infections. The second is the nature of the virus. Ebola does not spread through the air. And by the time you're contagious, most people are so sick that they're bedridden. Third, it didn't get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas, the case numbers would have been much larger. 

So next time, we might not be so lucky. You can have a virus where people feel well enough while they're infectious that they get on a plane or they go to a market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So there are things that would literally make things a thousand times worse. 

In fact, let's look at a model of a virus spread through the air, like the Spanish Flu back in 1918. So here's what would happen: It would spread throughout the world very, very quickly. And you can see over 30 million people died from that epidemic. So this is a serious problem. We should be concerned. 

But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talk about here. We've got cell phones to get information from the public and get information out to them. We have satellite maps where we can see where people are and where they're moving. We have advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that pathogen. So we can have tools, but those tools need to be put into an overall global health system. And we need preparedness. 

The best lessons, I think, on how to get prepared are again, what we do for war. For soldiers, we have full-time, waiting to go. We have reserves that can scale us up to large numbers. NATO has a mobile unit that can deploy very rapidly. NATO does a lot of war games to check, are people well trained? Do they understand about fuel and logistics and the same radio frequencies? So they are absolutely ready to go. So those are the kinds of things we need to deal with an epidemic. 

What are the key pieces? First, we need strong health systems in poor countries. That's where mothers can give birth safely, kids can get all their vaccines. But, also where we'll see the outbreak very early on. We need a medical reserve corps: lots of people who've got the training and background who are ready to go, with the expertise. And then we need to pair those medical people with the military. taking advantage of the military's ability to move fast, do logistics and secure areas. We need to do simulations, germ games, not war games, so that we see where the holes are. The last time a germ game was done in the United States was back in 2001, and it didn't go so well. So far the score is germs: 1, people: 0. Finally, we need lots of advanced R&D in areas of vaccines and diagnostics. There are some big breakthroughs, like the Adeno-associated virus, that could work very, very quickly. 

Now I don't have an exact budget for what this would cost, but I'm quite sure it's very modest compared to the potential harm. The World Bank estimates that if we have a worldwide flu epidemic, global wealth will go down by over three trillion dollars and we'd have millions and millions of deaths. These investments offer significant benefits beyond just being ready for the epidemic. The primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe. 

So I think this should absolutely be a priority. There's no need to panic. We don't have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side. 

In fact, if there's one positive thing that can come out of the Ebola epidemic, it's that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic. 

Thank you. 

(Applause)

如果有什么东西在未来几十年里可以杀掉上千万人，那更可能是个有高度传染性的病毒，而不是战争。不是导弹，而是微生物。

If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war. Not missiles, but microbes.

演讲实录：

当我还是小孩时，我们最担心的灾害是核战争。所以我们在地下室有个这样的筒子，装满了罐头食物和水。当核战争爆发时，我们就要躲到地下室去，蹲低身子并靠那个筒子维生。

今天的全球灾难最大的危险看起来已不像这样了。事实上，会像这样。如果有什么东西在未来几十年里可以杀掉上千万人，那更可能是个有高度传染性的病毒，而不是战争。不是导弹，而是微生物。部分的理由是因为我们在核威慑上投注了很大的精力和金钱。但是我们在防止疫情的系统上却投资很少。我们还没有准备好预防下一场大疫情的发生。

让我们看看埃博拉病毒。我相信大家在报纸上都有读到这样的新闻，充满了许多艰难的挑战。用我们追踪消灭脊髓灰质炎（小儿麻痹症）的案例分析工具，我仔细地追踪这病毒的发展。随着疫情的发展我们可以看到，问题不在于我们没有一套可以使用的系统，而是我们根本没有任何系统。事实上我们可以看到有几个很明显的不足。

我们找不到一群准备好了的流行病学家，能去疫区看看病理和病情发展。病例都是由纸上报道传来的。信息传上线时已经很晚了，此外还很不准确。我们也找不到训练有素的医护小组。我们没有一套让人们严阵以待的方法。目前，“无国界医生”在动员志愿者上做了很大的贡献。但即使如此，我们调动数千名工作者到疫区的速度还是十分差强人意的。大的疫情会需要我们动员数十万的人员，但我们没有任何人在研究治疗的方向。也没有人在看诊断的方法。没有人在想该用什么工具。举个例子来说，我们也许可以抽取生还者的血液，处理过后，再将血浆注入人体内来保护没得病的人。但是这个方法从来没有试过，所以有很多事都还没来得及做。而这的确是全球性的失败。世界卫生组织的目的是来监视流行病，而不是来做我刚讲的事。但是在电影中演的剧情又是另一回事。有一群很英俊的流行病学家准备就绪，他们到了疫区拯救了大家，但这是纯好莱坞的剧情。

我们的准备不足，可能会导致下一场疫情，比埃博拉病毒的危害更严重。让我们看看埃博拉病毒在过去一年中的发展。大约死了一万人，所有的死者都在西非的三个国家里。之所以没有扩散的原因有三个。第一个是卫生工作人员作的很多英雄事迹。他们找到很多病人并防止了更多人得病。第二个是病毒的特性，埃博拉病毒不是靠空气传染的。等到你有足够的传染力时，大部分的人已经病得卧床不起了。第三个是因为病毒没有传到城市区。这纯粹是运气好。如果病毒传到了城市区，那么死亡的人数绝对不止于此。

所以下一次我们可能不会这么幸运了。有的病毒可能让你毫无察觉，但当感染病毒的人乘飞机或者去逛商场，他们其实已经具有一定的传染力了。此外病毒的来源可以是天然的，像埃博拉病毒，或是由生物恐怖攻击产生的。所以可以让疫情惨上千倍的病毒是存在的。

事实上，让我们来看看一个病毒由空气传染的模型，像1918年的西班牙流感。疫情有可能像这样发展：病毒会以很快的速度向全世界蔓延。你可以看到全球有三千万人死于这个疾病。这就是个很严重的问题。我们绝不应该忽视。

1918年的西班牙流感模拟

但事实上我们可以建立一个很好的反应系统。我们可以利用所有发展至今的科技和科学。我们可以用手机来收集信息和发布信息。我们有卫星地图可以看到人们在哪里和往哪移动。我们在生物学上也有进展，这可以大幅缩短我们找到病原的时间，并可以在很短的时间里找出解药和疫苗。所以我们是有工具的，但这些工具必须统合在一个全球健康系统下。此外我们必须处在准备好的状态。

而我们如何做好准备，最好的例子还是来自于备战。对军人来说，他们是随时随地都准备好要投入战争的。我们还有预备军人，能使备战人口大量增加。北约组织有个机动小组，可以很快地行动起来。北约组织有很多战争游戏可以测试人员是否已训练有素？他们是否了解燃油，补给和相同的收音机频率？是的话，那么他们就已准备好了。这些就是面对疫情时我们该准备的事。

关键的项目有哪些？第一，在贫穷的国家里必须有发达的卫生系统。母亲们可以安全地生小孩，小孩们可以接种疫苗。我们也可以在很早的阶段侦查到疫情的爆发。我们需要后备的医疗部队：还有很多训练有素的专业人员，随时准备好能带着他们专长到疫区。我们可以用军队来配合医护人员，利用军队移动迅速的特性，来进行后勤运输和维持安全。我们也需要进行一些情境模拟，不是进行战争游戏而是进行病菌游戏，看看防卫漏洞在哪。上一次的病菌游戏是在美国进行的，那是在2001年了，进行得也不是很顺利。目前病菌得一分人类零分。最后我们在疫苗和病理学上还需要很多的研发工作。在某些方面例如腺相关病毒上，我们已经有了相当的突破，这可以在很短的时间内生效。

我目前没有明确的预算这到底需要多少钱，但是我确信跟损失比起来是比较便宜的。根据世界银行的估算，如果我们有流感的疫情暴发，全球经济会损失三万多亿美元。我们还会可能有千百万人员的死亡。跟仅仅只是准备好比起来，这些额外的投资会带来显著的益处。基础的卫生保健，研发，可以促进全球健康的平衡发展，让这个世界更健康更安全。

所以我觉得这非常重要重要。刻不容缓。不需要惊慌。我们不需要囤积面罐头或是躲到地下室去，但是我们必须急起直追，因为时间有限。

事实上，要说这场埃博拉病毒的疫情带来了什么正面影响的话，那就是提早响起了警报，让我们觉醒并做好准备。我们如果即刻开始准备，那么在下一场疫情来临前我们是可以准备好的。

谢谢大家。

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