TED学院 | 疫苗研制为何总是落后？

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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！

https://v.qq.com/txp/iframe/player.html?width=500&height=375&auto=0&vid=q07396tfs4n中英文演讲稿

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.

这个患儿的症状首先是 低烧、头痛和肌肉痛， 之后出现呕吐和腹泻， 后来口、鼻和牙龈开始出血， 最终由于低血压引起器官衰竭，导致死亡

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. 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.

是不是听起来很熟悉？ 如果你觉得这会不会是埃博拉， 实际上，就本例来说并不是。 本例是登革热的极端形式，这是一种通过蚊子传播的疾病，它也没有有效的治疗方法或疫苗，并且每年杀死 2.2 万人。 其实，这一数字相当于 埃博拉病毒，在自我们知道它以来的 近 40 年里，所杀死的人数的两倍 而近期新闻中频繁提到的麻疹 死亡人数实际上是登革热的十倍之多。 然而在去年， 占据所有头条，引起所有恐慌的 却是埃博拉。

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.

显然，有某种东西深深地根植其中， 这种东西让我们如此害怕， 成为了挥之不去的阴影，没有其它疾病能做到这一点。 而它到底是什么呢？ 其实，得上埃博拉是很不容易的， 但如果真的患病， 以可怕的死状离去，是极有可能的。 为什么？ 因为现在我们没有任何有效的治疗方法或疫苗可用。

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.

所以，这就是原因。 可能我们终将研制出来。 所以我们害怕埃博拉，是合情合理的， 因为它杀死的人没有其它疾病那么多， 实际上，它的传染性比 流感和麻疹之类的病毒，低多了。 我们害怕埃博拉是因为这一事实： 它能杀死我们，我们却无能为力。 我们害怕伴随埃博拉而来的某种不可避免性。 埃博拉的这种不可避免性 似乎是在挑战现代医学。

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?

等一下，为什么会这样？ 从 1976 年起我们就知道埃博拉了， 我们知道它有多厉害， 我们也有足够的机会来研究它， 因为一共出现了 24 起爆发的病例。 而实际上， 现在我们手上已经有了候选疫苗， 在十多年前就有了。 那为什么这些疫苗到现在才进行临床实验？

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.

这就遇到了研制感染性疾病的疫苗时 面临的根本问题。 大致情况是这样： 患上这些疾病风险最高的人 也是最无力支付疫苗的一群人。 这就导致几乎没有市场动力 来推动生产商研制疫苗， 除非在富国有大量人群面临风险。 简单来说，商业风险过高。

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，则完全没有市场， 所以，如今我们能有两种疫苗进入后期临床实验， 唯一的原因是，有点被误导的恐惧。相对来说，埃博拉一直以来被忽视了，直到 911 和炭疽袭击，突然之间，人们意识到 埃博拉是一种潜在的，具有生物恐怖袭击性的武器。

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. 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.

为什么这时埃博拉疫苗还没有完全研制出来？ 部分是因为非常困难--或者说觉得很困难--来使病毒武器化。 但主要原因是研制疫苗的财务风险。 这一点是问题真正所在。 现实的可悲之处在于， 我们研制一种疫苗， 并非是考虑病原体对人类的风险有多大， 而是考虑研制疫苗的经济风险有多大。 研制疫苗既昂贵又复杂， 要花费高达数亿美元 才能选出一种，甚至是已经熟知的抗原， 将它转化为可用的疫苗。

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. By creating capabilities within countries, we then create the ability for those countries to create epidemiological and laboratory networks which are capable of collecting and categorizing these pathogens. The data from that 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.

幸运的是，对于像埃博拉这样的疾病， 我们还是可以做一些事情 来打破这些壁垒的。 首先，要承认市场已经完全不起作用的现状， 在这种情况下，如果我们想得到疫苗， 就必须提供奖励措施，或某种形式的补贴。 我们也需要更加努力， 来找出对我们威胁最大的疾病有哪些。 首先确立这些国家内部的研发力量，在此基础上 我们帮助这些国家建起 创立流行病学和实验室网络的能力，有了这些，我们就有能力采集这些病原体，并进行分类。由此而来的数据 可用于了解其地理分布和遗传多样性， 有助于帮助我们了解 这些免疫学上的变化是如何产生的 以及促进了哪种类型的反应。

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. 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 –

所以说，这些事情是可以做的， 但要做到这些， 如果我们想要在市场无力的情况下解决问题， 就必须改变我们看待、预防传染性疾病的方法。 我们不能在看到疾病成为全球性威胁的证据之前， 总是袖手旁观。 当我们认为它是的时候，就应该行动起来 所以，对于埃博拉来说， 对传染性疾病的极度恐慌， 出现于几例传染者转移至富裕国家之后。 这种恐慌促使全球各国携起手来， 加上专门的疫苗公司的努力， 我们才有了现在的结果： 两种埃博拉疫苗正在发病国家进行疗效试验，

and a pipeline of vaccines that are following behind.

后续还会有疫苗不断地生产出来。

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. And make no mistake about it -- it's not a question of "if," but "when."

每年我们花费数十亿美元， 以维持核潜艇舰队， 在海洋中持续巡逻， 而这支舰队所预防的威胁， 几乎可以肯定绝不会出现。 然而，我们又实际上几乎没有花费多少钱 来预防流行性传染病这样的问题， 这个问题切实存在，并且一定是不断进化的。

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.

对此不应当犯错--这不是“如果”的问题，而是“什么时候”的问题。这些病毒还会不断进化，还会威胁整个世界，而疫苗是我们的最佳防御手段。所以如果我们想要预防譬如埃博拉的蔓延， 我们就必须承担风险， 向疫苗研制与物资储备投入资金。 而且我们应当，把它看作最终防线-- 我们确保有效的良方， 而与此同时， 祈祷永远不要用到它。

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