In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The COVID-19 pandemic is an excellent case in point. The world needs to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.
面对任何危机，领导人都肩负着两个同等重要的责任：解决眼前的问题，以及防止问题再次发生。新冠肺炎疫情（COVID-19）就是一个有力的证明。我们不仅需要拯救生命，也要从整体上改善应对疫情爆发的方式。前者更加紧迫，而后者从长远来看至关重要。
The long-term challenge—improving our ability to respond to outbreaks—isn’t new. Global health experts have been saying for years that another pandemic rivalling the speed and severity of the 1918 influenza epidemic wasn’t a matter of if but when. The Bill & Melinda Gates Foundation has committed significant resources in recent years to helping the world prepare for such a scenario.提高疫情应对能力是世界长期面临的挑战。全球健康专家近年来多次提醒，传播速度和严重程度都堪比1918年大流感的大流行病势必会发生，只是时间早晚的问题。比尔及梅琳达·盖茨基金会近年来已经投入大量的资源，帮助世界做好应对此类疫情的准备。
Now, in addition to the perennial challenge, we face an immediate crisis. In the past week, COVID-19 has started to behave a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume that it will be until we know otherwise.如今，我们还面临着眼下的危机。在过去一周，2019新型冠状病毒开始表现出百年不遇的病原体的迹象，这是我们一直担心的。我希望情况不会这么糟糕，但我们应该做好充分准备。
There are two reasons that COVID-19 is such a threat. First, it can kill healthy adults in addition to elderly people with existing health problems. The data so far suggests that the virus has a case fatality risk around 1%; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).新冠肺炎的威胁主要基于两点原因。首先，除了已经存在健康问题的老年人以外，新冠肺炎还能造成健康成年人的死亡。目前的数据表明，2019新型冠状病毒的病死率在1%左右，这一数据介于1957年大流感（病死率0.6%）和1918年大流感（病死率2%）之间，说明它比典型的季节性流感要严重好几倍。
Second, COVID-19 is transmitted quite efficiently. The average infected person spreads the disease to two or three others. That’s an exponential rate of increase. There is also strong evidence that it can be transmitted by people who are just mildly ill or not even showing symptoms yet. This means COVID-19 will be much harder to contain than Middle East Respiratory Syndrome or Severe Acute Respiratory Syndrome (SARS), which were only spread by those showing symptoms and were much less efficiently transmitted. In fact, COVID-19 has already caused 10 times as many cases as SARS in just a quarter of the time.其次，新冠肺炎传播力很强。平均一个感染者会传染两到三个人，形成指数级增长。另有确切证据表明，它可以通过轻症甚至无症状的患者传播。这意味着新冠肺炎将比中东呼吸综合征（MERS）和非典型性肺炎（SARS）更难控制，因为MERS和SARS只通过已经出现症状的患者传播，且传播力低很多。事实上，新冠肺炎在短短四分之一的时间内就已经造成了十倍于SARS的确诊病例。
The good news is that national, state, and local governments and public health agencies can take steps over the next few weeks to slow the spread of COVID-19.各个国家和地方政府以及公共卫生机构可以在未来几周采取行动，从而减缓新冠肺炎的传播。
For example, in addition to helping their own citizens respond, donor governments should help low- and middle-income countries prepare for this pandemic. The health systems in many of these countries are already stretched thin, and a pathogen like coronavirus can quickly overwhelm them. And poorer countries have little political or economic leverage, given wealthier countries’ natural desire to put their own people first.例如，除了保护好本国公民，捐助国政府应该帮助中低收入国家做好应对疫情的准备。很多中低收入国家的卫生系统本已相当薄弱，而2019新型冠状病毒会很快让他们不堪重负。此外，鉴于更富裕国家自然会将本国国民的利益放在首位，相对贫困的国家就会更加缺乏政治和经济上的资本来获取支持。
By helping countries in Africa and South Asia get ready now, we can save lives and also slow the global circulation of the virus.通过帮助非洲和南亚的国家做好准备，我们不仅可以拯救生命，同时还能减缓病毒的全球扩散。
By helping countries in Africa and South Asia get ready now, we can save lives and also slow the global circulation of the virus. (A significant portion of the commitment Melinda and I recently made to help kickstart the global response to COVID-19—which could total up to $100 million—is focused particularly on developing countries.)通过帮助非洲和南亚的国家做好准备，我们不仅可以拯救生命，同时还能减缓病毒的全球扩散。我和梅琳达最近承诺投入最高1亿美元支持全球应对新冠肺炎疫情，其中很大一部分将用于支持中低收入国家。
The world also needs to accelerate work on treatments and vaccines for COVID-19. Scientists were able to sequence the genome of the virus and develop several promising vaccine candidates in a matter of days, and the Coalition for Epidemic Preparedness Innovations is already preparing up to eight promising vaccine candidates for clinical trials. If one or more of these vaccines proves safe and effective in animal models, they could be ready for larger-scale trials as early as June. Drug discovery can also be accelerated by drawing on libraries of compounds that have already been tested for safety and by applying new screening techniques, including machine learning, to identify antivirals that could be ready for large-scale clinical trials within weeks.我们还需要加快针对新冠肺炎的治疗和疫苗开发工作。科学家们在几天之内就掌握了病毒的基因组序列并且开发出具有前景的候选疫苗。流行病防范创新联盟（CEPI）已经在准备将八种具有前景的候选疫苗投入临床试验。如果这些疫苗中的一个或多个在动物模型中被证明安全有效，它们最早在六月便可以进入大规模临床试验。利用已经通过安全性测试的化合物库和新的筛选技术（包括机器学习），科学家们可以在几周内筛选出可用于大规模临床试验的抗病毒药物，从而加快药物研发的进程。
All these steps would help address the current crisis. But we also need to make larger systemic changes so we can respond more efficiently and effectively when the next epidemic arrives.所有这些措施都将有助于应对目前的危机。但我们仍然需要做出系统性调整，确保更高效地应对下一次大流行病疫情。
It’s essential to help low- and middle-income countries strengthen their primary health care systems. When you build a health clinic, you’re also creating part of the infrastructure for fighting epidemics. Trained health care workers not only deliver vaccines; they can also monitor disease patterns, serving as part of the early warning systems that will alert the world to potential outbreaks.帮助中低收入国家加强其初级卫生保健系统也十分必要。当你建立一家诊所，你同时也在为抗击传染病建设基础设施。训练有素的卫生保健工作者不仅提供疫苗，他们还可以成为预警系统的一部分，监测疾病趋势，向世界发出潜在疫情的警报。
The world also needs to invest in disease surveillance, including a case database that is instantly accessible to the relevant organizations and rules that require countries to share their information. Governments should have access to lists of trained personnel, from local leaders to global experts, who are prepared to deal with an epidemic immediately, as well as lists of supplies to be stockpiled or redirected in an emergency.世界还需要在疾病监测方面进行投资，包括建立一个相关机构可以立刻接入的病例数据库，并建立要求各国分享信息的规则。各国政府应该掌握训练有素的人员名单——无论是地方领导人还是全球专家，都应该随时准备好应对传染病疫情，以及在紧急情况下须进行储备和调动的物资清单。
In addition, we need to build a system that can develop safe and effective vaccines and antivirals, get them approved, and deliver billions of doses within a few months of the discovery of a fast-moving pathogen. That’s a tough challenge that presents technical, diplomatic, and budgetary obstacles, as well as demanding partnership between the public and private sectors. But all these obstacles can be overcome.此外，我们需要建立一个系统，用以开发安全、有效的疫苗和抗病毒药物，确保它们通过审批，并能在发现快速传播的病原体后的几个月里生产并供给数十亿剂量。这是一项艰巨的挑战，不仅有技术、外交和资金的障碍，还需要公私部门间的通力合作。但所有障碍都可以被克服。
One of the main technical challenges for vaccines is to improve on the old ways of manufacturing proteins, which are just too slow for responding to an epidemic. We need to develop platforms that are predictably safe, so regulatory reviews can happen quickly, and that make it easy for manufacturers to produce doses at a low cost and a massive scale. For antivirals, there will need to be an organized system to screen existing treatments and candidate molecules in a swift and standardized manner.关于疫苗的一项主要技术挑战，是改善生产蛋白质的方式，传统方式对于应对传染病疫情实在太慢了。我们需要开发安全可靠的平台，确保监管审查可以迅速进行，也能让制造商以低成本进行量产。对于抗病毒药物，我们需要有一个有组织的系统以快速和标准化的方式筛选已有的治疗方法和候选分子。
Another technical challenge involves constructs based on nucleic acids. These constructs can be produced within hours after a virus’s genome has been sequenced; now we need to find ways to produce them at scale.关于疫苗的一项主要技术挑战，是改善生产蛋白质的方式，传统方式对于应对传染病疫情实在太慢了。我们需要开发安全可靠的平台，确保监管审查可以迅速进行，也能让制造商以低成本进行量产。对于抗病毒药物，我们需要有一个有组织的系统以快速和标准化的方式筛选已有的治疗方法和候选分子。
In addition to these technical solutions, we’ll need diplomatic efforts to drive international collaboration and data sharing. Developing antivirals and vaccines involves massive clinical trials and licensing agreements that would cross national borders. We should make the most of global forums that can help achieve consensus on research priorities and trial protocols so that promising vaccine and antiviral candidates can move quickly through this process. These platforms include the World Health Organization R&D Blueprint, the International Severe Acute Respiratory and Emerging Infection Consortium trial network, and the Global Research Collaboration for Infectious Disease Preparedness. The goal of this work should be to get conclusive clinical trial results and regulatory approval in three months or less, without compromising patients’ safety.除了这些技术解决方案之外，我们还将需要外交方面的努力，推动国际合作和数据共享。开发抗病毒药物和疫苗涉及大量跨越国界的临床试验和授权协议。我们应该通过全球平台来推动各方针对有前景的候选疫苗和抗病毒药物在研究重点和试验方案等方面快速达成共识。这些全球性平台包括“世界卫生组织研发蓝图”、“国际严重急性呼吸系统和新发感染联合会试验网络”和“全球传染病防控研究合作组织”。这项工作的目标应该是在三个月甚至更短的时间内，在保证患者安全的前提下得到确定性的临床试验结果和监管审批。
Budgets for these efforts need to be expanded several times over.这些工作的预算需要成倍增加。
Then there is the question of funding. Budgets for these efforts need to be expanded several times over. Billions more dollars are needed to complete Phase III trials and secure regulatory approval for coronavirus vaccines, and still more funding will be needed to improve disease surveillance and response.接着就是资金的问题了。这些工作的预算需要成倍增加。完成新冠病毒疫苗的三期临床试验并获得监管审批就需要额外数十亿美元的投入。提升疾病监测和应对还需要更多资金。
Why does this require government funding—can’t the private sector solve this on its own? Pandemic products are extraordinarily high-risk investments, and pharmaceutical companies will need public funding to de-risk their work and get them to jump in with both feet. In addition, governments and other donors will need to fund—as a global public good—manufacturing facilities that can generate a vaccine supply in a matter of weeks. These facilities can make vaccines for routine immunization programs in normal times and be quickly refitted for production during a pandemic. Finally, governments will need to finance the procurement and distribution of vaccines to the populations that need them.需要政府投入资金，是因为大流行病相关产品是非常高风险的投资，公共资金有助于将药企的风险最小化，从而确保他们得以全身心投入工作。此外，政府和其他捐助方需要以支持全球公共产品的方式，资助建设可以在几周内实现疫苗供应的生产设施。这些设施可以在平常用来生产常规免疫规划需要的疫苗，而在大流行病期间可以迅速改装生产所需疫苗。最后，政府需要资助疫苗的采购和分发，确保它们抵达需要的人群。
Obviously, billions of dollars for anti-pandemic efforts is a lot of money. But that’s the scale of investment required to solve the problem. And given the economic pain that an epidemic can impose—just look at the way COVID-19 is disrupting supply chains and stock markets, not to mention people’s lives—it will be a bargain.投入数十亿美元用来抗击大流行病，这不是一笔小数目，但想要解决问题，这是必须的投资。而且考虑到疫情可能带来的经济损失——只要看看新冠肺炎对供应链和股票市场造成的影响，更不用说对人们生活的影响——这将是一笔值得的投入。
Finally, governments and industry will need to come to an agreement: During a pandemic, vaccines and antivirals won’t simply be sold to the highest bidder. They’ll be available and affordable for people who are at the heart of the outbreak and in greatest need. Not only is this the right thing to do, it’s also the right strategy for short-circuiting transmission and preventing future pandemics.最后，政府和行业需要达成协议：在大流行病期间，疫苗和抗病毒药物不能简单地卖给出价最高的买家，而应该让身处疫情中心及最有需要的人们以可负担的价格买到。这不仅是正确的做法，也是阻断传播和防止疫情继续蔓延的正确策略。
These are the actions that leaders should be taking now. There is no time to waste.This post originally appeared on the website of the New England Journal of Medicine. 本文英文发表于《新英格兰医学杂志》，由《NEJM医学前沿》授权并合作翻译。