在6个月内为全世界普及疫苗接种 | 盖茨笔记
The greatest medical breakthrough of this pandemic—and surely one of the most important in decades—is the creation of COVID-19 vaccines. One study found that in their first year, they saved more than 1 million lives and prevented 10 million hospitalizations in the U.S. alone. The number of deaths averted around the world is of course far higher. It’s horrifying to think what COVID-19 would be doing to humanity if it weren’t for vaccines.
新冠大流行中最了不起的医学突破——当然也是数十年来最重要的突破之一——就是新冠疫苗的研发。一项研究发现，疫苗推出后仅一年，仅在美国，就挽救了100多万人的生命，并让1000万人免于住院治疗。若放眼世界，因疫苗而避免死亡的人数当然要高得多。如果没有疫苗，新冠会对人类造成怎样的影响，想到这真是令人感到恐惧。
The world has a lot to be proud of in the creation and delivery of these vaccines. Scientists have never developed one nearly as quickly as they did in 2020, and the governments of the world have never run immunization campaigns that were as fast and as far-reaching as the ones that took place in 2021.
新冠疫苗的研发和交付有很多值得骄傲的地方。科学家们从未像2020年那样快速地开发过一种疫苗，世界各国政府也从未开展过像2021年那样如此迅速且影响深远的免疫接种运动。
But there are also serious problems that we need to solve before the next potential pandemic comes along. One is the huge inequity in who has been vaccinated and who has not. It is both unjust and unwise to give a third shot to a healthy 25-year-old in a rich country before a 75-year-old cancer survivor in a poor country gets her first shot.
但在下一次可能的大流行病到来之前，我们需要解决一些非常重要的问题。其一就是，已接种疫苗者与未接种者之间存在着显著的不平等。在一位来自于贫穷国家的75岁癌症康复者注射第一针新冠疫苗之前，身处富裕国家的25岁健康的年轻人就能接种第三针加强针，这既不公正，也不明智。
Another concern is that the speed with which vaccines were created was only partly a matter of skill and diligence. It was also a matter of luck.
另一个值得关注的问题是，疫苗研发的速度并不单单取决于技术和勤奋，这其中也包含了运气的因素。
Because coronaviruses had already caused two previous outbreaks (SARS and MERS), scientists had learned quite a lot about the structure of the virus. In particular, they had identified its characteristic spike protein—the tips on the crownlike virus you’ve seen a dozen pictures of—as a potential target for vaccines. When it came time to create new vaccines, they had a sense of what part of the virus was most vulnerable to attack.
由于冠状病毒此前已经有过两次暴发（非典和中东呼吸综合征），科学家们已经对这种病毒的结构有了相当多的了解。特别是，他们已经确定了其独特的刺突蛋白——你已经从很多照片上看到过的冠状病毒的顶端——作为疫苗的潜在靶点。因此在研发新疫苗时，他们知道病毒的哪一部分最容易受到攻击。
在下一次疫情暴发中，我们可能就没有这么幸运了。下一次大流行病可能是由一种科学家尚未深入研究过，或是一种他们从未见过的病毒引起的。
This is why the world needs to adopt a serious plan for developing, manufacturing, and distributing new vaccines to prevent another pandemic. The manufacturing alone is a huge challenge: To prevent the inequities we’ve seen in COVID-19, the world needs to be ready to produce enough vaccines for everyone on the planet within six months of discovering a new pathogen. That’s 8 billion doses for a single-dose vaccine, and 16 billion for a two-dose version. In a typical year, around 5 billion or 6 billion doses are produced—that’s all vaccines combined.
这就是为什么世界需要为新疫苗的开发、生产和分配制定一个认真的计划，从而预防下一次大流行病。生产过程本身就是一项巨大的挑战：为了防止我们在新冠疫情中看到的不平等现象，世界需要在发现一种新型病原体后的六个月内为世界上的每个人生产出足够的疫苗。这意味着80亿剂单剂量疫苗以及160亿剂双剂量疫苗的生产能力。通常，全世界全年的疫苗生产总量约为50亿或60亿剂。
The plan needs to cover four steps, starting with accelerating the invention of new vaccines.
该计划需要四个步骤来执行，首先是加快新型疫苗的研发。
During the pandemic, the process of creating a new vaccine got a huge boost (no pun intended). Typically, the process involves a lot of trial and error: Scientists spend years identifying weak spots in the virus and trying to identify vaccine candidates that would teach the immune system to attack them.
在新冠大流行期间，研发新疫苗的进程得到了巨大的推动（绝无一语双关之意）。通常情况下，这一过程涉及大量的试错：科学家们花费数年时间识别病毒的薄弱点，并试图找出能够训练免疫系统攻击这些薄弱点的候选疫苗。
The creation of the first mRNA vaccines during the COVID-19 pandemic was a big step forward. They work by delivering genetic code to your body that instructs it to make shapes that look like the weak part of the virus. Your immune system notices that those shapes are foreign and sets out to attack them. Once it does, it remembers what the shapes looked like and will attack them the next time they show up. That’s what makes you immune.
在新冠大流行期间研制出的首个mRNA疫苗是一项巨大突破。其工作原理是向你的身体传递基因编码，指示身体制造出看起来类似病毒弱点形状的蛋白质。免疫系统注意到这些外来蛋白质并开始攻击它们。一旦这样做了，它就会记住这些形状的样子，并在它们下次出现时发动攻击。这就是你获得免疫的原理。
One reason mRNA vaccines were so revolutionary is that they’re easily adapted for different pathogens. Once the weak spot of a virus has been identified—a process made much easier by recent advances in mapping viral genomes—it’s simply a matter of changing the genetic code in the vaccine so that it tells your body to make a new shape. This can be done in a matter of days.
mRNA疫苗如此具有革命性的一个原因是，它们很容易适应不同的病原体。一旦确定了病毒的“命门”——由于近期在绘制病毒基因组图谱方面取得的进展，这一过程变得更加容易——只需改变疫苗的基因编码，它就会告诉你的身体制造一种新的形状。而这可以在几天内完成。
As a result, the development of new vaccines will be exponentially faster—as long as researchers have the same deep understanding of future pathogens as they did of coronaviruses. So it is imperative to invest in basic research on a wider array of known viruses and other pathogens, so we understand as much as possible before the next outbreak.
因此，只要研究人员对未来病原体的理解像对冠状病毒一样深入，新疫苗的开发速度就会呈指数增长。因此，当务之急是投资于对更多已知病毒和其他病原体的基础研究，以便我们在下一次疫情暴发之前（对它们）有尽可能多的了解。
Once a vaccine has been invented, the second step is to test it and get it approved for use in humans. Typically, it takes years to run all the trials necessary to prove that a vaccine is safe and effective—including time spent recruiting tens of thousands of volunteers. Assuming the vaccine proves out, it can take another year to get it authorized by the WHO and the relevant government agencies.
一旦一种疫苗被研发出来，第二步就是对其进行测试进而批准其用于人类。通常情况下，这需要花费数年时间来进行所有必要的试验，以证明疫苗是安全有效的——包括招募数万名志愿者所花费的时间。而即使疫苗已被证明有效，还需要一年时间才能得到世界卫生组织和相关政府机构的批准。
But when an outbreak is threatening to go global, we won’t have years. So we need ways to speed up the process without sacrificing the safety and effectiveness that people have come to expect from vaccines.
但当疫情有蔓延全球的风险时，我们就没有这么多时间了。因此，我们需要在不牺牲人们对疫苗安全性和有效性的期待的前提下，加快这一过程。
The world should build on models like the RECOVERY trial in the U.K. It set up protocols for running drug trials in advance and built infrastructure that made it much easier to get started once COVID hit. In addition, the agencies that regulate vaccines need to agree ahead of time on how volunteers will be enrolled in trials and on the software tools that will enable people around the world to sign up as soon as the disease strikes. And by connecting diagnostic tests to the trial system, we can automatically suggest to doctors that their patients should join a trial if they’re eligible.
世界应该以英国RECOVERY研究组的试验为范本，构建类似的模式。该小组提前制定了药物试验的运行协议，并建设了基础设施，这样新冠疫情来袭时就更容易启动试验。此外，疫苗监管机构需要提前就一些问题达成协议，比方说如何招募志愿者参加试验，以及开发软件工具，使世界各地的人在疾病来袭后能够立即注册参加试验。通过将诊断测试与临床试验系统相关联，我们可以自动向医生建议，如果病人符合条件，可以参加临床试验。
The third step, once a vaccine has been approved for use in humans, is to make enough of it fast enough to stop the outbreak. Ending a relatively small outbreak might require hundreds of thousands of doses of a new vaccine, which is not hard to make. (The world already produces more than 5 billion doses of vaccines every year.) But countries need to be prepared for the worst—another big outbreak in which everyone needs to be vaccinated—so we must be ready to produce as many as 8 billion or even 16 billion, roughly triple the amount manufactured in a typical year.
第三步，一旦一种疫苗被获准用于人类，就要快速生产出足够剂量的疫苗来阻止疫情暴发。结束一场规模相对较小的疫情可能需要数十万剂新疫苗，这并不难生产。(全世界每年疫苗产量已超过50亿剂。）但是各国需要为最坏的情况做好准备——一场每个人都需要接种疫苗的大规模的疫情暴发——因此我们必须要做好准备生产多达80亿甚至160亿剂疫苗，约为一般年份产量的三倍。
During COVID-19, the closest thing to a breakthrough in manufacturing vaccines was the proliferation of second-source deals. These are agreements in which a company that invented a vaccine agrees to let other companies use their factories to make it. (Picture Honda Accords rolling off the line of a Ford facility.)
在新冠疫情期间，疫苗生产中最能称得上接近突破的事情就是合同生产商协议的激增。在这些协议中，研发疫苗的公司同意让其他公司使用其工厂来生产疫苗。(想象一下本田雅阁从福特工厂里下线。)
It’s hard to overstate the impact of second-source deals during COVID-19. In less than two years, a single manufacturer, AstraZeneca, signed second-source deals involving 25 factories in 15 countries. (AZ also agreed to forgo its profits on the COVID vaccine.) Novavax also signed one with Serum Institute of India—leading to a COVID-19 vaccine now being used in many countries—and Johnson & Johnson signed one with the Indian company Biological E. Limited and the South African firm Aspen Pharmacare. All told, second-source deals led to the production of billions of additional COVID vaccine doses.
在新冠疫情期间，合同生产商协议的影响再怎么强调都不为过。在不到两年的时间里，仅阿斯利康一家疫苗厂商就签署了涉及15个国家25家工厂的合同生产商协议。(阿斯利康也同意放弃其新冠疫苗的所得利润。)诺瓦瓦克斯与印度血清研究所签署了一项协议——该协议下生产的疫苗目前正在许多国家使用——强生公司也与印度生物制药有限公司以及南非阿斯彭制药公司签订了协议。总而言之，合同生产商协议促成了数十亿剂新冠疫苗的生产。
In the future, such deals could be done even faster if companies that have them now can maintain their relationships with one another so they can hit the ground running during the next outbreak.
如果这些已拥有合同生产商协议的公司能够维持好彼此之间的关系，以便在下一次疫情暴发时迅速开展合作，那么这类协议在未来将能更快地履行。
mRNA vaccines could also help speed up manufacturing. Many of the conventional ways to make vaccines are quite complex, so it can take a lot of time to transfer the technology and know-how from one company to another. But because the basic approach to mRNA is pretty much the same—you just swap out your old mRNA for the new one and make sure the lipid is made the right way—it should be easier to transfer between companies. There are also some new modular technologies in the pipeline that, if they prove out, will make it cheaper and easier to build and run factories that can be adapted to make different vaccines.
mRNA疫苗也有助于加快生产速度。许多制造疫苗的传统方法都相当复杂，因此从一家公司向另一家公司转让技术和专业知识可能需要很长时间。但是，由于mRNA技术的基本原理大同小异（你只需要用新的mRNA替换掉旧的mRNA，并确保脂质的制造方法正确），技术和知识在公司之间的转让应该会更加容易。还有一些新的模块化技术正在筹备中，如果它们被证实可行，将促使生产不同疫苗的工厂的建造成本更低廉、运转更容易。
Finally, the fourth step in the world’s plan should be to make sure that new vaccines reach everyone who needs them—including people who live in low-income countries. In 2021, only 8 percent of people in those countries received at least one dose of a COVID-19 vaccine, while more than half of the world’s population did.
最后，全球计划的第四步应该是确保新疫苗能够惠及每一个需要它的人——包括生活在低收入国家的人。2021年，低收入国家中只有8%的人口接种了至少一剂新冠疫苗，与之相比，世界一半以上的人口都已接种至少一剂疫苗。
So how can the world make sure that doesn’t happen in future outbreaks?
那么，世界如何才能确保这种情况在未来的疫情暴发中不会发生呢？
One key is to take on the problem of vaccine hesitancy. Check out this video about how, by dealing with rumors and myths, one community in India increased its COVID-19 vaccination rate by a factor of five and created a model that other communities are now taking up:
关键之一是解决“疫苗犹豫”问题。观看下面这段视频，了解下印度的一个社区是如何通过解决流言蜚语，将新冠疫苗接种率提高了五倍，并创建了一个其他社区效仿的模式的：
Another key is to make sure it’s possible to manufacture enough vaccines that supply is not a limiting factor, as it was during much of 2021. Another is to make sure that vaccines are affordable for every country. Organizations like COVAX have helped with that during COVID-19. It also helps to work with manufacturers in developing countries to design new vaccines that are much cheaper to produce than existing ones. This is how the price of the pentavalent vaccine, which protects against five debilitating and deadly diseases, dropped from $3.50 per dose to less than $1 a dose—which in turn allowed the number of children who get it every year to increase by more than 16 times since 2005.
另一个关键是确保能够生产足够多的疫苗，使供应不再像2021年的大部分时间里那样成为限制因素。此外，还应确保每个国家都能负担得起疫苗。在新冠疫情期间，像新冠肺炎疫苗实施计划（COVAX）这样的组织已经在此方面提供了帮助。该组织还帮助发展中国家的疫苗厂商设计出生产成本远低于现有疫苗的新疫苗。这就是五联疫苗（可同时预防五种致命疾病的疫苗）的价格从每剂3.5美元降至不到1美元的原因——这使得自2005年以来，每年接种该疫苗的儿童数量增加了16倍以上。
There are also a lot of innovations that make it easier to deliver vaccines. For example, auto-disable syringes have a built-in safety mechanism so health workers can’t accidentally poke themselves or use them more than once. New coolers can keep vaccines at the right temperature for longer. Advanced methods for delivering vaccines, such as replacing the needle and syringe with a small patch containing micro-needles—picture something that looks superficially like the nicotine patches that people use to stop smoking—will also help.
疫苗供应上也有很多创新。例如，自动禁用注射器有一个内置的安全装置，这样卫生工作者就不会不小心戳到自己或重复使用注射器。新型冷却器可以使疫苗在合适的温度下保存更长时间。先进的疫苗注射方式，如用含有微型针头的小贴片代替针头和注射器（这种东西乍一看像是人们用来戒烟的尼古丁贴片）也会有所帮助。
With these advances, it will be possible to achieve something amazing beyond preventing pandemics: eradicating entire families of pathogens. The world could rid itself of all coronaviruses, for example, or even all influenza viruses. A future without pandemics—and without the flu—is worth investing in.
除了预防大流行病之外，上述进展还有可能实现一些惊人的目标：消灭整个病原体家族。例如，世界可以摆脱所有冠状病毒，甚至所有流感病毒。一个没有大流行病和流感的未来是值得投资的。