It is hard to overstate the beneficial effects of immunization. According to the US Centers for Disease Control, US children born over the last 20 years -- for those children, vaccines will prevent greater than 322 million illnesses, greater than 21 million hospitalizations and greater than 730,000 deaths, with the societal cost savings of nearly 1.4 trillion dollars. Those are big numbers. But let's zoom in and look at a particular example.
免疫的好處是再怎麼 強調也不為過的。 根據美國疾病管制與預防中心, 在過去二十年間 出生的美國兒童—— 針對這些兒童,疫苗就能預防 至少三億兩千兩百萬次生病、 至少兩千一百萬次住院, 以及超過七十三萬人死亡, 省下近一兆四千億美金的社會成本。 這些數字很驚人。 但,咱們放大來看看 一個特別的例子。
Vaccines have nearly eliminated a bacterial infection called Haemophilus influenzae. This bacterium used to infect young infants causing bloodstream infections, pneumonia, meningitis, death or permanent disability. As a young pediatrician, I saw a few cases. You folks probably have never heard of this disease, because vaccines have been so effective. You could see in the graph on the right that since the introduction of vaccines, the incidence of Haemophilus bacterial infections has plummeted like a rock, and it's nearly vanished. So vaccines are generally a success story. But we also face challenges.
疫苗幾乎消滅了一種細菌性感染: 流行性嗜血桿菌。 以前,這種細菌會感染小嬰兒, 造成血液感染、肺炎、腦膜炎、 死亡,或永久性的殘疾。 當我還是年輕的小兒科醫生時 看過幾個案例。 各位可能從來沒有聽過這種疾病, 因為疫苗相當有效。 可以從右邊的圖上看到, 從疫苗推出之後, 流行性嗜血桿菌的感染率 就像岩石掉落一樣,幾乎完全消失。 疫苗的故事通常都是成功的故事。 但,我們也會面臨挑戰。
For one, for most vaccines, we need to give multiple doses to achieve or maintain protection. The scientific community is working on developing single-shot vaccines. Imagine being able to get only one influenza shot your whole life and not having to get a seasonal flu vaccine. Certain microbes are difficult to immunize against. A classic example is human immunodeficiency virus, or HIV. The need is urgent, progress is being made; we're not there yet. Another critical element in vaccine research right now is optimizing vaccines for the most vulnerable among us, the very young and the elderly. And this is an active area of research.
比如,大部分的疫苗需要多劑 才能達到或維持保護效果。 科學圈一直在開發一劑奏效的疫苗。 想像你一生只需接種流感疫苗一次, 無需每季接種季節性的流感疫苗。 我們很難對某些微生物免疫。 一個經典的例子就是 人體免疫缺損病毒(愛滋病病毒)。 這需求非常迫切,已經有所進展, 但我們還沒達成。 目前在疫苗研究中 還有另一個關鍵元素, 就是為我們當中最虛弱的人, 將疫苗做到最好, 包括最小和最年長的人。 這是個很活躍的研究領域。
Finally, one of the biggest challenges we unfortunately face right now are anti-vax attitudes. In fact, it's alarming that over 100,000 infants and children in the United States have not received any vaccines, and that number is growing. In fact, the World Health Organization, or WHO, has declared anti-vax attitudes as one of the 10 most important threats to human health in the world today. This graphic illustrates the spread of anti-vax sentiment in the state of California, from the year 2000 to 2013, by looking at the percentage of public kindergarten students who claim the personal exemption against immunization.
最後,我們不幸正面臨著的 最大挑戰之一 就是反對疫苗的態度。 事實上,這很讓人擔憂, 在美國有超過十萬名嬰兒和兒童 尚未接種任何疫苗, 且人數一直在增加。 事實上,世界衛生組織(WHO) 已經公佈反對疫苗的態度 是現今世界中 人類健康受到的前十大威脅之一。 這張圖所呈現的是反對疫苗的情節 在加州的分佈狀況, 時間是從 2000 年到 2013 年, 計算的基礎是公立幼稚園中 要求不要接種疫苗的學生比率。
Anti-vax sentiment is on the rise, and it has very real consequences. Many of you may be aware of the fact that we're seeing infections that we thought we conquered long ago coming back. Measles outbreaks have been reported in multiple US states. And many have forgotten, but measles is very infectious and dangerous. Just a few viral particles can infect an individual. And there have been even reports at sporting events and at an Olympic stadium where the virus, through the air, travels long distances and infects a vulnerable person in the crowd. In fact, if I had a measles cough right now,
反對疫苗的情節正在攀升, 這會帶來很實在的後果。 在座許多人可能知道, 已經開始有一些我們以為 早就解決掉的感染又重新出現。 美國有不只一州接獲麻疹的通報。 很多人已經忘了, 但麻疹的感染性很強且很危險。 只要少數幾個病毒粒子 就足以感染人。 甚至有報告指出, 在運動比賽和奧林匹克體育館中, 病毒透過空氣,傳播很遠的距離, 感染到群眾中虛弱的人。 事實上,如果我得了 麻疹且現在咳嗽,
(Coughs)
(咳嗽)
somebody in the back of this auditorium could get infected. And this has had very real-world consequences. Just a few months ago, an airline stewardess contracted measles on a flight, the virus entered her brain and caused encephalitis, and she died. So people are now dying due to this anti-vax sentiment.
在觀眾席後排的人 都有可能受到感染。 這會產生非常現實的後果。 幾個月前, 一名女空服員在飛機上得到麻疹, 病毒進入她的腦部,造成腦炎, 她過世了。 現在有人因為這種 反對疫苗的情節而死。
I do want to take a few minutes to address those who don't believe in vaccines and who resist vaccines. As a pediatrician who receives my yearly flu vaccination, as a parent of three children who have been vaccinated according to the recommended schedule, and as a pediatric infectious disease consultant who has taken care of young children with meningitis that would have been preventable had their parents accepted immunization, this is a personal matter to me. Let's take a look at who is going to pay the price if we start dialing back the amount of vaccination in our society. This graph depicts, on the Y axis, the number of individuals dying of infection in the world. And on the X axis, the age of the individuals who are dying. And as you can see, it's very much a U-shaped distribution, and it's particularly stark in the very young ages. So vaccines shield the very young from infection. And if we want to talk, my friends, about what vaccines cause, because there's a lot of speculation, unfounded speculation on the internet, of what vaccines cause, vaccines cause adults, OK? That's what they cause. And the other thing that they cause is for elderly individuals to live longer. Because they are shielded against influenza and other killers of the elderly.
我真心想要花幾分鐘的時間, 對不相信疫苗的人 以及抗拒疫苗的人說幾句話。 因為我的身分包括每年接種 感冒疫苗的小兒科醫生、 一直都有根據建議時間表 去接種疫苗的三個孩子的爸爸, 以及兒童感染性疾病顧問, 曾經照顧過腦膜炎病童, 本來如果他們的父母願意 讓他們接種疫苗就可以避免染病, 因此我視此為切身相關的事。 如果開始減少社會裡的疫苗接種, 看誰會付出代價。 在這張圖上,Y 軸(縱軸) 代表世界上因為感染而死的人數。 X 軸(橫軸) 則是死者的年齡。 各位可以看到, 分佈非常接近 U 字型, 年齡非常小的人數特別多。 所以,疫苗能保護 年齡非常小的人不受感染。 各位朋友,若我們想要談 疫苗會造成什麼後果, 因為有很多揣測, 對於疫苗會造成什麼後果, 網路上有很多沒有基礎的揣測。 疫苗讓兒童得以長大成人,了解嗎? 那是疫苗造成的結果。 疫苗還讓老年人更長壽。 因為疫苗能保護老人對抗 流感和其他老人殺手疾病。
Now, let's talk a little bit about how we can improve vaccines even further. We can create vaccines that can immunize the most vulnerable among us and perhaps even vaccines that protect with single shots. Let me go over a little bit of the immunology. In the top panel, what you see is a simple vaccine. All vaccines contain something called an antigen. The antigen is like a piece of a germ, of a microbe, that your body remembers, right? It forms antibodies and those antibodies can protect you. So those kind of vaccines can induce an immune response, but as you see here, that immune response tends to go up and back down, and you need to get another dose and another dose to maintain protection. What can we do?
現在來談談如何進一步改善疫苗。 我們可以創造 讓我們當中最虛弱的人 也能具有免疫力的疫苗, 甚至只要接種一次就能 產生保護作用的疫苗。 讓我幫大家簡單複習一下免疫學。 各位在上半部所看到的 是一種簡單的疫苗。 所有的疫苗都含有所謂的「抗原」。 抗原就像是你的身體所記得的 病菌、微生物的一部分。 它會形成抗體,而抗體會保護你。 所以,那些疫苗能誘發免疫反應, 但,在這裡可以看到, 免疫反應通常會起起伏伏, 你需要再接種一劑,然後再接種一劑, 才能維持保護作用。 我們能怎麼辦?
We and other scientists around the world are finding molecules that can boost a vaccine response. Those are called adjuvants, from the Latin "adjuvare," to help or aid. Adjuvants are molecules we might add to a vaccine to get a stronger response. And in the presence of the adjuvant, depicted here in red, you have a much more profound activation of the white blood cells of your immune system, and generate a much more profound immune response, with much higher antibody levels, more rapidly, and that lasts a long time for durable immunity. Interestingly, these adjuvants have different effects depending on the age or other demographic factors of the individual. Which brings me to the notion of precision vaccines.
我們及世界各地的科學家 正在尋找能夠促進 疫苗反應的分子。 它們被稱為「佐藥」, 來自拉丁字「adjuvare」, 意思是協助或幫助。 我們可以把這些被稱為佐藥的分子 加到疫苗中以造成更強的反應。 這裡的紅色標記表示有用到佐藥, 有佐藥時,免疫細胞的白血球細胞 會活化得比較完全, 產生更完全的免疫反應, 有更高的抗體濃度,速度也更快, 也會讓免疫能力更持久。 有趣的是,這些佐藥對人的影響, 會因年齡或其他人口統計因子而異。 這就要談到「精準疫苗」的想法。
This is the idea that we will take precision medicine -- you know what precision medicine is, right, that's the idea that populations may vary in their response to a particular medicine -- and apply that to vaccines. Right? And here in Boston Children's Hospital at the Precision Vaccines Program I direct, we have five approaches, stepwise approaches we take, to build precision vaccines that are tailored to vulnerable populations.
這個概念是把「精準醫學」—— 你們知道精準醫學是什麼吧, 它的概念就是人對於 某種藥的反應會有所不同—— 把這概念套到疫苗上。 對吧? 在波士頓兒童醫院這裡, 在我主導的精準疫苗計畫中, 我們採用五個逐步式的方法, 來打造精準疫苗, 為較虛弱的族群來量身打造。
Number one, we need to understand what the attitude of a given population is towards a vaccine. You could build the most sophisticated vaccine in the world, but if nobody wants to take it, you're going nowhere. Number two, we have to think of the route of immunization. Most vaccines are intramuscular, or IM, but there are others, intranasal, oral and others. Then, as I just described to you, vaccines have components. All vaccines have an antigen, that's the part of the microbe that your body remembers, that you might make antibodies or cell-mediated immunity against. And we might add an adjuvant, as we talked about, to boost an immune response. But guess what? There are many different antigens to choose from and many different adjuvants. How are we going to make that decision? And the menu of these keeps growing.
第一, 我們得要了解某個目標族群 對於疫苗的態度是什麼。 你可以打造出世界上 最精密的疫苗, 但如果沒有人想接種,就沒有用。 第二,我們得要思考 產生免疫力的途徑。 大部分的疫苗是肌肉注射(IM), 但也有鼻內、口服, 及其他類型的疫苗。 我剛才有提過,疫苗有構成要素。 所有的疫苗都有抗原, 它是你的身體所記得的 微生物的一部分, 你可能會產生抗體或細胞介導免疫 來對抗這種微生物。 而我們可以像剛才提到的, 加入佐藥,來促進免疫反應。 但你猜怎樣? 可選的抗原有很多種,佐藥也很多種。 我們要怎麼選? 且選項還不斷增加。
So on our team, we've developed ways to test vaccines outside the body -- in Latin, that's "in vitro" -- in a tissue culture dish. So we use tissue engineering with blood cells to immunize outside the body and study the effect of the vaccine against, for example, infants or elderly individuals or others. And if you think about it, this is critical, because if you look at all the infections we want to build vaccines against, like Zika virus and Ebola virus and HIV and others, all the candidate antigens, all the candidate adjuvants, all the different populations, it's going to be impossible to do large, phase III clinical trials for every combination. This is where we think being able to test vaccines outside the body can make a big difference to accelerate vaccine development.
所以,我們的團隊已經開發出 在體外測試疫苗的方法—— 拉丁文稱為「in vitro」—— 在組織培養皿裡面進行。 我們把組織工程應用在血球細胞上, 在體外產生免疫力, 研究疫苗對於 諸如嬰兒、老人或其他人的效果。 仔細想想,這是很重要的, 因為如果探究我們想開發疫苗 來對抗的各種感染, 比如茲卡病毒、伊波拉病毒、 愛滋病病毒,及其他, 有那麼多候選抗體, 有那麼多候選佐藥, 有那麼多不同的族群, 不可能針對每種組合來做 大型的第三階段臨床試驗。 因此我們認為在體外測試疫苗 可以大大幫助加速疫苗開發。
And finally, this whole effort is to drive an immune response that will protect against that particular pathogen, getting antibodies and other cells to defend the body. We are also using additional innovative approaches to bring the most cutting-edge science to vaccine development. We're taking a deeper dive as to how current vaccines protect. We've formed an international consortium to study how hepatitis B vaccine protects newborns from hepatitis B infection. And to do this, we've developed a technique called small sample, big data. We can get a tiny little drop of baby blood before immunization, and take a tiny little drop after immunization, and we can measure the inventory of all the cells, and all the genes and all the molecules in that drop of blood, and we can compare after the vaccine to before the vaccine in that same baby and understand in a deep way exactly how that successful vaccine protects. And those lessons we can use to build the next vaccines in the future. So this diagram is really illustrating a tiny drop of blood yielding huge amounts of information, tens of thousands of analytes, and that hairball is meant to depict the gene pathways that are turned on and the molecular pathways that are turned on. So much more to come on that, and very exciting science.
最後,做這麼多努力的目的 是要促發免疫反應, 保護人體對抗某種病原體, 讓抗體及其他細胞能夠悍衛人體。 我們亦採用額外的創新方法, 把最先進的科學引入疫苗開發中。 我們正在更深入探究目前的疫苗 如何產生保護作用。 我們已經組成了一個國際同盟, 來研究 B 型肝炎疫苗 如何保護新生兒 不受 B 型肝炎感染。 為此,我們開發了一種技術, 叫做小樣本大資料。 在嬰兒產生免疫力之前, 我們可以取得嬰兒的一小滴血液, 在產生免疫力之後再取一小滴, 接著,我們可以測量 那滴血液中的所有細胞、 所有基因,及所有分子, 針對同一個嬰兒, 比較接種疫苗前後的差別, 以深入了解 該疫苗的保護作用有多成功。 我們所學到的,就可以 用在未來打造新的疫苗。 這張圖所呈現出來的是一小滴血液 就能產生出大量的資訊, 數以萬計的被分析物, 那團毛球所描繪的是 被啟動的基因路徑 以及被啟動的分子路徑。 這方面還有許多可期待的, 很讓人興奮的科學。
So we are partnering with scientists around the world to bring all these new technologies to invigorate vaccine development in a Precision Vaccines network. We are going to advance personalized vaccines for vulnerable populations around the world. Our team includes scientists, technical experts and physicians. And we're developing vaccines against infectious diseases like pertussis, which is whooping cough. We have a whooping cough vaccine, but it requires multiple doses, and the immunity keeps dropping. We want to develop a single-shot pertussis vaccine. We're working on a vaccine for respiratory syncytial virus, the number one cause of infant hospitalization in the United States. A better vaccine against influenza, and, of course, HIV. We're also looking at vaccines against cancer, allergy and, interestingly, opioid overdose.
我們和世界各地的科學家合作, 導入各種新科技, 為精準疫苗網路的疫苗開發 帶來新的可能性。 我們打算要為全世界虛弱的族群 繼續發展個人化疫苗。 我們的團隊成員有科學家、 技術專家,以及醫師。 我們針對感染性疾病來開發疫苗, 比如百日咳。 我們有百日咳疫苗, 但需要不只一劑, 且免疫力會越來越低。 我們想要開發出 只需一劑的百日咳疫苗。 我們也在致力開發 呼吸道融合病毒的疫苗, 在美國,造成嬰兒住院的 頭號原因就是這種病毒。 還有更好的流感疫苗, 當然,還有愛滋病。 我們也在研究對抗 癌症、過敏的疫苗, 很有趣的是還有對抗 鴉片過量的疫苗。
So, this is my final message to you. Vaccines protect you and your loved ones and the people around you. Not only do they protect you against infection, they prevent you from spreading it to others. Get immunized. Scientific progress is fragile and can be lost. We must foster accurate and respectful public dialogue. And finally, we're on the verge of great things, a new era of vaccination. We've just scratched the surface of what can be accomplished. Please advocate for this research.
接著是我要給各位的 最後一個訊息。 疫苗能保護你、你所愛的人, 及你周遭的人。 疫苗不僅能保護你不受感染, 也能預防你將疾病散播給他人。 去接種疫苗。 科學進展很脆弱,易失去。 我們必須要讓大眾培養 正確且帶著尊重的討論對話。 最後,我們已經很接近 美妙的疫苗新紀元。 相對於能達成的成就, 我們現在只觸及皮毛而已。 請支持這項研究。
Thank you.
謝謝。
(Applause)
(掌聲)