Do you worry about what is going to kill you? Heart disease, cancer, a car accident? Most of us worry about things we can't control, like war, terrorism, the tragic earthquake that just occurred in Haiti. But what really threatens humanity? A few years ago, Professor Vaclav Smil tried to calculate the probability of sudden disasters large enough to change history. He called these, "massively fatal discontinuities," meaning that they could kill up to 100 million people in the next 50 years. He looked at the odds of another world war, of a massive volcanic eruption, even of an asteroid hitting the Earth. But he placed the likelihood of one such event above all others at close to 100 percent, and that is a severe flu pandemic. Now, you might think of flu as just a really bad cold, but it can be a death sentence. Every year, 36,000 people in the United States die of seasonal flu. In the developing world, the data is much sketchier but the death toll is almost certainly higher. You know, the problem is if this virus occasionally mutates so dramatically, it essentially is a new virus and then we get a pandemic.
Se kdaj sprašujete, zaradi česa boste umrli? Zaradi bolezni srca, raka, prometne nesreče? Večinoma nas skrbijo stvari, ki jih ne moremo nadzorovati, kot na primer vojna, terorizem, tragični potres, ki je pred kratkim prizadel Haiti. A kaj resnično grozi človeštvu? Pred nekaj leti je profesor Vaclav Smil skušal izračunati verjetnost, da se bo nenadoma zgodila dovolj velika katastrofa, ki bo spremenila zgodovino. Te dogodke je poimenoval "uničujoče motnje", s čimer je hotel povedati, da lahko povzročijo smrt 100 milijonov ljudi v naslednjih 50 letih. Zanimala ga je verjetnost ponovne svetovne vojne, velikih vulkanskih izbruhov in celo padca asteroida na Zemljo. Verjetnost enega večjega dogodka je presegala vse ostale. S skoraj 100 % verjetnostjo se bo zgodila huda epidemija gripe. Verjetno se vam zdi, da je gripa pravzaprav le malo hujši prehlad, a lahko pomeni tudi smrtno obsodbo. Vsako leto v ZDA za sezonsko gripo umre 36.000 ljudi. Podatki za države v razvoju niso tako natančni, vendar je zagotovo tam smrtnost še večja. Težavo predstavljajo mutacije virusov gripe, ki so včasih tako obsežne, da pravzaprav nastane nov virus. Takrat se pojavi pandemija.
In 1918, a new virus appeared that killed some 50 to 100 million people. It spread like wildfire and some died within hours of developing symptoms. Are we safer today? Well, we seem to have dodged the deadly pandemic this year that most of us feared, but this threat could reappear at any time. The good news is that we're at a moment in time when science, technology, globalization is converging to create an unprecedented possibility: the possibility to make history by preventing infectious diseases that still account for one-fifth of all deaths and countless misery on Earth. We can do this. We're already preventing millions of deaths with existing vaccines, and if we get these to more people, we can certainly save more lives. But with new or better vaccines for malaria, TB, HIV, pneumonia, diarrhea, flu, we could end suffering that has been on the Earth since the beginning of time.
Leta 1918, ko se je pojavil nov virus, je umrlo od 50 do 100 milijonov ljudi. Širil se je z neverjetno hitrostjo. Marsikdo je umrl v nekaj urah po pojavu simptomov. Ali smo dandanes kaj bolj varni? Vse kaže, da smo se letos uspeli izogniti smrtonosni pandemiji, ki smo se je bali, toda grožnja se lahko kadarkoli spet pojavi. Na srečo živimo v obdobju, v katerem se znanost, tehnologija in globalizacija združujejo in povezujejo ter nam tako omogočajo, da spremenimo zgodovino, tako da preprečimo širjenje nalezljivih bolezni, ki še vedno povzročijo petino vseh smrti in neskončno trpljenje. Zmogli bomo. Z obstoječimi cepivi že lahko preprečimo milijone smrti. Bolj kot razširimo cepiva med ljudi, več življenj lahko rešimo. Z novimi ali boljšimi cepivi proti malariji, tuberkulozi, virusu HIV, pljučnici, diareji ali gripi bi lahko končali trpljenje, ki ga povzročajo nalezljive bolezni.
So, I'm here to trumpet vaccines for you. But first, I have to explain why they're important because vaccines, the power of them, is really like a whisper. When they work, they can make history, but after a while you can barely hear them. Now, some of us are old enough to have a small, circular scar on our arms from an inoculation we received as children. But when was the last time you worried about smallpox, a disease that killed half a billion people last century and no longer is with us? Or polio? How many of you remember the iron lung? We don't see scenes like this anymore because of vaccines.
Tukaj sem, da vam predstavim cepiva. A najprej moram razložiti, zakaj so pomembna. Moč cepiv je namreč zelo pretanjena. Kadar delujejo, jih vsi poznamo, a sčasoma utonejo v pozabo. Nekateri tukaj smo dovolj stari, da imamo na rami majhno okroglo brazgotino, ki je posledica cepljenja v otroštvu. Toda kdaj so vas nazadnje skrbele črne koze, ki so v prejšnjem stoletju ubile pol milijarde ljudi, zdaj pa jih ni več med nami? Ali pa otroška paraliza - kdo se še spomni železnih pljuč? Prav zaradi cepiv takih prizorov ne videvamo več.
Now, it's interesting because there are 30-odd diseases that can be treated with vaccines now, but we're still threatened by things like HIV and flu. Why is that? Well, here's the dirty little secret. Until recently, we haven't had to know exactly how a vaccine worked. We knew they worked through old-fashioned trial and error. You took a pathogen, you modified it, you injected it into a person or an animal and you saw what happened. This worked well for most pathogens, somewhat well for crafty bugs like flu, but not at all for HIV, for which humans have no natural immunity.
Zanimivo je, da poznamo dobrih 30 bolezni, ki jih lahko preprečimo s cepljenjem, pa vendar nas gripa in HIV še vedno ogrožata. Zakaj? Naj vam zaupam umazano skrivnost. Še do nedavega namreč nismo vedeli, kako cepiva delujejo. Njihovo delovanje smo odkrili z metodo poskusov in napak. Poiskali smo mikrob in ga v laboratoriju spremenili, nato smo ga vbrizgali v osebo ali žival in opazovali, kaj se bo zgodilo. Pri večini mikrobov se je ta metoda dobro obnesla, pri prebrisanem virusu gripe malo manj, pri virusu HIV pa sploh ne, ker nanj ljudje niso naravno odporni.
So let's explore how vaccines work. They basically create a cache of weapons for your immune system which you can deploy when needed. Now, when you get a viral infection, what normally happens is it takes days or weeks for your body to fight back at full strength, and that might be too late. When you're pre-immunized, what happens is you have forces in your body pre-trained to recognize and defeat specific foes. So that's really how vaccines work. Now, let's take a look at a video that we're debuting at TED, for the first time, on how an effective HIV vaccine might work.
Poglejmo si torej, kako cepiva delujejo. V telesu ustvarijo nekakšno skladišče orožja za vaš imunski sistem, ki ga lahko uporabite, ko je to potrebno. Kadar se okužite z virusom, običajno traja več dni ali tednov, da se vaše telo začne proti okužbi boriti na vso moč. Takrat je lahko že prepozno. Če ste cepljeni, je v vašem telesu že prisoten obrambni sistem, ki natančno prepozna sovražne mikrobe in jih porazi. Tako torej deluje cepivo. Poglejmo si video posnetek - danes bo premierno predvajan - o tem, kako naj bi delovalo učinkovito cepivo proti virusu HIV.
(Music)
(Glasba)
Narrator: A vaccine trains the body in advance how to recognize and neutralize a specific invader. After HIV penetrates the body's mucosal barriers, it infects immune cells to replicate. The invader draws the attention of the immune system's front-line troops. Dendritic cells, or macrophages, capture the virus and display pieces of it. Memory cells generated by the HIV vaccine are activated when they learn HIV is present from the front-line troops. These memory cells immediately deploy the exact weapons needed. Memory B cells turn into plasma cells, which produce wave after wave of the specific antibodies that latch onto HIV to prevent it from infecting cells, while squadrons of killer T cells seek out and destroy cells that are already HIV infected. The virus is defeated. Without a vaccine, these responses would have taken more than a week. By that time, the battle against HIV would already have been lost.
Cepivo vnaprej pripravi telo, da prepozna in uniči točno določenega napadalca. Ko HIV preide sluznico, okuži imunske celice in se v njih razmnožuje. Napadalec pritegne pozornost celic, ki skrbijo za naravno odpornost. Dendritične celice oz. makrofagi virus ujamejo in predstavijo njegove delce. Spominske celice, ki nastanejo ob cepljenju, se aktivirajo, ko prepoznajo delce virusa HIV, predstavljene na makrofagih. Nato nemudoma pripravijo orožje, ki je potrebno. Spominske celice B se preobrazijo v plazmatke, ki izdelujejo številna točno določena protitelesa, ki se oklenejo virusa HIV in mu s tem preprečijo okužbo celic. Medtem gruče celic T ubijalk iščejo in uničijo celice, ki so okužene z virusom HIV. Tako je virus poražen. Brez cepiva se tak odgovor razvije po več kot enem tednu. Do takrat je boj z virusom HIV že lahko izgubljen.
Seth Berkley: Really cool video, isn't it? The antibodies you just saw in this video, in action, are the ones that make most vaccines work. So the real question then is: How do we ensure that your body makes the exact ones that we need to protect against flu and HIV? The principal challenge for both of these viruses is that they're always changing. So let's take a look at the flu virus. In this rendering of the flu virus, these different colored spikes are what it uses to infect you. And also, what the antibodies use is a handle to essentially grab and neutralize the virus. When these mutate, they change their shape, and the antibodies don't know what they're looking at anymore. So that's why every year you can catch a slightly different strain of flu. It's also why in the spring, we have to make a best guess at which three strains are going to prevail the next year, put those into a single vaccine and rush those into production for the fall.
Odličen posnetek, a ne? Protitelesa, ki ste jih videli, so tista, ki omogočijo delovanje cepiva. Vprašati se moramo, kako naj telo pripravimo do tega, da bo izdelalo pravilna protitelesa za boj proti virusom gripe in HIV. Največji izziv nam predstavlja njihovo stalno spreminjanje. Poglejmo si, kako izgleda virus gripe. Na tej shemi vidimo obarvane dele virusa, ki so odgovorni za okužbo. Na ista mesta se pritrdijo protitelesa, da lahko uničijo virus. Ko virus mutira, se njegova oblika spremeni, tako da ga protitelesa ne prepoznajo več. Zaradi tega torej vsako leto razsaja malo drugačna gripa. Zaradi teh sprememb vsako pomlad ugibamo, kateri tip gripe bo prevladal v naslednji sezoni, da lahko ustvarimo cepivo in ga do jeseni proizvedemo v zadostnih količinah.
Even worse, the most common influenza -- influenza A -- also infects animals that live in close proximity to humans, and they can recombine in those particular animals. In addition, wild aquatic birds carry all known strains of influenza. So, you've got this situation: In 2003, we had an H5N1 virus that jumped from birds into humans in a few isolated cases with an apparent mortality rate of 70 percent. Now luckily, that particular virus, although very scary at the time, did not transmit from person to person very easily. This year's H1N1 threat was actually a human, avian, swine mixture that arose in Mexico. It was easily transmitted, but, luckily, was pretty mild. And so, in a sense, our luck is holding out, but you know, another wild bird could fly over at anytime.
Še več! Najbolj razširjena vrsta gripe, tip A, lahko okuži tudi živali, ki živijo v človekovi bližini ter se v njih razmnožuje in spreminja. Poleg tega divje vodne ptice prenašajo vse poznane vrste gripe. Zgodilo se je naslednje. Leta 2003 je bilo nekaj primerov, ko se je virus H5N1 prenesel s ptic na ljudi. Smrtnost je znašala približno 70 odstotkov. Na srečo se ta virus, čeprav se je zdel precej strašen, ni z lahkoto prenašal s človeka na človeka. Letošnja grožnja, virus H1N1, je bil kombinacija človeških, ptičjih in prašičjih virusov, izviral pa je iz Mehike. Zelo enostavno se je prenašal, a je bil na srečo precej blag. Zdi se, da se nas zaenkrat drži sreča, a kadarkoli lahko prileti mimo nova divja ptica.
Now let's take a look at HIV. As variable as flu is, HIV makes flu look like the Rock of Gibraltar. The virus that causes AIDS is the trickiest pathogen scientists have ever confronted. It mutates furiously, it has decoys to evade the immune system, it attacks the very cells that are trying to fight it and it quickly hides itself in your genome. Here's a slide looking at the genetic variation of flu and comparing that to HIV, a much wilder target. In the video a moment ago, you saw fleets of new viruses launching from infected cells. Now realize that in a recently infected person, there are millions of these ships; each one is just slightly different. Finding a weapon that recognizes and sinks all of them makes the job that much harder.
Poglejmo si zdaj še virus HIV. Čeprav je virus gripe zelo spremenljiv, se v primerjavi s HIV-om zdi trden kot skala. Virus, ki povzroča AIDS, je najbolj zafrknjen mikrob, kar so jih znanstveniki odkrili. Zelo pogosto mutira in je sposoben pretentati imunski sistem. Napade vsako celico, ki se mu skuša upreti, nato pa se hitro skrije v vaš lasten genom. Na prosojnici lahko primerjate genetske različice gripe in virusa HIV, ki je precej bolj raznolik. V prejšnjem video posnetku ste videli številne nove viruse ubežati iz okužene celice. Ne pozabite, da ima na novo okužena oseba milijone takih virusov, vendar je vsak malenkost drugačen od ostalih. Poiskati orožje, ki bi učinkovalo na vse različice, je precej težko delo.
Now, in the 27 years since HIV was identified as the cause of AIDS, we've developed more drugs to treat HIV than all other viruses put together. These drugs aren't cures, but they represent a huge triumph of science because they take away the automatic death sentence from a diagnosis of HIV, at least for those who can access them. The vaccine effort though is really quite different. Large companies moved away from it because they thought the science was so difficult and vaccines were seen as poor business. Many thought that it was just impossible to make an AIDS vaccine, but today, evidence tells us otherwise.
V zadnjih 27 letih, odkar vemo, da je HIV povzročitelj AIDS-a, je bilo zanj odkritih več zdravil kot za vse ostale viruse skupaj. Kljub temu da bolezni ne ozdravijo, so ta zdravila velik dosežek znanosti, saj tako diagnoza okužbe s HIV ne predstavlja več takojšnje smrtne obsodbe; vsaj za tiste, ki si zdravila lahko privoščijo. Cepiva so povsem druga zgodba. Velike farmacevtske družbe so se jih izogibale, ker je bilo razvijanje cepiva zelo zahtevno in se finančno ni izplačalo. Mnogi so menili, da je cepivo proti AIDS-u nemogoče izdelati, a dandanes imamo dokaze, da le ni tako.
In September, we had surprising but exciting findings from a clinical trial that took place in Thailand. For the first time, we saw an AIDS vaccine work in humans -- albeit, quite modestly -- and that particular vaccine was made almost a decade ago. Newer concepts and early testing now show even greater promise in the best of our animal models. But in the past few months, researchers have also isolated several new broadly neutralizing antibodies from the blood of an HIV infected individual. Now, what does this mean? We saw earlier that HIV is highly variable, that a broad neutralizing antibody latches on and disables multiple variations of the virus. If you take these and you put them in the best of our monkey models, they provide full protection from infection. In addition, these researchers found a new site on HIV where the antibodies can grab onto, and what's so special about this spot is that it changes very little as the virus mutates. It's like, as many times as the virus changes its clothes, it's still wearing the same socks, and now our job is to make sure we get the body to really hate those socks.
Septembra so v klinični študiji na Tajskem odkrili nekaj nepričakovanega. Prvič v zgodovini so pokazali, da cepivo proti AIDS-u deluje tudi pri človeku, četudi bolj slabo. To cepivo je bilo izdelano pred skoraj desetimi leti. Z novimi koncepti in zgodnjim testiranjem pričakujemo na živalskih modelih še boljše rezultate. V zadnjih nekaj mesecih so raziskovalci iz krvi z virusom HIV okuženih posameznikov osamili številna protitelesa s širokim spektrom delovanja. Kaj to pomeni? Že prej smo videli, da je HIV zelo raznolik virus. Protitelesa s širokim delovanjem se vežejo na številne različice virusa in jih onesposobijo. Če vzamemo ta protitelesa in jih prenesemo v najboljše opičje modele, bodo zagotovili popolno zaščito pred okužbo. Poleg tega so isti raziskovalci odkrili še novo mesto na virusu HIV, na katerega se lahko vežejo protitelesa. To mesto je nekaj posebnega, saj se med mutacijo virusa zelo malo spreminja. Kot če bi se virus ves čas preoblačil, a bi vsakič obdržal iste nogavice. Naša naloga je, da prepričamo telo, da so tiste nogavice res grozne.
So what we've got is a situation. The Thai results tell us we can make an AIDS vaccine, and the antibody findings tell us how we might do that. This strategy, working backwards from an antibody to create a vaccine candidate, has never been done before in vaccine research. It's called retro-vaccinology, and its implications extend way beyond that of just HIV. So think of it this way. We've got these new antibodies we've identified, and we know that they latch onto many, many variations of the virus. We know that they have to latch onto a specific part, so if we can figure out the precise structure of that part, present that through a vaccine, what we hope is we can prompt your immune system to make these matching antibodies. And that would create a universal HIV vaccine. Now, it sounds easier than it is because the structure actually looks more like this blue antibody diagram attached to its yellow binding site, and as you can imagine, these three-dimensional structures are much harder to work on. And if you guys have ideas to help us solve this, we'd love to hear about it.
Kako torej stojijo stvari? Rezultati s Tajske pravijo, da je izdelava cepiva proti AIDS-u možna. Odkritja o protitelesih nam kažejo, kako bi se tega lotili. To, da bi delali "vzvratno" in iz protiteles izdelali cepivo, je povsem nova metoda izdelovanja cepiv. Retrogradna izdelava cepiva ni uporabna le pri virusu HIV, temveč tudi pri številnih drugih mikrobih. Pomislite. Odkrili smo nova protitelesa, za katera vemo, da se lahko vežejo na številne različice virusa. Vemo, da se vežejo na točno določen del virusa. Če bi lahko ugotovili natančno zgradbo tega dela in ga predstavili telesu v obliki cepiva, bi morda lahko spodbudili imunski sistem k izdelavi enakih protiteles. Tako bi dobili univerzalno cepivo proti HIV-u. Sliši se bolj preprosto, kot je v resnici, saj zgradba izgleda nekako tako kot ta ponazoritev modrega protitelesa, pritrjenega na vezavno mesto, označeno z rumeno. Lahko si predstavljate, da je s tridimenzionalnimi zgradbami precej težko delati. Če ima kdo izmed vas kakšno idejo, kako se tega lotiti, kar na dan z njo!
But, you know, the research that has occurred from HIV now has really helped with innovation with other diseases. So for instance, a biotechnology company has now found broadly neutralizing antibodies to influenza, as well as a new antibody target on the flu virus. They're currently making a cocktail -- an antibody cocktail -- that can be used to treat severe, overwhelming cases of flu. In the longer term, what they can do is use these tools of retro-vaccinology to make a preventive flu vaccine. Now, retro-vaccinology is just one technique within the ambit of so-called rational vaccine design.
Kljub vsemu je raziskovanje virusa HIV pripomoglo k boljšemu zdravljenju ostalih bolezni. Eno izmed biotehnoloških podjetjij je odkrilo nova protitelesa s širokim spektrom delovanja, ki delujejo proti gripi, pa tudi novo tarčno mesto na virusu samem. Trenutno je v pripravi mešanica protiteles, ki bi jo lahko uporabili za zdravljenje hudih primerov gripe. Dolgoročno gledano bi lahko z retrogradno metodo pridobivanja cepiv izdelali učinkovito cepivo za gripo. A retrogradna metoda je le ena izmed t.i. racionalnih metod pridobivanja cepiv.
Let me give you another example. We talked about before the H and N spikes on the surface of the flu virus. Notice these other, smaller protuberances. These are largely hidden from the immune system. Now it turns out that these spots also don't change much when the virus mutates. If you can cripple these with specific antibodies, you could cripple all versions of the flu. So far, animal tests indicate that such a vaccine could prevent severe disease, although you might get a mild case. So if this works in humans, what we're talking about is a universal flu vaccine, one that doesn't need to change every year and would remove the threat of death. We really could think of flu, then, as just a bad cold.
Poglejmo si še en primer. Prej smo govorili o vrhovih H in M, ki se nahajata na površini virusa gripe. Poglejte si še te manjše izbokline. Pred imunskim sistemom so zelo dobro skrite. Izkazalo se je, da se tudi ta mesta med mutacijo virusa zelo malo spremenijo. Če jih okvarimo s točno določenimi protitelesi, s tem okvarimo vse različice gripe. Zaenkrat testi na živalih kažejo, da bi takšno cepivo sicer preprečilo hudo obliko bolezni, a za blažjo obliko bi vseeno lahko zboleli. Če bo to cepivo delovalo pri ljudeh, dejansko govorimo o univerzalnem cepivu proti gripi, ki ga ni treba spreminjati vsako leto, pa se kljub temu izognemo številnim smrtnim žrtvam. Gripa bi tako postala le malo hujša oblika prehlada.
Of course, the best vaccine imaginable is only valuable to the extent we get it to everyone who needs it. So to do that, we have to combine smart vaccine design with smart production methods and, of course, smart delivery methods. So I want you to think back a few months ago. In June, the World Health Organization declared the first global flu pandemic in 41 years. The U.S. government promised 150 million doses of vaccine by October 15th for the flu peak. Vaccines were promised to developing countries. Hundreds of millions of dollars were spent and flowed to accelerating vaccine manufacturing. So what happened?
Jasno, tudi najboljše cepivo je koristno le takrat, ko ga dobijo vsi, ki ga potrebujejo. Da bi bilo to možno, potrebujemo poleg dobrega cepiva še učinkovite metode izdelave in, seveda, premišljeno razširjanje med ljudi. Spomnite se, kaj se je zgodilo pred nekaj meseci. Junija je Svetovna zdravstvena organizacija razglasila prvo globalno pandemijo gripe po 41 letih. Vlada ZDA je obljubila, da bo do 15. oktobra zagotovila 150 milijonov odmerkov cepiva. Cepivo je bilo obljubljeno državam v razvoju. Za pospešeno izdelavo cepiva je bilo porabljenih na stotine milijonov dolarjev. In kaj se je zgodilo?
Well, we first figured out how to make flu vaccines, how to produce them, in the early 1940s. It was a slow, cumbersome process that depended on chicken eggs, millions of living chicken eggs. Viruses only grow in living things, and so it turned out that, for flu, chicken eggs worked really well. For most strains, you could get one to two doses of vaccine per egg. Luckily for us, we live in an era of breathtaking biomedical advances. So today, we get our flu vaccines from ... chicken eggs, (Laughter) hundreds of millions of chicken eggs. Almost nothing has changed. The system is reliable but the problem is you never know how well a strain is going to grow. This year's swine flu strain grew very poorly in early production: basically .6 doses per egg. So, here's an alarming thought. What if that wild bird flies by again? You could see an avian strain that would infect the poultry flocks, and then we would have no eggs for our vaccines. So, Dan [Barber], if you want billions of chicken pellets for your fish farm, I know where to get them. So right now, the world can produce about 350 million doses of flu vaccine for the three strains, and we can up that to about 1.2 billion doses if we want to target a single variant like swine flu. But this assumes that our factories are humming because, in 2004, the U.S. supply was cut in half by contamination at one single plant. And the process still takes more than half a year.
Najprej smo torej ugotovili, kako se cepivo izdeluje, in sicer v zgodnjih štiridesetih letih. Proces je bil počasen in naporen ter odvisen od kokošjih jajc. Milijonov živih kokošjih jajc! Virusi namreč živijo le v živih organizmih, za gripo pa se je izkazalo, da še posebej dobro uspeva v jajcih. Pri večini sevov virusa je eno jajce zadostovalo za en ali dva odmerka cepiva. Na srečo živimo v obdobju osupljivih biomedicinskih dosežkov. Danes namreč cepivo proti gripi pridobivamo iz ... ... kokošjih jajc. (Smeh) Iz milijonov kokošjih jajc. Veste, skoraj nič se ni spremenilo. Ta sistem je zanesljiv. Težavo predstavlja dejstvo, da nikoli ne vemo, kako dobro bo določen sev uspeval. Sev letošnje prašičje gripe je v zgodnjem obdobju uspeval precej slabo, dobili smo kakih 0.6 odmerkov na jajce. Skrbi me naslednje: kaj če divje ptice ponovno priletijo tod mimo? Predstavljajte si sev ptičje gripe, ki bi okužil jate perutnine, tako da bi ostali brez jajc za proizvajanje cepiv. Dan [Barber], če hočeš za svojo ribjo farmo milijarde kokošjih peletov, vem, kako do njih. Trenutno po celem svetu proizvedemo okoli 350 milijonov odmerkov cepiva za tri seve virusa gripe. To bi lahko povečali na 1,2 milijardi odmerkov, če bi ciljali na točno določeno različico, na primer na prašičjo gripo. Seveda, če domnevamo, da tovarne delajo s polno paro. Leta 2004 je bila namreč zaloga v ZDA prepolovljena zaradi okuženja v eni sami tovarni. Poleg tega proces pridobivanja še vedno traja več kot pol leta.
So are we better prepared than we were in 1918? Well, with the new technologies emerging now, I hope we can say definitively, "Yes." Imagine we could produce enough flu vaccine for everyone in the entire world for less than half of what we're currently spending now in the United States. With a range of new technologies, we could. Here's an example: A company I'm engaged with has found a specific piece of the H spike of flu that sparks the immune system. If you lop this off and attach it to the tail of a different bacterium, which creates a vigorous immune response, they've created a very powerful flu fighter. This vaccine is so small it can be grown in a common bacteria, E. coli. Now, as you know, bacteria reproduce quickly -- it's like making yogurt -- and so we could produce enough swine origin flu for the entire world in a few factories, in a few weeks, with no eggs, for a fraction of the cost of current methods.
Ali smo torej danes kaj bolje pripravljeni kot leta 1918? Glede na pojav vedno novih tehnologij upam, da lahko odgovorimo z "da". Predstavljajte si, da bi lahko proizvedli zadosti cepiva proti gripi za ves svet, in to s pol manjšimi stroški, kot jih imamo trenutno v ZDA. S pomočjo nove tehnologije bi šlo. Poglejmo primer. Podjetje, s katerim delam, je našlo točno določen delček na vrhu H virusa gripe, ki spodbuja imunski sistem. Če ta delček odrežemo in pritrdimo na drugo bakterijo, ta povzroči močan imunski odgovor; ustvarili so učinkovito cepivo proti gripi. Tako cepivo je zelo majhno - lahko raste v bakteriji E. coli. Kot veste, se bakterije razmnožujejo hitro. Kot bi delali jogurt! Na ta način bi izdelali zadosti prašičje gripe, da bi imeli cepivo za ves svet pripravljeno v nekaj tednih brez uporabe jajc in za neprimerno manj denarja.
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So here's a comparison of several of these new vaccine technologies. And, aside from the radically increased production and huge cost savings -- for example, the E. coli method I just talked about -- look at the time saved: this would be lives saved. The developing world, mostly left out of the current response, sees the potential of these alternate technologies and they're leapfrogging the West. India, Mexico and others are already making experimental flu vaccines, and they may be the first place we see these vaccines in use. Because these technologies are so efficient and relatively cheap, billions of people can have access to lifesaving vaccines if we can figure out how to deliver them.
Primerjajmo nekaj novejših metod izdelave cepiva. Poleg izjemno povečane proizvodnje in velikih prihrankov - poglejte recimo metodo z uporabo E. coli, ki sem jo že omenil - je pomemben tudi prihranek na času, ki rešuje življenja. Svet v razvoju, ki še ni zajet v večino raziskav, se zaveda potenciala novih metod in že dohiteva Zahod. Indija, Mehika in druge države že izdelujejo poskusna cepiva proti gripi, najverjetneje pa bodo prav tam tudi prvič preizkusili njihovo uporabnost. Ker so nove tehnološke metode zelo učinkovite in tudi relativno poceni, imajo lahko odslej milijarde ljudi dostop do cepiva, ki bi jim rešilo življenje - le dostaviti jim ga moramo.
Now think of where this leads us. New infectious diseases appear or reappear every few years. Some day, perhaps soon, we'll have a virus that is going to threaten all of us. Will we be quick enough to react before millions die? Luckily, this year's flu was relatively mild. I say, "luckily" in part because virtually no one in the developing world was vaccinated. So if we have the political and financial foresight to sustain our investments, we will master these and new tools of vaccinology, and with these tools we can produce enough vaccine for everyone at low cost and ensure healthy productive lives. No longer must flu have to kill half a million people a year. No longer does AIDS need to kill two million a year. No longer do the poor and vulnerable need to be threatened by infectious diseases, or indeed, anybody. Instead of having Vaclav Smil's "massively fatal discontinuity" of life, we can ensure the continuity of life. What the world needs now are these new vaccines, and we can make it happen.
Pomislite, kam nas bo to pripeljalo. Vsakih nekaj let se pojavijo nove ali pa ponovno že znane nalezljive bolezni. Nekega dne, verjetno kmalu, bo določen virus gripe ogrozil vse nas. Ali se bomo dovolj hitro odzvali, da ne bodo umrli milijoni ljudi? Na srečo je bila letošnja gripa precej blaga. "Na srečo" pravim zato, ker skoraj nihče v državah v razvoju ni bil cepljen. Če predvidimo politično in finančno situacijo ter zavarujemo svoje investicije, bomo lahko izkoriščali te in druge metode pri izdelavi cepiv. S takimi orodji lahko izdelamo velike količine poceni cepiva in ljudem omogočimo zdravo, kakovostno življenje. Gripa ne bo več pobila pol milijona ljudi na leto. AIDS ne bo več pokopal dveh milijonov letno. Nalezljive bolezni ne bodo več ogrožale revnejših slojev prebivalstva. Nikogar, pravzaprav. Namesto da bi doživeli "uničujoče motnje" Vaclava Smila, si lahko zagotovimo zdravo življenje. Svet potrebuje nova cepiva, mi pa jih lahko proizvedemo.
Thank you very much.
Najlepša hvala.
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Chris Anderson: Thank you. (Applause) Thank you. So, the science is changing. In your mind, Seth -- I mean, you must dream about this -- what is the kind of time scale on, let's start with HIV, for a game-changing vaccine that's actually out there and usable?
Hvala. (Aplavz) Hvala. Znanost se spreminja. Kaj misliš, Seth? Verjetno kdaj sanjariš o tem ... Kdaj približno bi, začnimo recimo z virusom HIV, bilo lahko pripravljeno in dosegljivo uporabno cepivo?
SB: The game change can come at any time, because the problem we have now is we've shown we can get a vaccine to work in humans; we just need a better one. And with these types of antibodies, we know humans can make them. So, if we can figure out how to do that, then we have the vaccine, and what's interesting is there already is some evidence that we're beginning to crack that problem. So, the challenge is full speed ahead.
Ta trenutek lahko pride kadarkoli. Problem je namreč v tem, da čeprav cepivo lahko deluje pri ljudeh, še ni dovolj dobro. Vemo tudi, da človeško telo lahko proizvede te vrste protiteles. Ko bomo ugotovili, kako telo pripraviti do tega, bomo dobili cepivo. Zanimivo je, da se že dokazano bližamo rešitvi tega problema. Približujemo se mu s polno hitrostjo.
CA: In your gut, do you think it's probably going to be at least another five years?
Bi lahko rekel, da bo dosegljivo v naslednjih petih letih?
SB: You know, everybody says it's 10 years, but it's been 10 years every 10 years. So I hate to put a timeline on scientific innovation, but the investments that have occurred are now paying dividends.
Vsi pravijo, da bo trajalo kakih 10 let, vendar tako rečejo vsakih 10 let. Znanstveno odkritje je težko časovno omejiti, a dosedanja vlaganja že kažejo rezultate.
CA: And that's the same with universal flu vaccine, the same kind of thing?
Ali za cepivo proti gripi velja podobno?
SB: I think flu is different. I think what happened with flu is we've got a bunch -- I just showed some of this -- a bunch of really cool and useful technologies that are ready to go now. They look good. The problem has been that, what we did is we invested in traditional technologies because that's what we were comfortable with. You also can use adjuvants, which are chemicals you mix. That's what Europe is doing, so we could have diluted out our supply of flu and made more available, but, going back to what Michael Specter said, the anti-vaccine crowd didn't really want that to happen.
Gripa je drugačna. Kot ste videli, imamo cel kup inovacij, ki so pripravljene za uporabo. Zdijo se dobre, a problem je v tem, da smo vlagali v tradicionalno proizvodnjo, ker jo poznamo in je bilo tako najlažje. Uporabljamo lahko tudi adjuvanse, kemikalije. V Evropi to že počnejo - tudi mi bi lahko z adjuvansi povečali zaloge cepiva, a če se spomnite, je Michael Specter prej dejal, da so aktivisti proti cepljenju to onemogočili.
CA: And malaria's even further behind?
Pri malariji pa še bolj zaostajamo?
SB: No, malaria, there is a candidate that actually showed efficacy in an earlier trial and is currently in phase three trials now. It probably isn't the perfect vaccine, but it's moving along.
Ne, glede malarije se je v zgodnji študiji izkazalo, da eno izmed cepiv učinkuje; ta študija je zdaj v tretji fazi. Verjetno ne bomo dobili popolnega cepiva, a nekaj le bo.
CA: Seth, most of us do work where every month, we produce something; we get that kind of gratification. You've been slaving away at this for more than a decade, and I salute you and your colleagues for what you do. The world needs people like you. Thank you.
Seth, večina nas je zaposlenih in ob koncu meseca imamo občutek, da smo nekaj storili. Ti pa že več kot desetletje garaš kot črna živina, zato ti iskreno čestitam, prav tako tudi tvojim kolegom. Svet potrebuje ljudi, kot ste vi. Hvala.
SB: Thank you.
Hvala.
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