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.
你是否擔心自己將會命喪何種事故? 心臟病?癌症? 還是車禍呢? 大部分我們擔心的,都不是我們能控制的, 像是戰爭、恐怖攻擊、 或像海地的那種大地震。 有哪些是真正威脅到人類的? 幾年前,瓦茨•拉夫史米爾教授 試著去計算 世界上足以改變人類歷史的災害 所出現的機率。 他稱之為 嚴重的致命不連續性 (massively fatal discontinuities), 意味著這些事故 在未來的 50 年內 最多可能導致一億人喪命。 他也研究了第三次世界大戰發生的機率、 大規模火山爆發的機率、 甚至小行星撞地球的機率。 但是他把某個事件發生的可能性 放在第一位, 幾乎 100% 會發生, 這個事件就是嚴重的全球性流感。 現在,你可能會覺得流感 只是一種比較嚴重的感冒而已。 但是,它能取你性命, 每年有三萬六千名美國人 死於季節性的流感。 在開發中國家,雖然資料很粗略, 不過死亡人數 一定都比帳面上的還要高。 各位應該要瞭解,問題就在 流感病毒偶爾會產生 劇烈的突變。 本質上可將其視為一種新的病毒, 然後就會導致全球性大流行。
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.
1918 年,出現了一種新病毒(註:西班牙流感) 導致五千萬到一億人喪命, 它的蔓延速度跟野火一樣快, 有些人在症狀顯現後數小時內即死亡。 現在我們有比較安全嗎? 嗯,看起來今年 我們已經避開了 很多人害怕的死亡性流感, 但是這種威脅隨時可能再出現。 好消息是, 此時此刻, 科學、技術、全球化的匯集, 創造了前所未有的可能性。 在傳染性疾病的預防上 我們也有創造歷史的可能。 傳染性疾病所導致的死亡案例佔人類死亡總數的 1/5, 同時帶來無窮盡的痛苦。 我們能做得到。 我們已經用疫苗 拯救了數以百萬的生命。 如果我們能提供疫苗給更多人 我們就能拯救更多生命。 現在有許多最新、最棒的疫苗, 像是瘧疾疫苗、肺結核疫苗、愛滋病疫苗 肺炎疫苗、痢疾疫苗、流感疫苗。 我們能阻止 那從古老紀元以來就有的苦難
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.
所以我到這裡,來告訴各位疫苗的好處。 首先,我要跟各位解釋為什麼這些疫苗如此重要。 疫苗的威力 非常低調。 它們起了作用,它們創造了歷史。 但過沒多久, 你可能就很少再聽到人們討論疫苗。 年紀稍大一點的人, 都應該有一個小小的圓形疤痕在我們的手臂上, 這是我們小時候就接種的疫苗痕跡。 我們上一次害怕得天花是什麼時候? 這個在上個世紀奪走數億人命的疾病 就這樣消失了嗎? 小兒痲痺,還有多少人記得鐵肺這個東西? 這種情景不會再發生了, 這都是疫苗帶來的功勞。
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.
令人感到有趣的是, 目前有卅種古老的疾病 可以用疫苗來防範。 但我們卻依然受到愛滋病和流感的威脅, 為什麼會這樣? 嗯,是因為有不可告人的秘密。 直到最近,我們還無法完全瞭解 要如何找到有效的疫苗。 我們是透過試誤法來尋找有效的疫苗, 我們培養病原體,稍微調整病原體的特性, 然後把它注射到人或動物體內, 等看看有什麼結果發生。 這套方法對大部分的疾病治療很有用, 對付像流感這種奸詐系的病毒有時候有效, 但對會讓人類失去免疫系統的愛滋病毒而言, 這套方法完全沒用。
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.
讓我們來探索疫苗運作的原理, 基本上,疫苗幫助免疫系統 建立一套快取式的防禦武器, 好讓你在需要的時候能在體內快速部屬。 當你感染到病毒, 通常需要數天或數星期, 你身體的免疫系統才能 全力反擊, 那時候可能就太遲了。 若你接受預防接種, 免疫系統因為已經接受過「事前訓練」 所以能很快辨認出該病毒, 同時消滅它們, 這是疫苗的功用。 讓我們先看段影片, 我們選擇在 TED 大會上公開首映這個影片, 影片探討有效的愛滋病疫苗該如何運作。
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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.
旁白:疫苗會事先鍛鍊身體, 讓身體能辨認與壓制 特殊的入侵者。 當愛滋病病毒滲透了體內的黏膜屏障時, 它感染免疫細胞然後開始複製, 這些病毒的入侵 會立刻吸引免疫系統第一道防線的注意, 樹突狀細胞,或巨噬細胞 會開始追捕病毒,並公告身體各機關。 當愛滋病毒 接觸到免疫系統的第一道防線, 過去接種的疫苗會刺激身體,產生記憶細胞。 這些記憶細胞 會立刻部屬用來對付該病毒的武器。 記憶 B 細胞會變成漿細胞, 這些漿細胞會產生一波又一波的 特定抗體, 以纏住病毒, 防止病毒感染其他細胞。 T 細胞這群殺手部隊, 會找出並摧毀 已被愛滋病病毒感染的細胞, 病毒就是這樣被打敗。 若沒有疫苗, 身體要一星期以上,才會有前述的反應, 等到那時候 這場對付愛滋病病毒的戰爭早就輸了。
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.
非常棒的影片,對吧? 剛剛各位都在影片中看到抗體是如何作用的, 而這些抗體是大多數疫苗帶來的成果。 真正令人好奇的是, 我們如何保證自己的身體 能夠確實地產生 抵抗流感或是愛滋病的抗體? 對付這二種病毒的主要挑戰是 它們會一直改變, 讓我們先來觀察流感這種病毒。 在這個流感病毒示意圖中, 不同顏色的棘蛋白是用來感染你的武器。 而抗體之所以能夠捉住、中和病毒, 也是靠病毒上的這些棘蛋白。 當病毒突變時,它們會改變整個外觀, 讓抗體沒有辦法從外觀來辨認出病毒, 這就是為什麼每一年 你會得到稍微不同的流感病株。 這也是為什麼在春天時, 我們就要開始猜測 來年的流感可能會有哪些病株, 而將這些病株置入單一疫苗的製作, 然後倉促的量產,以在秋天做好準備。
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.
更糟的是, 大多的普通流感、A 型流感, 也會感染給 跟人類相當親近的動物們。 這些病毒會在動物體內 重新合成。 此外,野生水鳥 是帶來許多已知流感病毒的 源頭之一, 大家都瞭解這種情況, 在 2003 年 我們發現了 H5N1 病毒, 這是從鳥類轉移到人類的 少數個別案例之一。 人類感染後的死亡率高達 70%, 幸運的是,這種特殊病毒 雖然在當時有引起一陣恐慌, 但它不容易產生 人傳人的情形。 今年 H1N1 的威脅, 實際上是經過人、鳥、豬的混合體, 並在墨西哥爆發開來, 這種病毒在傳播上就非常容易, 不過還好它的症狀就溫和多了。 就某種意義上來說, 我們的運氣一直不錯, 不過野鳥可是帶著這病毒飛來飛去的。
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.
現在來看愛滋病毒, 跟流感一樣有多變性, 愛滋病毒會讓小小感冒, 變得像個固若金湯的堡壘 (Rock of Gibraltar)。 這種病毒所引起的愛滋病, 成為科學家到目前為止 所面對最棘手的問題。 它會瘋狂地變異, 釋放出誘餌以躲避免疫系統, 同時瘋狂的攻擊體內想反抗的細胞。 而且它會很快地 躲在你的染色體裡面。 現在這張投影片, 是流感和愛滋病病毒 基因變異程度的比較, 你會發現愛滋病病毒的變異程度非常誇張, 剛剛的影片中都有看到, 體內被感染的細胞,會增生一批又一批的病毒艦隊。 現在的愛滋病患者 體內就有這數百萬的病毒艦隊, 而且每一艘都長得不一樣。 要找到適當的武器, 去辨認並同時摧毀這些艦隊 是非常困難的。
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.
自從 27 年前愛滋病病毒 被確認是引起愛滋病的元兇之後, 我們針對愛滋病所開發出來的藥物, 比其他疾病所開發的藥品總和還要多, 雖然這些藥還無法治癒愛滋病, 但它們代表了現代科學的重大勝利。 因為這些藥避免了 得愛滋等於被判死刑的悲劇, 至少感染者還有一線生機。 疫苗的開發就不一樣了, 大公司都不願投入疫苗研究, 因為他們認為這方面的技術太難, 而且認為疫苗是窮人生意, 有部份的公司認為開發愛滋病疫苗是不可能的。 但今日,證據顯示事實並非如此。
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.
在 9 月的時候, 在泰國的臨床實驗中, 我們得到了意外,但令人興奮的發現。 這是第一次,愛滋病疫苗在人體上起了作用, 儘管效果並不顯著。 這款特別的疫苗 大約十年前就製造出來了。 新的概念和過去的實驗成果結合, 並從動物實驗中取得了重大的成果。 過去幾個月,科學家從愛滋病患的血液中 成功地分離出 數種新的廣效中和抗體。 這是什麼意思? 我們剛提到愛滋病毒 是非常多變化的, 而這具中和力的抗體 能夠同時拴住樣貌不同的愛滋病毒, 並使它們無效化。 如果把這種疫苗 注射到一個健康的猴子體內, 這些猴子就不會再感染愛滋病。 此外, 科學家在愛滋病毒上發現了一個特徵, 抗體可以抓到這個特徵。 特別的是, 當愛滋病毒突變時, 這個特徵幾乎不會改變。 這就像, 不管病毒換穿幾件不同款式的衣服, 它依舊會穿同一雙襪子。 所以我們的工作就是確保 讓身體討厭這些襪子就好,
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.
我們正朝這方面努力。 泰國的實驗結果告訴我們, 我們可以成功製作出愛滋病疫苗。 而抗體的發現 告訴我們可行的策略。 這個策略是由 抗體倒推到疫苗候選株的, 這個策略在疫苗的研發中是首例。 我們稱之為反向疫苗學 (retro-vaccinology) 而這研究的影響 不僅只於愛滋病的研究。 你可以這樣想: 我們已經發現了這些新的抗體, 而且已知這些抗體可以有效地辨認許多不同的病毒變異株。 抗體會糾纏住病毒的某部份, 所以如果我們可以清楚地描繪出那部份的結構, 再透過疫苗 去刺激免疫系統, 讓免疫系統自己製造出此種抗體。 使用這種方法, 能製造出廣效性疫苗。 這方法聽起來比之前的簡單多了。 就像圖中 藍色的抗體, 要去吸附那隱藏在病毒底下的黃色部份。 你們可以想像得到,要解開這些東西的立體結構 並不是那麼地容易。 如果各位有能幫助我們解決這問題的點子, 我們很樂意傾聽。
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.
但是,你知道,這從愛滋病毒研究開始的反向疫苗學, 現在也大大地幫助了其他疾病研究的創新。 舉例來說,生技公司 目前已經找到了流感的 廣效性中和抗體, 也找到了流感病毒上可以用來鎖定的新抗體目標物。 他們目前正在製造混合劑, 一種抗體的混合劑, 可以治療非常嚴重的流感。 對長期來說,他們能做的 就是使用反向疫苗學的工具 去製造出保護性的流感疫苗。 在所謂循理性地疫苗設計中, 反向疫苗學只是其中地一項技術而已。
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.
讓我另外跟各位舉個例, 之前提過流感病毒表面的兩種棘蛋白 分別叫 H 棘蛋白和 M 棘蛋白, 注意到表面其他較小的突點, 免疫系統是看不太到它們的。 而病毒突變時,這些小突點 也不會有太大地改變。 若能發展出特殊的抗體,專門偵測這些小突點, 你就能偵測到整個病毒。 目前為止, 動物實驗已經證明,這種疫苗可以防止重大疾病發生, 雖然接種疫苗時,可能會產生輕微的症狀。 因此若這疫苗在人體中也有同樣的效果, 那我們現在所討論的就是大一統的流感疫苗, 一種不需要每年重新研發, 並能移除死亡威脅的疫苗。 我們真的可以把流感想像成 比較嚴重的普通感冒。
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?
當然,再棒的疫苗, 也要能發放給所需要的人, 才會有價值。 為了做到這點,我們必須將 最有效的疫苗設計和有效率的生產方法結合在一起, 當然,還要有傑出的物流系統。 我請各位回想一下幾個月前的情形, 2009 年六月,世界衛生組織 公告了首波全球性流感, 是 41 年來首例。 美國政府承諾 在流感達到高峰的十月 15 日前, 會製造出一億五千萬支疫苗, 疫苗會被送到開發中國家。 花費了數百萬美金, 投入到疫苗的製造工廠以加速疫苗生產。 那又怎樣?
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.
我們第一次 學到如何製造流感疫苗,如何生產疫苗, 是在 1940 年代早期。 當時的生產流程非常地笨重且速度緩慢, 那時的流感疫苗是要從 數百萬個受精雞蛋中培養, 因為病毒只能在活體中成長。 經過實驗證明, 流感病毒能在雞蛋裡成長。 對多數流感病株來說, 平均一顆蛋,可以製造 1~2 劑疫苗。 運氣很好的是, 我們生長在這個 生物醫學超先進的時代。 恩,現在生產疫苗的來源 ....... 還是雞蛋。 (笑聲) 我們還是需要上億個雞蛋。 你知道,幾乎沒有改變, 你說,這方法是可依賴的。 但問題是, 你不知道雞蛋內的病株成長情形。 今年的豬流感病株, 在雞蛋裡的生長狀況就很糟。 平均一個雞蛋只能製造 0.6 支疫苗, 這可響起警訊了, 萬一禽流感再來襲怎麼辦? 你知道禽流感病株 會感染成千上萬的家禽, 然後我們會連用來製造疫苗的雞蛋也沒有了。 所以,丹•巴伯(名廚師), 如果你想用大量的雞肉丸 來當作你的魚飼料, 我知道哪兒找得到。 目前,全世界能製造三億五千萬支 含有三種去活化病毒株的 流感疫苗。 如果我們能鎖定一種病毒變異株, 譬如像是豬流感 那產量可以達到一兆二千億支。 但這是假設全部的工廠都在運作, 因為 2004 年時, 美國的疫苗供應量減半, 只是因為一間疫苗工廠受汙染無法運作。 再加上整個培養過程, 仍需要半年以上的時間。
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.
所以, 我們現在的情況有比 1918 年好嗎? 恩,在現代的新技術下 我希望我們能肯定的說:「沒錯,比1918年好」 想像一下,如果我們能生產足夠的流感疫苗, 並提供給全世界的人, 而且只需要目前美國疫苗工廠的 一半時間。 在新技術的發展下,我們可以做到的。 這裡有個例子, 有家公司發現, 流感 H 棘蛋白上的特殊片段 可以誘導免疫系統作用。 若把這片段切下, 並將之附著在另一個不同細菌的尾端, 會導致激烈的免疫反應。 他們已經用此製造出非常強大的流感戰士。 這種疫苗的片段非常的小, 因此能在普通的實驗用細菌 — 大腸桿菌內培養。 如你所知,細菌能快速增殖。 就像做優格一樣簡單。 這樣,我們就能製造足夠的豬流感原病株疫苗給世界各地, 只需要少數的工廠生產,只需要短短的幾周 而且不再需要雞蛋了, 所需要的成本也少了很多。
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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.
這是數種新疫苗科計的對照表。 剛剛說到的大腸桿菌培養法, 除了能讓產量激增, 成本大量下降, 還有時間的節省,這也意味著能拯救更多的生命。 開發中國家, 排除各方異見, 看見了這種有潛力的替代性技術, 他們直接跳過西方國家的支援, 印度、墨西哥等等國家 都已經研發出許多實驗性的疫苗。 這些地方也可能將會是 第一批實驗性疫苗率先施打的地區。 因為這些技術非常有效率, 也相對便宜, 若我們能想辦法把疫苗交到需要的人的手上, 那數億的人將因此得救。
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.
想想看這對我們的未來有什麼樣的影響。 新型的傳染病, 每隔幾年, 就會一而再的出現。 有一天,也許就快了, 某個病毒傳染病將會威脅全人類。 在數百萬的生命消逝之前, 我們是否有足夠的時間反應呢? 運氣好,今年的流感比較溫和。 我說「運氣好」,有部分是因為 實際上在開發中國家, 幾乎沒有人接種流感疫苗。 因此,若我們在政治和財務上有遠見, 持續的投資疫苗研發, 我們就能駕馭新的疫苗技術。 利用這些技術, 我們就能用超低的成本,製造出足以供應全人類的疫苗, 確保健康有益的生活。 流感不會再每年奪走 50 萬人的生命, 愛滋病 也不會再每年奪走 200 萬人的生命。 窮人或是體弱的人 不會再被傳染病威脅生命, 或者說,任何人都不會。 不會出現瓦茨拉夫•史米爾教授所說的 「大量致命的不連續性」時期, 取而代之的是,我們能確保 生生不息的生命。 當今世界需要的是這些防止疾病的新疫苗, 我們可以做得到。
Thank you very much.
感謝各位的聆聽。
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(掌聲)
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?
克里斯:謝謝你 (掌聲) 感謝你帶來的演說。 科學正在劇變中, 在你心中,賽思,你一直有這樣的夢想, 在這樣的時間框架下... 喔,我還是從愛滋病說起好了, 治療愛滋的革命性疫苗,是否真的會出現?
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.
SB:這種革命性疫苗隨時會出現, 現在的問題是, 我們已能研發出提供人類使用的疫苗, 但我們需要更優良的疫苗。 現在有了這些新的抗體,我們知道我們可以製造出這些抗體, 所以,若我們能想清楚如何去做, 我們就會得到疫苗。 另人感興趣的是, 有越來越多的證據顯示,我們即將解決這個問題。 所以目前的挑戰是要加快研發進度。
CA: In your gut, do you think it's probably going to be at least another five years?
CA:就你的直覺,你認為五年內能辦到嗎?
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.
SB:很多專家都是說十年內就能, 結果時間是十年又十年地過去了。 所以,我並不喜歡為科學革新 訂定時間表, 但是過去的投資都開始獲利了。
CA: And that's the same with universal flu vaccine, the same kind of thing?
CA:愛滋病疫苗跟流感疫苗是否相似呢?
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.
SB:我認為流感是不同的,我想流感的問題是, 我們在流感疫苗上已經有了突破,就像我剛說的, 我們有很棒且實用的技術,已經準備好,隨時可以應用上。 這聽起來不錯,但問題就是, 我們都一直投資在傳統的生產技術上, 因為這套方法讓我們感到安心。 你也可以使用免疫輔助劑,那是跟抗原混合在一起的化合物。 這是歐洲各國正在做的,我們可以在疫苗中加入輔助劑, 這樣現有的流感疫苗劑量可以提供給更多的人使用, 不過,麥可•斯佩克特曾說過(紐約時報專欄作者), 反對疫苗的群眾並不希望如此。
CA: And malaria's even further behind?
CA:瘧疾疫苗的研發是否進度落後呢?
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.
SB:不,對於瘧疾,已經有種方法 在早期臨床試驗就已經展現出功效, 目前已經進入第三階段的臨床試驗, 它也許還不是完美的疫苗,但遲早會是的。
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.
CA:賽思,像我們這樣的人每天都在工作, 某方面來說我們都在製造某種東西, 我們想從工作中得到某種滿足。 但像你這樣的人已經在這個領域奉獻了十年, 我必須要向你和你的同事們致上敬意。 這世界就是需要像你們這樣的人,謝謝你。
SB: Thank you.
SB:謝謝。
(Applause)
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