The child's symptoms begin with mild fever, headache, muscle pains, followed by vomiting and diarrhea, then bleeding from the mouth, nose and gums. Death follows in the form of organ failure from low blood pressure.
Esimesed sümptomid on lapsel kerge palavik, peavalu ja lihasevalu, millele järgneb oksendamine ja kõhulahtisus, seejärel hakkavad veritsema tema suu, nina ja igemed. Surm saabub madalast vererõhust tingitud elundipuudulikkuse tagajärjel.
Sounds familiar? If you're thinking this is Ebola, actually, in this case, it's not. It's an extreme form of dengue fever, a mosquito-born disease which also does not have an effective therapy or a vaccine, and kills 22,000 people each year. That is actually twice the number of people that have been killed by Ebola in the nearly four decades that we've known about it. As for measles, so much in the news recently, the death toll is actually tenfold higher. Yet for the last year, it has been Ebola that has stolen all of the headlines and the fear.
Tuleb tuttav ette? Kui arvad, et see on ebola, siis antud juhul pole see nii. See on raskekujuline dengue palavik, sääskedega leviv haigus, millele samuti pole tõhusat ravi ega vaktsiini ja millesse sureb 22 000 inimest aastas. Seda on tegelikult kaks korda rohkem kui neid, kes on surnud ebolasse ligi nelja aastakümne jooksul, mil seda haigust on tuntud. Leetrite puhul, millest on nüüd uudistes palju juttu, on suremus kümme korda suuremgi. Viimasel aastal on aga ebola hõivanud kõik esiküljed ja külvanud hirmu.
Clearly, there is something deeply rooted about it, something which scares us and fascinates us more than other diseases. But what is it, exactly? Well, it's hard to acquire Ebola, but if you do, the risk of a horrible death is high. Why? Because right now, we don't have any effective therapy or vaccine available.
On näha, et ebola puudutab meid väga sügaval tasandil, ta on ühtaegu hirmutav ja paeluv palju enam kui teised haigused. Mis see siis täpselt on? Ebolasse pole lihtne haigestuda, ent kui sa haigestud, siis on suur tõenäosus, et sured piinarikkalt. Miks? Sest praegu pole olemas sellele mingit tõhusat ravi või vaktsiini.
And so, that's the clue. We may have it someday. So we rightfully fear Ebola, because it doesn't kill as many people as other diseases. In fact, it's much less transmissible than viruses such as flu or measles. We fear Ebola because of the fact that it kills us and we can't treat it. We fear the certain inevitability that comes with Ebola. Ebola has this inevitability that seems to defy modern medical science.
See annabki vihje. Me võime ühel päeval sellesse haigestuda. Seepärast me kardame õigusega ebolat, sest ... see küll ei tapa nii paljusid kui teised haigused. Tegelikult on see palju vähem nakkav kui gripp või leetrid. Aga me kardame ebolat, sest see on surmav ja me ei oska seda ravida. Me kardame seda paratamatust, mis ebolaga kaasneb. Ebolat saadab teatav paratamatus, mis esitab tänapäeva arstiteadusele väljakutse
But wait a second, why is that? We've known about Ebola since 1976. We've known what it's capable of. We've had ample opportunity to study it in the 24 outbreaks that have occurred. And in fact, we've actually had vaccine candidates available now for more than a decade. Why is that those vaccines are just going into clinical trials now?
Miks on see aga nii? Oleme olnud ebolast teadlikud 1976. aastast alates. Me teame, milleks ta on võimeline. Meil on olnud ohtralt võimalusi seda uurida seni aset leidnud 24 haiguspuhangu jooksul, Ja tegelikult on meil olnud ka võimalikud vaktsiinid olemas juba üle kümne aasta. Miks on need vaktsiinid alles kliiniliste katsete etapis?
This goes to the fundamental problem we have with vaccine development for infectious diseases. It goes something like this: The people most at risk for these diseases are also the ones least able to pay for vaccines. This leaves little in the way of market incentives for manufacturers to develop vaccines, unless there are large numbers of people who are at risk in wealthy countries. It's simply too commercially risky.
Siit tulenebki aga meie põhiprobleem nakkushaiguste vaktsiinide väljatöötamises. Ma sõnastaksin selle nii: inimesed, kel on suurem oht neisse haigustesse haigestuda on need, kel on vähem võimalusi vaktsiinide eest maksta. Tootajate meelest pole selliste vaktsiinide tootmine majanduslikult tulus enne, kui haigus ei ohusta jõukamate riikide elanikke. Majanduslikus mõttes liiga riskantne äri.
As for Ebola, there is absolutely no market at all, so the only reason we have two vaccines in late-stage clinical trials now, is actually because of a somewhat misguided fear. Ebola was relatively ignored until September 11 and the anthrax attacks, when all of a sudden, people perceived Ebola as, potentially, a bioterrorism weapon.
Ebolast rääkides pole turgu ollagi. Ainus põhjus, miks kaks vaktsiini on kliiniliste katsete lõppfaasis, on tegelikult mõneti alusetu hirm. Ebolat ignoreeriti kuni 11. septembri ja antraksi rünnakuteni, mil ühtäkki inimesed adusid, et ebolat võidakse kasutada biorelvana.
Why is it that the Ebola vaccine wasn't fully developed at this point? Well, partially, because it was really difficult -- or thought to be difficult -- to weaponize the virus, but mainly because of the financial risk in developing it. And this is really the point. The sad reality is, we develop vaccines not based upon the risk the pathogen poses to people, but on how economically risky it is to develop these vaccines. Vaccine development is expensive and complicated. It can cost hundreds of millions of dollars to take even a well-known antigen and turn it into a viable vaccine.
Miks polnud ebola vaktsiini selleks ajaks välja töötatud? Osaliselt seepärast, et oli väga raske - või peeti väga raskeks - viirust relvaks muuta, kuid põhiliselt, kuna arendusega kaasnes finantsrisk. Ja selles asi ongi. On kurb tõsiasi, et vaktsiine arendatakse mitte tulenevalt haigustekitaja ohtlikkusest, vaid hinnates riski, kuivõrd see äriliselt ära tasuks. Vaktsiini väljatöötamine on kallis ja keeruline. Võib kuluda sadu miljoneid dollareid, et muuta ka mõni tuntud antigeen toimivaks vaktsiiniks.
Fortunately for diseases like Ebola, there are things we can do to remove some of these barriers. The first is to recognize when there's a complete market failure. In that case, if we want vaccines, we have to provide incentives or some type of subsidy. We also need to do a better job at being able to figure out which are the diseases that most threaten us. By creating capabilities within countries, we then create the ability for those countries to create epidemiological and laboratory networks which are capable of collecting and categorizing these pathogens. The data from that then can be used to understand the geographic and genetic diversity, which then can be used to help us understand how these are being changed immunologically, and what type of reactions they promote.
Õnneks saame ebola sarnaste haiguste puhul midagi teha ära selleks, et neid takistusi kõrvaldada. Esiteks tuleb ära tunda, millal eksisteerib turutõrge. Sel juhul, kui me soovime vaktsiine, tuleb pakkuda stiimuleid või võimaldada toetust. Samuti on vaja rohkem pingutada, et suudaksime kindlaks teha, haigused, mis meid enim ohustavad. Toetades riikide võimekust anname neile võimaluse ehitada üles epidemioloogiline ja laboratoorne võrgustik, mis suudaks patogeene koguda ja tuvastada. Nende andmeid saab siis kasutada selleks, et mõista geograafilisi ja geneetilisi erinevusi, mida omakorda saab kasutada selleks, et mõista, kuidas need on muutunud immunoloogiliselt ja milliseid reaktsioone need tekitavad.
So these are the things that can be done, but to do this, if we want to deal with a complete market failure, we have to change the way we view and prevent infectious diseases. We have to stop waiting until we see evidence of a disease becoming a global threat before we consider it as one. So, for Ebola, the paranoid fear of an infectious disease, followed by a few cases transported to wealthy countries, led the global community to come together, and with the work of dedicated vaccine companies, we now have these: Two Ebola vaccines in efficacy trials in the Ebola countries --
Seda kõike on võimalik teha, kuid selleks, et tulla toime täieliku turutõrke olukorras, tuleb muuta senist ennetustööd ja suhtumist nakkushaigustesse. Pole aega oodata, kuni on ilmselge, et haigus on levinud globaalselt enne kui me sellest arugi saame. Ebola puhul sundis paranoiline hirm nakkuse ees, mille järgnesid vaid üksikud haigusjuhud jõukamates riikides, globaalset üldsust tegema ühiseid jõupingutusi. Koostöös vaktsiinifirmadega oleme saavutanud selle: kaks ebola vaktsiini, mida katsetatakse ebola kolletega riikides, ...
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and a pipeline of vaccines that are following behind.
... ja tulemas on veel hulk vaktsiine.
Every year, we spend billions of dollars, keeping a fleet of nuclear submarines permanently patrolling the oceans to protect us from a threat that almost certainly will never happen. And yet, we spend virtually nothing to prevent something as tangible and evolutionarily certain as epidemic infectious diseases. And make no mistake about it -- it's not a question of "if," but "when." These bugs are going to continue to evolve and they're going to threaten the world. And vaccines are our best defense. So if we want to be able to prevent epidemics like Ebola, we need to take on the risk of investing in vaccine development and in stockpile creation. And we need to view this, then, as the ultimate deterrent -- something we make sure is available, but at the same time, praying we never have to use it.
Igal aastal me kulutame miljardeid dollareid, et hoida tuumaallveelaevu ookeanides patrullimas ja kaitsmas meid ohu eest, mida ilmselt mitte kunagi ei tekigi. Samas ei kuluta me praktiliselt sentigi sellele, et hoida ära midagi meid otseselt puudutavat ja evolutsiooniliselt tõenäolist nagu seda on nakkushaiguste epideemiad. Siin pole kahtlust, et küsimus on pigem millal see juhtub, mitte kas see juhtub. Viirused arenevad pidevalt ja ohustavad jätkuvalt kogu maailma. Ja vaktsiinid on meie parim kaitse. Kui me tahame vältida selliseid epideemiaid nagu ebola, tuleb meil riskida investeerimisega vaktsiinide väljatöötamisse ja nende varude soetamisse. Peaksime suhtuma vaktsiinidesse kui ülimasse heidutusvahendisse - midagi, mis peaks kindlasti olemas olema, kuid mida poleks loodetavasti vaja kunagi kasutada.
Thank you.
Aitäh.
(Applause)
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