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.
小孩子的症狀 一開始有些發燒、頭痛、肌肉酸痛, 接著嘔吐和腹瀉, 然後是嘴巴、鼻子、牙齦出血, 因血壓低帶來的 器官衰竭樣貌伴隨著死亡。
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.
聽起來很耳熟嗎? 如果你正想著這是「伊波拉病毒」的話, 事實上這個案例並不是的; 它是一種登革熱的極端樣態 - 一種蚊子所帶來的疾病, 這東西同樣沒有行得通的 藥方或是疫苗, 而且每年奪走 22,000 條人命! 在我們已經知道登革熱近四十年來 那確實是喪命於伊波拉病毒人數的兩倍。 至於近來如此大量登上新聞的麻疹, 死亡總計實際上高出十倍; 然而去年一整年裡 「伊波拉」已經搶走所有的頭條和恐懼。
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.
很清楚地有某種東西深植於其中, 某種遠比其他疾病還要嚇人 以及使我們著迷的東西。 但是那到底是什麼呢? 要染上「伊波拉」是很難的, 不過要是你染上了 - 不得好死的風險很高, 為什麼呢? 因為此時我們沒有任何行得通的 藥方或疫苗是可到手的,
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.
這就是線索了, 我們也許到哪天會有藥方、疫苗; 所以我們理該害怕伊波拉病毒, 它並沒有如同其他疾病奪走了許多人命, 事實上它比起流行感冒或是 麻疹等病毒更不會轉傳出去, 我們害怕伊波拉是因為它會奪走 我們的性命而我們不能治好它的事實, 我們懼怕伴隨著伊波拉的 必然無可倖免性, 伊波拉有著看似否定 現代醫療科學的無可倖免性。
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?
不過慢著 - 那是為什麼呢? 我們自從 1976 年以來 就知道伊波拉病毒了, 我們知道它有什麼能耐, 我們早就有充分的機會 在 24 個已經出現過伊波拉的 爆發區來研究它, 而且事實上我們確實已經有可到手的 疫苗候選劑超過十年以上, 為什麼那些疫苗現在才正要 進入臨床測試呢?
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.
這要講到我們在研發給 傳染性疾病用的疫苗 現有的根本問題, 要講到像這些東西 - 「對這些疾病最有風險的人, 同樣也是最買不起疫苗的人!」, 這留下很少的市場誘因 給廠商來研發疫苗; 除非在富裕的國家裡有著 一大堆人處於風險之下, 研發疫苗絕對是商業上太冒風險的。
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.
至於伊波拉病毒是絕對 絲毫市場誘因也沒有, 所以我們現在會有兩個在 後段臨床測試的疫苗, 唯一的理由確實是因為 某種被誤導的恐懼。 伊波拉病毒直到 911 和炭疽病攻擊前 相對之下是被輕忽的, 但是突然間染上伊波拉病毒的人 就如同潛在性生物恐怖攻擊武器。
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.
為什麼伊波拉疫苗在這時候 沒有被完全地研發出來呢? 有一部分是因為它確實很難, 或是被想成很難 - 把病毒武器化, 不過主要是因為要開發它的財務風險, 而這真的就是關鍵。 令人難過的現實就是我們研發疫苗 不是基於病原體對人體造成的風險, 卻是基於研發這些疫苗 經濟上是如何冒風險的; 疫苗的研發是既昂貴又繁瑣的, 它可以花到上億美元 把一個就算相當清楚的抗體 轉變成大有機會的疫苗。
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.
幸好對類似於「伊波拉」的疾病來講, 有著我們能移除些許阻礙的事情可做。 首先是認知到當那裡 市場完全失能的時候, 在那個案例裡如果我們想要疫苗, 我們得提供誘因或是某類補助, 我們同樣需要在有辦法弄清楚 威脅我們最大的疾病有哪些 這檔事上做得更好; 透過在國與國之間催生多種本事, 我們接著為那些國家催生能力 來建立流行病學和實驗室的網絡, 該網絡有辦法收集和歸類這些病原體。 從那裡得來的資料稍後可以被用來 理解地理和基因的歧異性, 那些接著可以被用來幫助我們理解 這些病原體是如何在免疫學上被更改了, 以及它們會促發什麼樣的反應。
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 --
這些是可以被做到的事情, 不過要做到 - 假使我們想要解決 市場完全失能的話, 我們得要改變我們看待 以及防治傳染病的方式, 我們必須停止直到我們看見 疾病之證據前的空等 - 早在我們認定之前形成全球威脅。 所以拿伊波拉病毒來說, 對一種傳染病疑神疑鬼的懼怕、 接下來極少數的病例 被轉送到富裕的國家去, 導致全球社會來攜手合作; 而且有了盡職的疫苗公司在做事, 我們現在有了這些東西 - 在出現伊波拉的國家中有了 兩種臨床療效試驗中的伊波拉疫苗,
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and a pipeline of vaccines that are following behind.
以及源源不絕的疫苗緊接其後。
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.
每一年我們花費掉數十億美元 維持核子潛艇艦隊不間斷地巡防大洋, 以保護我們遠離幾乎鐵定 永遠不會發生的威脅, 再加上我們實際上沒花錢 來避免某種碰得到的 以及肯定會進化的流行傳染病。 而且別搞錯了 - 這不是「會不會」 而是「何時」的問題, 這些病菌將會繼續進化, 而且它們將會威脅到全世界, 而疫苗就是我們最佳的庇護。 因此要是我們想要能夠避免 像伊波拉一般的傳染病, 我們必須冒投資在疫苗研發 以及產生囤積的風險。 我們必須正視這個然後 當做終極遏制 - 我們要確保那是到手的東西, 不過同一時間祈禱我們永遠用不上它!
Thank you.
謝謝大家!
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