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Bill Gates: The next outbreak? We're not ready! 比爾-蓋茨TED演講:下次疫情爆發?我們還沒準備好!

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When I was a kid, the disaster we worried about most was a nuclear war. That's why we had a barrel like this down in our basement, filled with cans of food and water. When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel.

當我還是小孩時,我們最擔心的災害是核戰爭。所以我們在地下室有個這樣的筒子,裝滿了罐頭食物和水。當核戰爭爆發時,我們就要躲到地下室去,蹲低身子并靠那個筒子維生。

Today the greatest risk of global catastrophe doesn't look like this. Instead, it looks like this. If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war. Not missiles, but microbes. Now, part of the reason for this is that we've invested a huge amount in nuclear deterrents. But we've actually invested very little in a system to stop an epidemic. We're not ready for the next epidemic.

今天的全球災難最大的危險看起來已不像這樣了。事實上,會像這樣。如果有什么東西在未來幾十年里可以殺掉上千萬人,那比較有可能是個高度傳染的病毒,而不是戰爭。不是導彈,而是微生物。部分的理由是因為我們在核威懾上投注了很大的精力和金錢。但是我們在防止疫情的系統上卻投資很少。我們還沒有準備好預防下一場大疫情的發生。

Let's look at Ebola. I'm sure all of you read about it in the newspaper, lots of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication. And as you look at what went on, the problem wasn't that there was a system that didn't work well enough, the problem was that we didn't have a system at all. In fact, there's some pretty obvious key missing pieces.

讓我們看看埃博拉病毒。我相信大家在報紙上都有讀到這樣的新聞,充滿了許多艱難的挑戰。用我們追蹤消滅脊髓灰質炎(小兒麻痹)的案例分析工具,我仔細地追蹤這病毒的發展。隨著疫情的發展我們可以看到,問題不在于我們沒有一套可以使用的系統,而是我們根本沒有任何系統。事實上我們可以看到有幾個很明顯的不足。

We didn't have a group of epidemiologists ready to go, who would have gone, seen what the disease was, seen how far it had spread. The case reports came in on paper. It was very delayed before they were put online and they were extremely inaccurate. We didn't have a medical team ready to go. We didn't have a way of preparing people.

我們找不到一群準備好了的流行病學家,能去疫區看看病理和病情發展。病例都是由紙上報道傳來的。信息傳上線時已經很晚了,此外還很不準確。我們也找不到訓練有素的醫護小組。我們沒有一套讓人們嚴陣以待的方法。

Now, Médecins Sans Frontières did a great job orchestrating volunteers. But even so, we were far slower than we should have been getting the thousands of workers into these countries.

目前,“無國界醫生”在動員志愿者上做了很大的貢獻。但即使如此,我們調動數千名工作者到疫區的速度還是十分差強人意的。

And a large epidemic would require us to have hundreds of thousands of workers. There was no one there to look at treatment approaches. No one to look at the diagnostics. No one to figure out what tools should be used. As an example, we could have taken the blood of survivors, processed it, and put that plasma back in people to protect them. But that was never tried.

大的疫情會需要我們動員數十萬的人員,但我們沒有任何人在研究治療的方向。也沒有人在看診斷的方法。沒有人在想該用什么工具。舉個例子來說,我們也許可以抽取生還者的血液,處理過后,再將血漿注入人體內來保護沒得病的人。但是這個方法從來沒有試過。

So there was a lot that was missing. And these things are really a global failure. The WHO is funded to monitor epidemics, but not to do these things I talked about. Now, in the movies it's quite different. There's a group of handsome epidemiologists ready to go, they move in, they save the day, but that's just pure Hollywood.

所以有很多事都還沒來得及做。而這的確是全球性的失敗。世界衛生組織的目的是來監視流行病,而不是來做我剛講的事。但是在電影中演的劇情又是另一回事。有一群很英俊的流行病學家準備就緒,他們到了疫區拯救了大家,但這是純好萊塢的劇情。

The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola Let's look at the progression of Ebola over this year. About 10,000 people died, and nearly all were in the three West African countries. There's three reasons why it didn't spread more.

我們的準備不足 ,可能會導致下一場疫情,比埃博拉病毒的危害更嚴重。讓我們看看埃博拉病毒在過去一年中的發展。大約死了一萬人,所有的死者都在西非的三個國家里。之所以沒有擴散的原因有三個。

The first is that there was a lot of heroic work by the health workers. They found the people and they prevented more infections. The second is the nature of the virus. Ebola does not spread through the air. And by the time you're contagious, most people are so sick that they're bedridden. Third, it didn't get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas, the case numbers would have been much larger.

第一個是衛生工作人員作的很多英雄事跡。他們找到很多病人并防止了更多人得病。第二個是病毒的特性,埃博拉病毒不是靠空氣傳染的。等到你有足夠的傳染力時,大部分的人已經病得臥床不起了。第三個是因為病毒沒有傳到都會區。這純粹是運氣好。如果病毒傳到了都會區,那么死亡的人數絕對不止于此。

So next time, we might not be so lucky. You can have a virus where people feel well enough while they're infectious that they get on a plane or they go to a market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So there are things that would literally make things a thousand times worse.

所以下一次我們可能不會這么幸運了。有的病毒可能讓你毫無察覺,但當感染病毒的人乘飛機或者去逛商場,他們其實已經具有一定的傳染力了。此外病毒的來源可以是天然的,像埃博拉病毒,或是由生物恐怖攻擊產生的。所以可以讓疫情慘上千倍的病毒是存在的。

In fact, let's look at a model of a virus spread through the air, like the Spanish Flu back in 1918. So here's what would happen: It would spread throughout the world very, very quickly. And you can see over 30 million people died from that epidemic. So this is a serious problem. We should be concerned.

事實上,讓我們來看看一個病毒由空氣傳染的模型,像1918年的西班牙流感。疫情有可能像這樣發展:病毒會以很快的速度向全世界蔓延。你可以看到全球有三千萬人死于這個疾病。這就是個很嚴重的問題。我們絕不應該忽視。

But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talk about here. We've got cell phones to get information from the public and get information out to them. We have satellite maps where we can see where people are and where they're moving. We have advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that pathogen. So we can have tools, but those tools need to be put into an overall global health system. And we need preparedness.

但事實上我們可以建立一個很好的反應系統。我們可以利用所有發展至今的科技和科學。我們可以用手機來收集信息和發布信息。我們有衛星地圖可以看到人們在哪里和往哪移動。我們在生物學上也有進展,這可以大幅縮短我們找到病原的時間,并可以在很短的時間里找出解藥和疫苗。所以我們是有工具的,但這些工具必須統合在一個全球健康系統下。此外我們必須處在準備好的狀態。

The best lessons, I think, on how to get prepared are again, what we do for war. For soldiers, we have full-time, waiting to go. We have reserves that can scale us up to large numbers.

而我們如何做好準備,最好的例子還是來自于備戰。對軍人來說,他們是隨時隨地都準備好要投入戰爭的。我們還有預備軍人,能使備戰人口大量增加。

NATO has a mobile unit that can deploy very rapidly. NATO does a lot of war games to check, are people well trained? Do they understand about fuel and logistics and the same radio frequencies? So they are absolutely ready to go. So those are the kinds of things we need to deal with an epidemic.

北約組織有個機動小組,可以很快地行動起來。北約組織有很多戰爭游戲可以測試人員是否已訓練有素?他們是否了解燃油,補給和相同的收音機頻率?是的話,那么他們就已準備好了。這些就是面對疫情時我們該準備的事。

What are the key pieces? First, we need strong health systems in poor countries. That's where mothers can give birth safely, kids can get all their vaccines. But, also where we'll see the outbreak very early on.

關鍵的項目有哪些?第一,在貧窮的國家里必須有發達的衛生系統。母親們可以安全地生小孩,小孩們可以接種疫苗。我們也可以在很早的階段偵查到疫情的爆發。

We need a medical reserve corps: lots of people who've got the training and background who are ready to go, with the expertise. And then we need to pair those medical people with the military. taking advantage of the military's ability to move fast, do logistics and secure areas.

我們需要后備的醫療部隊:還有很多訓練有素的專業人員,隨時準備好能帶著他們專長到疫區。我們可以用軍隊來配合醫護人員,利用軍隊移動迅速的特性,來進行后勤運輸和維持安全。

We need to do simulations, germ games, not war games, so that we see where the holes are. The last time a germ game was done in the United States was back in 2001, and it didn't go so well. So far the score is germs: 1, people: 0.

我們也需要進行一些情境模擬,不是進行戰爭游戲而是進行病菌游戲 ,看看防衛漏洞在哪。上一次的病菌游戲是在美國進行的,那是在2001年了, 進行得也不是很順利。目前病菌得一分人類零分。

Finally, we need lots of advanced R&D in areas of vaccines and diagnostics. There are some big breakthroughs, like the Adeno-associated virus, that could work very, very quickly.

最后我們在疫苗和病理學上還需要很多的研發工作。在某些方面例如腺相關病毒上,我們已經有了相當的突破,這可以在很短的時間內生效。

Now I don't have an exact budget for what this would cost, but I'm quite sure it's very modest compared to the potential harm. The World Bank estimates that if we have a worldwide flu epidemic, global wealth will go down by over three trillion dollars and we'd have millions and millions of deaths.

我目前沒有明確的預算這到底需要多少錢,但是我確信跟損失比起來是比較便宜的。根據世界銀行的估算,如果我們有流感的疫情暴發,全球經濟會損失三萬多億美元。我們還會可能有千百萬人員的死亡。

These investments offer significant benefits beyond just being ready for the epidemic. The primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe.

跟僅僅只是準備好比起來,這些額外的投資會帶來顯著的益處。基礎的衛生保健,研發,可以促進全球健康的平衡發展,讓這個世界更健康更安全。

So I think this should absolutely be a priority. There's no need to panic. We don't have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side.

所以我覺得這非常重要重要。刻不容緩。不需要驚慌。我們不需要囤積面罐頭或是躲到地下室去,但是我們必須急起直追,因為時間有限。

In fact, if there's one positive thing that can come out of the Ebola epidemic, it's that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.

事實上,要說這場埃博拉病毒的疫情帶來了什么正面影響的話,那就是提早響起了警報,讓我們覺醒并做好準備。我們如果即刻開始準備,那么在下一場疫情來臨前我們是可以準備好的。

Thank you.

謝謝大家。

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