比爾蓋茨TED演講:The next outbreak？Were?not?ready?for?the?next?epidemic

The next outbreak? We're not ready for the next epidemic

下一場(chǎng)疫情爆發(fā)，我們還沒(méi)有準(zhǔn)備好

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.

當(dāng)我還是個(gè)孩子的時(shí)候，我們最擔(dān)心的災(zāi)難是核戰(zhàn)爭(zhēng)。這就是為什么我們?cè)诘叵率依镉幸粋€(gè)這樣的桶，里面裝滿了食物和水。

When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel. Today, the greatest risk of global catastrophe doesn't look like this. Instead, it looks like this.

當(dāng)核攻擊來(lái)臨時(shí)，我們應(yīng)該躲在地下室，靠桶維生。今天，全球?yàn)?zāi)難的最大風(fēng)險(xiǎn)不是這樣（核爆炸），而是這樣的（病毒）。

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.

如果在未來(lái)幾十年里有什么東西殺死了上千萬(wàn)人，那很可能是一種高度傳染性的病毒，而不是戰(zhàn)爭(zhēng)，不是導(dǎo)彈，而是微生物。

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.

現(xiàn)在，部分原因是我們?cè)诤送厣贤度肓舜罅抠Y金，但實(shí)際上我們?cè)谧柚沽餍胁〉南到y(tǒng)上投入很少，我們還沒(méi)有準(zhǔn)備好迎接下一場(chǎng)流行病。

Let's look at Ebola. I'm sure all of you read about it in the newspaper. A lot of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication.

讓我們來(lái)看看埃博拉病毒。我相信你們都在報(bào)紙上看到了。我們面臨很多艱難的挑戰(zhàn)。我仔細(xì)地用追蹤根除小兒麻痹癥的病例分析工具來(lái)分析了埃博拉。

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.

隨著疫情的發(fā)展我們可以看到，總感覺(jué)我們的問(wèn)題是我們的疾控系統(tǒng)不夠好，但實(shí)際上問(wèn)題是我們壓根就沒(méi)有這樣的系統(tǒng)。

In fact, there are some pretty obvious key missing pieces. 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.

事實(shí)上，有一些非常明顯的關(guān)鍵缺失部分。我們沒(méi)有一群流行病學(xué)家準(zhǔn)備好，去疫情區(qū)看看病毒的發(fā)展情況。病例都是從報(bào)紙上傳來(lái)的。

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 preparing people.

信息傳上線已經(jīng)很晚了，此外還不是很準(zhǔn)確。我們也找不到訓(xùn)練有素的醫(yī)護(hù)小組，也沒(méi)有一套讓人們嚴(yán)陣以待的方法。

Now medecins sans frontierers did a great job orchestrating volunteers, but even so, we were far slower than we should have been getting thousands of workers into these countries. And a large epidemic will require us to have hundreds of thousands of workers.

現(xiàn)在，無(wú)國(guó)界醫(yī)生（medecins sans frontiers，簡(jiǎn)稱medecins sans frontiers）在組織志愿者方面做得很好，但即便如此，我們調(diào)動(dòng)數(shù)千名工作者到疫情區(qū)的速度還是差強(qiáng)人意，而一場(chǎng)大規(guī)模的流行病將需要我們動(dòng)員數(shù)十萬(wàn)名人員。

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.

但是我們沒(méi)有任何人在研究治療的方向，也沒(méi)有人早看診斷的方法，沒(méi)有人想該用什么工具。舉個(gè)例子，我們也許可以抽取生還者的血液處理過(guò)后，再將血液注入沒(méi)得病的人體，來(lái)保護(hù)他們。

But that was never tried. So there was a lot that was missing. And these things are really a global failure.

但是這個(gè)方法從來(lái)沒(méi)嘗試過(guò)，所以很多事情都還沒(méi)來(lái)得及做，而這的卻是全球性的失敗。

The WHO is found 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.

世界衛(wèi)生組織的目的是來(lái)監(jiān)視流行病，而不是來(lái)做我剛才將的事情。但是在電影中的劇情又是另外一回事。有一群英俊的流行病學(xué)家準(zhǔn)備好，他們到了疫區(qū)拯救了大家。

But that's just pure Hollywood. The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola.

但是這是純好萊塢的劇情，我們的準(zhǔn)備不足可能會(huì)導(dǎo)致下一場(chǎng)疫情的無(wú)法控制。

Let's look at the progression of Ebola over this year, about 10000 people died, and nearly all were in the three west African countries. There are three reasons why it didn't spread more. The first is that there was a lot of heroic work by the health workers.

讓我們來(lái)看看今年埃博拉疫情的進(jìn)展，大約有1萬(wàn)人死亡，幾乎所有人都在西非三個(gè)國(guó)家。埃博拉疫情沒(méi)有進(jìn)一步蔓延的原因有三個(gè)：第一，衛(wèi)生工作者做了很多英勇的工作。

They found 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. 3rd, it didn't get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas.

他們發(fā)現(xiàn)了病人進(jìn)行隔離阻止了更多的感染。第二是病毒的性質(zhì)。埃博拉病毒不會(huì)通過(guò)空氣傳播。當(dāng)你被傳染時(shí)，大多數(shù)人都病得臥床不起。第三，它并沒(méi)有進(jìn)入很多城市地區(qū)。那只是運(yùn)氣。如果它進(jìn)入了更多的城市地區(qū)。

The case numbers would have been much larger. 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.

病例數(shù)量會(huì)大得多。所以下次我們可能就沒(méi)那么幸運(yùn)了。你可能會(huì)在不知不覺(jué)中感染一種病毒，并把病毒帶上飛機(jī)或者帶進(jìn)超市。

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. In fact, let's look at a model of a virus are spread through the air.

病毒的來(lái)源可能是像埃博拉這樣的自然流行病，也可能是生物恐怖主義。所以有些事情確實(shí)會(huì)使情況惡化上千倍。讓我們來(lái)看看病毒通過(guò)空氣傳播的模型。

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 there's over 30 million people die from that epidemic. So this is a serious problem. We should be concerned. But in fact, we can build a really good response system.

就像1918年的西班牙流感。接下來(lái)會(huì)發(fā)生什么。它會(huì)很快蔓延到全世界。你可以看到有超過(guò)3000萬(wàn)人死于這種流行病。所以這是一個(gè)很嚴(yán)重的問(wèn)題。我們應(yīng)該關(guān)注。事實(shí)上，我們可以建立一個(gè)很好的反應(yīng)系統(tǒng)。

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 can get Information out to them.

我們從這里談?wù)摰乃锌茖W(xué)技術(shù)中獲益，我們有手機(jī)從公眾那里獲取信息，也可以把信息傳遞給他們。

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 that pathogen. So we can have tools, but those tools need to be put into an overall global health system.

我們有衛(wèi)星地圖，在那里我們可以看到人們?cè)谀?，他們?cè)谀睦镆苿?dòng)。我們有生物學(xué)上的進(jìn)步，這將顯著改變觀察病原體的周轉(zhuǎn)時(shí)間，并能夠制造出適合這種病原體的藥物和疫苗。所以我們可以有工具，但這些工具需要納入全球整體衛(wèi)生體系。

And we need preparedness. The best lessons, I think, on how to get prepared aer again, what we do for war, for soldiers, we have full time waiting to go. We have reserves that can scale this up to large numbers.

此外，我們必須處在備戰(zhàn)狀態(tài)，而我們?nèi)绾巫龊脺?zhǔn)備？最好的例子還是來(lái)自于備戰(zhàn)。最軍人來(lái)說(shuō)，我們是隨時(shí)隨地都要準(zhǔn)備好投入戰(zhàn)爭(zhēng)的。我們還有預(yù)備役軍人，能使備戰(zhàn)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.

北約有一個(gè)機(jī)動(dòng)小組，可以很快的行動(dòng)起來(lái)，北約組織有很多戰(zhàn)爭(zhēng)游戲可以測(cè)試人員是否是訓(xùn)練有素的，他們是否了解燃料，補(bǔ)給和相同的收音機(jī)頻率，是的話，他們已經(jīng)準(zhǔn)備好了。這些就是面對(duì)疫情時(shí)我們?cè)摐?zhǔn)備的事情。

What are the key pieces ? First we need strong health systems in poor countries. That's where mothers can give birth safely.

關(guān)鍵部分是什么？首先，我們需要在貧窮國(guó)家建立強(qiáng)有力的衛(wèi)生系統(tǒng)，作為母親可以安全的生小孩。

Kids can get all the vaccines, but also where we`ll see the outbreak very early on. We need a medical reserve corps. Lots of people who have got the training and background who are ready to go with the expertise.

孩子們可以接種所有的疫苗，我們也可以在很早就會(huì)看到疫情爆發(fā)。我們需要一支醫(yī)療后備隊(duì)。還有很多訓(xùn)練有素的專業(yè)人員，隨時(shí)準(zhǔn)備好帶他們到疫區(qū)去。

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. We need to do simulations, germ games, not war games. So that we see where the holes are.

然后我們可以用軍隊(duì)來(lái)配合醫(yī)護(hù)人員，利用軍隊(duì)快速移動(dòng)的特點(diǎn)，來(lái)進(jìn)行后勤運(yùn)輸和維護(hù)安全。我們需要做情景模擬，細(xì)菌游戲，而不是戰(zhàn)爭(zhēng)游戲。這樣我們才能看到漏洞在哪里。

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.

上次的病毒游戲是在美國(guó)進(jìn)行的，那是在2001年了，進(jìn)行的也不是很順利，目前，病菌得一分，人類得零分。

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

最后，我們需要在疫苗和診斷領(lǐng)域進(jìn)行大量的先進(jìn)研發(fā)。在比如在胰相關(guān)病毒上，我們已經(jīng)有了相當(dāng)大得突破?？梢栽诤芏痰脮r(shí)間內(nèi)生效?，F(xiàn)在，我還沒(méi)有一個(gè)確切的預(yù)算這需要多少錢(qián)，但我敢肯定，與潛在的危害相比，這是非常溫和的。

The World Bank estimates that if we have a worldwide flu epidemic. Global wealth will go down by over $3 trillion. And we`d have millions and millions of deaths. These investments offer significant benefits beyond just being ready for the epidemic. The primary health care they R＆D. those things would reduce global health equity and make the world more just as well as more safe.

世界銀行估計(jì)，如果我們?cè)谌蚍秶鷥?nèi)爆發(fā)流感疫情，全球財(cái)富將減少3萬(wàn)億美元以上，我們將有數(shù)百萬(wàn)人死亡。這些投資帶來(lái)的好處不僅僅是為疫情做好準(zhǔn)備，還有基礎(chǔ)得衛(wèi)生保健，研發(fā)，可以促進(jìn)全球健康得平衡發(fā)展，使世界更加健康和安全。

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

所以我認(rèn)為這絕對(duì)應(yīng)該是優(yōu)先考慮的事情，不必驚慌。我們沒(méi)有必要貯藏罐頭，也沒(méi)有必要到地下室去。但是我們得奮起直追。因?yàn)闀r(shí)間不在我們這邊。

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

事實(shí)上，如果埃博拉疫情能帶來(lái)一個(gè)積極的影響，那就是它可以作為一個(gè)預(yù)警，警告我們覺(jué)醒并做好準(zhǔn)備。如果即可開(kāi)始準(zhǔn)備，我們就可以為下一次流行病做好準(zhǔn)備。

Thank you！

謝謝！