TED2010
Seth Berkley: HIV and flu -- the vaccine strategy
塞思•巴克利：愛滋病病毒與流感 — 疫苗的策略
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塞思•巴克利說明目前先進的疫苗設計、生產、配送流程將如何滅絕全球的疾病威脅，從愛滋病、瘧疾到流感。
Seth Berkley - Vaccine visionary
Epidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world. Full bio
Epidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world. Full bio
Double-click the English transcript below to play the video.
00:17
Do you worry about what is going to kill you?
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你是否擔心自己將會命喪何種事故？
00:20
Heart disease, cancer,
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心臟病？癌症？
00:22
a car accident?
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還是車禍呢？
00:24
Most of us worry about things we can't control,
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大部分我們擔心的，都不是我們能控制的，
00:27
like war, terrorism,
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像是戰爭、恐怖攻擊、
00:29
the tragic earthquake that just occurred in Haiti.
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或像海地的那種大地震。
00:32
But what really threatens humanity?
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有哪些是真正威脅到人類的？
00:36
A few years ago, Professor Vaclav Smil
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幾年前，瓦茨•拉夫史米爾教授
00:38
tried to calculate the probability
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試著去計算
00:40
of sudden disasters
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世界上足以改變人類歷史的災害
00:42
large enough to change history.
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所出現的機率。
00:44
He called these,
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他稱之為
00:46
"massively fatal discontinuities,"
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嚴重的致命不連續性 (massively fatal discontinuities)，
00:48
meaning that they could kill
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意味著這些事故
00:50
up to 100 million people
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在未來的 50 年內
00:52
in the next 50 years.
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最多可能導致一億人喪命。
00:54
He looked at the odds of another world war,
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他也研究了第三次世界大戰發生的機率、
00:57
of a massive volcanic eruption,
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大規模火山爆發的機率、
00:59
even of an asteroid hitting the Earth.
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甚至小行星撞地球的機率。
01:01
But he placed the likelihood of one such event
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但是他把某個事件發生的可能性
01:04
above all others
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放在第一位，
01:06
at close to 100 percent,
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幾乎 100% 會發生，
01:08
and that is a severe flu pandemic.
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這個事件就是嚴重的全球性流感。
01:12
Now, you might think of flu
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現在，你可能會覺得流感
01:14
as just a really bad cold,
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只是一種比較嚴重的感冒而已。
01:17
but it can be a death sentence.
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但是，它能取你性命，
01:19
Every year, 36,000 people in the United States
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每年有三萬六千名美國人
01:22
die of seasonal flu.
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死於季節性的流感。
01:25
In the developing world, the data is much sketchier
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在開發中國家，雖然資料很粗略，
01:27
but the death toll is almost
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不過死亡人數
01:29
certainly higher.
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一定都比帳面上的還要高。
01:31
You know, the problem is if
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各位應該要瞭解，問題就在
01:33
this virus occasionally mutates
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流感病毒偶爾會產生
01:35
so dramatically,
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劇烈的突變。
01:37
it essentially is a new virus
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本質上可將其視為一種新的病毒，
01:39
and then we get a pandemic.
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然後就會導致全球性大流行。
01:43
In 1918, a new virus appeared
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1918 年，出現了一種新病毒（註：西班牙流感）
01:46
that killed some 50 to 100 million people.
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導致五千萬到一億人喪命，
01:49
It spread like wildfire
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它的蔓延速度跟野火一樣快，
01:51
and some died within hours of developing symptoms.
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有些人在症狀顯現後數小時內即死亡。
01:54
Are we safer today?
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現在我們有比較安全嗎？
01:56
Well, we seem to have dodged
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嗯，看起來今年
01:58
the deadly pandemic this year
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我們已經避開了
02:00
that most of us feared,
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很多人害怕的死亡性流感，
02:02
but this threat could reappear at any time.
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但是這種威脅隨時可能再出現。
02:05
The good news is that
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好消息是，
02:07
we're at a moment in time
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此時此刻，
02:09
when science, technology, globalization is converging
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科學、技術、全球化的匯集，
02:12
to create an unprecedented possibility:
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創造了前所未有的可能性。
02:14
the possibility to make history
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在傳染性疾病的預防上
02:16
by preventing infectious diseases
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我們也有創造歷史的可能。
02:19
that still account for one-fifth of all deaths
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傳染性疾病所導致的死亡案例佔人類死亡總數的 1/5，
02:22
and countless misery on Earth.
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同時帶來無窮盡的痛苦。
02:25
We can do this.
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我們能做得到。
02:27
We're already preventing millions of deaths
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我們已經用疫苗
02:29
with existing vaccines,
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拯救了數以百萬的生命。
02:31
and if we get these to more people,
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如果我們能提供疫苗給更多人
02:33
we can certainly save more lives.
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我們就能拯救更多生命。
02:36
But with new or better vaccines
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現在有許多最新、最棒的疫苗，
02:38
for malaria, TB, HIV,
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像是瘧疾疫苗、肺結核疫苗、愛滋病疫苗
02:41
pneumonia, diarrhea, flu,
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肺炎疫苗、痢疾疫苗、流感疫苗。
02:43
we could end suffering
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我們能阻止
02:45
that has been on the Earth since the beginning of time.
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那從古老紀元以來就有的苦難
02:48
So, I'm here to trumpet vaccines for you.
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所以我到這裡，來告訴各位疫苗的好處。
02:50
But first, I have to explain why they're important
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首先，我要跟各位解釋為什麼這些疫苗如此重要。
02:53
because vaccines, the power of them,
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疫苗的威力
02:56
is really like a whisper.
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非常低調。
02:58
When they work, they can make history,
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它們起了作用，它們創造了歷史。
03:00
but after a while
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但過沒多久，
03:02
you can barely hear them.
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你可能就很少再聽到人們討論疫苗。
03:04
Now, some of us are old enough
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年紀稍大一點的人，
03:07
to have a small, circular scar on our arms
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都應該有一個小小的圓形疤痕在我們的手臂上，
03:10
from an inoculation we received as children.
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這是我們小時候就接種的疫苗痕跡。
03:13
But when was the last time you worried about smallpox,
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我們上一次害怕得天花是什麼時候？
03:16
a disease that killed half a billion people last century
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這個在上個世紀奪走數億人命的疾病
03:19
and no longer is with us?
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就這樣消失了嗎？
03:21
Or polio? How many of you remember the iron lung?
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小兒痲痺，還有多少人記得鐵肺這個東西？
03:24
We don't see scenes like this anymore
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這種情景不會再發生了，
03:27
because of vaccines.
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這都是疫苗帶來的功勞。
03:29
Now, it's interesting
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令人感到有趣的是，
03:31
because there are 30-odd diseases
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目前有卅種古老的疾病
03:34
that can be treated with vaccines now,
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可以用疫苗來防範。
03:36
but we're still threatened by things like HIV and flu.
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但我們卻依然受到愛滋病和流感的威脅，
03:39
Why is that?
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為什麼會這樣？
03:41
Well, here's the dirty little secret.
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嗯，是因為有不可告人的秘密。
03:43
Until recently, we haven't had to know
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直到最近，我們還無法完全瞭解
03:45
exactly how a vaccine worked.
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要如何找到有效的疫苗。
03:48
We knew they worked through old-fashioned trial and error.
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我們是透過試誤法來尋找有效的疫苗，
03:51
You took a pathogen, you modified it,
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我們培養病原體，稍微調整病原體的特性，
03:53
you injected it into a person or an animal
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然後把它注射到人或動物體內，
03:56
and you saw what happened.
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等看看有什麼結果發生。
03:58
This worked well for most pathogens,
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這套方法對大部分的疾病治療很有用，
04:01
somewhat well for crafty bugs like flu,
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對付像流感這種奸詐系的病毒有時候有效，
04:04
but not at all for HIV,
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但對會讓人類失去免疫系統的愛滋病毒而言，
04:06
for which humans have no natural immunity.
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這套方法完全沒用。
04:09
So let's explore how vaccines work.
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讓我們來探索疫苗運作的原理，
04:12
They basically create a cache
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基本上，疫苗幫助免疫系統
04:14
of weapons for your immune system
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建立一套快取式的防禦武器，
04:16
which you can deploy when needed.
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好讓你在需要的時候能在體內快速部屬。
04:19
Now, when you get a viral infection,
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當你感染到病毒，
04:22
what normally happens is it takes days or weeks
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通常需要數天或數星期，
04:24
for your body to fight back
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你身體的免疫系統才能
04:26
at full strength,
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全力反擊，
04:28
and that might be too late.
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那時候可能就太遲了。
04:30
When you're pre-immunized,
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若你接受預防接種，
04:32
what happens is you have forces in your body
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免疫系統因為已經接受過「事前訓練」
04:34
pre-trained to recognize
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所以能很快辨認出該病毒，
04:36
and defeat specific foes.
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同時消滅它們，
04:38
So that's really how vaccines work.
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這是疫苗的功用。
04:40
Now, let's take a look at a video
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讓我們先看段影片，
04:42
that we're debuting at TED, for the first time,
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我們選擇在 TED 大會上公開首映這個影片，
04:45
on how an effective HIV vaccine might work.
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影片探討有效的愛滋病疫苗該如何運作。
04:49
(Music)
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（音樂）
04:55
Narrator: A vaccine trains the body in advance
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旁白：疫苗會事先鍛鍊身體，
04:57
how to recognize and neutralize
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讓身體能辨認與壓制
04:59
a specific invader.
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特殊的入侵者。
05:01
After HIV penetrates the body's mucosal barriers,
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當愛滋病病毒滲透了體內的黏膜屏障時，
05:04
it infects immune cells to replicate.
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它感染免疫細胞然後開始複製，
05:08
The invader draws the attention
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這些病毒的入侵
05:10
of the immune system's front-line troops.
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會立刻吸引免疫系統第一道防線的注意，
05:12
Dendritic cells, or macrophages,
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樹突狀細胞，或巨噬細胞
05:14
capture the virus and display pieces of it.
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會開始追捕病毒，並公告身體各機關。
05:18
Memory cells generated by the HIV vaccine
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當愛滋病毒
05:21
are activated when they learn
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接觸到免疫系統的第一道防線，
05:23
HIV is present from the front-line troops.
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過去接種的疫苗會刺激身體，產生記憶細胞。
05:26
These memory cells immediately deploy
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這些記憶細胞
05:29
the exact weapons needed.
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會立刻部屬用來對付該病毒的武器。
05:32
Memory B cells turn into plasma cells,
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記憶 B 細胞會變成漿細胞，
05:35
which produce wave after wave
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這些漿細胞會產生一波又一波的
05:37
of the specific antibodies
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特定抗體，
05:39
that latch onto HIV
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以纏住病毒，
05:41
to prevent it from infecting cells,
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防止病毒感染其他細胞。
05:43
while squadrons of killer T cells
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T 細胞這群殺手部隊，
05:45
seek out and destroy cells
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會找出並摧毀
05:47
that are already HIV infected.
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已被愛滋病病毒感染的細胞，
05:50
The virus is defeated.
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病毒就是這樣被打敗。
05:52
Without a vaccine,
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若沒有疫苗，
05:54
these responses would have taken more than a week.
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身體要一星期以上，才會有前述的反應，
05:57
By that time, the battle against HIV
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等到那時候
05:59
would already have been lost.
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這場對付愛滋病病毒的戰爭早就輸了。
06:08
Seth Berkley: Really cool video, isn't it?
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非常棒的影片，對吧？
06:11
The antibodies you just saw in this video,
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剛剛各位都在影片中看到抗體是如何作用的，
06:14
in action, are the ones that make most vaccines work.
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而這些抗體是大多數疫苗帶來的成果。
06:17
So the real question then is:
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真正令人好奇的是，
06:19
How do we ensure that your body makes
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我們如何保證自己的身體
06:21
the exact ones that we need to protect
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能夠確實地產生
06:23
against flu and HIV?
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抵抗流感或是愛滋病的抗體？
06:25
The principal challenge for both of these viruses
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對付這二種病毒的主要挑戰是
06:28
is that they're always changing.
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它們會一直改變，
06:30
So let's take a look at the flu virus.
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讓我們先來觀察流感這種病毒。
06:33
In this rendering of the flu virus,
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在這個流感病毒示意圖中，
06:35
these different colored spikes are what it uses to infect you.
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不同顏色的棘蛋白是用來感染你的武器。
06:38
And also, what the antibodies use is a handle
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而抗體之所以能夠捉住、中和病毒，
06:41
to essentially grab and neutralize the virus.
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也是靠病毒上的這些棘蛋白。
06:44
When these mutate, they change their shape,
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當病毒突變時，它們會改變整個外觀，
06:47
and the antibodies don't know what they're looking at anymore.
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讓抗體沒有辦法從外觀來辨認出病毒，
06:50
So that's why every year
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這就是為什麼每一年
06:53
you can catch a slightly different strain of flu.
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你會得到稍微不同的流感病株。
06:56
It's also why in the spring,
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這也是為什麼在春天時，
06:58
we have to make a best guess
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我們就要開始猜測
07:00
at which three strains are going to prevail the next year,
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來年的流感可能會有哪些病株，
07:03
put those into a single vaccine
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而將這些病株置入單一疫苗的製作，
07:05
and rush those into production for the fall.
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然後倉促的量產，以在秋天做好準備。
07:08
Even worse,
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更糟的是，
07:10
the most common influenza -- influenza A --
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大多的普通流感、A 型流感，
07:13
also infects animals
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也會感染給
07:15
that live in close proximity to humans,
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跟人類相當親近的動物們。
07:17
and they can recombine
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這些病毒會在動物體內
07:19
in those particular animals.
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重新合成。
07:21
In addition, wild aquatic birds
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此外，野生水鳥
07:23
carry all known strains
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是帶來許多已知流感病毒的
07:25
of influenza.
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源頭之一，
07:27
So, you've got this situation:
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大家都瞭解這種情況，
07:29
In 2003,
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在 2003 年
07:31
we had an H5N1 virus
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我們發現了 H5N1 病毒，
07:34
that jumped from birds into humans
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這是從鳥類轉移到人類的
07:37
in a few isolated cases
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少數個別案例之一。
07:39
with an apparent mortality rate of 70 percent.
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人類感染後的死亡率高達 70%，
07:42
Now luckily, that particular virus,
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幸運的是，這種特殊病毒
07:45
although very scary at the time,
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雖然在當時有引起一陣恐慌，
07:47
did not transmit from person to person
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但它不容易產生
07:49
very easily.
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人傳人的情形。
07:51
This year's H1N1 threat
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今年 H1N1 的威脅，
07:54
was actually a human, avian, swine mixture
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實際上是經過人、鳥、豬的混合體，
07:58
that arose in Mexico.
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並在墨西哥爆發開來，
08:00
It was easily transmitted,
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這種病毒在傳播上就非常容易，
08:02
but, luckily, was pretty mild.
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不過還好它的症狀就溫和多了。
08:05
And so, in a sense,
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就某種意義上來說，
08:07
our luck is holding out,
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我們的運氣一直不錯，
08:09
but you know, another wild bird could fly over at anytime.
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不過野鳥可是帶著這病毒飛來飛去的。
08:13
Now let's take a look at HIV.
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現在來看愛滋病毒，
08:15
As variable as flu is,
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跟流感一樣有多變性，
08:17
HIV makes flu
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愛滋病毒會讓小小感冒，
08:19
look like the Rock of Gibraltar.
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變得像個固若金湯的堡壘 (Rock of Gibraltar)。
08:21
The virus that causes AIDS
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這種病毒所引起的愛滋病，
08:23
is the trickiest pathogen
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成為科學家到目前為止
08:25
scientists have ever confronted.
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所面對最棘手的問題。
08:27
It mutates furiously,
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它會瘋狂地變異，
08:29
it has decoys to evade the immune system,
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釋放出誘餌以躲避免疫系統，
08:31
it attacks the very cells that are trying to fight it
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同時瘋狂的攻擊體內想反抗的細胞。
08:34
and it quickly hides itself
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而且它會很快地
08:36
in your genome.
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躲在你的染色體裡面。
08:38
Here's a slide looking at
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現在這張投影片，
08:40
the genetic variation of flu
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是流感和愛滋病病毒
08:42
and comparing that to HIV,
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基因變異程度的比較，
08:44
a much wilder target.
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你會發現愛滋病病毒的變異程度非常誇張，
08:47
In the video a moment ago,
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剛剛的影片中都有看到，
08:49
you saw fleets of new viruses launching from infected cells.
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體內被感染的細胞，會增生一批又一批的病毒艦隊。
08:52
Now realize that in a recently infected person,
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現在的愛滋病患者
08:55
there are millions of these ships;
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體內就有這數百萬的病毒艦隊，
08:57
each one is just slightly different.
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而且每一艘都長得不一樣。
08:59
Finding a weapon that recognizes
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要找到適當的武器，
09:01
and sinks all of them
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去辨認並同時摧毀這些艦隊
09:03
makes the job that much harder.
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是非常困難的。
09:05
Now, in the 27 years since HIV
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自從 27 年前愛滋病病毒
09:08
was identified as the cause of AIDS,
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被確認是引起愛滋病的元兇之後，
09:11
we've developed more drugs to treat HIV
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我們針對愛滋病所開發出來的藥物，
09:13
than all other viruses put together.
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比其他疾病所開發的藥品總和還要多，
09:16
These drugs aren't cures,
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雖然這些藥還無法治癒愛滋病，
09:18
but they represent a huge triumph of science
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但它們代表了現代科學的重大勝利。
09:20
because they take away the automatic death sentence
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因為這些藥避免了
09:22
from a diagnosis of HIV,
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得愛滋等於被判死刑的悲劇，
09:24
at least for those who can access them.
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至少感染者還有一線生機。
09:27
The vaccine effort though is really quite different.
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疫苗的開發就不一樣了，
09:30
Large companies moved away from it
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大公司都不願投入疫苗研究，
09:32
because they thought the science was so difficult
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因為他們認為這方面的技術太難，
09:35
and vaccines were seen as poor business.
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而且認為疫苗是窮人生意，
09:38
Many thought that it was just impossible to make an AIDS vaccine,
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有部份的公司認為開發愛滋病疫苗是不可能的。
09:41
but today, evidence tells us otherwise.
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但今日，證據顯示事實並非如此。
09:44
In September,
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在 9 月的時候，
09:46
we had surprising but exciting findings
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在泰國的臨床實驗中，
09:49
from a clinical trial that took place in Thailand.
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我們得到了意外，但令人興奮的發現。
09:52
For the first time, we saw an AIDS vaccine work in humans --
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這是第一次，愛滋病疫苗在人體上起了作用，
09:55
albeit, quite modestly --
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儘管效果並不顯著。
09:58
and that particular vaccine was made
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這款特別的疫苗
10:00
almost a decade ago.
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大約十年前就製造出來了。
10:02
Newer concepts and early testing now
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新的概念和過去的實驗成果結合，
10:04
show even greater promise in the best of our animal models.
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並從動物實驗中取得了重大的成果。
10:09
But in the past few months, researchers have also isolated
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過去幾個月，科學家從愛滋病患的血液中
10:12
several new broadly neutralizing antibodies
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成功地分離出
10:15
from the blood of an HIV infected individual.
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數種新的廣效中和抗體。
10:18
Now, what does this mean?
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這是什麼意思？
10:20
We saw earlier that HIV
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我們剛提到愛滋病毒
10:22
is highly variable,
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是非常多變化的，
10:24
that a broad neutralizing antibody
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而這具中和力的抗體
10:26
latches on and disables
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能夠同時拴住樣貌不同的愛滋病毒，
10:28
multiple variations of the virus.
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並使它們無效化。
10:31
If you take these and you put them
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如果把這種疫苗
10:33
in the best of our monkey models,
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注射到一個健康的猴子體內，
10:35
they provide full protection from infection.
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這些猴子就不會再感染愛滋病。
10:38
In addition, these researchers found
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此外，
10:40
a new site on HIV
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科學家在愛滋病毒上發現了一個特徵，
10:42
where the antibodies can grab onto,
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抗體可以抓到這個特徵。
10:44
and what's so special about this spot
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特別的是，
10:46
is that it changes very little
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當愛滋病毒突變時，
10:48
as the virus mutates.
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這個特徵幾乎不會改變。
10:50
It's like, as many times
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這就像，
10:52
as the virus changes its clothes,
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不管病毒換穿幾件不同款式的衣服，
10:54
it's still wearing the same socks,
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它依舊會穿同一雙襪子。
10:55
and now our job is to make sure
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所以我們的工作就是確保
10:58
we get the body to really hate those socks.
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讓身體討厭這些襪子就好，
11:01
So what we've got is a situation.
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我們正朝這方面努力。
11:03
The Thai results tell us
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泰國的實驗結果告訴我們，
11:05
we can make an AIDS vaccine,
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我們可以成功製作出愛滋病疫苗。
11:07
and the antibody findings
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而抗體的發現
11:09
tell us how we might do that.
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告訴我們可行的策略。
11:11
This strategy, working backwards
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這個策略是由
11:14
from an antibody to create a vaccine candidate,
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抗體倒推到疫苗候選株的，
11:16
has never been done before in vaccine research.
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這個策略在疫苗的研發中是首例。
11:19
It's called retro-vaccinology,
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我們稱之為反向疫苗學 (retro-vaccinology)
11:22
and its implications extend
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而這研究的影響
11:24
way beyond that of just HIV.
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不僅只於愛滋病的研究。
11:27
So think of it this way.
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你可以這樣想：
11:29
We've got these new antibodies we've identified,
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我們已經發現了這些新的抗體，
11:32
and we know that they latch onto many, many variations of the virus.
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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。
11:35
We know that they have to latch onto a specific part,
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抗體會糾纏住病毒的某部份，
11:38
so if we can figure out the precise structure of that part,
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所以如果我們可以清楚地描繪出那部份的結構，
11:41
present that through a vaccine,
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再透過疫苗
11:43
what we hope is we can prompt
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去刺激免疫系統，
11:45
your immune system to make these matching antibodies.
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讓免疫系統自己製造出此種抗體。
11:48
And that would create
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使用這種方法，
11:50
a universal HIV vaccine.
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能製造出廣效性疫苗。
11:52
Now, it sounds easier than it is
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這方法聽起來比之前的簡單多了。
11:54
because the structure actually looks more like
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就像圖中
11:56
this blue antibody diagram
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藍色的抗體，
11:58
attached to its yellow binding site,
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要去吸附那隱藏在病毒底下的黃色部份。
12:00
and as you can imagine, these three-dimensional structures
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你們可以想像得到，要解開這些東西的立體結構
12:02
are much harder to work on.
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並不是那麼地容易。
12:04
And if you guys have ideas to help us solve this,
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如果各位有能幫助我們解決這問題的點子，
12:06
we'd love to hear about it.
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我們很樂意傾聽。
12:08
But, you know, the research that has occurred from HIV now
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但是，你知道，這從愛滋病毒研究開始的反向疫苗學，
12:11
has really helped with innovation with other diseases.
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現在也大大地幫助了其他疾病研究的創新。
12:14
So for instance, a biotechnology company
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舉例來說，生技公司
12:16
has now found broadly neutralizing
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目前已經找到了流感的
12:18
antibodies to influenza,
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廣效性中和抗體，
12:20
as well as a new antibody target on the flu virus.
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也找到了流感病毒上可以用來鎖定的新抗體目標物。
12:23
They're currently making a cocktail --
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他們目前正在製造混合劑，
12:26
an antibody cocktail -- that can be used to treat
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一種抗體的混合劑，
12:29
severe, overwhelming cases of flu.
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可以治療非常嚴重的流感。
12:32
In the longer term, what they can do
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對長期來說，他們能做的
12:34
is use these tools of retro-vaccinology
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就是使用反向疫苗學的工具
12:36
to make a preventive flu vaccine.
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去製造出保護性的流感疫苗。
12:39
Now, retro-vaccinology is just one technique
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在所謂循理性地疫苗設計中，
12:42
within the ambit of so-called rational vaccine design.
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反向疫苗學只是其中地一項技術而已。
12:45
Let me give you another example.
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讓我另外跟各位舉個例，
12:48
We talked about before the H and N spikes
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之前提過流感病毒表面的兩種棘蛋白
12:50
on the surface of the flu virus.
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分別叫 H 棘蛋白和 M 棘蛋白，
12:52
Notice these other, smaller protuberances.
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注意到表面其他較小的突點，
12:55
These are largely hidden from the immune system.
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免疫系統是看不太到它們的。
12:58
Now it turns out that these spots
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而病毒突變時，這些小突點
13:00
also don't change much when the virus mutates.
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也不會有太大地改變。
13:03
If you can cripple these with specific antibodies,
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若能發展出特殊的抗體，專門偵測這些小突點，
13:05
you could cripple all versions of the flu.
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你就能偵測到整個病毒。
13:08
So far, animal tests indicate
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目前為止，
13:10
that such a vaccine could prevent severe disease,
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動物實驗已經證明，這種疫苗可以防止重大疾病發生，
13:13
although you might get a mild case.
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雖然接種疫苗時，可能會產生輕微的症狀。
13:15
So if this works in humans, what we're talking about
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因此若這疫苗在人體中也有同樣的效果，
13:18
is a universal flu vaccine,
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那我們現在所討論的就是大一統的流感疫苗，
13:20
one that doesn't need to change every year
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一種不需要每年重新研發，
13:22
and would remove the threat of death.
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並能移除死亡威脅的疫苗。
13:25
We really could think of flu, then,
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我們真的可以把流感想像成
13:27
as just a bad cold.
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比較嚴重的普通感冒。
13:30
Of course, the best vaccine imaginable
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當然，再棒的疫苗，
13:32
is only valuable to the extent
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也要能發放給所需要的人，
13:34
we get it to everyone who needs it.
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才會有價值。
13:36
So to do that, we have to combine
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為了做到這點，我們必須將
13:38
smart vaccine design with smart production methods
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最有效的疫苗設計和有效率的生產方法結合在一起，
13:41
and, of course, smart delivery methods.
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當然，還要有傑出的物流系統。
13:44
So I want you to think back a few months ago.
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我請各位回想一下幾個月前的情形，
13:46
In June, the World Health Organization
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2009 年六月，世界衛生組織
13:49
declared the first global
330
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公告了首波全球性流感，
13:51
flu pandemic in 41 years.
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是 41 年來首例。
13:53
The U.S. government promised
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美國政府承諾
13:55
150 million doses of vaccine
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在流感達到高峰的十月 15 日前，
13:57
by October 15th for the flu peak.
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會製造出一億五千萬支疫苗，
13:59
Vaccines were promised to developing countries.
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疫苗會被送到開發中國家。
14:01
Hundreds of millions of dollars were spent
336
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花費了數百萬美金，
14:03
and flowed to accelerating vaccine manufacturing.
337
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投入到疫苗的製造工廠以加速疫苗生產。
14:06
So what happened?
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那又怎樣？
14:08
Well, we first figured out
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我們第一次
14:10
how to make flu vaccines, how to produce them,
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學到如何製造流感疫苗，如何生產疫苗，
14:13
in the early 1940s.
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是在 1940 年代早期。
14:15
It was a slow, cumbersome process
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當時的生產流程非常地笨重且速度緩慢，
14:18
that depended on chicken eggs,
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那時的流感疫苗是要從
14:21
millions of living chicken eggs.
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數百萬個受精雞蛋中培養，
14:24
Viruses only grow in living things,
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因為病毒只能在活體中成長。
14:26
and so it turned out that, for flu,
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經過實驗證明，
14:28
chicken eggs worked really well.
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流感病毒能在雞蛋裡成長。
14:30
For most strains, you could get one to two doses
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對多數流感病株來說，
14:33
of vaccine per egg.
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平均一顆蛋，可以製造 1~2 劑疫苗。
14:35
Luckily for us,
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運氣很好的是，
14:37
we live in an era of breathtaking
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我們生長在這個
14:39
biomedical advances.
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生物醫學超先進的時代。
14:41
So today, we get our flu vaccines from ...
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恩，現在生產疫苗的來源
14:44
chicken eggs,
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....... 還是雞蛋。
14:46
(Laughter)
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（笑聲）
14:48
hundreds of millions of chicken eggs.
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我們還是需要上億個雞蛋。
14:50
Almost nothing has changed.
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你知道，幾乎沒有改變，
14:52
The system is reliable
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你說，這方法是可依賴的。
14:54
but the problem is you never know how well
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但問題是，
14:56
a strain is going to grow.
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你不知道雞蛋內的病株成長情形。
14:59
This year's swine flu strain
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今年的豬流感病株，
15:01
grew very poorly in early production:
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在雞蛋裡的生長狀況就很糟。
15:04
basically .6 doses per egg.
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平均一個雞蛋只能製造 0.6 支疫苗，
15:08
So, here's an alarming thought.
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這可響起警訊了，
15:10
What if that wild bird flies by again?
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萬一禽流感再來襲怎麼辦？
15:12
You could see an avian strain
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你知道禽流感病株
15:14
that would infect the poultry flocks,
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會感染成千上萬的家禽，
15:16
and then we would have no eggs for our vaccines.
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然後我們會連用來製造疫苗的雞蛋也沒有了。
15:18
So, Dan [Barber], if you want
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所以，丹•巴伯（名廚師），
15:20
billions of chicken pellets
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如果你想用大量的雞肉丸
15:22
for your fish farm,
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來當作你的魚飼料，
15:24
I know where to get them.
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我知道哪兒找得到。
15:26
So right now, the world can produce
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目前，全世界能製造三億五千萬支
15:28
about 350 million doses
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含有三種去活化病毒株的
15:30
of flu vaccine for the three strains,
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流感疫苗。
15:33
and we can up that to about 1.2 billion doses
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如果我們能鎖定一種病毒變異株，
15:36
if we want to target a single variant
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譬如像是豬流感
15:38
like swine flu.
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那產量可以達到一兆二千億支。
15:40
But this assumes that our factories are humming
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但這是假設全部的工廠都在運作，
15:43
because, in 2004,
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因為 2004 年時，
15:45
the U.S. supply was cut in half
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美國的疫苗供應量減半，
15:47
by contamination at one single plant.
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只是因為一間疫苗工廠受汙染無法運作。
15:50
And the process still takes
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再加上整個培養過程，
15:52
more than half a year.
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仍需要半年以上的時間。
15:54
So are we better prepared
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所以，
15:56
than we were in 1918?
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我們現在的情況有比 1918 年好嗎？
15:58
Well, with the new technologies emerging now,
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恩，在現代的新技術下
16:00
I hope we can say definitively, "Yes."
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我希望我們能肯定的說：「沒錯，比1918年好」
16:02
Imagine we could produce enough flu vaccine
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想像一下，如果我們能生產足夠的流感疫苗，
16:05
for everyone in the entire world
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並提供給全世界的人，
16:08
for less than half of what we're currently spending
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而且只需要目前美國疫苗工廠的
16:10
now in the United States.
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一半時間。
16:12
With a range of new technologies, we could.
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在新技術的發展下，我們可以做到的。
16:15
Here's an example:
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這裡有個例子，
16:17
A company I'm engaged with has found
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有家公司發現，
16:19
a specific piece of the H spike of flu
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流感 H 棘蛋白上的特殊片段
16:21
that sparks the immune system.
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可以誘導免疫系統作用。
16:23
If you lop this off and attach it
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若把這片段切下，
16:25
to the tail of a different bacterium,
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並將之附著在另一個不同細菌的尾端，
16:28
which creates a vigorous immune response,
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會導致激烈的免疫反應。
16:30
they've created a very powerful flu fighter.
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他們已經用此製造出非常強大的流感戰士。
16:32
This vaccine is so small
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這種疫苗的片段非常的小，
16:34
it can be grown in a common bacteria, E. coli.
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因此能在普通的實驗用細菌 — 大腸桿菌內培養。
16:37
Now, as you know, bacteria reproduce quickly --
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如你所知，細菌能快速增殖。
16:40
it's like making yogurt --
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就像做優格一樣簡單。
16:42
and so we could produce enough swine origin flu
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這樣，我們就能製造足夠的豬流感原病株疫苗給世界各地，
16:44
for the entire world in a few factories, in a few weeks,
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只需要少數的工廠生產，只需要短短的幾周
16:47
with no eggs,
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而且不再需要雞蛋了，
16:49
for a fraction of the cost of current methods.
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所需要的成本也少了很多。
16:52
(Applause)
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（掌聲）
16:57
So here's a comparison of several of these new vaccine technologies.
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這是數種新疫苗科計的對照表。
17:00
And, aside from the radically increased production
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剛剛說到的大腸桿菌培養法，
17:03
and huge cost savings --
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除了能讓產量激增，
17:05
for example, the E. coli method I just talked about --
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成本大量下降，
17:08
look at the time saved: this would be lives saved.
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還有時間的節省，這也意味著能拯救更多的生命。
17:11
The developing world,
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開發中國家，
17:13
mostly left out of the current response,
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排除各方異見，
17:16
sees the potential of these alternate technologies
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看見了這種有潛力的替代性技術，
17:19
and they're leapfrogging the West.
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他們直接跳過西方國家的支援，
17:21
India, Mexico and others are already
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印度、墨西哥等等國家
17:23
making experimental flu vaccines,
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都已經研發出許多實驗性的疫苗。
17:25
and they may be the first place
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這些地方也可能將會是
17:27
we see these vaccines in use.
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第一批實驗性疫苗率先施打的地區。
17:29
Because these technologies are so efficient
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因為這些技術非常有效率，
17:32
and relatively cheap,
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也相對便宜，
17:34
billions of people can have access to lifesaving vaccines
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若我們能想辦法把疫苗交到需要的人的手上，
17:37
if we can figure out how to deliver them.
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那數億的人將因此得救。
17:39
Now think of where this leads us.
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想想看這對我們的未來有什麼樣的影響。
17:41
New infectious diseases
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新型的傳染病，
17:43
appear or reappear
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每隔幾年，
17:45
every few years.
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就會一而再的出現。
17:47
Some day, perhaps soon,
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有一天，也許就快了，
17:49
we'll have a virus that is going to threaten all of us.
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某個病毒傳染病將會威脅全人類。
17:52
Will we be quick enough to react
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在數百萬的生命消逝之前，
17:54
before millions die?
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我們是否有足夠的時間反應呢？
17:56
Luckily, this year's flu was relatively mild.
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運氣好，今年的流感比較溫和。
17:59
I say, "luckily" in part
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我說「運氣好」，有部分是因為
18:01
because virtually no one in the developing world
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實際上在開發中國家，
18:04
was vaccinated.
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幾乎沒有人接種流感疫苗。
18:06
So if we have the political and financial foresight
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因此，若我們在政治和財務上有遠見，
18:09
to sustain our investments,
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持續的投資疫苗研發，
18:11
we will master these and new tools of vaccinology,
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我們就能駕馭新的疫苗技術。
18:14
and with these tools we can produce
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利用這些技術，
18:16
enough vaccine for everyone at low cost
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我們就能用超低的成本，製造出足以供應全人類的疫苗，
18:18
and ensure healthy productive lives.
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確保健康有益的生活。
18:21
No longer must flu have to kill half a million people a year.
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流感不會再每年奪走 50 萬人的生命，
18:24
No longer does AIDS
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愛滋病
18:26
need to kill two million a year.
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也不會再每年奪走 200 萬人的生命。
18:28
No longer do the poor and vulnerable
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窮人或是體弱的人
18:30
need to be threatened by infectious diseases,
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不會再被傳染病威脅生命，
18:33
or indeed, anybody.
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或者說，任何人都不會。
18:35
Instead of having Vaclav Smil's
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不會出現瓦茨拉夫•史米爾教授所說的
18:38
"massively fatal discontinuity" of life,
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「大量致命的不連續性」時期，
18:41
we can ensure
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取而代之的是，我們能確保
18:43
the continuity of life.
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生生不息的生命。
18:45
What the world needs now are these new vaccines,
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當今世界需要的是這些防止疾病的新疫苗，
18:47
and we can make it happen.
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我們可以做得到。
18:49
Thank you very much.
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感謝各位的聆聽。
18:51
(Applause)
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（掌聲）
18:59
Chris Anderson: Thank you.
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克里斯：謝謝你
19:01
(Applause)
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（掌聲）
19:07
Thank you.
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感謝你帶來的演說。
19:09
So, the science is changing.
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科學正在劇變中，
19:12
In your mind, Seth -- I mean, you must dream about this --
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在你心中，賽思，你一直有這樣的夢想，
19:15
what is the kind of time scale
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在這樣的時間框架下...
19:18
on, let's start with HIV,
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喔，我還是從愛滋病說起好了，
19:20
for a game-changing vaccine that's actually out there and usable?
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治療愛滋的革命性疫苗，是否真的會出現？
19:24
SB: The game change can come at any time,
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SB：這種革命性疫苗隨時會出現，
19:26
because the problem we have now is
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現在的問題是，
19:28
we've shown we can get a vaccine to work in humans;
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我們已能研發出提供人類使用的疫苗，
19:30
we just need a better one.
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但我們需要更優良的疫苗。
19:32
And with these types of antibodies, we know humans can make them.
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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，
19:34
So, if we can figure out how to do that,
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所以，若我們能想清楚如何去做，
19:36
then we have the vaccine,
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我們就會得到疫苗。
19:38
and what's interesting is there already is
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另人感興趣的是，
19:40
some evidence that we're beginning to crack that problem.
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有越來越多的證據顯示，我們即將解決這個問題。
19:42
So, the challenge is full speed ahead.
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所以目前的挑戰是要加快研發進度。
19:44
CA: In your gut, do you think it's probably going to be at least another five years?
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CA：就你的直覺，你認為五年內能辦到嗎？
19:46
SB: You know, everybody says it's 10 years,
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SB：很多專家都是說十年內就能，
19:48
but it's been 10 years every 10 years.
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結果時間是十年又十年地過去了。
19:50
So I hate to put a timeline
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所以，我並不喜歡為科學革新
19:52
on scientific innovation,
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訂定時間表，
19:54
but the investments that have occurred are now paying dividends.
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但是過去的投資都開始獲利了。
19:57
CA: And that's the same with universal flu vaccine, the same kind of thing?
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CA：愛滋病疫苗跟流感疫苗是否相似呢？
20:00
SB: I think flu is different. I think what happened with flu is
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SB：我認為流感是不同的，我想流感的問題是，
20:02
we've got a bunch -- I just showed some of this --
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我們在流感疫苗上已經有了突破，就像我剛說的，
20:04
a bunch of really cool and useful technologies that are ready to go now.
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我們有很棒且實用的技術，已經準備好，隨時可以應用上。
20:07
They look good. The problem has been that,
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這聽起來不錯，但問題就是，
20:09
what we did is we invested in traditional technologies
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我們都一直投資在傳統的生產技術上，
20:12
because that's what we were comfortable with.
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因為這套方法讓我們感到安心。
20:14
You also can use adjuvants, which are chemicals you mix.
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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。
20:17
That's what Europe is doing, so we could have diluted out
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這是歐洲各國正在做的，我們可以在疫苗中加入輔助劑，
20:19
our supply of flu and made more available,
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這樣現有的流感疫苗劑量可以提供給更多的人使用，
20:21
but, going back to what Michael Specter said,
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不過，麥可•斯佩克特曾說過（紐約時報專欄作者），
20:24
the anti-vaccine crowd didn't really want that to happen.
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反對疫苗的群眾並不希望如此。
20:27
CA: And malaria's even further behind?
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CA：瘧疾疫苗的研發是否進度落後呢？
20:29
SB: No, malaria, there is a candidate
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SB：不，對於瘧疾，已經有種方法
20:31
that actually showed efficacy in an earlier trial
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在早期臨床試驗就已經展現出功效，
20:34
and is currently in phase three trials now.
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目前已經進入第三階段的臨床試驗，
20:36
It probably isn't the perfect vaccine, but it's moving along.
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它也許還不是完美的疫苗，但遲早會是的。
20:39
CA: Seth, most of us do work where every month,
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CA：賽思，像我們這樣的人每天都在工作，
20:41
we produce something;
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某方面來說我們都在製造某種東西，
20:43
we get that kind of gratification.
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我們想從工作中得到某種滿足。
20:45
You've been slaving away at this for more than a decade,
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但像你這樣的人已經在這個領域奉獻了十年，
20:48
and I salute you and your colleagues for what you do.
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我必須要向你和你的同事們致上敬意。
20:51
The world needs people like you. Thank you.
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這世界就是需要像你們這樣的人，謝謝你。
20:53
SB: Thank you.
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SB：謝謝。
20:55
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Seth Berkley - Vaccine visionaryEpidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world.
Why you should listen
Seth Berkley is an epidemiologist and the CEO of Gavi, the Vaccine Alliance, the global health organization protecting lives by improving access to vaccines in developing countries. Seth joined Gavi in 2011 in a period of rapid acceleration of Gavi’s programs. Now, with more than half a billion children immunized, he is leading Gavi’s efforts to reach a further 300 million children in the next five years and build sustainability into country immunization programs. Prior to Gavi, he spearheaded the development of vaccines for HIV as founder and CEO of the International AIDS Vaccine Initiative.
Seth Berkley | Speaker | TED.com