TED2010
Seth Berkley: HIV and flu -- the vaccine strategy
Seth Berkley: HIV in gripa - strategija cepljenja
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Seth Berkley predstavlja napredek v izdelavi in uporabi cepiv, s katerimi smo korak bližje k učinkoviti obrambi proti grožnjam, kot so AIDS, malarija in epidemije gripe.
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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Se kdaj sprašujete, zaradi česa boste umrli?
00:20
Heart disease, cancer,
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Zaradi bolezni srca, raka,
00:22
a car accident?
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prometne nesreče?
00:24
Most of us worry about things we can't control,
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Večinoma nas skrbijo stvari, ki jih ne moremo nadzorovati,
00:27
like war, terrorism,
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kot na primer vojna, terorizem,
00:29
the tragic earthquake that just occurred in Haiti.
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tragični potres, ki je pred kratkim prizadel Haiti.
00:32
But what really threatens humanity?
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A kaj resnično grozi človeštvu?
00:36
A few years ago, Professor Vaclav Smil
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Pred nekaj leti je profesor Vaclav Smil
00:38
tried to calculate the probability
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skušal izračunati verjetnost,
00:40
of sudden disasters
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da se bo nenadoma zgodila dovolj velika katastrofa,
00:42
large enough to change history.
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ki bo spremenila zgodovino.
00:44
He called these,
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Te dogodke je poimenoval
00:46
"massively fatal discontinuities,"
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"uničujoče motnje",
00:48
meaning that they could kill
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s čimer je hotel povedati,
00:50
up to 100 million people
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da lahko povzročijo smrt 100 milijonov ljudi
00:52
in the next 50 years.
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v naslednjih 50 letih.
00:54
He looked at the odds of another world war,
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Zanimala ga je verjetnost ponovne svetovne vojne,
00:57
of a massive volcanic eruption,
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velikih vulkanskih izbruhov
00:59
even of an asteroid hitting the Earth.
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in celo padca asteroida na Zemljo.
01:01
But he placed the likelihood of one such event
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Verjetnost enega večjega dogodka
01:04
above all others
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je presegala vse ostale.
01:06
at close to 100 percent,
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S skoraj 100 % verjetnostjo
01:08
and that is a severe flu pandemic.
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se bo zgodila huda epidemija gripe.
01:12
Now, you might think of flu
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Verjetno se vam zdi, da je gripa pravzaprav
01:14
as just a really bad cold,
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le malo hujši prehlad,
01:17
but it can be a death sentence.
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a lahko pomeni tudi smrtno obsodbo.
01:19
Every year, 36,000 people in the United States
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Vsako leto v ZDA za sezonsko gripo
01:22
die of seasonal flu.
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umre 36.000 ljudi.
01:25
In the developing world, the data is much sketchier
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Podatki za države v razvoju niso tako natančni,
01:27
but the death toll is almost
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vendar je zagotovo tam
01:29
certainly higher.
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smrtnost še večja.
01:31
You know, the problem is if
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Težavo predstavljajo
01:33
this virus occasionally mutates
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mutacije virusov gripe,
01:35
so dramatically,
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ki so včasih tako obsežne,
01:37
it essentially is a new virus
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da pravzaprav nastane nov virus.
01:39
and then we get a pandemic.
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Takrat se pojavi pandemija.
01:43
In 1918, a new virus appeared
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Leta 1918, ko se je pojavil nov virus,
01:46
that killed some 50 to 100 million people.
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je umrlo od 50 do 100 milijonov ljudi.
01:49
It spread like wildfire
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Širil se je z neverjetno hitrostjo.
01:51
and some died within hours of developing symptoms.
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Marsikdo je umrl v nekaj urah po pojavu simptomov.
01:54
Are we safer today?
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Ali smo dandanes kaj bolj varni?
01:56
Well, we seem to have dodged
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Vse kaže, da smo se letos
01:58
the deadly pandemic this year
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uspeli izogniti smrtonosni pandemiji,
02:00
that most of us feared,
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ki smo se je bali,
02:02
but this threat could reappear at any time.
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toda grožnja se lahko kadarkoli spet pojavi.
02:05
The good news is that
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Na srečo živimo
02:07
we're at a moment in time
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v obdobju, v katerem
02:09
when science, technology, globalization is converging
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se znanost, tehnologija in globalizacija združujejo in povezujejo
02:12
to create an unprecedented possibility:
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ter nam tako omogočajo,
02:14
the possibility to make history
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da spremenimo zgodovino,
02:16
by preventing infectious diseases
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tako da preprečimo širjenje nalezljivih bolezni,
02:19
that still account for one-fifth of all deaths
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ki še vedno povzročijo petino vseh smrti
02:22
and countless misery on Earth.
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in neskončno trpljenje.
02:25
We can do this.
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Zmogli bomo.
02:27
We're already preventing millions of deaths
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Z obstoječimi cepivi
02:29
with existing vaccines,
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že lahko preprečimo milijone smrti.
02:31
and if we get these to more people,
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Bolj kot razširimo cepiva med ljudi,
02:33
we can certainly save more lives.
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več življenj lahko rešimo.
02:36
But with new or better vaccines
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Z novimi ali boljšimi cepivi
02:38
for malaria, TB, HIV,
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proti malariji, tuberkulozi, virusu HIV,
02:41
pneumonia, diarrhea, flu,
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pljučnici, diareji ali gripi
02:43
we could end suffering
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bi lahko končali trpljenje,
02:45
that has been on the Earth since the beginning of time.
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ki ga povzročajo nalezljive bolezni.
02:48
So, I'm here to trumpet vaccines for you.
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Tukaj sem, da vam predstavim cepiva.
02:50
But first, I have to explain why they're important
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A najprej moram razložiti, zakaj so pomembna.
02:53
because vaccines, the power of them,
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Moč cepiv je namreč
02:56
is really like a whisper.
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zelo pretanjena.
02:58
When they work, they can make history,
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Kadar delujejo, jih vsi poznamo,
03:00
but after a while
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a sčasoma
03:02
you can barely hear them.
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utonejo v pozabo.
03:04
Now, some of us are old enough
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Nekateri tukaj smo dovolj stari,
03:07
to have a small, circular scar on our arms
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da imamo na rami majhno okroglo brazgotino,
03:10
from an inoculation we received as children.
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ki je posledica cepljenja v otroštvu.
03:13
But when was the last time you worried about smallpox,
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Toda kdaj so vas nazadnje skrbele črne koze,
03:16
a disease that killed half a billion people last century
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ki so v prejšnjem stoletju ubile pol milijarde ljudi,
03:19
and no longer is with us?
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zdaj pa jih ni več med nami?
03:21
Or polio? How many of you remember the iron lung?
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Ali pa otroška paraliza - kdo se še spomni železnih pljuč?
03:24
We don't see scenes like this anymore
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Prav zaradi cepiv takih prizorov
03:27
because of vaccines.
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ne videvamo več.
03:29
Now, it's interesting
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Zanimivo je, da poznamo
03:31
because there are 30-odd diseases
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dobrih 30 bolezni,
03:34
that can be treated with vaccines now,
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ki jih lahko preprečimo s cepljenjem,
03:36
but we're still threatened by things like HIV and flu.
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pa vendar nas gripa in HIV še vedno ogrožata.
03:39
Why is that?
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Zakaj?
03:41
Well, here's the dirty little secret.
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Naj vam zaupam umazano skrivnost.
03:43
Until recently, we haven't had to know
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Še do nedavega namreč
03:45
exactly how a vaccine worked.
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nismo vedeli, kako cepiva delujejo.
03:48
We knew they worked through old-fashioned trial and error.
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Njihovo delovanje smo odkrili z metodo poskusov in napak.
03:51
You took a pathogen, you modified it,
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Poiskali smo mikrob in ga v laboratoriju spremenili,
03:53
you injected it into a person or an animal
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nato smo ga vbrizgali v osebo ali žival
03:56
and you saw what happened.
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in opazovali, kaj se bo zgodilo.
03:58
This worked well for most pathogens,
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Pri večini mikrobov se je ta metoda dobro obnesla,
04:01
somewhat well for crafty bugs like flu,
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pri prebrisanem virusu gripe malo manj,
04:04
but not at all for HIV,
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pri virusu HIV pa sploh ne,
04:06
for which humans have no natural immunity.
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ker nanj ljudje niso naravno odporni.
04:09
So let's explore how vaccines work.
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Poglejmo si torej, kako cepiva delujejo.
04:12
They basically create a cache
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V telesu ustvarijo nekakšno skladišče
04:14
of weapons for your immune system
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orožja za vaš imunski sistem,
04:16
which you can deploy when needed.
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ki ga lahko uporabite, ko je to potrebno.
04:19
Now, when you get a viral infection,
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Kadar se okužite z virusom,
04:22
what normally happens is it takes days or weeks
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običajno traja več dni ali tednov,
04:24
for your body to fight back
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da se vaše telo začne
04:26
at full strength,
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proti okužbi boriti na vso moč.
04:28
and that might be too late.
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Takrat je lahko že prepozno.
04:30
When you're pre-immunized,
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Če ste cepljeni,
04:32
what happens is you have forces in your body
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je v vašem telesu že prisoten obrambni sistem,
04:34
pre-trained to recognize
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ki natančno prepozna sovražne mikrobe
04:36
and defeat specific foes.
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in jih porazi.
04:38
So that's really how vaccines work.
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Tako torej deluje cepivo.
04:40
Now, let's take a look at a video
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Poglejmo si video posnetek -
04:42
that we're debuting at TED, for the first time,
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danes bo premierno predvajan -
04:45
on how an effective HIV vaccine might work.
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o tem, kako naj bi delovalo učinkovito cepivo proti virusu HIV.
04:49
(Music)
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(Glasba)
04:55
Narrator: A vaccine trains the body in advance
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Cepivo vnaprej pripravi telo,
04:57
how to recognize and neutralize
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da prepozna in uniči
04:59
a specific invader.
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točno določenega napadalca.
05:01
After HIV penetrates the body's mucosal barriers,
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Ko HIV preide sluznico,
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it infects immune cells to replicate.
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okuži imunske celice in se v njih razmnožuje.
05:08
The invader draws the attention
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Napadalec pritegne pozornost
05:10
of the immune system's front-line troops.
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celic, ki skrbijo za naravno odpornost.
05:12
Dendritic cells, or macrophages,
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Dendritične celice oz. makrofagi
05:14
capture the virus and display pieces of it.
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virus ujamejo in predstavijo njegove delce.
05:18
Memory cells generated by the HIV vaccine
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Spominske celice, ki nastanejo ob cepljenju,
05:21
are activated when they learn
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se aktivirajo, ko prepoznajo
05:23
HIV is present from the front-line troops.
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delce virusa HIV, predstavljene na makrofagih.
05:26
These memory cells immediately deploy
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Nato nemudoma pripravijo orožje,
05:29
the exact weapons needed.
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ki je potrebno.
05:32
Memory B cells turn into plasma cells,
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Spominske celice B se preobrazijo v plazmatke,
05:35
which produce wave after wave
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ki izdelujejo številna
05:37
of the specific antibodies
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točno določena protitelesa,
05:39
that latch onto HIV
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ki se oklenejo virusa HIV
05:41
to prevent it from infecting cells,
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in mu s tem preprečijo okužbo celic.
05:43
while squadrons of killer T cells
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Medtem gruče celic T ubijalk
05:45
seek out and destroy cells
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iščejo in uničijo celice,
05:47
that are already HIV infected.
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ki so okužene z virusom HIV.
05:50
The virus is defeated.
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Tako je virus poražen.
05:52
Without a vaccine,
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Brez cepiva
05:54
these responses would have taken more than a week.
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se tak odgovor razvije po več kot enem tednu.
05:57
By that time, the battle against HIV
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Do takrat je boj z virusom HIV
05:59
would already have been lost.
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že lahko izgubljen.
06:08
Seth Berkley: Really cool video, isn't it?
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Odličen posnetek, a ne?
06:11
The antibodies you just saw in this video,
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Protitelesa, ki ste jih videli,
06:14
in action, are the ones that make most vaccines work.
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so tista, ki omogočijo delovanje cepiva.
06:17
So the real question then is:
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Vprašati se moramo,
06:19
How do we ensure that your body makes
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kako naj telo pripravimo do tega,
06:21
the exact ones that we need to protect
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da bo izdelalo pravilna protitelesa
06:23
against flu and HIV?
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za boj proti virusom gripe in HIV.
06:25
The principal challenge for both of these viruses
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Največji izziv nam predstavlja
06:28
is that they're always changing.
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njihovo stalno spreminjanje.
06:30
So let's take a look at the flu virus.
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Poglejmo si, kako izgleda virus gripe.
06:33
In this rendering of the flu virus,
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Na tej shemi vidimo
06:35
these different colored spikes are what it uses to infect you.
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obarvane dele virusa, ki so odgovorni za okužbo.
06:38
And also, what the antibodies use is a handle
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Na ista mesta se pritrdijo protitelesa,
06:41
to essentially grab and neutralize the virus.
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da lahko uničijo virus.
06:44
When these mutate, they change their shape,
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Ko virus mutira, se njegova oblika spremeni,
06:47
and the antibodies don't know what they're looking at anymore.
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tako da ga protitelesa ne prepoznajo več.
06:50
So that's why every year
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Zaradi tega torej vsako leto
06:53
you can catch a slightly different strain of flu.
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razsaja malo drugačna gripa.
06:56
It's also why in the spring,
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Zaradi teh sprememb
06:58
we have to make a best guess
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vsako pomlad ugibamo,
07:00
at which three strains are going to prevail the next year,
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kateri tip gripe bo prevladal v naslednji sezoni,
07:03
put those into a single vaccine
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da lahko ustvarimo cepivo
07:05
and rush those into production for the fall.
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in ga do jeseni proizvedemo v zadostnih količinah.
07:08
Even worse,
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Še več!
07:10
the most common influenza -- influenza A --
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Najbolj razširjena vrsta gripe, tip A,
07:13
also infects animals
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lahko okuži tudi živali,
07:15
that live in close proximity to humans,
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ki živijo v človekovi bližini
07:17
and they can recombine
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ter se v njih
07:19
in those particular animals.
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razmnožuje in spreminja.
07:21
In addition, wild aquatic birds
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Poleg tega divje vodne ptice
07:23
carry all known strains
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prenašajo vse poznane
07:25
of influenza.
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vrste gripe.
07:27
So, you've got this situation:
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Zgodilo se je naslednje.
07:29
In 2003,
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Leta 2003
07:31
we had an H5N1 virus
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je bilo nekaj primerov,
07:34
that jumped from birds into humans
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ko se je virus H5N1 prenesel
07:37
in a few isolated cases
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s ptic na ljudi.
07:39
with an apparent mortality rate of 70 percent.
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Smrtnost je znašala približno 70 odstotkov.
07:42
Now luckily, that particular virus,
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Na srečo se ta virus,
07:45
although very scary at the time,
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čeprav se je zdel precej strašen,
07:47
did not transmit from person to person
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ni z lahkoto prenašal
07:49
very easily.
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s človeka na človeka.
07:51
This year's H1N1 threat
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Letošnja grožnja, virus H1N1,
07:54
was actually a human, avian, swine mixture
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je bil kombinacija človeških, ptičjih in prašičjih virusov,
07:58
that arose in Mexico.
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izviral pa je iz Mehike.
08:00
It was easily transmitted,
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Zelo enostavno se je prenašal,
08:02
but, luckily, was pretty mild.
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a je bil na srečo precej blag.
08:05
And so, in a sense,
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Zdi se, da se nas
08:07
our luck is holding out,
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zaenkrat drži sreča,
08:09
but you know, another wild bird could fly over at anytime.
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a kadarkoli lahko prileti mimo nova divja ptica.
08:13
Now let's take a look at HIV.
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Poglejmo si zdaj še virus HIV.
08:15
As variable as flu is,
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Čeprav je virus gripe zelo spremenljiv,
08:17
HIV makes flu
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se v primerjavi s HIV-om
08:19
look like the Rock of Gibraltar.
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zdi trden kot skala.
08:21
The virus that causes AIDS
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Virus, ki povzroča AIDS,
08:23
is the trickiest pathogen
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je najbolj zafrknjen mikrob,
08:25
scientists have ever confronted.
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kar so jih znanstveniki odkrili.
08:27
It mutates furiously,
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Zelo pogosto mutira
08:29
it has decoys to evade the immune system,
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in je sposoben pretentati imunski sistem.
08:31
it attacks the very cells that are trying to fight it
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Napade vsako celico, ki se mu skuša upreti,
08:34
and it quickly hides itself
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nato pa se hitro skrije
08:36
in your genome.
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v vaš lasten genom.
08:38
Here's a slide looking at
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Na prosojnici lahko primerjate
08:40
the genetic variation of flu
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genetske različice gripe
08:42
and comparing that to HIV,
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in virusa HIV,
08:44
a much wilder target.
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ki je precej bolj raznolik.
08:47
In the video a moment ago,
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V prejšnjem video posnetku ste videli
08:49
you saw fleets of new viruses launching from infected cells.
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številne nove viruse ubežati iz okužene celice.
08:52
Now realize that in a recently infected person,
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Ne pozabite, da ima na novo okužena oseba
08:55
there are millions of these ships;
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milijone takih virusov,
08:57
each one is just slightly different.
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vendar je vsak malenkost drugačen od ostalih.
08:59
Finding a weapon that recognizes
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Poiskati orožje, ki bi učinkovalo
09:01
and sinks all of them
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na vse različice,
09:03
makes the job that much harder.
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je precej težko delo.
09:05
Now, in the 27 years since HIV
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V zadnjih 27 letih, odkar vemo,
09:08
was identified as the cause of AIDS,
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da je HIV povzročitelj AIDS-a,
09:11
we've developed more drugs to treat HIV
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je bilo zanj odkritih več zdravil
09:13
than all other viruses put together.
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kot za vse ostale viruse skupaj.
09:16
These drugs aren't cures,
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Kljub temu da bolezni ne ozdravijo,
09:18
but they represent a huge triumph of science
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so ta zdravila velik dosežek znanosti,
09:20
because they take away the automatic death sentence
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saj tako diagnoza okužbe s HIV
09:22
from a diagnosis of HIV,
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ne predstavlja več takojšnje smrtne obsodbe;
09:24
at least for those who can access them.
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vsaj za tiste, ki si zdravila lahko privoščijo.
09:27
The vaccine effort though is really quite different.
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Cepiva so povsem druga zgodba.
09:30
Large companies moved away from it
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Velike farmacevtske družbe so se jih izogibale,
09:32
because they thought the science was so difficult
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ker je bilo razvijanje cepiva zelo zahtevno
09:35
and vaccines were seen as poor business.
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in se finančno ni izplačalo.
09:38
Many thought that it was just impossible to make an AIDS vaccine,
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Mnogi so menili, da je cepivo proti AIDS-u nemogoče izdelati,
09:41
but today, evidence tells us otherwise.
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a dandanes imamo dokaze, da le ni tako.
09:44
In September,
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Septembra
09:46
we had surprising but exciting findings
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so v klinični študiji na Tajskem
09:49
from a clinical trial that took place in Thailand.
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odkrili nekaj nepričakovanega.
09:52
For the first time, we saw an AIDS vaccine work in humans --
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Prvič v zgodovini so pokazali, da cepivo
09:55
albeit, quite modestly --
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proti AIDS-u deluje tudi pri človeku, četudi bolj slabo.
09:58
and that particular vaccine was made
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To cepivo je bilo izdelano
10:00
almost a decade ago.
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pred skoraj desetimi leti.
10:02
Newer concepts and early testing now
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Z novimi koncepti in zgodnjim testiranjem
10:04
show even greater promise in the best of our animal models.
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pričakujemo na živalskih modelih še boljše rezultate.
10:09
But in the past few months, researchers have also isolated
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V zadnjih nekaj mesecih so raziskovalci iz krvi
10:12
several new broadly neutralizing antibodies
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z virusom HIV okuženih posameznikov osamili
10:15
from the blood of an HIV infected individual.
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številna protitelesa s širokim spektrom delovanja.
10:18
Now, what does this mean?
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Kaj to pomeni?
10:20
We saw earlier that HIV
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Že prej smo videli,
10:22
is highly variable,
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da je HIV zelo raznolik virus.
10:24
that a broad neutralizing antibody
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Protitelesa s širokim delovanjem
10:26
latches on and disables
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se vežejo na številne različice virusa
10:28
multiple variations of the virus.
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in jih onesposobijo.
10:31
If you take these and you put them
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Če vzamemo ta protitelesa in jih prenesemo
10:33
in the best of our monkey models,
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v najboljše opičje modele,
10:35
they provide full protection from infection.
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bodo zagotovili popolno zaščito pred okužbo.
10:38
In addition, these researchers found
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Poleg tega so isti raziskovalci odkrili
10:40
a new site on HIV
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še novo mesto na virusu HIV,
10:42
where the antibodies can grab onto,
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na katerega se lahko vežejo protitelesa.
10:44
and what's so special about this spot
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To mesto je nekaj posebnega,
10:46
is that it changes very little
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saj se med mutacijo virusa
10:48
as the virus mutates.
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zelo malo spreminja.
10:50
It's like, as many times
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Kot če bi se virus
10:52
as the virus changes its clothes,
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ves čas preoblačil,
10:54
it's still wearing the same socks,
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a bi vsakič obdržal iste nogavice.
10:55
and now our job is to make sure
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Naša naloga je, da prepričamo telo,
10:58
we get the body to really hate those socks.
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da so tiste nogavice res grozne.
11:01
So what we've got is a situation.
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Kako torej stojijo stvari?
11:03
The Thai results tell us
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Rezultati s Tajske pravijo,
11:05
we can make an AIDS vaccine,
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da je izdelava cepiva proti AIDS-u možna.
11:07
and the antibody findings
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Odkritja o protitelesih
11:09
tell us how we might do that.
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nam kažejo, kako bi se tega lotili.
11:11
This strategy, working backwards
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To, da bi delali "vzvratno" in
11:14
from an antibody to create a vaccine candidate,
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iz protiteles izdelali cepivo,
11:16
has never been done before in vaccine research.
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je povsem nova metoda izdelovanja cepiv.
11:19
It's called retro-vaccinology,
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Retrogradna izdelava cepiva
11:22
and its implications extend
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ni uporabna le pri virusu HIV,
11:24
way beyond that of just HIV.
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temveč tudi pri številnih drugih mikrobih.
11:27
So think of it this way.
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Pomislite.
11:29
We've got these new antibodies we've identified,
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Odkrili smo nova protitelesa, za katera vemo,
11:32
and we know that they latch onto many, many variations of the virus.
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da se lahko vežejo na številne različice virusa.
11:35
We know that they have to latch onto a specific part,
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Vemo, da se vežejo na točno določen del virusa.
11:38
so if we can figure out the precise structure of that part,
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Če bi lahko ugotovili natančno zgradbo tega dela
11:41
present that through a vaccine,
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in ga predstavili telesu v obliki cepiva,
11:43
what we hope is we can prompt
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bi morda lahko spodbudili imunski sistem
11:45
your immune system to make these matching antibodies.
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k izdelavi enakih protiteles.
11:48
And that would create
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Tako bi dobili
11:50
a universal HIV vaccine.
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univerzalno cepivo proti HIV-u.
11:52
Now, it sounds easier than it is
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Sliši se bolj preprosto, kot je v resnici,
11:54
because the structure actually looks more like
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saj zgradba izgleda nekako tako
11:56
this blue antibody diagram
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kot ta ponazoritev modrega protitelesa,
11:58
attached to its yellow binding site,
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pritrjenega na vezavno mesto, označeno z rumeno.
12:00
and as you can imagine, these three-dimensional structures
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Lahko si predstavljate, da je s tridimenzionalnimi
12:02
are much harder to work on.
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zgradbami precej težko delati.
12:04
And if you guys have ideas to help us solve this,
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Če ima kdo izmed vas kakšno idejo, kako se tega lotiti,
12:06
we'd love to hear about it.
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kar na dan z njo!
12:08
But, you know, the research that has occurred from HIV now
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Kljub vsemu je raziskovanje virusa HIV
12:11
has really helped with innovation with other diseases.
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pripomoglo k boljšemu zdravljenju ostalih bolezni.
12:14
So for instance, a biotechnology company
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Eno izmed biotehnoloških podjetjij je odkrilo
12:16
has now found broadly neutralizing
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nova protitelesa s širokim spektrom delovanja,
12:18
antibodies to influenza,
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ki delujejo proti gripi,
12:20
as well as a new antibody target on the flu virus.
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pa tudi novo tarčno mesto na virusu samem.
12:23
They're currently making a cocktail --
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Trenutno je v pripravi mešanica protiteles,
12:26
an antibody cocktail -- that can be used to treat
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ki bi jo lahko uporabili
12:29
severe, overwhelming cases of flu.
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za zdravljenje hudih primerov gripe.
12:32
In the longer term, what they can do
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Dolgoročno gledano bi lahko
12:34
is use these tools of retro-vaccinology
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z retrogradno metodo pridobivanja cepiv
12:36
to make a preventive flu vaccine.
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izdelali učinkovito cepivo za gripo.
12:39
Now, retro-vaccinology is just one technique
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A retrogradna metoda je le ena izmed
12:42
within the ambit of so-called rational vaccine design.
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t.i. racionalnih metod pridobivanja cepiv.
12:45
Let me give you another example.
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Poglejmo si še en primer.
12:48
We talked about before the H and N spikes
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Prej smo govorili o vrhovih H in M,
12:50
on the surface of the flu virus.
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ki se nahajata na površini virusa gripe.
12:52
Notice these other, smaller protuberances.
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Poglejte si še te manjše izbokline.
12:55
These are largely hidden from the immune system.
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Pred imunskim sistemom so zelo dobro skrite.
12:58
Now it turns out that these spots
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Izkazalo se je, da se tudi ta mesta
13:00
also don't change much when the virus mutates.
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med mutacijo virusa zelo malo spremenijo.
13:03
If you can cripple these with specific antibodies,
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Če jih okvarimo s točno določenimi protitelesi,
13:05
you could cripple all versions of the flu.
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s tem okvarimo vse različice gripe.
13:08
So far, animal tests indicate
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Zaenkrat testi na živalih kažejo,
13:10
that such a vaccine could prevent severe disease,
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da bi takšno cepivo sicer preprečilo hudo obliko bolezni,
13:13
although you might get a mild case.
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a za blažjo obliko bi vseeno lahko zboleli.
13:15
So if this works in humans, what we're talking about
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Če bo to cepivo delovalo pri ljudeh, dejansko
13:18
is a universal flu vaccine,
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govorimo o univerzalnem cepivu proti gripi,
13:20
one that doesn't need to change every year
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ki ga ni treba spreminjati vsako leto,
13:22
and would remove the threat of death.
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pa se kljub temu izognemo številnim smrtnim žrtvam.
13:25
We really could think of flu, then,
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Gripa bi tako postala
13:27
as just a bad cold.
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le malo hujša oblika prehlada.
13:30
Of course, the best vaccine imaginable
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Jasno, tudi najboljše cepivo
13:32
is only valuable to the extent
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je koristno le takrat,
13:34
we get it to everyone who needs it.
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ko ga dobijo vsi, ki ga potrebujejo.
13:36
So to do that, we have to combine
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Da bi bilo to možno, potrebujemo
13:38
smart vaccine design with smart production methods
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poleg dobrega cepiva še učinkovite metode izdelave
13:41
and, of course, smart delivery methods.
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in, seveda, premišljeno razširjanje med ljudi.
13:44
So I want you to think back a few months ago.
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Spomnite se, kaj se je zgodilo pred nekaj meseci.
13:46
In June, the World Health Organization
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Junija je Svetovna zdravstvena organizacija
13:49
declared the first global
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razglasila prvo globalno
13:51
flu pandemic in 41 years.
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pandemijo gripe po 41 letih.
13:53
The U.S. government promised
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Vlada ZDA je obljubila,
13:55
150 million doses of vaccine
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da bo do 15. oktobra zagotovila
13:57
by October 15th for the flu peak.
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150 milijonov odmerkov cepiva.
13:59
Vaccines were promised to developing countries.
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Cepivo je bilo obljubljeno državam v razvoju.
14:01
Hundreds of millions of dollars were spent
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Za pospešeno izdelavo cepiva je bilo
14:03
and flowed to accelerating vaccine manufacturing.
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porabljenih na stotine milijonov dolarjev.
14:06
So what happened?
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In kaj se je zgodilo?
14:08
Well, we first figured out
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Najprej smo torej ugotovili,
14:10
how to make flu vaccines, how to produce them,
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kako se cepivo izdeluje,
14:13
in the early 1940s.
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in sicer v zgodnjih štiridesetih letih.
14:15
It was a slow, cumbersome process
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Proces je bil počasen in naporen
14:18
that depended on chicken eggs,
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ter odvisen od kokošjih jajc.
14:21
millions of living chicken eggs.
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Milijonov živih kokošjih jajc!
14:24
Viruses only grow in living things,
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Virusi namreč živijo le v živih organizmih,
14:26
and so it turned out that, for flu,
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za gripo pa se je izkazalo,
14:28
chicken eggs worked really well.
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da še posebej dobro uspeva v jajcih.
14:30
For most strains, you could get one to two doses
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Pri večini sevov virusa je eno jajce
14:33
of vaccine per egg.
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zadostovalo za en ali dva odmerka cepiva.
14:35
Luckily for us,
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Na srečo
14:37
we live in an era of breathtaking
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živimo v obdobju
14:39
biomedical advances.
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osupljivih biomedicinskih dosežkov.
14:41
So today, we get our flu vaccines from ...
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Danes namreč cepivo proti gripi pridobivamo iz ...
14:44
chicken eggs,
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... kokošjih jajc.
14:46
(Laughter)
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(Smeh)
14:48
hundreds of millions of chicken eggs.
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Iz milijonov kokošjih jajc.
14:50
Almost nothing has changed.
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Veste, skoraj nič se ni spremenilo.
14:52
The system is reliable
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Ta sistem je zanesljiv.
14:54
but the problem is you never know how well
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Težavo predstavlja dejstvo, da nikoli
14:56
a strain is going to grow.
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ne vemo, kako dobro bo določen sev uspeval.
14:59
This year's swine flu strain
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Sev letošnje prašičje gripe
15:01
grew very poorly in early production:
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je v zgodnjem obdobju uspeval precej slabo,
15:04
basically .6 doses per egg.
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dobili smo kakih 0.6 odmerkov na jajce.
15:08
So, here's an alarming thought.
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Skrbi me naslednje:
15:10
What if that wild bird flies by again?
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kaj če divje ptice ponovno priletijo tod mimo?
15:12
You could see an avian strain
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Predstavljajte si sev ptičje gripe,
15:14
that would infect the poultry flocks,
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ki bi okužil jate perutnine,
15:16
and then we would have no eggs for our vaccines.
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tako da bi ostali brez jajc za proizvajanje cepiv.
15:18
So, Dan [Barber], if you want
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Dan [Barber], če hočeš
15:20
billions of chicken pellets
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za svojo ribjo farmo
15:22
for your fish farm,
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milijarde kokošjih peletov,
15:24
I know where to get them.
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vem, kako do njih.
15:26
So right now, the world can produce
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Trenutno po celem svetu proizvedemo
15:28
about 350 million doses
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okoli 350 milijonov odmerkov
15:30
of flu vaccine for the three strains,
375
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cepiva za tri seve virusa gripe.
15:33
and we can up that to about 1.2 billion doses
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To bi lahko povečali na 1,2 milijardi odmerkov,
15:36
if we want to target a single variant
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če bi ciljali na točno določeno različico,
15:38
like swine flu.
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na primer na prašičjo gripo.
15:40
But this assumes that our factories are humming
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Seveda, če domnevamo, da tovarne delajo s polno paro.
15:43
because, in 2004,
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Leta 2004 je bila namreč
15:45
the U.S. supply was cut in half
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zaloga v ZDA prepolovljena
15:47
by contamination at one single plant.
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zaradi okuženja v eni sami tovarni.
15:50
And the process still takes
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Poleg tega proces pridobivanja
15:52
more than half a year.
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še vedno traja več kot pol leta.
15:54
So are we better prepared
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Ali smo torej danes
15:56
than we were in 1918?
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kaj bolje pripravljeni kot leta 1918?
15:58
Well, with the new technologies emerging now,
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Glede na pojav vedno novih tehnologij
16:00
I hope we can say definitively, "Yes."
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upam, da lahko odgovorimo z "da".
16:02
Imagine we could produce enough flu vaccine
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Predstavljajte si, da bi lahko proizvedli zadosti
16:05
for everyone in the entire world
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cepiva proti gripi za ves svet,
16:08
for less than half of what we're currently spending
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in to s pol manjšimi stroški,
16:10
now in the United States.
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kot jih imamo trenutno v ZDA.
16:12
With a range of new technologies, we could.
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S pomočjo nove tehnologije bi šlo.
16:15
Here's an example:
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Poglejmo primer.
16:17
A company I'm engaged with has found
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Podjetje, s katerim delam, je našlo
16:19
a specific piece of the H spike of flu
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točno določen delček na vrhu H virusa gripe,
16:21
that sparks the immune system.
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ki spodbuja imunski sistem.
16:23
If you lop this off and attach it
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Če ta delček odrežemo
16:25
to the tail of a different bacterium,
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in pritrdimo na drugo bakterijo,
16:28
which creates a vigorous immune response,
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ta povzroči močan imunski odgovor;
16:30
they've created a very powerful flu fighter.
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ustvarili so učinkovito cepivo proti gripi.
16:32
This vaccine is so small
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Tako cepivo je zelo majhno -
16:34
it can be grown in a common bacteria, E. coli.
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lahko raste v bakteriji E. coli.
16:37
Now, as you know, bacteria reproduce quickly --
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Kot veste, se bakterije razmnožujejo hitro.
16:40
it's like making yogurt --
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Kot bi delali jogurt!
16:42
and so we could produce enough swine origin flu
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Na ta način bi izdelali zadosti prašičje gripe,
16:44
for the entire world in a few factories, in a few weeks,
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da bi imeli cepivo za ves svet pripravljeno v nekaj tednih
16:47
with no eggs,
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brez uporabe jajc
16:49
for a fraction of the cost of current methods.
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in za neprimerno manj denarja.
16:52
(Applause)
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(Aplavz)
16:57
So here's a comparison of several of these new vaccine technologies.
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Primerjajmo nekaj novejših metod izdelave cepiva.
17:00
And, aside from the radically increased production
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Poleg izjemno povečane proizvodnje
17:03
and huge cost savings --
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in velikih prihrankov - poglejte recimo
17:05
for example, the E. coli method I just talked about --
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metodo z uporabo E. coli, ki sem jo že omenil -
17:08
look at the time saved: this would be lives saved.
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je pomemben tudi prihranek na času, ki rešuje življenja.
17:11
The developing world,
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Svet v razvoju,
17:13
mostly left out of the current response,
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ki še ni zajet v večino raziskav,
17:16
sees the potential of these alternate technologies
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se zaveda potenciala novih metod
17:19
and they're leapfrogging the West.
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in že dohiteva Zahod.
17:21
India, Mexico and others are already
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Indija, Mehika in druge države
17:23
making experimental flu vaccines,
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že izdelujejo poskusna cepiva proti gripi,
17:25
and they may be the first place
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najverjetneje pa bodo prav tam
17:27
we see these vaccines in use.
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tudi prvič preizkusili njihovo uporabnost.
17:29
Because these technologies are so efficient
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Ker so nove tehnološke metode zelo učinkovite
17:32
and relatively cheap,
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in tudi relativno poceni,
17:34
billions of people can have access to lifesaving vaccines
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imajo lahko odslej milijarde ljudi dostop do cepiva,
17:37
if we can figure out how to deliver them.
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ki bi jim rešilo življenje - le dostaviti jim ga moramo.
17:39
Now think of where this leads us.
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Pomislite, kam nas bo to pripeljalo.
17:41
New infectious diseases
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Vsakih nekaj let se pojavijo
17:43
appear or reappear
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nove ali pa ponovno že znane
17:45
every few years.
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nalezljive bolezni.
17:47
Some day, perhaps soon,
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Nekega dne, verjetno kmalu,
17:49
we'll have a virus that is going to threaten all of us.
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bo določen virus gripe ogrozil vse nas.
17:52
Will we be quick enough to react
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Ali se bomo dovolj hitro odzvali,
17:54
before millions die?
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da ne bodo umrli milijoni ljudi?
17:56
Luckily, this year's flu was relatively mild.
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Na srečo je bila letošnja gripa precej blaga.
17:59
I say, "luckily" in part
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"Na srečo" pravim zato,
18:01
because virtually no one in the developing world
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ker skoraj nihče v državah v razvoju
18:04
was vaccinated.
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ni bil cepljen.
18:06
So if we have the political and financial foresight
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Če predvidimo politično in finančno situacijo
18:09
to sustain our investments,
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ter zavarujemo svoje investicije,
18:11
we will master these and new tools of vaccinology,
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bomo lahko izkoriščali te in druge metode pri izdelavi cepiv.
18:14
and with these tools we can produce
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S takimi orodji lahko izdelamo
18:16
enough vaccine for everyone at low cost
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velike količine poceni cepiva
18:18
and ensure healthy productive lives.
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in ljudem omogočimo zdravo, kakovostno življenje.
18:21
No longer must flu have to kill half a million people a year.
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Gripa ne bo več pobila pol milijona ljudi na leto.
18:24
No longer does AIDS
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AIDS ne bo več pokopal
18:26
need to kill two million a year.
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dveh milijonov letno.
18:28
No longer do the poor and vulnerable
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Nalezljive bolezni ne bodo več ogrožale
18:30
need to be threatened by infectious diseases,
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revnejših slojev prebivalstva.
18:33
or indeed, anybody.
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Nikogar, pravzaprav.
18:35
Instead of having Vaclav Smil's
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Namesto da bi doživeli
18:38
"massively fatal discontinuity" of life,
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"uničujoče motnje" Vaclava Smila,
18:41
we can ensure
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si lahko zagotovimo
18:43
the continuity of life.
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zdravo življenje.
18:45
What the world needs now are these new vaccines,
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Svet potrebuje nova cepiva,
18:47
and we can make it happen.
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mi pa jih lahko proizvedemo.
18:49
Thank you very much.
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Najlepša hvala.
18:51
(Applause)
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(Aplavz)
18:59
Chris Anderson: Thank you.
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Hvala.
19:01
(Applause)
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(Aplavz)
19:07
Thank you.
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Hvala.
19:09
So, the science is changing.
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Znanost se spreminja.
19:12
In your mind, Seth -- I mean, you must dream about this --
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Kaj misliš, Seth? Verjetno kdaj sanjariš o tem ...
19:15
what is the kind of time scale
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Kdaj približno bi,
19:18
on, let's start with HIV,
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začnimo recimo z virusom HIV,
19:20
for a game-changing vaccine that's actually out there and usable?
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bilo lahko pripravljeno in dosegljivo uporabno cepivo?
19:24
SB: The game change can come at any time,
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Ta trenutek lahko pride kadarkoli.
19:26
because the problem we have now is
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Problem je namreč v tem, da čeprav
19:28
we've shown we can get a vaccine to work in humans;
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cepivo lahko deluje pri ljudeh,
19:30
we just need a better one.
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še ni dovolj dobro.
19:32
And with these types of antibodies, we know humans can make them.
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Vemo tudi, da človeško telo lahko proizvede te vrste protiteles.
19:34
So, if we can figure out how to do that,
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Ko bomo ugotovili, kako telo pripraviti do tega,
19:36
then we have the vaccine,
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bomo dobili cepivo.
19:38
and what's interesting is there already is
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Zanimivo je, da se že dokazano bližamo
19:40
some evidence that we're beginning to crack that problem.
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rešitvi tega problema.
19:42
So, the challenge is full speed ahead.
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Približujemo se mu s polno hitrostjo.
19:44
CA: In your gut, do you think it's probably going to be at least another five years?
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Bi lahko rekel, da bo dosegljivo v naslednjih petih letih?
19:46
SB: You know, everybody says it's 10 years,
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Vsi pravijo, da bo trajalo kakih 10 let,
19:48
but it's been 10 years every 10 years.
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vendar tako rečejo vsakih 10 let.
19:50
So I hate to put a timeline
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Znanstveno odkritje
19:52
on scientific innovation,
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je težko časovno omejiti,
19:54
but the investments that have occurred are now paying dividends.
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a dosedanja vlaganja že kažejo rezultate.
19:57
CA: And that's the same with universal flu vaccine, the same kind of thing?
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Ali za cepivo proti gripi velja podobno?
20:00
SB: I think flu is different. I think what happened with flu is
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Gripa je drugačna.
20:02
we've got a bunch -- I just showed some of this --
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Kot ste videli, imamo cel kup inovacij,
20:04
a bunch of really cool and useful technologies that are ready to go now.
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ki so pripravljene za uporabo.
20:07
They look good. The problem has been that,
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Zdijo se dobre, a problem je v tem,
20:09
what we did is we invested in traditional technologies
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da smo vlagali v tradicionalno proizvodnjo,
20:12
because that's what we were comfortable with.
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ker jo poznamo in je bilo tako najlažje.
20:14
You also can use adjuvants, which are chemicals you mix.
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Uporabljamo lahko tudi adjuvanse, kemikalije.
20:17
That's what Europe is doing, so we could have diluted out
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V Evropi to že počnejo - tudi mi bi lahko z adjuvansi
20:19
our supply of flu and made more available,
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povečali zaloge cepiva,
20:21
but, going back to what Michael Specter said,
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a če se spomnite, je Michael Specter prej dejal,
20:24
the anti-vaccine crowd didn't really want that to happen.
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da so aktivisti proti cepljenju to onemogočili.
20:27
CA: And malaria's even further behind?
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Pri malariji pa še bolj zaostajamo?
20:29
SB: No, malaria, there is a candidate
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Ne, glede malarije se je v zgodnji študiji
20:31
that actually showed efficacy in an earlier trial
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izkazalo, da eno izmed cepiv učinkuje;
20:34
and is currently in phase three trials now.
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ta študija je zdaj v tretji fazi.
20:36
It probably isn't the perfect vaccine, but it's moving along.
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Verjetno ne bomo dobili popolnega cepiva, a nekaj le bo.
20:39
CA: Seth, most of us do work where every month,
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Seth, večina nas je zaposlenih in
20:41
we produce something;
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ob koncu meseca imamo občutek,
20:43
we get that kind of gratification.
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da smo nekaj storili.
20:45
You've been slaving away at this for more than a decade,
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Ti pa že več kot desetletje garaš kot črna živina,
20:48
and I salute you and your colleagues for what you do.
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zato ti iskreno čestitam, prav tako tudi tvojim kolegom.
20:51
The world needs people like you. Thank you.
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Svet potrebuje ljudi, kot ste vi. Hvala.
20:53
SB: Thank you.
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Hvala.
20:55
(Applause)
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(Aplavz)
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