TED2015
Bill Gates: The next outbreak? We're not ready
比尔盖茨: 下次的疫情暴发？我们还没准备好
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Readability: 3.5
3,303,597 views
在2014年这世界幸免了一场埃博拉病毒的暴发，这都要感谢成千上万无私的卫生工作者的奉献和太好的运气。事后看来我们应该可以做得更好。所以现在正是行动的时候。比尔盖兹建议将我们所有的好主意集合起来付诸行动，例如模拟情景，疫苗研发和卫生工作者训练等等。正如他所说，“无需惊慌，但我们必须未雨绸缪。”
Bill Gates - Philanthropist
A passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation. Full bio
A passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation. Full bio
Double-click the English transcript below to play the video.
00:17
When I was a kid,
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当我还是小孩时,
我们最担心的灾害是核战争。
00:19
the disaster we worried about most
was a nuclear war.
was a nuclear war.
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00:23
That's why we had a barrel like this
down in our basement,
down in our basement,
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所以我们在地下室有个这样的筒子，
00:27
filled with cans of food and water.
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装满了罐头食物和水。
00:30
When the nuclear attack came,
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当核战争爆发时，
我们就要躲到地下室去，
蹲低身子并靠那个筒子维生。
蹲低身子并靠那个筒子维生。
00:31
we were supposed to go downstairs,
hunker down, and eat out of that barrel.
hunker down, and eat out of that barrel.
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00:37
Today the greatest risk
of global catastrophe
of global catastrophe
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今天的全球灾难最大的危险
00:41
doesn't look like this.
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看起来已不像这样了。
事实上，会像这样。
00:44
Instead, it looks like this.
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如果有什么东西在未来几十年里
可以杀掉上千万人，
可以杀掉上千万人，
00:48
If anything kills over 10 million people
in the next few decades,
in the next few decades,
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00:53
it's most likely to be
a highly infectious virus
a highly infectious virus
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那比较有可能是个高度传染的病毒，
00:57
rather than a war.
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而不是战争。
00:59
Not missiles, but microbes.
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不是导弹，而是微生物。
01:03
Now, part of the reason for this is that
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部分的理由是因为
01:05
we've invested a huge amount
in nuclear deterrents.
in nuclear deterrents.
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我们在核威慑上投注了很大的
精力和金钱。
精力和金钱。
01:10
But we've actually invested very little
in a system to stop an epidemic.
in a system to stop an epidemic.
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但是我们在防止疫情的
系统上却投资很少。
系统上却投资很少。
我们还没有准备好预防
下一场大疫情的发生。
下一场大疫情的发生。
01:16
We're not ready for the next epidemic.
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让我们看看埃博拉病毒。
01:20
Let's look at Ebola.
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01:21
I'm sure all of you read about it
in the newspaper,
in the newspaper,
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我相信大家在报纸上
都有读到这样的新闻，
都有读到这样的新闻，
01:25
lots of tough challenges.
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充满了许多艰难的挑战。
01:27
I followed it carefully
through the case analysis tools
through the case analysis tools
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用我们追踪消灭脊髓灰质炎（小儿麻痹）的
案例分析工具，
案例分析工具，
01:30
we use to track polio eradication.
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我仔细地追踪这病毒的发展。
01:35
And as you look at what went on,
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随着疫情的发展我们可以看到，
01:37
the problem wasn't that there was a system
that didn't work well enough,
that didn't work well enough,
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问题不在于我们没有一套
可以使用的系统，
可以使用的系统，
01:42
the problem was that we
didn't have a system at all.
didn't have a system at all.
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而是我们根本没有任何系统。
事实上我们可以看到有几个
很明显的不足。
很明显的不足。
01:46
In fact, there's some pretty obvious
key missing pieces.
key missing pieces.
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01:51
We didn't have a group of epidemiologists
ready to go, who would have gone,
ready to go, who would have gone,
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我们找不到一群准备好了的流行病学家，
01:55
seen what the disease was,
seen how far it had spread.
seen how far it had spread.
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能去疫区看看病理和病情发展。
01:59
The case reports came in on paper.
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病例都是由纸上报道传来的。
02:02
It was very delayed
before they were put online
before they were put online
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信息传上线时已经很晚了，
02:04
and they were extremely inaccurate.
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此外还很不准确。
02:07
We didn't have a medical team ready to go.
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我们也找不到训练有素的医护小组。
02:09
We didn't have a way of preparing people.
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我们没有一套让人们严阵以待的方法。
02:12
Now, Médecins Sans Frontières
did a great job orchestrating volunteers.
did a great job orchestrating volunteers.
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目前，“无国界医生”
在动员志愿者上做了很大的贡献。
在动员志愿者上做了很大的贡献。
02:17
But even so, we were far slower
than we should have been
than we should have been
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但即使如此，我们调动数千名
工作者到疫区的速度
工作者到疫区的速度
02:20
getting the thousands of workers
into these countries.
into these countries.
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还是十分差强人意的。
02:24
And a large epidemic would require us
to have hundreds of thousands of workers.
to have hundreds of thousands of workers.
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大的疫情会需要我们动员
数十万的人员，
数十万的人员，
02:32
There was no one there
to look at treatment approaches.
to look at treatment approaches.
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但我们没有任何人在研究治疗的方向。
02:37
No one to look at the diagnostics.
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也没有人在看诊断的方法。
02:38
No one to figure out
what tools should be used.
what tools should be used.
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没有人在想该用什么工具。
02:42
As an example, we could have
taken the blood of survivors,
taken the blood of survivors,
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举个例子来说，
我们也许可以抽取生还者的血液，
我们也许可以抽取生还者的血液，
02:45
processed it, and put that plasma
back in people to protect them.
back in people to protect them.
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处理过后，再将血浆注入
人体内来保护没得病的人。
人体内来保护没得病的人。
02:51
But that was never tried.
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但是这个方法从来没有试过，
02:53
So there was a lot that was missing.
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所以有很多事都还没来得及做。
02:55
And these things
are really a global failure.
are really a global failure.
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而这的确是全球性的失败。
03:00
The WHO is funded to monitor epidemics,
but not to do these things I talked about.
but not to do these things I talked about.
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世界卫生组织的目的是来监视流行病，
而不是来做我刚讲的事。
而不是来做我刚讲的事。
但是在电影中演的剧情又是另一回事。
03:07
Now, in the movies it's quite different.
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03:09
There's a group of handsome
epidemiologists ready to go,
epidemiologists ready to go,
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有一群很英俊的流行病学家准备就绪，
03:14
they move in, they save the day,
but that's just pure Hollywood.
but that's just pure Hollywood.
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他们到了疫区拯救了大家，
但这是纯好莱坞的剧情。
但这是纯好莱坞的剧情。
我们的准备不足 ，
可能会导致下一场疫情，
可能会导致下一场疫情，
03:22
The failure to prepare
could allow the next epidemic
could allow the next epidemic
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03:25
to be dramatically
more devastating than Ebola
more devastating than Ebola
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比埃博拉病毒的危害更严重。
03:30
Let's look at the progression
of Ebola over this year.
of Ebola over this year.
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让我们看看埃博拉病毒在
过去一年中的发展。
过去一年中的发展。
03:36
About 10,000 people died,
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大约死了一万人，
03:39
and nearly all were in the three
West African countries.
West African countries.
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所有的死者都在西非的三个国家里。
03:43
There's three reasons why
it didn't spread more.
it didn't spread more.
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之所以没有扩散的原因有三个。
03:46
The first is that there was a lot
of heroic work by the health workers.
of heroic work by the health workers.
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第一个是卫生工作人员作的
很多英雄事迹。
很多英雄事迹。
03:50
They found the people and they
prevented more infections.
prevented more infections.
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他们找到很多病人
并防止了更多人得病。
并防止了更多人得病。
03:54
The second is the nature of the virus.
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第二个是病毒的特性，
03:56
Ebola does not spread through the air.
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埃博拉病毒不是靠空气传染的。
03:59
And by the time you're contagious,
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等到你有足够的传染力时，
04:01
most people are so sick
that they're bedridden.
that they're bedridden.
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大部分的人已经病得卧床不起了。
04:06
Third, it didn't get
into many urban areas.
into many urban areas.
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第三个是因为病毒没有传到都会区。
04:10
And that was just luck.
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这纯粹是运气好。
04:12
If it had gotten into a lot
more urban areas,
more urban areas,
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如果病毒传到了都会区，
04:14
the case numbers
would have been much larger.
would have been much larger.
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那么死亡的人数绝对不止于此。
04:17
So next time, we might not be so lucky.
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所以下一次我们可能不会这么幸运了。
04:21
You can have a virus where people
feel well enough while they're infectious
feel well enough while they're infectious
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有的病毒可能让你毫无察觉，
但当感染病毒的人乘飞机或者去逛商场，
但当感染病毒的人乘飞机或者去逛商场，
04:26
that they get on a plane
or they go to a market.
or they go to a market.
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他们其实已经具有一定的传染力了。
04:29
The source of the virus could be
a natural epidemic like Ebola,
a natural epidemic like Ebola,
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此外病毒的来源可以是
天然的，像埃博拉病毒，
天然的，像埃博拉病毒，
04:32
or it could be bioterrorism.
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或是由生物恐怖攻击产生的。
04:34
So there are things that would literally
make things a thousand times worse.
make things a thousand times worse.
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所以可以让疫情惨上千倍的
病毒是存在的。
病毒是存在的。
04:39
In fact, let's look at a model
of a virus spread through the air,
of a virus spread through the air,
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事实上，让我们来看看一个病毒
由空气传染的模型，
由空气传染的模型，
04:45
like the Spanish Flu back in 1918.
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像1918年的西班牙流感。
04:49
So here's what would happen:
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疫情有可能像这样发展：
04:51
It would spread throughout the world
very, very quickly.
very, very quickly.
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病毒会以很快的速度向全世界蔓延。
04:55
And you can see over 30 million people
died from that epidemic.
died from that epidemic.
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你可以看到全球有三千万人
死于这个疾病。
死于这个疾病。
05:00
So this is a serious problem.
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这就是个很严重的问题。
05:02
We should be concerned.
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我们绝不应该忽视。
05:04
But in fact, we can build
a really good response system.
a really good response system.
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但事实上我们可以建立
一个很好的反应系统。
一个很好的反应系统。
05:08
We have the benefits of all the science
and technology that we talk about here.
and technology that we talk about here.
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我们可以利用所有发展至今的科技和科学。
05:13
We've got cell phones
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我们可以用手机
05:14
to get information from the public
and get information out to them.
and get information out to them.
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来收集信息和发布信息。
05:18
We have satellite maps where we can see
where people are and where they're moving.
where people are and where they're moving.
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我们有卫星地图可以看到
人们在哪里和往哪移动。
人们在哪里和往哪移动。
05:22
We have advances in biology
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我们在生物学上也有进展，
05:24
that should dramatically change
the turnaround time to look at a pathogen
the turnaround time to look at a pathogen
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这可以大幅缩短我们找到病原的时间，
05:28
and be able to make drugs and vaccines
that fit for that pathogen.
that fit for that pathogen.
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并可以在很短的时间里找出解药和疫苗。
05:33
So we can have tools,
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所以我们是有工具的，
05:34
but those tools need to be put
into an overall global health system.
into an overall global health system.
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但这些工具必须统合在
一个全球健康系统下。
一个全球健康系统下。
05:39
And we need preparedness.
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此外我们必须处在准备好的状态。
05:41
The best lessons, I think,
on how to get prepared
on how to get prepared
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而我们如何做好准备，
05:44
are again, what we do for war.
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最好的例子还是来自于备战。
05:46
For soldiers, we have full-time,
waiting to go.
waiting to go.
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对军人来说，他们是随时随地
都准备好要投入战争的。
都准备好要投入战争的。
05:51
We have reserves that can scale
us up to large numbers.
us up to large numbers.
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我们还有预备军人，
能使备战人口大量增加。
能使备战人口大量增加。
北约组织有个机动小组，
可以很快地行动起来。
可以很快地行动起来。
05:54
NATO has a mobile unit
that can deploy very rapidly.
that can deploy very rapidly.
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05:58
NATO does a lot of war games
to check, are people well trained?
to check, are people well trained?
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北约组织有很多战争游戏可以测试
人员是否已训练有素？
人员是否已训练有素？
06:01
Do they understand
about fuel and logistics
about fuel and logistics
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他们是否了解燃油，补给
06:03
and the same radio frequencies?
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和相同的收音机频率？
06:06
So they are absolutely ready to go.
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是的话，那么他们就已准备好了。
06:08
So those are the kinds of things
we need to deal with an epidemic.
we need to deal with an epidemic.
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这些就是面对疫情时我们该准备的事。
06:13
What are the key pieces?
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关键的项目有哪些？
06:15
First, we need strong health systems
in poor countries.
in poor countries.
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第一，在贫穷的国家里
必须有发达的卫生系统。
必须有发达的卫生系统。
母亲们可以安全地生小孩，
06:20
That's where mothers
can give birth safely,
can give birth safely,
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小孩们可以接种疫苗。
06:23
kids can get all their vaccines.
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06:25
But, also where we'll see
the outbreak very early on.
the outbreak very early on.
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我们也可以在很早的阶段
侦查到疫情的爆发。
侦查到疫情的爆发。
我们需要后备的医疗部队：
06:30
We need a medical reserve corps:
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06:31
lots of people who've got
the training and background
the training and background
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还有很多训练有素的专业人员，
06:34
who are ready to go, with the expertise.
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随时准备好能带着他们专长到疫区。
06:37
And then we need to pair those
medical people with the military.
medical people with the military.
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我们可以用军队来配合医护人员，
06:42
taking advantage of the military's ability
to move fast, do logistics
to move fast, do logistics
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利用军队移动迅速的特性，
06:46
and secure areas.
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来进行后勤运输和维持安全。
06:48
We need to do simulations,
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我们也需要进行一些情境模拟，
06:51
germ games, not war games,
so that we see where the holes are.
so that we see where the holes are.
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不是进行战争游戏而是进行病菌游戏 ，
看看防卫漏洞在哪。
看看防卫漏洞在哪。
06:55
The last time a germ game
was done in the United States
was done in the United States
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上一次的病菌游戏是在美国进行的，
06:58
was back in 2001,
and it didn't go so well.
and it didn't go so well.
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那是在2001年了， 进行得也不是很顺利。
07:02
So far the score is germs: 1, people: 0.
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目前病菌得一分人类零分。
最后我们在疫苗和病理学上
还需要很多的研发工作。
还需要很多的研发工作。
07:07
Finally, we need lots of advanced R&D
in areas of vaccines and diagnostics.
in areas of vaccines and diagnostics.
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07:13
There are some big breakthroughs,
like the Adeno-associated virus,
like the Adeno-associated virus,
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在某些方面例如腺相关病毒上，
我们已经有了相当的突破，
我们已经有了相当的突破，
07:17
that could work very, very quickly.
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这可以在很短的时间内生效。
07:21
Now I don't have an exact budget
for what this would cost,
for what this would cost,
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我目前没有明确的预算
这到底需要多少钱，
这到底需要多少钱，
07:24
but I'm quite sure it's very modest
compared to the potential harm.
compared to the potential harm.
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但是我确信跟损失比起来是比较便宜的。
07:29
The World Bank estimates that
if we have a worldwide flu epidemic,
if we have a worldwide flu epidemic,
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根据世界银行的估算，
如果我们有流感的疫情暴发，
如果我们有流感的疫情暴发，
07:33
global wealth will go down
by over three trillion dollars
by over three trillion dollars
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全球经济会损失三万多亿美元。
07:37
and we'd have millions
and millions of deaths.
and millions of deaths.
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我们还会可能有千百万人员的死亡。
07:41
These investments
offer significant benefits
offer significant benefits
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跟仅仅只是准备好比起来，
07:44
beyond just being ready for the epidemic.
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这些额外的投资会带来显著的益处。
07:46
The primary healthcare, the R&D,
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基础的卫生保健，研发，
可以促进全球健康的平衡发展，
07:48
those things would reduce
global health equity
global health equity
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让这个世界更健康更安全。
07:51
and make the world more just
as well as more safe.
as well as more safe.
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所以我觉得这非常重要重要。刻不容缓。
07:55
So I think this should absolutely
be a priority.
be a priority.
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07:59
There's no need to panic.
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不需要惊慌。
08:00
We don't have to hoard cans of spaghetti
or go down into the basement.
or go down into the basement.
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我们不需要囤积面罐头
或是躲到地下室去，
或是躲到地下室去，
08:05
But we need to get going,
because time is not on our side.
because time is not on our side.
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但是我们必须急起直追，因为时间有限。
08:09
In fact, if there's one positive thing
that can come out of the Ebola epidemic,
that can come out of the Ebola epidemic,
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事实上，要说这场埃博拉病毒的疫情
带来了什么正面影响的话，
带来了什么正面影响的话，
08:15
it's that it can serve as an early
warning, a wake-up call, to get ready.
warning, a wake-up call, to get ready.
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那就是提早响起了警报，
让我们觉醒并做好准备。
让我们觉醒并做好准备。
08:21
If we start now, we can be ready
for the next epidemic.
for the next epidemic.
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我们如果即刻开始准备，那么在
下一场疫情来临前我们是可以准备好的。
下一场疫情来临前我们是可以准备好的。
08:26
Thank you.
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谢谢大家。
08:28
(Applause)
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（掌声）
ABOUT THE SPEAKER
Bill Gates - PhilanthropistA passionate techie and a shrewd businessman, Bill Gates changed the world while leading Microsoft to dizzying success. Now he's doing it again with his own style of philanthropy and passion for innovation.
Why you should listen
Bill Gates is the founder and former CEO of Microsoft. A geek icon, tech visionary and business trailblazer, Gates' leadership -- fueled by his long-held dream that millions might realize their potential through great software -- made Microsoft a personal computing powerhouse and a trendsetter in the Internet dawn. Whether you're a suit, chef, quant, artist, media maven, nurse or gamer, you've probably used a Microsoft product today.
In summer of 2008, Gates left his day-to-day role with Microsoft to focus on philanthropy. Holding that all lives have equal value (no matter where they're being lived), the Bill and Melinda Gates Foundation has now donated staggering sums to HIV/AIDS programs, libraries, agriculture research and disaster relief -- and offered vital guidance and creative funding to programs in global health and education. Gates believes his tech-centric strategy for giving will prove the killer app of planet Earth's next big upgrade.
Read a collection of Bill and Melinda Gates' annual letters, where they take stock of the Gates Foundation and the world. And follow his ongoing thinking on his personal website, The Gates Notes. His new paper, "The Next Epidemic," is published by the New England Journal of Medicine.
Bill Gates | Speaker | TED.com