TED2015
Seth Berkley: The troubling reason why vaccines are made too late ... if they're made at all
塞斯•伯克利: 为什么疫苗研制出来得总是太迟
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似乎我们总是要等到灾难性的疾病爆发之后才会认真考虑研制相应的疫苗。塞斯•伯克利揭示了为什么我们没有为世界上最严重的疾病研制疫苗，以及背后的市场困境和不平衡的风险。
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.
00:13
The child's symptoms begin
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这个患儿的症状首先是
00:15
with mild fever, headache, muscle pains,
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低烧、头痛和肌肉痛，
00:18
followed by vomiting and diarrhea,
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之后出现呕吐和腹泻，
00:21
then bleeding from the mouth,
nose and gums.
nose and gums.
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后来口、鼻和牙龈开始出血，
00:25
Death follows in the form of organ failure
from low blood pressure.
from low blood pressure.
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最终由于低血压引起器官衰竭，导致死亡
00:31
Sounds familiar?
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是不是听起来很熟悉？
00:33
If you're thinking this is Ebola,
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如果你觉得这会不会是埃博拉，
00:36
actually, in this case, it's not.
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实际上，就本例来说并不是。
00:38
It's an extreme form of dengue fever,
a mosquito-born disease
a mosquito-born disease
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本例是登革热的极端形式，
这是一种通过蚊子传播的疾病，
这是一种通过蚊子传播的疾病，
00:43
which also does not have
an effective therapy or a vaccine,
an effective therapy or a vaccine,
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它也没有有效的治疗方法或疫苗，
00:48
and kills 22,000 people each year.
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并且每年杀死2.2万人。
00:52
That is actually twice
the number of people
the number of people
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其实，这一数字相当于
埃博拉病毒，在自我们知道它以来的
00:54
that have been killed by Ebola
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00:56
in the nearly four decades
that we've known about it.
that we've known about it.
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近40年里，所杀死的人数的两倍
01:00
As for measles, so much
in the news recently,
in the news recently,
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而近期新闻中频繁提到的麻疹
01:04
the death toll is actually tenfold higher.
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死亡人数实际上是登革热的十倍之多。
01:09
Yet for the last year,
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然而在去年，
01:11
it has been Ebola that has stolen
all of the headlines and the fear.
all of the headlines and the fear.
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占据所有头条，引起所有恐慌的
却是埃博拉。
却是埃博拉。
01:17
Clearly, there is something
deeply rooted about it,
deeply rooted about it,
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显然，有某种东西深深地根植其中，
01:19
something which scares us
and fascinates us
and fascinates us
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这种东西让我们如此害怕，
成为了挥之不去的阴影，
成为了挥之不去的阴影，
01:22
more than other diseases.
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没有其它疾病能做到这一点。
01:24
But what is it, exactly?
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而它到底是什么呢？
01:27
Well, it's hard to acquire Ebola,
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其实，得上埃博拉是很不容易的，
01:29
but if you do, the risk
of a horrible death is high.
of a horrible death is high.
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但如果真的患病，
以可怕的死状离去，是极有可能的。
以可怕的死状离去，是极有可能的。
01:33
Why?
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为什么？
01:34
Because right now, we don't have any
effective therapy or vaccine available.
effective therapy or vaccine available.
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因为现在我们没有任何有效的治疗方法或疫苗可用。
01:40
And so, that's the clue.
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所以，这就是原因。
01:43
We may have it someday.
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可能我们终将研制出来。
01:45
So we rightfully fear Ebola,
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所以我们害怕埃博拉，是合情合理的，
01:48
because it doesn't kill
as many people as other diseases.
as many people as other diseases.
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因为它杀死的人没有其它疾病那么多，
01:53
In fact, it's much less transmissible
than viruses such as flu or measles.
than viruses such as flu or measles.
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实际上，它的传染性比
流感和麻疹之类的病毒，低多了。
流感和麻疹之类的病毒，低多了。
01:59
We fear Ebola because of the fact
that it kills us and we can't treat it.
that it kills us and we can't treat it.
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我们害怕埃博拉是因为这一事实：
它能杀死我们，我们却无能为力。
它能杀死我们，我们却无能为力。
02:05
We fear the certain inevitability
that comes with Ebola.
that comes with Ebola.
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我们害怕伴随埃博拉而来的某种不可避免性。
02:08
Ebola has this inevitability
that seems to defy modern medical science.
that seems to defy modern medical science.
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埃博拉的这种不可避免性
似乎是在挑战现代医学。
似乎是在挑战现代医学。
02:14
But wait a second, why is that?
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等一下，为什么会这样？
02:16
We've known about Ebola since 1976.
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从1976年起我们就知道埃博拉了，
02:20
We've known what it's capable of.
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我们知道它有多厉害，
02:22
We've had ample opportunity to study it
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我们也有足够的机会来研究它，
02:24
in the 24 outbreaks that have occurred.
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因为一共出现了24起爆发的病例。
02:27
And in fact, we've actually had
vaccine candidates available now
vaccine candidates available now
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而实际上，
现在我们手上已经有了候选疫苗，
现在我们手上已经有了候选疫苗，
02:31
for more than a decade.
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在十多年前就有了。
02:33
Why is that those vaccines
are just going into clinical trials now?
are just going into clinical trials now?
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那为什么这些疫苗到现在才进行临床实验？
02:38
This goes to the fundamental
problem we have
problem we have
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这就遇到了研制感染性疾病的疫苗时
02:41
with vaccine development
for infectious diseases.
for infectious diseases.
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面临的根本问题。
02:45
It goes something like this:
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大致情况是这样：
02:47
The people most at risk for these diseases
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患上这些疾病风险最高的人
02:50
are also the ones least able
to pay for vaccines.
to pay for vaccines.
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也是最无力支付疫苗的一群人。
02:55
This leaves little in the way
of market incentives
of market incentives
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这就导致几乎没有市场动力
02:59
for manufacturers to develop vaccines,
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来推动生产商研制疫苗，
03:02
unless there are large numbers of people
who are at risk in wealthy countries.
who are at risk in wealthy countries.
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除非在富国有大量人群面临风险。
03:07
It's simply too commercially risky.
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简单来说，商业风险过高。
03:11
As for Ebola, there is absolutely
no market at all,
no market at all,
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至于埃博拉，则完全没有市场，
03:15
so the only reason we have two vaccines
in late-stage clinical trials now,
in late-stage clinical trials now,
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所以，如今我们能有两种疫苗进入后期临床实验，
03:21
is actually because
of a somewhat misguided fear.
of a somewhat misguided fear.
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唯一的原因是，有点被误导的恐惧。
03:24
Ebola was relatively ignored
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相对来说，埃博拉一直以来被忽视了，
03:27
until September 11
and the anthrax attacks,
and the anthrax attacks,
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直到911和炭疽袭击，
03:32
when all of a sudden,
people perceived Ebola
people perceived Ebola
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突然之间，人们意识到
03:34
as, potentially, a bioterrorism weapon.
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埃博拉是一种潜在的，具有生物恐怖袭击性的武器。
03:37
Why is it that the Ebola vaccine
wasn't fully developed at this point?
wasn't fully developed at this point?
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为什么这时埃博拉疫苗还没有完全研制出来？
03:42
Well, partially, because
it was really difficult --
it was really difficult --
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部分是因为非常困难--
03:44
or thought to be difficult --
to weaponize the virus,
to weaponize the virus,
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或者说觉得很困难--
来使病毒武器化。
来使病毒武器化。
03:47
but mainly because
of the financial risk in developing it.
of the financial risk in developing it.
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但主要原因是研制疫苗的财务风险。
03:53
And this is really the point.
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这一点是问题真正所在。
03:55
The sad reality is, we develop vaccines
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现实的可悲之处在于，
03:58
not based upon the risk
the pathogen poses to people,
the pathogen poses to people,
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我们研制一种疫苗，
并非是考虑病原体对人类的风险有多大，
并非是考虑病原体对人类的风险有多大，
04:02
but on how economically risky it is
to develop these vaccines.
to develop these vaccines.
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而是考虑研制疫苗的经济风险有多大。
04:06
Vaccine development
is expensive and complicated.
is expensive and complicated.
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研制疫苗既昂贵又复杂，
04:09
It can cost hundreds
of millions of dollars
of millions of dollars
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要花费高达数亿美元
04:11
to take even a well-known antigen
and turn it into a viable vaccine.
and turn it into a viable vaccine.
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才能选出一种，甚至是已经熟知的抗原，
将它转化为可用的疫苗。
将它转化为可用的疫苗。
04:17
Fortunately for diseases like Ebola,
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幸运的是，对于像埃博拉这样的疾病，
04:19
there are things we can do
to remove some of these barriers.
to remove some of these barriers.
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我们还是可以做一些事情
来打破这些壁垒的。
来打破这些壁垒的。
04:23
The first is to recognize
when there's a complete market failure.
when there's a complete market failure.
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首先，要承认市场已经完全不起作用的现状，
04:27
In that case, if we want vaccines,
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在这种情况下，如果我们想得到疫苗，
04:30
we have to provide incentives
or some type of subsidy.
or some type of subsidy.
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就必须提供奖励措施，或某种形式的补贴。
04:36
We also need to do a better job
at being able to figure out
at being able to figure out
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我们也需要更加努力，
04:40
which are the diseases
that most threaten us.
that most threaten us.
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来找出对我们威胁最大的疾病有哪些。
04:43
By creating capabilities within countries,
we then create the ability
we then create the ability
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首先确立这些国家内部的研发力量，在此基础上
我们帮助这些国家建起
创立流行病学和实验室网络的能力，
创立流行病学和实验室网络的能力，
04:48
for those countries to create
epidemiological and laboratory networks
epidemiological and laboratory networks
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04:52
which are capable of collecting
and categorizing these pathogens.
and categorizing these pathogens.
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有了这些，
我们就有能力采集这些病原体，并进行分类。
我们就有能力采集这些病原体，并进行分类。
04:58
The data from that then can be used
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由此而来的数据
05:00
to understand the geographic
and genetic diversity,
and genetic diversity,
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可用于了解其地理分布和遗传多样性，
05:03
which then can be used
to help us understand
to help us understand
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有助于帮助我们了解
05:06
how these are being changed
immunologically,
immunologically,
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这些免疫学上的变化是如何产生的
05:10
and what type of reactions they promote.
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以及促进了哪种类型的反应。
05:13
So these are the things that can be done,
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所以说，这些事情是可以做的，
05:15
but to do this, if we want to deal
with a complete market failure,
with a complete market failure,
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但要做到这些，
如果我们想要在市场无力的情况下解决问题，
如果我们想要在市场无力的情况下解决问题，
05:19
we have to change the way
we view and prevent infectious diseases.
we view and prevent infectious diseases.
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就必须改变我们看待、预防传染性疾病的方法。
05:24
We have to stop waiting
until we see evidence
until we see evidence
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我们不能在看到疾病成为全球性威胁的证据之前，
总是袖手旁观。
总是袖手旁观。
05:28
of a disease becoming a global threat
before we consider it as one.
before we consider it as one.
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当我们认为它是的时候，就应该行动起来
05:34
So, for Ebola,
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所以，对于埃博拉来说，
05:36
the paranoid fear
of an infectious disease,
of an infectious disease,
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对传染性疾病的极度恐慌，
05:40
followed by a few cases
transported to wealthy countries,
transported to wealthy countries,
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出现于几例传染者转移至富裕国家之后。
05:45
led the global community to come together,
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这种恐慌促使全球各国携起手来，
05:48
and with the work
of dedicated vaccine companies,
of dedicated vaccine companies,
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加上专门的疫苗公司的努力，
05:51
we now have these:
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我们才有了现在的结果：
05:54
Two Ebola vaccines in efficacy trials
in the Ebola countries --
in the Ebola countries --
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两种埃博拉疫苗正在发病国家进行疗效试验，
06:00
(Applause)
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（掌声）
06:06
and a pipeline of vaccines
that are following behind.
that are following behind.
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后续还会有疫苗不断地生产出来。
06:10
Every year, we spend billions of dollars,
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每年我们花费数十亿美元，
06:13
keeping a fleet of nuclear submarines
permanently patrolling the oceans
permanently patrolling the oceans
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以维持核潜艇舰队，
在海洋中持续巡逻，
在海洋中持续巡逻，
06:18
to protect us from a threat
that almost certainly will never happen.
that almost certainly will never happen.
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而这支舰队所预防的威胁，
几乎可以肯定绝不会出现。
几乎可以肯定绝不会出现。
06:23
And yet, we spend virtually nothing
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然而，我们又实际上几乎没有花费多少钱
06:26
to prevent something as tangible
and evolutionarily certain
and evolutionarily certain
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来预防流行性传染病这样的问题，
06:31
as epidemic infectious diseases.
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这个问题切实存在，并且一定是不断进化的。
06:35
And make no mistake about it --
it's not a question of "if," but "when."
it's not a question of "if," but "when."
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对此不应当犯错--
这不是“如果”的问题，而是“什么时候”的问题。
这不是“如果”的问题，而是“什么时候”的问题。
06:38
These bugs are going to continue to evolve
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这些病毒还会不断进化，
06:41
and they're going to threaten the world.
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还会威胁整个世界，
06:44
And vaccines are our best defense.
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而疫苗是我们的最佳防御手段。
06:47
So if we want to be able to prevent
epidemics like Ebola,
epidemics like Ebola,
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所以如果我们想要预防譬如埃博拉的蔓延，
06:51
we need to take on the risk
of investing in vaccine development
of investing in vaccine development
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我们就必须承担风险，
06:55
and in stockpile creation.
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向疫苗研制与物资储备投入资金。
06:58
And we need to view this, then,
as the ultimate deterrent --
as the ultimate deterrent --
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而且我们应当，把它看作最终防线--
07:02
something we make sure is available,
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我们确保有效的良方，
07:05
but at the same time,
praying we never have to use it.
praying we never have to use it.
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而与此同时，
祈祷永远不要用到它。
祈祷永远不要用到它。
07:09
Thank you.
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谢谢大家。
07:10
(Applause)
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（掌声）
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