TED2015
Seth Berkley: The troubling reason why vaccines are made too late ... if they're made at all
塞斯．伯克利: 為什麼疫苗太慢做出來令人苦惱的原因 － 它們到底被製作了沒？
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在我們變得認真為疾病製作出疫苗前，看起來我們像是在等待重大疫情的爆發；塞斯．伯克利揭露了為什麼我們無法來給世界最大宗的疾病做出疫苗，以及其背後市場的現實與失衡的風險。
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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小孩子的症狀
一開始有些發燒、頭痛、肌肉酸痛，
00:15
with mild fever, headache, muscle pains,
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00:18
followed by vomiting and diarrhea,
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接著嘔吐和腹瀉，
00:21
then bleeding from the mouth,
nose and gums.
nose and gums.
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然後是嘴巴、鼻子、牙齦出血，
00:25
Death follows in the form of organ failure
from low blood pressure.
from low blood pressure.
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因血壓低帶來的
器官衰竭樣貌伴隨著死亡。
器官衰竭樣貌伴隨著死亡。
00:31
Sounds familiar?
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聽起來很耳熟嗎？
00:33
If you're thinking this is Ebola,
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如果你正想著這是「伊波拉病毒」的話，
00:36
actually, in this case, it's not.
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事實上這個案例並不是的；
00:38
It's an extreme form of dengue fever,
a mosquito-born disease
a mosquito-born disease
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它是一種登革熱的極端樣態 －
一種蚊子所帶來的疾病，
一種蚊子所帶來的疾病，
00:43
which also does not have
an effective therapy or a vaccine,
an effective therapy or a vaccine,
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這東西同樣沒有行得通的
藥方或是疫苗，
藥方或是疫苗，
00:48
and kills 22,000 people each year.
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而且每年奪走 22,000 條人命！
00:52
That is actually twice
the number of people
the number of people
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在我們已經知道登革熱近四十年來
00:54
that have been killed by Ebola
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那確實是喪命於伊波拉病毒人數的兩倍。
00:56
in the nearly four decades
that we've known about it.
that we've known about it.
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01:00
As for measles, so much
in the news recently,
in the news recently,
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至於近來如此大量登上新聞的麻疹，
01:04
the death toll is actually tenfold higher.
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死亡總計實際上高出十倍；
01:09
Yet for the last year,
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然而去年一整年裡
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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「伊波拉」已經搶走所有的頭條和恐懼。
01:17
Clearly, there is something
deeply rooted about it,
deeply rooted about it,
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很清楚地有某種東西深植於其中，
01:19
something which scares us
and fascinates us
and fascinates us
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某種遠比其他疾病還要嚇人
以及使我們著迷的東西。
01:22
more than other diseases.
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01:24
But what is it, exactly?
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但是那到底是什麼呢？
01:27
Well, it's hard to acquire Ebola,
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要染上「伊波拉」是很難的，
01:29
but if you do, the risk
of a horrible death is high.
of a horrible death is high.
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不過要是你染上了 －
不得好死的風險很高，
不得好死的風險很高，
01:33
Why?
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為什麼呢？
01:34
Because right now, we don't have any
effective therapy or vaccine available.
effective therapy or vaccine available.
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因為此時我們沒有任何行得通的
藥方或疫苗是可到手的，
藥方或疫苗是可到手的，
01:40
And so, that's the clue.
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這就是線索了，
01:43
We may have it someday.
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我們也許到哪天會有藥方、疫苗；
01:45
So we rightfully fear Ebola,
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所以我們理該害怕伊波拉病毒，
01:48
because it doesn't kill
as many people as other diseases.
as many people as other diseases.
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它並沒有如同其他疾病奪走了許多人命，
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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事實上它比起流行感冒或是
麻疹等病毒更不會轉傳出去，
麻疹等病毒更不會轉傳出去，
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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我們害怕伊波拉是因為它會奪走
我們的性命而我們不能治好它的事實，
我們的性命而我們不能治好它的事實，
02:05
We fear the certain inevitability
that comes with Ebola.
that comes with Ebola.
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我們懼怕伴隨著伊波拉的
必然無可倖免性，
必然無可倖免性，
02:08
Ebola has this inevitability
that seems to defy modern medical science.
that seems to defy modern medical science.
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伊波拉有著看似否定
現代醫療科學的無可倖免性。
現代醫療科學的無可倖免性。
02:14
But wait a second, why is that?
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不過慢著 － 那是為什麼呢？
02:16
We've known about Ebola since 1976.
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我們自從 1976 年以來
就知道伊波拉病毒了，
就知道伊波拉病毒了，
02:20
We've known what it's capable of.
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我們知道它有什麼能耐，
02:22
We've had ample opportunity to study it
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我們早就有充分的機會
02:24
in the 24 outbreaks that have occurred.
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在 24 個已經出現過伊波拉的
爆發區來研究它，
爆發區來研究它，
02:27
And in fact, we've actually had
vaccine candidates available now
vaccine candidates available now
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而且事實上我們確實已經有可到手的
疫苗候選劑超過十年以上，
疫苗候選劑超過十年以上，
02:31
for more than a decade.
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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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為什麼那些疫苗現在才正要
進入臨床測試呢？
進入臨床測試呢？
02:38
This goes to the fundamental
problem we have
problem we have
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這要講到我們在研發給
傳染性疾病用的疫苗
傳染性疾病用的疫苗
02:41
with vaccine development
for infectious diseases.
for infectious diseases.
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現有的根本問題，
02:45
It goes something like this:
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要講到像這些東西 －
02:47
The people most at risk for these diseases
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「對這些疾病最有風險的人，
02:50
are also the ones least able
to pay for vaccines.
to pay for vaccines.
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同樣也是最買不起疫苗的人！」，
02:55
This leaves little in the way
of market incentives
of market incentives
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這留下很少的市場誘因
02:59
for manufacturers to develop vaccines,
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給廠商來研發疫苗；
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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除非在富裕的國家裡有著
一大堆人處於風險之下，
一大堆人處於風險之下，
03:07
It's simply too commercially risky.
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研發疫苗絕對是商業上太冒風險的。
03:11
As for Ebola, there is absolutely
no market at all,
no market at all,
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至於伊波拉病毒是絕對
絲毫市場誘因也沒有，
絲毫市場誘因也沒有，
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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所以我們現在會有兩個在
後段臨床測試的疫苗，
後段臨床測試的疫苗，
03:21
is actually because
of a somewhat misguided fear.
of a somewhat misguided fear.
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唯一的理由確實是因為
某種被誤導的恐懼。
某種被誤導的恐懼。
03:24
Ebola was relatively ignored
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伊波拉病毒直到 911 和炭疽病攻擊前
03:27
until September 11
and the anthrax attacks,
and the anthrax attacks,
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相對之下是被輕忽的，
03:32
when all of a sudden,
people perceived Ebola
people perceived Ebola
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但是突然間染上伊波拉病毒的人
03:34
as, potentially, a bioterrorism weapon.
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就如同潛在性生物恐怖攻擊武器。
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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為什麼伊波拉疫苗在這時候
沒有被完全地研發出來呢？
沒有被完全地研發出來呢？
03:42
Well, partially, because
it was really difficult --
it was really difficult --
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有一部分是因為它確實很難，
03:44
or thought to be difficult --
to weaponize the virus,
to weaponize the virus,
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或是被想成很難 － 把病毒武器化，
03:47
but mainly because
of the financial risk in developing it.
of the financial risk in developing it.
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不過主要是因為要開發它的財務風險，
03:53
And this is really the point.
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而這真的就是關鍵。
03:55
The sad reality is, we develop vaccines
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令人難過的現實就是我們研發疫苗
03:58
not based upon the risk
the pathogen poses to people,
the pathogen poses to people,
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不是基於病原體對人體造成的風險，
04:02
but on how economically risky it is
to develop these vaccines.
to develop these vaccines.
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卻是基於研發這些疫苗
經濟上是如何冒風險的；
經濟上是如何冒風險的；
04:06
Vaccine development
is expensive and complicated.
is expensive and complicated.
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疫苗的研發是既昂貴又繁瑣的，
04:09
It can cost hundreds
of millions of dollars
of millions of dollars
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它可以花到上億美元
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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把一個就算相當清楚的抗體
轉變成大有機會的疫苗。
轉變成大有機會的疫苗。
04:17
Fortunately for diseases like Ebola,
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幸好對類似於「伊波拉」的疾病來講，
04:19
there are things we can do
to remove some of these barriers.
to remove some of these barriers.
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有著我們能移除些許阻礙的事情可做。
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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首先是認知到當那裡
市場完全失能的時候，
市場完全失能的時候，
04:27
In that case, if we want vaccines,
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在那個案例裡如果我們想要疫苗，
04:30
we have to provide incentives
or some type of subsidy.
or some type of subsidy.
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我們得提供誘因或是某類補助，
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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我們同樣需要在有辦法弄清楚
04:40
which are the diseases
that most threaten us.
that most threaten us.
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威脅我們最大的疾病有哪些
這檔事上做得更好；
這檔事上做得更好；
04:43
By creating capabilities within countries,
we then create the ability
we then create the ability
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透過在國與國之間催生多種本事，
04:48
for those countries to create
epidemiological and laboratory networks
epidemiological and laboratory networks
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我們接著為那些國家催生能力
來建立流行病學和實驗室的網絡，
來建立流行病學和實驗室的網絡，
04:52
which are capable of collecting
and categorizing these pathogens.
and categorizing these pathogens.
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該網絡有辦法收集和歸類這些病原體。
04:58
The data from that then can be used
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從那裡得來的資料稍後可以被用來
理解地理和基因的歧異性，
理解地理和基因的歧異性，
05:00
to understand the geographic
and genetic diversity,
and genetic diversity,
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05:03
which then can be used
to help us understand
to help us understand
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那些接著可以被用來幫助我們理解
05:06
how these are being changed
immunologically,
immunologically,
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這些病原體是如何在免疫學上被更改了，
05:10
and what type of reactions they promote.
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以及它們會促發什麼樣的反應。
05:13
So these are the things that can be done,
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這些是可以被做到的事情，
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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不過要做到 － 假使我們想要解決
市場完全失能的話，
市場完全失能的話，
05:19
we have to change the way
we view and prevent infectious diseases.
we view and prevent infectious diseases.
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我們得要改變我們看待
以及防治傳染病的方式，
以及防治傳染病的方式，
05:24
We have to stop waiting
until we see evidence
until we see evidence
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我們必須停止直到我們看見
疾病之證據前的空等 －
疾病之證據前的空等 －
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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早在我們認定之前形成全球威脅。
05:34
So, for Ebola,
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所以拿伊波拉病毒來說，
05:36
the paranoid fear
of an infectious disease,
of an infectious disease,
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對一種傳染病疑神疑鬼的懼怕、
05:40
followed by a few cases
transported to wealthy countries,
transported to wealthy countries,
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接下來極少數的病例
被轉送到富裕的國家去，
被轉送到富裕的國家去，
05:45
led the global community to come together,
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導致全球社會來攜手合作；
05:48
and with the work
of dedicated vaccine companies,
of dedicated vaccine companies,
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而且有了盡職的疫苗公司在做事，
05:51
we now have these:
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我們現在有了這些東西 －
05:54
Two Ebola vaccines in efficacy trials
in the Ebola countries --
in the Ebola countries --
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在出現伊波拉的國家中有了
兩種臨床療效試驗中的伊波拉疫苗，
兩種臨床療效試驗中的伊波拉疫苗，
06:00
(Applause)
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（掌聲）
06:06
and a pipeline of vaccines
that are following behind.
that are following behind.
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以及源源不絕的疫苗緊接其後。
06:10
Every year, we spend billions of dollars,
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每一年我們花費掉數十億美元
06:13
keeping a fleet of nuclear submarines
permanently patrolling the oceans
permanently patrolling the oceans
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維持核子潛艇艦隊不間斷地巡防大洋，
06:18
to protect us from a threat
that almost certainly will never happen.
that almost certainly will never happen.
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以保護我們遠離幾乎鐵定
永遠不會發生的威脅，
永遠不會發生的威脅，
06:23
And yet, we spend virtually nothing
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再加上我們實際上沒花錢
06:26
to prevent something as tangible
and evolutionarily certain
and evolutionarily certain
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來避免某種碰得到的
以及肯定會進化的流行傳染病。
06:31
as epidemic infectious diseases.
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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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而且別搞錯了 － 這不是「會不會」
而是「何時」的問題，
而是「何時」的問題，
06:38
These bugs are going to continue to evolve
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這些病菌將會繼續進化，
06:41
and they're going to threaten the world.
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而且它們將會威脅到全世界，
06:44
And vaccines are our best defense.
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而疫苗就是我們最佳的庇護。
06:47
So if we want to be able to prevent
epidemics like Ebola,
epidemics like Ebola,
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因此要是我們想要能夠避免
像伊波拉一般的傳染病，
像伊波拉一般的傳染病，
06:51
we need to take on the risk
of investing in vaccine development
of investing in vaccine development
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我們必須冒投資在疫苗研發
06:55
and in stockpile creation.
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以及產生囤積的風險。
06:58
And we need to view this, then,
as the ultimate deterrent --
as the ultimate deterrent --
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我們必須正視這個然後
當做終極遏制 －
當做終極遏制 －
07:02
something we make sure is available,
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我們要確保那是到手的東西，
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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不過同一時間祈禱我們永遠用不上它！
07:09
Thank you.
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謝謝大家！
07:10
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Seth Berkley - Vaccine visionaryEpidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world.
Why you should listen
Seth Berkley is an epidemiologist and the CEO of Gavi, the Vaccine Alliance, the global health organization protecting lives by improving access to vaccines in developing countries. Seth joined Gavi in 2011 in a period of rapid acceleration of Gavi’s programs. Now, with more than half a billion children immunized, he is leading Gavi’s efforts to reach a further 300 million children in the next five years and build sustainability into country immunization programs. Prior to Gavi, he spearheaded the development of vaccines for HIV as founder and CEO of the International AIDS Vaccine Initiative.
Seth Berkley | Speaker | TED.com