What it takes to crush a pandemic | Johanna Benesty

49,719 views ・ 2020-12-08

TED


Dvaput kliknite na engleske titlove ispod za reprodukciju videozapisa.

Prevoditelj: Stela Šegović Recezent: Sanda Liker
00:13
My son was born in January 2020,
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Moj sin je rođen u siječnju 2020. nedugo prije pariškog lockdowna.
00:15
shortly before the lockdown in Paris.
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00:18
He was never scared of people wearing masks,
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Nikada ga nije bilo strah ljudi u maskama,
00:20
because that's all he knows.
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jer to je jedino što zna.
00:22
My three-year-old daughter knows how to say "gel hydro-alcoolique."
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Moja trogodišnja kći zna reći "gel hydro-alcoolique".
00:26
That's the French word for hydroalcoholic gel.
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To je francuska riječ za hidroalkoholni gel.
00:29
She actually pronounces it better than I do.
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Ona to zapravo bolje izgovara od mene.
00:32
But no one wants to be wearing a mask
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Ali nitko ne želi nositi masku
00:34
or wash their hands with hand sanitizer every 20 seconds.
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ili prati ruke dezinfekcijskim sredstvom svakih 20 sekunda.
00:38
We're all desperately looking at R and D to find us a solution: a vaccine.
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Zbog toga svi očajnički priželjkujemo da R & D nađu rješenje: cjepivo.
00:44
It's interesting that in our minds,
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Zanimljivo je što u našim mislima
00:46
we keep thinking of the vaccine discovery like it's the Holy Grail.
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nastojimo razmišljati o pronalasku cjepiva kao da je Sveti Gral.
00:50
But there are a couple of shortcuts here that I'd like to unpack.
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Ali ima nekoliko prečaca koje bih rado razjasnila.
00:54
I'm not a doctor, I'm just a consultant.
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Nisam liječnica, samo sam savjetnica.
00:56
My clients focus on health care --
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Moji klijenti fokusirani su na zdravstvo,
00:58
biopharma companies, providers, global health institutions --
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farmaceutske kompanije, dobavljači, globalne zdravstvene institucije
01:03
and they've educated me.
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i oni su me educirali.
01:05
We need to find the tools to fight COVID,
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Trebamo naći sredstva za borbu protiv COVID-a,
01:08
and we need to make them accessible to all.
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i trebamo ih učiniti svima dostupnima.
01:11
First, one single vaccine will not get us out of this.
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Prvo, jedno cjepivo nas neće izvući iz ove situacije.
01:15
What we need is an arsenal of tools.
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Treba nam arsenal sredstava i pomagala.
01:18
We need vaccines, we need therapeutics, we need diagnostics
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Trebamo cjepiva, trebamo terapije, trebamo dijagnostičare
01:22
to make sure that we can prevent, identify and treat COVID cases
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kako bismo spriječili, identificirali i liječili COVID slučajeve
01:26
in a variety of populations.
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u raznovrsnim populacijama.
01:28
Second, it's not just about finding a tool.
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Drugo, ne radi se samo o pronalasku cjepiva.
01:33
What do you think will happen when one of those clinical trials
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Što će se dogoditi kada klinička istraživanja
01:36
demonstrates that the tool is effective?
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dokažu da je sredstvo učinkovito?
01:39
Do you think we can all run to the pharmacy next door,
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Mislite li da ćemo svi trčati u ljekarnu,
01:41
we get the product, we take off our masks
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dobiti proizvod, skinuti maske
01:43
and we go back to French kissing?
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i vratiti se ponovno francuskom ljubljenju?
01:46
No.
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Ne.
01:48
Finding an effective tool is just one step in this big fight,
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Pronalazak učinkovitog sredstva samo je jedan korak u ovoj velikoj borbi,
01:52
because there is a difference between the existence of a product
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jer postoji razlika između postojanja proizvoda
01:55
and access to that product.
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i dostupnosti tog proizvoda.
01:58
And now you're thinking,
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I sada mislite:
01:59
"Oh -- she means other countries will have to wait."
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,,Oh -- time misli da će druge zemlje trebati čekati."
02:02
Well, no, that's not my point.
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Ali, ne, to nije moja poanta.
02:04
Not only others may have to wait,
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Ne samo da će drugi trebati čekati,
02:06
but any of us may have to.
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nego će bilo tko od nas također trebati čekati.
02:09
The humbling thing about COVID
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Poučna stvar kod COVID-a je ta
02:10
is that because of its speed and magnitude,
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da zbog svoje brzine i magnitude širenja,
02:13
it's exposing all of us to the same challenges
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nas sve izlaže jednakim izazovima,
02:16
and giving us a flavor of challenges we're not used to.
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izazovima na koje nismo navikli.
02:20
Remember when China got into lockdown?
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Sjećate li se kada je Kina išla u lockdown?
02:22
Did you imagine that you would be in the same situation
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Jeste li razmišljali da ćete i vi biti u istoj situaciji
02:25
a few weeks after?
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nekoliko tjedana kasnije?
02:27
I certainly didn't.
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Ja zasigurno nisam.
02:29
Let's go to the theoretical moment when we have a vaccine.
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Sagledajmo teoretski dio pronalaska cjepiva.
02:33
In this case, the next access challenge
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U tom slučaju, sljedeći izazov dostupnosti cjepiva
02:35
will be supply.
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biti će zaliha.
02:37
The current estimate of the global community
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Trenutna pretpostavka globalnog društva je
02:39
is that by the end of 2021 --
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da do kraja 2021. --
02:41
so that's over a year after the discovery of the vaccine --
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to jest više od godinu dana nakon otkrića cjepiva --
02:44
we would have enough doses to cover one to two billion
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imali bismo dovoljno doza za pokriti jednu do dvije milijarde
02:47
of the eight billion of us on the planet.
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od osam milijardi ljudi na planeti.
02:50
So who will have to wait?
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Dakle, tko će morati čekati?
02:53
How do you think about access when supply is short?
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Kako razmišljati o dostupnosti kada je zaliha premala?
02:56
Scenario number one:
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Scenarij broj jedan:
02:58
we let the market forces play,
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prepustimo tržišnim snagama da se bore,
03:00
and those who can pay the highest price or be the fastest to negotiate deals
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i onaj tko će moći ponuditi najvišu cijenu
ili biti najbrži u pregovaranju
03:03
will get access to the product first.
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prvi će dobiti pristup cjepivu.
03:06
It's not equitable at all,
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Nije pravedno nimalo,
03:07
but it's a very likely scenario.
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ali je vrlo moguć scenarij.
03:10
Scenario number two:
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Scenarij broj dva:
03:11
we could all agree, based on public health rationale,
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Svi bismo se mogli složiti, na osnovi javnog zdravstvenog razuma,
03:14
who gets the product first.
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tko će prvi dobiti cjepivo.
03:16
Let's say we agree that health care workers would get it first,
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Recimo da se slažemo da bi ga zdravstveni djelatnici dobili prvi,
03:19
and then the elderly
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zatim starije osobe,
03:20
and then the general population.
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a tada ostalo stanovništvo.
03:22
Now let me be a bit more provocative.
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Dopustite da budem malo provokativna.
03:24
Scenario number three:
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Scenarij broj tri:
03:27
countries who have demonstrated that they can manage the pandemic well
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države koje su demonstrirale da mogu dobro podnijeti pandemiju
03:31
would get access to the product first.
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prve bi dobile pristup cjepivu.
03:34
It's a little bit extrapolated,
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To je malo ekstrapolirano,
03:35
but it's not complete science fiction.
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no nije znanstvena fantastika.
03:38
Years ago, when the supply of high-quality second-line tuberculosis drug was scarce,
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U prošlosti, kada je zaliha visoko kvalitetnog lijeka za tuberkulozu bila oskudna,
03:42
a special committee was established
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specijalni komitet bio je osnovan
03:44
to determine which countries had health systems that were strong enough
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kako bi odlučili koje države su imale zdravstvene sustave dovoljno jake
03:48
to ensure that the products would be distributed properly
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da osiguraju pravilnu raspodjelu lijeka
03:51
and that patients would follow their treatment plans properly.
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i da će pacijenti pratiti svoje planove liječenja.
03:54
Those select countries got access first.
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Te odabrane države prve su dobile pristup.
03:58
Or, scenario number four:
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Ili scenarij broj četiri:
04:00
we could decide on a random rule,
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mogli bismo odrediti nasumično pravilo,
04:02
for instance, that people get to be vaccinated on their birthday.
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na primjer, da ljudi budu cijepljeni na svoj rođendan.
04:06
Now let me ask you this:
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Da vas pitam:
04:08
How does it feel to think of a future where the vaccine exists,
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Kakav je osjećaj razmišljati o budućnosti u kojoj cjepivo postoji,
04:12
but you would still have to wear a mask and keep your kids home from school,
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ali vi biste i dalje morali nositi masku i vaša djeca bi pratila nastavu od kuće,
04:17
and you would not be able to go to work the way you want
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i ne biste imali mogućnost ići na posao kako želite
04:19
because you wouldn't have access to that product?
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jer ne biste imali pristup tom cjepivu?
04:23
Every day that passed would feel unacceptable, right?
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Svaki dan bio bi neprihvatljiv, zar ne?
04:27
But guess what?
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Ali pogodite što?
04:29
There are many diseases for which we have treatments and even cures,
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Postoji mnogo bolesti za koje imamo terapiju pa čak i lijek,
04:33
and yet people keep being infected and die every year.
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no ljudi i dalje nastoje biti zaraženi i umiru svake godine.
04:38
Let's take tuberculosis:
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Uzmimo primjer tuberkuloze:
04:40
10 million people infected every year,
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10 milijuna zaraženih svake godine,
04:42
1.5 million people dying,
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1,5 milijuna ljudi umre,
04:45
although we've had a cure for years.
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iako imamo lijek već godinama.
04:48
And that's just because we haven't completely figured out
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I to je samo posljedica toga što nismo potpuno shvatili
04:50
some of the key access issues.
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neke od ključnih problema dostupnosti.
04:54
Equitable access is the right thing to do,
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Pravedna dostupnost je ispravna stvar za učiniti,
04:57
but beyond this humanitarian argument
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no osim ovog humanitarnog argumenta
05:00
that I hope we are more sensitive to
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za koji se nadam da smo više osjetljivi
05:02
now that we've experienced it in our flesh,
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sada kada smo ga osjetili na svojoj koži,
05:04
there is a health and an economic argument
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postoji zdravstveni i ekonomski argument
05:06
to equitable access.
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o pravednoj dostupnosti.
05:09
The health argument is that as long as the virus is active somewhere,
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Zdravstveni argument je da ukoliko je virus negdje aktivan,
05:12
we're all at risk of reimported cases.
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svi imamo rizik ponovnog uvoza virusa.
05:15
The economic argument is that because of the interdependencies
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Ekonomski argument je da zbog međuzavisnosti
05:19
in our economies,
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naših ekonomija,
05:20
no domestic economy can fully restart if others are not picking up as well.
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nijedna domaća ekonomija ne može se ponovno pokrenuti
ukoliko to ne učine i ostale.
05:26
Think of the sectors that rely on global mobility,
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Razmislite o sektorima koji ovise o globalnoj mobilnosti
05:29
like aerospace or travel and tourism.
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poput zračne industrije ili putovanja i turizma.
05:32
Think of the supply chains that cut across the globe,
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Razmislite o dobavljačima sa svih strana svijeta
05:34
like textiles or automotive.
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poput tekstilne i automobilske industrije.
05:36
Think of the share of the economic growth that is coming from emerging markets.
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Razmislite o udjelu ekonomskog rasta koji je posljedica tržišta u usponu.
05:40
The reality is that we need all countries to be able to crush the pandemic in sync.
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Stvarnost je da su sve države potrebne za usklađeno zaustavljanje pandemije.
05:47
So not only is equitable access the right thing to do,
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Dakle, pravedna dostupnost nije jedini ispravan potez,
05:50
it is also the smart thing to do.
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već i pametan potez.
05:53
But how do we do that?
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Ali kako da to učinimo?
05:56
Let's make sure we're on the same page in terms of what "access" means.
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Budimo sigurni da svi isto mislimo što dostupnost znači.
05:59
It would actually mean that the product exists;
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To bi zapravo značilo da proizvod postoji;
06:01
that it's working sufficiently well;
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da djeluje dovoljno dobro;
06:04
that it's been approved by the local authorities;
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da je odobren od strane lokalnih vlasti;
06:07
that it is affordable;
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da je povoljan;
06:09
but also that there is evidence that it works in all the populations
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ali i da ima dokaza da djeluje na svim populacijama koje ga trebaju,
06:12
that need it,
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06:13
and that can include pregnant women or immunodepressed people, or children;
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i to može uključivati trudnice, osobe sa slabim imunitetom ili djecu;
06:18
that it can be distributed in a variety of settings,
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da može biti distribuiran u razne okoline,
06:20
like hospitals or rural clinics, or hot climate or cold climate;
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poput bolnica ili seoskih klinika, u vruća ili hladna klimatska područja;
06:26
and that we can produce it at the right scale.
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i da ga možemo proizvoditi u točnom razmjeru.
06:29
It's a very long checklist, I know,
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Zaista je duga lista uvjeta, znam,
06:31
and in a non-crisis situation,
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i u normalnoj situaciji,
06:33
we would likely address these issues one after the other in a sequential way,
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ovim problemima bismo pristupili jednim za drugim u nizu,
06:37
which takes a lot of time.
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za što je potrebno mnogo vremena.
06:40
So what do we do?
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Dakle, što nam je činiti?
06:42
Access is far from being a new challenge,
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Dostupnost nije nov izazov,
06:45
and in the case of COVID,
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i pojavom COVID-a,
06:46
I have to say, we're seeing extraordinary collaboration
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moram reći da uočavamo izvanrednu suradnju
06:50
of international organizations, civil society, industry and others
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internacionalnih organizacija, građanskog društva, industrije i ostalih
06:53
to accelerate access:
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kako bi se ubrzala dostupnost:
06:55
working things in parallel,
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radeći paralelno,
06:57
speeding up regulatory processes,
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ubrzavanjem regulatornih postupaka,
06:59
engineering supply mechanisms,
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konstruiranjem dostavljačkih mehanizama,
07:01
securing procurement, mobilizing resources, etc.
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osiguravanjem nabave, mobiliziranjem resursa, itd.
07:04
Yet we are likely to face a situation where, for instance,
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No, vjerojatno ćemo se suočiti sa situacijom u kojoj će, na primjer,
07:09
the vaccine would need to be constantly stored at, let's say,
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cjepivo biti potrebno skladištiti u, recimo,
07:12
minus 80 Celsius degrees;
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minus 80 Celzijevih stupnjeva;
07:14
or where the treatment would need to be administered
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ili gdje će liječenje provoditi
07:16
by a highly specialized health care worker;
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visoko specijalizirani zdravstveni radnici,
07:19
or where the diagnostic would need to be analyzed
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ili gdje će dijagnostiku trebati analizirati
07:21
by a sophisticated lab.
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u modernim laboratorijima.
07:23
So what more can we do?
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Dakle, što još možemo učiniti?
07:27
Pushing further the logic that the global health community
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Nastavljajući logiku koju globalna zdravstvena zajednica
07:30
has advocated for for years,
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zagovara već godinama,
07:31
there is one additional thing I can think of that might help.
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postoji jedna dodatna stvar koje sam se sjetila i možda može pomoći.
07:35
There is a concept in product development and manufacturing
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Postoji koncept u razvijanju proizvoda i manufakture
07:38
that's called "design to cost."
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koji se zove "design to cost".
07:40
The basic idea is that the cost management conversation
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Glavna ideja je da se upravljanje troškovima raspravlja
07:43
happens at the same time as the product being designed,
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u isto vrijeme kada se proizvod i dizajnira,
07:46
as opposed to the product being designed first
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umjesto da se proizvod prvo dizajnira
07:48
and then reworked to bring the cost down.
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i zatim prerađuje kako bi se smanjili troškovi.
07:51
It's a simple method that helps ensure
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To je jednostavna metoda koja pomaže osigurati
07:53
that when cost has been identified as a priority criteria for a product,
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da kada je trošak identificiran kao glavni kriterij za proizvod,
07:58
it's made a target from day one.
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trošak je cilj od prvog dana.
08:01
Now, in the context of health and access,
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U kontekstu zdravstva i dostupnosti,
08:04
I think there is untapped potential
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smatram da postoji neiskorišteni potencijal
08:06
in R and D to access,
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kod istraživanja i razvoja dostupnosti
08:08
the same way that manufacturers design to cost.
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na isti način na koji proizvođači dizajniraju po cijeni.
08:12
This would mean that, instead of developing a product
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To bi značilo umjesto da se proizvod razvije
08:16
and then working to adapt it to ensure equitable access later,
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i zatim prerađuje kako bi se osigurala pravedna dostupnost,
08:20
all of the items on the checklist I mentioned
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svi uvjeti koje sam spomenula
08:22
would be built into the R and D process from the beginning,
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bili bi dio procesa istraživanja i razvoja od početka,
08:25
and this would actually benefit us all.
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i to bi zapravo bilo korisno svima nama.
08:28
Let's take an example.
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Na primjer.
08:30
If we develop a product with equitable access in mind,
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Ako razvijemo proizvod misleći na pravednu dostupnost,
08:33
we might be able to optimize for scale-up faster.
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možda bismo brže mogli proizvoditi taj proizvod u većim razmjerima.
08:37
In my experience, drug developers often focus on finding a dose that works,
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Prema mom iskustvu, proizvođači lijekova često se fokusiraju na pronalazak doze
08:42
and only after do they optimize the dosage or make adjustments.
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koja djeluje i tek zatim optimiziraju dozu ili rade prilagodbe.
08:46
Now imagine that we're talking of a candidate product
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Zamislite sada da pričamo o mogućem proizvodu
08:49
for which the active ingredient is a scarce resource.
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čiji je aktivni sastojak oskudni resurs.
08:52
What if instead we focused on developing a treatment
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Što bi bilo ako bismo se fokusirali na razvijanje terapije
08:55
that uses the lowest possible amount of that active ingredient?
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koja koristi najmanji mogući udio tog aktivnog sastojka?
08:59
It could help us produce more doses.
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To bi nam omogućilo proizvodnju više doza.
09:02
Let's take another example.
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Još jedan primjer.
09:04
If we develop a product with equitable access in mind,
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Ukoliko razvijemo proizvod misleći na pravednu dostupnost,
09:07
we might be able to optimize for mass distribution faster.
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možda bismo mogli optimizirati masovnu distribuciju brže.
09:11
In high-income countries,
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U visoko prihodnim državama
09:13
we have strong health systems capacity.
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imamo snažne zdravstvene sustave velikih kapaciteta.
09:15
We can always distribute products the way we want.
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Uvijek možemo distribuirati proizvode kako želimo.
09:18
So we often take for granted that products can be stored
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Često uzimamo zdravo za gotovo da proizvodi mogu biti skladišteni
09:20
in temperature-controlled environments
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u prostorijama kontrolirane temperature
09:22
or requires a highly skilled health care worker for administration.
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ili da trebaju visoko specijalizirane zdravstvene radnike za administraciju.
09:27
Of course,
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Naravno,
09:28
temperature-controlled environments and highly skilled health care workers
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prostorije kontrolirane temperature i visoko specijalizirani zdravstveni radnici
09:32
are not available everywhere.
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nisu svugdje dostupni.
09:33
If we were to approach R and D
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Ako pristupimo R & D-u
09:35
with the constraints of weaker health systems in mind,
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misleći na ograničenja slabijih zdravstvenih sustava,
09:39
we might get creative
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mogli bismo biti kreativni
09:40
and develop sooner, for instance, temperature-agnostic products
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i razviti brže, na primjer, proizvode neovisne o temperaturi
09:44
or products that can be taken as easily as a vitamin
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ili proizvode koji se mogu uzimati kao vitamini
09:47
or long-lasting formulations instead of repeat doses.
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ili dugotrajne formule umjesto ponavljajućih doza.
09:51
If we were able to produce and develop such simplified tools,
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Ako bismo mogli proizvoditi i razvijati takva pojednostavljena sredstva,
09:57
it would have the added benefit
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imali bismo dodatnu korist
09:58
of putting less strains on hospitals and health systems
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stavljanja manje pritiska na bolnice i zdravstvene sustave
10:02
for both high- and low-income countries.
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u visoko prihodnim i nisko prihodnim državama.
10:05
Given the speed of the virus
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Suočeni brzinom širenja virusa
10:07
and the magnitude of the consequences we're facing,
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i magnitudom posljedica,
10:10
I think we have to continue challenging ourselves
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smatram da trebamo nastaviti gurati sami sebe
10:12
to find the fastest way to make products to fight COVID
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da pronađemo najbrži način proizvodnje proizvoda protiv COVID-a
10:15
and future pandemics accessible to all.
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i budućih pandemija dostupnih svima.
10:18
In my perspective,
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Iz moje perspektive,
10:19
unless the virus disappears,
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ukoliko virus ne nestane,
10:21
there are two ways this story ends.
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postoje samo dva završetka ove priče.
10:24
Either the scales tip one way --
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Ili će vaga prevagnuti na jednu stranu --
10:26
only some of us get access to the product
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tako da samo neki od nas imaju pristup proizvodu
10:28
and COVID remains a threat to all of us --
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i da COVID ostane prijetnja svima nama --
10:30
or we balance the scales,
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ili da uravnotežimo vagu,
10:32
we all get access to the right weapons,
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da svi dobijemo pristup ispravnim sredstvima
10:35
and we all move on together.
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i nastavimo dalje zajedno.
10:38
Innovative R and D can't beat COVID alone,
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Inovativni R & D ne mogu pobijediti COVID sami,
10:41
but innovative management of R and D might help.
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ali inovativno upravljanje R & D-om možda pomogne.
10:44
Thank you.
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Hvala.
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