What it takes to crush a pandemic | Johanna Benesty

Prevoditelj: Stela Šegović Recezent: Sanda Liker

My son was born in January 2020,

Moj sin je rođen u siječnju 2020. nedugo prije pariškog lockdowna.

shortly before the lockdown in Paris.

He was never scared of people wearing masks,

Nikada ga nije bilo strah ljudi u maskama,

because that's all he knows.

jer to je jedino što zna.

My three-year-old daughter knows how to say "gel hydro-alcoolique."

Moja trogodišnja kći zna reći "gel hydro-alcoolique".

That's the French word for hydroalcoholic gel.

To je francuska riječ za hidroalkoholni gel.

She actually pronounces it better than I do.

Ona to zapravo bolje izgovara od mene.

But no one wants to be wearing a mask

Ali nitko ne želi nositi masku

or wash their hands with hand sanitizer every 20 seconds.

ili prati ruke dezinfekcijskim sredstvom svakih 20 sekunda.

We're all desperately looking at R and D to find us a solution: a vaccine.

Zbog toga svi očajnički priželjkujemo da R & D nađu rješenje: cjepivo.

It's interesting that in our minds,

Zanimljivo je što u našim mislima

we keep thinking of the vaccine discovery like it's the Holy Grail.

nastojimo razmišljati o pronalasku cjepiva kao da je Sveti Gral.

But there are a couple of shortcuts here that I'd like to unpack.

Ali ima nekoliko prečaca koje bih rado razjasnila.

I'm not a doctor, I'm just a consultant.

Nisam liječnica, samo sam savjetnica.

My clients focus on health care --

Moji klijenti fokusirani su na zdravstvo,

biopharma companies, providers, global health institutions --

farmaceutske kompanije, dobavljači, globalne zdravstvene institucije

and they've educated me.

i oni su me educirali.

We need to find the tools to fight COVID,

Trebamo naći sredstva za borbu protiv COVID-a,

and we need to make them accessible to all.

i trebamo ih učiniti svima dostupnima.

First, one single vaccine will not get us out of this.

Prvo, jedno cjepivo nas neće izvući iz ove situacije.

What we need is an arsenal of tools.

Treba nam arsenal sredstava i pomagala.

We need vaccines, we need therapeutics, we need diagnostics

Trebamo cjepiva, trebamo terapije, trebamo dijagnostičare

to make sure that we can prevent, identify and treat COVID cases

kako bismo spriječili, identificirali i liječili COVID slučajeve

in a variety of populations.

u raznovrsnim populacijama.

Second, it's not just about finding a tool.

Drugo, ne radi se samo o pronalasku cjepiva.

What do you think will happen when one of those clinical trials

Što će se dogoditi kada klinička istraživanja

demonstrates that the tool is effective?

dokažu da je sredstvo učinkovito?

Do you think we can all run to the pharmacy next door,

Mislite li da ćemo svi trčati u ljekarnu,

we get the product, we take off our masks

dobiti proizvod, skinuti maske

and we go back to French kissing?

i vratiti se ponovno francuskom ljubljenju?

No.

Ne.

Finding an effective tool is just one step in this big fight,

Pronalazak učinkovitog sredstva samo je jedan korak u ovoj velikoj borbi,

because there is a difference between the existence of a product

jer postoji razlika između postojanja proizvoda

and access to that product.

i dostupnosti tog proizvoda.

And now you're thinking,

I sada mislite:

"Oh -- she means other countries will have to wait."

,,Oh -- time misli da će druge zemlje trebati čekati."

Well, no, that's not my point.

Ali, ne, to nije moja poanta.

Not only others may have to wait,

Ne samo da će drugi trebati čekati,

but any of us may have to.

nego će bilo tko od nas također trebati čekati.

The humbling thing about COVID

Poučna stvar kod COVID-a je ta

is that because of its speed and magnitude,

da zbog svoje brzine i magnitude širenja,

it's exposing all of us to the same challenges

nas sve izlaže jednakim izazovima,

and giving us a flavor of challenges we're not used to.

izazovima na koje nismo navikli.

Remember when China got into lockdown?

Sjećate li se kada je Kina išla u lockdown?

Did you imagine that you would be in the same situation

Jeste li razmišljali da ćete i vi biti u istoj situaciji

a few weeks after?

nekoliko tjedana kasnije?

I certainly didn't.

Ja zasigurno nisam.

Let's go to the theoretical moment when we have a vaccine.

Sagledajmo teoretski dio pronalaska cjepiva.

In this case, the next access challenge

U tom slučaju, sljedeći izazov dostupnosti cjepiva

will be supply.

biti će zaliha.

The current estimate of the global community

Trenutna pretpostavka globalnog društva je

is that by the end of 2021 --

da do kraja 2021. --

so that's over a year after the discovery of the vaccine --

to jest više od godinu dana nakon otkrića cjepiva --

we would have enough doses to cover one to two billion

imali bismo dovoljno doza za pokriti jednu do dvije milijarde

of the eight billion of us on the planet.

od osam milijardi ljudi na planeti.

So who will have to wait?

Dakle, tko će morati čekati?

How do you think about access when supply is short?

Kako razmišljati o dostupnosti kada je zaliha premala?

Scenario number one:

Scenarij broj jedan:

we let the market forces play,

prepustimo tržišnim snagama da se bore,

and those who can pay the highest price or be the fastest to negotiate deals

i onaj tko će moći ponuditi najvišu cijenu

ili biti najbrži u pregovaranju

will get access to the product first.

prvi će dobiti pristup cjepivu.

It's not equitable at all,

Nije pravedno nimalo,

but it's a very likely scenario.

ali je vrlo moguć scenarij.

Scenario number two:

Scenarij broj dva:

we could all agree, based on public health rationale,

Svi bismo se mogli složiti, na osnovi javnog zdravstvenog razuma,

who gets the product first.

tko će prvi dobiti cjepivo.

Let's say we agree that health care workers would get it first,

Recimo da se slažemo da bi ga zdravstveni djelatnici dobili prvi,

and then the elderly

zatim starije osobe,

and then the general population.

a tada ostalo stanovništvo.

Now let me be a bit more provocative.

Dopustite da budem malo provokativna.

Scenario number three:

Scenarij broj tri:

countries who have demonstrated that they can manage the pandemic well

države koje su demonstrirale da mogu dobro podnijeti pandemiju

would get access to the product first.

prve bi dobile pristup cjepivu.

It's a little bit extrapolated,

To je malo ekstrapolirano,

but it's not complete science fiction.

no nije znanstvena fantastika.

Years ago, when the supply of high-quality second-line tuberculosis drug was scarce,

U prošlosti, kada je zaliha visoko kvalitetnog lijeka za tuberkulozu bila oskudna,

a special committee was established

specijalni komitet bio je osnovan

to determine which countries had health systems that were strong enough

kako bi odlučili koje države su imale zdravstvene sustave dovoljno jake

to ensure that the products would be distributed properly

da osiguraju pravilnu raspodjelu lijeka

and that patients would follow their treatment plans properly.

i da će pacijenti pratiti svoje planove liječenja.

Those select countries got access first.

Te odabrane države prve su dobile pristup.

Or, scenario number four:

Ili scenarij broj četiri:

we could decide on a random rule,

mogli bismo odrediti nasumično pravilo,

for instance, that people get to be vaccinated on their birthday.

na primjer, da ljudi budu cijepljeni na svoj rođendan.

Now let me ask you this:

Da vas pitam:

How does it feel to think of a future where the vaccine exists,

Kakav je osjećaj razmišljati o budućnosti u kojoj cjepivo postoji,

but you would still have to wear a mask and keep your kids home from school,

ali vi biste i dalje morali nositi masku i vaša djeca bi pratila nastavu od kuće,

and you would not be able to go to work the way you want

i ne biste imali mogućnost ići na posao kako želite

because you wouldn't have access to that product?

jer ne biste imali pristup tom cjepivu?

Every day that passed would feel unacceptable, right?

Svaki dan bio bi neprihvatljiv, zar ne?

But guess what?

Ali pogodite što?

There are many diseases for which we have treatments and even cures,

Postoji mnogo bolesti za koje imamo terapiju pa čak i lijek,

and yet people keep being infected and die every year.

no ljudi i dalje nastoje biti zaraženi i umiru svake godine.

Let's take tuberculosis:

Uzmimo primjer tuberkuloze:

10 million people infected every year,

10 milijuna zaraženih svake godine,

1.5 million people dying,

1,5 milijuna ljudi umre,

although we've had a cure for years.

iako imamo lijek već godinama.

And that's just because we haven't completely figured out

I to je samo posljedica toga što nismo potpuno shvatili

some of the key access issues.

neke od ključnih problema dostupnosti.

Equitable access is the right thing to do,

Pravedna dostupnost je ispravna stvar za učiniti,

but beyond this humanitarian argument

no osim ovog humanitarnog argumenta

that I hope we are more sensitive to

za koji se nadam da smo više osjetljivi

now that we've experienced it in our flesh,

sada kada smo ga osjetili na svojoj koži,

there is a health and an economic argument

postoji zdravstveni i ekonomski argument

to equitable access.

o pravednoj dostupnosti.

The health argument is that as long as the virus is active somewhere,

Zdravstveni argument je da ukoliko je virus negdje aktivan,

we're all at risk of reimported cases.

svi imamo rizik ponovnog uvoza virusa.

The economic argument is that because of the interdependencies

Ekonomski argument je da zbog međuzavisnosti

in our economies,

naših ekonomija,

no domestic economy can fully restart if others are not picking up as well.

nijedna domaća ekonomija ne može se ponovno pokrenuti

ukoliko to ne učine i ostale.

Think of the sectors that rely on global mobility,

Razmislite o sektorima koji ovise o globalnoj mobilnosti

like aerospace or travel and tourism.

poput zračne industrije ili putovanja i turizma.

Think of the supply chains that cut across the globe,

Razmislite o dobavljačima sa svih strana svijeta

like textiles or automotive.

poput tekstilne i automobilske industrije.

Think of the share of the economic growth that is coming from emerging markets.

Razmislite o udjelu ekonomskog rasta koji je posljedica tržišta u usponu.

The reality is that we need all countries to be able to crush the pandemic in sync.

Stvarnost je da su sve države potrebne za usklađeno zaustavljanje pandemije.

So not only is equitable access the right thing to do,

Dakle, pravedna dostupnost nije jedini ispravan potez,

it is also the smart thing to do.

već i pametan potez.

But how do we do that?

Ali kako da to učinimo?

Let's make sure we're on the same page in terms of what "access" means.

Budimo sigurni da svi isto mislimo što dostupnost znači.

It would actually mean that the product exists;

To bi zapravo značilo da proizvod postoji;

that it's working sufficiently well;

da djeluje dovoljno dobro;

that it's been approved by the local authorities;

da je odobren od strane lokalnih vlasti;

that it is affordable;

da je povoljan;

but also that there is evidence that it works in all the populations

ali i da ima dokaza da djeluje na svim populacijama koje ga trebaju,

that need it,

and that can include pregnant women or immunodepressed people, or children;

i to može uključivati trudnice, osobe sa slabim imunitetom ili djecu;

that it can be distributed in a variety of settings,

da može biti distribuiran u razne okoline,

like hospitals or rural clinics, or hot climate or cold climate;

poput bolnica ili seoskih klinika, u vruća ili hladna klimatska područja;

and that we can produce it at the right scale.

i da ga možemo proizvoditi u točnom razmjeru.

It's a very long checklist, I know,

Zaista je duga lista uvjeta, znam,

and in a non-crisis situation,

i u normalnoj situaciji,

we would likely address these issues one after the other in a sequential way,

ovim problemima bismo pristupili jednim za drugim u nizu,

which takes a lot of time.

za što je potrebno mnogo vremena.

So what do we do?

Dakle, što nam je činiti?

Access is far from being a new challenge,

Dostupnost nije nov izazov,

and in the case of COVID,

i pojavom COVID-a,

I have to say, we're seeing extraordinary collaboration

moram reći da uočavamo izvanrednu suradnju

of international organizations, civil society, industry and others

internacionalnih organizacija, građanskog društva, industrije i ostalih

to accelerate access:

kako bi se ubrzala dostupnost:

working things in parallel,

radeći paralelno,

speeding up regulatory processes,

ubrzavanjem regulatornih postupaka,

engineering supply mechanisms,

konstruiranjem dostavljačkih mehanizama,

securing procurement, mobilizing resources, etc.

osiguravanjem nabave, mobiliziranjem resursa, itd.

Yet we are likely to face a situation where, for instance,

No, vjerojatno ćemo se suočiti sa situacijom u kojoj će, na primjer,

the vaccine would need to be constantly stored at, let's say,

cjepivo biti potrebno skladištiti u, recimo,

minus 80 Celsius degrees;

minus 80 Celzijevih stupnjeva;

or where the treatment would need to be administered

ili gdje će liječenje provoditi

by a highly specialized health care worker;

visoko specijalizirani zdravstveni radnici,

or where the diagnostic would need to be analyzed

ili gdje će dijagnostiku trebati analizirati

by a sophisticated lab.

u modernim laboratorijima.

So what more can we do?

Dakle, što još možemo učiniti?

Pushing further the logic that the global health community

Nastavljajući logiku koju globalna zdravstvena zajednica

has advocated for for years,

zagovara već godinama,

there is one additional thing I can think of that might help.

postoji jedna dodatna stvar koje sam se sjetila i možda može pomoći.

There is a concept in product development and manufacturing

Postoji koncept u razvijanju proizvoda i manufakture

that's called "design to cost."

koji se zove "design to cost".

The basic idea is that the cost management conversation

Glavna ideja je da se upravljanje troškovima raspravlja

happens at the same time as the product being designed,

u isto vrijeme kada se proizvod i dizajnira,

as opposed to the product being designed first

umjesto da se proizvod prvo dizajnira

and then reworked to bring the cost down.

i zatim prerađuje kako bi se smanjili troškovi.

It's a simple method that helps ensure

To je jednostavna metoda koja pomaže osigurati

that when cost has been identified as a priority criteria for a product,

da kada je trošak identificiran kao glavni kriterij za proizvod,

it's made a target from day one.

trošak je cilj od prvog dana.

Now, in the context of health and access,

U kontekstu zdravstva i dostupnosti,

I think there is untapped potential

smatram da postoji neiskorišteni potencijal

in R and D to access,

kod istraživanja i razvoja dostupnosti

the same way that manufacturers design to cost.

na isti način na koji proizvođači dizajniraju po cijeni.

This would mean that, instead of developing a product

To bi značilo umjesto da se proizvod razvije

and then working to adapt it to ensure equitable access later,

i zatim prerađuje kako bi se osigurala pravedna dostupnost,

all of the items on the checklist I mentioned

svi uvjeti koje sam spomenula

would be built into the R and D process from the beginning,

bili bi dio procesa istraživanja i razvoja od početka,

and this would actually benefit us all.

i to bi zapravo bilo korisno svima nama.

Let's take an example.

Na primjer.

If we develop a product with equitable access in mind,

Ako razvijemo proizvod misleći na pravednu dostupnost,

we might be able to optimize for scale-up faster.

možda bismo brže mogli proizvoditi taj proizvod u većim razmjerima.

In my experience, drug developers often focus on finding a dose that works,

Prema mom iskustvu, proizvođači lijekova često se fokusiraju na pronalazak doze

and only after do they optimize the dosage or make adjustments.

koja djeluje i tek zatim optimiziraju dozu ili rade prilagodbe.

Now imagine that we're talking of a candidate product

Zamislite sada da pričamo o mogućem proizvodu

for which the active ingredient is a scarce resource.

čiji je aktivni sastojak oskudni resurs.

What if instead we focused on developing a treatment

Što bi bilo ako bismo se fokusirali na razvijanje terapije

that uses the lowest possible amount of that active ingredient?

koja koristi najmanji mogući udio tog aktivnog sastojka?

It could help us produce more doses.

To bi nam omogućilo proizvodnju više doza.

Let's take another example.

Još jedan primjer.

If we develop a product with equitable access in mind,

Ukoliko razvijemo proizvod misleći na pravednu dostupnost,

we might be able to optimize for mass distribution faster.

možda bismo mogli optimizirati masovnu distribuciju brže.

In high-income countries,

U visoko prihodnim državama

we have strong health systems capacity.

imamo snažne zdravstvene sustave velikih kapaciteta.

We can always distribute products the way we want.

Uvijek možemo distribuirati proizvode kako želimo.

So we often take for granted that products can be stored

Često uzimamo zdravo za gotovo da proizvodi mogu biti skladišteni

in temperature-controlled environments

u prostorijama kontrolirane temperature

or requires a highly skilled health care worker for administration.

ili da trebaju visoko specijalizirane zdravstvene radnike za administraciju.

Of course,

Naravno,

temperature-controlled environments and highly skilled health care workers

prostorije kontrolirane temperature i visoko specijalizirani zdravstveni radnici

are not available everywhere.

nisu svugdje dostupni.

If we were to approach R and D

Ako pristupimo R & D-u

with the constraints of weaker health systems in mind,

misleći na ograničenja slabijih zdravstvenih sustava,

we might get creative

mogli bismo biti kreativni

and develop sooner, for instance, temperature-agnostic products

i razviti brže, na primjer, proizvode neovisne o temperaturi

or products that can be taken as easily as a vitamin

ili proizvode koji se mogu uzimati kao vitamini

or long-lasting formulations instead of repeat doses.

ili dugotrajne formule umjesto ponavljajućih doza.

If we were able to produce and develop such simplified tools,

Ako bismo mogli proizvoditi i razvijati takva pojednostavljena sredstva,

it would have the added benefit

imali bismo dodatnu korist

of putting less strains on hospitals and health systems

stavljanja manje pritiska na bolnice i zdravstvene sustave

for both high- and low-income countries.

u visoko prihodnim i nisko prihodnim državama.

Given the speed of the virus

Suočeni brzinom širenja virusa

and the magnitude of the consequences we're facing,

i magnitudom posljedica,

I think we have to continue challenging ourselves

smatram da trebamo nastaviti gurati sami sebe

to find the fastest way to make products to fight COVID

da pronađemo najbrži način proizvodnje proizvoda protiv COVID-a

and future pandemics accessible to all.

i budućih pandemija dostupnih svima.

In my perspective,

Iz moje perspektive,

unless the virus disappears,

ukoliko virus ne nestane,

there are two ways this story ends.

postoje samo dva završetka ove priče.

Either the scales tip one way --

Ili će vaga prevagnuti na jednu stranu --

only some of us get access to the product

tako da samo neki od nas imaju pristup proizvodu

and COVID remains a threat to all of us --

i da COVID ostane prijetnja svima nama --

or we balance the scales,

ili da uravnotežimo vagu,

we all get access to the right weapons,

da svi dobijemo pristup ispravnim sredstvima

and we all move on together.

i nastavimo dalje zajedno.

Innovative R and D can't beat COVID alone,

Inovativni R & D ne mogu pobijediti COVID sami,

but innovative management of R and D might help.

ali inovativno upravljanje R & D-om možda pomogne.

Thank you.

Hvala.