Romina Libster: The power of herd immunity (with English subtitles) | TED

Translator: Gisela Giardino Reviewer: Romina Pol

Prevodilac: Milenka Okuka Lektor: Ivana Korom

One of the first patients I had to see as a pediatrician was Sol,

Jedan od prvih pacijenata koje sam imala kao pedijatar bila je Sol,

a beautiful month-old baby

prelepa beba od mesec dana,

who was admitted with signs of a severe respiratory infection.

koja je došla u ordinaciju sa simptomima ozbiljne respiratorne infekcije.

Until then, I had never seen a patient worsen so fast.

Nikada do tad nisam videla pacijenta

čije se stanje tako brzo pogoršava.

In just two days she was connected to a respirator

Za samo dva dana priključili smo je na respirator,

and on the third day she died.

a trećega dana je preminula.

Sol had whooping cough.

Sol je imala veliki kašalj.

After discussing the case in the room and after a quite distressing catharsis,

Nakon diskusije o slučaju, u ordinaciji

i nakon izuzetno tegobne katarze,

sećam se da mi je šef sale rekao:

I remember my chief resident said to me,

"Okay, take a deep breath. Wash your face.

"U redu, diši duboko, umij se

And now comes the hardest part:

jer sad nam sledi najteži deo,

moramo da razgovaramo s roditeljima."

We have to go talk to her parents."

U tom momentu na hiljade pitanja vam prođe kroz glavu.

At that time, a thousand questions came to mind,

Od pitanja: zašto je jednomesečna beba

from, "How could a one-month-old baby be so unfortunate?"

bila tako loše sreće,

to, "Could we have done something about it?"

do pitanja: da li smo mogli nekako da to izbegnemo.

Pre vakcina,

Before vaccines existed,

many infectious diseases killed millions of people per year.

razne zarazne bolesti

su ubijale milione ljudi godišnje.

During the 1918 flu pandemic

Tokom pandemije gripa 1918. godine

umrlo je 50 miliona ljudi.

50 million people died.

That's greater than Argentina's current population.

To je više ljudi nego što ih ima današnja Argentina.

Možda se malo stariji među vama

Perhaps, the older ones among you remember the polio epidemic

sećaju epidemije dečje paralize

that occurred in Argentina in 1956.

koja je izbila u Argentini 1956. godine.

At that time, there was no vaccine available against polio.

Tada nije bilo dostupnih vakcina za dečju paralizu.

People didn't know what to do. They were going crazy.

Ljudi nisu znali šta da rade.

Bili su kao ludi.

They would go painting trees with caustic lime.

Izlazili su na ulice i krečili drveće.

They'd put little bags of camphor

Stavljali su deci u odeću vrećice s kamforom

in their children's underwear, as if that could do something.

kao da od toga ima neke koristi.

Tokom epidemije dečje paralize umrlo je na hiljade ljudi.

During the polio epidemic, thousands of people died.

And thousands of people were left with very significant neurological damage.

I hiljadama ljudi su ostale ozbiljne neurološke posledice.

I know this because I read about it,

Ja to znam jer sam čitala o tome,

jer zahvaljujući vakcinama

because thanks to vaccines, my generation was lucky

moja generacija je imala sreće

da ne mora da proživljava tako strašnu epidemiju.

to not live through an epidemic as terrible as this.

Vaccines are one of the great successes of the 20th century's public health.

Vakcine su jedno od najvećih dostignuća

javnog zdravlja u XX veku.

After potable water,

Odmah nakon pijaće vode,

they are the interventions that have most reduced mortality,

to je intervencija koja je najviše doprinela smanjenju smrtnosti,

even more than antibiotics.

čak i više od antibiotika.

Vaccines eradicated terrible diseases such as smallpox from the planet

Vakcine su uspešno iskorenile s planete

bolest tako strašnu kao što su velike boginje

i uspele su da značajno umanje smrtnost

and succeeded in significantly reducing mortality

due to other diseases such as measles,

od drugih bolesti, poput malih boginja,

whooping cough, polio and many more.

velikog kašlja, dečje paralize i mnogih drugih.

Sve ove bolesti spadaju u grupu bolesti

All these diseases are considered vaccine-preventable diseases.

koje se zovu bolestima koje se mogu sprečiti vakcinama.

What does this mean?

Šta to znači?

That they are potentially preventable,

Da se potencijalno mogu sprečiti,

ali da bismo u tome uspeli, nešto moramo da preduzmemo.

but in order to be so, something must be done.

You need to get vaccinated.

Moramo da se vakcinišemo.

Pretpostavljam da je velika većina, ako ne i svi mi ovde,

I imagine that most, if not all of us here today,

received a vaccine at some point in our life.

primila bar jednom u životu neku vakcinu.

E sad, ne bih bila tako ubeđena

Now, I'm not so sure that many of us know

da mnogi među nama znaju koje su to vakcine, iliti imunizatori

which vaccines or boosters we should receive after adolescence.

koje moramo da primimo nakon adolescencije.

Have you ever wondered who we are protecting

Jeste li se nekada zapitali koga štitimo

when we vaccinate?

kada se vakcinišemo?

What do I mean by that?

Šta hoću da kažem?

Is there any other effect beyond protecting ourselves?

Da li su efekti vakcinacije veći

od zaštite nas samih?

Dozvolite da vam nešto pokažem.

Let me show you something.

Imagine for a moment

Zamislite na trenutak

da se nalazimo u gradu

that we are in a city

koji nikada nije imao iskustva s određenom bolešću,

that has never had a case of a particular disease,

such as the measles.

poput, na primer, malih boginja.

This would mean that no one in the city has ever had contact with the disease.

Šta želim da kažem?

U tom gradu niko nikada nije dolazio u dodir s tom bolešću,

to jest ne postoji prirodni imunitet,

No one has natural defenses against, nor been vaccinated against measles.

niti je iko vakcinisan protiv malih boginja.

Ako bi se jednoga dana, u tom gradu pojavila osoba

If one day, a person sick with the measles appears in this city

koja boluje od malih boginja,

the disease won't find much resistance

bolest ne bi naišla na dovoljan otpor

and will begin spreading from person to person,

i počela bi da se prenosi sa osobe na osobu,

and in no time it will disseminate throughout the community.

i za kratko vreme zarazila bi celokupnu zajednicu.

After a certain time

Za određeno vreme

a big part of the population will be ill.

velika većina stanovništva bila bi bolesna.

This happened when there were no vaccines.

To se dešavalo kada nije bilo vakcina.

Now, imagine the complete opposite case.

A sada, zamislite potpuno suprotan slučaj.

We are in a city

Nalazimo se u gradu

where more than 90 percent of the population

gde više od 90% stanovništva

has defenses against the measles, which means

ima izgrađen imunitet protiv malih boginja.

Što će reći da su preležali tu bolest

that they either had the disease, survived, and developed natural defenses;

i da su stekli prirodni imunitet.

or that they had been immunized against measles.

Preživeli su.

Ili su primili vakcinu protiv malih boginja.

I jednoga dana, u tom gradu se pojavi

If one day,

a person sick with the measles appears in this city,

osoba bolesna od malih boginja.

the disease will find much more resistance

Bolest će da naiđe na mnogo veći otpor

and won't be transmitted that much from person to person.

i neće moći toliko da se prenosi sa osobe na osobu.

The spread will probably remain contained

Širenje će, najverovatnije, da bude obuzdano

and a measles outbreak won't happen.

i neće doći do epidemije malih boginja.

Želim da vam skrenem pažnju na nešto.

I would like you to pay attention to something.

People who are vaccinated

Vakcinisane osobe,

are not only protecting themselves,

ne samo da štite same sebe,

već i sprečavaju širenje bolesti

but by blocking the dissemination of the disease

within the community,

unutar zajednice,

they are indirectly protecting the people in this community

oni, indirektno, štite osobe iz zajednice

koje nisu vakcinisane.

who are not vaccinated.

They create a kind of protective shield

Oni formiraju svojevrstan štit

which prevents them from coming in contact with the disease,

koji nevakcinisane čuva od kontakta s bolešću,

so that these people are protected.

te oni ostaju zaštićeni.

This indirect protection

Taj efekat indirektne zaštite

that the unvaccinated people within a community receive

nevakcinisanih osoba unutar zajednice,

samo zbog toga što su okruženi vakcinisanim pojedincima,

simply by being surrounded by vaccinated people,

is called herd immunity.

se zove kolektivni imunitet.

Mnogi unutar zajednice

Many people in the community

depend almost exclusively on this herd immunity

zavise, gotovo isključivo, od kolektivnog imuniteta

da bi se zaštitili od bolesti.

to be protected against disease.

The unvaccinated people you see in infographics are not just hypothetical.

Ti ljudi nisu prosto hipoteze u nekoj animaciji.

Ti ljudi su naša rodbina,

Those people are our nieces and nephews, our children,

naša deca,

who may be too young to receive their first shots.

koja su možda isuviše mala da bi primila svoje prve vakcine.

To su naši roditelji, naši bližnji,

They are our parents, our siblings,

our acquaintances,

naši poznanici,

who may have a disease,

koji možda imaju neku bolest

or take medication that lowers their defenses.

ili primaju neki lek koji im narušava imunitet.

Takođe postoje ljudi koji su alergični

There are also people who are allergic to a particular vaccine.

na određenu vakcinu.

Takođe, među nama se nađu i oni

They could even be among us,

any of us who got vaccinated,

koji se vakcinišu,

ali kod kojih vakcina

but the vaccine didn't produce the expected effect,

ne postigne željeni efekat.

Jer nisu sve vakcine uvek 100% efikasne.

because not all vaccines are always 100 percent effective.

All these people depend almost exclusively on herd immunity

Svi ti ljudi zavise, gotovo isključivo,

od kolektivnog imuniteta

to be protected against diseases.

da bi se zaštitili od boesti.

To achieve this effect of herd immunity,

Da bi se postigao efekat kolektivnog imuniteta

potrebno je da značajan procenat stanovništva bude vakcinisan.

it is necessary that a large percentage of the population be vaccinated.

This percentage is called the threshold.

Taj procenat se zove prag.

The threshold depends on many variables:

Prag zavisi od mnogo varijabli.

Zavisi od karakteristika klice,

It depends on the germ's characteristics,

and those of the immune response that the vaccine generates.

od karakteristika imunološke reakcije

koju prouzrokuje vakcina.

Ali svi imaju nešto zajednčko:

But they all have something in common.

If the percentage of the population in a vaccinated community

ako je procenat vakcinisanog stanovništva u jednoj zajednici

is below this threshold number,

ispod vrednosti praga,

bolest počinje da se širi slobodnije

the disease will begin to spread more freely

and may generate an outbreak of this disease within the community.

i može da pređe u epidemiju u toj zajednici.

Even diseases which were at some point controlled may reappear.

Takođe i bolesti koje su u ovom trenutku pod kontrolom

mogu ponovo da se vrate.

This is not just a theory.

Ovo nije puka teorija.

This has happened, and is still happening.

Ovo se dešavalo i dešava se i dalje.

Godine 1998, jedan britanski istraživač

In 1998, a British researcher published an article

je objavio članak u jednom od najuticajnijih časopisa iz medicine

in one of the most important medical journals,

saying that the MMR vaccine,

u kome je tvrdio da MMR vakcina,

koja se daje protiv malih boginja, zauški i rubeole,

which is given for measles, mumps and rubella,

was associated with autism.

uzrokuje autizam.

This generated an immediate impact.

Ovo je imalo trenutni učinak.

Ljudi su odustajali od vakcinacije,

People began to stop getting vaccinated, and stopped vaccinating their children.

prestali su da vakcinišu svoju decu.

And what happened?

I šta se desilo?

The number of people vaccinated,

Broj vakcinisanih

in many communities around the world, fell below this threshold.

u mnogim zajednicama u svetu

je pao ispod vrednosti praga.

And there were outbreaks of measles in many cities in the world --

Imali smo epidemiju malih boginja

u mnogim gradovima u svetu.

in the U.S., in Europe.

U SAD-u, u Evropi.

Many people got sick.

Mnogi ljudi su oboleli,

a neki su i umrli od malih boginja.

People died of measles.

What happened?

Šta se desilo?

This article also generated a huge stir within the medical community.

Ovaj članak je izazvao ogromnu pometnju

unutar zdravstva.

Desetine naučnika odlučili su da provere

Dozens of researchers began to assess if this was actually true.

da li je ovo uistinu tačno.

Ne samo da niko nije mogao da pronađe

Not only could no one find

a causal association between MMR and autism at the population level,

uzročno-posledičnu vezu između MMR vakcine

i autizma na nivou populacije,

but it was also found that this article had incorrect claims.

već su i otkrili da sam članak

sadrži brojne neistine.

Even more, it was fraudulent.

I ne samo to, već i da je u pitanju obmanjivanje.

Obmanjivao je javnost.

It was fraudulent.

Kao posledica toga, časopis se javno ogradio

In fact, the journal publicly retracted the article in 2010.

od tog članka 2010. godine.

One of the main concerns and excuses for not getting vaccinated

Jedan od glavnih razloga i izgovora za nevakcinisanje,

u ovom trenutku su negativna dejstva.

are the adverse effects.

Vakcine, kao i lekovi,

Vaccines, like other drugs, can have potential adverse effects.

mogu da imaju negativna dejstva.

Most are mild and temporary.

Većinom se radi o blagim i privremenim dejstvima.

But the benefits are always greater than possible complications.

Ali korist je uvek veća

od potencijalnih komplikacija.

When we are ill, we want to heal fast.

Kada smo bolesni,

želimo što pre da se izlečimo.

Većina nas ovde,

Many of us who are here

take antibiotics when we have an infection,

kada imamo neku infekciju,

uzmemo antibiotike.

Ako imamo povišen pritisak, uzimamo antihipertenzive.

we take anti-hypertensives when we have high blood pressure,

Uzimamo lekove za srce.

we take cardiac medications.

Zašto? Zato što smo bolesni

Why? Because we are sick and we want to heal fast.

i želimo da brzo ozdravimo.

And we don't question it much.

I ne razmišljamo previše.

Why is it so difficult to think of preventing diseases,

Zašto nam je toliko teško

da suzbijamo bolesti,

by taking care of ourselves when we are healthy?

tako što ćemo da brinemo o sebi dok smo zdravi?

Brinemo se o sebi mnogo kada smo bolesni

We take care of ourselves a lot when affected by an illness,

ili se pazimo neposredno pred trenutnom opasnošću.

or in situations of imminent danger.

Pretpostvaljam da se većina vas ovde

I imagine most of us here,

remember the influenza-A pandemic

seća pandemije gripa

koja se desila ovde u Argentini, i u celom svetu, 2009. godine.

which broke out in 2009 in Argentina and worldwide.

When the first cases began to come to light,

Kada su prvi slučajevi obelodanjeni,

we, here in Argentina, were entering the winter season.

kod nas u Argentini je počinjala zima.

We knew absolutely nothing.

Ništa se nije znalo.

Sve je bilo haotično.

Everything was a mess.

People wore masks on the street, ran into pharmacies to buy alcohol gel.

Ljudi su s maskama izlazili na ulice,

hrlili smo u apoteke

da bismo kupili alkohol u gelu.

People would line up in pharmacies to get a vaccine,

Ljudi su formirali redove u apotekama da bi primili vakcinu,

without even knowing if it was the right vaccine

a da nisu ni znali da li ih ta vakcina štiti od ovog novog virusa.

that would protect them against this new virus.

We knew absolutely nothing.

Apsolutno ništa se nije znalo.

At that time, in addition to doing my fellowship at the Infant Foundation,

Ja sam tada, pored toga što sam stažirala na Institutu za novorođenčad,

I worked as a home pediatrician for a prepaid medicine company.

radila kao kućni pedijatar

za jednu privatnu medicinsku kompaniju.

I remember that I started my shift at 8 a.m.,

Sećam se da bih započela dežurstvo u osam ujutru

and by 8, I already had a list of 50 scheduled visits.

i već u osam sati sam dobijala listu od pedeset zakazanih poseta.

Bilo je haotično, ljudi nisu znali šta da rade.

It was chaos; people didn't know what to do.

I remember the types of patients that I was examining.

Sećam se da su mi privukle pažnju

odlike pacijenata koje sam gledala.

The patients were a little older than what we were used to seeing in winter,

To su bili pacijenti nešto stariji

od onih koje smo navikli da gledamo tokom zime,

s groznicom koja je duže trajala.

with longer fevers.

I sećam se da sam to pomenula mom mentoru

And I mentioned that to my fellowship mentor,

kod kog sam stažirala,

and he, for his part, had heard the same from a colleague,

a on je čuo, od jednog kolege,

about the large number of pregnant women

da je veliki broj trudnica

and young adults

i mladih ljudi

poslato na intenzivnu negu

being hospitalized in intensive care,

with hard-to-manage clinical profiles.

s ne baš tako dobrim izgledima.

At that time, we set out to understand what was happening.

Tada smo odlučili da pokušamo da dokučimo

šta se to dešava.

First thing Monday morning, we took the car

U ponedeljak, čim je svanulo, ušli smo u auto

i odvezli se do bolnice u predgrađu Buenos Ajresa

and went to a hospital in Buenos Aires Province,

u koju su upućivani

that served as a referral hospital for cases of the new influenza virus.

slučajevi novog virusa gripa.

Stigli smo u bolnicu, koja je vrvela od ljudi.

We arrived at the hospital; it was crowded.

All health staff were dressed in NASA-like bio-safety suits.

Svi medicinski radnici su bili obučeni u zaštitna odela, poput NASA-inih.

We all had face masks in our pockets.

A mi smo imali po maskicu u džepu.

I, being a hypochondriac, didn't breathe for two hours.

Ja, hipohondar, nisam disala dva sata.

Ali bilo nam je jasno šta se dešavalo.

But we could see what was happening.

Immediately, we started reaching out to pediatricians

Istog trena smo stupili u kontakt

s pedijatrima iz šest bolnica u Buenos Ajresu i iz predgrađa.

from six hospitals in the city and in Buenos Aires Province.

Our main goal was to find out

I predložili smo da, u najkraćem roku,

how this new virus behaved in contact with our children,

otkrijemo kako se manifestuje ovaj novi virus kod naše dece.

in the shortest time possible.

A marathon work.

U jednom maratonskom poduhvatu,

za manje od tri meseca,

In less than three months,

we could see what effect this new H1N1 virus had

mogli smo da vidimo kakve su odlike ovog novog virusa H1N1

on the 251 children hospitalized by this virus.

kod 251 deteta, hospitalizovanog zbog ovog virusa.

We could see which children got more seriously ill:

Mogli smo da vidimo koja deca su najozbiljnije obolela,

children under four, especially those less than one year old;

a to su bili mlađi od četiri godine,

naročito oni mlađi od godinu dana,

pacijenti s neurološkim oboljenjima,

patients with neurological diseases;

and young children with chronic pulmonary diseases.

mališani s hroničnim plućnim bolestima.

Identifying these at-risk groups was important

Identifikovati te rizične grupe, bilo je izuzetno važno

to include them as priority groups

kako bismo mogli da ih obeležimo kao prioritetne grupe

in the recommendations for getting the influenza vaccine,

za primanje vakcine protiv gripa,

ne samo ovde u Argentini,

not only here in Argentina,

već i drugde gde još uvek nije stigla pandemija.

but also in other countries which the pandemic not yet reached.

A year later,

Godinu dana kasnije,

when a vaccine against the pandemic H1N1 virus became available,

kada je vakcina protiv gripa H1N1 već bila dostupna,

we wanted to see what happened.

želeli smo da vidimo šta se dešava.

After a huge vaccination campaign

Nakon obuhvatne kampanje za vakcinaciju,

aimed at protecting at-risk groups,

usmerene na zaštitu rizičnih grupa,

u ovim bolnicama,

these hospitals, with 93 percent of the at-risk groups vaccinated,

gde je 93% vakcinisanih iz rizičnih grupa,

had not hospitalized a single patient

nismo imali ni jedan slučaj hospitalizacije

for the pandemic H1N1 virus.

zbog pandemije virusa H1N1.

(Applause)

(Aplauz)

In 2009: 251.

Godine 2009: 251 slučaj.

Godine 2010: nula.

In 2010: zero.

Vaccination is an act of individual responsibility,

Vakcinacija je čin lične odgovornosti,

but it has a huge collective impact.

koji ima ogroman uticaj na društvo.

If I get vaccinated, not only am I protecting myself,

Ako se vakcinišem, ne štitim samo sebe,

but I am also protecting others.

takođe štitim druge.

Sol had whooping cough.

Sol je imala veliki kašalj.

Sol was very young,

Sol je bila isuviše mala i još uvek nije bila primila

and she hadn't yet received her first vaccine against whooping cough.

svoju prvu vakcinu protiv velikog kašlja.

I still wonder what would have happened

Ja se i danas pitam, šta bi se desilo

if everyone around Sol had been vaccinated.

da su sve osobe u Solinom okruženju

bile vakcinisane.

(Applause)

(Aplauz)