Ramanan Laxminarayan: The coming crisis in antibiotics

Prevodilac: Ljiljana Ikodinovic Lektor: Mile Živković

The first patient to ever be treated with an antibiotic

Prvi pacijent ikada lečen antibiotikom

was a policeman in Oxford.

je bio oksfordski policajac.

On his day off from work,

On se tokom slobodnog dana,

he was scratched by a rose thorn while working in the garden.

radeći u bašti, ogrebao o ružin trn.

That small scratch became infected.

Ta mala ogrebotina se inficirala.

Over the next few days, his head was swollen

Tokom nekoliko narednih dana, čitava glava mu je bila otečena

with abscesses,

gnojnim čirevima,

and in fact his eye was so infected

a oko mu je bilo toliko inficirano

that they had to take it out,

da su morali da ga izvade,

and by February of 1941,

te je do februara 1941,

this poor man was on the verge of dying.

ovaj jadan čovek bio na rubu smrti.

He was at Radcliffe Infirmary in Oxford,

Bio je u ambulanti Redklif u Oksfordu,

and fortunately for him,

i na njegovu sreću,

a small team of doctors

mali tim lekara

led by a Dr. Howard Florey

predvođen dr Hauardom Florijem

had managed to synthesize

je uspeo da sintetizuje

a very small amount of penicillin,

jako malu količinu penicilina,

a drug that had been discovered

leka koji je 12 godina ranije

12 years before by Alexander Fleming

otkrio Aleksandar Fleming

but had never actually been used to treat a human,

ali koji nikada nije bio korišćen u lečenju ljudi,

and indeed no one even knew if the drug would work,

i zaista niko nije znao ni da li će lek delovati,

if it was full of impurities that would kill the patient,

da li je pun nečistoća koje bi ubile pacijenta,

but Florey and his team figured

ali su Florej i njegov tim računali

if they had to use it, they might as well use it

da ako već treba da ga upotrebe,

on someone who was going to die anyway.

onda bolje da ga daju nekome ko će svakako umreti.

So they gave Albert Alexander,

Tako da su Albertu Aleksandru,

this Oxford policeman, the drug,

tom oksfordskom policajcu, dali lek

and within 24 hours,

i tokom 24 sata,

he started getting better.

počelo je da mu postaje bolje.

His fever went down, his appetite came back.

Pala mu je temperatura, povratio se apetit.

Second day, he was doing much better.

Drugog dana mu je bilo znatno bolje.

They were starting to run out of penicillin,

Počelo je da im ponestaje penicilina,

so what they would do was run with his urine

i oni bi sa njegovim urinom

across the road to re-synthesize the penicillin from his urine

trčali na drugu stranu ulice, kako bi iz urina resintetizovali penicilin

and give it back to him,

i ponovo mu ga dali,

and that worked.

i to je dalo rezultate.

Day four, well on the way to recovery.

Četvrtog dana, uveliko na putu izlečenja.

This was a miracle.

To je bilo čudo.

Day five, they ran out of penicillin,

Petog dana im je nestalo penicilina

and the poor man died.

i ovaj nesrećni čovek je umro.

So that story didn't end that well,

Tako da ta priča nema srećan kraj,

but fortunately for millions of other people,

ali na sreću miliona drugih ljudi,

like this child who was treated again in the early 1940s,

poput ovog deteta koje je lečeno ranih 1940-ih,

who was again dying of a sepsis,

koje je umiralo od sepse,

and within just six days, you can see,

i koje se tokom samo šest dana, kao što vidite,

recovered thanks to this wonder drug, penicillin.

oporavilo zahvaljujući tom magičnom leku, penicilinu.

Millions have lived,

Milioni su preživeli,

and global health has been transformed.

i globalno zdravlje je bilo promenjeno.

Now, antibiotics have been used

Antibioticima su lečeni

for patients like this,

pacijenti poput ovih,

but they've also been used rather frivolously

ali su korišćeni i prilično lakomisleno

in some instances,

u nekim slučajevima,

for treating someone with just a cold or the flu,

kako bi se pacijenti lečili od samo prehlade ili gripa,

which they might not have responded to an antibiotic,

na koje antibiotici možda i nisu delovali,

and they've also been used in large quantities

a i korišćeni su u velikim količinama

sub-therapeutically, which means in small concentrations,

neterapeutski, što znači u maloj koncentraciji,

to make chicken and hogs grow faster.

kako bi se ubrzao rast kokoški i svinja.

Just to save a few pennies on the price of meat,

Samo zarad uštede od nekoliko penija na ceni mesa,

we've spent a lot of antibiotics on animals,

potrošili smo velike količine antibiotika na životinje,

not for treatment, not for sick animals,

ne radi lečenja, ne na bolesne životinje,

but primarily for growth promotion.

već prvenstveno radi ubrzavanja rasta.

Now, what did that lead us to?

I gde nas je to dovelo?

Basically, the massive use of antibiotics

Suštinski, velika upotreba antibiotika

around the world

širom sveta

has imposed such large selection pressure on bacteria

je bakterijama nametnula tako oštru selekciju

that resistance is now a problem,

da je danas problem otpornost,

because we've now selected for just

jer smo sada selektovali

the resistant bacteria.

samo otporne bakterije.

And I'm sure you've all read about this in the newspapers,

Siguran sam da ste svi o ovome čitali u novinama,

you've seen this in every magazine

videli u svakom magazinu

that you come across,

na koji ste naišli,

but I really want you to appreciate

ali zaista želim da pravilno shvatite

the significance of this problem.

značaj ovog problema.

This is serious.

Ovo je ozbiljno.

The next slide I'm about to show you is of carbapenem resistance in acinetobacter.

Sledeći slajd koji ću vam pokazati je otpornost acinetobaktera na karbapenem.

Acinetobacter is a nasty hospital bug,

Acinetobakter je opasan bolnički bacil,

and carbapenem is pretty much

a karbapenem je gotovo

the strongest class of antibiotics

najjača klasa antibiotika

that we can throw at this bug.

kojom bismo mogli da ga napadnemo.

And you can see in 1999

I vidite 1999.

this is the pattern of resistance,

ovo je model otpornosti,

mostly under about 10 percent across the United States.

uglavnom ispod 10 procenata širom Sjedinjenih Država.

Now watch what happens when we play the video.

A sada pogledajte šta se dešava kada pustimo video.

So I don't know where you live,

Ne znam gde živite,

but wherever it is, it certainly is a lot worse now

ali gde god to bilo, sada je sigurno daleko lošije

than it was in 1999,

nego što je bilo 1999,

and that is the problem of antibiotic resistance.

i to je problem otpornosti na antibiotike.

It's a global issue

To je globalno pitanje

affecting both rich and poor countries,

koje pogađa i bogate i siromašne zemlje,

and at the heart of it, you might say, well,

možda ćete reći, pa suštinski,

isn't this really just a medical issue?

zar to nije zapravo medicinski problem?

If we taught doctors how not to use antibiotics as much,

Ukoliko naučimo lekare da ne koriste tako mnogo antibiotike,

if we taught patients how not to demand antibiotics,

ukoliko naučimo pacijente da ih ne traže,

perhaps this really wouldn't be an issue,

možda to zaista i ne bi bio problem,

and maybe the pharmaceutical companies

i možda bi farmaceutske kompanije

should be working harder to develop

trebale da rade napornije

more antibiotics.

na razvijanju novih antibiotika.

Now, it turns out that there's something fundamental about antibiotics

Ispostavilo se da je kod antibiotika nešto temeljno drugačije

which makes it different from other drugs,

nego kod drugih lekova,

which is that if I misuse antibiotics

a to je da moje zloupotrebljavanje

or I use antibiotics,

ili upotrebljavanje antibiotika,

not only am I affected but others are affected as well,

neće samo uticati na mene, već i na druge,

in the same way as if I choose to drive to work

baš kao i moja odluka da na posao idem kolima

or take a plane to go somewhere,

ili da nekuda letim avionom,

that the costs I impose on others

cena koju drugima namećem

through global climate change go everywhere,

kroz globalnu promenu klime ide svuda,

and I don't necessarily take these costs into consideration.

a nije izvesno da tu cenu uzimam u razmatranje.

This is what economists might call a problem of the commons,

To je ono što bi ekonomisti mogli nazvati problemom zajedničkih dobara

and the problem of the commons is exactly

a problem zajedničkih dobara

what we face in the case of antibiotics as well:

je upravo ono sa čime se suočavamo i u slučaju antibiotika:

that we don't consider —

da mi ne uzimamo u obzir -

and we, including individuals, patients,

a "mi" uključuje: pojedince, pacijente,

hospitals, entire health systems —

bolnice, čitave zdravstvene sisteme -

do not consider the costs that they impose on others

ne uzimamo u obzir cenu koju namećemo drugima

by the way antibiotics are actually used.

načinom na koji se koriste antibiotici.

Now, that's a problem that's similar

To je problem sličan

to another area that we all know about,

drugoj oblasti koju svi poznajemo,

which is of fuel use and energy,

a to je korišćenje goriva i energije,

and of course energy use

i naravno korišćenje energije

both depletes energy as well as

crpi energiju

leads to local pollution and climate change.

i vodi ka lokalnom zagađenju i klimatskim promenama.

And typically, in the case of energy,

A u slučaju energije, tipično

there are two ways in which you can deal with the problem.

postoje dva načina na koja možete da se nosite sa problemom.

One is, we can make better use of the oil that we have,

Prvi je da bolje koristimo naftu koju imamo,

and that's analogous to making better use

što je istovetno boljoj upotrebi

of existing antibiotics,

postojećih antibiotika,

and we can do this in a number of ways

i to možemo da činimo na različite načine

that we'll talk about in a second,

o kojima ćemo uskoro govoriti,

but the other option is the "drill, baby, drill" option,

a druga mogućnost je: "drill, baby, drill" opcija,

which in the case of antibiotics is to go find new antibiotics.

što u slučaju antibiotika znači pronalaženje novih antibiotika.

Now, these are not separate.

Ovo nije razdvojivo.

They're related, because if we invest heavily

Povezano je, jer ukoliko značajno investiramo

in new oil wells,

u nova naftna polja,

we reduce the incentives for conservation of oil

smanjujemo podstrek očuvanju nafte

in the same way that's going to happen for antibiotics.

na isti način koji će se dogoditi u slučaju antibiotika.

The reverse is also going to happen, which is that

Dogodiće se i obrnuti slučaj,

if we use our antibiotics appropriately,

da ukoliko antibiotike koristimo na odgovarajući način,

we don't necessarily have to make the investments

ne moramo nužno da investiramo

in new drug development.

u razvijanje novih lekova.

And if you thought that these two were entirely,

I ukoliko ste mislili da su ove dve mogućnosti

fully balanced between these two options,

u potpunosti uravnotežene,

you might consider the fact that

možete uzeti u obzir činjenicu

this is really a game that we're playing.

da je to zapravo igra koju igramo.

The game is really one of coevolution,

To je igra koevolucije,

and coevolution is, in this particular picture,

a koevolucija je, na ovoj konkretnoj fotografiji

between cheetahs and gazelles.

između geparda i gazela.

Cheetahs have evolved to run faster,

Gepard je evoluirao da brže trči,

because if they didn't run faster,

jer ukoliko ne trči brže,

they wouldn't get any lunch.

neće dobiti ručak.

Gazelles have evolved to run faster because

Gazele su evoluirale da trče brže

if they don't run faster, they would be lunch.

jer ukoliko ne trče brže, postaće ručak.

Now, this is the game we're playing against the bacteria,

Dakle, ovo je igra koju igramo sa bakterijama,

except we're not the cheetahs,

izuzev što mi nismo gepardi,

we're the gazelles,

mi smo gazele,

and the bacteria would,

i bakterija bi,

just in the course of this little talk,

samo tokom ovog kratkog govora,

would have had kids and grandkids

dobila decu i unuke

and figured out how to be resistant

i shvatila kako da bude otporna

just by selection and trial and error,

samo selekcijom i proverom raznih mogućnosti,

trying it over and over again.

upornim pokušavanjem.

Whereas how do we stay ahead of the bacteria?

A kako da preduhitrimo bakteriju?

We have drug discovery processes,

Imamo procese otkrivanja lekova,

screening molecules,

ispitivanje molekula,

we have clinical trials,

imamo klinička testiranja,

and then, when we think we have a drug,

a onda, kada mislimo da imamo lek,

then we have the FDA regulatory process.

tada imamo regulatorni proces Uprave za hranu i lekove (FDA)

And once we go through all of that,

I kada jednom prođemo kroz sve to,

then we try to stay one step ahead

tada pokušavamo da budemo

of the bacteria.

korak ispred bakterije.

Now, this is clearly not a game that can be sustained,

Jasno je da ovo nije održiva igra,

or one that we can win

ili igra u kojoj možemo da pobedimo

by simply innovating to stay ahead.

koristeći samo inovaciju.

We've got to slow the pace of coevolution down,

Moramo da usporimo ritam koevolucije,

and there are ideas that we can borrow from energy

a postoje ideje koje možemo da pozajmimo od energetike,

that are helpful in thinking about

i koje su korisne u razmišljanjima

how we might want to do this in the case

o tome kako da postupimo

of antibiotics as well.

i u slučaju antibiotika.

Now, if you think about how we deal with

Ukoliko razmislite o tome kako formiramo

energy pricing, for instance,

cene energenata, na primer,

we consider emissions taxes,

mi uračunavamo takse za zagađenje,

which means we're imposing the costs of pollution

što znači da cenu zagađenja naplaćujemo

on people who actually use that energy.

ljudima koji koriste tu energiju.

We might consider doing that for antibiotics as well,

Mogli bismo da razmislimo da isto učinimo sa antibioticima,

and perhaps that would make sure that antibiotics

i možda bi to obezbedilo

actually get used appropriately.

odgovarajuću upotrebu antibiotika.

There are clean energy subsidies,

Postoje subvencije za čistu energiju,

which are to switch to fuels which don't pollute as much

što znači prelazak na korišćenje goriva koja manje zagađuju

or perhaps don't need fossil fuels.

ili koja nisu fosilna goriva.

Now, the analogy here is, perhaps we need

Ovde je analogija da možda treba

to move away from using antibiotics,

da manje koristimo antibiotike

and if you think about it, what are good substitutes for antibiotics?

i ako o tome razmislite, koja je dobra alternativa antibioticima?

Well, turns out that anything that reduces

Pa, ispada da bi delovalo sve što smanjuje

the need for the antibiotic would really work,

potrebu za upotrebom antibiotika,

so that could include improving hospital infection control

a to uključuje i poboljšanje kontrole bolničkih infekcija

or vaccinating people,

ili vakcinisanje,

particularly against the seasonal influenza.

naročito protiv sezonskog gripa.

And the seasonal flu is probably

A sezonski grip je verovatno

the biggest driver of antibiotic use,

najveći pokretač upotrebe antibiotika,

both in this country as well as in many other countries,

kako u ovoj tako i u mnogim drugim zemljama,

and that could really help.

i to bi zaista moglo da pomogne.

A third option might include something like tradeable permits.

A treća mogućnost bi mogla da uključi nešto poput dozvola koje bi se prodavale.

And these seem like faraway scenarios,

A one se čine poput jako udaljenih mogućnosti,

but if you consider the fact that we might not

ali ukoliko uzmete u obzir činjenicu da možda

have antibiotics for many people who have infections,

nećemo imati antibiotike za mnoge ljude sa infekcijama,

we might consider the fact that we might

možda treba da razmislimo o tome

want to allocate who actually gets to use

da bismo možda želeli da odredimo ko će

some of these antibiotics over others,

koristiti koje antibiotike,

and some of these might have to be on the basis of clinical need,

i neke od ovih odluka će biti zasnovane na kliničkim potrebama,

but also on the basis of pricing.

ali i na osnovu cene.

And certainly consumer education works.

I svakako da obrazovanje potrošača daje rezultate.

Very often, people overuse antibiotics

Vrlo često ljudi prekomerno koriste antibiotike

or prescribe too much without necessarily

ili ih previše prepisuju

knowing that they do so,

a da toga nisu svesni, tako da su se

and feedback mechanisms

mehanizmi informisanja

have been found to be useful,

pokazali korisnima,

both on energy —

kao i kod energije -

When you tell someone that they're using

kada nakome kažete da koristi

a lot of energy during peak hour,

previše energije u udarnom terminu,

they tend to cut back,

on obično smanjuje potrošnju,

and the same sort of example has been performed

a slični primeri su korišćeni

even in the case of antibiotics.

čak i u slučaju antibiotika.

A hospital in St. Louis basically would put up

Bolnica u Sent Luisu bi istakla grafikon

on a chart the names of surgeons

sa imenima hirurga

in the ordering of how much antibiotics they'd used

rangiranih po upotrebi antibiotika

in the previous month,

tokom prethodnog meseca,

and this was purely an informational feedback,

ovo je bilo čisto informativne prirode,

there was no shaming,

nije bilo okrivljavanja,

but essentially that provided some information back

ali je hirurzima pružalo informaciju

to surgeons that maybe they could rethink

da bi možda mogli da razmisle

how they were using antibiotics.

o tome kako koriste antibiotike.

Now, there's a lot that can be done

Mnogo toga može da se uradi

on the supply side as well.

i na polju snabdevanja.

If you look at the price of penicillin,

Ukoliko pogledate cenu penicilina,

the cost per day is about 10 cents.

dnevni trošak iznosi 10 centi.

It's a fairly cheap drug.

To je prilično jeftin lek.

If you take drugs that have been introduced since then —

Ukoliko posmatrate lekove koji su uvedeni kasnije

linezolid or daptomycin —

poput linezolida i daptomicina,

those are significantly more expensive,

oni su daleko skuplji,

so to a world that has been used to paying 10 cents a day for antibiotics,

tako da bi se svetu, naviknutom da dnevno za antibiotike plaća 10 centi,

the idea of paying 180 dollars per day

dnevni trošak od 180 dolara

seems like a lot.

učinio veoma visokim.

But what is that really telling us?

Ali šta nam to zaista govori?

That price is telling us

Ta cena nam govori

that we should no longer

da više ne treba da, u doglednoj budućnosti,

take cheap, effective antibiotics as a given

jeftin i delotvoran antibiotik uzimamo zdravo za gotovo

into the foreseeable future,

and that price is a signal to us

a ta cena nam poručuje

that perhaps we need to be paying

da bismo možda trebali

much more attention to conservation.

da mnogo više obratimo pažnju na očuvanje.

That price is also a signal

Ova cena nam takođe poručuje

that maybe we need to start looking at other technologies,

da bismo možda trebali da se okrenemo drugim tehnologijama,

in the same way that gasoline prices are a signal

baš kao što je cena goriva signal

and an impetus, to, say,

i takoreći, podsticaj

the development of electric cars.

razvoju električnih automobila.

Prices are important signals

Cene su značajni pokazatelji

and we need to pay attention,

i na njih moramo da obratimo pažnju,

but we also need to consider the fact that

ali u obzir moramo da uzmemo i činjenicu

although these high prices seem unusual for antibiotics,

da iako se ove cene čine neobično visokim za antibiotike,

they're nothing compared to the price per day

one su ništavne u poređenju sa dnevnim troškom

of some cancer drugs,

nekih lekova protiv karcinoma,

which might save a patient's life only for a few months or perhaps a year,

koji pacijentu produžavaju život za samo nekoliko meseci ili godinu dana,

whereas antibiotics would potentially

dok antibiotici imaju mogućnost

save a patient's life forever.

da pacijentu spasu život.

So this is going to involve

Tako da će ovo uključiti

a whole new paradigm shift,

i potpuno novu promenu ugla posmatranja,

and it's also a scary shift because

a to će biti i zastrašujuća promena

in many parts of this country,

jer je u mnogim delovima ove zemlje,

in many parts of the world,

kao i u mnogim delovima sveta,

the idea of paying 200 dollars

ideja o plaćanju 200 dolara

for a day of antibiotic treatment

za dan lečenja antibioticima

is simply unimaginable.

jednostavno nezamisliva.

So we need to think about that.

Tako da o ovome moramo da razmislimo.

Now, there are backstop options,

Postoje i poslednje mere

which is other alternative technologies

a to su druge alternativne tehnologije

that people are working on.

na kojima se radi.

It includes bacteriophages, probiotics,

One uključuju bakteriofage, probiotike,

quorum sensing, synbiotics.

osećaj kvoruma, sinbiotike.

Now, all of these are useful avenues to pursue,

To su sve korisna istraživanja,

and they will become even more lucrative

i ona će postati još unosnija

when the price of new antibiotics starts going higher,

kada cena novih antibiotika počne da raste,

and we've seen that the market does actually respond,

i vidimo da tržište zaista reaguje,

and the government is now considering

tako da Vlada sada razmatra

ways of subsidizing new antibiotics and development.

načine na koje bi mogla da dotira razvijanje novih antibiotika.

But there are challenges here.

Ali, ovde postoje i izazovi.

Ne želimo da samo trošimo velike količine novca.

We don't want to just throw money at a problem.

What we want to be able to do

Želimo da budemo u mogućnosti

is invest in new antibiotics

da investiramo u nove antibiotike

in ways that actually encourage

na način koji podstiče

appropriate use and sales of those antibiotics,

odgovarajuću upotrebu i prodaju ovih antibiotika,

and that really is the challenge here.

i tu leži izazov.

Now, going back to these technologies,

Vratimo se na ove tehnologije,

you all remember the line from that famous

svi se sećate rečenice iz onog poznatog

dinosaur film, "Nature will find a way."

filma o dinosaurusima: "Priroda će pronači način".

So it's not as if these are permanent solutions.

Tako da to nisu trajna rešenja.

We really have to remember that, whatever the technology might be,

Moramo da upamtimo da, kakva god bila ta tehnologija,

that nature will find some way to work around it.

priroda će pronaći način da se izbori sa njom.

You might think, well, this is just a problem

Možete pomisliti, pa to je samo problem

just with antibiotics and with bacteria,

vezan za antibiotike i bakterije,

but it turns out that we have the exact same

ali ispostavilo se da imamo potpuno isti,

identical problem in many other fields as well,

identičan problem i u mnogim drugim oblastima,

with multidrug-resistant tuberculosis,

sa tuberkulozom otpornom na višestruke lekove,

which is a serious problem in India and South Africa.

što je ozbiljan problem u Indiji i Južnoj Africi.

Thousands of patients are dying because

Hiljade pacijenata umire

jer je cena lekova druge linije jako visoka,

the second-line drugs are so expensive,

and in some instances, even those don't work

a u nekim slučajevima, čak ni oni ne deluju

and you have XDR TB.

i imamo multirezistentnu tuberkulozu.

Viruses are becoming resistant.

Virusi postaju otporni.

Agricultural pests. Malaria parasites.

Poljoprivredne štetočine, malarijski paraziti.

Right now, much of the world depends on

Trenutno se veći deo sveta

one drug, artemisinin drugs,

za lečenje malarije suštinski

essentially to treat malaria.

oslanja na jedan lek: artemisinin.

Resistance to artemisinin has already emerged,

Otpornost na artemisinin se već pojavila,

and if this were to become widespread,

i ukoliko se ona raširi,

that puts at risk

ugroziće jedini lek

the single drug that we have to treat malaria around the world

kojim malariju lečimo širom sveta

in a way that's currently safe and efficacious.

na sada bezbedan i efikasan način.

Mosquitos develop resistance.

Komarci postaju otporni.

Ukoliko imate decu, onda verovatno znate o vaškama,

If you have kids, you probably know about head lice,

and if you're from New York City,

a ukoliko ste iz Njujorka,

I understand that the specialty there is bedbugs.

tamo su, koliko shvatam, specijalnost stenice.

So those are also resistant.

I one su otporne.

And we have to bring an example from across the pond.

Treba da damo primer i sa druge strane okeana.

Turns out that rats are also resistant to poisons.

Ispostavilo se da su i pacovi otporni na otrove.

Now, what's common to all of these things is

Ono što je svemu ovome zajedničko je

the idea that we've had these technologies

poimanje da mi sve ove tehnologije

to control nature only for the last 70, 80 or 100 years

kojima kontrolišemo prirodu posedujemo tek poslednjih 70, 80 ili 100 godina

and essentially in a blink,

a gotovo smo u trenutku,

we have squandered our ability to control,

prokockali tu mogućnost da kontrolišemo,

because we have not recognized

jer nismo uvideli

that natural selection and evolution was going to find

da će prirodna selekcija i evolucija pronaći način

a way to get back,

da uzvrate udarac,

and we need to completely rethink

i moramo da ponovo temeljno razmislimo

how we're going to use

o tome kako ćemo koristiti

measures to control biological organisms,

mere kojima kontrolišemo biološke organizme,

and rethink how we incentivize

i kako podstičemo

the development, introduction,

razvoj, uvođenje

in the case of antibiotics prescription,

u slučaju antibiotika prepisivanje,

and use of these valuable resources.

i korišćenje ovih dragocenih resursa.

And we really now need to start thinking about them

I sada zaista moramo da počnemo o njima da razmišljamo

as natural resources.

kao o prirodnim resursima.

And so we stand at a crossroads.

Mi se nalazimo na raskršću.

An option is to go through that rethinking

Jedna mogućnosti je da razmislimo

and carefully consider incentives

i pažljivo razmotrimo olakšice

to change how we do business.

kojima ćemo da promenimo način rada.

The alternative is

Alternativa je svet

a world in which even a blade of grass

u kojem čak i vlat trave

is a potentially lethal weapon.

može biti ubojito oružje.

Thank you.

Hvala.

(Applause)

(Aplauz)