What it takes to crush a pandemic | Johanna Benesty

49,554 views ・ 2020-12-08

TED


请双击下面的英文字幕来播放视频。

翻译人员: Nan Yang 校对人员: Yolanda Zhang
00:13
My son was born in January 2020,
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我的儿子出生于 2020 年 1 月,
00:15
shortly before the lockdown in Paris.
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就在巴黎封城前不久。
00:18
He was never scared of people wearing masks,
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他从来不害怕戴口罩的人,
00:20
because that's all he knows.
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因为那就是他 出生以来一直所见的。
00:22
My three-year-old daughter knows how to say "gel hydro-alcoolique."
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我三岁的女儿会说 “gel hydro-alcoolique”。
00:26
That's the French word for hydroalcoholic gel.
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这是水醇凝胶的法语说法。
00:29
She actually pronounces it better than I do.
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实际上她的发音比我还标准。
00:32
But no one wants to be wearing a mask
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但是没人想戴口罩,
00:34
or wash their hands with hand sanitizer every 20 seconds.
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或者每 20 秒就用洗手液洗手。
00:38
We're all desperately looking at R and D to find us a solution: a vaccine.
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我们都在拼命地研究、研发, 以找到解决方案:疫苗。
00:44
It's interesting that in our minds,
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非常有趣的是, 在我们的脑海里,
00:46
we keep thinking of the vaccine discovery like it's the Holy Grail.
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我们一直想象着疫苗的出现, 好像它是圣杯一样。
00:50
But there are a couple of shortcuts here that I'd like to unpack.
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但是,我们也有一些捷径, 我想展开讲一下。
00:54
I'm not a doctor, I'm just a consultant.
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我不是医生,只是一个顾问。
00:56
My clients focus on health care --
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我的客户主要是 医疗保健方面的——
00:58
biopharma companies, providers, global health institutions --
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生物制药公司、供应商、 全球卫生机构——
01:03
and they've educated me.
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他们教了我很多。
01:05
We need to find the tools to fight COVID,
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我们需要找到 对抗新冠肺炎的工具,
01:08
and we need to make them accessible to all.
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而且我们要让所有人可以使用。
01:11
First, one single vaccine will not get us out of this.
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首先,仅仅疫苗本身 不会使我们摆脱困境。
01:15
What we need is an arsenal of tools.
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我们需要的是一个工具库。
01:18
We need vaccines, we need therapeutics, we need diagnostics
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我们需要疫苗, 需要治疗方法和诊断,
01:22
to make sure that we can prevent, identify and treat COVID cases
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来确保我们可以在各种人群中
预防、识别和治疗 新冠病毒的病例。
01:26
in a variety of populations.
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01:28
Second, it's not just about finding a tool.
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第二,光找到工具还不够。
01:33
What do you think will happen when one of those clinical trials
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你们觉得当其中一个临床实验 证明了工具有效后
01:36
demonstrates that the tool is effective?
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会发生什么?
01:39
Do you think we can all run to the pharmacy next door,
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我们就可以都跑到附近的药店,
01:41
we get the product, we take off our masks
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打一针疫苗,然后拿掉口罩,
01:43
and we go back to French kissing?
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回到法式接吻的时候吗?
01:46
No.
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不能。
01:48
Finding an effective tool is just one step in this big fight,
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找到一个有效的工具 只是这场大战中的一步,
01:52
because there is a difference between the existence of a product
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因为产品的存在 和能够使用该产品
01:55
and access to that product.
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是截然不同的。
01:58
And now you're thinking,
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现在你会想,
01:59
"Oh -- she means other countries will have to wait."
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“哦,她的意思是 其它国家不得不等一等。”
02:02
Well, no, that's not my point.
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不是,这是我想说的。
02:04
Not only others may have to wait,
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不仅其他人可能要等,
02:06
but any of us may have to.
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我们每个人都可能必须等待。
02:09
The humbling thing about COVID
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新冠病毒之所以可怕,
02:10
is that because of its speed and magnitude,
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是因为它的传播速度和规模,
02:13
it's exposing all of us to the same challenges
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它使我们所有人都 面临着同样的挑战,
02:16
and giving us a flavor of challenges we're not used to.
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而且是给我们带来了 不常见的挑战。
02:20
Remember when China got into lockdown?
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记得中国封城的时候吗?
02:22
Did you imagine that you would be in the same situation
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当时的我们想象过, 在几周后,自己也会处于
02:25
a few weeks after?
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相同的境地吗?
02:27
I certainly didn't.
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我当然没有。
02:29
Let's go to the theoretical moment when we have a vaccine.
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现在让我们想象一下 疫苗出现之后会如何。
02:33
In this case, the next access challenge
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这种情况下,下一个挑战
02:35
will be supply.
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就是供应。
02:37
The current estimate of the global community
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当前,全球范围内的估计是,
02:39
is that by the end of 2021 --
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到 2021 年底——
02:41
so that's over a year after the discovery of the vaccine --
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就是疫苗出现的一年后——
02:44
we would have enough doses to cover one to two billion
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我们才有足够多的疫苗剂量覆盖
02:47
of the eight billion of us on the planet.
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全球 80 亿人口中的 10 到 20 亿人。
02:50
So who will have to wait?
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那么哪些人必须等待?
02:53
How do you think about access when supply is short?
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当供应短缺时候, 你们如何看待接种的问题?
02:56
Scenario number one:
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场景 1 :
02:58
we let the market forces play,
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我们让市场力量发挥作用,
03:00
and those who can pay the highest price or be the fastest to negotiate deals
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那些出得起高价的, 或者可以最快协商交易的人们
03:03
will get access to the product first.
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将会最先得到疫苗产品。
03:06
It's not equitable at all,
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这一点也不公平,
03:07
but it's a very likely scenario.
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但这是最有可能的情况。
03:10
Scenario number two:
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场景 2 :
03:11
we could all agree, based on public health rationale,
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基于公共卫生原则, 我们共同决定
03:14
who gets the product first.
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谁可以先获得疫苗。
03:16
Let's say we agree that health care workers would get it first,
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假设我们同意医护人员首先接种,
03:19
and then the elderly
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然后是老年人,
03:20
and then the general population.
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然后是普通大众。
03:22
Now let me be a bit more provocative.
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现在让问题更有挑战性一点。
03:24
Scenario number three:
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场景 3 :
03:27
countries who have demonstrated that they can manage the pandemic well
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那些已经展示出 自己能控制好疫情的国家
03:31
would get access to the product first.
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可以先获得疫苗接种。
03:34
It's a little bit extrapolated,
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这个有一点演绎成分,
03:35
but it's not complete science fiction.
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但不完全是想象出来的情景。
03:38
Years ago, when the supply of high-quality second-line tuberculosis drug was scarce,
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几年前,当高质量的 二线抗结核药物供应短缺时,
03:42
a special committee was established
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人们就成立了一个特别委员会,
03:44
to determine which countries had health systems that were strong enough
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来决定哪些国家的 卫生系统足够强大,
03:48
to ensure that the products would be distributed properly
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可以确保产品会正确分配,
03:51
and that patients would follow their treatment plans properly.
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且患者将正确遵循其治疗计划。
03:54
Those select countries got access first.
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于是那些国家先得到了药物。
03:58
Or, scenario number four:
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或者,看场景 4 :
04:00
we could decide on a random rule,
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我们决定一个随机的规则,
04:02
for instance, that people get to be vaccinated on their birthday.
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例如, 人们在各自生日那天接种疫苗。
04:06
Now let me ask you this:
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现在我来问你们:
04:08
How does it feel to think of a future where the vaccine exists,
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想象这样的未来是什么感觉?
04:12
but you would still have to wear a mask and keep your kids home from school,
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疫苗出现了, 但是因为没有机会接种,
04:17
and you would not be able to go to work the way you want
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你还是要戴着口罩, 孩子不能去学校,
04:19
because you wouldn't have access to that product?
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你也不能按照 你想要的方式去上班。
04:23
Every day that passed would feel unacceptable, right?
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这样度过的每一天 都让人无法忍受,对吗?
04:27
But guess what?
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但是猜猜怎么样?
04:29
There are many diseases for which we have treatments and even cures,
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有很多疾病,我们已经 有了治疗方法,甚至能治愈,
04:33
and yet people keep being infected and die every year.
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但是每年还会有人 因此感染并死亡。
04:38
Let's take tuberculosis:
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让我们说说结核病:
04:40
10 million people infected every year,
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每年有 1000 万人感染,
04:42
1.5 million people dying,
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150 万人死亡,
04:45
although we've had a cure for years.
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尽管很多年前 它就已不再是绝症。
04:48
And that's just because we haven't completely figured out
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而这只是因为 我们还没有完全解决
04:50
some of the key access issues.
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那些关键的接种问题。
04:54
Equitable access is the right thing to do,
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公平的接种是正确的选择,
04:57
but beyond this humanitarian argument
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但是除了这种人道主义的论点——
05:00
that I hope we are more sensitive to
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我希望我们对人体已经
05:02
now that we've experienced it in our flesh,
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经历过的事情更加敏感——
05:04
there is a health and an economic argument
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还存在一种 关于健康和经济的论点,
05:06
to equitable access.
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即公平分配。
05:09
The health argument is that as long as the virus is active somewhere,
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健康方面的论点是, 只要病毒在某处活跃,
05:12
we're all at risk of reimported cases.
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我们都有接触新生病例的风险。
05:15
The economic argument is that because of the interdependencies
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经济方面的观点是, 因为我们在经济上的
05:19
in our economies,
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相互依赖,
05:20
no domestic economy can fully restart if others are not picking up as well.
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如果其它国家没有处理好, 没有谁的经济能够完全重启。
05:26
Think of the sectors that rely on global mobility,
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想想那些依靠全球流动性的行业,
05:29
like aerospace or travel and tourism.
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比如航空或旅游业。
05:32
Think of the supply chains that cut across the globe,
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想想遍布全球的供应链,
05:34
like textiles or automotive.
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比如纺织品或者汽车。
05:36
Think of the share of the economic growth that is coming from emerging markets.
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再想想新兴市场 在经济增长中所占的份额。
05:40
The reality is that we need all countries to be able to crush the pandemic in sync.
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现实是,我们需要所有国家 携手同步击垮疫情。
05:47
So not only is equitable access the right thing to do,
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所以,公平的接种 不只是正确的选择,
05:50
it is also the smart thing to do.
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也是明智的选择。
05:53
But how do we do that?
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但是我们要怎么做呢?
05:56
Let's make sure we're on the same page in terms of what "access" means.
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首先要确保对于“接种”, 我们有着相同的理解。
05:59
It would actually mean that the product exists;
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它实际上意味着 产品首先要存在;
06:01
that it's working sufficiently well;
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可以有效地起作用;
06:04
that it's been approved by the local authorities;
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被地方当局批准;
06:07
that it is affordable;
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人们可以负担得起;
06:09
but also that there is evidence that it works in all the populations
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且也有证据表明,它可以 在所有需要它的人群中
06:12
that need it,
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发挥作用,
06:13
and that can include pregnant women or immunodepressed people, or children;
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包括孕妇、免疫力低下的人群, 或者儿童群体;
06:18
that it can be distributed in a variety of settings,
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而且它可以在不同条件下配发,
06:20
like hospitals or rural clinics, or hot climate or cold climate;
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无论是医院还是乡村诊所, 无论是在热带还是寒带地区;
06:26
and that we can produce it at the right scale.
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最后,我们要能够 以合适的规模生产。
06:29
It's a very long checklist, I know,
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我知道,这是一张很长的清单,
06:31
and in a non-crisis situation,
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而且在非危机的情况下,
06:33
we would likely address these issues one after the other in a sequential way,
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我们很可能会按照顺序 一项一项解决,
06:37
which takes a lot of time.
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会花费很长时间。
06:40
So what do we do?
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那么我们现在要怎么做?
06:42
Access is far from being a new challenge,
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接种问题绝不是一个新挑战,
06:45
and in the case of COVID,
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而且对于新冠病毒的情况,
06:46
I have to say, we're seeing extraordinary collaboration
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我不得不说,我们目睹了
06:50
of international organizations, civil society, industry and others
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国际机构、民间组织、 工业界和多方出色的合作,
06:53
to accelerate access:
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来加速接种的进程:
06:55
working things in parallel,
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多项工作并行,
06:57
speeding up regulatory processes,
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加快监管程序,
06:59
engineering supply mechanisms,
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工程化供应机制,
07:01
securing procurement, mobilizing resources, etc.
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安全采购、调动资源,等等。
07:04
Yet we are likely to face a situation where, for instance,
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但是我们很可能 要面临这样的状况,
07:09
the vaccine would need to be constantly stored at, let's say,
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例如,疫苗可能需要持续存放在
07:12
minus 80 Celsius degrees;
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零下 80 摄氏度的环境中;
07:14
or where the treatment would need to be administered
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或者治疗将需要由高度专业的
07:16
by a highly specialized health care worker;
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卫生保健工作者进行;
07:19
or where the diagnostic would need to be analyzed
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或者诊断将需要由
07:21
by a sophisticated lab.
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复杂的实验室进行分析。
07:23
So what more can we do?
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那么我们还能做什么?
07:27
Pushing further the logic that the global health community
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除了进一步推动全球卫生界
07:30
has advocated for for years,
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多年来倡导的原则,
07:31
there is one additional thing I can think of that might help.
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我还想到了另一件 可能会有所帮助的事。
07:35
There is a concept in product development and manufacturing
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产品开发和制造中 有一个概念叫做
07:38
that's called "design to cost."
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“按成本设计”。
07:40
The basic idea is that the cost management conversation
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其基本思想是, 成本管理对话
07:43
happens at the same time as the product being designed,
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与设计产品同时进行,
07:46
as opposed to the product being designed first
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而不是先设计产品,
07:48
and then reworked to bring the cost down.
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然后又重新设计以降低成本。
07:51
It's a simple method that helps ensure
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这是一种简单的方法,
07:53
that when cost has been identified as a priority criteria for a product,
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可帮助确保将成本确定为 产品的优先标准后,
07:58
it's made a target from day one.
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从第一天开始就将其作为目标。
08:01
Now, in the context of health and access,
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现在,在健康和接种方面,
08:04
I think there is untapped potential
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我认为研发部门
08:06
in R and D to access,
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有尚未开发的潜力,
08:08
the same way that manufacturers design to cost.
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与制造商根据成本 进行设计的方式相同。
08:12
This would mean that, instead of developing a product
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这就意味着, 要摒弃先开发产品,
08:16
and then working to adapt it to ensure equitable access later,
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然后进行调整, 以确保以后能够公平使用,
08:20
all of the items on the checklist I mentioned
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而是把我在清单中 提到的所有事项
08:22
would be built into the R and D process from the beginning,
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从一开始就 全部内置到研究过程中,
08:25
and this would actually benefit us all.
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这实际上将使我们所有人受益。
08:28
Let's take an example.
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我来举个例子。
08:30
If we develop a product with equitable access in mind,
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如果我们开发产品时 就考虑到公平的使用权,
08:33
we might be able to optimize for scale-up faster.
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我们也许可以进行优化, 以更快扩大生产规模。
08:37
In my experience, drug developers often focus on finding a dose that works,
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根据我的经验,药物开发人员 通常会专注于寻找有效的药剂,
08:42
and only after do they optimize the dosage or make adjustments.
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之后才会优化剂量 或进行调整。
08:46
Now imagine that we're talking of a candidate product
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现在想象一种候选产品,
08:49
for which the active ingredient is a scarce resource.
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它的有效成分是一种稀缺资源。
08:52
What if instead we focused on developing a treatment
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如果我们专注于开发 尽可能只是用最低计量的
08:55
that uses the lowest possible amount of that active ingredient?
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这种活性成分的治疗方法, 会怎么样?
08:59
It could help us produce more doses.
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它会帮助我们生产更多剂量。
09:02
Let's take another example.
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还有另一个例子。
09:04
If we develop a product with equitable access in mind,
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如果我们开发产品时 就考虑到公平的使用权,
09:07
we might be able to optimize for mass distribution faster.
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也许就可以更快地优化分配问题。
09:11
In high-income countries,
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高收入国家通常
09:13
we have strong health systems capacity.
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拥有强大的卫生系统。
09:15
We can always distribute products the way we want.
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我们始终可以 按照自己想要的方式分配产品。
09:18
So we often take for granted that products can be stored
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因此,我们通常理所当然地认为
09:20
in temperature-controlled environments
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产品可以存储在温度受控的环境中,
09:22
or requires a highly skilled health care worker for administration.
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或者由具有高技能的医护人员 进行管理。
09:27
Of course,
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当然,
09:28
temperature-controlled environments and highly skilled health care workers
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温度受控环境和 高技能的医护人员
并非随处都有。
09:32
are not available everywhere.
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09:33
If we were to approach R and D
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如果我们在研发时
09:35
with the constraints of weaker health systems in mind,
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就考虑到卫生系统薄弱的限制,
09:39
we might get creative
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就可能会变得有创意,
09:40
and develop sooner, for instance, temperature-agnostic products
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并更快地开发,例如, 不受温度影响的产品,
09:44
or products that can be taken as easily as a vitamin
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或者与维生素一样 容易服用的产品,
09:47
or long-lasting formulations instead of repeat doses.
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或者长效的配方, 而不是要重复服用的药剂。
09:51
If we were able to produce and develop such simplified tools,
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如果我们能够开发并生产 这类简化的工具,
09:57
it would have the added benefit
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就能同时为高收入 和低收入国家
09:58
of putting less strains on hospitals and health systems
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带来更多好处,
10:02
for both high- and low-income countries.
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减轻医院和卫生系统的负担。
10:05
Given the speed of the virus
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考虑到病毒传播的速度
10:07
and the magnitude of the consequences we're facing,
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和我们面临的严重后果,
10:10
I think we have to continue challenging ourselves
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我认为我们必须继续挑战自我,
10:12
to find the fastest way to make products to fight COVID
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以找到最快的方法,把针对 新冠病毒和未来流行病的产品
10:15
and future pandemics accessible to all.
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普及给所有人。
10:18
In my perspective,
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在我看来,
10:19
unless the virus disappears,
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除非病毒消失,
10:21
there are two ways this story ends.
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否则这个故事会有两个结局。
10:24
Either the scales tip one way --
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要么天平偏向于一方——
10:26
only some of us get access to the product
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我们中只有一部分人 接种到疫苗,
10:28
and COVID remains a threat to all of us --
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那么新冠病毒仍然会对 我们所有人构成威胁——
10:30
or we balance the scales,
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或者我们平衡天平,
10:32
we all get access to the right weapons,
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所有人都可以 使用到正确的武器,
10:35
and we all move on together.
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齐头并进。
10:38
Innovative R and D can't beat COVID alone,
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创新性研发无法 独自击败新冠病毒,
10:41
but innovative management of R and D might help.
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但是创新性的研发管理 可能会有所帮助。
10:44
Thank you.
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谢谢大家。
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