What it takes to crush a pandemic | Johanna Benesty

翻译人员: Nan Yang 校对人员: Yolanda Zhang

My son was born in January 2020,

我的儿子出生于 2020 年 1 月，

shortly before the lockdown in Paris.

就在巴黎封城前不久。

He was never scared of people wearing masks,

他从来不害怕戴口罩的人，

because that's all he knows.

因为那就是他 出生以来一直所见的。

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

我三岁的女儿会说 “gel hydro-alcoolique”。

That's the French word for hydroalcoholic gel.

这是水醇凝胶的法语说法。

She actually pronounces it better than I do.

实际上她的发音比我还标准。

But no one wants to be wearing a mask

但是没人想戴口罩，

or wash their hands with hand sanitizer every 20 seconds.

或者每 20 秒就用洗手液洗手。

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

我们都在拼命地研究、研发， 以找到解决方案：疫苗。

It's interesting that in our minds,

非常有趣的是， 在我们的脑海里，

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

我们一直想象着疫苗的出现， 好像它是圣杯一样。

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

但是，我们也有一些捷径， 我想展开讲一下。

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

我不是医生，只是一个顾问。

My clients focus on health care --

我的客户主要是 医疗保健方面的——

biopharma companies, providers, global health institutions --

生物制药公司、供应商、 全球卫生机构——

and they've educated me.

他们教了我很多。

We need to find the tools to fight COVID,

我们需要找到 对抗新冠肺炎的工具，

and we need to make them accessible to all.

而且我们要让所有人可以使用。

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

首先，仅仅疫苗本身 不会使我们摆脱困境。

What we need is an arsenal of tools.

我们需要的是一个工具库。

We need vaccines, we need therapeutics, we need diagnostics

我们需要疫苗， 需要治疗方法和诊断，

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

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。

in a variety of populations.

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

第二，光找到工具还不够。

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

你们觉得当其中一个临床实验 证明了工具有效后

demonstrates that the tool is effective?

会发生什么？

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

我们就可以都跑到附近的药店，

we get the product, we take off our masks

打一针疫苗，然后拿掉口罩，

and we go back to French kissing?

回到法式接吻的时候吗？

No.

不能。

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

找到一个有效的工具 只是这场大战中的一步，

because there is a difference between the existence of a product

因为产品的存在 和能够使用该产品

and access to that product.

是截然不同的。

And now you're thinking,

现在你会想，

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

“哦，她的意思是 其它国家不得不等一等。”

Well, no, that's not my point.

不是，这是我想说的。

Not only others may have to wait,

不仅其他人可能要等，

but any of us may have to.

我们每个人都可能必须等待。

The humbling thing about COVID

新冠病毒之所以可怕，

is that because of its speed and magnitude,

是因为它的传播速度和规模，

it's exposing all of us to the same challenges

它使我们所有人都 面临着同样的挑战，

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

而且是给我们带来了 不常见的挑战。

Remember when China got into lockdown?

记得中国封城的时候吗？

Did you imagine that you would be in the same situation

当时的我们想象过， 在几周后，自己也会处于

a few weeks after?

相同的境地吗？

I certainly didn't.

我当然没有。

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

现在让我们想象一下 疫苗出现之后会如何。

In this case, the next access challenge

这种情况下，下一个挑战

will be supply.

就是供应。

The current estimate of the global community

当前，全球范围内的估计是，

is that by the end of 2021 --

到 2021 年底——

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

就是疫苗出现的一年后——

we would have enough doses to cover one to two billion

我们才有足够多的疫苗剂量覆盖

of the eight billion of us on the planet.

全球 80 亿人口中的 10 到 20 亿人。

So who will have to wait?

那么哪些人必须等待？

How do you think about access when supply is short?

当供应短缺时候， 你们如何看待接种的问题？

Scenario number one:

场景 1 ：

we let the market forces play,

我们让市场力量发挥作用，

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

那些出得起高价的， 或者可以最快协商交易的人们

will get access to the product first.

将会最先得到疫苗产品。

It's not equitable at all,

这一点也不公平，

but it's a very likely scenario.

但这是最有可能的情况。

Scenario number two:

场景 2 :

we could all agree, based on public health rationale,

基于公共卫生原则， 我们共同决定

who gets the product first.

谁可以先获得疫苗。

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

假设我们同意医护人员首先接种，

and then the elderly

然后是老年人，

and then the general population.

然后是普通大众。

Now let me be a bit more provocative.

现在让问题更有挑战性一点。

Scenario number three:

场景 3 ：

countries who have demonstrated that they can manage the pandemic well

那些已经展示出 自己能控制好疫情的国家

would get access to the product first.

可以先获得疫苗接种。

It's a little bit extrapolated,

这个有一点演绎成分，

but it's not complete science fiction.

但不完全是想象出来的情景。

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

几年前，当高质量的 二线抗结核药物供应短缺时，

a special committee was established

人们就成立了一个特别委员会，

to determine which countries had health systems that were strong enough

来决定哪些国家的 卫生系统足够强大，

to ensure that the products would be distributed properly

可以确保产品会正确分配，

and that patients would follow their treatment plans properly.

且患者将正确遵循其治疗计划。

Those select countries got access first.

于是那些国家先得到了药物。

Or, scenario number four:

或者，看场景 4 ：

we could decide on a random rule,

我们决定一个随机的规则，

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

例如， 人们在各自生日那天接种疫苗。

Now let me ask you this:

现在我来问你们：

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

想象这样的未来是什么感觉？

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

疫苗出现了， 但是因为没有机会接种，

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

你还是要戴着口罩， 孩子不能去学校，

because you wouldn't have access to that product?

你也不能按照 你想要的方式去上班。

Every day that passed would feel unacceptable, right?

这样度过的每一天 都让人无法忍受，对吗？

But guess what?

但是猜猜怎么样？

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

有很多疾病，我们已经 有了治疗方法，甚至能治愈，

and yet people keep being infected and die every year.

但是每年还会有人 因此感染并死亡。

Let's take tuberculosis:

让我们说说结核病：

10 million people infected every year,

每年有 1000 万人感染，

1.5 million people dying,

150 万人死亡，

although we've had a cure for years.

尽管很多年前 它就已不再是绝症。

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

而这只是因为 我们还没有完全解决

some of the key access issues.

那些关键的接种问题。

Equitable access is the right thing to do,

公平的接种是正确的选择，

but beyond this humanitarian argument

但是除了这种人道主义的论点——

that I hope we are more sensitive to

我希望我们对人体已经

now that we've experienced it in our flesh,

经历过的事情更加敏感——

there is a health and an economic argument

还存在一种 关于健康和经济的论点，

to equitable access.

即公平分配。

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

健康方面的论点是， 只要病毒在某处活跃，

we're all at risk of reimported cases.

我们都有接触新生病例的风险。

The economic argument is that because of the interdependencies

经济方面的观点是， 因为我们在经济上的

in our economies,

相互依赖，

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

如果其它国家没有处理好， 没有谁的经济能够完全重启。

Think of the sectors that rely on global mobility,

想想那些依靠全球流动性的行业，

like aerospace or travel and tourism.

比如航空或旅游业。

Think of the supply chains that cut across the globe,

想想遍布全球的供应链，

like textiles or automotive.

比如纺织品或者汽车。

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

再想想新兴市场 在经济增长中所占的份额。

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

现实是，我们需要所有国家 携手同步击垮疫情。

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

所以，公平的接种 不只是正确的选择，

it is also the smart thing to do.

也是明智的选择。

But how do we do that?

但是我们要怎么做呢?

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

首先要确保对于“接种”， 我们有着相同的理解。

It would actually mean that the product exists;

它实际上意味着 产品首先要存在；

that it's working sufficiently well;

可以有效地起作用；

that it's been approved by the local authorities;

被地方当局批准；

that it is affordable;

人们可以负担得起；

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

且也有证据表明，它可以 在所有需要它的人群中

that need it,

发挥作用，

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

包括孕妇、免疫力低下的人群， 或者儿童群体；

that it can be distributed in a variety of settings,

而且它可以在不同条件下配发，

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

无论是医院还是乡村诊所， 无论是在热带还是寒带地区；

and that we can produce it at the right scale.

最后，我们要能够 以合适的规模生产。

It's a very long checklist, I know,

我知道，这是一张很长的清单，

and in a non-crisis situation,

而且在非危机的情况下，

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

我们很可能会按照顺序 一项一项解决，

which takes a lot of time.

会花费很长时间。

So what do we do?

那么我们现在要怎么做？

Access is far from being a new challenge,

接种问题绝不是一个新挑战，

and in the case of COVID,

而且对于新冠病毒的情况，

I have to say, we're seeing extraordinary collaboration

我不得不说，我们目睹了

of international organizations, civil society, industry and others

国际机构、民间组织、 工业界和多方出色的合作，

to accelerate access:

来加速接种的进程：

working things in parallel,

多项工作并行，

speeding up regulatory processes,

加快监管程序，

engineering supply mechanisms,

工程化供应机制，

securing procurement, mobilizing resources, etc.

安全采购、调动资源，等等。

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

但是我们很可能 要面临这样的状况，

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

例如，疫苗可能需要持续存放在

minus 80 Celsius degrees;

零下 80 摄氏度的环境中；

or where the treatment would need to be administered

或者治疗将需要由高度专业的

by a highly specialized health care worker;

卫生保健工作者进行；

or where the diagnostic would need to be analyzed

或者诊断将需要由

by a sophisticated lab.

复杂的实验室进行分析。

So what more can we do?

那么我们还能做什么？

Pushing further the logic that the global health community

除了进一步推动全球卫生界

has advocated for for years,

多年来倡导的原则，

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

我还想到了另一件 可能会有所帮助的事。

There is a concept in product development and manufacturing

产品开发和制造中 有一个概念叫做

that's called "design to cost."

“按成本设计”。

The basic idea is that the cost management conversation

其基本思想是， 成本管理对话

happens at the same time as the product being designed,

与设计产品同时进行，

as opposed to the product being designed first

而不是先设计产品，

and then reworked to bring the cost down.

然后又重新设计以降低成本。

It's a simple method that helps ensure

这是一种简单的方法，

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

可帮助确保将成本确定为 产品的优先标准后，

it's made a target from day one.

从第一天开始就将其作为目标。

Now, in the context of health and access,

现在，在健康和接种方面，

I think there is untapped potential

我认为研发部门

in R and D to access,

有尚未开发的潜力，

the same way that manufacturers design to cost.

与制造商根据成本 进行设计的方式相同。

This would mean that, instead of developing a product

这就意味着， 要摒弃先开发产品，

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

然后进行调整， 以确保以后能够公平使用，

all of the items on the checklist I mentioned

而是把我在清单中 提到的所有事项

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

从一开始就 全部内置到研究过程中，

and this would actually benefit us all.

这实际上将使我们所有人受益。

Let's take an example.

我来举个例子。

If we develop a product with equitable access in mind,

如果我们开发产品时 就考虑到公平的使用权，

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

我们也许可以进行优化， 以更快扩大生产规模。

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

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，

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

之后才会优化剂量 或进行调整。

Now imagine that we're talking of a candidate product

现在想象一种候选产品，

for which the active ingredient is a scarce resource.

它的有效成分是一种稀缺资源。

What if instead we focused on developing a treatment

如果我们专注于开发 尽可能只是用最低计量的

that uses the lowest possible amount of that active ingredient?

这种活性成分的治疗方法， 会怎么样？

It could help us produce more doses.

它会帮助我们生产更多剂量。

Let's take another example.

还有另一个例子。

If we develop a product with equitable access in mind,

如果我们开发产品时 就考虑到公平的使用权，

we might be able to optimize for mass distribution faster.

也许就可以更快地优化分配问题。

In high-income countries,

高收入国家通常

we have strong health systems capacity.

拥有强大的卫生系统。

We can always distribute products the way we want.

我们始终可以 按照自己想要的方式分配产品。

So we often take for granted that products can be stored

因此，我们通常理所当然地认为

in temperature-controlled environments

产品可以存储在温度受控的环境中，

or requires a highly skilled health care worker for administration.

或者由具有高技能的医护人员 进行管理。

Of course,

当然，

temperature-controlled environments and highly skilled health care workers

温度受控环境和 高技能的医护人员

并非随处都有。

are not available everywhere.

If we were to approach R and D

如果我们在研发时

with the constraints of weaker health systems in mind,

就考虑到卫生系统薄弱的限制，

we might get creative

就可能会变得有创意，

and develop sooner, for instance, temperature-agnostic products

并更快地开发，例如， 不受温度影响的产品，

or products that can be taken as easily as a vitamin

或者与维生素一样 容易服用的产品，

or long-lasting formulations instead of repeat doses.

或者长效的配方， 而不是要重复服用的药剂。

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

如果我们能够开发并生产 这类简化的工具，

it would have the added benefit

就能同时为高收入 和低收入国家

of putting less strains on hospitals and health systems

带来更多好处，

for both high- and low-income countries.

减轻医院和卫生系统的负担。

Given the speed of the virus

考虑到病毒传播的速度

and the magnitude of the consequences we're facing,

和我们面临的严重后果，

I think we have to continue challenging ourselves

我认为我们必须继续挑战自我，

to find the fastest way to make products to fight COVID

以找到最快的方法，把针对 新冠病毒和未来流行病的产品

and future pandemics accessible to all.

普及给所有人。

In my perspective,

在我看来，

unless the virus disappears,

除非病毒消失，

there are two ways this story ends.

否则这个故事会有两个结局。

Either the scales tip one way --

要么天平偏向于一方——

only some of us get access to the product

我们中只有一部分人 接种到疫苗，

and COVID remains a threat to all of us --

那么新冠病毒仍然会对 我们所有人构成威胁——

or we balance the scales,

或者我们平衡天平，

we all get access to the right weapons,

所有人都可以 使用到正确的武器，

and we all move on together.

齐头并进。

Innovative R and D can't beat COVID alone,

创新性研发无法 独自击败新冠病毒，

but innovative management of R and D might help.

但是创新性的研发管理 可能会有所帮助。

Thank you.

谢谢大家。