How to End Malaria Once and for All | Abdoulaye Diabaté | TED

翻译人员: Jing Quan 校对人员: Jinnie Sun

(Mosquitoes buzzing)

（蚊子嗡嗡声）

Mosquitoes.

蚊子。

I don't know about you,

我不知道你们，

but I don't have a good relationship with them.

但我和它们的关系不好。

(Laughter)

（笑声）

A friend of mine said one day,

我的一个朋友有一天说，

if you think that you are too small to make a big difference,

如果你认为自己太渺小 而影响不了太多事的话，

you've never spent a night with mosquitoes in a room.

你应该从来没有 和蚊子一起独处过夜。

(Laughter)

（笑声）

But ...

但是...

I don't have any mosquitoes in my pocket to release tonight,

我没有带什么蚊子来现场，

so it's going to be fine.

所以别害怕。

So let's start.

因此，让我们开始吧。

As unbelievable as it may sound, malaria is as old as humankind.

尽管听起来令人难以置信， 但疟疾几乎和人类同时出现。

And malaria once was a public health issue all over the world.

疟疾曾经是全球的公共卫生问题。

But then it has been successfully tackled in the US and Europe.

但是后来美国和欧洲成功地 解决了这个问题。

And yet, decades later,

然而，几十年后，

malaria still kills millions of people

疟疾仍造成数百万人死亡，

in Africa

在非洲

and in Asia.

和亚洲。

Why?

为什么？

I'm Abdoulaye Diabaté, a medical entomologist

我是阿卜杜拉耶·迪亚巴特，

from l'Institut de Recherche en Science de la Santé.

健康科学研究所的医学昆虫学家。

I'm here today,

我今天来这里，

flying all the way from Burkina Faso,

从布基纳法索一路飞来，

to tell you that we might be closer than ever

来告诉你们我们可能比以往任何时候

to eliminate malaria in Africa.

都离在非洲消灭疟疾这一目标更近。

(Applause)

（掌声）

Thank you.

谢谢。

Malaria is tightly linked to poverty.

疟疾与贫困密切相关。

But then you have no idea of how expensive it is to be poor.

但你根本不知道穷人的花费有多大。

There are 200 million cases worldwide

全球每年有 2 亿例病例，

that end up sadly every year with about 600,000 deaths.

约有 60 万人死亡。

And this is not a random collection of statistics on a piece of paper.

这不是写在纸上随机收集的统计数据。

Behind each of these 600,000 deaths,

在这 60 万死亡的患者背后，

there is a personal, tragic story, sometimes behind closed doors.

都是一个个有时候不为人知的悲惨故事。

Most of these deaths happen in Africa.

这些死亡大多发生在非洲。

Children and pregnant women bear the highest burden.

儿童和孕妇居多。

And I'm a fortunate childhood malaria survivor.

我是一个幸运的儿童疟疾幸存者。

When I was a kid, I used to think that my dad was a superhero.

当我还是个孩子的时候， 我曾以为我的父亲是个超级英雄。

I could see him leaving the house every morning at six,

我看着他每天早上六点离开家，

riding his bicycle to the farm, working very hard all day long.

骑着自行车去农场， 整天都在努力工作。

We did not have much for living.

我们的生活并不富裕。

But who said you need more to be happy?

但谁说你需要更多物质才能快乐？

But when happiness hangs by a thread,

但当幸福岌岌可危时，

it doesn't take much to turn your life around.

微小的变化就会改变你的生活。

My certainty in my dad got deeply shaken the day I got struck down by malaria.

在我被疟疾击倒的那一天， 我对父亲的信心摇摇欲坠。

I was three or four years old.

我当时三四岁。

As we used to say in my country,

正如我们国家的老话

kids may not understand the complexity of suffering,

孩子们可能无法理解痛苦的复杂性，

but pain has no age.

但痛苦不分年龄。

And gosh, I was in pain.

天哪，我当时很痛苦。

I can still clearly see myself

我还能清楚地看到自己

laying down there on the bed with high fever and suffering.

躺在床上发高烧和忍耐痛苦。

I could not eat anything.

我什么也吃不下。

Throwing up all the time.

一直在呕吐。

Will I survive? Will I not?

我能活下来吗？还是死去？

The psychological trauma my parents were going through

我父母所经历的心理创伤

was unbearable.

令人难以忍受。

But against all odds, I survived.

但尽管困难重重， 我还是活了下来。

But can we say today that we are done with malaria

不过，我们今天能否说 我们已经克服了疟疾，

because Diabaté survived and made it all the way down to Vancouver?

就因为迪亚巴特幸存下来 并一路逃到了温哥华？

If I say yes, no one can blame me.

如果我说“是”，没有人能责怪我。

But it’s a lie, because many children are still dying of malaria.

但这是个谎言， 因为仍有许多儿童死于疟疾。

The real question then is:

那么真正的问题是：

Why have we not been able to defeat it so far?

为什么我们目前为止 还没能打败它？

Well because malaria is a complex parasitic disease

因为疟疾是一种复杂的寄生虫病，

that plays on three grounds.

有三个基础要素。

Plasmodium, the pathogen;

疟原虫，它是病原体；

anopheles, the vector;

按蚊，传播媒介；

and human, the victim.

以及人类，受害者。

Each of these elements is very complex on its own,

所有这些要素本身都 非常复杂，

and the interactions make it even more complex

而相互作用会更加复杂，

to devise interventions that are really effective.

从而无法形成真正有效的干预措施。

But of course we are trying.

但当然我们在努力。

Currently, there are two vaccines to immunize people,

目前，有两种疫苗 可以对人们进行免疫接种，

but the heavy logistics to deliver this vaccine

但是运送这种疫苗的繁重后勤工作

may not allow us to reach their full potential.

可能无法使我们充分发挥其潜力。

Bed nets and first-hand treatment

蚊帐和直接治疗

are both threatened by insecticide and drug resistance,

都受到杀虫剂和耐药性的限制，

meaning that our best interventions have started to fail.

这意味着我们的最佳干预措施 已经开始失败。

And there is a general consensus today that without additional new tools,

如今，人们普遍认为， 如果没有新方法，

we may never cross the last mile of malaria elimination.

我们可能永远无法跨越 消灭疟疾的最后一英里。

And this is exactly where I come in.

而这正是我所进入的领域。

My colleagues and I at Target Malaria,

我和我在目标疟疾 （Target Malaria）的同事

and are working on something called gene drive:

正在研究一种叫做基因驱动的东西：

a way to control mosquito population and halt malaria transmission.

一种控制蚊子数量 和阻止疟疾传播的方法。

So what is gene drive?

那么什么是基因驱动呢？

It's a natural molecular mechanism

这是一种自然的分子机制，

that augments the frequency of a certain gene in the population

在正常的孟德尔遗传之外，

beyond the normal Mendelian inheritance.

它还会增加群体中特定基因的频率。

So what does it mean?

这是什么意思呢？

If you take any gene,

如果你携带任何基因，

in natural circumstances,

在自然环境中，

it has only a 50 percent chance of being transmitted to the next generation.

它只有 50％ 的机会传播给下一代。

Meaning that if the parents have 100 babies, like in mosquitoes,

这意味着，如果亲代 有 100 个后代，比如在蚊子中，

only 50 of them will get the gene and the other 50 will not.

其中只有 50 个会获得该基因， 而另外 50 个不会。

But not all genes behave this way in nature.

但是，并非所有基因 在自然界中都以这种方式表现。

Some genes have found a very clever way to bypass this law,

一些基因聪明地绕过了这个定律，

and can augment their own prospect to up to 90 percent.

可以将自己的存活提高到 90％ 。

Such genes are said to drive, and so the name "gene drive."

这些基因被认为可以驱动 ， 因此被命名为“基因驱动”。

Our most promising strain affects female fertility

我们最有前途的菌株 能够影响雌性的生育能力，

by targeting a gene called doublesex.

通过靶向名为 双性（doublesex）的基因。

This gene is responsible for the sex determination in mosquitoes,

这个基因负责蚊子的性别决定，

and so disrupting the doublesex gene

因此，破坏双性基因

may affect the sexual development for adult mosquitoes

可能会影响成年蚊子的性发育

and their reproduction.

及其繁殖。

Now

现在，

it may sound counterintuitive to affect female fertility

影响雌性的生育能力，

and spread a gene of interest in mosquito population at the same time.

并在蚊子种群中传播目标基因， 听起来可能违反直觉，

But it's working.

但它正在起作用。

And let me show you how.

让我来给你们展示这是怎么做到的。

We target a specific region of the gene called doublesex

我们靶向该基因中一个 名为双性的特定区域，

that affects only females.

该区域仅影响雌性。

Males bearing this modified gene are not affected at all.

携带这种变异基因的雄性 完全不受影响。

Females with just one copy of the altered gene are fully fertile.

只有携带一个变异基因的雌性 有完整生育能力。

However, females bearing two copies

但是，雌性如果携带两个

of the modified gene

变异基因的复制，

cannot lay eggs,

则不能产卵，

fail to bite

不会吸血，

and also have the physical characteristics of both male and female.

而且具有雄性和雌性的 双重身体特征。

It's called a suppression strategy.

它被称为抑制策略。

Once these mosquitoes are released in the field,

一旦这些蚊子被释放到野外，

they're going to spread the gene of interest to the wild population,

它们就会将目标基因传播给野生种群，

and this is going to reduce dramatically their reproductive capacity.

这将大大降低它们的繁殖能力。

Fewer mosquitoes means less malaria transmission

更少的蚊子 意味着减少疟疾的传播，

until it stops.

直到疟疾消失为止。

Mathematical models predict

数学模型预测，

that releasing such mosquitoes in the field

在野外释放此类蚊子，

is going to stop malaria transmission in just 20 generations.

只需 20 代蚊子就能阻止疟疾的传播。

That means in two years.

也就是两年后。

And the technology is sustainable,

而且该技术可持续、

cost-effective and easy to deploy,

经济实惠且易于部署，

as the released mosquitoes will do the job themselves

因为释放的蚊子将自己完成工作，

by finding the last hiding pocket of wild mosquitoes to convert.

通过找到最后一只 藏身野外的蚊子并转化它，

Fantastic.

非常棒。

The only problem,

唯一的问题是，

gene drive has never been tested anywhere in Africa.

基因驱动从未在非洲 任何地方进行过测试。

And while the technology brings a lot of hope,

尽管这项技术带来了很多希望，

it also carries its share of fear and skepticism.

但它也带来了恐惧和怀疑。

The pathway from the bench to the field

从替补席到球场的道路

is not straightforward and is full of pitfalls.

并不平坦，而且充满了陷阱。

Maybe the mosquitoes in the field

也许野外的蚊子

will develop resistance to the spread of the transgene.

会对转基因的传播产生抵抗力。

Or maybe two countries don't agree,

或者也许两个国家不同意，

but released mosquitoes do not respect the human borders.

但释放的蚊子可不管人类边界。

Or also, maybe there are risks to the environment.

或者也许存在环境风险。

And finally, the community that we are working with

并且，我们合作的社区

need to feel comfortable about this technology

需要对这项技术感到满意，

and give us the green light to operate.

才会为我们的运营开绿灯。

And so for such,

因此，

Target Malaria has adopted an incremental approach, step by step,

目标疟疾采取了循序渐进的方法，

whereby we will start releasing first non-gene-drive mosquitoes,

我们将开始释放第一批非基因驱动的蚊子，

meaning that the gene of interest here cannot self-propagate

这意味着目标基因无法自我传播，

and will just go extinct in a few generations.

会在几代后灭绝。

The gene drive, the exposure of this gene to the environment

基因驱动，即基因和环境的接触

is incrementally augmented

逐渐增加，

in a way that we start first with small cages

我们首先从欧洲的小笼子

and big indoor cages in Europe,

和大型室内笼子开始，

and then these mosquitoes are sent to Burkina Faso,

然后将这些蚊子送到布基纳法索，

where they are tested in a contained facility first,

先在那儿的封闭设施里进行测试，

and subsequently in a big indoor small cage field release.

然后在一个大型室内 小笼子里释放出来。

Now the gene drive mosquitoes are going to be tested in an open field

现在，只有在完成了初步步骤之后，

only after this preliminary step

才能在旷野中测试基因驱动的蚊子，

and the potential risks have been looked at very carefully.

并且要对潜在风险进行仔细评估。

And also additional research questions have been developed

此外，我们准备了防护手段

to address these risks, if any.

来应对这些风险（如果有的话）。

Now the question, how far are we from releasing gene drive?

现在的问题是，我们 离释放基因驱动还有多久？

Four to five years.

四到五年。

But let me tell you this.

但是请让我说明。

Gene drive mosquitoes are already in the lab,

基因驱动的蚊子已经在实验室中，

and releasing them in the field

将它们释放到野外

is not going to take us more than 30 minutes.

也不过 30 分钟时间。

But we need five years to get ready for these 30 minutes.

但是我们需要五年时间 为这 30 分钟做好准备。

And why is that?

这是为什么呢？

The answer is simple.

答案很简单。

Because we need to engage the community

因为我们需要让社区参与进来

and get the social license to operate.

并获得社会许可。

And so if there is one thing that you cannot afford the luxury to miss,

因此，如果有一件事你不能错过，

it's the stakeholder engagement.

那就是作为利益相关者参与。

I cannot just pop up in a village with a bucket of mosquitoes

我不能突然出现在 一个满是蚊子的村庄里，

on the assumption that I'm a scientist working for the public good.

和他们说我是 为公共利益出力的科学家。

It will not take anyone a PhD to understand

他们不需要一个博士学位来判断

if we are respectful of their values or not.

我们是否尊重他们。

We need to engage the community

我们需要让社区参与进来，

and then co-develop the technology with them.

然后与他们共同开发技术。

And so for that,

因此，

we've built our engagement strategy on the pyramidal structure,

我们制定了金字塔结构的参与策略，

starting with the villages where we operate

从我们活动的村庄开始，

all the way to the top with the government officials.

一直到高层与政府官员。

The engagement is done step-by-step.

参与是逐步完成的。

It’s done in an inclusive way

它是以包容的方式完成的，

and also is done in full transparency.

也是完全透明的。

Ladies and gentlemen,

女士和先生们，

there is one more thing that needs to be done

在非洲野外释放基因驱动蚊子之前，

before gene drive can be released in the field in Africa.

还有一件事要做。

That is capacity building.

那就是能力建设。

Gene drive holds a lot of promises,

基因驱动带来了很多希望，

but it will not take us anywhere

但如果我们非洲人不能自己运行它，

if we Africans aren’t enabled to run it on our own.

那将毫无成效。

Sadly,

不幸的是，

the technical platform in Africa is really very poor,

非洲的技术平台确实很差，

and this has to be solved before we can really beat malaria.

必须先解决这个问题， 然后我们才能真正战胜疟疾。

And so for that, we've set up in Burkina Faso

为此，我们在布基纳法索 设立了办事处，

a World Bank-funded center of excellence on vector-borne diseases, like malaria.

一个由世界银行资助的 疟疾等病媒传播疾病卓越中心。

And also with additional funds from the Gates Foundation,

此外，借助盖茨基金会的 额外资金，

we are building a critical mass of next generation scientists

我们正在整个非洲大陆

all over the continent

培养大量的下一代科学家，

to fill the knowledge gap and the know-how gap as well.

以填补知识缺口和专有技术缺口。

In April 1969, a child was born in a remote village of Burkina Faso.

1969 年 4 月，一个孩子出生在 布基纳法索的一个偏远村庄。

Like any other child of the world,

像世界上任何其他孩子一样，

he had dreams and expectations.

他有梦想和期望。

Sadly, however, as he came to learn,

但是，不幸的是，当他开始学习时，

the place where you are born in on this planet

你在这个星球上出生的地方

very often affects your perspective on life,

将会极大地影响你的认知，

and may even set the path you need to walk through into your future.

甚至可能限制你未来的发展。

That shouldn't be the case.

事情不应该是这样。

We are all citizens of the world.

我们都是世界公民。

Our dreams and aspirations should not be constrained

我们的梦想和抱负

by the place where we are born.

不应该受到出生地的限制。

And this is the reason why I became a scientist.

这就是我成为科学家的初心。

To offer endless possibility to any child anywhere on this continent,

为非洲大陆任何地方的 任何孩子提供无限的可能性，

so that they can see the future with hope.

使他们能够憧憬未来。

But there is no hope if you are cut short with malaria.

但是，如果被疟疾打败，就失去希望了。

But Target Malaria is here to fix that.

目标疟疾可以解决这个问题。

A world free of malaria is our vision.

一个没有疟疾的世界是我们的愿景。

And I will say, yes, we can.

并且我会说，没错，我们会做到。

Thank you for your attention.

感谢您的关注。

(Applause)

（掌声）