The next outbreak? We’re not ready | Bill Gates | TED

譯者: Regina Chu 審譯者: William Choi

When I was a kid,

在我小時候，

the disaster we worried about most was a nuclear war.

最讓我們感到擔憂的是核戰災難，

That's why we had a barrel like this down in our basement,

那就是我們在地下室 放個像這樣的桶子的原因，

filled with cans of food and water.

裝滿罐頭食物及水。

When the nuclear attack came,

如果發生核子攻擊，

we were supposed to go downstairs, hunker down, and eat out of that barrel.

我們就要躲到地下室， 蹲下，吃桶裡的食物。

Today the greatest risk of global catastrophe

但是今天全球最大的災難風險

doesn't look like this.

不是這個，

Instead, it looks like this.

而是這個。

If anything kills over 10 million people in the next few decades,

如果在未來數十年有任何東西 能殺死一千多萬人，

it's most likely to be a highly infectious virus

那極可能是具高度傳染性的病毒，

rather than a war.

而非一場戰爭，

Not missiles, but microbes.

不是各樣的飛彈，而是微生物。

Now, part of the reason for this is that

那麼，造成這種情況的部分原因是

we've invested a huge amount in nuclear deterrents.

我們投進了大把鈔票在核武威脅上，

But we've actually invested very little in a system to stop an epidemic.

卻極少投資在防止流行病的系統，

We're not ready for the next epidemic.

我們還沒準備好對抗下一場流行病。

Let's look at Ebola.

來看一下伊波拉。

I'm sure all of you read about it in the newspaper,

我敢肯定你們都在報上讀過相關消息，

lots of tough challenges.

很多艱難的挑戰。

I followed it carefully through the case analysis tools

我透過我們追蹤根除 小兒麻痺症的個案分析工具

we use to track polio eradication.

仔細追蹤伊波拉的情況。

And as you look at what went on,

你看看當時的情況，

the problem wasn't that there was a system that didn't work well enough,

問題不在系統沒有發揮足夠的作用，

the problem was that we didn't have a system at all.

問題在於我們根本就沒有系統。

In fact, there's some pretty obvious key missing pieces.

事實上，是有一些 相當明顯的重大缺失。

We didn't have a group of epidemiologists ready to go, who would have gone,

我們沒有一組流行病學家待命， 他們本該到發病當地，

seen what the disease was, seen how far it had spread.

察看這種疾病， 察看這種疾病蔓延的情況。

The case reports came in on paper.

個案報告以書寫形式發表，

It was very delayed before they were put online

但是耽擱許久後才放上網路，

and they were extremely inaccurate.

而且內容還極不正確。

We didn't have a medical team ready to go.

我們沒有醫療團隊待命，

We didn't have a way of preparing people.

我們沒有替隊員預備部署的方法。

Now, Médecins Sans Frontières did a great job orchestrating volunteers.

現在無國界醫生 在動員志工上表現極好，

But even so, we were far slower than we should have been

但是即便如此，我們仍然慢太多了，

getting the thousands of workers into these countries.

我們本來應該能動員 數千名人員進入這些國家的，

And a large epidemic would require us to have hundreds of thousands of workers.

而一場大型的流行病需要 我們數十萬名人員待命。

There was no one there to look at treatment approaches.

沒有人研究治療方法，

No one to look at the diagnostics.

沒有人研究診斷學，

No one to figure out what tools should be used.

沒有人去搞清楚到底要用什麼工具。

As an example, we could have taken the blood of survivors,

舉個例，我們本來可以 取倖存者的血液，

processed it, and put that plasma back in people to protect them.

處理一下，把那個血漿 打回人類身上來保護他們，

But that was never tried.

但是那個方法從未試過，

So there was a lot that was missing.

所以還有很多的事情沒有處理，

And these things are really a global failure.

而這些事真的是全球層面的失敗。

The WHO is funded to monitor epidemics, but not to do these things I talked about.

世界衛生組織是受資助去監控流行病，

但是沒有做我剛剛談及的那幾件事。

Now, in the movies it's quite different.

但是電影可不是這麼演的。

There's a group of handsome epidemiologists ready to go,

有一群好帥的流行病學家隨時待命，

they move in, they save the day, but that's just pure Hollywood.

他們進入災區，轉危為安， 但那只是好萊塢罷了。

The failure to prepare could allow the next epidemic

無法未雨綢繆可能會讓下一場疫情

to be dramatically more devastating than Ebola

比伊波拉更具破壞力。

Let's look at the progression of Ebola over this year.

來看一下今年伊波拉的進展，

About 10,000 people died,

大約一萬人死亡，

and nearly all were in the three West African countries.

而且死亡人口幾乎集中在 這三個西非國家。

There's three reasons why it didn't spread more.

有三個原因讓它沒有 蔓延到更遠的地方。

The first is that there was a lot of heroic work by the health workers.

第一是醫療人員做了很多英勇事蹟。

They found the people and they prevented more infections.

他們找出患病的人， 而且防止更多感染。

The second is the nature of the virus.

第二是這個病毒的天性。

Ebola does not spread through the air.

伊波拉不會透過空氣傳播，

And by the time you're contagious,

當你具傳染性時，

most people are so sick that they're bedridden.

大部分患者都已嚴重到臥病在床。

Third, it didn't get into many urban areas.

第三，它沒有傳到許多城市地區，

And that was just luck.

這僅是運氣好。

If it had gotten into a lot more urban areas,

如果它傳到更多城市地區，

the case numbers would have been much larger.

病例數可能會大幅提高。

So next time, we might not be so lucky.

所以下次，

我們可能就沒這麼幸運了！

You can have a virus where people feel well enough while they're infectious

可能有一種病毒， 讓大家的身體不會出現什麼毛病，

that they get on a plane or they go to a market.

這病毒卻具感染性， 他們還可以登機或去市場。

The source of the virus could be a natural epidemic like Ebola,

病毒的來源可能是 天然疫源如伊波拉，

or it could be bioterrorism.

也可能是生化恐怖主義。

So there are things that would literally make things a thousand times worse.

所以的確有東西會讓情況糟一千倍。

In fact, let's look at a model of a virus spread through the air,

事實上，讓我們來看一下 經空氣傳播的病毒傳染模式，

like the Spanish Flu back in 1918.

就像 1918 年發生的西班牙型流感。

So here's what would happen:

所以情況可能是這樣：

It would spread throughout the world very, very quickly.

它可能極快速地傳遍世界。

And you can see over 30 million people died from that epidemic.

你們可以看到超過三千萬人 死於那次疫情。

So this is a serious problem.

所以這是很嚴重的問題，

We should be concerned.

我們應當掛慮。

But in fact, we can build a really good response system.

但事實上，我們可以 建立良好的應變系統，

We have the benefits of all the science and technology that we talk about here.

我們有這裡談到的科學與技術優勢。

We've got cell phones

我們有手機

to get information from the public and get information out to them.

可以從民眾得到資訊， 也可以傳播資訊給民眾。

We have satellite maps where we can see where people are and where they're moving.

我們有衛星圖能看到 民眾聚集在哪裡又移動到哪裡。

We have advances in biology

我們的生物學蓬勃發展，

that should dramatically change the turnaround time to look at a pathogen

應能大幅提升從尋找病原體

and be able to make drugs and vaccines that fit for that pathogen.

到製造治療藥物及疫苗 所需的處理時間。

So we can have tools,

所以我們有工具，

but those tools need to be put into an overall global health system.

但是這些工具需要讓 全球衛生系統都運用到，

And we need preparedness.

而且我們要未雨綢繆。

The best lessons, I think, on how to get prepared

我想，如何未雨綢繆的最佳範例

are again, what we do for war.

就是我們如何備戰。

For soldiers, we have full-time, waiting to go.

在軍員方面，我們的軍人隨時待命，

We have reserves that can scale us up to large numbers.

而後備軍人也能大量擴充動員。

NATO has a mobile unit that can deploy very rapidly.

北約還有個機動組能快速遣兵，

NATO does a lot of war games to check, are people well trained?

北約做過很多軍事演習 以查驗大家是否訓練有素？

Do they understand about fuel and logistics

他們是否了解燃料及後勤，

and the same radio frequencies?

是否在同一無線頻率上？

So they are absolutely ready to go.

如此一來他們完全準備待命。

So those are the kinds of things we need to deal with an epidemic.

這些就是我們對抗流行病需要做的事。

What are the key pieces?

有哪些主要部分？

First, we need strong health systems in poor countries.

第一，在貧窮國家我們 需要完善的醫療系統，

That's where mothers can give birth safely,

在那裡母親能安全生產，

kids can get all their vaccines.

小孩能注射疫苗。

But, also where we'll see the outbreak very early on.

但是，那些地方也是我們 能早早發現疫情爆發的地方，

We need a medical reserve corps:

我們需要醫療後備部隊：

lots of people who've got the training and background

很多受過訓練且具備相關背景的人

who are ready to go, with the expertise.

能隨時待命，還有專門知識技能。

And then we need to pair those medical people with the military.

然後我們需要讓醫療人員與軍方配搭，

taking advantage of the military's ability to move fast, do logistics

利用軍方的能力快速行動、做後勤

and secure areas.

及採取安全措施保護當地。

We need to do simulations,

我們需要模擬演練，

germ games, not war games, so that we see where the holes are.

做微生物演習，而非軍事演習， 那樣才能發現漏洞所在。

The last time a germ game was done in the United States

美國最後一次微生物演習

was back in 2001, and it didn't go so well.

於 2001 年舉行，而且還不太成功。

So far the score is germs: 1, people: 0.

到目前為止比數是 微生物 1 分， 人類 0 分。

Finally, we need lots of advanced R&D in areas of vaccines and diagnostics.

最後，我們就疫苗及診斷方面 需要很多先進的研發，

There are some big breakthroughs, like the Adeno-associated virus,

也有一些重大的突破， 例如腺相關病毒，

that could work very, very quickly.

能產生非常非常快的成效。

Now I don't have an exact budget for what this would cost,

我對這個要花多少錢 並沒有明確的預算，

but I'm quite sure it's very modest compared to the potential harm.

但我還蠻確定與潛在危害相比 這應該不算多。

The World Bank estimates that if we have a worldwide flu epidemic,

世界銀行估計 如果來一場全球流感疫情，

global wealth will go down by over three trillion dollars

全球財富將會減少三兆多美元，

and we'd have millions and millions of deaths.

而且還會有數不清的死亡病例。

These investments offer significant benefits

這些投資提供的顯著效益

beyond just being ready for the epidemic.

不僅在於充分預備對抗流感疫情，

The primary healthcare, the R&D,

還有基礎衛生醫療與研發，

those things would reduce global health equity

這些事都可能縮小 全球健康公平性的差距，

and make the world more just as well as more safe.

讓這個世界更公平更安全。

So I think this should absolutely be a priority.

所以我認為這絕對是 該優先考慮的事情。

There's no need to panic.

我們絕不需要恐慌，

We don't have to hoard cans of spaghetti or go down into the basement.

不需要囤積義大利麵罐頭 或躲到地下室去。

But we need to get going, because time is not on our side.

但是我們需要開始行動， 因為時間並不站在我們這邊。

In fact, if there's one positive thing that can come out of the Ebola epidemic,

事實上，如果要說伊波拉疫情 帶給我們什麼正面的事情，

it's that it can serve as an early warning, a wake-up call, to get ready.

那就是它是早期警告， 一個警鐘，要我們準備好。

If we start now, we can be ready for the next epidemic.

如果我們現在就開始， 必定能夠準備好對抗下一場疫情。

Thank you.

謝謝。

(Applause)

（掌聲）