A global pandemic calls for global solutions | Larry Brilliant

Transcriber: Ivana Korom Reviewer: Krystian Aparta

譯者: S Y C 審譯者: Alice Jiang

Helen Walters: So, Chris, who's up first?

海倫．沃爾特斯： 好的，克里斯，誰是第一位講者？

克里斯．安德森：我們請到一位一生

Chris Anderson: Well, we have a man who's worried about pandemics

pretty much his whole life.

都在擔心流行病的男人。

He played an absolutely key role, more than 40 years ago,

40 年前，當我們在嘗試 擺脫天花的折磨時，

in helping the world get rid of the scourge of smallpox.

他至關重要。

And in 2006,

2006 年時，

he came to TED to warn the world

他來 TED 演講，並警告我們

of the dire risk of a global pandemic,

全球性流行病發生的可怕風險。

and what we might do about it.

以及我們能就此做些什麼。

So please welcome here Dr. Larry Brilliant.

讓我們熱烈歡迎 賴瑞．布萊恩特博士！

Larry, so good to see you.

賴瑞，很高興見到您。

Larry Brilliant: Thank you, nice to see you.

賴瑞．布萊恩特：謝謝，我也是。

CA: Larry, in that talk,

克里斯：賴瑞，在你的那次演講中，

you showed a video clip that was a simulation

你撥放了一段影片，

來模擬全球性流行病發生後 它可能的模樣。

of what a pandemic might look like.

I would like to play it -- this gave me chills.

我想重播一次—— 這是一個讓我背脊發涼的影片。

Larry Brilliant (TED2006): Let me show you a simulation

賴瑞．布萊恩特（TED2006)： 各位，請看這個模型，

of what a pandemic looks like,

它展示一場全球性流行病的 樣貌和規模，

so we know what we're talking about.

我們才可以瞭解到 我正在談的究竟是什麼。

舉例來說，我們假設首個病例在南亞。

Let's assume, for example, that the first case occurs in South Asia.

It initially goes quite slowly,

一開始，傳播非常緩慢。

you get two or three discrete locations.

有兩三個離散的爆發區。

Then there will be secondary outbreaks.

然後，就會有二次爆發的疫情。

And the disease will spread from country to country so fast

疾病就會飛速地在國家間傳播，

that you won't know what hit you.

快到你都不會知道 什麼時候來到你身邊。

Within three weeks, it will be everywhere in the world.

在三週之內，病毒就會遍佈全球。

Now if we had an undo button,

如果我們可以讓時光倒流，

and we could go back

我們可以回到過去，

and isolate it and grab it when it first started,

然後採取隔離措施， 抓住病毒的源頭，

if we could find it early and we had early detection

我們可以快速的識別病毒，

and early response,

快速做出應對，

and we could put each one of those viruses in jail,

然後把病毒「關進監獄」，

that's the only way to deal with something like a pandemic.

這才是應對全球性疫情的唯一方法。

CA: Larry, that phrase you mentioned there,

克里斯：賴瑞， 你剛剛說的這些詞組，

"early detection," "early response,"

「快速識別」、「快速應對」，

that was a key theme of that talk,

這就是當時演講的主題，

you made us all repeat it several times.

這些詞語重複地出現。

Is that still the key to preventing a pandemic?

如今，這還是控制疫情的要點嗎？

LB: Oh, surely.

賴瑞：喔，當然了。

You know, when you have a pandemic,

當疫情發生，

something moving at exponential speed,

病毒指數性的傳播，

if you miss the first two weeks, if you're late the first two weeks,

如果沒有抓住前十四天 控制病毒的機會，

it's not the deaths and the illness from the first two weeks you lose,

我們失去的不是僅僅是 這兩週的傷亡，

it's the two weeks at the peak.

更是高峰期的兩個星期。

Those are prevented if you act early.

如果我們當時快速行動， 病毒就可以被消滅。

Early response is critical,

快速的反應極其重要，

early detection is a condition precedent.

快速的識別是首要條件。

克里斯：你會如何就世界

CA: And how would you grade the world

on its early detection, early response to COVID-19?

對新冠病毒的快速反應及識別 來給世界做出的反應評分？

LB: Of course, you gave me this question earlier,

賴瑞：當然了， 你之前就問過我這件事，

so I've been thinking a lot about it.

所以我一直在思考這個問題。

I think I would go through the countries,

我覺得應該按國家來評分，

and I've actually made a list.

而我做了一個清單。

I think the island republics of Taiwan, Iceland and certainly New Zealand

我認為，島嶼國家如台灣、 冰島、當然還有紐西蘭，

would get an A.

可以拿到 A 級評分。

The island republic of the UK and the United States --

英國各島和美國——

which is not an island, no matter how much we may think we are --

不管我們可能會怎麼想， 美國並不是一個島——

would get a failing grade.

會拿到「不及格」。

I'd give a B to South Korea and to Germany.

我會給南韓和德國打 B 級。

And in between ...

在這之間⋯⋯

So it's a very heterogeneous response, I think.

我覺得，各國對病毒的反應都不相同。

The world as a whole is faltering.

我們的世界正在顫抖， 狀況不斷惡化。

We shouldn't be proud of what's happening right now.

我們不應對現在發生的一切 感到得意洋洋。

CA: I mean, we got the detection pretty early,

克里斯：我們還是 挺迅速地識別了病毒，

or at least some doctors in China got the detection pretty early.

或者說，中國的醫生 很早就檢測到了病毒。

LB: Earlier than the 2002 SARS, which took six months.

賴瑞：這比 2002 年的 SARS 檢測更及時，當時花了六個月。

This took about six weeks.

這次疫情的識別花了六周。

And detection means not only finding it,

識別的意思並不只是找到病毒，

but knowing what it is.

而更是了解它、知道它是什麼。

So I would give us a pretty good score on that.

我會在那一項上, 給我們一個不錯的成績。

The transparency, the communication -- those are other issues.

而信息的透明度和傳播—— 這些是其他的問題。

CA: So what was the key mistake

克里斯：所以，你認為不及格的國家

that you think the countries you gave an F to made?

犯下的重要錯誤是什麼？

LB: I think fear,

賴瑞：我認為是恐懼、

political incompetence, interference,

政治上的無能、從中干涉、

not taking it seriously soon enough --

馬虎的態度——

it's pretty human.

確實都是人性中會犯的錯誤。

I think throughout history,

我覺得在歷史上，

pretty much every pandemic is first viewed with denial and doubt.

每一場大流行 大概最初都被否認和懷疑過。

But those countries that acted quickly,

但做出快速反應的國家，

and even those who started slow, like South Korea,

包括反應較晚的，比如韓國，

they could still make up for it, and they did really well.

他們還是可以作出彌補， 而且做得很棒。

We've had two months that we've lost.

我們大概丟失了兩個月。

We've given a virus that moves exponentially

我們給了一個傳播迅速的病毒

a two-month head start.

兩個月的搶先傳播機會。

That's not a good idea, Chris.

克里斯，這可不是好事啊。

CA: No, indeed.

克里斯：嗯，確實不是。

I mean, there's so much puzzling information still out there

在網路媒體上， 還有那麼多令人費解的信息

about this virus.

與新冠病毒相關。

What do you think the scientific consensus is going to likely end up being

您認為，科學家最後對

on, like, the two key numbers

這兩個關鍵信息，

of its infectiousness and its fatality rate?

也就是病毒的傳染性和致死率 會達成什麼樣的共識？

LB: So I think the kind of equation to keep in mind

賴瑞：我覺得， 我們應記住的一個公式就是

is that the virus moves dependent on three major issues.

病毒的傳播基於三個主要因素。

One is the R0,

一個是 R0 指數，

the first number of secondary cases that there are when the virus emerges.

也就是當病毒出現時， 第一批二次傳播病例的指數。

In this case,

在這個情況下，

people talk about it being 2.2, 2.4.

它可以是 2.2、2.4。

But a really important paper three weeks ago,

但三周前，《新興傳染病期刊》中

in the "Emerging Infectious Diseases" journal came out,

發表了一篇極其重要的論文，

suggesting that looking back on the Wuhan data,

提出最初來自武漢的數據，

it's really 5.7.

R0 值其實是 5.7。

So for argument's sake,

介於所有的爭議，

let's say that the virus is moving at exponential speed

我假設病毒正在指數型的傳播，

and the exponent is somewhere between 2.2 and 5.7.

而其 R0 值在 2.2-5.7 之間。

The other two factors that matter

還有兩個因素為

are the incubation period or the generation time.

病毒的潛伏期和世代時間。

The longer that is,

這兩段時間越長，

the slower the pandemic appears to us.

我們觀察到的病毒傳播就越緩慢。

When it's really short, like six days, it moves like lightning.

當這兩段時間很短，比如 6 天， 病毒就閃電般的傳播。

And then the last, and the most important --

而最後，也是最重要的一點——

and it's often overlooked --

它通常不會被注意——

is the density of susceptibles.

它就是易感人群的密度。

This is a novel virus,

這是一個新型病毒，

so we want to know how many customers could it potentially have.

所以我們要知道它能夠感染多少人。

And as it's novel, that's eight billion of us.

介於它是新形的， 世界上有八十億人，

The world is facing a virus

我們面對著一個

that looks at all of us like equally susceptible.

將我們「一視同仁」的病毒。

Doesn't matter our color, our race,

不管我們有什麼膚色，是什麼人種，

or how wealthy we are.

有多少財富。

CA: I mean, none of the numbers that you've mentioned so far

克里斯：目前為止，您所提到的數值

are in themselves different from any other infections in recent years.

與近年其他病毒的數值都相差無幾。

What is the combination that has made this so deadly?

是什麼樣的組合， 讓這場大流行如此致命？

LB: Well, it is exactly the combination

賴瑞：它就是

of the short incubation period and the high transmissibility.

短潛伏期和高傳染性的組合。

But you know, everybody on this call has known somebody who has the disease.

大部分人都至少認識一位 新型冠狀病毒的受害者。

Sadly, many have lost a loved one.

令人難過的是， 很多人失去了他們所愛的人。

This is a terrible disease when it is serious.

這是一個可以造成嚴重傷害的疾病。

And I get calls from doctors in emergency rooms

世界各地急診室的醫生

and treating people in ICUs all over the world,

和重症病房的醫生都打過電話給我，

and they all say the same thing:

他們說的都是同一件事：

"How do I choose who is going to live and who is going to die?

「我應如何選擇誰該救活？誰該放棄？

I have so few tools to deal with."

可用的工具太少了。」

It's a terrifying disease,

這是一個可怕的疾病，

to die alone with a ventilator in your lungs,

人的肺中插著呼吸機孤獨地死亡。

and it's a disease that affects all of our organs.

它還是一個影響我們 所有器官的疾病。

It's a respiratory disease --

它是一個呼吸道疾病——

perhaps misleading.

這樣說可能令人誤解。

Makes you think of a flu.

你可能會聯想到流感。

But so many of the patients have blood in their urine

但很多病人的尿裡有血，

from kidney disease,

得了腎臟病，

they have gastroenteritis,

得了腸胃炎，

they certainly have heart failure very often,

常有心臟衰竭的現象，

we know that it affects taste and smell, the olfactory nerves,

這個病毒還影響味覺和嗅覺， 影響嗅覺神經，

we know, of course, about the lung.

而我們都知道，會影響肺部。

The question I have:

我現在的問題是：

is there any organ that it does not affect?

有沒有不受它影響的器官？

And in that sense,

從這方面來講，

it reminds me all too much of smallpox.

它讓我想起了天花。

CA: So we're in a mess.

克里斯：所以，我們的處境一團糟。

What's the way forward from here?

改善我們處境的方法是什麼？

LB: Well, the way forward is still the same.

賴瑞：方法還是一樣的。

Rapid detection,

快速檢測、

rapid response.

快速回應。

Finding every case,

找到每一個案例，

and then figuring out all the contacts.

然後找到其接觸者。

We've got great new technology for contact tracing,

我們掌握可追蹤接觸者的先進科技，

we've got amazing scientists working at the speed of light

我們有沒日沒夜工作、 敬業的科學家，

to give us test kits and antivirals and vaccines.

發明測試包、抗病毒藥、和疫苗。

We need to slow down,

我們需要慢下來，

the Buddhists say slow down time

佛教徒說，把時間放慢，

so that you can put your heart, your soul, into that space.

然後讓你的心靈進入那個空間。

We need to slow down the speed of this virus,

我們要讓病毒傳播的速度慢下來，

which is why we do social distancing.

所以我們保持社交距離。

Just to be clear --

為了講清楚，

flattening the curve, social distancing,

讓病毒傳播緩慢、保持距離，

it doesn't change the absolute number of cases,

也改變不了患者的數目本身。

but it changes what could be a Mount Fuji-like peak

但它會讓一個富士山般的病毒高峰期

into a pulse,

變成一個脈搏般的小波動，

and then we won't also lose people because of competition for hospital beds,

人們也不會因為 醫院床位的不足而去世。

people who have heart attacks, need chemotherapy, difficult births,

患心臟病、需要化療、難產的人

can get into the hospital,

能夠就診住院，

and we can use the scarce resources we have,

我們能夠使用珍貴的資源，

especially in the developing world,

特別是在發展中國家，

to treat people.

來治療患者。

So slow down,

所以，慢下來吧，

slow down the speed of the epidemic,

讓病毒的傳播慢下來，

and then in the troughs, in between waves,

然後在傳播的波谷之間，

jump on, double down, step on it,

跳起來，用力踩下去，

and find every case,

把每一個案例都找到，

trace every contact,

把每一個接觸者都找到，

test every case,

測試每一個患者，

and then only quarantine the ones who need to be quarantined,

然後只隔離那些需要被隔離的人們，

and do that until we have a vaccine.

直到我們獲得了疫苗為止。

CA: So it sounds like we have to get past the stage of just mitigation,

克里斯：所以，你是說， 我們不應只是減緩傳播，

where we're just trying to take a general shutdown,

不應只是全面停工，

to the point where we can start identifying individual cases again

我們應該找到每一個案例，

and contact-trace for them

追蹤他們的接觸者，

and treat them separately.

把他們隔離起來。

I mean, to do that,

我是說，要這樣做，

that seems like it's going to take a step up of coordination,

需要合作、

ambition, organization, investment,

信心、管理、投資，

that we're not really seeing the signs of yet in some countries.

在某些國家中，並沒有這樣的事情。

Can we do this, how can we do this?

我們能做到嗎？應如何做到？

LB: Oh, of course we can do this.

賴瑞：噢，我們當然可以做到。

I mean, Taiwan did it so beautifully,

台灣做得非常好，

Iceland did it so beautifully, Germany,

冰島也做到了，德國也是，

all with different strategies,

這些國家都採取了不同的方案。

South Korea.

還有韓國。

It really requires competent governance,

我們需要強力治理，

a sense of seriousness,

嚴肅、認真的態度，

and listening to the scientists, not the politicians following the virus.

聽從科學家的話，而不是政客的。

Of course we can do this.

我們當然可以做到。

Let me remind everybody --

我來給大家提個醒——

this is not the zombie apocalypse,

這不是殭屍啟示錄，

it's not a mass extinction event.

不是生物大滅絕，

You know, 98, 99 percent of us are going to get out of this alive.

有百分之 98、99 的人 都會活著從疫情中走出來。

We need to deal with it the way we know we can,

我們需要面對它， 用我們知道的方式，

and we need to be the best version of ourselves.

我們需要全力以赴。

Both sitting at home

這包括著「居家抗疫」、

as well as in science, and certainly in leadership.

也包括科學研發，還有領導力。

CA: And might there be even worse pathogens out there

克里斯：你認為，未來會不會有

in the future?

更加嚴重的病毒？

Like, can you picture or describe

比如，你能想像到

an even worse combination of those numbers

一個有更糟糕的因素組合的病毒，

that we should start to get ready for?

而我們需要為其做好準備？

LB: Well, smallpox had an R0 of 3.5 to 4.5,

賴瑞：天花的 R0 指數約為 3.5-4.5，

so that's probably about what I think this COVID will be.

所以我認為新型冠狀病毒的 R0 值和這差不多。

But it killed a third of the people.

但天花的感染者中， 約有三分之一去世。

But we had a vaccine.

我們有天花疫苗。

So those are the different sets that you have.

這是一些不同點。

But what I'm mostly worried about,

但我最擔心的事，

and the reason that we made "Contagion"

也就是我們拍《全境擴散》 這部電影的原因，

and that was a fictional virus --

電影裡是一種虛構的病毒——

I repeat, for those of you watching,

我重複一遍，觀眾們，

that's fiction.

虛構的。

We created a virus that killed a lot more than this one did.

我們編造了一種比新冠病毒 更致命的病毒。

CA: You're talking about the movie "Contagion"

克里斯：你是在說《全境擴散》，

that's been trending on Netflix.

那部最近在 Netflix 上很紅的電影。

And you were an advisor for.

您是片子的科學指導。

LB: Absolutely, that's right.

賴瑞：對，就是這樣。

But we made that movie deliberately

我們刻意要讓那部電影

to show what a real pandemic looked like,

揭露一場流行病的真面目。

but we did choose a pretty awful virus.

但我們的確選了一種極糟糕的病毒。

And the reason we showed it like that,

我們這樣做的原因是，

going from a bat to an apple,

從一隻蝙蝠到一個蘋果，

to a pig, to a cook, to Gwyneth Paltrow,

再到一隻豬，一位廚師， 到格溫妮絲·帕特洛，

was because that is in nature what we call spillover,

是因為自然中的溢出效應。

as zoonotic diseases,

人畜共患疾病，

diseases of animals, spill over to human beings.

也就是動物的疾病，會溢給人類。

And if I look backwards three decades

如果我倒退三十年，

or forward three decades --

或快進三十年，

looking backward three decades, Ebola, SARS, Zika,

三十年前，伊波拉、 SARS、茲卡病毒、

swine flu, bird flu, West Nile,

豬流感、禽流感、西尼羅病毒，

we can begin almost a catechism

我們幾乎可以開始教理，

and listen to all the cacophony of these names.

並聽聽這些名稱有多刺耳。

But there were 30 to 50 novel viruses that jumped into human beings.

但約有 30～50 個 新型的病毒感染了人類，

And I'm afraid, looking forward,

而恐怕，展望未來，

we are in the age of pandemics,

我們正處於「大流行時代」。

we have to behave like that,

我們一定要這樣做，

we need to practice One Health,

我們要「健康一體化」，

we need to understand that we're living in the same world

我們需要了解， 我們生活在同一個世界，

as animals, the environment, and us,

動物、大自然、還有我們。

and we get rid of this fiction that we are some kind of special species.

我們不應認為 我們是一類特殊的種族，

To the virus, we're not.

對病毒來說，我們並不是。

CA: Mmm.

克里斯：嗯⋯⋯

You mentioned vaccines, though.

你提到了疫苗。

Do you see any accelerated path to a vaccine?

你知道如何才能 更快速地生產疫苗嗎？

LB: I do.

賴瑞：我知道的。

I'm actually excited to see that we're doing something

我很興奮地看到現在我們在進行的

that we only get to think of in computer science,

是以往我們只能在電腦科學看到的事，

which is we're changing what should have always been,

就是我們在改變，

or has always been, rather,

或是說，原本一直是

multiple sequential processes.

多順序的流程。

Do safety testing, then you test for effectiveness,

做安全測試，然後測試有效性，

then for efficiency.

然後測試效率，

And then you manufacture.

然後再開始生產。

We're doing all three or four of those steps,

我們遵循三/四個步驟，

instead of doing it in sequence, we're doing in parallel.

但我們可以不再一步一步地做， 而是同時做這些事。

Bill Gates has said he's going to build seven vaccine production lines

比爾·蓋茨說，

他要在美國建造七條疫苗生產線，

in the United States,

and start preparing for production,

然後開始準備生產，

但並不知道最終的疫苗 會是什麼樣的。

not knowing what the end vaccine is going to be.

We're simultaneously doing safety tests and efficacy tests.

我們同時做安全性測試和功效測試。

I think the NIH has jumped up.

我認為，美國國立衛生研究院 已開始動作。

I'm very thrilled to see that.

我很期待這件事。

CA: And how does that translate into a likely time line, do you think?

克里斯：您認為，它可能 會有一個什麼樣的時間表？

A year, 18 months, is that possible?

一年，或者一年半， 這是可能的嗎？

LB: You know, Tony Fauci is our guru in this,

賴瑞：安東尼·佛奇是這方面的專家，

and he said 12 to 18 months.

而他認為的耗時約為 12-18 個月。

I think that we will do faster than that in the initial vaccine.

我覺得，我們以後製造疫苗， 會比第一次更快。

But you may have heard that this virus

但你可能聽說過，這個病毒

may not give us the long-term immunity --

可能不會讓我們對它長期免疫——

that something like smallpox would do.

天花這樣的病毒可以長期免疫。

So we're trying to make vaccines where we add adjuvants

製作疫苗時，我們嘗試加入佐劑，

that actually make the vaccine create better immunity

讓疫苗產生比病毒更厲害的免疫力，

than the disease,

so that we can confer immunity for many years.

我們才可以擁有長達多年的免疫性。

That's going to take a little longer.

做這件事所需的時間較長。

CA: Last question, Larry.

克里斯：賴瑞， 我的最後一個問題是：

Back in 2006, as a winner of the TED Prize,

在 2006 年，作為 TED 獎得主，

we granted you a wish,

您許了一個願望，

and you wished the world would create this pandemic preparedness system

您的願望是要在世上 有個流行病防禦系統，

that would prevent something like this happening.

來防範這樣的事。

I feel like we, the world, let you down.

恐怕我們，這個世界，讓你失望了。

If you were to make another wish now,

現在，你如果再許一個願，

what would it be?

你會許什麼？

LB: Well, I don't think we're let down in terms of speed of detection.

賴瑞：以識別病毒的 速度來說，我並不失望。

I'm actually pretty pleased.

我倒是很欣喜。

When we met in 2006,

在 2006 年，

the average one of these viruses leaping from an animal to a human,

我們平均要花六個月的時間來辨別

it took us six months to find that --

一個普通的人畜共患病毒——

like the first Ebola, for example.

舉個例子，第一次伊波拉疫情。

We're now finding the first cases in two weeks.

我們現在可以在兩週內 找到第一例病情。

I'm not unhappy about that,

我對這件事並沒有失望，

I'd like to push it down to a single incubation period.

但我希望，在未來，我們能 用一個潛伏期的時間做到它。

It's a bigger issue for me.

對我來說，這是個更大的問題。

What I found is that in the Smallpox Eradication Programme

我在天花根除計劃中發現

people of all colors, all religions, all races,

擁有各個膚色、信仰各個宗教、 來自各個種族的人，

so many countries,

那麼多的國家，

came together.

都聯手了。

And it took working as a global community

而我們必須作為 一個全球性社區來工作，

to conquer a global pandemic.

來征服一場全球性疫情。

Now, I feel that we have become victims of centrifugal forces.

我認為，我們成為了 挑撥離間的勢力的受害者。

We're in our nationalistic kind of barricades.

我們的民族主義也會成為某種障礙。

We will not be able to conquer a pandemic

除非我們相信，我們生死與共，

unless we believe we're all in it together.

不然我們無法面對任何疫情。

This is not some Age of Aquarius, or Kumbaya statement,

這並不是新紀元運動的寶瓶座年代， 也不是祈求神降臨解救苦難的宣言，

this is what a pandemic forces us to realize.

這是一場大流行 讓我們必須意識到的事。

We are all in it together,

我們確實生死與共，

we need a global solution to a global problem.

全球大流行 需要全球人民來攜手抗疫。

Anything less than that is unthinkable.

如果我們做不到，後果不堪設想。

CA: Larry Brilliant, thank you so very much.

克里斯：非常感謝您， 賴瑞·布萊恩特！

LB: Thank you, Chris.

賴瑞：謝謝，克里斯。