Mark Kendall: Demo: A needle-free vaccine patch that's safer and way cheaper

譯者: Yuexin Gao 審譯者: Hao-Wei Chang

It's a pleasure to be here

很高興來到

in Edinburgh, Scotland,

蘇格蘭的愛丁堡

the birthplace of the needle and syringe.

注射器和針頭的發源地

Less than a mile from here in this direction,

沿這個方向不到一英里處

in 1853 a Scotsman

一個蘇格蘭人於 1853 年

filed his very first patent on the needle and syringe.

申請了他的第一項 關於針頭和注射器的專利

His name was Alexander Wood,

這個人就是 亜歷山大．伍德

and it was at the Royal College of Physicians.

他申請專利的地點 是皇家內科醫學院

This is the patent.

這是他當時的專利

What blows my mind when I look at it even today

令我驚訝的是 專利上的針頭

is that it looks almost identical

與我們現在所使用的

to the needle in use today.

一模一樣

Yet, it's 160 years old.

沒錯，它有 160 年的歷史了

So we turn to the field of vaccines.

現在我們來說一下疫苗的歷史

Most vaccines are delivered with

有大半疫苗都是 依靠這項 160 年的技術

the needle and syringe, this 160-year-old technology.

利用注射器和針頭注入人體

And credit where it's due -- on many levels,

鑒於它在於多層面上的功績

vaccines are a successful technology.

疫苗注射是一項很成功的技術

After clean water and sanitation,

繼淨水處理系統和 衛生系統出現之後

vaccines are the one technology that has increased

注射疫苗是最能

our life span the most.

延長人類壽命的的發明

That's a pretty hard act to beat.

這個成就難以超越

But just like any other technology,

然而，和其他科技一樣

vaccines have their shortcomings,

疫苗注射也有不足之處

and the needle and syringe

而針頭和注射器

is a key part within that narrative --

就成了其中的關鍵部份

this old technology.

我們要改進這項古老的技術

So let's start with the obvious:

讓我們先從明顯的地方入手

Many of us don't like the needle and syringe.

許多人都不喜歡針頭和注射器

I share that view.

我也一樣

However, 20 percent of the population

不過，有 20% 的人

have a thing called needle phobia.

患有針頭恐懼症

That's more than disliking the needle;

這是更加嚴重的厭惡針頭注射

that is actively avoiding being vaccinated

這些人會因為針頭恐懼症

because of needle phobia.

而主動避免注射疫苗

And that's problematic in terms of the rollout of vaccines.

這個問題自 疫苗推行以來就難以解決

Now, related to this is another key issue,

與其相關的是另一個關鍵問題

which is needlestick injuries.

即針刺傷口

And the WHO has figures

世界衛生組織的數據顯示

that suggest about 1.3 million deaths per year

每年有約 130 萬人

take place due to cross-contamination

死於針刺傷口

with needlestick injuries.

的交叉污染

These are early deaths that take place.

這縮短了人們的壽命

Now, these are two things that you probably may have heard of,

你很可能聽說過上述兩個缺陷

but there are two other shortcomings

但另外兩種由針頭和注射器產生的影響

of the needle and syringe you may not have heard about.

你可能沒有聽說過

One is it could be holding back

一個是它會限制

the next generation of vaccines

次世代疫苗

in terms of their immune responses.

引起免疫反應的能力

And the second is that it could be responsible

第二點我等下會提到

for the problem of the cold chain that I'll tell you about as well.

是其所仰賴的 冷藏運輸出現的問題

I'm going to tell you about some work

接著我要為大家介紹

that my team and I are doing in Australia

我和我的團隊

at the University of Queensland

在澳大利亞昆士蘭大學 的研究成果

on a technology designed to tackle those four problems.

關於一項為解決 以上四個問題而研發的技術

And that technology is called the Nanopatch.

這項技術叫做納米貼片

Now, this is a specimen of the Nanopatch.

這是一個納米貼片的樣本

To the naked eye

用肉眼看

it just looks like a square

它看起來是個正方形

smaller than a postage stamp,

比郵票小一些

but under a microscope

但還在顯微鏡下觀察

what you see are thousands of tiny projections

可以看到成千上萬

that are invisible to the human eye.

肉眼不可見的突起

And there's about 4,000 projections

就在這個正方形上 大概有 4 千個凸起

on this particular square compared to the needle.

與這支針頭相比

And I've designed those projections

我所設計的這些凸起

to serve a key role, which is to work with the skin's immune system.

作用於皮膚的免疫系統

So that's a very important function

這是納米貼片的

tied in with the Nanopatch.

一項非常重要的功能

Now we make the Nanopatch

我們製作納米貼片

with a technique

應用到一項技術

called deep reactive ion etching.

叫做深反應離子刻蝕

And this particular technique is one that's been borrowed

這項特殊的技術

from the semiconductor industry,

源自半導體產業

and therefore is low cost

所以成本低廉

and can be rolled out in large numbers.

可以大量製造

Now we dry-coat vaccines to the projections of the Nanopatch

我們將乾燥疫苗 附著在納米貼片的凸起上

and apply it to the skin.

並將它貼在皮膚上

Now, the simplest form of application

最簡單的方式

is using our finger,

是用手指

but our finger has some limitations,

但用手指有侷限性

so we've devised an applicator.

所以我們設計了一款塗抹器

And it's a very simple device --

很簡單的裝置

you could call it a sophisticated finger.

你可以稱它為更靈巧的手指

It's a spring-operated device.

這款裝置內嵌彈簧

What we do is when we apply the Nanopatch to the skin as so --

我們要做的是將納米貼片貼在皮膚上

(Click) --

（嗒）

immediately a few things happen.

緊接著出現一些變化

So firstly, the projections on the Nanopatch

首先，納米貼片上的這些凸起

breach through the tough outer layer

會頂破堅硬的外殼

and the vaccine is very quickly released --

隨後疫苗被迅速釋放

within less than a minute, in fact.

事實上，不到一分鐘

Then we can take the Nanopatch off

然後就可以摘下納米貼片

and discard it.

丟掉

And indeed we can make a reuse of the applicator itself.

而塗抹器可以再次使用

So that gives you an idea of the Nanopatch,

這就是納米貼片的使用方法

and immediately you can see some key advantages.

你能夠立即見識到 它的一些主要優勢

We've talked about it being needle-free --

我們談到了它無需使用針頭

these are projections that you can't even see --

你甚至看不見上面的凸起

and, of course, we get around

當然，我們也避免了

the needle phobia issue as well.

針頭恐懼症的問題

Now, if we take a step back and think about

現在讓我們退一步思考

these other two really important advantages:

另外兩個重大優勢

One is improved immune responses through delivery,

其一個通過注射方式提高免疫反應

and the second is getting rid of the cold chain.

另一個是不再需要冷藏運輸

So let's start with the first one, this immunogenicity idea.

先說第一個 引起免疫反應的觀點

It takes a little while to get our heads around,

這需要花一點時間弄清楚

but I'll try to explain it in simple terms.

我將用簡單的術語進行講解

So I'll take a step back and explain to you

回到上一步 我要簡單的解釋一下

how vaccines work in a simple way.

疫苗是怎樣作用的

So vaccines work by introducing into our body

疫苗是通過向人體內注入抗原

a thing called an antigen

而起作用

which is a safe form of a germ.

抗原是一種 不具傷害力的病原體

Now that safe germ, that antigen,

安全的抗原 (譯註：抗原指能引起免疫反應的物質)

tricks our body into mounting an immune response,

誘使人體進行免疫反應

learning and remembering how to deal with intruders.

學習和記憶如何對抗病原體

When the real intruder comes along

真正的入侵者出現時

the body quickly mounts an immune response

人體就能迅速做出免疫反應

to deal with that vaccine

對抗病原體

and neutralizes the infection.

并消除感染

So it does that well.

效果很好

Now, the way it's done today with the needle and syringe,

如今人們用 針頭和注射器進行這項工作

most vaccines are delivered that way --

多數疫苗都是 以用這種古老的技術

with this old technology and the needle.

用針頭注射

But it could be argued that the needle is holding back our immune responses;

但是有人指出 針頭限制了人體的免疫反應

it's missing our immune sweet spot in the skin.

因為它錯過了 位於皮膚上的有效免疫區

To describe this idea,

為了描述這個觀點

we need to take a journey through the skin,

讓我們仔細看看皮膚

starting with one of those projections

從貼到皮膚上奈米貼片的

and applying the Nanopatch to the skin.

一個凸起開始

And we see this kind of data.

可以看到這些數據

Now, this is real data --

真實的數據

that thing that we can see there is one projection

圖片上的是一個凸起

from the Nanopatch that's been applied to the skin

位於貼在皮膚上的納米貼片上

and those colors are different layers.

這些顏色代表不同的皮膚表層

Now, to give you an idea of scale,

這讓你們有大小的概念

if the needle was shown here, it would be too big.

如果用的是針頭 就會巨大無比

It would be 10 times bigger

會比屏幕的尺寸大十倍

than the size of that screen, going 10 times deeper as well.

也比它深十倍

It's off the grid entirely.

完全超出了屏幕範圍

You can see immediately that we have those projections in the skin.

你可以看到凸起深入到皮膚裡

That red layer is a tough outer layer of dead skin,

紅色表示硬的角質層

but the brown layer and the magenta layer

而棕色和洋紅色兩層

are jammed full of immune cells.

滿滿的全是免疫細胞

As one example, in the brown layer

例如：棕色那層

there's a certain type of cell called a Langerhans cell --

有一種細胞叫朗格漢斯細胞

every square millimeter of our body

人體的每平方公釐

is jammed full of those Langerhans cells,

都佈滿了朗格漢斯細胞

those immune cells, and there's others shown as well

這是一種免疫細胞 而圖片中也有其他免疫細胞

that we haven't stained in this image.

只是沒有特別標記顏色

But you can immediately see that the Nanopatch

但你可以看到納米貼片

achieves that penetration indeed.

確切到達了免疫細胞層

We target thousands upon thousands of these particular cells

我們把成千上萬的 免疫細胞作為目標群

just residing within a hair's width

細胞群只以一根頭髮的寬度

of the surface of the skin.

存在于皮膚表面

Now, as the guy that's invented this thing and designed it to do that,

這項發明可以達到如此效果

I found that exciting. But so what?

我覺得這很激動人心 但那又怎樣呢？

So what if you've targeted cells?

即便鎖定了這些細胞又怎樣呢？

In the world of vaccines, what does that mean?

在疫苗注射到 這個區域有什麼意義？

The world of vaccines is getting better.

現在疫苗的使用越來越進步

It's getting more systematic.

越來越系統化

However, you still don't really know

然而，除非捲起袖子施打

if a vaccine is going to work

你就仍無法確定

until you roll your sleeves up

疫苗是否有效

and vaccinate and wait.

注射疫苗， 然後等待它發揮作用

It's a gambler's game even today.

即便在今天看來 這仍是一場豪賭

So, we had to do that gamble.

我們不得不進行這場賭博

We obtained an influenza vaccine,

我們得到了一種流感疫苗

we applied it to our Nanopatches

將它用在納米貼片上

and we applied the Nanopatches to the skin,

然後將納米貼片貼在皮膚上

and we waited --

等待它發揮作用

and this is in the live animal.

我們用的是活體動物

We waited a month,

在等了一個月之後

and this is what we found out.

這就是我們的發現

This is a data slide showing the immune responses

而幻燈片展示的是實驗數據

that we've generated with a Nanopatch

分別使用納米貼片和肌肉注射時

compared to the needle and syringe into muscle.

所發生的免疫反應

So on the horizontal axis we have the dose shown in nanograms.

水平座標以豪微克 為單位表示疫苗的劑量

On the vertical axis we have the immune response generated,

垂直座標表示 發生免疫反應的強度

and that dashed line indicates the protection threshold.

虛線表示 達到產生保護作用的閾值

If we're above that line it's considered protective;

虛線以上具有保護作用

if we're below that line it's not.

虛線以下則沒有

So the red line is mostly below that curve

而紅色線幾乎都位於虛線以下

and indeed there's only one point that is achieved with the needle that's protective,

用針頭注射只有一點達到虛線以上

and that's with a high dose of 6,000 nanograms.

要高達 6000 豪微克的劑量 才能起到保護作用

But notice immediately the distinctly different curve

但是可以明顯看到

that we achieve with the blue line.

藍色線條完全不同

That's what's achieved with the Nanopatch;

納米貼片的作用結果

the delivered dose of the Nanopatch is

用納米貼片輸送的劑量

a completely different immunogenicity curve.

是一個完全不同的免疫原性曲線

That's a real fresh opportunity.

這實在是一個嶄新的機會

Suddenly we have a brand new lever

突然間我們在疫苗應用領域

in the world of vaccines.

有了一個全新的方式

We can push it one way,

我們可以這麼說

where we can take a vaccine that works but is too expensive

過往有效卻昂貴的疫苗

and can get protection

可以借此應用推行

with a hundredth of the dose compared to the needle.

比起針管注射 它只需要百分之一的劑量

That can take a vaccine that's suddenly 10 dollars down to 10 cents,

如此，疫苗的價錢 就從十美元降至十美分

and that's particularly important within the developing world.

在發展中國家這一點特別重要

But there's another angle to this as well --

也可以從另一個視角來看

you can take vaccines that currently don't work

你可以使用 目前因計量無法作用的疫苗

and get them over that line

用這個方法 使其超過閾值的虛線

and get them protective.

而達到保護作用

And certainly in the world of vaccines

這在疫苗應用領域

that can be important.

十分重要

Let's consider the big three:

看看這三大疾病吧

HIV, malaria, tuberculosis.

愛滋病、瘧疾、肺結核

They're responsible for about 7 million deaths per year,

它們導致了每年 7 百萬的死亡人數

and there is no adequate vaccination method for any of those.

每種疾病都缺少足夠的接種疫苗

So potentially, with this new lever that we have with the Nanopatch,

所以通過使用 納米貼片的新方式

we can help make that happen.

很可能會解決上述問題

We can push that lever to help get those candidate vaccines over the line.

我們可以通過這種方式 使那些珍貴的疫苗達到保護標準

Now, of course, we've worked within my lab

當然，在我的實驗室

with many other vaccines that have attained

許多疫苗都得到了

similar responses and similar curves to this,

像流感病毒一樣

what we've achieved with influenza.

類似的反應曲線

I'd like to now switch to talk about

現在我要將話題轉向

another key shortcoming of today's vaccines,

傳統疫苗的 另一個主要缺陷

and that is the need to maintain the cold chain.

即是冷藏運輸的必要性

As the name suggests -- the cold chain --

就如同「冷鏈」這個名字

it's the requirements of keeping a vaccine right from production

從生產出一種疫苗開始

all the way through to when the vaccine is applied,

一直保存到使用

to keep it refrigerated.

都必須確保疫苗冷藏

Now, that presents some logistical challenges

這就給物流方面帶來了許多挑戰

but we have ways to do it.

但我們有方法應對

This is a slightly extreme case in point

這是一個稍微極端的典型例子

but it helps illustrate the logistical challenges,

但它有助於說明 在資源貧乏的環境裡

in particular in resource-poor settings,

物流方面的難度

of what's required to get vaccines

需要冷藏疫苗

refrigerated and maintain the cold chain.

并維持冷藏運輸

If the vaccine is too warm the vaccine breaks down,

如果疫苗處在 太過溫暖的環境就會損壞

but interestingly it can be too cold

有意思的是：溫度過低

and the vaccine can break down as well.

也可能損壞疫苗

Now, the stakes are very high.

損壞風險非常高

The WHO estimates that within Africa,

世界衛生組織 評估非洲的情況後

up to half the vaccines used there

認為超過半數疫苗

are considered to not be working properly

都沒有起到應有的作用效果

because at some point the cold chain has fallen over.

是因為不健全的冷藏供應系統

So it's a big problem, and it's tied in with the needle and syringe

這是個嚴重的問題 與使用注射器和針頭相關

because it's a liquid form vaccine, and when it's liquid it needs the refrigeration.

液體狀態的疫苗需要冷藏

A key attribute of our Nanopatch

納米貼片的一個關鍵屬性是

is that the vaccine is dry,

疫苗是乾燥儲存

and when it's dry it doesn't need refrigeration.

這種疫苗不需要冷藏

Within my lab we've shown that we can keep

我的實驗室發現

the vaccine stored at 23 degrees Celsius

我們能將疫苗貯存在 23 攝氏度

for more than a year without any loss in activity at all.

並長達一年以上 而完全不失其活性

That's an important improvement.

這是一項重大改進

(Applause)

(掌聲)

We're delighted about it as well.

對此，我們也很高興

And the thing about it is that we have well and truly proven

事實上我們已經

the Nanopatch within the laboratory setting.

在實驗室內證明 納米貼片的作用

And as a scientist, I love that and I love science.

作為一名科學家， 我喜歡做出成果，我熱愛科學

However, as an engineer,

然而，作為一個工程師

as a biomedical engineer

作為一名生物醫學工程師

and also as a human being,

作為一個人

I'm not going to be satisfied

除非我們已經推行該產品

until we've rolled this thing out, taken it out of the lab

走出實驗室 我就對結果仍不滿意

and got it to people in large numbers

讓更多人能使用

and particularly the people that need it the most.

特別是最需要它的人

So we've commenced this particular journey,

我們已經開始了這段測試

and we've commenced this journey in an unusual way.

我們有個特別的起點

We've started with Papua New Guinea.

我們從 巴布亞新幾內亞開始

Now, Papua New Guinea is an example of a developing world country.

巴布亞新幾內亞是一個發展中國家

It's about the same size as France,

與法國的大小相同

but it suffers from many of the key barriers

但該國受許多關鍵性障礙困擾

existing within the world of today's vaccines.

存在於今天的疫苗世界的關鍵障礙

There's the logistics:

在物流方面

Within this country there are only 800 refrigerators to keep vaccines chilled.

在這個國家僅有 800 臺冰箱可以冷藏疫苗

Many of them are old, like this one in Port Moresby, many of them are breaking down

很多冰箱都已經老化 像莫爾斯比港的這一台，而且都逐漸損壞

and many are not in the Highlands where they are required.

還有很多 並沒有配備在所需的高地

That's a challenge.

這是一項挑戰

But also, Papua New Guinea has the world's highest incidence of HPV,

並且，人類乳頭瘤病毒在 巴布亞新幾內亞有世界上最高的染病率

human papillomavirus, the cervical cancer [risk factor].

人類乳頭瘤病毒是宮頸癌的風險隱患

Yet, that vaccine is not available in large numbers

然而，該疫苗無法大量使用

because it's too expensive.

因為太貴了

So for those two reasons, with the attributes of the Nanopatch,

基於這兩個理由 與納米貼片的特性

we've got into the field and worked with the Nanopatch,

我們進入這個領域 生產納米貼片

and taken it to Papua New Guinea

並送往巴布亞新幾內亞

and we'll be following that up shortly.

我們馬上會繼續跟進

Now, doing this kind of work is not easy.

做這種工作並不容易

It's challenging,

具有挑戰性

but there's nothing else in the world I'd rather be doing.

但是這世上我只想做這件事

And as we look ahead

當我們展望未來

I'd like to share with you a thought:

我想與你們分享一個想法

It's the thought of a future where

關於未來的一個想法：

the 17 million deaths per year

每年有 1700 萬人死亡

that we currently have due to infectious disease

死於目前發現的傳染性疾病

is a historical footnote.

會因為疫苗的發展

And it's a historical footnote that has been achieved

讓這個數字逐漸成為

by improved, radically improved vaccines.

微不足道的歷史腳註

Now standing here today in front of you

今天大家所在的

at the birthplace of the needle and syringe,

是針頭和注射器誕生的地方

a device that's 160 years old,

有 160 年歷史的技術

I'm presenting to you an alternative approach

今天，我介紹了另一種方法

that could really help make that happen --

可以真正實現這個目標的方法

and it's the Nanopatch with its attributes of being needle-free, pain-free,

無需針頭 無疼痛的納米貼片

the ability for removing the cold chain and improving the immunogenicity.

不再需要冷藏運輸 還可以提高免疫能力

Thank you.

謝謝

(Applause)

（掌聲）