How we'll fight the next deadly virus | Pardis Sabeti

譯者: 易帆 余 審譯者: Tim Lan

You may never have heard of Kenema, Sierra Leone

你可能沒聽過位於獅子山共和國的凱內馬

or Arua, Nigeria.

或是奈及利亞的阿魯阿。

But I know them as two of the most extraordinary places on earth.

但我知道它們是地球上 兩個最奇特的地方。

In hospitals there, there's a community of nurses, physicians and scientists

那裡的醫院，有一個護士、 醫生、科學家組成的社群，

that have been quietly battling

他們正安靜地對抗

one of the deadliest threats to humanity for years:

一個危害人類多年致命威脅：

Lassa virus.

拉薩病毒。

Lassa virus is a lot like Ebola.

拉薩病毒與伊波拉病毒非常像。

It can cause a severe fever and can often be fatal.

它會引發嚴重的感冒， 而且常常會致命。

但這些人，他們每天冒著生命危險

But these individuals, they risk their lives every day

to protect the individuals in their communities,

來保護他們社群裡的個體，

and by doing so, protect us all.

也因為如此，保護了我們全部人。

But one of the most extraordinary things I learned about them

但，我從他們身上學到最棒的一件事就是--

on one of my first visits out there many years ago

好幾年前，在我第一次 拜訪的時候發現，

was that they start each morning --

在前線這充滿挑戰的特殊日子裡，

these challenging, extraordinary days on the front lines -- by singing.

他們的每個早晨是這樣開始的--唱歌。

They gather together, and they show their joy.

他們聚集並展現他們的愉悅。

They show their spirit.

他們展現他們的活力。

And over the years,

過了幾年，

from year after year as I've visited them and they've visited me,

年復一年，我們互相拜訪，

I get to gather with them and I sing

我與他們聚會，一同歌唱

and we write and we love it,

一起寫歌、我們超愛這樣做，

because it reminds us that we're not just there to pursue science together;

因為這樣可以提醒我們， 我們不是只有在那裡一起追求科學而已；

we're bonded through a shared humanity.

我們藉由共同的天性 而緊緊地聯繫在一起。

And that of course, as you can imagine, becomes extremely important,

當然，你可以想像，這變得很重要，

even essential, as things begin to change.

甚至是必要的，因為事情開始有了變化。

And that changed a great deal in March of 2014,

而變化真的很大， 2014 年的 3 月，

when the Ebola outbreak was declared in Guinea.

當伊波拉病毒在幾內亞被宣布爆發時。

This is the first outbreak in West Africa,

這是西非的第一次爆發，

near the border of Sierra Leone and Liberia.

位置接近獅子山共和國和 利比里亞的邊界。

And it was frightening, frightening for us all.

而這非常可怕，我們都嚇壞了，

We had actually suspected for some time

實際上，我們已經懷疑了很久，

that Lassa and Ebola were more widespread than thought,

拉薩病毒與伊波拉病毒的散佈情況 比想像中的還要來的嚴重。

and we thought it could one day come to Kenema.

我們在想，有一天它會來到凱內馬。

And so members of my team immediately went out

我團隊裡的一些成員立刻出發

and joined Dr. Humarr Khan and his team there,

加入Humarr Khan博士在那邊的團隊，

and we set up diagnostics to be able to have sensitive molecular tests

我們建立起能進行高敏分子測試的診斷機制，

to pick up Ebola if it came across the border

來收集跨過邊界進入到獅子山共和國的伊波拉病毒。

and into Sierra Leone.

We'd already set up this kind of capacity for Lassa virus,

我們之前已經為拉薩病毒建立過 類似的診斷設施。

we knew how to do it,

我們知道如何做，

the team is outstanding.

團隊非常的傑出。

We just had to give them the tools and place to survey for Ebola.

我們只要給他們工具和場所， 他們就可以進行伊波拉病毒的調查。

And unfortunately, that day came.

但不幸的是，那天真的到來了。

On May 23, 2014, a woman checked into the maternity ward at the hospital,

2014 年 5 月 23 日， 一名婦女住進醫院的產房，

and the team ran those important molecular tests

我們的團隊進行了 一些重要的分子檢測測試，

and they identified the first confirmed case of Ebola in Sierra Leone.

然後確診了第一起獅子山共和國的 伊波拉病毒病例。

這件事已經完成的非常好了，

This was an exceptional work that was done.

They were able to diagnose the case immediately,

他們可以立刻確診病例，

to safely treat the patient

來安全地治療病患，

and to begin to do contact tracing to follow what was going on.

然後開始追蹤接觸者 並觀測後續發展。

It could've stopped something.

這本可以阻止一些事情。

But by the time that day came,

但那一天來之前，

the outbreak had already been breeding for months.

病毒已經爆發並擴散繁殖了好幾個月。

With hundreds of cases, it had already eclipsed all previous outbreaks.

這幾百個案例， 遠遠超過了以往所有爆發

And it came into Sierra Leone not as that singular case,

它並不是以單一個案 來侵入獅子山共和國，

but as a tidal wave.

而是席捲而來。

We had to work with the international community,

我們必須跟國際組織合作、

with the Ministry of Health, with Kenema, to begin to deal with the cases,

跟衛生局、跟凱內馬合作 來開始解決這些問題，

as the next week brought 31,

一個星期後，在凱內馬 出現了31個、

then 92, then 147 cases -- all coming to Kenema,

接著是92個、147個病例，

one of the only places in Sierra Leone that could deal with this.

出現在這個獅子山共和國內 唯一能處理這種病的地方。

And we worked around the clock trying to do everything we could,

我們日以繼夜地工作， 嘗試盡我們所能得做每件事情、

trying to help the individuals, trying to get attention,

嘗試幫助每個人、嘗試引起注意、

but we also did one other simple thing.

但我們也做了另一件簡單的事。

From that specimen that we take from a patient's blood to detect Ebola,

從一個患者的血液拿出 伊波拉病毒樣本開始，

we can discard it, obviously.

你知道，顯然地， 我們可以不管這件事的。

The other thing we can do is, actually, put in a chemical and deactivate it,

但實際上，我們可以做的另一件事 就是加入化學藥劑並讓它失去活性，

so just place it into a box and ship it across the ocean,

我們把它放進盒子，跨海運送出去，

and that's what we did.

而這就是我們做的。

We sent it to Boston, where my team works.

我們把它送到波士頓， 我團隊工作的地方。

And we also worked around the clock doing shift work, day after day,

我們也是日以繼夜、換班、不斷的工作，

and we quickly generated 99 genomes of the Ebola virus.

我們很快地做出 99 個 伊波拉病毒的基因組。

This is the blueprint -- the genome of a virus is the blueprint.

這是藍圖--病毒的基因組。

We all have one.

我們都有一個基因藍圖。

It says everything that makes up us,

它展示了我們所有的組成成分，

and it tells us so much information.

也告訴了我們很多資訊。

The results of this kind of work are simple and they're powerful.

這類工作的成果 相當簡單且它們很有用處，

We could actually take these 99 different viruses,

我們實際上可以拿這 99 個不同的病毒，

look at them and compare them,

檢視它們並比對它們，

and we could see, actually, compared to three genomes

而我們可以看到，實際上， 比對出來的 3 種基因組

that had been previously published from Guinea,

之前已經在幾內亞被公布過了，

we could show that the outbreak emerged in Guinea months before,

我們可以證明，爆發是在幾內亞 好幾個月前發生的，

once into the human population,

一旦入侵人類，

and from there had been transmitting from human to human.

病毒就開始人傳人了。

Now, that's incredibly important

現在，這真的相當重要，

when you're trying to figure out how to intervene,

當你嘗試要找出如何阻止的方法，

but the important thing is contact tracing.

最重要的就是接觸感染的追蹤。

We also could see that as the virus was moving between humans,

我們也可以看到，當病毒 在人類之間移動時，

it was mutating.

它會突變。

And each of those mutations are so important,

而每個突變都相當重要，

because the diagnostics, the vaccines,

因為我們使用的

診斷、疫苗、治療方法

the therapies that we're using,

are all based on that genome sequence, fundamentally --

所有基礎都是建立在 這些基因組序列上的，基本上--

that's what drives it.

就是這些在驅動整件事情的。

And so global health experts would need to respond,

所以全球的醫療保健專家

would have to develop,

必須得回應和繼續開發

to recalibrate everything that they were doing.

以此重新調整他們著手的所有工作。

But the way that science works, the position I was in at that point

但以科學工作的方法而言，

is, I had the data,

我當時的處境是這樣：因為我有數據，

and I could have worked in a silo for many, many months,

所以我本可以實驗倉裡工作好幾個月，

analyzed the data carefully, slowly,

仔細地、慢慢地分析資料，

submitted the paper for publication, gone through a few back-and-forths,

透過來回的文件往返，然後發表文章，

and then finally when the paper came out, might release that data.

而最後當報告出來， 也許要公開那些資料。

That's the way the status quo works.

這就是現狀工作的方法。

Well, that was not going to work at this point, right?

但，在這個關鍵時刻，如果那樣做 根本行不通，對吧？

We had friends on the front lines

我們前線有朋友，

and to us it was just obvious that what we needed is help,

對我們而言，很明顯的，我們需要的就是幫助，

lots of help.

很多的幫助，

So the first thing we did is,

所以，我們做的第一件事就是，

as soon as the sequences came off the machines,

盡可能地趕快把 序列從機器裡跑完，

we published it to the web.

然後把它公布到網站上，

We just released it to the whole world and said, "Help us."

我們只是把它公布到全世界， 並到訴大家「幫助我們」

And help came.

然後，幫助來了，

Before we knew it,

在我們知道這件事以前，

we were being contacted from people all over,

我們已經聯繫來自各地的人們，

surprised to see the data out there and released.

他們很驚訝看到資料 就在那裏被公布出來。

Some of the greatest viral trackers in the world

一些世界上最偉大的病毒追蹤專家，

were suddenly part of our community.

突然間變成我們社群的一部分。

We were working together in this virtual way,

我們用這種虛擬的方式一起工作、

sharing, regular calls, communications,

分享、定時回報、溝通、

trying to follow the virus minute by minute,

分分秒秒跟蹤著病毒，

to see ways that we could stop it.

看看有甚麼方法可以阻止它。

And there are so many ways that we can form communities like that.

我們有很多可以建立 類似這種社群的方式。

Everybody, particularly when the outbreak started to expand globally,

特別是當爆發開始擴散到全球時，

was reaching out to learn, to participate, to engage.

每個人都想伸出援手學習、參與、加入。

Everybody wants to play a part.

每個人都想扮演一個角色。

The amount of human capacity out there is just amazing,

人類的能力綜合，加起來相當驚人，

and the Internet connects us all.

網路連結了我們。

And could you imagine that instead of being frightened of each other,

你可以想像， 我們不在彼此傳播恐懼，

that we all just said, "Let's do this.

而是一起說，「讓我們做這件事，

Let's work together, and let's make this happen."

讓我們一起工作、讓這件事成真」

But the problem is that the data that all of us are using,

但問題是， 我們大家都在使用那些google上搜尋來的資料，

Googling on the web, is just too limited to do what we need to do.

對我們的工作實在太具有局限性了，

And so many opportunities get missed when that happens.

所以當機會來臨時我們會錯過很多，

So in the early part of the epidemic from Kenema,

因此，在凱內馬疫情的初期，

we'd had 106 clinical records from patients,

我們有 106 位病人的臨床紀錄，

and we once again made that publicly available to the world.

然後我們再次地向世界公布，

And in our own lab, we could show that you could take those 106 records,

在我們自己的實驗室，我們可以讓 你可以拿走這 106 個紀錄，

we could train computers to predict the prognosis for Ebola patients

我們可以訓練電腦， 去預判病人的伊波拉病毒，

to near 100 percent accuracy.

準確率接近 100%。

And we made an app that could release that,

我們做了一個app程式 來發放這些資料，

to make that available to health-care workers in the field.

供出外勤的醫療人員使用。

But 106 is just not enough to make it powerful,

但 106 個樣本還是

不夠多也不夠強來發揮效果

to validate it.

So we were waiting for more data to release that.

所以，我們還要等更多的資料來公布它，

and the data has still not come.

但，資料仍然還沒來。

We are still waiting, tweaking away,

我們仍在實驗倉裡等待、苦惱，

in silos rather than working together.

而不是一起工作。

And this just -- we can't accept that.

要是這樣--我們根本無法接受，對吧？

Right? You, all of you, cannot accept that.

你們全部都無法接受。

It's our lives on the line.

我們的生命，箭在弦上。

And in fact, actually,

而事實上，

many lives were lost, many health-care workers,

已有很多生命離開、很多醫療照顧者、

including beloved colleagues of mine,

包括我最愛的五個同事：

five colleagues: Mbalu Fonnie, Alex Moigboi,

Mbalu Fonnie, Alex Moigboi,

Dr. Humarr Khan, Alice Kovoma and Mohamed Fullah.

Humarr Khan博士、Alice Kovoma 及Mohamed Fullah.

These are just five of many health-care workers

這些僅是在凱內馬多位在幕後 默默奉獻的其中五位醫療照顧者，

at Kenema and beyond

that died while the world waited and while we all worked,

當全世界在等待、當我們全部在工作時， 他們已安靜地離我們而去。

quietly and separately.

你看！伊波拉病毒就像全體人類的威脅，

See, Ebola, like all threats to humanity,

it's fueled by mistrust and distraction and division.

它是由不信任、分心、分裂所組成

When we build barriers amongst ourselves and we fight amongst ourselves,

在我們彼此阻隔並相互鬥爭時，

the virus thrives.

病毒就從中茂盛了起來。

But unlike all threats to humanity,

但不像人類的其他威脅，

Ebola is one where we're actually all the same.

實際上，面對伊波拉病毒的威脅時， 我們都是一樣的。

We're all in this fight together.

我們全部都在這一場戰役裡面。

Ebola on one person's doorstep could soon be on ours.

伊波拉在某人家的門口， 很快的，就會來到我們家。

And so in this place with the same vulnerabilities,

所以在這個地方，我們都一樣脆弱，

the same strengths, the same fears, the same hopes,

一樣的抵抗力、一樣的恐懼、 一樣的希望，

I hope that we work together with joy.

我希望我們可以一起開心工作。

A graduate student of mine was reading a book about Sierra Leone,

我的一位研究生，當時在讀一本 有關於獅子山共和國的書，

and she discovered that the word "Kenema,"

她發現，我們在獅子山共和國工作的醫院 所坐落的城市「凱內馬」，

the hospital that we work at and the city where we work in Sierra Leone,

is named after the Mende word for "clear like a river, translucent

是以曼德語中的「清澈如溪，

公開透明給大眾檢視」而命名的。

and open to the public gaze."

That was really profound for us,

這對我們影響相當深刻，

because without knowing it, we'd always felt

因為認識到這一點， 我們才會覺得為了尊重凱內馬的人民，

that in order to honor the individuals in Kenema where we worked,

we had to work openly, we had to share and we had to work together.

所以我們必須公開、分享、共同工作。

And we have to do that.

而我們必須這麼做。

We all have to demand that of ourselves and others --

我們每個人都必須專心一致--

to be open to each other when an outbreak happens,

彼此公開，當下次病毒爆發時，

to fight in this fight together.

我們一起並肩作戰，

Because this is not the first outbreak of Ebola,

因為這不是伊波拉病毒的第一次爆發，

it will not be the last,

它也不會是最後一次，

and there are many other microbes out there that are lying in wait,

還有很多的細菌潛伏著，

like Lassa virus and others.

像是拉薩病毒等。

And the next time this happens,

當下次再次發生時，

it could happen in a city of millions, it could start there.

它可能會在一個百萬人的城市開始爆發。

It could be something that's transmitted through the air.

它可能會是透過空氣傳染的某種東西。

It could even be disseminated intentionally.

它甚至有可能全球性地散播。

And I know that that is frightening, I understand that,

我知道這很恐怖，我懂這個，

but I know also, and this experience shows us,

但我也知道，這個經驗告訴我們，

that we have the technology and we have the capacity

我們擁有科技，我們也有能力

to win this thing,

能贏得這場勝利，

to win this and have the upper hand over viruses.

戰勝並克服病毒。

But we can only do it if we do it together

但我們要實現勝利，只能通過一起努力

and we do it with joy.

並開心地做。

So for Dr. Khan

為了Khan博士、為了那些在前線

and for all of those who sacrificed their lives on the front lines

犧牲掉生命

永遠與我們同在的那些人，

in this fight with us always,

let us be in this fight with them always.

讓我們經常伴隨他們一起奮戰。

And let us not let the world be defined

讓我們不要讓這個世界，

by the destruction wrought by one virus,

被一個病毒的毀滅所定義，

but illuminated by billions of hearts and minds

而是被數十億個 團結在一起的心靈所照耀。

working in unity.

Thank you.

謝謝！

(Applause)

（掌聲）