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

譯者: Wenjer Leuschel 審譯者: Shelley Tsang 曾雯海

(Mosquitoes buzzing)

（蚊子嗡嗡聲）

Mosquitoes.

蚊子。

I don't know about you,

我不知道各位如何，

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

但我和牠們的關係不是很好。

(Laughter)

（笑聲）

A friend of mine said one day,

有一天，我的一位友人說，

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

如果你認為自己太渺小， 無法造成重大的改變，

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

那你肯定從未和蚊子 共處一室一個晚上。

(Laughter)

（笑聲）

But ...

但是……

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

我今晚口袋裡沒有蚊子可以釋放，

so it's going to be fine.

所以不會有問題。

So let's start.

咱們開始吧。

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

儘管聽起來讓人難以置信，

瘧疾和人類一樣古老。

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

且瘧疾曾經一度是 全世界的公共衛生議題。

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

但後來美國和歐洲 已成功把瘧疾處理掉了。

And yet, decades later,

但，數十年後，

malaria still kills millions of people

瘧疾仍然在非洲及亞洲

in Africa

造成數百萬人死亡。

and in Asia.

Why?

為什麼？

I'm Abdoulaye Diabaté, a medical entomologist

我是阿布杜拉耶‧迪亞巴提，

我是健康科學學生所的 醫學昆蟲學家。

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

I'm here today,

我今天來到這裡，

flying all the way from Burkina Faso,

大老遠從布吉納法索飛過來，

to tell you that we might be closer than ever

是要告訴各位，我們可能比以往 都還要接近消滅非洲的瘧疾。

to eliminate malaria in Africa.

(Applause)

（掌聲）

Thank you.

謝謝。

Malaria is tightly linked to poverty.

瘧疾與貧窮有很密切的關係。

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

但各位可能不知道， 貧窮是多麼昂貴。

There are 200 million cases worldwide

全世界每年有兩億個瘧疾案例，

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

很不幸最後會有大約六十萬人死亡。

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

且這並不是紙上的隨機統計資料。

Behind each of these 600,000 deaths,

在這六十萬個死亡案例背後，

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

是悲劇的個人故事， 有時還不為人知。

Most of these deaths happen in Africa.

死亡案例多半發生在非洲。

Children and pregnant women bear the highest burden.

兒童和孕婦承擔的負擔最沉重。

And I'm a fortunate childhood malaria survivor.

我很幸運，兒時得過 瘧疾但存活下來了。

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

小時候，我認為我爸爸是超級英雄。

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

每天早上六點我就會看到他出家門，

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

騎腳踏車去農場， 整天都非常努力工作。

We did not have much for living.

我們的生活資源不多。

But who said you need more to be happy?

但誰說你需要更多才會幸福？

But when happiness hangs by a thread,

但，當幸福只懸在一條線上，

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

你的人生很容易就會天翻地覆。

我對爸爸的信任

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

在我得瘧疾的那天深受動搖。

I was three or four years old.

那時才我三、四歲大。

As we used to say in my country,

在我的國家，大家常說，

kids may not understand the complexity of suffering,

孩子可能不能理解苦難的複雜，

but pain has no age.

但痛苦不分年齡。

And gosh, I was in pain.

而，天啊，我很痛苦。

I can still clearly see myself

我仍然清楚記得那時我躺在床上，

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

發著高燒，痛苦不堪。

I could not eat anything.

我無法進食。

不斷地嘔吐。

Throwing up all the time.

Will I survive? Will I not?

我撐得過嗎？我撐不過嗎？

The psychological trauma my parents were going through

我父母所經歷的心理創傷

was unbearable.

大到難以忍受。

But against all odds, I survived.

但，儘管面臨重重困難， 我還是活下來了。

But can we say today that we are done with malaria

但是我們現今能否說 瘧疾已經解決了，

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

因為迪亞巴提活下來 且一路來到了溫哥華？

If I say yes, no one can blame me.

如果我說是，沒有人可以怪我。

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

但那是個謊言，

因為還有許多孩子因為瘧疾而死。

The real question then is:

真正的問題是：

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

為什麼目前為止我們還無法擊敗它？

Well because malaria is a complex parasitic disease

因為瘧疾是種複雜的 寄生蟲疾病，涉及三個層面。

that plays on three grounds.

Plasmodium, the pathogen;

瘧原蟲，病原體；

anopheles, the vector;

瘧蚊，傳播媒介；

and human, the victim.

以及人類，受害者。

Each of these elements is very complex on its own,

這些元素每一個本身都非常複雜，

and the interactions make it even more complex

交互作用又再增加複雜度，

to devise interventions that are really effective.

很難設計出真正有效的干預措施。

But of course we are trying.

但，當然，我們在嘗試。

Currently, there are two vaccines to immunize people,

目前有兩種疫苗可以讓人免疫，

but the heavy logistics to deliver this vaccine

但遞送這些疫苗的物流很繁重，

may not allow us to reach their full potential.

可能會讓它們無法完全發揮。

Bed nets and first-hand treatment

蚊帳和一線治療

are both threatened by insecticide and drug resistance,

都受到殺蟲劑和抗藥性的威脅，

meaning that our best interventions have started to fail.

意味著我們最好的 干預措施已開始失效了。

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

現今有一個普遍共識：

如果沒有額外的新工具，

we may never cross the last mile of malaria elimination.

我們可能永遠無法跨越 消除瘧疾的最後一哩路。

And this is exactly where I come in.

這就是需要我的地方。

My colleagues and I at Target Malaria,

我和我在「目標瘧疾」的同事 正在致力於所謂的

and are working on something called gene drive:

基因驅動：

a way to control mosquito population and halt malaria transmission.

一種可以控制蚊子數量 並阻止瘧疾傳播的方法。

So what is gene drive?

基因驅動是什麼？

It's a natural molecular mechanism

它是一種自然的分子機制，

that augments the frequency of a certain gene in the population

可以提高某基因在族群中的頻率， 超過正常的孟德爾遺傳範圍。

beyond the normal Mendelian inheritance.

So what does it mean?

這是什麼意思？

If you take any gene,

不論任何基因，

in natural circumstances,

在自然的情況中，

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

它被傳給下一代的機率只有 50%。

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

意思就是，如果父母生了 一百個寶寶，如蚊子，

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

只有五十個寶寶會得到該基因， 另外五十個則沒有。

But not all genes behave this way in nature.

但在大自然中，並非 所有基因皆是如此。

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

有些基因已經找到了非常 聰明的方法來繞過這條法則。

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

可以將把自己傳下去的 機率提高到 90%。

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

我們說這是驅動，因此才有 「基因驅動」這個名詞。

Our most promising strain affects female fertility

我們前景最看好的菌株

能針對一種叫做 doublesex 的 基因來影響雌性生育率，

by targeting a gene called doublesex.

This gene is responsible for the sex determination in mosquitoes,

該基因負責決定蚊子的性別，

and so disrupting the doublesex gene

因此擾亂

doublesex 基因可能會 影響成蚊的性別發育

may affect the sexual development for adult mosquitoes

and their reproduction.

及其繁殖。

Now

這聽起來可能和直覺相反，

it may sound counterintuitive to affect female fertility

一邊去影響雌性生育率

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

一邊在蚊子中散播我們關注的基因。

But it's working.

但這是有效的。

And let me show you how.

讓我展示給大家看。

We target a specific region of the gene called doublesex

我們針對基因中的特定區域，

doublesex，

that affects only females.

它只會影響雌性。

Males bearing this modified gene are not affected at all.

帶有這種改造基因的雄性 完全不會受到影響。

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

只有一個改造基因的雌性 仍然具有完整的生孕能力。

However, females bearing two copies

然而，有兩個改造基因的雌性 無法產卵，無法叮咬，

of the modified gene

cannot lay eggs,

fail to bite

且具有雄性和雌性的身體特徵。

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

It's called a suppression strategy.

這稱為抑制策略。

Once these mosquitoes are released in the field,

一旦這些蚊子被實地釋放，

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

牠們會把我們關注的基因 散播到野生族群中，

and this is going to reduce dramatically their reproductive capacity.

這會大幅降低牠們的生殖能力。

Fewer mosquitoes means less malaria transmission

蚊子減少意味著瘧疾傳播減少，

until it stops.

直到傳播停止。

Mathematical models predict

數學模型預測，

that releasing such mosquitoes in the field

實地釋放這些蚊子

is going to stop malaria transmission in just 20 generations.

只要二十個世代 就能讓瘧疾傳播告終。

That means in two years.

二十個世代就是兩年。

And the technology is sustainable,

且這項技術是永續的，

cost-effective and easy to deploy,

成本效益很高，且容易部署實施，

as the released mosquitoes will do the job themselves

被釋放的蚊子本身 就會完成這項工作，

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

後一個隱藏的野生蚊子來 轉化來完成這項工作。

Fantastic.

太棒了

The only problem,

唯一的問題，

gene drive has never been tested anywhere in Africa.

基因驅動從未經過非洲 任何地方測試。

And while the technology brings a lot of hope,

雖然這項技術 帶來了很多希望，

it also carries its share of fear and skepticism.

但它還帶著它的 恐懼和懷疑態度。

The pathway from the bench to the field

從長椅前往球場的路線並

is not straightforward and is full of pitfalls.

不簡單，而且充滿陷阱。

Maybe the mosquitoes in the field

也許田野中的蚊子

will develop resistance to the spread of the transgene.

會對轉基因的 擴散發生抵抗力。

Or maybe two countries don't agree,

或者也許兩個國家不同意，

but released mosquitoes do not respect the human borders.

但被釋放的蚊子 不尊重人類邊界。

Or also, maybe there are risks to the environment.

或者，也許對環境存在風險。

And finally, the community that we are working with

最後，我們正在與我們合作的

need to feel comfortable about this technology

社區需要對這項技術感到

and give us the green light to operate.

舒適，並給我們綠燈運行。

And so for such,

因此，對於此，Target Malaria 採用了

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

Target Malaria 採用了 一種逐步的增量方法，

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

我們將開始釋放第一個 非基因驅動蚊子，

meaning that the gene of interest here cannot self-propagate

這意味著這裡感興趣的 基因無法自我傳播，

and will just go extinct in a few generations.

而且幾代後就會滅絕。

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

基因驅動因素，這種 基因對環境的曝光

is incrementally augmented

會逐漸增加，

in a way that we start first with small cages

我們首先從歐洲的小籠 和大型室內籠子開始，

and big indoor cages in Europe,

然後這些蚊子被 送到布吉納法索，

and then these mosquitoes are sent to Burkina Faso,

在那裡首先在密閉式 設施中進行測試，

where they are tested in a contained facility first,

然後在一個大型

and subsequently in a big indoor small cage field release.

室內小籠子裡實地釋放。

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

現在，基因驅動蚊子 只有在這個初步之後才會

only after this preliminary step

在開放場地進行測試，

and the potential risks have been looked at very carefully.

並非常仔細研究 潛在的風險。

And also additional research questions have been developed

此外，我們還開發了 其他研究問題，

to address these risks, if any.

以解決這些風險（如果有的話）。

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

現在的問題，我們距離釋放 基因驅動器有多遠？

Four to five years.

四到五年。

But let me tell you this.

但讓我告訴你這個。

Gene drive mosquitoes are already in the lab,

基因驅動蚊子已經在實驗室裡，

and releasing them in the field

我們將它們放在野外

is not going to take us more than 30 minutes.

超過 30 分鐘的 時間並不會花。

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

但我們需要五年 才能為這 30 分鐘做好準備

And why is that?

為什麼是這樣？

The answer is simple.

答案很簡單。

Because we need to engage the community

因為我們需要參與社區

and get the social license to operate.

並獲得社會許可證來運營。

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

因此，如果有一件事是 您無法錯過的奢侈品，

it's the stakeholder engagement.

那就是利益相關者的參與。

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

我不能只是一個為 公共利益工作的

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

科學家而帶著一桶蚊子 出現在一個村莊裡。

It will not take anyone a PhD to understand

沒有任何人需要 博士學位才能

if we are respectful of their values or not.

理解我們是否 尊重他們的價值觀。

We need to engage the community

我們需要參與社區，

and then co-develop the technology with them.

然後與他們 共同開發技術。

And so for that,

為此，我們在

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

金字塔結構上建立了 我們的參與策略，

starting with the villages where we operate

從我們運營到 最高的村莊開始，

all the way to the top with the government officials.

與政府官員一起開始。

The engagement is done step-by-step.

參與是逐步完成的。

It’s done in an inclusive way

這是以包容的方式完成，

and also is done in full transparency.

並且以完全透明度完成。

Ladies and gentlemen,

女士們，

there is one more thing that needs to be done

先生們，基因 驅動器能在非洲

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

現場發放之前， 還需要做一件事。

That is capacity building.

這就是能力建設。

Gene drive holds a lot of promises,

基因驅動有很多承諾，

but it will not take us anywhere

但如果我們非洲人沒有能夠

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

自己運行它，它將不會 帶我們到任何地方。

Sadly,

可悲的是，

the technical platform in Africa is really very poor,

非洲的技術平台確實非常差，

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

我們必須解決這個問題， 才能真正擊敗感染瘧疾。

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

因此，我們在布吉納法索設立

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

世界銀行資助的傳媒傳播疾病， 例如卓越的流行性疾病中心。

And also with additional funds from the Gates Foundation,

此外，透過蓋茨基金會 提供的額外資金，

we are building a critical mass of next generation scientists

我們正在在整個 大陸建立新一代

all over the continent

科學家的關鍵量，

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

以填補知識缺口和 專業知識差距。

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

1969 年 4 月，一個孩子出生 在布吉納法索偏遠的村莊。

Like any other child of the world,

像世界上任何其他孩子一樣，

he had dreams and expectations.

他有夢想和期望。

Sadly, however, as he came to learn,

然而，可悲的是， 隨著他來了解的時候，

the place where you are born in on this planet

very often affects your perspective on life,

很常會影響你對生活的觀點，

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

甚至可能會設定 你需要走進未來的道路。

That shouldn't be the case.

這不應該是如此。

We are all citizens of the world.

我們都是世界的公民。

Our dreams and aspirations should not be constrained

我們的夢想和願望不應受到

by the place where we are born.

我們的出生地的限制。

And this is the reason why I became a scientist.

這就是我成為科學家的原因

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

為這個大陸任何地方的 孩子們提供無限的可能性，

so that they can see the future with hope.

讓他們能夠以希望看到未來。

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

但是，如果你被 感染了瘧疾，那就沒有希望。

But Target Malaria is here to fix that.

但是目標的瘧疾就是爲了 解決這個問題

A world free of malaria is our vision.

我們的願景是一個沒有瘧疾的世界。

And I will say, yes, we can.

我會說，是的，我們可以。

Thank you for your attention.

感謝您的關注。

(Applause)

（掌聲）