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Transcriber: Ivana Korom
Reviewer: Krystian Aparta
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譯者: Lilian Chiu
審譯者: Helen Chang
00:12
It is hard to overstate
the beneficial effects of immunization.
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免疫的好處是再怎麼
強調也不為過的。
00:18
According to the US
Centers for Disease Control,
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根據美國疾病管制與預防中心,
00:22
US children born over the last 20 years --
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在過去二十年間
出生的美國兒童——
00:25
for those children, vaccines will prevent
greater than 322 million illnesses,
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針對這些兒童,疫苗就能預防
至少三億兩千兩百萬次生病、
00:31
greater than 21 million hospitalizations
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至少兩千一百萬次住院,
00:34
and greater than 730,000 deaths,
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以及超過七十三萬人死亡,
00:37
with the societal cost savings
of nearly 1.4 trillion dollars.
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省下近一兆四千億美金的社會成本。
00:43
Those are big numbers.
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這些數字很驚人。
00:44
But let's zoom in
and look at a particular example.
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但,咱們放大來看看
一個特別的例子。
00:47
Vaccines have nearly eliminated
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疫苗幾乎消滅了一種細菌性感染:
00:50
a bacterial infection
called Haemophilus influenzae.
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流行性嗜血桿菌。
00:53
This bacterium
used to infect young infants
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以前,這種細菌會感染小嬰兒,
00:56
causing bloodstream infections,
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造成血液感染、肺炎、腦膜炎、
00:58
pneumonia, meningitis, death
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死亡,或永久性的殘疾。
01:01
or permanent disability.
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01:03
As a young pediatrician,
I saw a few cases.
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當我還是年輕的小兒科醫生時
看過幾個案例。
01:07
You folks probably have never
heard of this disease,
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各位可能從來沒有聽過這種疾病,
01:10
because vaccines have been so effective.
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因為疫苗相當有效。
01:12
You could see in the graph on the right
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可以從右邊的圖上看到,
01:14
that since the introduction of vaccines,
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從疫苗推出之後,
01:17
the incidence of Haemophilus
bacterial infections
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流行性嗜血桿菌的感染率
01:19
has plummeted like a rock,
and it's nearly vanished.
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就像岩石掉落一樣,幾乎完全消失。
01:24
So vaccines are generally a success story.
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疫苗的故事通常都是成功的故事。
01:26
But we also face challenges.
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但,我們也會面臨挑戰。
01:29
For one, for most vaccines,
we need to give multiple doses
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比如,大部分的疫苗需要多劑
01:33
to achieve or maintain protection.
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才能達到或維持保護效果。
01:36
The scientific community is working
on developing single-shot vaccines.
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科學圈一直在開發一劑奏效的疫苗。
01:41
Imagine being able to get only one
influenza shot your whole life
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想像你一生只需接種流感疫苗一次,
01:44
and not having to get
a seasonal flu vaccine.
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無需每季接種季節性的流感疫苗。
01:48
Certain microbes
are difficult to immunize against.
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我們很難對某些微生物免疫。
01:51
A classic example is human
immunodeficiency virus, or HIV.
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一個經典的例子就是
人體免疫缺損病毒(愛滋病病毒)。
01:56
The need is urgent,
progress is being made;
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這需求非常迫切,已經有所進展,
01:59
we're not there yet.
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但我們還沒達成。
02:01
Another critical element
in vaccine research right now
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目前在疫苗研究中
還有另一個關鍵元素,
02:05
is optimizing vaccines
for the most vulnerable among us,
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就是為我們當中最虛弱的人,
將疫苗做到最好,
02:08
the very young and the elderly.
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包括最小和最年長的人。
02:10
And this is an active area of research.
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這是個很活躍的研究領域。
02:13
Finally, one of the biggest challenges
we unfortunately face right now
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最後,我們不幸正面臨著的
最大挑戰之一
02:18
are anti-vax attitudes.
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就是反對疫苗的態度。
02:20
In fact, it's alarming that over 100,000
infants and children in the United States
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事實上,這很讓人擔憂,
在美國有超過十萬名嬰兒和兒童
02:27
have not received any vaccines,
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尚未接種任何疫苗,
02:29
and that number is growing.
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且人數一直在增加。
02:31
In fact, the World Health
Organization, or WHO,
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事實上,世界衛生組織(WHO)
02:34
has declared anti-vax attitudes
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已經公佈反對疫苗的態度
02:37
as one of the 10 most important
threats to human health
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是現今世界中
人類健康受到的前十大威脅之一。
02:41
in the world today.
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02:43
This graphic illustrates
the spread of anti-vax sentiment
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這張圖所呈現的是反對疫苗的情節
在加州的分佈狀況,
02:47
in the state of California,
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02:48
from the year 2000 to 2013,
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時間是從 2000 年到 2013 年,
02:52
by looking at the percentage
of public kindergarten students
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計算的基礎是公立幼稚園中
02:55
who claim the personal exemption
against immunization.
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要求不要接種疫苗的學生比率。
03:00
Anti-vax sentiment is on the rise,
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反對疫苗的情節正在攀升,
03:02
and it has very real consequences.
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這會帶來很實在的後果。
03:05
Many of you may be aware of the fact
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在座許多人可能知道,
03:07
that we're seeing infections
that we thought we conquered long ago
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已經開始有一些我們以為
早就解決掉的感染又重新出現。
03:10
coming back.
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03:11
Measles outbreaks have been reported
in multiple US states.
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美國有不只一州接獲麻疹的通報。
03:15
And many have forgotten,
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很多人已經忘了,
03:16
but measles is very
infectious and dangerous.
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但麻疹的感染性很強且很危險。
03:20
Just a few viral particles
can infect an individual.
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只要少數幾個病毒粒子
就足以感染人。
03:24
And there have been even reports
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甚至有報告指出,
03:26
at sporting events
and at an Olympic stadium
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在運動比賽和奧林匹克體育館中,
03:29
where the virus, through the air,
travels long distances
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病毒透過空氣,傳播很遠的距離,
03:31
and infects a vulnerable
person in the crowd.
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感染到群眾中虛弱的人。
03:35
In fact, if I had
a measles cough right now,
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事實上,如果我得了
麻疹且現在咳嗽,
03:37
(Coughs)
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(咳嗽)
03:38
somebody in the back
of this auditorium could get infected.
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在觀眾席後排的人
都有可能受到感染。
03:43
And this has had
very real-world consequences.
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這會產生非常現實的後果。
03:47
Just a few months ago,
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幾個月前,
03:48
an airline stewardess
contracted measles on a flight,
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一名女空服員在飛機上得到麻疹,
03:52
the virus entered her brain
and caused encephalitis,
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病毒進入她的腦部,造成腦炎,
03:55
and she died.
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她過世了。
03:56
So people are now dying
due to this anti-vax sentiment.
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現在有人因為這種
反對疫苗的情節而死。
04:01
I do want to take a few minutes
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我真心想要花幾分鐘的時間,
對不相信疫苗的人
04:02
to address those
who don't believe in vaccines
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以及抗拒疫苗的人說幾句話。
04:05
and who resist vaccines.
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04:08
As a pediatrician who receives
my yearly flu vaccination,
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因為我的身分包括每年接種
感冒疫苗的小兒科醫生、
04:13
as a parent of three children
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一直都有根據建議時間表
04:15
who have been vaccinated according
to the recommended schedule,
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去接種疫苗的三個孩子的爸爸,
04:19
and as a pediatric infectious
disease consultant
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以及兒童感染性疾病顧問,
04:22
who has taken care
of young children with meningitis
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曾經照顧過腦膜炎病童,
04:25
that would have been preventable
had their parents accepted immunization,
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本來如果他們的父母願意
讓他們接種疫苗就可以避免染病,
04:29
this is a personal matter to me.
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因此我視此為切身相關的事。
04:31
Let's take a look
at who is going to pay the price
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如果開始減少社會裡的疫苗接種,
04:34
if we start dialing back the amount
of vaccination in our society.
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看誰會付出代價。
04:38
This graph depicts, on the Y axis,
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在這張圖上,Y 軸(縱軸)
04:41
the number of individuals
dying of infection in the world.
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代表世界上因為感染而死的人數。
04:44
And on the X axis,
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X 軸(橫軸)
04:46
the age of the individuals who are dying.
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則是死者的年齡。
04:48
And as you can see,
it's very much a U-shaped distribution,
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各位可以看到,
分佈非常接近 U 字型,
04:52
and it's particularly stark
in the very young ages.
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年齡非常小的人數特別多。
04:55
So vaccines shield
the very young from infection.
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所以,疫苗能保護
年齡非常小的人不受感染。
05:00
And if we want to talk, my friends,
about what vaccines cause,
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各位朋友,若我們想要談
疫苗會造成什麼後果,
05:03
because there's a lot of speculation,
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因為有很多揣測,
05:05
unfounded speculation on the internet,
of what vaccines cause,
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對於疫苗會造成什麼後果,
網路上有很多沒有基礎的揣測。
05:09
vaccines cause adults, OK?
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疫苗讓兒童得以長大成人,了解嗎?
05:12
That's what they cause.
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那是疫苗造成的結果。
05:13
And the other thing that they cause
is for elderly individuals to live longer.
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疫苗還讓老年人更長壽。
05:18
Because they are shielded
against influenza
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因為疫苗能保護老人對抗
流感和其他老人殺手疾病。
05:21
and other killers of the elderly.
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05:24
Now, let's talk a little bit
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現在來談談如何進一步改善疫苗。
05:25
about how we can improve
vaccines even further.
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05:28
We can create vaccines that can immunize
the most vulnerable among us
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我們可以創造
讓我們當中最虛弱的人
也能具有免疫力的疫苗,
05:32
and perhaps even vaccines
that protect with single shots.
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甚至只要接種一次就能
產生保護作用的疫苗。
05:36
Let me go over a little bit
of the immunology.
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讓我幫大家簡單複習一下免疫學。
05:38
In the top panel, what you see
is a simple vaccine.
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各位在上半部所看到的
是一種簡單的疫苗。
05:42
All vaccines contain
something called an antigen.
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所有的疫苗都含有所謂的「抗原」。
05:45
The antigen is like a piece
of a germ, of a microbe,
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抗原就像是你的身體所記得的
05:48
that your body remembers, right?
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病菌、微生物的一部分。
05:50
It forms antibodies
and those antibodies can protect you.
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它會形成抗體,而抗體會保護你。
05:53
So those kind of vaccines
can induce an immune response,
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所以,那些疫苗能誘發免疫反應,
05:57
but as you see here,
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但,在這裡可以看到,
05:58
that immune response
tends to go up and back down,
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免疫反應通常會起起伏伏,
06:01
and you need to get another dose
and another dose
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你需要再接種一劑,然後再接種一劑,
06:04
to maintain protection.
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才能維持保護作用。
06:06
What can we do?
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我們能怎麼辦?
06:07
We and other scientists around the world
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我們及世界各地的科學家
06:10
are finding molecules
that can boost a vaccine response.
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正在尋找能夠促進
疫苗反應的分子。
06:13
Those are called adjuvants,
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它們被稱為「佐藥」,
06:15
from the Latin "adjuvare," to help or aid.
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來自拉丁字「adjuvare」,
意思是協助或幫助。
06:18
Adjuvants are molecules
we might add to a vaccine
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我們可以把這些被稱為佐藥的分子
加到疫苗中以造成更強的反應。
06:21
to get a stronger response.
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06:23
And in the presence of the adjuvant,
depicted here in red,
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這裡的紅色標記表示有用到佐藥,
06:26
you have a much more profound
activation of the white blood cells
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有佐藥時,免疫細胞的白血球細胞
06:29
of your immune system,
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會活化得比較完全,
06:31
and generate a much more
profound immune response,
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產生更完全的免疫反應,
06:33
with much higher antibody
levels, more rapidly,
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有更高的抗體濃度,速度也更快,
06:36
and that lasts a long time
for durable immunity.
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也會讓免疫能力更持久。
06:40
Interestingly, these adjuvants
have different effects
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有趣的是,這些佐藥對人的影響,
06:43
depending on the age or other demographic
factors of the individual.
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會因年齡或其他人口統計因子而異。
06:47
Which brings me to the notion
of precision vaccines.
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這就要談到「精準疫苗」的想法。
06:51
This is the idea that we will take
precision medicine --
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這個概念是把「精準醫學」——
06:55
you know what precision
medicine is, right,
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你們知道精準醫學是什麼吧,
06:57
that's the idea that populations may vary
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它的概念就是人對於
06:59
in their response
to a particular medicine --
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某種藥的反應會有所不同——
07:02
and apply that to vaccines.
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把這概念套到疫苗上。
07:04
Right?
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對吧?
07:05
And here in Boston Children's Hospital
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在波士頓兒童醫院這裡,
07:08
at the Precision Vaccines
Program I direct,
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在我主導的精準疫苗計畫中,
07:10
we have five approaches,
stepwise approaches we take,
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我們採用五個逐步式的方法,
07:14
to build precision vaccines
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來打造精準疫苗,
07:15
that are tailored
to vulnerable populations.
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為較虛弱的族群來量身打造。
07:18
Number one,
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第一,
07:19
we need to understand
what the attitude of a given population is
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我們得要了解某個目標族群
對於疫苗的態度是什麼。
07:22
towards a vaccine.
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07:24
You could build the most
sophisticated vaccine in the world,
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你可以打造出世界上
最精密的疫苗,
07:26
but if nobody wants to take it,
you're going nowhere.
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但如果沒有人想接種,就沒有用。
07:29
Number two,
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第二,我們得要思考
產生免疫力的途徑。
07:30
we have to think
of the route of immunization.
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07:33
Most vaccines are intramuscular, or IM,
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大部分的疫苗是肌肉注射(IM),
07:36
but there are others,
intranasal, oral and others.
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但也有鼻內、口服,
及其他類型的疫苗。
07:40
Then, as I just described to you,
vaccines have components.
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我剛才有提過,疫苗有構成要素。
07:43
All vaccines have an antigen,
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所有的疫苗都有抗原,
07:45
that's the part of the microbe
that your body remembers,
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它是你的身體所記得的
微生物的一部分,
07:48
that you might make antibodies
or cell-mediated immunity against.
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你可能會產生抗體或細胞介導免疫
來對抗這種微生物。
07:52
And we might add an adjuvant,
as we talked about,
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而我們可以像剛才提到的,
加入佐藥,來促進免疫反應。
07:54
to boost an immune response.
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07:55
But guess what?
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但你猜怎樣?
07:57
There are many different
antigens to choose from
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可選的抗原有很多種,佐藥也很多種。
07:59
and many different adjuvants.
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08:00
How are we going to make that decision?
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我們要怎麼選?
08:02
And the menu of these keeps growing.
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且選項還不斷增加。
08:04
So on our team,
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所以,我們的團隊已經開發出
在體外測試疫苗的方法——
08:06
we've developed ways
to test vaccines outside the body --
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08:09
in Latin, that's "in vitro" --
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拉丁文稱為「in vitro」——
08:11
in a tissue culture dish.
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在組織培養皿裡面進行。
08:12
So we use tissue engineering
with blood cells
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我們把組織工程應用在血球細胞上,
08:16
to immunize outside the body
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在體外產生免疫力,
08:18
and study the effect of the vaccine
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研究疫苗對於
08:20
against, for example, infants
or elderly individuals or others.
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諸如嬰兒、老人或其他人的效果。
08:25
And if you think about it,
this is critical,
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仔細想想,這是很重要的,
08:27
because if you look at all the infections
we want to build vaccines against,
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因為如果探究我們想開發疫苗
來對抗的各種感染,
08:31
like Zika virus and Ebola virus
and HIV and others,
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比如茲卡病毒、伊波拉病毒、
愛滋病病毒,及其他,
08:35
all the candidate antigens,
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有那麼多候選抗體,
08:37
all the candidate adjuvants,
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有那麼多候選佐藥,
08:39
all the different populations,
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有那麼多不同的族群,
08:41
it's going to be impossible to do
large, phase III clinical trials
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不可能針對每種組合來做
大型的第三階段臨床試驗。
08:44
for every combination.
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08:46
This is where we think being able
to test vaccines outside the body
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因此我們認為在體外測試疫苗
08:50
can make a big difference
to accelerate vaccine development.
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可以大大幫助加速疫苗開發。
08:54
And finally, this whole effort
is to drive an immune response
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最後,做這麼多努力的目的
是要促發免疫反應,
08:57
that will protect against
that particular pathogen,
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保護人體對抗某種病原體,
09:00
getting antibodies and other cells
to defend the body.
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讓抗體及其他細胞能夠悍衛人體。
09:05
We are also using additional
innovative approaches
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我們亦採用額外的創新方法,
09:07
to bring the most cutting-edge science
to vaccine development.
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把最先進的科學引入疫苗開發中。
09:11
We're taking a deeper dive
as to how current vaccines protect.
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我們正在更深入探究目前的疫苗
如何產生保護作用。
09:15
We've formed an international consortium
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我們已經組成了一個國際同盟,
09:17
to study how hepatitis B vaccine
protects newborns
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來研究 B 型肝炎疫苗
如何保護新生兒
09:21
from hepatitis B infection.
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不受 B 型肝炎感染。
09:23
And to do this,
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為此,我們開發了一種技術,
叫做小樣本大資料。
09:24
we've developed a technique
called small sample, big data.
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09:28
We can get a tiny little drop
of baby blood before immunization,
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在嬰兒產生免疫力之前,
我們可以取得嬰兒的一小滴血液,
09:32
and take a tiny little drop
after immunization,
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在產生免疫力之後再取一小滴,
09:35
and we can measure the inventory
of all the cells,
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接著,我們可以測量
那滴血液中的所有細胞、
09:38
and all the genes and all the molecules
in that drop of blood,
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所有基因,及所有分子,
09:41
and we can compare after the vaccine
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針對同一個嬰兒,
09:43
to before the vaccine in that same baby
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比較接種疫苗前後的差別,
09:46
and understand in a deep way
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以深入了解
09:48
exactly how that successful
vaccine protects.
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該疫苗的保護作用有多成功。
09:51
And those lessons we can use
to build the next vaccines in the future.
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我們所學到的,就可以
用在未來打造新的疫苗。
09:56
So this diagram is really illustrating
a tiny drop of blood
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這張圖所呈現出來的是一小滴血液
09:59
yielding huge amounts of information,
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就能產生出大量的資訊,
10:02
tens of thousands of analytes,
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數以萬計的被分析物,
10:04
and that hairball is meant to depict
the gene pathways that are turned on
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那團毛球所描繪的是
被啟動的基因路徑
10:08
and the molecular pathways
that are turned on.
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以及被啟動的分子路徑。
10:11
So much more to come on that,
and very exciting science.
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這方面還有許多可期待的,
很讓人興奮的科學。
10:14
So we are partnering
with scientists around the world
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我們和世界各地的科學家合作,
10:17
to bring all these new technologies
to invigorate vaccine development
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導入各種新科技,
為精準疫苗網路的疫苗開發
10:21
in a Precision Vaccines network.
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帶來新的可能性。
10:23
We are going to advance
personalized vaccines
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我們打算要為全世界虛弱的族群
10:26
for vulnerable populations
around the world.
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繼續發展個人化疫苗。
10:29
Our team includes scientists,
technical experts and physicians.
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我們的團隊成員有科學家、
技術專家,以及醫師。
10:33
And we're developing vaccines
against infectious diseases
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我們針對感染性疾病來開發疫苗,
10:36
like pertussis, which is whooping cough.
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比如百日咳。
10:39
We have a whooping cough vaccine,
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我們有百日咳疫苗,
10:41
but it requires multiple doses,
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但需要不只一劑,
且免疫力會越來越低。
10:43
and the immunity keeps dropping.
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10:44
We want to develop a single-shot
pertussis vaccine.
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我們想要開發出
只需一劑的百日咳疫苗。
10:47
We're working on a vaccine
for respiratory syncytial virus,
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我們也在致力開發
呼吸道融合病毒的疫苗,
10:50
the number one cause of infant
hospitalization in the United States.
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在美國,造成嬰兒住院的
頭號原因就是這種病毒。
10:54
A better vaccine against influenza,
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還有更好的流感疫苗,
10:56
and, of course, HIV.
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當然,還有愛滋病。
10:59
We're also looking at vaccines
against cancer, allergy
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我們也在研究對抗
癌症、過敏的疫苗,
11:03
and, interestingly, opioid overdose.
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很有趣的是還有對抗
鴉片過量的疫苗。
11:07
So, this is my final message to you.
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接著是我要給各位的
最後一個訊息。
11:11
Vaccines protect you and your loved ones
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疫苗能保護你、你所愛的人,
11:14
and the people around you.
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及你周遭的人。
11:15
Not only do they protect you
against infection,
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疫苗不僅能保護你不受感染,
11:17
they prevent you
from spreading it to others.
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也能預防你將疾病散播給他人。
11:20
Get immunized.
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去接種疫苗。
11:21
Scientific progress is fragile
and can be lost.
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科學進展很脆弱,易失去。
11:25
We must foster accurate
and respectful public dialogue.
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我們必須要讓大眾培養
正確且帶著尊重的討論對話。
11:29
And finally, we're on the verge
of great things,
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最後,我們已經很接近
11:31
a new era of vaccination.
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美妙的疫苗新紀元。
11:33
We've just scratched the surface
of what can be accomplished.
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相對於能達成的成就,
我們現在只觸及皮毛而已。
11:36
Please advocate for this research.
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請支持這項研究。
11:38
Thank you.
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謝謝。
11:40
(Applause)
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(掌聲)
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