The Next Outbreak? We're Not Ready

the disaster we worried about most was a nuclear war.

我们最担心的灾难是核战争。

That's why we had a barrel like this down in our basement,

这就是为什么我们的地下室里有一个这样的桶，

filled with cans of food and water.

装满了食物和水罐头。

When the nuclear attack came,

当核攻击来临时，

we were supposed to go downstairs, hunker down, and eat out of that barrel.

我们应该下楼，蹲下来，用那个桶吃东西。

Today the greatest risk of global catastrophe

今天全球灾难的最大风险

doesn't look like this.

看起来不是这样的。

Instead, it looks like this.

相反，它看起来像这样。

If anything kills over 10 million people in the next few decades,

如果有什么东西在未来几十年内杀死超过 1000 万人

it's most likely to be a highly infectious virus

它很可能是一种传染性很强的病毒

Not missiles, but microbes.

不是导弹，而是微生物。

Now, part of the reason for this is that

现在，造成这种情况的部分原因是

we've invested a huge amount in nuclear deterrents.

我们在核威慑力量上投入了大量资金。

But we've actually invested very little in a system to stop an epidemic.

但我们实际上在阻止流行病的系统上投入很少。

We're not ready for the next epidemic.

我们还没有为下一次流行病做好准备。

Let's look at Ebola.

我们来看看埃博拉病毒。

I'm sure all of you read about it in the newspaper,

相信大家都在报纸上读到过这件事

lots of tough challenges.

许多严峻的挑战。

I followed it carefully through the case analysis tools

我通过案例分析工具仔细跟踪它

we use to track polio eradication.

我们用来追踪脊髓灰质炎的根除情况。

And as you look at what went on,

当你看到所发生的事情时

the problem wasn't that there was a system that didn't work well enough,

问题不在于系统运行得不够好

the problem was that we didn't have a system at all.

问题是我们根本没有系统。

In fact, there's some pretty obvious key missing pieces.

事实上，有一些非常明显的关键缺失部分。

We didn't have a group of epidemiologists ready to go, who would have gone,

我们没有一群流行病学家准备好出发，他们本来会走的，

seen what the disease was, seen how far it had spread.

看到这种疾病是什么，看到它传播了多远。

The case reports came in on paper.

病例报告是纸质的。

It was very delayed before they were put online

上线前耽误了很长时间

and they were extremely inaccurate.

而且它们非常不准确。

We didn't have a medical team ready to go.

我们没有准备好出发的医疗队。

We didn't have a way of preparing people.

我们没有办法让人们做好准备。

Now, Médecins Sans Frontières did a great job orchestrating volunteers.

现在，无国界医生组织在组织志愿者方面做得非常出色。

But even so, we were far slower than we should have been

但即便如此，我们还是比应有的速度慢了很多

getting the thousands of workers into these countries.

让成千上万的工人进入这些国家。

And a large epidemic would require us to have hundreds of thousands of workers.

而大规模的疫情需要我们有几十万的工作人员。

There was no one there to look at treatment approaches.

那里没有人研究治疗方法。

No one to look at the diagnostics.

没有人看诊断。

No one to figure out what tools should be used.

没有人弄清楚应该使用什么工具。

As an example, we could have taken the blood of survivors,

举个例子，我们可以采集幸存者的血液，

processed it, and put that plasma back in people to protect them.

对其进行处理，然后将血浆放回到人们体内以保护他们。

But that was never tried.

但这从未被尝试过。

So there was a lot that was missing.

所以有很多东西缺失了。

And these things are really a global failure.

而这些事情确实是全球性的失败。

The WHO is funded to monitor epidemics, but not to do these things I talked about.

世界卫生组织的资金是用来监测流行病的，但不是用来做我谈到的这些事情的。

Now, in the movies it's quite different.

现在，在电影中却完全不同了。

There's a group of handsome epidemiologists ready to go,

一群帅气的流行病学家已经整装待发，

they move in, they save the day, but that's just pure Hollywood.

他们搬进去，他们拯救了世界，但这只是纯粹的好莱坞。

The failure to prepare could allow the next epidemic

如果不做好准备，可能会引发下一次流行病

to be dramatically more devastating than Ebola

比埃博拉病毒更具破坏性

Let's look at the progression of Ebola over this year.

让我们看看今年埃博拉疫情的进展情况。

About 10,000 people died,

大约有10,000人死亡，

and nearly all were in the three West African countries.

几乎所有这些都在三个西非国家。

There's three reasons why it didn't spread more.

其未能进一步传播的原因有以下三个。

The first is that there was a lot of heroic work by the health workers.

首先，卫生工作者做出了很多英勇的工作。

They found the people and they prevented more infections.

他们找到了这些人，并阻止了更多的感染。

The second is the nature of the virus.

第二是病毒的性质。

Ebola does not spread through the air.

埃博拉病毒不会通过空气传播。

And by the time you're contagious,

当你具有传染性时，

most people are so sick that they're bedridden.

大多数人病得很重，卧床不起。

Third, it didn't get into many urban areas.

第三，它没有进入很多城市地区。

And that was just luck.

那只是运气。

If it had gotten into a lot more urban areas,

如果它进入更多的城市地区

the case numbers would have been much larger.

病例数量会多得多。

So next time, we might not be so lucky.

所以下一次，我们可能就没那么幸运了。

You can have a virus where people feel well enough while they're infectious

感染病毒后，人们在具有传染性的同时仍感觉良好

that they get on a plane or they go to a market.

他们登上飞机或去市场。

The source of the virus could be a natural epidemic like Ebola,

病毒的来源可能是像埃博拉病毒这样的自然流行病，

or it could be bioterrorism.

或者它可能是生物恐怖主义。

So there are things that would literally make things a thousand times worse.

所以有些事情实际上会让事情变得更糟一千倍。

In fact, let's look at a model of a virus spread through the air,

事实上，让我们看一下通过空气传播的病毒模型，

like the Spanish Flu back in 1918.

就像 1918 年的西班牙流感一样。

So here's what would happen:

那么将会发生以下情况：

It would spread throughout the world very, very quickly.

它会非常非常快地传播到世界各地。

And you can see over 30 million people died from that epidemic.

你可以看到超过 3000 万人死于那场流行病。

So this is a serious problem.

所以这是一个严重的问题。

We should be concerned.

我们应该担心。

But in fact, we can build a really good response system.

但事实上，我们可以建立一个非常好的响应系统。

We have the benefits of all the science and technology that we talk about here.

我们拥有我们在这里谈论的所有科学技术的好处。

We've got cell phones

我们有手机

to get information from the public and get information out to them.

从公众那里获取信息并将信息传递给他们。

We have satellite maps where we can see where people are and where they're moving.

我们有卫星地图，可以看到人们在哪里以及他们在哪里移动。

We have advances in biology

我们在生物学方面取得了进展

that should dramatically change the turnaround time to look at a pathogen

这应该会极大地改变病原体检测的周转时间

and be able to make drugs and vaccines that fit for that pathogen.

并能够制造适合该病原体的药物和疫苗。

So we can have tools,

这样我们就可以拥有工具，

but those tools need to be put into an overall global health system.

但这些工具需要纳入整个全球卫生系统。

And we need preparedness.

我们需要做好准备。

The best lessons, I think, on how to get prepared

我认为最好的课程是关于如何做好准备

are again, what we do for war.

再次，我们为战争所做的事情。

For soldiers, we have full-time, waiting to go.

对于士兵来说，我们有全职的，等着去。

We have reserves that can scale us up to large numbers.

我们拥有可以扩大规模的储备。

NATO has a mobile unit that can deploy very rapidly.

北约拥有一支可以非常快速部署的移动部队。

NATO does a lot of war games to check, are people well trained?

北约进行了大量的战争游戏来检查人们是否训练有素？

Do they understand about fuel and logistics

他们了解燃料和物流吗

and the same radio frequencies?

和相同的无线电频率？

So they are absolutely ready to go.

所以他们已经完全准备好了。

So those are the kinds of things we need to deal with an epidemic.

这些就是我们应对流行病所需要的事情。

What are the key pieces?

关键部分是什么？

First, we need strong health systems in poor countries.

首先，贫穷国家需要强大的卫生系统。

That's where mothers can give birth safely,

在这里，妈妈们可以安心分娩，

kids can get all their vaccines.

孩子们可以接种所有疫苗。

But, also where we'll see the outbreak very early on.

但是，我们也会很早就看到疫情爆发。

We need a medical reserve corps:

我们需要一支医疗后备队：

lots of people who've got the training and background

很多受过培训和背景的人

who are ready to go, with the expertise.

他们已经准备好并拥有专业知识。

And then we need to pair those medical people with the military.

然后我们需要将这些医务人员与军队配对。

taking advantage of the military's ability to move fast, do logistics

利用军队快速行动的能力，做好后勤保障

We need to do simulations,

我们需要进行模拟，

germ games, not war games, so that we see where the holes are.

细菌游戏，而不是战争游戏，这样我们就能看到漏洞在哪里。

The last time a germ game was done in the United States

上次在美国进行细菌游戏

was back in 2001, and it didn't go so well.

早在2001年，事情就不太顺利了。

So far the score is germs: 1, people: 0.

到目前为止，细菌得分为 1，人类得分为 0。

Finally, we need lots of advanced R\u0026amp;D in areas of vaccines and diagnostics.

最后，我们需要在疫苗和诊断领域进行大量先进的研发。

There are some big breakthroughs, like the Adeno-associated virus,

有一些重大突破，比如腺相关病毒，

that could work very, very quickly.

这可以非常非常快地发挥作用。

Now I don't have an exact budget for what this would cost,

现在我还没有具体的预算，

but I'm quite sure it's very modest compared to the potential harm.

但我确信与潜在的危害相比，这是非常轻微的。

The World Bank estimates that if we have a worldwide flu epidemic,

世界银行估计，如果流感在全球范围内流行，

global wealth will go down by over three trillion dollars

全球财富将减少逾3万亿美元

and we'd have millions and millions of deaths.

我们将会有数百万人死亡。

These investments offer significant benefits

这些投资带来显着效益

beyond just being ready for the epidemic.

不仅仅是为流行病做好准备。

The primary healthcare, the R\u0026amp;D,

初级医疗保健、研发、

those things would reduce global health equity

这些事情会降低全球卫生公平性

and make the world more just as well as more safe.

让世界更加公正、更加安全。

So I think this should absolutely be a priority.

所以我认为这绝对应该是一个优先事项。

There's no need to panic.

无需惊慌。

We don't have to hoard cans of spaghetti or go down into the basement.

我们不必囤积意大利面罐头或进入地下室。

But we need to get going, because time is not on our side.

但我们需要继续前进，因为时间不在我们这边。

In fact, if there's one positive thing that can come out of the Ebola epidemic,

事实上，如果说埃博拉疫情能带来一件积极的事情的话，

it's that it can serve as an early warning, a wake-up call, to get ready.

它可以作为预警、警钟，让我们做好准备。

If we start now, we can be ready for the next epidemic.

如果我们现在就开始，我们就可以为下一次流行病做好准备。