比尔盖茨演讲: 面对疫情爆发? 全世界都没准备好

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[00:00.00]When I was a kid, the disaster we worried about most was a nuclear war. 当我还是小孩时, 我们最担心的灾害是核战争。 
[00:04.89]That's why we had a barrel like this down in our basement, filled with cans of food and water. 所以我们在地下室有个这样的筒子， 装满了罐头食物和水。 
[00:11.84]When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel. 当核战争爆发时， 我们就要躲到地下室去， 蹲低身子并靠那个筒子维生。 
[00:18.31]Today the greatest risk of global catastrophe doesn't look like this. 今天的全球灾难最大的危险看起来已不像这样（战争）了。 
[00:25.65]Instead, it looks like this. 事实上，会像这样(病毒)。
[00:29.12]If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war.  如果有什么东西在未来几十年里可以杀掉上千万人，那比较有可能是个高度传染的病毒，而不是战争。
[00:41.00]Not missiles, but microbes. 不是导弹，而是微生物。 
[00:44.99]Now, part of the reason for this is that we've invested a huge amount in nuclear deterrents.  部分的理由是因为我们在核威慑上投注了很大的精力和金钱。 
[00:52.00]But we've actually invested very little in a system to stop an epidemic. 但是我们在防止疫情的系统上却投资很少。
[00:57.25]We're not ready for the next epidemic. 我们还没有准备好预防下一场大疫情的发生。 
[01:01.49]Let's look at Ebola. 让我们看看埃博拉病毒。
[01:03.81]I'm sure all of you read about it in the newspaper, lots of tough challenges. 我相信大家在报纸上都有读到这样的新闻，充满了许多艰难的挑战。
[01:09.76]I followed it carefully through the case analysis tools we use to track polio eradication. 用我们追踪消灭脊髓灰质炎（小儿麻痹）的案例分析工具，我仔细地追踪这病毒的发展。
[01:16.98]And as you look at what went on, the problem wasn't that there was a system that didn't work well enough, the problem was that we didn't have a system at all. 随着疫情的发展我们可以看到，问题不在于我们没有一套可以使用的系统，而是我们根本没有任何系统。
[01:28.10]In fact, there's some pretty obvious key missing pieces. 事实上我们可以看到有几个很明显的不足。
[01:32.66]We didn't have a group of epidemiologists ready to go, who would have gone, seen what the disease was, seen how far it had spread. 我们找不到一群准备好了的流行病学家，能去疫区看看病理和病情发展。
[01:41.58]The case reports came in on paper. 病例都是由纸上报道传来的。
[01:44.37]It was very delayed before they were put online and they were extremely inaccurate. 信息传上线时已经很晚了，此外还很不准确。
[01:49.19]We didn't have a medical team ready to go. 我们也找不到训练有素的医护小组。
[01:52.30]We didn't have a way of preparing people. 我们没有一套让人们严阵以待的方法。
[01:54.36]Now, Médecins Sans Frontières did a great job orchestrating volunteers. 目前，“无国界医生”在动员志愿者上做了很大的贡献。
[02:00.14]But even so, we were far slower than we should have been getting the thousands of workers into these countries. 但即使如此，我们调动数千名工作者到疫区的速度还是十分差强人意的。
[02:06.37]And a large epidemic would require us to have hundreds of thousands of workers. 大的疫情会需要我们动员数十万的人员，
[02:12.83]There was no one there to look at treatment approaches. 但我们没有任何人在研究治疗的方向。
[02:18.59]No one to look at the diagnostics. 也没有人在看诊断的方法。
[02:21.23]No one to figure out what tools should be used. 没有人在想该用什么工具。
[02:24.69]As an example, we could have taken the blood of survivors, processed it, and put that plasma back in people to protect them. 举个例子来说，我们也许可以抽取生还者的血液，处理过后，再将血浆注入人体内来保护没得病的人。
[02:32.88]But that was never tried. 但是这个方法从来没有试过。
[02:35.10]So there was a lot that was missing. 所以有很多事都还没来得及做。
[02:37.84]And these things are really a global failure. 而这的确是全球性的失败。
[02:41.33]The WHO is funded to monitor epidemics, but not to do these things I talked about. 世界卫生组织的目的是来监视流行病，而不是来做我刚讲的事。
[02:47.94]Now, in the movies it's quite different. 但是在电影中演的剧情又是另一回事。
[02:51.40]There's a group of handsome epidemiologists ready to go, they move in, they save the day, but that's just pure Hollywood. 有一群很英俊的流行病学家准备就绪，他们到了疫区拯救了大家，但这是纯好莱坞的剧情。
[03:02.77]The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola.我们的准备不足，可能会导致下一场疫情，比埃博拉病毒的危害更严重。
[03:11.47]Let's look at the progression of Ebola over this year. 让我们看看埃博拉病毒在过去一年中的发展。
[03:16.80]About 10,000 people died,  and nearly all were in the three West African countries. 大约死了一万人，所有的死者都在西非的三个国家里。
[03:24.96]There's three reasons why it didn't spread more. 之所以没有扩散的原因有三个。
[03:28.93]The first is that there was a lot of heroic work by the health workers. 第一个是卫生工作人员做的很多英雄事迹。
[03:32.79]They found the people and they prevented more infections. 他们找到很多病人并防止了更多人得病。
[03:36.20]The second is the nature of the virus. 第二个是病毒的特性，
[03:38.75]Ebola does not spread through the air. 埃博拉病毒不是靠空气传染的。
[03:41.14]And by the time you're contagious, most people are so sick that they're bedridden. 等到你有足够的传染力时，大部分的人已经病得卧床不起了。
[03:46.90]Third, it didn't get into many urban areas. 第三个是因为病毒没有传到都会区。
[03:52.67]And that was just luck. 这纯粹是运气好。
[03:53.86]If it had gotten into a lot more urban areas, the case numbers would have been much larger. 如果病毒传到了都会区，那么死亡的人数绝对不止于此。
[03:59.71]So next time, we might not be so lucky. 所以下一次我们可能不会这么幸运了。
[04:02.87]You can have a virus where people feel well enough while they're infectious that they get on a plane or they go to a market. 有的病毒可能让你毫无察觉，但当感染病毒的人乘飞机或者去逛商场，他们其实已经具有一定的传染力了。
[04:11.57]The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. 此外病毒的来源可以是天然的，像埃博拉病毒，或是由生物恐怖攻击产生的。
[04:16.96]So there are things that would literally make things a thousand times worse. 所以可以让疫情惨上千倍的病毒是存在的。
[04:21.70]In fact, let's look at a model of a virus spread through the air, like the Spanish Flu back in 1918. 事实上，让我们来看看一个病毒由空气传染的模型，像1918年的西班牙流感。
[04:31.51]So here's what would happen: It would spread throughout the world very, very quickly. 疫情有可能像这样发展：病毒会以很快的速度向全世界蔓延。
[04:37.35]And you can see over 30 million people died from that epidemic. 你可以看到全球有三千万人死于这个疾病。
[04:41.84]So this is a serious problem. 这就是个很严重的问题。
[04:44.49]We should be concerned. 我们绝不应该忽视。
[04:46.20]But in fact, we can build a really good response system. 但事实上我们可以建立一个很好的反应系统。
[04:50.83]We have the benefits of all the science and technology that we talk about here. 我们可以利用所有发展至今的科技和科学。
[04:55.95]We've got cell phones to get information from the public and get information out to them. 我们可以用手机来收集信息和发布信息。
[05:00.32]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和往哪移动。
[05:04.50]We have advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that pathogen. 我们在生物学上也有进展，这可以大幅缩短我们找到病原的时间，并可以在很短的时间里找出解药和疫苗。
[05:15.61]So we can have tools, but those tools need to be put into an overall global health system. 所以我们是有工具的，但这些工具必须统合在一个全球健康系统下。
[05:21.53]And we need preparedness. 此外我们必须处在准备好的状态。
[05:23.58]The best lessons, I think, on how to get prepared are again, what we do for war. 而我们如何做好准备，最好的例子还是来自于备战。
[05:28.74]For soldiers, we have full-time, waiting to go. 对军人来说，他们是随时随地都准备好要投入战争的。
[05:32.69]We have reserves that can scale us up to large numbers. 我们还有预备军人，能使备战人口大量增加。
[05:36.22]NATO has a mobile unit that can deploy very rapidly. 北约组织有个机动小组，可以很快地行动起来。
[05:39.99]NATO does a lot of war games to check, are people well trained? 北约组织有很多战争游戏可以测试人员是否已训练有素？
[05:43.89]Do they understand about fuel and logistics and the same radio frequencies? 他们是否了解燃油，补给和相同的收音机频率？
[05:48.43]So they are absolutely ready to go. 是的话，那么他们就已准备好了。
[05:50.41]So those are the kinds of things we need to deal with an epidemic. 这些就是面对疫情时我们该准备的事。
[05:55.60]What are the key pieces? 关键的项目有哪些？
[05:57.37]First, we need strong health systems in poor countries. 第一，在贫穷的国家里必须有发达的卫生系统。
[06:02.25]That's where mothers can give birth safely, kids can get all their vaccines. 母亲们可以安全地生小孩，小孩们可以接种疫苗。
[06:07.56]But, also where we'll see the outbreak very early on. 我们也可以在很早的阶段侦查到疫情的爆发。
[06:11.53]We need a medical reserve corps: lots of people who've got the training and background who are ready to go, with the expertise. 我们需要后备的医疗部队：还有很多训练有素的专业人员，随时准备好能带着他们专长到疫区。
[06:19.50]And then we need to pair those medical people with the military. 我们可以用军队来配合医护人员，
[06:24.39]taking advantage of the military's ability to move fast, do logistics and secure areas. 利用军队移动迅速的特性，来进行后勤运输和维持安全。
[06:29.79]We need to do simulations, germ games, not war games, so that we see where the holes are. 我们也需要进行一些情境模拟，不是进行战争游戏而是进行病菌游戏，看看防卫漏洞在哪。
[06:37.66]The last time a germ game was done in the United States was back in 2001, and it didn't go so well. 上一次的病菌游戏是在美国进行的，那是在2001年了，进行得也不是很顺利。
[06:44.62]So far the score is germs: 1, people: 0. 目前病菌得一分人类零分。
[06:48.38]Finally, we need lots of advanced R&D in areas of vaccines and diagnostics. 最后我们在疫苗和病理学上还需要很多的研发工作。
[06:55.76]There are some big breakthroughs, like the Adeno-associated virus, that could work very, very quickly. 在某些方面例如腺相关病毒上，我们已经有了相当的突破，这可以在很短的时间内生效。	
[07:02.25]Now I don't have an exact budget for what this would cost, but I'm quite sure it's very modest compared to the potential harm. 我目前没有明确的预算这到底需要多少钱，但是我确信跟损失比起来是比较便宜的。
[07:11.24]The World Bank estimates that if we have a worldwide flu epidemic, global wealth will go down by over three trillion dollars and we'd have millions and millions of deaths. 根据世界银行的估算，如果我们有流感的疫情暴发，全球经济会损失三万多亿美元。我们还会可能有千百万人员的死亡。
[07:22.75]These investments offer significant benefits beyond just being ready for the epidemic. 跟仅仅只是准备好比起来，这些额外的投资会带来显著的益处。
[07:28.65]The primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe. 基础的卫生保健，研发，可以促进全球健康的平衡发展，让这个世界更健康更安全。
[07:36.93]So I think this should absolutely be a priority. 所以我觉得这非常重要重要。 刻不容缓。
[07:41.38]There's no need to panic.不需要惊慌。
[07:43.21]We don't have to hoard cans of spaghetti or go down into the basement. 我们不需要囤积面罐头或是躲到地下室去，
[07:47.86]But we need to get going, because time is not on our side. 但是我们必须急起直追，因为时间有限。
[07:51.67]In fact, if there's one positive thing that can come out of the Ebola epidemic, it's that it can serve as an early warning, a wake-up call, to get ready. 事实上，要说这场埃博拉病毒的疫情带来了什么正面影响的话，那就是提早响起了警报，让我们觉醒并做好准备。
[08:03.41]If we start now, we can be ready for the next epidemic. 我们如果即刻开始准备，那么在下一场疫情来临前我们是可以准备好的。
[08:08.92]Thank you. 谢谢大家。
[08:10.23](Applause) 	（掌声）

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比尔盖茨演讲: 面对疫情爆发? 全世界都没准备好