比尔盖茨TED演讲:The next outbreak？Were not ready for the next epidemic

The next outbreak? We're not ready for the next epidemic

下一场疫情爆发，我们还没有准备好

When I was a kid, the disaster we worried about most was a nuclear war. That's why we had a barrel like this down in our basement, filled with cans of food and water.

当我还是个孩子的时候，我们最担心的灾难是核战争。这就是为什么我们在地下室里有一个这样的桶，里面装满了食物和水。

When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel. Today, the greatest risk of global catastrophe doesn't look like this. Instead, it looks like this.

当核攻击来临时，我们应该躲在地下室，靠桶维生。今天，全球灾难的最大风险不是这样（核爆炸），而是这样的（病毒）。

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, not missiles, but microbes.

如果在未来几十年里有什么东西杀死了上千万人，那很可能是一种高度传染性的病毒，而不是战争，不是导弹，而是微生物。

Now, part of the reason for this is that we've invested a huge amount in nuclear deterrents. But we've actually invested very little in a system to stop an epidemic. We're not ready for the next epidemic.

现在，部分原因是我们在核威慑上投入了大量资金，但实际上我们在阻止流行病的系统上投入很少，我们还没有准备好迎接下一场流行病。

Let's look at Ebola. I'm sure all of you read about it in the newspaper. A lot of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication.

让我们来看看埃博拉病毒。我相信你们都在报纸上看到了。我们面临很多艰难的挑战。我仔细地用追踪根除小儿麻痹症的病例分析工具来分析了埃博拉。

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，总感觉我们的问题是我们的疾控系统不够好，但实际上问题是我们压根就没有这样的系统。

In fact, there are some pretty obvious key missing pieces. 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 . The case reports came in on paper.

事实上，有一些非常明显的关键缺失部分。我们没有一群流行病学家准备好，去疫情区看看病毒的发展情况。病例都是从报纸上传来的。

It was very delayed before they were put online and they were extremely inaccurate. We didn't have a medical team ready to go. We didn't have a way preparing people.

信息传上线已经很晚了，此外还不是很准确。我们也找不到训练有素的医护小组，也没有一套让人们严阵以待的方法。

Now medecins sans frontierers did a great job orchestrating volunteers, but even so, we were far slower than we should have been getting thousands of workers into these countries. And a large epidemic will require us to have hundreds of thousands of workers.

现在，无国界医生（medecins sans frontiers，简称medecins sans frontiers）在组织志愿者方面做得很好，但即便如此，我们调动数千名工作者到疫情区的速度还是差强人意，而一场大规模的流行病将需要我们动员数十万名人员。

There was no one there to look at treatment approaches, no one to look at the diagnostics. No one to figure out what tools should be used. As an example. We could have taken the blood of survivors, processed it, and put that plasma back in people to protect them.

但是我们没有任何人在研究治疗的方向，也没有人早看诊断的方法，没有人想该用什么工具。举个例子，我们也许可以抽取生还者的血液处理过后，再将血液注入没得病的人体，来保护他们。

But that was never tried. So there was a lot that was missing. And these things are really a global failure.

但是这个方法从来没尝试过，所以很多事情都还没来得及做，而这的却是全球性的失败。

The WHO is found to monitor epidemics, but not to do these things I talked about. Now, in the movies. It's quite different. There's a group of handsome epidemiologists ready to go. They move in, they save the day.

世界卫生组织的目的是来监视流行病，而不是来做我刚才将的事情。但是在电影中的剧情又是另外一回事。有一群英俊的流行病学家准备好，他们到了疫区拯救了大家。

But that's just pure Hollywood. The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola.

但是这是纯好莱坞的剧情，我们的准备不足可能会导致下一场疫情的无法控制。

Let's look at the progression of Ebola over this year, about 10000 people died, and nearly all were in the three west African countries. There are three reasons why it didn't spread more. The first is that there was a lot of heroic work by the health workers.

让我们来看看今年埃博拉疫情的进展，大约有1万人死亡，几乎所有人都在西非三个国家。埃博拉疫情没有进一步蔓延的原因有三个：第一，卫生工作者做了很多英勇的工作。

They found people and they prevented more infections. The second is the nature of the virus. Ebola does not spread through the air. And by the time you're contagious, most people are so sick that they're bedridden. 3rd, it didn't get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas.

他们发现了病人进行隔离阻止了更多的感染。第二是病毒的性质。埃博拉病毒不会通过空气传播。当你被传染时，大多数人都病得卧床不起。第三，它并没有进入很多城市地区。那只是运气。如果它进入了更多的城市地区。

The case numbers would have been much larger. So next time we might not be so lucky. 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.

病例数量会大得多。所以下次我们可能就没那么幸运了。你可能会在不知不觉中感染一种病毒，并把病毒带上飞机或者带进超市。

The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So there are things that would literally make things a thousand times worse. In fact, let's look at a model of a virus are spread through the air.

病毒的来源可能是像埃博拉这样的自然流行病，也可能是生物恐怖主义。所以有些事情确实会使情况恶化上千倍。让我们来看看病毒通过空气传播的模型。

Like the Spanish flu back in 1918. So here's what would happen. It would spread throughout the world very,very quickly. And you can see there's over 30 million people die from that epidemic. So this is a serious problem. We should be concerned. But in fact, we can build a really good response system.

就像1918年的西班牙流感。接下来会发生什么。它会很快蔓延到全世界。你可以看到有超过3000万人死于这种流行病。所以这是一个很严重的问题。我们应该关注。事实上，我们可以建立一个很好的反应系统。

We have the benefits of all the science and technology that we talk about here. We've got cell phones to get Information from the public can get Information out to them.

我们从这里谈论的所有科学技术中获益，我们有手机从公众那里获取信息，也可以把信息传递给他们。

We have satellite maps where we can see where people are, and where they're moving. 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 that pathogen. So we can have tools, but those tools need to be put into an overall global health system.

我们有卫星地图，在那里我们可以看到人们在哪，他们在哪里移动。我们有生物学上的进步，这将显著改变观察病原体的周转时间，并能够制造出适合这种病原体的药物和疫苗。所以我们可以有工具，但这些工具需要纳入全球整体卫生体系。

And we need preparedness. The best lessons, I think, on how to get prepared aer again, what we do for war, for soldiers, we have full time waiting to go. We have reserves that can scale this up to large numbers.

此外，我们必须处在备战状态，而我们如何做好准备？最好的例子还是来自于备战。最军人来说，我们是随时随地都要准备好投入战争的。我们还有预备役军人，能使备战人口大量增加。

NATO has a mobile unit that can deploy very rapidly. Nato does a lot of war games to check ,are people well trained? Do they understand about fuel and logistics and the same radio frequencies. So they are absolutely ready to go. So those are the kinds of things we need to deal with an epidemic.

北约有一个机动小组，可以很快的行动起来，北约组织有很多战争游戏可以测试人员是否是训练有素的，他们是否了解燃料，补给和相同的收音机频率，是的话，他们已经准备好了。这些就是面对疫情时我们该准备的事情。

What are the key pieces ? First we need strong health systems in poor countries. That's where mothers can give birth safely.

关键部分是什么？首先，我们需要在贫穷国家建立强有力的卫生系统，作为母亲可以安全的生小孩。

Kids can get all the vaccines, but also where we`ll see the outbreak very early on. We need a medical reserve corps. Lots of people who have got the training and background who are ready to go with the expertise.

孩子们可以接种所有的疫苗，我们也可以在很早就会看到疫情爆发。我们需要一支医疗后备队。还有很多训练有素的专业人员，随时准备好带他们到疫区去。

And then we need to pair those medical people with the military, taking advantage of the military's ability to move fast do logistics and secure areas. We need to do simulations, germ games, not war games. So that we see where the holes are.

然后我们可以用军队来配合医护人员，利用军队快速移动的特点，来进行后勤运输和维护安全。我们需要做情景模拟，细菌游戏，而不是战争游戏。这样我们才能看到漏洞在哪里。

The last time a germ game was done in the United States was back in 2001, and it didn't go so well. So far the score is germs: 1, people :0.

上次的病毒游戏是在美国进行的，那是在2001年了，进行的也不是很顺利，目前，病菌得一分，人类得零分。

Finally, we need lots of advanced R＆D in areas of vaccines and diagnostics. There are some big breakthroughs, like the Adino-associated virus that could work very, very quickly. 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.

最后，我们需要在疫苗和诊断领域进行大量的先进研发。在比如在胰相关病毒上，我们已经有了相当大得突破。可以在很短得时间内生效。现在，我还没有一个确切的预算这需要多少钱，但我敢肯定，与潜在的危害相比，这是非常温和的。

The World Bank estimates that if we have a worldwide flu epidemic. Global wealth will go down by over $3 trillion. And we`d have millions and millions of deaths. These investments offer significant benefits beyond just being ready for the epidemic. The primary health care they R＆D. those things would reduce global health equity and make the world more just as well as more safe.

世界银行估计，如果我们在全球范围内爆发流感疫情，全球财富将减少3万亿美元以上，我们将有数百万人死亡。这些投资带来的好处不仅仅是为疫情做好准备，还有基础得卫生保健，研发，可以促进全球健康得平衡发展，使世界更加健康和安全。

So I think this should absolutely be a priority. There's no need to panic. We don't have the hoard cans spaghetti or go down into the basement. We need to get going. Because time is not on our side.

所以我认为这绝对应该是优先考虑的事情，不必惊慌。我们没有必要贮藏罐头，也没有必要到地下室去。但是我们得奋起直追。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. It's that it can serve as a early warning, a wake up call to get ready. If we start now, we can be ready for the next epidemic.

事实上，如果埃博拉疫情能带来一个积极的影响，那就是它可以作为一个预警，警告我们觉醒并做好准备。如果即可开始准备，我们就可以为下一次流行病做好准备。

Thank you！

谢谢！