2000.04.23 比尔-盖茨谈如何对抗未来的大流行病

shiyi18

By Invitation | The world after covid-19
Bill Gates on how to fight future pandemics
The coronavirus will hasten three big medical breakthroughs. That is just a start

Apr 23rd 2020 (Updated Apr 23rd 2020)

By Bill Gates


When historians write the book on the covid-19 pandemic, what we’ve lived through so far will probably take up only the first third or so. The bulk of the story will be what happens next.

In most of Europe, East Asia and North America the peak of the pandemic will probably have passed by the end of this month. In a few weeks’ time, many hope, things will return to the way they were in December. Unfortunately, that won’t happen.

I believe that humanity will beat this pandemic, but only when most of the population is vaccinated. Until then, life will not return to normal. Even if governments lift shelter-in-place orders and businesses reopen their doors, humans have a natural aversion to exposing themselves to disease. Airports won’t have large crowds. Sports will be played in basically empty stadiums. And the world economy will be depressed because demand will stay low and people will spend more conservatively.


As the pandemic slows in developed nations, it will accelerate in developing ones. Their experience, however, will be worse. In poorer countries, where fewer jobs can be done remotely, distancing measures won’t work as well. The virus will spread quickly, and health systems won’t be able to care for the infected. Covid-19 overwhelmed cities like New York, but the data suggest that even a single Manhattan hospital has more intensive-care beds than most African countries. Millions could die.

Wealthy nations can help, for example, by making sure critical supplies don’t just go to the highest bidder. But people in rich and poor places alike will be safe only once we have an effective medical solution for this virus, which means a vaccine.

Over the next year, medical researchers will be among the most important people in the world. Fortunately, even before this pandemic, they were making giant leaps in vaccinology. Conventional vaccines teach your body to recognise the shape of a pathogen, usually by introducing a dead or weakened form of the virus. But there’s also a new kind of immunisation that doesn’t require researchers to spend time growing large volumes of pathogens. These mrna vaccines use genetic code to give your cells instructions for how to mount an immune response. They can probably be produced faster than traditional vaccines.

My hope is that, by the second half of 2021, facilities around the world will be manufacturing a vaccine. If that’s the case, it will be a history-making achievement: the fastest humankind has ever gone from recognising a new disease to immunising against it.

Apart from this progress in vaccines, two other big medical breakthroughs will emerge from the pandemic. One will be in the field of diagnostics. The next time a novel virus crops up, people will probably be able to test for it at home in the same way they test for pregnancy. Instead of peeing on a stick, though, they’ll swab their nostrils. Researchers could have such a test ready within a few months of identifying a new disease.


The third breakthrough will be in antiviral drugs. These have been an underinvested branch of science. We haven’t been as effective at developing drugs to fight viruses as we have those to fight bacteria. But that will change. Researchers will develop large, diverse libraries of antivirals, which they’ll be able to scan through and quickly find effective treatments for novel viruses.

All three technologies will prepare us for the next pandemic by allowing us to intervene early, when the number of cases is still very low. But the underlying research will also assist us in fighting existing infectious diseases—and even help advance cures for cancer. (Scientists have long thought mrna vaccines could lead to an eventual cancer vaccine. Until covid-19, though, there wasn’t much research into how they could be produced en masse at even somewhat affordable prices.)

Our progress won’t be in science alone. It will also be in our ability to make sure everyone benefits from that science. In the years after 2021, I think we’ll learn from the years after 1945. With the end of the second world war, leaders built international institutions like the un to prevent more conflicts. After covid-19, leaders will prepare institutions to prevent the next pandemic.

These will be a mix of national, regional and global organisations. I expect they will participate in regular “germ games” in the same way as armed forces take part in war games. These will keep us ready for the next time a novel virus jumps from bats or birds to humans. They will also prepare us should a bad actor create an infectious disease in a home-made lab and try to weaponise it. By practising for a pandemic, the world will also be defending itself against an act of bioterrorism.

Keep it global
I hope wealthy nations include poorer ones in these preparations, especially by devoting more foreign aid to building up their primary health-care systems. Even the most self-interested person—or isolationist government—should agree with this by now. This pandemic has shown us that viruses don’t obey border laws and that we are all connected biologically by a network of microscopic germs, whether we like it or not. If a novel virus appears in a poor country, we want its doctors to have the ability to spot it and contain it as soon as possible.

None of this is inevitable. History doesn’t follow a set course. People choose which direction to take, and may make the wrong turn. The years after 2021 may resemble the years after 1945. But the best analogy for today might be November 10th 1942. Britain had just won its first land victory of the war, and Winston Churchill declared in a speech: “This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” ■

Bill Gates is the co-founder of Microsoft and co-chair of the Bill & Melinda Gates Foundation.



应邀参加｜19世纪初的世界
比尔-盖茨谈如何对抗未来的大流行病
冠状病毒将催生三大医学突破。这只是一个开始

2020年4月23日（2020年4月23日更新）


作者：比尔-盖茨


当历史学家写下关于19号病毒大流行的书时，我们到目前为止所经历的事情可能只占前三分之一左右的篇幅。故事的主要内容将是接下来发生的事情。

在欧洲、东亚和北美的大部分地区，大流行病的高峰期可能会在本月底前过去。许多人希望，在几周后，情况将恢复到12月时的样子。不幸的是，这不会发生。

我相信人类会战胜这场大流行病，但只有当大多数人都接种了疫苗。在那之前，生活将不会恢复正常。即使政府取消了就地收容的命令，企业重新开门，人类对暴露在疾病面前有一种天然的厌恶。机场不会有大量的人群。体育比赛将在基本空旷的体育场进行。世界经济将受到压制，因为需求将保持低位，人们将更加保守地消费。


随着大流行病在发达国家放缓，它将在发展中国家加速。然而，他们的经历会更糟糕。在较贫穷的国家，可以远程完成的工作较少，疏远措施不会有多大效果。病毒将迅速蔓延，卫生系统将无法照顾到受感染的人。Covid-19压倒了像纽约这样的城市，但数据表明，即使是曼哈顿的一家医院，其重症监护床位也比大多数非洲国家多。数百万人可能会死亡。

富裕的国家可以提供帮助，例如，确保关键的物资不会被出价最高的人拿走。但是，只有当我们对这种病毒有了有效的医疗解决方案，也就是有了疫苗，富人区和穷人区的人们才会安全。

在接下来的一年里，医学研究人员将成为世界上最重要的人之一。幸运的是，甚至在这次大流行之前，他们就在疫苗学方面取得了巨大的飞跃。传统的疫苗教你的身体识别病原体的形状，通常是通过引入病毒的死亡或弱化形式。但也有一种新的免疫，不需要研究人员花时间培养大量的病原体。这些mrna疫苗使用遗传代码来给你的细胞提供如何发起免疫反应的指令。它们可能比传统疫苗生产得更快。

我的希望是，到2021年下半年，世界各地的设施将制造出一种疫苗。如果是这样的话，这将是一个创造历史的成就：人类有史以来从认识一种新的疾病到对其进行免疫的最快速度。

除了疫苗方面的这一进展外，大流行病还将带来另外两项重大的医学突破。一项是在诊断领域。下一次出现新的病毒时，人们可能会像测试怀孕一样，在家里对其进行测试。不过，他们不是在棍子上撒尿，而是刷一下鼻孔。研究人员可以在发现一种新疾病的几个月内准备好这种测试。


第三个突破将是在抗病毒药物方面。这一直是科学的一个投资不足的分支。我们在开发对抗病毒的药物方面没有像对抗细菌的药物那样有效。但这将改变。研究人员将开发大型的、多样化的抗病毒药物库，他们将能够通过扫描，迅速找到对新型病毒的有效治疗方法。

所有这三种技术都将使我们为下一次大流行做好准备，使我们能够在病例数量仍然很低的情况下进行早期干预。但是基础研究也将帮助我们对抗现有的传染病--甚至帮助推进癌症的治疗。(科学家们一直认为mrna疫苗可以导致最终的癌症疫苗。然而，在covid-19之前，对于如何以某种可承受的价格大规模生产这些疫苗并没有太多的研究。）

我们的进步将不仅仅是在科学方面。它也将体现在我们确保每个人都能从科学中受益的能力。在2021年之后的几年里，我认为我们将从1945年之后的几年中学习。随着第二次世界大战的结束，领导人建立了像联合国这样的国际机构来防止更多的冲突。在covid-19之后，领导人将准备机构以防止下一次大流行病。

这些机构将是国家、区域和全球组织的组合。我预计他们将定期参加 "细菌游戏"，就像武装部队参加战争游戏一样。这将使我们为下一次新型病毒从蝙蝠或鸟类跳到人类身上做好准备。它们还将使我们做好准备，以防坏蛋在自制的实验室里制造出一种传染病并试图将其武器化。通过对大流行病的演练，世界也将对生物恐怖主义行为进行自我防御。

保持全球化
我希望富裕国家在这些准备工作中包括较贫穷的国家，特别是通过投入更多的外国援助来建立他们的初级卫生保健系统。即使是最利己的人或孤立主义的政府，现在也应该同意这一点。这场大流行向我们表明，病毒不遵守边界法则，无论我们喜欢与否，我们都被一个微观的病菌网络所连接，在生物学上。如果一种新的病毒出现在一个贫穷的国家，我们希望其医生有能力发现它并尽快控制它。

这一切都不是不可避免的。历史并不遵循一个既定的路线。人们选择哪个方向，并可能会做出错误的决定。2021年之后的几年可能类似于1945年之后的几年。但对今天来说，最好的比喻可能是1942年11月10日。英国刚刚赢得了战争中的第一次陆地胜利，温斯顿-丘吉尔在一次演讲中宣布。"这不是结束。它甚至不是结束的开始。但是，它也许是开始的结束"。■

比尔-盖茨是微软公司的联合创始人，也是比尔和梅琳达-盖茨基金会的联合主席。