迈克·奥斯特霍尔姆与埃里克·托波尔 - 探讨《大灾难》一书

好的。我今天真的很兴奋。能和我最喜欢的流行病学家交谈，他刚刚出版了一本名为《大流行》的重要著作。这是一本了不起的书，我有幸在出版前就阅读了它。我想读一下我对它的评价，与其他评论者相比，我只是个小人物。

Okay. Well, I am really excited today. I get to talk to my favorite epidemiologist, and he has just launched, a big book called The Big one. And it is an incredible book that I had a chance to review prior to its launch. And I'll I just wanna read what I said about it, and I'm I'm a a little guy compared to the other people that, have reviewed the book.

我写道：'如果要找一个人来指导未来大流行的防范工作，那一定是迈克尔·奥斯坦，他是世界顶尖的流行病学家之一。在《大流行》这本里程碑式的著作中，他与马克·奥斯坦共同提出了一种极其清晰、以科学为基础且全面的预防方法。'所以，迈克尔，欢迎你。

I wrote, if it was one person to turn for future pandemic readiness, it would be Michael Ostin, one of the world's leading epidemiologists. In the big one, a landmark book. He, along with Mark Ostin, provide a remarkably clear eyed, science driven, and comprehensive preventive approach. So Michael, welcome.

非常感谢，埃里克。能和你在一起真是莫大的荣幸。

Thank you very much, Eric. It's a real honor to be with you.

不，对我来说更是如此，因为这本书的出版时机、内容平衡，以及其中蕴含的洞察力和智慧都来自一位在这个领域深耕了四十年的专家。据我所知，你是美国最受尊敬的流行病学家。我只能说这些了。

Well, no, it's much more for me because this book is really the timing of it and the balance in it and the insight and wisdom from a person who's been doing it, what, four decades and is the highest, as far as I know, the highest regarded, American epidemiologist. That's all I can say.

我想补充一点，好吗？因为书里提到了这点，我也不想隐瞒。听众们可能不知道的是，在疫情期间，你和几位同事每周五都会与我一起召开所谓的'派对策划小组'会议来协调日程安排。从你身上学到的知识让我觉得我几乎可以再拿一个博士学位，至少再拿一个硕士学位。我想亲自感谢你，你清晰的表达和卓越的临床与流行病学问题分析能力对我们来说是一份礼物。

If I could add one addendum to this, okay? Because it's in the book, so I surely don't want to disguise it, but what the audience may not realize is that you, along with several other colleagues and I, got together every Friday throughout the pandemic, what we call the party planning group to cover our calendars. And what I learned from you during the pandemic, I felt like I could almost have gotten another PhD or at least another master's. I just want to personally thank you. Your clarity of voice, your brilliant, brilliant assessment of what the various clinical and epidemiologic issues mean has been just a gift.

所以当你开设这个Substack专栏时，正如你所知，我迫不及待地订阅了。我希望今天所有听众都能意识到你对我们的价值有多大。能和你在一起真是我的荣幸，莫大的荣幸。

So when you started this Substack, obviously as you know, I couldn't wait to subscribe and I hope everyone who's listening today realizes just what a valuable tool you are to those of us. So it's an honor, a real honor for me to be here with you.

你太客气了，迈克尔。你一直给予我巨大支持，我从你身上学到了很多。其中贯穿全书的一点就是谦逊的重要性。你不仅是我最喜欢用比喻的人——那些朴实无华的比喻，而且你非常善于保持谦逊，总是说'我们不知道'、'我不知道'、'我们确实不知道'。

You're really kind, Michael, and you've been such a great support, and I've learned so much from you. And one of the things I learned from you, and it's throughout the book, is the importance of humility. Not only are you my favorite, person for coming up with metaphors, you come up with, you know, country bumpkin metaphors, but you're really good at, having humility saying, well, you know, we don't know. I don't know. We don't know.

那么让我们来探讨一个未知的领域——这本书的最后一章。我们正在倒序进行。但最后一章才是重头戏，它讲的是SARS三型，一种能迅速获得传播力、数小时内席卷全球的病毒——假设它从索马里起源，然后蔓延到你们明尼阿波利斯地区。这显然是虚构的情节，但距离现实可能并不遥远。

So let's get into something we don't know about, which is the last chapter of the book. We're we're going in reverse here. But the last chapter of the book is the big one. It's SARS three, and it's about a virus that gets wings and circles around the world in hours, I guess starting in Somalia and then wind getting into your neck of the woods in Minneapolis. And it's obviously something that's, you imagined, but it's maybe not so far off from what could happen.

请带我们梳理一下你构想的SARS三型疫情场景。

So take us through the SARS SARS three scenario that you envisioned.

首先，我们写这本书的初衷是通过虚构一场疫情——第一章就从索马里的首例传播开始——来展示病毒扩散的速度有多快。这个设定非常真实，我们核验过索马里、肯尼亚和机场的每个数据。每章都基于这个虚构场景展开，随后转入非虚构部分，评估我们本应或能够吸取的教训。

Well, first of all, what we attempted to do with this book is provide basically a fictional outbreak that begins in the first chapter with the very first transmission in Somalia. And it points out just how quickly this virus would spread. And it's very realistic. I mean, we checked every figure with everyone in Somalia, Kenya, airports. And what we try to do then is based on that, each chapter begins with that fictional scenario and then we go into the non fiction actual assessment of what shouldn't we or could we have learned.

众所周知，这场疫情让我们学到了太多。最具挑战性的是，我们从未在事后投入足够精力——无论是决心还是时间——去彻底复盘：到底发生了什么？我们经历了什么？我们需要一个类似911事件的独立调查委员会，不搞指责游戏，不分党派，只求总结教训。于是我们构思了这个病毒。

And as you know, we've learned a heck of a lot during this pandemic. One of the things that was very challenging is that we never spent the time afterwards, either commitment wise or just from a time standpoint, to assess what the heck happened. What did we go through? We needed a nineeleven like commission without finger pointing, not partisan, just to say what are the lessons we could have and should have learned. And so we came up with this virus.

当COVID爆发时，很多人怀疑冠状病毒能否造成这种冲击。众所周知，SARS和MERS作为冠状病毒原型，虽然致死率高达15%到35%，但传染性较弱。除少数超级传播者案例外，传播链基本能被阻断。关键问题在于——我有幸请教过冠状病毒专家——如果出现一种兼具COVID传播力（比如通过ACE受体等完美传播机制）和SARS/MERS重症率的病毒会怎样？

At the time as we saw COVID take off, there were a lot of people skeptical that a coronavirus was going to do this. As we know, SARS and MERS were both two prototype coronaviruses that in fact were of great concern, but fortunately, much as they could kill fifteen percent to thirty five percent of the people who got infected, they weren't that infectious. There were rare instances where we did have some super spreaders, but basically we were able to stop that transmission. Well, the whole point came up and of course, I had the good fortune to spend some time with the real coronavirus experts where what would happen if we had a coronavirus that had the ability to basically spread like we saw with COVID, meaning with the ACE receptor, etcetera, perfect package for spread? Also one that had the perfect package on board to cause severe illness, like we saw with MERS and SARS.

事实上，我们已在自然界发现这类病毒。严峻的现实是：这并非危言耸听的假设，而是极可能发生的场景。无论下一场疫情是SARS类病毒还是流感，它终将到来。正如我们常说的，大流行时钟正在滴答作响。

And sure enough, we've now actually found viruses like that in the wild. And so the challenge really is right now is the fact that this isn't such a sensational potential scenario. It's one that very realistically could happen. But regardless of what happens with the next SARS, like a pandemic or influenza, it's going to happen. As we've talked about, the pandemic clock is ticking.

只是我们不知道现在几点。刚经历一场疫情并不能保证下一场不会明天就来。但假设我们还有缓冲期，关键问题是：如何从COVID中吸取教训，为未来做更好准备？如何利用五年前尚未拥有的技术优势？这正是本书的核心驱动力。

We just don't know what time it is. And there's no guarantee because we just came through a pandemic that the next one couldn't start tomorrow. But assuming that we may have a little bit of time, the question is, what can we do now to learn from what we went through with COVID, to be much better prepared for the future? What are the technology issues that we can use to our advantage now we didn't have five years ago? And I think this has been to me the whole driving force behind this book.

我常说，这实际上是一封写给我子孙的情书。我能做些什么来让世界变得更美好，让他们不必经历那些苦难，这正是这本书的核心所在？

I basically often say, This was really a love letter to my kids and grandkids. What can I do to help make the world a better place so that what they don't have to go through is what this book was written all about?

嗯，你从事这项工作已相当长时间，这本书是你工作的结晶。但书中众多引述中，约书亚·莱德伯格的话最令我震撼：'对人类在地球上持续统治地位构成最大威胁的是病毒，病毒。'而你或许比任何人都更清楚病毒的破坏力。正如你所概述的，如果MERS和Omicron结合，既能像野火般蔓延，又不仅对年轻健康人群相对无害——

Well, you've been doing that quite a while, and this is a culmination of that work. But one of the many, many quotes that are in the book that really hit me is the one from Joshua Lederberg. The single biggest threat to man's continued dominance on the planet is the virus, the virus. And you, of course, know this perhaps better than anyone about what a virus is capable of doing. And as you outlined, you know, what if you had the combination of, a MERS and a Omicron that could spread like wildfire, but also wasn't just this, at times for younger, healthier people, you know, relatively not relatively innocuous.

当然，它仍可能导致这些人长期新冠症状。但现在我们面临的是可能更严重的威胁。有人认为这只是时间问题。但我想谈谈你创造的术语'微生物911'——

Of course, it could still cause long COVID in those people. But now we have potential it could be something much worse. And some people would say it's just a matter of time. But I wanna go now to the well, that term that you can you coined so many microbial nine one one. You know?

没错。当我们面对SARS二代病毒，无论称其为当前大流行还是地方病，问题重重。你曾指出八大主要失误，其中首要错误就是完全否认了空气传播途径，执着于飞沫理论——

That's right there. When you get to SARS two, our current pandemic, endemic, whatever you wanna call it, there's many things. You you've said there were the eight major mistakes. Right? And right at the top of the list was the whole denial of airborne transmission with this thing about fixation.

哦，他们坚持认为只是液滴传播，不会通过空气传播对吧？能否详细说明这点？有个惊人数据我此前不知：若两人同处一室佩戴贴合紧密的N95口罩，即使呼吸相同空气超过一天也不会发生传播。

Oh, it's it's the liquid droplets. It doesn't get airborne. Right? And I wonder if you could elaborate that. And on the one of the striking statistics that I didn't even know before is that if two people are sitting in a room that had tightly fit N95 masks, they wouldn't transmit for more than a day breathing the same air.

能否详细讲讲空气传播理论和口罩防护机制？

Can you tell us more about the airborne story and the masks?

首先，我非常幸运地得到该领域多位顶尖专家的指导，特别是CIDRAP的丽莎·布鲁索，她在此领域做了大量开创性工作。同时我也结合了自己作为明尼苏达州传染病流行病学家的经验，处理过多次空气传播至关重要的疫情。举个典型案例：多年前明尼苏达州举办特奥会，开幕式在休伯特·汉弗莱大都会体育馆举行，那是块巨大的棒球场——

Well, of all, I have been very, very fortunate to be tutored by several people who are really expert in this area, at least Lisa Brousseau from CIDRAP, who has done a lot of the pioneering work in this area. But I also brought to the table my work as an infectious disease epidemiologist and state epidemiologist in Minnesota working up outbreaks where in fact airborne transmission was very important. Let me give you a classic example of that. A number of years ago, we had the Special Olympics that were held in Minnesota and the opening night session was held in the Hubert Humphrey Metrodome. And this was the large, large baseball diamond there.

当时的情况是，所有队员都从右外野的一扇门列队入场，经过本垒板区域，绕行至中外野和左外野后聚集。阿根廷队（As队）正好在本垒板附近。结果当晚我们发现一名阿根廷少年刚出现麻疹症状，两天后确诊。随后疫情在队员和教练中爆发，而开幕式当晚现场观众超过六万人。

And what happened was all the individual team members marched in a door, what was out in right field, came down to home plate, kind of went around to center field, left field, and they collected there. Well, the teams from Argentina, the As, were right at home plate. And it turned out that that night we had a young boy from Argentina who was just breaking with measles. His case was confirmed two days later. And we had an outbreak that occurred among the team members and the coaches, but that opening night session where there were over 60,000 people in the actual venue.

参加开幕式的观众中也出现了疫情。这些人互不相识，毫无头绪。但通过座位定位发现，他们都坐在右外野看台远端420英尺处的同一小块区域——那个连服用兴奋剂的马克·麦奎尔都打不出本垒打的角落。结果该区域观众全部感染。经仔细调查发现，从本垒板后方上升的气流恰好将病毒颗粒带到了那个高空角落，由于气流运动方向，病毒直接感染了远处人群，却跳过了中间所有观众。

And we had an outbreak among individuals who went to that opening night session. They did not know each other, they had no idea. But when we placed them by seats, they were all seated in the same small section up in the far right field bleacher area four twenty feet away where Mark McGuire couldn't hit a home run on steroids. And they all came down with it. Well, when we actually looked at this carefully, it turned out that the air patterns coming off of home plate from behind home plate actually deposited up in that upper air corner up there where in fact, because the air was moving with this individual, that virus infected those people up there that far away and skipped over everybody in between.

用更直观的日常现象来说明：如果我走在街上突然闻到烟味，抬头发现吸烟者在35-40英尺外，而我处于下风向——烟雾正是气溶胶。我们想阐明的是：流感显然是经空气传播的疾病，所谓六英尺安全距离并无实质依据。人们对飞沫传播和气溶胶传播存在根本误解。当你在剧院第二排看到演员在聚光灯下喷溅唾沫时，大颗粒飞沫确实主要落在六英尺内，但该范围内同时存在悬浮的气溶胶微粒。明尼阿波利斯整个夏天都在应对气溶胶防控问题，因为加拿大山火产生的烟雾已飘散上千英里。

Now take that on a more apparent basis of saying every day, if I were walking down the street today and I suddenly smelled cigarette smoke, I look up and I see the person smoking is 35 to 40 feet ahead of me, but I'm downwind, smoke is an aerosol. And so what we were trying to get across the point is if you look at influenza, obviously that's an airborne related transmitted disease, there's nothing real about this six feet space, whatever, and there really has been a misconception as to what it means to actually put virus out in terms of droplets versus aerosol. Everywhere that there's a droplet where it's big enough, so when you're sitting in the second row at the theater and the actor is You can spewing away, you can see it in the lights, that does fall largely usually within six feet. But there's aerosols in those six feet, so these tiny things that float and then they go from there. Minneapolis has just spent the entire summer working with our aerosol prevention means because we've had all these wildfires from Canada where the smoke has gone over a thousand miles.

烟雾属于气溶胶，会在空气中悬浮。促使我们迅速反应的原因之一，是12月30日接到武汉疫情的首个通报时，我第一反应是'天哪，这又是一场流感，可能是场硬仗'。但随后几天我们确认这是冠状病毒。

Smoke is an aerosol, it floats in the air. And so one of the things that caused us to react as we did, when I got the first call about what was happening in Wuhan on December 30, My first reaction was, Oh my God, no, this is another flu. This could be the battle. Okay? And then we learned over the next few days, of course, wasn't, it was a coronavirus.

我当时想'还好我们有预案，情况虽不乐观但能控制'。然而我们联系武汉和往返香港的人员后，埃里克明确指出存在无症状传播者。

I thought, Oh, we're covered. It's not going to be good, but we can put this one out. But then what we did is we had contacts with people in Wuhan. We had contacts with people in Hong Kong that were coming back and forth with Wuhan. And Eric was very clear that there were people transmitting the virus who were themselves not yet ill.

分析传播方式后发现这是典型的空气传播——这并不意外，因为加拿大研究者早已证实SARS存在空气传播，只是传播规模有限。所以1月20日我就在官网上发布声明（至今可见）：'全世界醒醒，这将是下一场大流行'。

And that if you looked at how the transmission was occurring, it was classic airborne transmission, which shouldn't be surprising because in fact, the Canadian researchers had concluded that with SARS, there was airborne transmission. It was just limited in terms of the number of people that actually did that. So this wasn't a surprise to us. So actually on January 20, I put out a statement on our website, still there, that said, Wake up world. This is going to be the next pandemic.

正如你先前所说，我称之为'长翅膀的病毒'。这些呼吸道病毒通过气溶胶空气传播，那些围绕有机玻璃的卫生剧场、佩戴围巾等面部遮挡物都无济于事。但正如你指出，正确佩戴的N95口罩能为同处一室24小时的两人提供绝佳防护。

And it's because So you labeled it earlier, I call them viruses with wings. These are the respiratory transmitted viruses that are airborne, aerosol transmitted, and all the hygiene theater around plexiglass and all these things make no different. All the things about wearing something in front of your face, a bandana, whatever, doesn't make a difference. But as you just pointed out, on the other hand, N95s, when they're face fitted, provide incredible protection for two people sitting in the same room for twenty four hours.

是的。我是说，这很引人注目。我认为，很多人关注的统计数据，当然还有双向口罩，至关重要。现在，你在书中提到的那些事情，有些人会说，是关于强制令的。正如你比任何人都清楚，我们因为强制令看到了所有这些对立。

Yeah. I mean, that's striking. I think that, something that a lot of people, that statistic, and of course the two way mask, so critical. Now, one of the things that you came out, in the book, which some will say, is about, you know, mandates. As you, know better than anyone, we saw all this polarity because of the mandates.

这让很多人感到愤怒。当然，其中一项强制令是封锁，尤其是学校。所以我想听听你对学校强制令的看法。这个话题至今仍然非常热门。

It bristled a lot of people. And one of the mandates, of course, was the lockdowns and particularly school. So I want to get your view about the school mandates. This is such a hot topic still today.

是的，是的。首先让我说明一下，当时我在公共卫生领域并不受欢迎。我和合著者马克·奥什克在《华盛顿邮报》上发表了一篇专栏文章，我说不要实施封锁。那是在2020年3月。

Yeah. Yeah. Well, let me start out by first of all saying I was not a real popular guy in public health at the time. I wrote an op ed piece that was in the Washington Post with my co author Mark Olshaker, in which I said, do not do lockdowns. This was in March in 2020.

我说，原因是你们在概念上没有预见到即将发生的事情，即这不会像一场严重的飓风，12到18小时后就会过去，然后你们可以进入恢复阶段。这将是一个持续数年之久的情况。如果你们现在要封锁，你们打算如何解除？有什么替代方案能让你们解除封锁？因为事实并非如此。

And I said, the reason for that is you're conceptually not viewing what is about to happen, namely the fact that this was not gonna be like a bad, bad hurricane, which would blow through in twelve to eighteen hours and then you could go into recovery. This was gonna be a sustained situation that could last for several years. If you're gonna lock down right now, how do you wanna ring a bell? What's gonna give you the opportunity then to release that lockdown with some alternative? Because it's not.

事实上，我们在中国看到了这一点，2021年、2022年，那些被严格封锁的人群。我是说，他们真的只能靠送餐到家。当封锁结束时，他们还没有接种疫苗，短时间内就有数百万人死亡。我们一直提出的问题是：如果有任何东西能拯救我们，那会是什么？是良好的医疗护理。是能够充分获得良好的医疗护理。

And in fact, we saw that in China when in 2021, 2022 for populations that had been really heavily locked out. I mean, they literally had food delivered to their homes. When that lockdown was ended and they were not vaccinated, they lost millions of people in So a short order because of what we had proposed all along was what is the one thing that's going to save us, if anything? It's good medical care. It's having adequate access to good medical care.

如果你们的医院负荷达到140%，就无法做到这一点。所以我们讨论的是，无论你们是在前六个月、后六个月、第三个月还是第四个月死亡，疫情结束时你们都已经死了。关键在于，我们如何最大化医疗护理，最小化风险？我们提出的建议之一是，每家医院每天应该标注或提供当前的负荷情况。

Well, you can't do that if you're at 140% census. You just can't do that. And so what we were talking about is whether you die in the first six months or the second six months or the third six months or the fourth six months, you're still pretty dead at the end of the pandemic. And the point was, what can we do to maximize hospital care, minimize the risk of that being launched? And so one of the things we'd proposed is the fact that every hospital should in fact label or provide every day, what's our census at?

在一个社区里，每个人都能看到这些信息，这样就没有隐瞒。如果负荷达到95%或100%，你们可以请求人们休息几天，比如接下来的7到10天，如果可以的话，减少公共活动，尽量减少接触，这将对我们有所帮助。一旦负荷降下来——当然，变异病毒对此有很大影响，它们也会起伏不定——但这会给我们更好的机会。这是你们可以在整个疫情期间持续做的事情。这从来不是为了预防感染，因为你们无法预防。人们会在三年内陆续被感染。

And in a community and everybody can see it, so there was no And then if you got to 95% or 100%, you'd ask people to take a snow day or days where you'd say, for the next seven to ten days, please, if you can back off public events, if you can do anything to minimize contact, that'll help us. And then once we get the census back down, and of course, the variants had a lot to do with that, whether they came up and down too, but that would give us a better chance of having that. And that's something you could sustain through the entire pandemic. It was never about preventing infections because you weren't going to prevent them. People were going to get infected over three years.

事情就这么简单。问题在于，如何最大化利用机会来获得优质医疗护理？而那次机会已经错失了。我认为下次再面临疫情时，我们必须明白这可能持续数年。疫情初期，埃里克，你知道的，我因为言论耸动遭到同事诸多批评。

It's just that simple. The question was, how could you maximize the opportunity to then have good medical care? And that was just lost. And I think next time we get into the pandemic situation, we have to understand we could be in this for several years. Early on in the pandemic, Eric, as you know, I took a lot of criticism from my colleagues for being sensationally crazy.

2020年3月10日我上乔·罗根节目时就说过，当时我真心认为未来18个月可能会有80万人死亡。我的收件箱简直爆炸了——人们质问我为什么要散布恐慌？结果18个月后，死亡人数刚好略低于80万。人们没预见到的是这种长期性——这不是飓风过境，而是持续三年的传染病暴风雪。

And I was on Joe Rogan on 03/10/2020, and I said at that time, I really honestly believe we could see eight hundred thousand deaths in the next eighteen months. And I'm telling you, you should have seen my inbox for why are you doing this, scaring people? It turned out that 18 later, were just short of eight hundred thousand deaths. That's what people didn't envision is this long term, not a hurricane, but we're talking about an infectious disease blizzard that lasted three years.

确实。想想大萧条时期。你的预言成真了。当时很多人不理解，给你贴上危言耸听的标签，但这并非事实。而现在你正试图整合所有经验教训，不仅来自SARS-CoV-2，还包括其他...

Yeah. I mean, think depression. You called it. I think a lot of people didn't appreciate and labeled you as a scaremonger, which couldn't have been truth. But here you are, you're now trying to take all that wisdom, not just from SARS CoV two, but all the other Yeah.

流感等其他病毒。你在规划未来应对策略。这涉及通用疫苗等多个领域——许多实验室正在研发的不仅针对冠状病毒，还包括流感和其它潜在 pandemic 病毒。还有你强调的监测系统、重建公众信任这个关键环节、确保资金到位。看着你列出的清单，我不禁要问：我们现在根本没推进这些工作——这个决策对吗？

Influenza and everything else. And you're trying to project what do we have to do? And, you know, this transcends many different areas about universal vaccines, which many academic labs have been coming up with, not just for, coronavirus, but also for influenza and other leading potential viruses that could cause a pandemic, surveillance systems, the the critical aspect of public trust that you emphasized that we've got to reestablish, getting the right funding. Now as I look down the list of all the things you brought up, I'm saying, We're not doing any of this stuff. Is that the right call on that?

很遗憾你是对的。关于上个问题我再补充一点，你问到我但当时没回答——是关于孩子的部分。

Unfortunately, you're right. And let me just add one little piece to my last answer because you asked me and I didn't answer it. It was about kids.

对，哦是的。

Yeah. Oh, yeah.

人们没意识到的是，病毒变异使得儿童感染情况天差地别。疫情前三年，我国约有1559名儿童死亡。第一年只有199例——我说'只有'当然仍是悲剧——但87%的儿童死亡集中在第二和第三年。随着阿尔法变异株被贝塔取代，贝塔又被德尔塔取代，最后到奥密克戎阶段，对儿童的影响发生了显著变化。

And what people didn't realize is the variance made all the difference between night and day with kids. In the first three years of the pandemic, we had roughly fifteen fifty nine kids die in this country. If you look at the first year, it was only one hundred and ninety nine. And I'd say only, and it's still a tragedy, but eighty seven percent of the deaths in kids occurred in year two and year three. And what happened was as Alpha gave way to Beta, Beta gave way to Delta and the variants, and then we got to Omicron, we saw a very different impact on kids.

但人们在第一年发表的这些论文声称，这对儿童风险不大。既然我不会病得很重。我们完全忽视了流行病学和儿科COVID随不同变种的变化。因此，87%的死亡发生在第二年和第三年这一事实，我们完全错过了。我们当时还在争论学校是否应该开放或关闭，或是基于第一年的数据做决策。

But people had published these papers in the first year saying, It's not a big risk for kids. Now that I don't get seriously ill. And we missed totally what was changing with the epidemiology and pediatric COVID per the different variants. And so the fact that eighty seven percent of the deaths occurred in year two and three, we totally missed that. We were having all the arguments about school being open or closed or what we did based on what was from year one data.

我认为这是给我们的教训之一：必须持续评估数据，无论是传播性、疾病严重程度等方面。这也是我们应从这些变种中吸取的教训。这些变种非常重要。虽然这是一个较新的视角问题，但我认为事实如此。但就你最后一点而言，不幸的是，真正能终结大流行的唯一途径是通过疫苗实现全球覆盖，让所有人都能获得有效疫苗。

And I think this was one of the lessons that taught us is you got to constantly be evaluating the data, whether it be for transmission purposes, for disease severity, etcetera. And I think that's one of the lessons we should learn with these variants. These variants were really important. And that was a newer picture issue, but I think that's the case. But in terms of your last point, unfortunately, the only thing that's ever really going to take a pandemic off the table is having a global reach with vaccine, having access to everyone that's an effective vaccine.

正如你所知，我在书中写了很多关于流感的内容，因为这是我深入参与的领域。目前全球通过鸡蛋和细胞培养方法——这套沿用数十年的技术——若一切顺利，我们一年内能生产覆盖全球约四分之一的疫苗。而要满足全球需求需要三年或更久，到那时流感大流行可能已结束。短期内我对通用疫苗的最大希望是mRNA技术——它不一定会生产出更好的流感疫苗（我们知道流感疫苗存在免疫力衰减的挑战，且不一定能阻断传播），但能大幅预防重症、住院和死亡。这正是COVID疫苗通过mRNA技术实现的。

And as you know, and I wrote in the book, I talked a lot about influenza because is an area that I've been very involved with. Right now, globally, we have the ability to make using chicken egg and cell culture methods, the tool we relied on for decades, we can make enough vaccine in one year if everything goes right to cover about a quarter of the world. It would take us three or more years to get enough vaccine for the world, which by that time, the influenza pandemic could be over. Now, where I had great hope, at least in the short term, I'd like to get that universal vaccine is mRNA technology because there, it wouldn't necessarily be any better vaccine for flu, meaning in terms of we know we have challenges with waning immunity with influenza vaccines, it doesn't necessarily stop transmission, but it does a lot to prevent severe illness, hospitalizations and deaths. That's what the COVID vaccine has done with mRNA technology.

但用mRNA技术应对流感，我们很可能在第一年就能生产覆盖全球的疫苗量。这将决定数百万生命的生死差别。所以当我们看到现政府撤回对mRNA的所有支持，几乎将其妖魔化时，这非常不幸——因为此刻它本是我们最好的救命稻草。从这个意义上说，这是个典型案例。否则，我们现有的其他手段最多只能略微限制疫情发展，疫苗才是真正的关键。

But with mRNA technology for influenza, it's very likely we can make enough vaccine to cover the world within that first year. That is the difference between millions and millions of deaths. And so when we recently saw this administration withdraw us any support for mRNA and basically almost cast it aside as evil, that's been really unfortunate because that was our best get out of jail card right now. And so in that sense, that's an example. But otherwise, all the other things we have going for us at best can limit a bit of what happens with the pandemic, but we really need to have these vaccines.

我完全同意你的观点。你在书中特别强调：我们对mRNA纳米颗粒包装从第一天起就毫无改进。当然，从基因测序到首支疫苗问世只用了十个月已是奇迹。但比如在日本，他们使用自扩增mRNA技术，剂量极小，副作用风险更低，纳米颗粒也可调整。

I couldn't agree with you more there. You really highlight this in the book. The point here is that you know, we haven't done anything to improve the mRNA nanoparticle package since day one. It was, of course, a that we had it in ten months from the time of sequence to the first vaccine being able to be given to people. But we know, like, example, in Japan, they're self amplifying mRNA at tiny doses, much less potential for side effects, and the nanoparticles can be tweaked.

而现在——疫苗问世五年多后——制药公司依然毫无作为。正如你指出的，迈克，HHS放弃mRNA技术不仅是传染病领域的损失，更是对癌症、自身免疫疾病、基因编辑等领域的重创。很多人没意识到：mRNA疫苗能快速大量生产。我们本可以储备通用流感疫苗、通用冠状病毒疫苗，再选几种主要病原体，按你所说准备数十亿剂库存。

And and we're still now, you know, five years later or four years plus later from the vaccines being available, and the companies are doing nothing. Of course, as you point out, Mike, the abandonment of HHS, of mRNA, perhaps not just even for infectious diseases, but for cancer, autoimmune diseases, gene editing, and all sorts of other things. This is really a tragedy, I think. Because as you just pointed out, a lot of people don't realize it, you can make enormous amount of mRNA vaccines quickly. And, of course, we could stockpile uni ideally, flu, universal coronavirus, and pick pick a couple more leading culprits and have, you know, like you said, billions of doses ready.

你在书中确实聚焦了这一点：投资储备通用mRNA疫苗，将能抵消生命损失、经济冲击等连锁悲剧，对吧？

And the you you you really spotlighted this in the book. The investment in stockpiling universal vaccines, mRNA vaccines, off that would offset the tragedy and the loss of lives, the economic impact, on and on and on, right?

埃里克，如果我们有那个，就不会面临大问题了。就这么简单。这就是区别，明白吗？所以我们需要让民众理解这一点。当人们讨论国防开支时，他们总说我们在这上面花了太多钱。

If we had that, Eric, we wouldn't have the big one. It's that simple. That's the difference, okay? And so that's what we need to get across to people. When you think about defense spending, people say, Well, we spent too much money on it.

我们投入得还不够。我不明白，真的不理解。但我明白的是，如果要建造新航母，他们会做十五年建造预算。从今天开始规划，就不必每年都去申请退款或指望持续获得资金。

We don't spend enough on it. I don't know. I don't understand that. But I do understand, if you're going to build a new aircraft carrier, they budget that for fifteen years of construction. So it starts today and you don't have to go in every year to get refunded or hoping that you're going to continue to get funding.

本来就是按计划行事。我们的疫苗研发也该如此。私营部门不会接手这事，看看现在mRNA技术失宠后发生了什么？所有投资者都在撤资，怕赔得血本无归。谁会为不能日常维持的生产线买单？

It's planned that way. We should be doing this with our vaccines. And the private sector is not going to pick this up because already look what's happening once the mRNA fell out of favor with this administration. Everybody investment wise is getting out of it because they're afraid they're going to lose their shirts. Who pays for manufacturing capacity that you don't keep warm basically day to day?

必须保持生产线热状态，突发事件时才能立即启动。这必须是政府的责任。在我看来这是个挑战。我们中心——有些人知道——可以说是流感和冠状病毒疫苗研发路线图的资料库，一直有专项资金支持。

You got to keep it warm so when something happens, you can start up right away. Again, that's got to be government. And so to me, this is a challenge. Our center, which some people know, has been the depository, you might say, for the vaccine roadmaps for both influenza and coronavirus. We've been funded to keep track of that.

我们随时能告诉你哪些项目正在获得资助、资金来源等信息。看看这些数据，相比我们刚经历的疫情损失，投入金额简直微不足道。想象下如果能避免这种损失...这就是我认为的好消息所在。你无法阻止疫情爆发。

We can tell you at any moment what's being funded, where it's being funded by, etcetera. And when you look at that, it's just a small amount of money compared to the cost of what we just went through. And imagine if you could take that off the table. This is where I think the good news comes in. You can't prevent a pandemic.

有人说可以，其实不行。带翅膀的病毒一旦起飞就失控了。但你能大幅限制其影响吗？实际上，这部分是完全可能的。

Some people say you can. You can't. Once a virus with wings takes off, it's gone. But can you do a lot to limit it? Actually, and that's the part that's possible.

所以并非全无希望，但我们需要世界各国政府——尤其是美国——的领导层支持这类疫苗研究。就像你说得很对，这些疫苗蕴含着许多激动人心的新机遇。我们只需投资其中。多么微小的保险单啊。

So this is where it's not all lost, but we need to have leadership at government levels around the world, but particularly The United States, to support this kind of vaccine research. Just as you said very nicely, there is a lot of potential exciting new opportunities with these vaccines. We just have to invest in them. What a small, small insurance policy.

我是说，这对我来说太不可思议了——我们本可以大规模生产通用疫苗，只需使用现今mRNA技术的一小部分，搭配更优的纳米颗粒和更强的免疫反应，但我们却无所作为，正如你所说还遭到谴责。而且

I mean, it's just extraordinary to me that we could be building at mass quantities universal vaccines with a tiny fraction of the mRNA that's used today with better nanoparticles, better immune response, and we're doing nothing, and it's getting condemned, like you said. And

你知道，你对其他替代性疫苗方案——比如莱姆病减毒疫苗等——的评论非常到位。我们本应竭尽所能。这对季节性病毒也同样适用。我是说，就流感而言，上个季度美国就有256名儿童死于流感。256个孩子啊。

you know, you've commented on this very nicely on other alternative vaccine approaches, Lyme attenuated vaccines, etcetera. We should be doing everything we can. And it's also for seasonal viruses. I mean, the terms of the influenza, influenza killed two fifty six kids in this country this last season. Two fifty six kids died from influenza.

只要我们在这个领域投入资金，我们能做的远不止这些。

There's so much more that we can do if we just had this investment in this area.

现在，在我讨论HHS部门当前的工作疏失之前，我想先问问你：眼下我们正面临新一波疫情，COVID将伴随我们很多很多年。事实上很多人预测，这种病毒可能再次出现类似奥密克戎的变异。是的。

Now, before I go to what the lapses are at the moment with a thing called HHS, I do wanna ask you, you know, right now, of course, we we have some wave. COVID will be with us for, you know, many, many years ahead. And in fact, many suggest that we may see another Omicron like event just with this virus. Yep.

是的。

Yep.

因为病毒有无限种变异组合，谁知道会发生什么。但我们现在已经有很多死亡病例，数百人死亡，更多人患上长新冠。疫苗正在被剥夺，除非是65岁及以上人群——即便如此在很多州也很难获得。

Because have infinite number of mutation combinations, who knows what could happen. But we have a lot of deaths now. We got hundreds of deaths. We have more people getting long COVID. We have vaccines that are being taken away from people, unless they're fit with the 65 and older, and and even that is gonna be hard to get in many states.

现在情况一团糟。夏季这波疫情会怎样发展还不明确，可能不会像之前那么严重，但XFG变种加上开学季等各种因素...在免疫力下降等情况下我们正变得毫无防备，你对当前形势怎么看？

We have a mess right now. We have a a summer wave that you know, we don't know exactly where that's gonna it probably won't be as bad as prior ones, but it's this XFG variant and all the other things that happened with, you know, with going back to school and and the What what is your read on the current situation where we're being made defenseless with the waning immunity and everything else.

首先，你阐述得非常到位。我都不敢妄加改动，因为你确实做得比我更好。但请允许我补充一点，无论是在特朗普政府还是拜登政府时期，白宫及其下属办公室都切实存在着一支应对突发事件的团队。例如，保罗·弗里德里希斯博士在拜登执政期间负责这项工作，他领导着一个由多人组成的团队，他们每天都专注于生物防御准备。

Well, first of all, you laid it out so well. I wouldn't dare want to touch it because you actually did a better job than I could. But let me just add, in the Trump one administration and in the Biden administration, there was a very real presence of preparedness in the White House and the offices that were there. And for example, Doctor. Paul Friedrichs, who headed this up during the Biden administration, he had a staff, a number of people, and they every day were on top of bio preparedness.

他们曾努力应对这方面工作。但你知道吗？现在白宫国家安全委员会里竟没有一个具备该领域专长的在职人员？一个都没有。简直是难以置信。

They were trying to deal with it. Do you know that there's nobody now employed at the White House from the Security Council that has any expertise in this area? None. Zero's up. Incredible.

如果今天爆发危机，他们还不如直接跑到街上拦辆出租车，问问司机到底该怎么办。

If a crisis begins to happen today, they might as well go out and they get to Hail down the first taxi and ask the taxi driver what the hell to do.

你知道吗？这太可怕了。迈克尔，我实在无法理解，因为现在根本没有疫情应对办公室了。这是否认主义吗？还是纯粹的愚蠢？

You know? Is This is scary. Michael, I don't get it because here you have There's no one No pandemic preparedness office anymore. And is this denialism? Is it just pure stupidity?

我们都看到小罗伯特·肯尼迪通过特朗普总统罢免了CDC主任。但我们也从那些CDC资深官员那里听说，当麻疹疫情或禽流感等事件发生时，尽管他们拥有全部专业知识，却从未被征询过意见。你怎么看？

You know, we've seen how RFK Jr. Fired the CDC director through, of course, president Trump. But we also heard from the other people who you know well, these other CDC leading seniors, that when anything happened, like a measles outbreak or bird flu, whatever, that they have all the expertise, they were never consulted about anything. What do you make of that?

听着，现在我们面临一个非常简单的抉择：我们是否要支持科学？过去几十年里，科学在改善健康、延长寿命等方面给予我们无数馈赠。想想疫苗出现前的时代，想想清洁安全饮用水普及前的岁月。

Well, let me tell you, we're down to a simple decision, a very simple decision. Are we going to put our lot behind science? Something that over the past decades have given us many, many gifts in terms of better health, longer health, etcetera. I mean, think back to what it was before vaccines. Think back what it was before we had clean and safe water supplies, etcetera.

自那时起，我们见证了上个世纪人类预期寿命从四五十岁提升到如今的八十多岁。知道吗？这主要归功于公共卫生事业。所以你要选择科学，还是选择那些装神弄鬼的把戏？

And since that time, we've watched life expectancy in the last century go from in the high 40s, low 50s to now in the 80s. Okay? That came largely from public health. So you got science. Or do you decide to go with magic smoke and mirrors?

这就是另一种选择——魔法的烟雾与镜子。我不知道公众何时会醒悟，意识到他们必须让民选官员行动起来，必须让人们明白。这不仅仅是意识形态的争论，而是关乎真实的人生。

And that's what the other alternative is. Magic smoke and mirrors. And I don't know when the public is gonna wake up to the fact that they've got to get their elected officials, they've got to get people to understand. This is not something that's just an ideologic argument. This is real people's lives.

我们将看到各类可预防疫苗疾病及其他疾病导致的死亡人数大幅上升。我们正在削弱这个国家的食源性疾病监测体系，正在瓦解虫媒病毒与蚊虫防控的整个领域。更不用说我们在全球范围内对美国国际开发署等所有资助项目所做的一切——我们已不再是世界卫生组织成员。

We are going to see major increases in deaths across the board from vaccine preventable diseases, from other diseases. We're gutting the foodborne disease surveillance in this country. We're gutting the whole area of arboviruses and mosquitoes in this country. And then of course, look what we've done globally in terms of USAID and all the funding. We're no longer part of WHO.

我们曾多少次成功阻止了特定疾病的爆发？

And how many times did we stop outbreaks of certain disease?

好的，音量问题。你的音频音量太低我听不清。看看能否恢复。好了。

Okay. Cut out on the volume here. I lost you on your volume audio. Let's see if we get it back. Okay.

因为现状如此。明白了，抱歉刚才没听清。关键在于我们的处境更加糟糕了，虽然不知道需要什么才能改变，但我们必须认清这显然是社会面临的重大抉择——我们是否要接受这种局面？

Because here we are. Got it. Sorry, I lost you there. So the point though is that we are in much worse shape, and I don't know what it's gonna take, but we have got to understand that it is clearly, clearly a major decision by society. Are we going to accept this or not?

是的。问题是所有迹象都显示我们在倒退。正当公共卫生威胁可能比以往任何时候都严重时，美国却仿佛正在步入公共卫生的拜占庭时代。科学没有进步或难以进步，资金被削减，有经验的人才因辞职或被解雇等原因不断流失。我知道你是个乐观的人...

Yeah. I mean, the thing is that everything has to look that we're going backward. We're going into like a Byzantine era of public health in The United States just when the threats are, you know, more than perhaps ever. And the science hasn't advanced or can advance the funding being reduced, people with experience being lost because resignations or being fired or whatnot. Can you I know you as an optimistic guy.

我也...你知道的，你写的那本大部头书里贯穿的主题就是怀抱希望。但在当前形势下，你还能保持这种整体乐观的态度吗？

I also you know, it it resonates through the big one book that you're you're hoping for the best. But are you able to keep your, you know, your whole, overall positive outlook with all that's going on?

埃里克，你知道吗，我的孩子们以这样的方式影响了我。几年前，他们送给我一个放在办公桌上的电子相框，每三十秒就会轮换显示一张孙辈们的照片，有时是单人照，有时是合照。每次开会或做任何事时，我都会忍不住时不时看向那个相框，它给了我继续前进的全部动力。我们要给子孙后代留下什么？所以我怎能不保持乐观？

You know, Eric, I have been, I'll say, affected by my kids in the following way. Several years ago, they brought me an electronic picture frame that sits on my desk, and every thirty seconds a new picture of one of my grandkids flashes up there, singly or in combination. And every meeting I'm in, everything I do, can't help but keep looking from time to time at that electronic picture frame, It gives me every motivation to keep going. What is it that we're leaving our kids and grandkids? And so am I optimistic?

我想，如果我不认为我们能成功，就不会坚持做这件事了。另一方面，我是否意识到挑战？当然，但如果你考虑的不是我——我这个老头子很快就要离世了——那么这个挑战就值得面对。

Well, I guess I wouldn't keep doing this if I didn't think we could make On a the other hand, do I realize the challenge? Yes, but that challenge is worth it if you're thinking about, Not me. I'm an old guy. Yeah, well, I'll be gone soon. Okay?

但我的子孙们将成长在一个世界里，如果我没有竭尽全力让世界变得更好，那我还有什么存在意义？这就是我坚守信念的方式。

But my kids and grandkids are growing up into a world that if I haven't done everything I can to make that world better, then who the hell am I? So that's how I stay where I stay.

不，你一点儿都不老。我们需要你。你必须坚持下去。事实上，我认同你的乐观。虽然我们正经历艰难时期，这种状态可能还会持续一段时间。

No, you're not at all super eight. We need you. You gotta hang up. I share, actually, your optimism. I think that ultimately, we're in a tough spell here, and that may be go on for some period of time.

但我坚信，随着科学势不可挡的进步——正如你在书中精辟阐述的那样——我们必须做好应对准备。不是我个人，而是全人类要准备好。所以我希望，在下一场疫情（无论是SARS-3还是其他大流行病）来临前，我们最终能做好准备。虽然眼下正处于艰难阶段，但你知道吗？

But I do think, you know, with, the irrepressible advances in science, you know, that we know you outlined it so well in the book, the things we have to do to get ready. Not me, but to be ready. So I you know, I I'm hoping that before this comes on, this whether it's SARS three or whatever that the big one is, that we will ultimately be ready. And we're going through a a rough time right now. But you know what?

全球许多学术团体里有无数聪明人正在攻克这个问题，这种进步势头无法阻挡。我们已取得的进展让我想用这句话作结：这本书实在太棒了。

There's so many smart people out there that I know in many academic groups throughout the world that are on this, and it can't be suppressed. And the advances that we made. So I wanna just close well and say, this is an incredible book.

谢谢。

Thank you.

你知道吗？事情远不止如此，因为我们正在取消儿童疫苗接种。今天在佛罗里达实施，谁知道下一个地方是哪里？短期内肯定会出现更多传染病问题。但我们不是短视的人。

You know what? It's much bigger than that, because we're getting rid of vaccines for children. Today, offer in Florida, who knows where next? I mean, there's gonna be more infectious disease problems in the short term. But we are not short term thinkers.

你写这本书的事实说明你着眼长远。你在问，我们要怎么做才能避免再次陷入这种可怕的混乱？所以感谢你整理这些内容。大家如果今晚想看看迈克的表现，可以关注安德森·库珀的节目，看他与安德森的对谈。我知道这会是个精彩的访谈，因为

The fact that you wrote this book is you're looking long term. You're saying, what are we gonna do here so that we don't get in this mess, this horrific mess, again? So thank you for putting this together. And everybody should know if they wanna see Mike in action tonight, Anderson Cooper, see him with an Anderson. It'll be a great interview, I know, because

我聊过

Any I've talked

安德森还有其他结束语要说吗，迈克尔？

to Anderson many other other closing thoughts, Michael?

两点。首先是1950年代有个机油广告，标语是'现在付款或以后付款'。我们必须明白，无论如何我们都要付出代价，现在付出的成本将截然不同。最后我想说，我们身处艰难时期，团队启动了疫苗诚信项目来支持疫苗可及性等工作。我们在CIDRAP中心有句座右铭：'我们会弯曲，会屈服，但绝不会断裂'。

Two things. One is just quickly, there was an oil to oil fram commercial back in the 1950s and the tagline was, You can pay me now or you'll pay me later. And I think we have to understand, we're gonna pay for this one way or the other, if we pay now, what that costs us will be very, very different. The final piece is we are in tough times and our group has started this vaccine integrity project to help support vaccine availability, etcetera. And we have a motto at our center at CIDRAP, and it is, We will bend and we will bend, but we will not break.

我认为现在所有人都需要保持这种态度。无论发生什么，我们都不会崩溃。

And I think all of us need to take that attitude right now. Despite what's going on, we're not going to break.

其实我很高兴你提到这点，因为这是你主导的另一个行动要点——你的CIDRAP中心。你们创建了疫苗诚信项目，我不想说它像什么替代方案，但它确实是。你提供的信息值得所有人关注。

Actually, I'm really glad you mentioned that because that's another action point that you have been leading, which is your, CIDRAP Mhmm. Or such as these, you have created a vaccine integrity project. And I don't wanna say it's like alt whatever. It is alt whatever. And you're kinda good information that everybody should be tuned in on.

你知道，我...那个消息最近才公布，你在做这件事真是太棒了，因为我们急需一个优质的信息源。而很难找到比你们更好的来源了——你，SidRap，还有你的合作者们。所以Mike，非常感谢你今天参加《Ground Truths》节目，我们期待你持续不断的努力。这本书只是所有这些工作中又一个重要的支柱。

So, you know, I I that was just announced recently, and it's fantastic that you are working on that because we need a great source. And it's hard to find a better source. You, SidRap, your collaborators. So, Mike, thanks so much for joining today on Ground Truths, and we look forward to your continued, you know, work. The book is just one more pillar in all that effort.

是啊是啊。我今晚会收看的。

Yeah. Yeah. And I'll be watching tonight.

好的。我只有一个请求。请继续当我的老师好吗？我还在学习。

Okay. And I just have one request. Please keep you my teacher. Okay? I'm learning.

我还有很长的路要走。

I still got a lot to go.

天啊，你太客气了。我真的很感激，我们很快会再聊的。

Oh my You're too much. I really appreciate it, and we'll talk again soon.

谢谢。再见。

Thank you. Bye bye.

那就再见啦。

Bye bye now.