塞斯·伯克利与埃里克·托波尔 - 探讨《公平剂量》一书

我非常高兴在我们的新播客《伟大真相》中欢迎塞斯·伯克利。塞斯是全球疫苗领域的重要人物，他有一本新书叫《公平剂量》，我们今天将讨论这本书。如果你有任何问题，可以在我们进行过程中留言，我们会直接进入主题。塞斯是一位著名的流行病学医生，他在国际公共合作伙伴和公私合作项目中非常活跃，参与了艾滋病疫苗项目以及12年的全球疫苗免疫联盟工作。在这本新书中，他描述了这个故事，我想它会从2020年1月的达沃斯开始讲起。

I am just delighted on our new podcast of Grand Truths to welcome Seth Berkley. Seth has been a major force in vaccines around the world, and he has a new book called Fair Doses, which we're going to be discussing today. And, if you have questions, you can put them in the message, as we go forward, and we're going to get right into it. Seth is a noted physician epidemiologist who has been so active in these international public partner public private partnerships with the AIDS vaccine and then twelve years of Gavi. And in this new book, he describes the story, which I guess will start back at Davos, January 2020.

你在硬石酒店吗？那是个酒吧吗？

You're in the Hard Rock is it a bar?

咖啡馆？是个酒吧。你知道，所有这些故事都是从酒吧开始的，它有

The cafe? It's a bar. As all these stories start in the bar, you know, it has

这是一个难以置信的故事，一个在医学史上几乎令人难以置信的故事。那是2020年1月，大多数人甚至还没有承认有疫情。而你正在制定一些大计划。

to This is an incredible story, one that would really be, you know, in the archives of just beyond belief in medicine. So it's January 2020. Most people haven't even acknowledged that there's a pandemic. Right. And you're making some big plans.

告诉我们当时发生了什么。

Tell us about what was going on then.

嗯，那是个有趣的时期，因为那是我们听说武汉发生的事情几周后。最初，人们认为这是从湿市场传播给人的。虽然我们开始听到关于人际传播的传言，但当时还没有充分记录的证据。当然，如果你是一个公共卫生工作者，这会让你感到紧张。当时我们面临的问题是：这是大流行还是大流行的一次彩排？理查德·哈切特负责流行病防范创新联盟（CEPI），我和我的妻子辛西娅（也是一名医生）坐在那里讨论这个问题。

Well, it was it was a funny time because it was a few weeks after we heard about what was going on in Wuhan. And, you know, initially, it was thought to be a transmission from a wet market, you know, to people. There wasn't any well documented evidence of person to person transmission, although, of course, we were beginning to hear rumors of that going on, and of course, that's what gets you nervous if you're a, you know, a public health person. And so the question we had at that moment was, is this the big one or is this just a dress rehearsal for the big one? And Richard Hatchett, runs CEPI, the Coalition for Epidemic Preparedness Innovation, myself and my wife, Cynthia, who's also a physician, were sitting there and having that discussion.

与此同时，唐纳德·特朗普在街那边说，哦，是的，有一些病例到了美国，但不用担心。没有问题，它不会传播。我们完全控制住了，系统很棒。

Meanwhile, Donald Trump was down the street saying, oh, yeah, some case came to The US, but don't worry about it. There's no problem. It's not going anywhere. We got it completely under control. The system's great.

你知道吗？一无所有。而且，我们当时对此并不确定。真正的问题是，如何开始扩大规模？那时我们既没有授权，也没有资金，更没有人手。

You know? Nothing. And and, you know, we were not sure about that at that moment. And so really the question was, you know, how do you begin to scale up? And we had we had at that point no mandate, no money, and no people.

当然，全球疫苗免疫联盟（Gavi）是一个庞大的项目，为全球超过一半的儿童提供疫苗。但董事会明确表示，我们不能挪用这笔资金来做新项目。理查德曾获得过流行病疫苗生产的资金支持，因此他立即能拨出一些款项，包括向Moderna提供的第一笔临床批次资助。我们基本上就是围坐在一起，像俗话说的那样在餐巾纸上勾勒出计划雏形。达沃斯会议后，我回去会见了联盟所有合作伙伴，而他则开始着手扩大规模。

Of course of course, Gavi was a large operation providing vaccines to more than fifty percent of the world's children, But the board was quite clear that we couldn't take money away from that to do this new work. Richard had had money for epidemic vaccine production. So he right away was able to make some grants, including the first grant to Moderna for their clinical lot. And so this was really, you know, we basically sat around and proverbially writing it out on a napkin on what it would look like. And after Davos, I went back and met with all of the partners of the alliance and he went back and began to scale up.

这实际上就是COVAX的启动——尽管存在各种问题，它最终成为历史上规模最大、速度最快的疫苗分发计划。我写这本书的原因之一，就是想记录下其中的成败得失，因为不铭记历史就注定会重蹈覆辙。这算是个小小的开端吧。

And, and that really was the launch of COVAX, which is, ultimately the largest and fastest rollout of vaccine in history, although it had all kinds of problems. And one of the reasons I wrote the book was to try to document that, both the good and bad, because if you don't, follow history, you're doomed to repeat it. So that's a little bit of a start.

你们和理查德·哈切特、塞佩等合作伙伴展现的远见令人惊叹——早在人们意识到这是场重大疫情前数月，你们就集结了力量。这成就了非凡的成果，但很多人可能不知道，塞斯，正如你所说，这创造了最快记录——首支疫苗问世仅39天后就通过COVAX在加纳落地，并进而推动了——

You know, it's just incredible, the insight that you all had and the partners like Richard Hatchett and Cepe and others that you brought together so early, months before people started to realize that this was a real deal major pandemic. It's extraordinary because what this led to, I think a lot of people don't know this, Seth, this led to the As you said, the fastest, but we're talking about thirty nine days after the very first vaccine. And it's in Ghana with Covax. And it led to-

抱歉纠正一下，39天是在印度实现的。原因是印度监管机构已批准使用，但世卫组织尚未完成预认证——这对监管体系较弱的国家是必备条件。

It actually isn't in Ghana. Sorry. The thirty nine days, it was in India. The reason was because India's regulatory authority had already approved it, but WHO hadn't prequalified it. And that's a requirement for us for countries that have weaker systems.

所以又过了43天才轮到加纳和科特迪瓦。我们对此感到遗憾，因为疫苗早已准备就绪。这给了我们一个教训：如何加速审批流程？但在非洲启动后，仅42天我们就覆盖了100个国家，推进速度非常快。

So it was another forty three days after that- Oh, before it hit Ghana and, and, and Cote D'Ivoire. And, and, you know, we felt bad about that because we had vaccine doses ready to go. And that's one of the lessons is how do we get faster approvals moving forward. But after that launch in Africa, another forty two days after that, we were in a 100 countries. So this was fast rollout.

是的，为了让听众更清楚——到2024年共交付20亿剂疫苗，覆盖146个国家，挽救了270万生命。正如你所说，当美国大多数人还没开始接种时，你们39天就进入了印度市场，并迅速向全球扩展。

Yeah. What we're talking about, just so everybody knows, 2,000,000,000 doses by the 2024. 146 countries. Two point seven million lives saved from this effort. And as you say, thirty nine days to get into India where most of the people in The US hadn't even gotten into the vaccine startup, and you already are expanding around the world.

这确实是具有重大意义的非凡加速，正如我从相关书籍中回忆起的核心理念——除非所有人都安全，否则没有人是安全的。这就是全球疫苗接种计划。要知道，人们最初并未考虑这点。随后各种阻碍接踵而至，你们需要应对囤积疫苗、民族主义、政治因素和错误信息这些难以置信的障碍。请谈谈这些真实存在的严峻挑战。

This is just momentous, extraordinary acceleration of and I think the whole idea, if I recall from the book about this, you know, no one is safe until everyone is safe. This is the vaccinate the world. You know, people weren't thinking about this. And then it brings in all the obstacles because you were dealing with the incredible obstacles of hoarding and nationalism, politics, misinformation. Tell us about the real these are serious obstacles.

考虑到所有反对COVAX运动的阻力因素，你们能完成这项事业其实相当了不起。

It's actually kind of amazing how you did this considering all the things, the forces against this whole COVAX movement.

确实。首先显然没有资金就寸步难行，所以我们不得不开始筹款。从获得资金承诺到实际到账还存在时间差。最终我们为此筹集了125亿美元。

Yeah. I mean, the first thing was, of course, without any money, we couldn't do anything. So we had to begin to fundraise. And, and there's a delay from the time you actually get a promise of money till the time you get it. So we ultimately raised $12,500,000,000 for this.

但到2020年时，我们虽获得约20亿美元承诺，账面实际资金却只有4亿美元。我们不得不依靠一笔接一笔的拨款，才能与制药公司签订协议下订单，并启动技术转让。最初的设想并非为全世界接种，当时形势艰难，所有人都处于恐慌状态。

But, as we got to the 2020, for example, we had commitments of about $2,000,000,000 but we only had $400,000,000 in the bank. So we were living from, you know, one grant to another to be able to make agreements with pharmaceutical companies to put orders in place and also to begin to do technology transfer. So the original idea wasn't vaccinate the whole world. People were, it was hard during that moment. Everybody was panicked.

最初构想是覆盖全球高风险人群。从疫苗民族主义角度看，各国领导人优先为本国民众接种无可厚非。但关键在于：他们是否需要覆盖全国所有人？能否先保护本国高风险人群，再由我们覆盖其他地区的高风险群体？例如全球医护工作者作为抗疫前线英雄，理应是优先保护对象。这正是我们努力的方向。

The original idea was to cover the high risk populations across the world we understood from a vaccine nationalism point of view, it's every leader's job to vaccinate their population. So, you know, it made sense for countries to say, you know, I want vaccines for us first. But the question is, did they need to cover everybody in the country, or could they cover their high risk, and then could we cover other high risk? And for example, I think physicians, nurses, healthcare workers around the world needed to be covered because they were the front lines and the heroes of this in terms of doing it. So that's what we were trying to do.

真正的挑战不在于民众接种，而在于当各国开始抢购疫苗时，他们表示无法预知哪种疫苗会有效。因此富裕国家不是采购一种，而是同时购买五六七种疫苗。最终导致疫苗获取变得极其困难。

You know, the challenge was not even that people were vaccinating, but when countries begin to buy up doses, they said, we don't know if any of these vaccines are going to work or which one. So the wealthy countries didn't buy one vaccine. They bought five, six, seven vaccines. Yeah. And so at the end, it was very difficult to get access.

正因如此，在下订单的同时启动技术转让至关重要——需要提升发展中国家制造商的产能，与合同生产组织合作等，以最大限度扩大疫苗产量。顺便说个惊人成果：仅用327天就完成了（通常需要更长时间，你在《超级长寿者》书中提到过，此前最快疫苗研发纪录是四年）。

And that's why it was important at the same time to put orders in was to begin to do technology transfers, to scale up manufacturing in developing country manufacturers, to work with contract manufacturing organizations, etcetera, to try to get as much vaccine produced as possible. And by the way, extraordinary outcome, three twenty seven days. And we, you know, we originally were talking about much longer time periods. You cover this in your book, Super Agers, when you talk about vaccines. You know, the previous fastest vaccine was four years.

我们曾说过或许能在两年、十八个月或三百二十七天内完成，这已经非常了不起。而现在我们显然能做得更好，因为我们有了mRNA这样的工具——尽管现在有一种趋势要远离这项技术，我认为这是当前最糟糕的事情之一，因为从进化论角度看，我们必然会面临新的流行病和大流行，这些工具本应成为我们的战略储备。

We said maybe we can do it in, you know, two years, eighteen months, three twenty seven days was extraordinary. And, and obviously we can even do better now, because we now have tools like mRNA, although there is a movement to move away from this, which is, you know, I think one of the, you know, really terrible things that are happening now because you want these tools in your armamentarium for it is evolutionarily certain we will have new, epidemics and pandemics.

是的。我们稍后会讨论你提到的mRNA问题，这在当前政府执政下确实很严重。但在此之前，我想先梳理一下——你的前瞻性工作体现在两个层面：一是当时人们甚至还未意识到这是一场大流行，他们拒绝承认。

Yeah. We're gonna get into the mRNA problem that you're bringing up, which is serious with the current administration. But before I do that, you know, this framing this, there is two levels of your visionary work here. One was the fact that people didn't even know it was a pandemic yet. They didn't acknowledge it.

另一方面如你所言，腮腺炎疫苗研发最快耗时四年，而疫苗平均研发周期至少八到十年，成功率仅7%。而你却从获得SARS-CoV-2病毒序列到完成大规模随机安慰剂对照试验、获得疫苗批准，仅用三百二十七天。这堪称史无前例的医学奇迹，至今仍是历史上最非凡的医学成就之一。

And the other is, as you mentioned, mumps was the fastest vaccine, four years. And the average vaccine is at least eight to ten years. And the success rate for vaccines is seven percent. So you were basically gearing up somehow, this, what, three twenty seven days from the sequence of the SARS CoV-two virus to actually having big randomized placebo controlled trials finished and regulatory clearance to give the vaccine. I mean, this is unprecedented, and still I think stands as one of the most, extraordinary medical triumphs in history.

但你当时并不知道进展会如此神速。我们

But you didn't know that it was gonna go that fast. We

完全没预料到。事实上在那段时期，我们俩还做过一期播客讨论这些话题。这本书揭示的一个重要教训是：人们不愿谈论风险。但在大流行中，你必须冒险行事。我认为特朗普总统第一任期最伟大的成就是'曲速行动'，他让财政部表态愿意承担这个风险。

had no idea. And in fact, you and I had a podcast together where we talked about these things, you know, during this time period. And, you know, the other thing about it is, and, and this is an important lesson that comes out of the book, is people don't like to talk about risk. And in a pandemic, you have to do things at risk. So, you know, we did see in The US, I mean, I think probably President Trump's, you know, greatest accomplishment in the first term was his, you know, Operation Warp Speed and opening up the US Treasury to say, we'll take that risk.

美国财政部确实有这个实力。而我们则是筹集资金——当然我们对捐赠者保持透明——将资金投入毫无把握的领域。想象一下，如果我们投入数百亿资金最终失败，人们会惊呼'天哪发生了什么'。书中也详细讨论了损耗问题，同样的情况也发生在这上面。

You know, that's a big treasury and they can do that. For us, we were taking money. We, of course, were transparent with the donors, but we were taking money and investing in things that we had no idea whether they were going to work. So imagine, my head would have been on a stake if we had invested billions and billions of dollars in products that ultimately didn't work, and people would say, oh my god, what's happening? And even the same thing happened on the wastage side, which we talk a lot about in the book.

记者们当时在搜寻损耗证据，事实上损耗无处不在——特别是各国研发多种疫苗造成的浪费。但没人敢公开讨论，担心反对党会指责'看这些人浪费了多少钱'。这成了某种肮脏的秘密。瑞士最终公布了数据（我将其收录在书中），这很有启发性。我曾对G7、G20领导人说：如果你们能承认存在损耗将极大帮助抗疫，因为在大流行中，绝不能因吝啬而准备不足。

You know, reporters were looking for evidence of wastage, And the truth is there was wastage everywhere, particularly because of the many different types of vaccines countries were developing. But nobody wanted to talk about that because they were worried about the opposition leaders saying, look at all the money that, you know, so and so wasted. And so it was like kind of a dirty secret. Switzerland ultimately published its numbers, which I put in the book, and that was, you know, enlightening. But I said to the G7, G20 leaders, it would help enormously if you would just admit that there's wastage because in a pandemic, you don't want to go short.

你们希望长期储备，想要有额外的疫苗剂量。显然，在可能的情况下你们不愿浪费任何一剂，但也不希望出现短缺。当时我们还面临捐赠方极度不愿看到我们浪费任何一剂的情况，最终我们的疫苗损耗率非常低，远低于预期。但这也是这段时期必须解决的流程之一。

You want to go long. You want to have extra doses of vaccine. And obviously, you don't want to waste anything if you can help it, but you don't want to be short. So, you know, we were also in this situation where donors were desperate to not have us waste a single dose, and we ended up having very low wastage, much less actually than we predicted. But this was also one of the processes that had to be worked through during this period.

是的。在转向更宏观的话题前，你们实际上还面临其他我们尚未谈及的障碍。比如我记得印度有超过5亿剂疫苗遭遇了严重的供应链中断。你们还必须处理mRNA疫苗存储等冷链问题。能简单谈谈这方面吗？

Yeah. And before moving away to the broader picture, you you actually had other obstacles we haven't touched on yet. Like, for example, I think it was over 500,000,000 doses in India that, there was a whole there was a massive supply disruption. You had to deal with the cold chain issues of storage of things like mRNA vaccines. Can you just tell us a bit about that?

当然。某种程度上我们是幸运的，因为我们此前已努力建立了免疫系统。我们新建了6.5万个冷链站点，其中许多是现代化、环保的太阳能冷链设施，适用于电力系统薄弱的国家。疫苗本就是覆盖面最广的医疗干预手段——我在书里也提到，上世纪70年代全球接种率还不足5%，更不用说获得全部可用疫苗了。

Sure. So in a sense, we were lucky because we had worked very hard to build up the immunization system before this. So we had built 65,000 new cold chain points, and a lot of it was modern, you know, environmentally sound, solar based cold chain for countries that didn't have, you know, strong, electricity systems, etcetera. So, and we were, of course, vaccines are the most widely distributed health intervention. We went from the 1970s, and I covered this in the book, because there's also a story about vaccine equity, less than five percent of people in the world got even a single dose of vaccines, much less all the ones that were available there.

快进到疫情前，常规免疫系统覆盖率已达约90%-91%，这意味着全球已具备卫生工作者、冷链站点和供应链网络。令人惊叹的是，疫情期间2020年疫苗接种率仅下降4%，2021年再降1%。虽然这使传统疾病和儿童生命面临风险，但想想看——这些卫生工作者完成了三倍于历史最高水平的接种量。

And you fast forward to right before the pandemic, it was around ninety, ninety one percent were plugged into the routine system and got at least one dose through that. So that meant there were health workers, there were cold chain points, there were supply chains. And what's extraordinary is during the pandemic, vaccines went down in 2020 about four percent, and then 2021 another one percent. And that was terrible because it puts at risk the traditional diseases and, you know, and- and- and children's lives. But if you think about it, those health workers delivered three times the number of doses they had ever done in history.

若事先告诉我这个目标，我本以为接种率会暴跌得更厉害。他们不仅维持常规疫苗接种，还为老年人、医务工作者和基础疾病患者提供了新疫苗。关于冷链，我们原本没有超低温设备——此前仅在埃博拉疫苗中使用过。我们研究过如何在运输中实现超低温保存，刚果热带地区等偏远地带也使用过，但规模远未达标。

And if you said to me, you know, we're gonna, we're gonna do this, I would have thought that the drop would have been much higher. So, they continued the routine vaccines, plus they brought these new vaccines and delivered them to the elderly and to healthcare workers and to people with comorbidities. On the cold chain stuff, we, of course, didn't have ultra cold chain. The only time we used ultra cold chain before was in, Ebola. The Ebola vaccine needed to be an ultra cold chain, and we worked through how to do that and how to do it in transit, you know, to have carriers and because we had to use it in DRC and the tropics and, you know, places way off the grid, but not to the scale ultimately we wanted.

其实推广传统疫苗和2-8度常规冷链会更理想。但人们想要mRNA疫苗——因为美国等国都在用。我们尽力应对后，最终分发最多的反而是mRNA疫苗，这迫使我们紧急在全球搭建超低温冷链。类似的后勤问题很多——比如辉瑞疫苗使用了非标准规格的注射器。

So it would have been better for us to roll out, you know, traditional vaccines and, and traditional cold chain, two to eight degrees regular refrigerators. But, you know, people wanted mRNA because that was what, you know, the, The US and other countries were using. And so we did our best and ultimately that became the most va- the vaccine we distributed the most were mRNA vaccines, which meant we had to all of a sudden scramble and build ultra cold chain around the world. So there were lots of logistics problems like that. The Pfizer vaccine used a non stable, a non standard syringe size.

为此我们不得不找人生产数亿支特定规格的自毁式注射器以防交叉感染。这本质上关乎资金、政治意愿和物流体系。印度的情况很复杂就不详述了——当时印度因拥有大量未经世卫预认证的疫苗，开始向周边国家分发。这种疫苗外交很受欢迎，也让该国领导人获得了关注。

So we had to find people to produce, you know, tens of millions, hundreds of millions of those size of auto disabled syringes because we didn't want people to get infected. So it really is a story of, you know, money, political will, logistics, and all of that. The India story does not I'm not going to go into detail, but, you know, it was very hard because what happened was India, because they had doses and WHO hadn't prequalified, started giving them to countries around. And, you know, people loved that. It was vaccine diplomacy and, you know, the president, you know, was getting attention.

然后你看，当Delta变种疫情袭击印度时，我们看到那些可怕的遍地焚烧葬礼柴堆的画面，反对派就说，看啊，总理在分发这些印度本土生产的疫苗。官方从未正式停止出口，但突然间就完全断供了。正如你所说，这导致我们短缺了近6亿剂疫苗，这也是造成严重延误的原因之一。但在回答下一个问题前，我想用一组数据收尾：最终，最贫困的92个国家中57%的人口接种了基础剂，而全球平均水平约为67%。

And then lo and behold, when the when the Delta, epidemic hit India and we saw those horrible pictures of funeral pyres burning everywhere, you know, the opposition said, well, look, you know, here's the here's the prime minister giving out, you know, vaccines to all these people that were Indian vaccines. They never stopped the export officially, but all of a sudden there was no export at all. And that, as you said, led us to be about closer to 600,000,000 doses short, and that's one of the reasons there were such terrible delays. But one statistic just to finish before we go back to the next question is, at the end, fifty seven percent of people in the poorest 92 countries received a primary dose. That compared to about sixty seven percent globally.

所以分配并不完全公平，而且高风险人群更多集中在老龄化地区等。我们无法精确计算理想比例，但延误本身就是问题。不过最终我们还是实现了很高的覆盖率，我认为这是这项努力的重大成果。

So it wasn't quite equitable, but also there's, there is more high risk populations in places that have more elderly populations, etcetera. So we don't know what that number exactly should be, but, it was very delayed, which is the problem. But, ultimately, we were able to get very high coverage, which is, I think, a big positive of this effort.

这简直太了不起了。你们是怎么做到的？这个故事恐怕很多听众都不了解。人们知道OWS（超速行动），但全球范围内这个项目启动更早，在全世界产生了巨大影响。克服了所有障碍，实在令人惊叹。

Oh, I mean, it's phenomenal. I mean, just how you did this. And this is a story that I think a lot of people, and certainly people listening, would not be familiar with. I mean, people know about OWS, Operation Warp Speed, but here on the global front, this one, it started earlier than OWS, and it achieved a grand impact throughout the world. So just amazing, all obstacles.

现在说说疫苗，多年来它们拯救了约5亿生命。每200名儿童接种疫苗就能挽救一条生命，这数据很惊人吧？

Now, let's go to vaccines. They've saved about five hundred million lives over the years. Every 200 children get a vaccine, it saves each one life. It's amazing statistics, right?

这特指疟疾疫苗，不过——

That's for the malaria vaccine particularly, but-

是的。今天还有篇关于结核病mRNA疫苗的论文。我们在疟疾等数十年无疫苗的病原体研究上取得了重大进展。但面对反疫苗浪潮，mRNA技术支持的退潮将产生深远影响——如你所知，这不仅涉及传染病，还关乎癌症、自身免疫疾病、罕见病的基因编辑等等。

Yeah, yeah. I mean, so today, there's a a paper on, tuberculosis mRNA vaccine. There we've made big progress with malaria, all these other pathogens that have been going for decades without a vaccine. So we are in the face of anti vaccine. We are seeing the withdrawal of support for mRNA, which has implications well beyond, as you well know, infectious disease for cancer and autoimmune diseases, genome editing for rare diseases, and on and on.

所以我们面临许多毫无逻辑的荒谬现象。你能帮忙梳理这些问题吗？

And so we have things that don't make any sense. They're irrational. Can you help frame all this?

嗯，我当然可以描述它，但我肯定无法让它合理，因为它本身就毫无道理。是的。这么说吧，疫苗的进展确实令人惊叹。要知道，我们从仅有六种基础疫苗，发展到拥有针对儿童最大杀手——腹泻和肺炎的疫苗。现在甚至开始出现针对常见癌症的疫苗。

Well, I certainly I can frame it, but I certainly can't make it make sense because it makes no sense. Yeah. Just to say that, you know, the progress on vaccines has been extraordinary. So, you know, we went from having six basic vaccines to having vaccines against the largest killers of children, diarrhea and pneumonia. We began to have vaccines against common cancers.

比如我们在中国推出了肝癌疫苗。该国每年有35万例肝癌患者。要知道，在那个年代你无法为这些人群进行肝脏移植。因此乙肝传播导致的死亡率极高，宫颈癌也是同样情况。我们正在全球范围内推广这类疫苗，因为在许多国家，这是女性最大的癌症杀手，现在还包括寄生虫病疫苗。

So we rolled out in China, for example, a vaccine against liver cancer. They had 350,000 cases a year of this disease. And, you know, you can't do liver transplants in those days, you know, for that population. So terrible death rates from hepatitis B where there was transmission and cervical cancer. Again, we're in the process of rolling that out worldwide to get women, because this is in many countries, the largest cancer killer of women, and now parasitic diseases.

正如你所说，我们正开始研发针对原发性肿瘤抗原的疫苗。这意味着我们将拥有癌症的免疫疗法、预防手段，以及针对其他传染病的预防措施。我预测未来还会出现针对慢性病和免疫系统疾病的疫苗等等。进展非常多。但同时我们面临两个问题：疫苗犹豫现象自古存在。

And to your point, we're beginning to now have vaccines against primer tumor antigens. And so, you know, we're going to have, you know, immunotherapy for cancers and prevention for cancers and prevention for other infectious diseases that antecede, and we'll have vaccines, I predict also for chronic diseases and immune diseases, etcetera. So a lot of stuff is happening. Now, meanwhile, we have two different problems. We have vaccine hesitancy, and that's existed from the beginning.

就拿天花时期来说，当时木版画上人们头上长着牛角，因为疫苗源自牛只。错误信息始终存在——顺便说下，错误信息和虚假信息的区别在于：前者可能是波莉阿姨随口说的糊涂话，可以用知识纠正；后者则是有人故意散播的谎言。

You know, smallpox time, they had a woodcut with people having cows horns growing out of their heads because it was- came from cows. And, you know, there's always been misinformation. And the difference, by the way, between misinformation is what aunt Polly might say and not knowing what she's talking about. And you can correct that with knowledge. Disinformation is somebody intentionally putting out information.

如今后者成了大问题。更糟的是政治化现象，比如美国疫情期间未接种疫苗的共和党人均死亡率更高。疫苗本不该涉及政治，应基于个人风险因素普及全民接种。这已成为未来发展的重大障碍。

And that is a big problem now. But on top of that, we have this politicization where we've had more, for example, Republicans per capita die in The US during the COVID pandemic because of not getting vaccinated. And, you know, again, the vaccines shouldn't be political. They should be based upon your risk and, you know, and getting them for everyone. So this has become a huge problem going forward.

mRNA技术的故事很荒诞——如果你从根本上认为mRNA不够安全（尽管全球已有数十亿接种案例），科学界的做法本该是继续研究，追踪数据，这才是正确解决方案。但现实是我们反而削减了相关研究投入。

The mRNA story is a crazy one because if you believe fundamentally that the mRNA isn't safe enough, and by the way, we've had now billions and billions of observations, because they've been used everywhere in the world. But if you believe that, what we do in science is we do more research. We do following what's happening there, and that would be the right solution. But instead, what we've done is pulled the research. We've pulled out the efforts that are on that.

说实话，或许某天会出现更好的技术。但若现在爆发新疫情（可能不是1.5%死亡率，而是30%、40%甚至50%致死率的病原体），每分每秒都关乎生死，没有任何技术比mRNA反应更快。此前我们从未使用过mRNA技术，它未经许可，所以人们的接受速度本可以更快。

And, you know, the truth is we may, maybe someday we'll have something better. But today, if we had another pandemic, and maybe it wouldn't be one point five percent mortality rate, you know, we have pathogens that are thirty percent, forty percent, fifty percent mortality rate. Every minute counts in those moments to try to move towards something, and nothing is as fast as mRNA. So in this case, we, we, we had not used mRNA before. It was not licensed, you know, so people were slower than it could be.

但如果我没记错数字的话，从基因组公布开始，我们仅用42天就将其装入小瓶，63天完成首次注射——现在这个时间还能进一步压缩。没有其他技术能以这种速度推进。我不知道政策制定者在想什么，但我希望这种技术能纳入我们的医疗武器库，并尽可能优化它。与此同时，中国正在飞速前进，还有其他一些国家也在努力优化并推进这项技术。

But if I remember the numbers correctly, we had it, from the time the genome was published, we had it in forty two days in a vial and sixty three days the first injection, you know, and that could now be compressed down. There is nothing else can move at that speed. So I don't know about, you know, what the policymakers are thinking, but I want that in my armamentarium, and I wanna, you know, optimize it as best as possible. Meanwhile, China is shooting ahead now, you know, trying to optimize this and move this forward as are now some other countries?

关于mRNA技术有太多可谈的了。我最近写了份简报，讨论这篇非凡的论文——只有mRNA疫苗能通过刺激干扰素激活癌症患者的免疫治疗，这是非mRNA疫苗做不到的。因此那些在新冠期间接种mRNA疫苗的癌症患者获得了巨大收益，这是其他方式无法实现的。但让我痛心的是，塞斯，我们一直停滞不前。明明知道这些mRNA疫苗可以做得更好。

Well, there's so much to talk about on the mRNA front. I mean, I wrote a sub deck about how this recent paper, extraordinary, that only the mRNA vaccines with people with cancer rev up immunotherapy by stimulating interferon, not seen with the non mRNA vaccines so that people that got these shots along the way with COVID who had cancer had a huge benefit that otherwise wouldn't have been realized. So there's benefits. But what gets me, Seth, is that we have sat stagnant. We know these mRNA vaccines could be better.

纳米颗粒可以改进。日本已批准了增效型mRNA疫苗。而我们却毫无作为，技术仍停留在2020年的水平。为什么我们不...这真是...

The nanoparticles can be improved. There's amplifying mRNA vaccines in Japan that are approved. We've we've done nothing to make these better. We just it frozen from, you know, 2020. Why why don't we That's

这都是政治因素。但我想说的是，如果我们刚刚经历了百年最严重的疫情——事实确实如此——正确的反应应该是什么？我理解1918年大流感后人们不愿再提流感这种事。

all that's all politics. I mean, and that's not my point is is, you know, if you just had the worst pandemic in the last hundred years, which we did, what should be the reaction? Okay. I understand. After the nineteen eighteen pandemic, people said, I you don't want to talk about flu anymore, etcetera.

但当时我们不具备现在的科学条件。正确的反应应该是：普通民众可以不再讨论，但科学界应该获得资金来研发通用冠状病毒疫苗，并持续优化技术。

We didn't have the same science then. What should be the reaction? Okay, people don't have to talk about it, but the science community should be funded to make, for example, universal coronavirus vaccines. Right. And they should be optimizing the technology.

正如你在《超级长寿者》书中写的，mRNA疫苗的挑战之一在于保护期似乎不够长。这是个可解决的问题，只需要更多研究和设计工作。我们本应持续投入，直到掌握这些技术——毕竟新冠仍在流行，仍在夺走生命。

As you wrote in your book, you know, SuperAgers, you know, one of the challenges with mRNA vaccines is they didn't seem to have really long duration of protection. This is a solvable problem. Just takes some more research and some more design work, etcetera. And so we should have continued that work, continued the investment to get us to a place where we have these tools, because frankly, COVID is still around. It's still causing deaths.

可能会出现致病性更强、能逃逸现有免疫保护的新冠变异株，或者世界上某处的蝙蝠又携带另一种冠状病毒出现。我们对此毫无准备简直荒谬。最后我想指出：我前几天刚发表的论文中提到——我们正在削减全球卫生投入，削减健康领域的投资。

And we could have a strain that appears of either COVID-nineteen that, you know, is is much more, a disease causing and and and may escape from some of the protection, or we could have another coronavirus pop out of a bat somewhere in the world. And and so why we're not doing this just seems to me to be crazy. And the last point I'd make on this is I just wrote a paper, a couple of days ago, and I made this observation. We're cutting global health. We're cutting health investments.

与此同时，我们正在增加国防投资。我们讨论的是将预算提高12%，达到一万亿美元。我无法评论这是否是资金的合理运用。但如果你提出这个问题，虽然这有点像比较苹果和橘子，但它确实提供了一个视角：新冠疫情中多少美国人失去了生命？

And at the same time, we're increasing defense investments. So we're talking about a 12% increase to a trillion dollars. I can't comment on whether that's a good use of money or not. But if you ask the question, and this is a little apples and oranges, but it just puts it into perspective. How many Americans died during COVID?

因此，新冠疫情中死亡的美国人数量超过了内战以来所有战争中死亡人数的总和。所以当讨论安全问题时，没有全球卫生安全就谈不上真正的安全。如今，在合成生物学和人工智能时代，我们面临巨大风险——不仅是自然发生的传染病或实验室事故，还包括生物恐怖主义。这必将发生，而我们早已处于风险之中。

So more Americans died during COVID than died in all wars after the civil war till today. So when you start talking about security, you can't have security without global health security. And today, with synthetic biology and AI, we are at enormous risk, not just for naturally occurring infectious edits or laboratory accidents, but also for bioterrorism. It will happen. We're overdue for it.

同样，我们需要提前做好快速生产疫苗的准备，建立分发系统和监测体系。我们本应为此做准备，但现实却是我们正在撤出相关投入，这简直愚蠢至极。

And again, the same preparations are gonna need to be there to make vaccines quickly, have distribution system, to have surveillance systems. So we should be preparing for that. And instead, we're just pulling away from it, which seems just stupid.

确实如此。我实在难以理解，尤其是考虑到我们讨论过的mRNA技术——它本可以比现有的非注射类疫苗（如贴片和鼻喷疫苗）取得更大突破。鼻喷疫苗前景广阔，显然也更便于大规模推广。正如你所说，我们还将面临新的疫情，甚至可能再次遭遇类似奥密克戎的变异株。

It really is. I I can't fathom it because we talked about the mRNA in particular, that could be made so much better even than what We we already haven't seen the non shot world develop, like patches and nasal vaccine. Nasal vaccines have so much promise, and of course, would be a lot easier to get out distributing for mass use. Now, we're gonna have another pandemic, as you say. We still could face another Omicron like event even with this virus.

没错。但就像你说的，可能是流感病毒，也可能是其他冠状病毒，或是名单上众多能摧毁我们的病毒之一。而我们却毫无作为。本届政府解散了大流行防范部门，基本上是在自废武功——

Yep. But as you say, it could be influenza, it could be another coronavirus, and many other viruses on the list here that could do us in. And we're doing nothing. We've eliminated this administration, the pandemic preparedness entity, and we're you're basically taking out

我们彻底斩首了CDC（疾控中心），我是说完全瘫痪了它的功能，明白吗？

any We decap CDC, I mean, completely. You know?

是的。我明天将采访苏珊·莫娜丝——这是她在CDC任职39天闪电离职后的首次直播访谈，期间CDC三分之一的员工被裁撤。我会和她深入探讨此事，不过显然你对此也很有洞见。我们看到的完全是反智操作：经历了这个世纪最恐怖的大流行后竟毫无长进，对像'曲速行动'疫苗计划这样的成功经验也不加以延续。这简直令人难以置信。

Yeah. I'm actually gonna talk tomorrow with Susan Monaes, the first live interview after her rapid tenure of thirty nine days at CDC with the gutting of one third of the workforce of CDC, So no less the I'll talk to her about it, but obviously, you have a lot of insight here too. We are seeing just the opposite of what we would be thinking would be rational, That what we went through, this horrendous century worst pandemic, and learning nothing from it. And all the success that we've seen, like what you had with COVAX Operation Warped, we should be building on it. And, you know, it's just it's just it's incredible to me.

我一定让你很沮丧，但你是如何应对这种沮丧的？

I must be frustrating to you, but how do you deal with the frustration?

嗯，我是说，归根结底，你知道，你必须继续前进。所以我正在预言让人们理解为什么这很重要并最终做出改变。因为最终，如果我们遭遇最严重的流行病——顺便说一句，我认为我们正进入一个多重流行病时代。为什么我这么认为？全球人口仍在持续增长。

Well, I mean, at the end of the day, you know, you you you gotta keep moving forward. And so, you know, I'm prophetizing for people to understand why this is important and to ultimately make changes. Because at the end, if we had one of these, worst pandemics, and by the way, I believe we're entering an era of poly epidemics. Why do I believe that? We've got still increasing populations worldwide.

我知道增速会放缓，但我们也面临着严重的城市化问题。气候难民正在迁移，我们将面临气候灾难。疾病传播媒介正在进入新区域。所以未来我们会看到越来越多的疫情爆发和大流行。

I know that's going to slow down, but we've also got, you know, intense urbanization. We've got, climate change refugees that are moving. We're going to have climate disasters. We're having vectors of disease that are now moving into new areas. So we're going to see more and more outbreaks and pandemics, you know, in the future.

因此这些事情变得比以往更重要。埃里克，另一件事是，如果你回溯历史，在没有干预措施时，儿童自然死亡率约为千分之三百五十。这就是在我们拥有所有干预措施之前的状况。清洁饮用水和卫生设施带来了巨大改变，更好的住房等许多因素都有帮助，但疫苗才是真正降低死亡率的关键。如今在美国这个数字是千分之五——从千分之三百五十降到了千分之五，而全球表现最好的地区约为千分之零点九。

And therefore, this stuff becomes even more important than it was And, you know, the other thing about this, Eric, is if you go back in time, the natural death rate without any interventions is about three fifty per thousand children. That's what it was back before we had all these interventions. And, you know, clean water and sanitation made a big difference, better housing, a bunch of things, but vaccines really were the big thing that have driven that down. And now here in The US, it's about five per thousand. You know, gone from three fifty, three fifty deaths per thousand to five per thousand, but the best places in the world are around zero point nine per thousand.

作为一个社会，我们应该做到不让任何父母因本可预防的感染而失去孩子或让孩子残疾。所以我实在无法理解那些常规操作——不仅是在大流行期间妖魔化MMR疫苗、放弃现有抗原、讨论不按推荐剂量接种的行为逻辑。这些都会产生影响。顺便说一句，如果我们削减发展援助导致其他国家疾病肆虐，反而会增加病毒回传美国的风险。美国在2000年就消灭了麻疹，现在爆发的疫情是2000年以来最严重的一次，就是因为有人从境外带回了病毒。

And as a society, what we should be doing is making no parent have to lose a child or have a child with, you know, disabilities because of infections that we can prevent. And so again, I just don't understand the logic on the routine side as well, not just on the pandemic side of demonizing MMR vaccines, you know, pulling away from existing antigens, of talking about not, you know, not giving them recommended dose schedules. These are all things that are going to have an effect. And by the way, if the rest of the world has these diseases raging because we've cut our, you know, development aid, then that increased the risk of importations back in The US. I mean, The US has eliminated measles, 2000, eliminated measles, the big outbreak we have now, the largest since 2000, because somebody brought it back in.

如果现在小儿麻痹症再次野生传播，加上麻疹、白喉和百日咳，这些疾病将卷土重来影响我们。我们这么做既是出于道义，也是一种自我保护。

And if we now have polio running, you know, wild again, and measles, diphtheria, and pertussis, that is going to come back and have an effect on us. So we ought to do it because it's the right thing, but we ought to do it for self protection as well.

那么，住在瑞士日内瓦对你的心理健康有帮助吗？至少知道那里的国家运作正常，不像这里？

Well, for your mental health, by being based living in, Geneva, Switzerland, does that help you, because knowing at least the country there is working unlike the one here?

这毫无帮助，因为你知道，我非常关心这个世界，而当前对世界的影响是如此剧烈。我是说，美国因为一些荒谬的阴谋论而撤资全球疫苗免疫联盟（Gavi），没有任何正当理由，这将导致7500万儿童无法接种疫苗，估计还会有120万儿童因此丧生。这难道是我们应该做的吗？瑞士有法治，是的，那里重视科学，尊重学术界和专业意见。

It's it's, it's, it's not helpful because, you know, I, I care so much about the world and, and, and the effects right now on the world are so dramatic. I mean, you know, the fact that The US walked away from funding Gavi because of some crazy conspiracy theory, not for any valid reason, you know, there's gonna be, 75,000,000 less kids vaccinated, and there's estimated to be another one point two million kids may die from this. I mean, again, is that what we should be doing? So, there is the rule of law in Switzerland. Yes, there is a attention to science and respect for academia and expertise.

是的。但我们需要在全球范围内重拾这种态度。

Yeah. But, you know, we need to get that back across the world.

我明白你从全球角度思考问题，但至少从日常来看，你们这片土地仍遵循着尊重数据、证据、科学和疫苗效力的传统方式——这是公共卫生领域最有力的工具。

Well, I mean, I know you think globally, but at least from a day to day standpoint, you're a land that is functioning by the old ways of respecting data, evidence, science, and the power of vaccines, most- That's right. Tool we have in all of public health.

不过我现在在波士顿，这里诞生了第一个公共卫生部门，我多年前曾在州流行病学部门等工作过，还在哈佛公共卫生学院任教。

I'm in Boston right now though, so the first public health department was, and where I worked years ago in the state epidemiology department among other places, taught at the Harvard School of Public Health. You know.

是啊，这里对你来说是故地。你曾执掌Gavi十二年，最终领导了COVAX计划，之后选择离开。是因为十二年任期已足够？还是有什么其他考虑？

Yeah, so it's familiar grounds for you. Now, you led Gavi for twelve years, and obviously culminated in this COVAX effort, then you decided to move on, I guess. Was there anything about the move from leading Gavi that was just twelve years enough? Or what were your thoughts about that one?

这类职位通常很抢手，毕竟是重要的国际职务。我最初只计划任职三年，后来他们欣赏我的工作，问我能否再续四年，之后又延长了四年。

So, in general, these types of jobs are desirable because, you know, it's a big international job. And I went there to do three years actually originally. And then they liked me and they said, we wanna show you we like you. Can you do four years? And then they liked me and did another four years.

最后他们说正值疫情期间，希望我再留任一年。但那时我觉得自己已经尽责了。Gavi是个了不起的机构——我们为超过12亿儿童接种疫苗，引进700多种新疫苗，使疫苗可预防疾病减少70%，促成五岁以下儿童死亡率下降50%。我至今仍深爱这个组织。

And then they finally said, well, you know, it's COVID and all that, maybe you could do another year. But I think at that point it was, you know, I had- I had done my- my service. And, you know, it's an amazing organization. It vaccinated more than 1,200,000,000 additional children, introduced more than 700 novel vaccines, you know, contributed to this effect of a seventy percent reduction in vaccine preventable diseases, which contributed to the fifty percent reduction in under five child mortality. So I love the organization, I still do.

但其目标仅仅是帮助各国。这不是，这并非真正的慈善。要知道，最贫困国家只需为疫苗支付象征性费用。我们致力于降低价格，帮助他们分发疫苗以完善医疗体系。随着这些国家逐渐富裕，他们会承担越来越多费用，直到最终脱离全球疫苗免疫联盟的资助体系。

But its goal is to just help countries. It's not to, it's not really charity. It's, you know, the poorest countries, they pay something for the doses, but just a little. We work to drive the prices down. We work to help them get vaccines out to help build their systems, and over time, as they get richer, they pay more and more until they graduate out of Gavi.

因此这是最理想的发展援助形式之一。有趣的是，尽管现任美国政府已停止资助，但在特朗普政府首个任期内，他们反而给全球疫苗免疫联盟增加了5%的拨款，认为这正是应该推行的发展援助模式——既通过控制疾病保护美国民众，又能帮助各国实现自主发展而非依赖救济，最终让他们有能力承担全部费用。美国只是众多资助方之一。

So it's some of the best type of development aid. And it's interesting because, as I said, the US administration has stopped funding it now, but during the first administration of the Trump administration, they actually gave Gavi a 5% increase because they said this is exactly the type of development aid we should be doing. It helps protect Americans by controlling disease. It helps countries, you know, have a- have a step up, you know, instead of charity, and it allows them to then take over the cost. And- and The US was one of many funders.

它并未承担不成比例的负担。我实在无法理解，这就是让那些固守成见、带着偏见上任的人担任领导职务的后果——他们不是推动科学进步，而是反对科学。而应对疫情我们唯一能依靠的就是科学。要知道，科学认知会在过程中不断更新，我们会持续获得新发现。

It wasn't carrying, you know, an unproportional burden. So I just don't understand, and this is the problem when you put people in leadership roles who are, have fixed, know, e day fix on these issues and come in with bias against them rather than trying to drive forward using the best science. And science is all we have when we deal with epidemics and pandemics. You know, it may change during it. We may learn new things.

但如果我们连科学都不能信任，还能信任什么？总不能指望社交媒体上的网红大V吧？他们根本不具备推动进步所需的知识与智慧。

But if we can't trust science, then what can we trust? You know, it can't be the biggest influencers on social media because, you know, they're not gonna have the knowledge and wisdom to move forward.

是的。我们试图探讨的另一个问题是：为何会陷入当前这种除非发生剧变否则毫无准备的境地？其中就有否认主义作祟——经历多年疫情灾难后，人们就像'谁还想管这些'？尽管每周仍有数百人死亡，却有人否认病毒存在，声称'不过是感冒'。

Yeah. So there's another part of what we're trying to probe here about why that we get into this situation where we're not gonna be prepared unless something drastic shakes things up as we stand right now. One of those courses, denialism, that is after going through what this horrific pandemic for years, it's just like, who needs to deal with it anymore? Just denying that there's even the virus out there, that although, oh, it's just a cold. I mean, all this kind of stuff, even though that we got hundreds of people dying every week.

正如你曾撰文指出的，新冠对心血管系统、肾脏系统和神经系统都会造成长期损害，绝非普通感冒。显然我们要尽量避免感染，因此需要能预防感染（而不仅是减轻症状）的优质疫苗。当前科研本应全速推进而非倒退。

And long term effects that, you know, I mean, you've written about this, and you know, the effects of getting COVID on cardiovascular system, on your renal system, on your neurologic system, it's not just a cold. Obviously, you know, we want to try to avoid that. That's why we need better vaccines. By the way, we need vaccines to prevent infection, not just, you know, mitigate disease. And that's why the research should be screaming ahead right now rather than being pulled back.

这正是我想探讨的：如果我们没有陷入否认模式...顺便说，我们上周刚启动了迄今规模最大的长效新冠治疗试验（使用替尔泽肽），报名情况异常火爆——原计划千人的试验，头几天就招募过半。虽然人们对治疗长效新冠充满热情，但更好的方式显然是预防。这就要谈到我想讨论的另一个话题：通用疫苗。疫情期间约有25所学术机构提出了通用疫苗研发方案。

And that's what I wanted to get into is, if we weren't in this denial mode and by the way, we did just start a very large the largest yet, long COVID trial with tirzepatide last week, and we've had incredible interest in enrollment, where it's a thousand participant trial. I think we had half as many of the thousand in the first couple few days. Great there's great interest in getting a treatment for long COVID, and obviously, even better would be preventing it, which we're not doing. This universal vaccine is the other topic I wanted to discuss with you. Over the course of the pandemic, maybe 25 different academic institutions came up with ways to develop a universal vaccine.

也就是说，无论是研究隐蔽抗原还是各种策略，甚至是促进T细胞免疫，诸如此类。这些进展都不显著，鼻喷疫苗也不例外——尽管已有许多成果，比如华盛顿大学等学术实验室将技术授权给印度，还有埃默里、耶鲁等机构。我们完全有智力资源开发更好的疫苗。但与COVAX或'曲速行动'不同——当时你们在毫无资金的情况下筹款并推进研发——现在这些全球顶尖实验室发表的杰出科研成果，我们真的会付诸行动吗？

That is, coming up with whether it's cryptic antigens or various strategies, even with fostering T cell immunity, whatever. And these have not gone forward in any significant way, no less than nasal vaccines, of which there have been many, again, by academic labs like Washington University that sold the license out to India, and many others too, Emory, Yale. So we have the brainpower to come up with much better vaccines. But unlike what you did in COVAX or Operation Warp Feed, finding the funding when there was none, and developing this, is there any chance that all this great science that's been published on from, you know, great labs all of throughout actually throughout the world that we're actually gonna act on this.

你确实精准指出了问题所在。我在波士顿的旗舰创新机构工作，担任Apriori Bio公司的执行副主席。这家公司曾为COVID研发过解决方案，他们运用AI和机器学习预测病毒变异趋势，设计出能覆盖未来变种的结构化抗原，从而生产出前瞻性疫苗。

I mean, you know, you open up exactly what the problem is. And, you know, I'm here in Boston in flagship pioneering. I'm executive vice chair of a company called Apriori Bio. They actually, you know, were one of the companies that actually made a solution for COVID. They were able to produce vaccines that were looking using AI and machine learning to where the virus was going, predicting what mutations could occur, what would structurally work, and then producing antigens that would cover those in the future.

这样至少能研制出具备两三年防护效力的疫苗。你还可以提前生产应对未来可能出现的变种，完成结构化设计。但现在没人对COVID感兴趣了，他们转向用同样技术应对流感，特别是H5型。即便H5型流感在加州引发全州紧急状态，他们还是撤资了。

So you could make vaccines that were at least starting with a couple of years of coverage. And, you know, you could make extra vaccines for things that might come in the future, so you have them structurally made. There's no interest in COVID. So, you know, it shifted over now to doing the same thing in flu and doing that on H5. And even on H5, again, they pulled out despite the fact that it was a, you know, in California, it was nationally, it was a state emergency.

当时一度有20%的牛奶被病毒污染——

I mean, twenty percent of the milk at one point was infected with virus and-

哦，但我们还能买到牛奶对吧？是的。

Oh, but we can get you milk, right? Yeah.

这正是关键。当前环境下我们不会投资这些。从投资者角度看，政府的态度是：'不知道回报率如何，反正民众不关心'。另一方面还得通过监管机构审批，如果他们对mRNA等技术持抵触态度，就会造成延误——而在生物科技领域，延误就是金钱。

Yeah, but this is the point. So we're not investing in these and environment. The problem is, is that when the government, and you have to understand from an investor point of view, people are saying, okay, well, don't know what the return's gonna be because, you know, people don't care about this. But the other side of it is you gotta get these things through regulatory agencies. And if the regulatory agencies are hostile to, you know, technologies like mRNA, etcetera, then you may have delays, which in, you know, delays in biotech is money.

学术界确实在做激动人心的研究，但要把成果转化为实际产品，目前市场意愿很低。不过在AI跨界领域倒有些机会，毕竟AI领域资金充裕，用AI推动这类技术发展能创造惊人价值。即便如此，最终还是要制成疫苗产品——包括黏膜疫苗也是如此。

So you've got academic investigators really doing exciting work. Those need to be converted into, you know, trying to turn it into real products, and there's not a lot of appetite right now for that. And, you know, so, I mean, you know, in the area of AI crossover, there is some interest because, of course, there's a lot of funding available for AI, and you can do really amazing things, AI for good, by using it for these types of technologies. But even then, still have to turn them into vaccine products and- Yeah. And, you know, and- and mucosal vaccines, the same thing.

我是说，监管方面的障碍可能很高，但我们必须克服这一点。如今借助人工智能，你可以开始更准确地预测事态发展。你能通过计算机模拟理解毒性。你可以朝着真正精确掌握所做之事的方向推进。让我们提醒人们，之所以能在327天内研发出新冠疫苗，是因为我们拥有20年mRNA疫苗的研究积累，以及此前两种冠状病毒疫苗的研究基础。

I mean, you know, the barrier is potentially high on the regulatory side, but we need to work through that. And today with AI, you can begin to do much better predictions of what's happening. You can understand toxicities in silico. You can begin to drive towards having, you know, really understanding exactly what you're doing. And let's just remind people that the reason we had COVID vaccines in three twenty seven days was because we had twenty years of research on mRNA vaccines, we had research on, two previous COVID vaccines.

我们研究过——抱歉不是新冠疫苗，而是冠状病毒疫苗。包括MERS和SARS。这些疫苗的研发过程中，人们解决了如何获取刺突蛋白、如何稳定它等一系列问题。

We had, not COVID, sorry, coronavirus vaccines. Coronavirus. We had MERS and we had SARS. And those vaccines, you know, vaccines were, built. People solve the problem of how to get a spike protein, how to stabilize it, how to do all that.

因此当疫情爆发时，人们清楚知道该怎么做。这就是为什么成功率并非如你之前所说的7%——大多数疫苗最终都有效，因为我们有坚实的科学基础。所以当我们削弱基础科学时，这会造成严重问题。这种影响现在可能感受不到，但未来必将显现。

So, you know, when the pandemic hit, people knew exactly what to do. And that's why the yield wasn't 7%, as you said before, you know, on the success rate for new vaccines. Most of the vaccines ended up working because we had all that science basis. So when we kill basic science, this is a real problem. You know, you won't feel it today, but you will feel it in the future.

如果没有年轻人投身科学，我们如何培养下一代科研力量？我看不出这如何能让美国恢复健康或重现辉煌。我认为我们应该加倍支持顶尖学术机构和杰出科学家，把科研作为发展引擎。因为没有健康，一切都无从谈起。我们都会老去。

And if we don't have young people going into science, how are we going to create the next generation for this? So I, you know, I don't see how that makes America healthy again or makes America great again. And it seems to me we ought to be doubling down on the great academic institutions, the great, you know, scientists we have in supporting that research as an engine. Because if you don't have your health, you don't have anything. We're all gonna get older.

正如你在超级老龄化研究中所描述的，人类寿命将延长。我们需要突破性的创新技术。因此我们必须对此进行投资。

Lifespan is, as you describe in super ages, lifespan's gonna increase. We're gonna need new innovate in in in innovations. And so we be ought investing in that.

我完全赞同。单就黏膜鼻喷疫苗或口服疫苗而言，我们掌握的所有数据都显示其前景广阔。然而现政府却中断了通过BARDA等渠道筹集的资金——这些资金本用于支持鼻喷和通用疫苗的研发。我们就这样放弃了它，而实际上我们需要阻断感染。

I couldn't agree more. I mean, just to touch on that mucosal nasal vaccine or oral vaccine, this is so promising, all the data that we have. And yet, this was dropped by the current administration, the money that was coming through BARDA and other sources that was put together to support both nasal and universal vaccines. So we just abandoned it. Whereas we need to block infections.

当然这也是那些反疫苗人士的最大借口——因为标注着新冠疫苗，他们就说‘看啊，它不能阻断感染’。确实，在变异株出现前它表现非常出色。如果我们投资推进鼻喷疫苗研发，完全可以重现这种效果。最后我想说的是...

And that's of course the biggest all these people that are anti vaccine because it says COVID vaccine, because, oh, it doesn't block infections. Well, yeah, it did really well until we had these variants pop up. And we could also get back to it doing really well if we were to invest and take the nasal vaccine story forward. Now, the last thing I And want part

是的，其中一部分还包括如何更好地理解免疫系统，如何理解其激活机制，如何在黏膜表面测量并标准化。如何在肺部测量？如何测量？因此，我们再次努力更好地理解免疫系统，理解人类免疫，研究基于黏膜的知识，这将对我们刚才讨论的内容产生影响，比如更好的疫苗，但它对理解过敏原、处理反应性气道疾病等方面也会有更广泛的影响，诸如此类。

of that is- Yeah. Part of that is also figuring out how to, better understand the immune system, how to understand the stimulation of it, how to measure it in mucosal surfaces and standardize it. How do you measure it in the lung? How do you measure it? So there again are efforts to better understand the immune system, to understand the human immune, to look at, you know, mucosal based knowledge, and that will have effects for what we're just talking about, better vaccines, but it'll have broader effects for understanding, you know, allergens and, you know, dealing with, you know, reactive airway disease, etcetera, etcetera.

所以我认为，这里的关键点在于我们不知道知识将引领我们去向何方。二十年前我们完成了人类基因组计划，直到现在我们才真正利用这些知识来开发治疗方法，实施我们讨论的这类干预措施。

So I think, you know, the important point here is that we don't know where the knowledge will take us. You know, it's twenty years ago we did the human genome. It's only now that we're really using that knowledge to create therapeutics to do the types of interventions we're talking about.

不，我完全同意你的观点。我们需要这项人类免疫组研究。耶鲁大学启动了一个项目，但资金并不充足。为了理解这个复杂系统，我们将在明年初开始看到所谓的免疫系统时钟，它能告诉我们一个人免疫系统衰老的速度，这对老年人尤为重要，因为他们中有些人已经出现免疫衰老。了解这一点很有帮助，特别是在给他们接种疫苗并希望疫苗能充分发挥作用时，当然还有其他许多原因。

No, I couldn't agree with you more about that. I mean, we need this human immunome work. There's a project that started at Yale, but it doesn't have that much funding. To understand this complex system, we're going to start to see in the beginning next year, these so called immune system clocks that will tell us the pace of a person's immune system aging, which is important in people who are older, just because some of them are immunosenescent already. And it's good to know that, especially when you're giving them a vaccine and you're hoping they're going to work really well, but lots of other reasons as well.

最后，在结束前，我想请你分享一点乐观的看法，因为我们总要以乐观的态度收尾。是的。我想说你参与COVAX的成就是如此难以置信。很多人并不了解这个故事。公平分配疫苗确实是一个非凡的故事。

So last, to close, before I ask you for this one note of optimism, because we gotta end with some optimism. Yep. I wanna say what you did with COVAX is just it's so beyond belief. And a lot of people don't know the story. Fair doses is really a way to tell a story that is just quite extraordinary.

对于那些真正想了解这里发生的一切、所有细节和内幕的人来说，如果你想了解是谁走到了一起、这一切是如何运作的、所有的绝对真相，我强烈推荐这本书。所以，塞斯，你能在我们结束前给我们一些乐观的寄语吗？

For those who really wanna know what happened here, all the ins and outs, the inside story, if you will, who came together, how it all worked, all the absolute. I couldn't recommend the book, more. So, Seth, can you leave us with some type of optimistic note as we finish up here?

是的。我的乐观源于科学和技术，就像你一样。这些工具确实令人惊叹。如果你回想我们过去的情况，实际上在书的结尾部分，我提到了这一点，因为我的职业生涯很长。如果这次疫情爆发、这场大流行发生在我职业生涯开始的四十年前，我们根本不会有任何所需的工具来完成这些工作。

Yeah. I mean, you know, my optimism comes from science and and science and technology as as does yours. And, you know, it is amazing, the tools. If you had to think and go back at where we were, in fact, the epilogue of the book, I kind of, you know, make this point, you know, because my career is is long. Had this outbreak occurred, had this pandemic occur, you know, forty years ago when I started my career, we wouldn't have any of the tools we needed to be able to do this.

顺便说一句，我们还没谈到我们不得不组织整个庞大的行动，筹集125亿美元资金，在全球范围内虚拟协作。因为我们当时处于...你知道，这不仅涉及生物科学的工具，还包括计算工具、视频会议、互联网等所有这些东西共同作用，才让我们实现了这一切。

I mean, by the way, we didn't talk about the fact that we had to organize the whole bloody campaign and raise the $12,500,000,000 and work across the world operating virtually, you know, because And we were in so, you know, it's not just the tools in biologic science. It was the, you know, the computational tools. It was, you know, video conferencing. It was the Internet. It was know, all of these things came together, you know, to give us this.

所以我的乐观态度正如你书中所描述的那样。我们正走在一条通往更健康、更长寿命、更好认知能力的道路上，希望随着人们年龄增长等等。我们还能做得更好，但必须持续推动相关科学研究。如果做到这一点，我认为潜力是无限的。虽然存在某些生物学限制，但我们的目标是实现健康寿命的延长。

So my optimism is exactly, you know, like in your book. We we've been on a pathway of better health, you know, longer lifespans, you know, better cognition, hopefully, you know, as people get older, etcetera, etcetera. And we can do better on that, but we're gonna have to continue to work on that science. And if we do that, I think, you know, the the the sky's the limit. I know there's some biological limits, but but, you know, the the goal here is to have a health span.

我们希望人们能健康地开始生活，童年时期零死亡率，没有慢性疾病，最终在睡眠中安详离世——无论那是什么年龄。你比我更清楚这一点。我们希望能尽可能接近那条理想的生命曲线。对我而言，这就是乐观主义。

You want people to, you know, start, live their lives healthy, have no mortality in childhood. You want no chronic diseases and you want people to die in their sleep when whatever that age is. You know, know better that than I do. And, you know, we wanna get as close as we can to that square curve. To me, that's the optimism.

我认为忽视健康是个严重问题，原因正如我们列举的种种。但归根结底，当你看到亿万富翁突然罹患重病时，他们会不惜一切代价试图恢复健康。而我们追求的并非恢复健康，而是让健康始终相伴。我们要的是预防。这在我看来，是能为家庭、父母和挚爱之人做的最具希望的事。

And, you know, the reason I think it's a problem to ignore health, we've laid all the different reasons, but at the end, you know, when you see, you know, the billionaire who all of a sudden gets, you know, a bad disease, you know, they'll do anything for trying to restore their health. And what we want is not to restore health. We wanna have health be there throughout time. We wanna have prevention. And that to me is the most optimistic thing that we can possibly do for families, for parents, for loved ones.

我相信只要我们坚持不懈，前方还有很长的路要走。

And, you know, I think we've got a long runway there if we if we keep at it.

我想补充你的乐观观点：人类通过COVAX计划实现的成就和潜力，以及公平分配疫苗的故事——就像'曲速行动'展示的那样——只要我们下定决心就能创造奇迹。必须承认，用'间歇期'形容当前处境已是委婉说法，实际情况糟糕得多。但我们终将复苏，必将见证科学证据和数据带来的反弹效应，推动人类伟大成就。

Well, I would just add to your optimism that the human achievement, the potential that you actualize with COVAX and tell the story on fair doses, as we saw with the Operation Warp Speed, we can do big things if we set our mind. And I have to also say that we're in a lull is a nice word right now for what we're going through. It's much worse than that. We will come back. We will see, I hope, a reactive hyperemia of the science of evidence and data to drive great human achievement.

当然，人工智能将在此过程中提供助力。公平分配疫苗的故事告诉我：要为整个星球、为数十亿居民做大事——在人们甚至不知道会有疫情爆发、不知道一年内就能研发出疫苗的时候。这将成为流传千古的传奇。塞斯，感谢你不仅因为这本书和我们的友谊，更感谢你今天分享这个故事并与我们探讨。

And sure, we'll have some help with AI along the way. But that's what I think the story of fair doses tells me, is doing big things for the planet, for the whole, you know, billions of people that inhabit it. When you don't even know that there's a pandemic, when you don't even know there's gonna be a vaccine in a year. That's a story that will go down, for the ages. So Seth, thank you, not just for the book and for our friendship, but for telling this story and discussing it with us today.

我想很多人原本对此一无所知。现在我们正在学习。希望我们能重回你发起这项非凡事业时的状态。

I think a lot of people didn't know anything about it. And now we're learning. And hopefully, we will get back to where we were when you launched this, you know, extraordinary effort.

非常感谢你邀请我，Eric，也感谢你所做的一切。让我们继续推动所有即将收听这期节目的听众们。帮助我们共同推动回归科学、真理和信任，因为这些正是我们所需要的。

So thank you so much for having me, Eric, and for all that you're doing. And, you know, let's continue to drive all the listeners that are gonna listen to this. Help us drive forward to a return to science and, and, truth and, you know, trust, because these are the things we need.

我们终有一天会实现目标的，我对此深信不疑。非常感谢你，Seth。

We will get there someday. I'm sure of it. Thanks so much, Seth.

非常感谢。

Thanks so much.

好的，再见。感谢大家的参与。明天请继续收听Susan Meniere的首次独家直播访谈，她将讲述在CDC任职期间的经历。

All right. Bye bye. Thanks everyone for joining. And please join tomorrow with Susan Meniere's, her first live exclusive interview about her tenure at the CDC.