药都造出来了，为啥不便宜给穷人用？

发布于 2026-09-01 · 时长 11:15

字幕摘录

时间	英文	中文
0:04	I've been writing about global health and medical innovation for years.	多年来我一直在写关于全球健康和医学创新的著作.
0:09	And when I tell my friends and family how much progress there's been,	当我告诉我的朋友和家人已经取得了多少进步,
0:14	the reaction is almost always the same.	反应几乎总是一样
0:16	They had no idea most of it was happening.	他们根本不知道事情正在发生
0:20	Take the most common cause of death today, heart disease.	今取最常见的死因,心病.
0:23	People today have roughly a quarter the chance of dying from heart disease	今天人们有四分之一的机会死于心脏病
0:27	as people did in the 1950s, at the same age.	和1950年代一样年龄也一样
0:31	A quarter.	25块
0:33	Back then, there were no statins,	当时,没有统计,
0:35	no cholesterol testing,	没有胆固醇测试,

展开字幕全文（203 条）

序号	英文	中文
1	I've been writing about global health and medical innovation for years.	多年来我一直在写关于全球健康和医学创新的著作.
2	And when I tell my friends and family how much progress there's been,	当我告诉我的朋友和家人已经取得了多少进步,
3	the reaction is almost always the same.	反应几乎总是一样
4	They had no idea most of it was happening.	他们根本不知道事情正在发生
5	Take the most common cause of death today, heart disease.	今取最常见的死因,心病.
6	People today have roughly a quarter the chance of dying from heart disease	今天人们有四分之一的机会死于心脏病
7	as people did in the 1950s, at the same age.	和1950年代一样年龄也一样
8	A quarter.	25块
9	Back then, there were no statins,	当时,没有统计,
10	no cholesterol testing,	没有胆固醇测试,
11	no implanted pacemakers,	没有植入的起搏器,
12	no anti-smoking campaigns,	没有禁烟运动,
13	no bans on trans fats,	不禁食过量脂肪,
14	no bypass surgery,	没有绕行手术,
15	no CPR.	没有心肺复苏。
16	But hardly anyone hears about the long-term impact of those breakthroughs.	但几乎没有人听到这些突破的长期影响。
17	When progress happens gradually,	当进步逐渐发生时,
18	it's rarely considered news.	这是很少考虑的新闻。
19	And I think it's a problem.	我认为这是一个问题。
20	I think it's part of why people don't know how important it's all been.	我认为这是人们不知道这一切有多重要的原因之一.
21	Public health, vaccines and all the rest,	公共卫生、疫苗和其他一切
22	and improving people's lives.	改善人们的生活
23	But what I want to tell you about is a thing that doesn't make the news at all.	但我想告诉你的是一个完全不做新闻的东西。
24	Not the breakthroughs themselves,	不是突破本身,
25	but everything that got in the way of them.	但所有妨碍他们的东西
26	I used to have this impression that breakthroughs were uncommon, sporadic,	我以前的印象是突破是不寻常的零星的
27	sometimes happening by pure chance,	有时纯粹是偶然的
28	sometimes by sheer determination.	有时候,只有决心。
29	The way I see it now,	现在看来
30	it's more like there's a continuous stream of medical innovation	更像是医疗创新不断流传
31	every year.	每年
32	In just the last two years, for example,	例如在过去两年里
33	we've had a new antiviral against HIV,	我们用新的抗病毒药物抗病毒
34	which protects against infections with an efficacy of nearly 100 percent,	能够防止100%的感染,
35	with just a single dose given every six months.	每六个月只给一剂
36	There are new drugs that reduce cholesterol levels by 60 percent,	有一些新药使胆固醇水平降低60%,
37	超越了Statins的作用.
38	There are new treatments that slow down the progression of certain cancers,	有一些新疗法减缓了某些癌症的发展,
39	certain lung cancers,	某些肺癌,
40	brain cancer and multiple myeloma by half or more.	脑癌和多发性肌瘤一半或更多
41	And in just the last five years,	在过去五年里,
42	we've had new vaccines against four diseases for the very first time.	我们第一次接种了新疫苗来防治四种疾病。
43	当然,COVID,
44	but also the first malaria vaccine,	也是第一种疟疾疫苗
45	第一种Khikungunya疫苗
46	and the first vaccine against RSV.	和第一个抗RSV的疫苗。
47	The tools to develop new drugs and vaccines have improved enormously,	研制新药和疫苗的工具有了极大的改进,
48	like genome sequencing, for example,	比如基因组测序
49	which has touched almost every part of biology.	这几乎触及了生物学的每个部分。
50	Back when the Human Genome Project was completed in 2003,	早在2003年人类基因组计划完成时,
51	it cost 50 million dollars to sequence one person's genome,	给一个人的基因组测序需要5000万美元
52	and it took half a year.	花了半年时间
53	Now, it takes under four hours,	现在,它需要四个小时,
54	and it costs a few hundred dollars.	花费几百美元。
55	There's also been a revolution in the technology of microscopes.	显微镜技术也发生了革命.
56	Over the past 200 years,	在过去的200年里,
57	their resolution has increased over 10,000-fold.	它们的分辨率增加了10 000倍以上。
58	We can now see viruses down to their individual atoms	我们现在可以看到病毒的个体原子
59	and design new drugs to target them extremely precisely.	设计新的药物以非常精确地瞄准他们。
60	This is RSV, respiratory syncytial virus.	这是RSV,呼吸同步病毒。
61	It's in the middle right there,	就在中间
62	and we can now see its atomic structure on the right.	现在我们可以看到它的原子结构在右边。
63	Until the 1930s, no one had ever seen a virus.	直到1930年代,没有人见过病毒.
64	So if our technology has advanced so much,	所以,如果我们的技术已经进步了这么多,
65	why are so many diseases still untreatable today?	为什么今天这么多疾病仍然无法治疗?
66	What I've learned is that technology isn't always the barrier.	我学到的是科技并不总是障碍
67	Sometimes it's about the funding, the institutions and the incentives.	有时它涉及到资金,机构和奖励.
68	We recently got a new malaria vaccine, as I mentioned,	最近我们得到了一个新的疟疾疫苗, 正如我提到,
69	and when I first heard about it, I was amazed.	当我第一次听说的时候,我感到惊讶。
70	I remember learning that malaria was a very complicated disease,	我记得我知道疟疾是一种非常复杂的疾病
71	scientifically.	科学
72	It's caused by a parasite, not a virus or bacterium,	是由寄生虫引起的不是病毒或细菌
73	and that parasite changes shape multiple times during its life cycle,	寄生虫在生命周期中多次变形,
74	which makes it really hard to know what to target with a vaccine.	这使得很难知道用疫苗的目标是什么。
75	So I wanted to write about it, this amazing breakthrough.	所以我想写这个,这个惊人的突破。
76	But one of the first things I learned about this new malaria vaccine	但我学到的关于这个新疟疾疫苗的最初一件事
77	that was introduced just a few years ago	几年前才介绍的
78	was that it was developed in the 90s, decades ago.	是在90年代几十年前开发的
79	The researchers who developed it	开发它的研究者
80	struggled to find funding to test it at every stage of the process.	努力寻找资金,在过程的每个阶段进行测试。
81	There was no commercial incentive.	没有商业奖励。
82	It's not profitable to develop new drugs and vaccines	研制新药和疫苗不赚钱
83	against diseases that affect people in poverty in foreign countries,	防止影响外国穷人的疾病,
84	even if millions of children might benefit,	即使数百万儿童受益,
85	even if there's a huge economic benefit as well.	即使还有巨大的经济利益
86	It took foreign aid and philanthropy to fund the research to test it,	需要外援和慈善机构资助研究来测试
87	and it literally took decades to reach the children who needed it.	并且实际上花了几十年的时间才能接触到需要它的儿童。
88	When I learned about this,	当我得知这一点,
89	I felt like there was nothing to celebrate.	我觉得没什么好庆祝的
90	It seemed more like a failure.	这似乎更像是失败。
91	How could we let that happen?	我们怎么能让这种情况发生呢?
92	How could it take so long to test a vaccine that had already been developed,	怎么会花这么长时间来测试已经研制出来的疫苗呢?
93	while half a million children were dying from malaria every year?	每年有50万儿童死于疟疾?
94	Why wasn't that the story?	为什么不是这个故事?
95	Those children aren't coming back,	那些孩子不会回来了,
96	but what I wanted to know was how we could prevent that from happening again.	但我想知道的是,我们如何防止这种情况再次发生。
97	Like, what if we could change the economic incentives?	比如,如果我们能改变经济刺激呢?
98	Well, economists have come up with an idea to do just that.	经济学家已经想出了一个办法
99	It's called an advanced market commitment.	这被称为高级市场承诺.
100	It's where donors commit to buying a vaccine at a certain price per dose,	捐献者承诺以每剂一定的价格购买疫苗,
101	but only if it's developed and proven safe and effective.	但前提是它得到发展和证明安全有效。
102	That commitment gives companies the confidence to invest in it	这种承诺让公司有信心投资
103	in the first place,	首先,
104	and it can bring vaccines into existence that would otherwise never get made.	它可以带来疫苗否则永远不会制造。
105	And most importantly, it makes sure that they're manufactured at scale	最重要的是,它确保它们被大规模制造
106	and sold at an affordable price,	以负担得起的价格出售,
107	so they reach children who need them.	因此,他们接触到需要他们的孩子。
108	That idea was used over a decade ago	这个想法十几年前就用过了
109	to help develop new vaccines against pneumococcal disease,	协助研制防治肺炎球菌疾病的新疫苗,
110	which is a deadly bacterial infection of the lungs.	这是肺部致命的细菌感染
111	Vaccines already existed,	疫苗已经存在
112	but they didn't include the strains that were common in Africa and South Asia.	但它们不包括在非洲和南亚常见的菌株.
113	So in 2009, several countries and philanthropists came together	因此在2009年,一些国家和慈善家走到一起
114	to fund an advanced market commitment for new vaccines.	为新疫苗的预先市场承诺提供资金。
115	And it actually worked.	而且它实际上奏效了。
116	Several companies developed them,	几家公司开发了它们,
117	and they reached children much faster than usual.	并且他们接触到儿童的速度比平常快得多。
118	It's estimated that those vaccines	估计这些疫苗
119	have saved over 700,000 children's lives since then.	自那时以来,拯救了70多万儿童的生命。
120	This idea to fix market incentives is one way to speed up the process,	改变市场激励的想法是加快这一进程的一个途径,
121	but it's not the only thing we can do.	但这不是我们唯一能做的
122	Take childhood leukemia, for example.	比如儿时白血病.
123	It used to be very difficult to test new treatments for the disease,	以前测试新疗法很困难
124	because leukemia is rare,	因为白血病很罕见
125	and individual hospitals struggle to find enough patients	和个别医院为寻找足够的病人而挣扎
126	to run clinical trials.	进行临床试验。
127	So researchers built networks across the US and later Europe and Canada	研究人员在美国和后来的欧洲和加拿大建立了网络
128	to help recruit patients from all over those countries	帮助从这些国家招募病人
129	into larger clinical trials.	进入更大的临床试验。
130	That collaboration made it possible	这种合作使得
131	to test treatments and learn what works faster.	测试治疗并学习什么工作更快。
132	And it's why leukemia is no longer the disease it used to be.	这也是为什么白血病不再是它曾经的疾病.
133	Before the 1970s,	1970年代以前,
134	only around 15 percent of children with leukemia	只有15%左右的白血病儿童
135	would survive even five years from a diagnosis,	能够活过五年的诊断
136	that's the bottom line on these graphs, two types of leukemia.	这就是这些图表的底线两种类型的白血病
137	Now, the top line,	现在,第一线,
138	that figure is 85 percent.	这个数字是85%。
139	Most children in richer countries today survive	今天富裕国家的大多数儿童都活下来了
140	and are effectively cured of the disease.	并被有效治愈疾病。
141	This graph is thousands of children	这个图是几千个孩子
142	who wouldn't have survived without that collaboration,	没有合作谁也不会活下来
143	without that progress.	没有这种进步。
144	I want to give you another example.	我想再举个例子
145	Back when I was at university,	我大学的时候
146	we had a substitute lecturer one day on my course on infectious diseases,	有一天,我们有位副讲师在我的传染病课程,
147	and she told us that our original lecturer was away,	她告诉我们我们的原讲师不在
148	because he had gone to West Africa	因为他去了西非
149	to do research to develop an Ebola vaccine.	研究研制埃博拉疫苗
150	I remember sitting in that lecture theater at the back,	我记得坐在后面那个讲演院里
151	and I was thinking to myself,	我想着自己,
152	can you just do that?	你能这样做吗?
153	Can you just pack up and go?	你能打包走人吗?
154	It hadn't even occurred to me.	我根本没想过
155	And it made me realize	这让我意识到
156	that all of these breakthroughs came from people like him,	所有这些突破都来自他这样的人
157	people who changed their lives to make them happen,	改变他们的生活让他们实现,
158	or people who thought differently,	或有不同想法的人们,
159	whether they were scientists, economists, operators or managers.	无论是科学家、经济学家、经营者还是管理人员。
160	They created the incentives and institutions	他们创造了激励机制
161	so that generations in the future, all of us,	以便后代,我们所有人,
162	wouldn't have to face the same problems that they did.	也不必面对同样的问题
163	And what's amazing is that we have an Ebola vaccine now	令人惊奇的是,我们现在有埃博拉疫苗
164	against the most common strain.	对抗最常见的病毒
165	It wasn't made by my lecturer, but by researchers like him.	不是讲师做的而是他这样的研究者做的
166	And it was hard to develop and test it for all the same reasons.	并且由于同样的原因,很难开发和测试它。
167	There was little commercial incentive,	没有什么商业刺激,
168	and it was hard to run clinical trials,	很难进行临床试验,
169	because it was hard to predict where Ebola outbreaks would arise	因为很难预测埃博拉的爆发地点
170	and vaccinate people in advance.	并预先为人们接种疫苗。
171	So scientists came up with a different idea.	于是科学家们想出了另一个想法。
172	They waited for individual cases of Ebola to appear,	他们等待埃博拉病毒的出现
173	and then quickly vaccinated all of the people around them,	然后很快地为周围的人接种了疫苗,
174	tested the vaccine that way.	测试疫苗的方式。
175	That idea, called ring vaccination,	这个想法,叫做环疫苗,
176	helped find a vaccine that we now know is very effective.	帮助找到一种疫苗,我们现在知道它非常有效。
177	Now, these are just some of the ideas that people have had so far.	现在,这些只是人们至今为止的一些想法。
178	But what I've learned from them is that breakthroughs don't just happen	但我从他们身上学到的是突破不只是发生
179	because we have the tools to make them.	因为我们有制造它们的工具。
180	They depend on how innovation happens in the real world.	它们取决于创新在现实世界中是如何发生的。
181	And there's something else that I've learned from them	我从他们那里学到了其他东西
182	that I find much harder to stomach.	我发现更难胃。
183	Many of them might not have happened at all.	其中许多可能根本没有发生。
184	So when I think back to that stream of innovation,	所以当我回到创新的潮流时
185	all of those breakthroughs and all of that progress that we've seen,	所有这些突破和我们所看到的所有进步,
186	I do find it amazing.	我确实觉得它惊人。
187	It's incredible.	不可思议.
188	But it also really frustrates me.	但也让我很沮丧
189	That's how much progress we've made, despite it being so hard.	这就是我们取得了多少进展,尽管它是如此艰难.
190	The good news is people have come up with ideas to change that.	好消息是人们想出了改变这种情况的想法。
191	Some of them really work, like the ones I've told you about today,	有些真的有用就像我今天告诉你的那些
192	and they just haven't been used enough.	他们只是没有被充分使用。
193	But we also need people to come up with new ideas	但我们也需要有人提出新的想法
194	and test them and scale them up, too.	并测试和提升它们。
195	I think it's more important than ever that we do it.	我认为我们这样做比以往更重要。
196	Because of cuts to science, global health and foreign aid,	由于科学、全球卫生和外援的削减,
197	we have to find ways to make our resources go further.	我们必须设法使我们的资源更进一步。
198	Progress isn't inevitable.	进步不是不可避免的。
199	It takes people who decide to persist despite that.	需要那些决定坚持下去的人
200	And I think here it takes people who recognize something quite simple,	我想这需要认识一些很简单的东西的人
201	that diseases are not a fact of life.	疾病不是生命的事实
202	They're problems that we can solve.	他们是我们能解决的问题。
203	Thank you.	谢谢

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