纽约时报官方译文 | 欢迎来到流行病时代

Welcome to the Age of Pandemics
欢迎来到流行病时代

In early 2018, during a meeting at the World Health Organization in Geneva, a group of experts I belong to (the R&D Blueprint) coined the term “Disease X”: We were referring to the next pandemic, which would be caused by an unknown, novel pathogen that hadn’t yet entered the human population. As the world stands today on the edge of the pandemic precipice, it’s worth taking a moment to consider whether Covid-19 is the disease our group was warning about.
2018年初,在世界卫生组织于日内瓦的一次会议上,我所在的专家组R&D Blueprint创造了“疾病X”这个词,它指的是下一次大范围流行病,届时会由一种未知、新奇、人类从未接触过的病原体引发。今天,世界正站在大范围流行病的悬崖边缘,我们有必要花点时间来考虑一下,Covid-19是否就是我们小组所警告的那种疾病。

Disease X, we said back then, would likely result from a virus originating in animals and would emerge somewhere on the planet where economic development drives people and wildlife together. Disease X would probably be confused with other diseases early in the outbreak and would spread quickly and silently; exploiting networks of human travel and trade, it would reach multiple countries and thwart containment. Disease X would have a mortality rate higher than a seasonal flu but would spread as easily as the flu. It would shake financial markets even before it achieved pandemic status.
我们当时说过,疾病X很可能来自一种源于动物的病毒,并将出现在地球上某个经济发展驱使人和野生动物紧密结合的地方。疾病X在暴发初期可能与其他疾病混淆,并迅速无声地传播;利用人类的旅行和贸易网络,它将到达多个国家并挫败遏制措施。疾病X的死亡率高于季节性流感,但传播起来和流感一样容易。甚至在大流行之前就能撼动金融市场。

In a nutshell, Covid-19 is Disease X.
简而言之,Covid-19就是疾病X。

Even as there are signs that the epidemic’s spread might be slowing in China, multiple communities and countries have now reported sustained transmission in their midst. The number of confirmed cases has exploded in South Korea in recent days. In Italy, villages and towns are on lockdown, Fashion Week in Milan has been disrupted and festivals are being canceled while public health authorities search for patient zero to identify who else is likely infected and may spread the disease in Europe. Iran appears to have become a new hub of transmission. The looming pandemic will challenge us in new ways, as people try to evade quarantines, and misinformation campaigns and conspiracy theorists ply their trade in open democracies.
尽管有迹象表明,疫情在中国的传播速度可能正在放缓,但多个社区和国家目前报告出现持续传播。最近几天,韩国确诊病例数量激增。在意大利,村庄和城镇被封锁,米兰时装周受到干扰,节日也被取消,与此同时,公共卫生部门正在搜寻“零号病人”,以确定还有谁可能被感染,并可能在欧洲传播这种疾病。伊朗似乎已成为新的传播中心。随着人们试图逃避检疫,散布不实信息,阴谋论者在开放的民主国家开展活动,迫在眉睫的大流行将以新的方式挑战我们。

But as the world struggles to respond to Covid-19, we risk missing the really big picture: Pandemics are on the rise, and we need to contain the process that drives them, not just the individual diseases.
但是,当全世界都在努力应对Covid-19的时候,我们却有可能忽视了真正的大方向:大规模流行病的势头正在上升,我们需要遏制推动它们的进程,而不是仅仅关注个别疾病。

Plagues are not only part of our culture; they are caused by it. The Black Death spread into Europe in the mid-14th century with the growth of trade along the Silk Road. New strains of influenza have emerged from livestock farming. Ebola, SARS, MERS and now Covid-19 have been linked to wildlife. Pandemics usually begin as viruses in animals that jump to people when we make contact with them.
瘟疫不仅是我们文化的一部分;它们就是由文化引起的。随着丝绸之路沿线贸易的发展,黑死病于14世纪中叶传入欧洲。畜牧业发展带来了新的流感毒株。埃博拉病毒、SARS、MERS以及现在的Covid-19都与野生动物有关。大范围流行病通常始于动物体内的病毒,当我们与它们接触时,病毒就会来到人类身上。

These spillovers are increasing exponentially as our ecological footprint brings us closer to wildlife in remote areas and the wildlife trade brings these animals into urban centers. Unprecedented road-building, deforestation, land clearing and agricultural development, as well as globalized travel and trade, make us supremely susceptible to pathogens like coronaviruses.
随着我们的生态足迹使我们更接近偏远地区的野生动物,以及野生动物贸易使这些动物进入城市中心,这些后果正呈指数级增长。史无前例的道路建设、森林砍伐、土地清理和农业发展,以及全球化的旅游和贸易,使我们极易受到冠状病毒等病原体的影响。

Yet the world’s strategy for dealing with pandemics is woefully inadequate. Across the board, from politicians to the public, we treat pandemics as a disaster-response issue: We wait for them to happen and hope a vaccine or drug can be developed quickly in their aftermath. But even as Covid-19 rages, there still is no vaccine available for the SARS virus of 2002-3, nor for HIV/AIDS or Zika or a host of emerging pathogens. The problem is that between outbreaks, the will to spend money on prevention wanes, and the market for vaccines and drugs against sporadic viral diseases isn’t enough to drive research and development.
然而,世界应对大范围流行病的策略严重不足。从政治人物到公众,我们都把它当作灾难来应对:我们坐等它们发生,并希望发生后能够迅速研制出疫苗或药物。但是,即使在Covid-19肆虐的时候,仍然没有能够针对2002-2003年SARS病毒的疫苗,也没有针对HIV/艾滋病、寨卡病毒或一系列新出现的病原体的疫苗。问题是,在两次疫情暴发间隙,投入资金预防的意愿减弱,针对零星病毒性疾病的疫苗和药物市场不足以推动研究和开发。

During its World Health Assembly in 2016, the W.H.O. set up the R&D Blueprint to bridge this gap and announced a priority list of pathogens that most threaten global health and for which no vaccines or drugs were in the pipeline. SARS made the list, as did MERS, Nipah, Ebola and other rare but serious diseases caused by epidemic viruses. The Coalition for Epidemic Preparedness Innovations — a global partnership between public, private, philanthropic and civil society organizations launched at Davos in 2017 — stepped up to the plate and sourced funding to develop vaccines and therapeutics against some of these.
在2016年的世界卫生大会(World Health Assembly)上,世卫组织成立了R&D Blueprint以求填补这一空白,并宣布了一份最有可能威胁全球健康的病原体优先关注名单,目前还没有针对这些病原体的疫苗或药物。SARS在这份名单上,MERS、尼帕病毒、埃博拉病毒以及其他由传染病毒引起的罕见但严重的疾病也榜上有名。流行病预防创新联盟(The Coalition for Epidemic Preparedness Innovations)——一个2017年由公共、私营、慈善和民间社会组织在达沃斯发起的全球合作组织——开始行动起来,寻找资金来开发针对其中一些疾病的疫苗和治疗方法。

To escape from the Age of Pandemics, we’ll need to treat them as a public health issue and start working on prevention in addition to responses. Our first goal should be to broaden our armory against potential mass epidemics. When some of us added “Disease X” to the W.H.O.’s priority list two years ago, we wanted to make the point that it’s not sufficient to develop vaccines and drugs for known agents when the next big one is likely to be a different pathogen — a virus close to SARS, say, but not close enough that the same vaccine can work against both.
为了摆脱大范围流行病,我们需要把它们当作一个公共卫生问题来对待,并在应对之外开始着手进行预防工作。我们的第一个目标应该是扩大应对潜在大范围流行病的武器库。我们中的一些人把“疾病X”加入世界卫生组织两年前的优先事项列表时,想说明的是,如果下一场大规模流行病可能由另一种病原体导致——比如说,一种跟SARS很接近,但又不足以用同一种疫苗应对的病毒——只为已知的病原体开发疫苗和药物是不够的。

As Covid-19 strikes today and a spate of other pathogens are ready to emerge in the future, we continue to butt up against nature. Scientists estimate that there are 1.67 million unknown viruses of the type that have previously emerged in people. Discovering and sequencing them should be a priority — a simple case of “know your enemy.” In the aftermath of SARS, research on coronaviruses originating in bats has discovered more than 50 related viruses, some of which have the potential to infect people; this information can now be used to test for broad-action vaccines and drugs. Scaling up this effort to cover all viral families, as the Global Virome Project proposes to do, is a logical first step toward prevention.
随着今天的Covid-19暴发和未来其他大量病原体的出现,我们还在继续与自然作斗争。科学家们估计,人类生活的世界里存在167万种未知病毒。发现它们并进行测序,应该是首先要做的事情——我们需要“知己知彼”,就这么简单。SARS过后,对源自蝙蝠的冠状病毒的研究发现了50多种相关病毒,其中一些可能会感染人类;这些信息现在可以用来测试作用广泛的疫苗和药物。按照Global Virome项目的建议,将这一努力扩大到所有病毒家族,这是迈向预防的合理第一步。

A radical shift is also needed in the way that tests, vaccines and drugs are designed so that entire groups of pathogens are targeted instead of individual pathogens that are already known. The National Institute of Allergy and Infectious Diseases in the United States is working on a universal flu vaccine that would cover all known strains of influenza; a universal coronavirus vaccine, an Ebola-virus vaccine and others will also be needed.
还需要对检测、疫苗和药物的设计方式进行根本转变,以便针对整个病原体群体,而不是已知的单个病原体。美国国家过敏和传染病研究所(National Institute of Allergy and Infectious Diseases)正在研究一种通用流感疫苗,它将覆盖所有已知的流感毒株;我们还需要通用的冠状病毒疫苗、埃博拉病毒疫苗和其他通用疫苗。

With a smaller investment, we can also try to get ahead of pandemics by working with communities in hot spots of emerging diseases. Disease surveillance should be focused on farmers, rural communities and anyone who has extensive contact with wildlife, to look for unusual illnesses, test for novel pathogens and work with people to develop alternatives to high-risk activities such as the wildlife trade.
用较少的投资,我们还可以通过与新发疾病热点地区的社区合作,争取在大规模流行之前采取行动。疾病监测应集中在农民、农村社区以及任何与野生动物有广泛接触的人身上,从而寻找不同寻常的疾病,检测新的病原体,并与人们合作,开发替代高风险活动(如野生动物贸易)的方法。

Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.
大范围流行病就像恐怖袭击:我们大致知道它们的起源和原因,但我们不知道下一次会在何时会发生。二者需要以同样的方式处理——确定所有可能的来源,并在下一次大范围袭击之前消除这些来源。