have spent decades in various battlegrounds,

克里斯．安德森（CA）： 久雅 你和你們「健康夥伴」組織

battling epidemics.

數十年來已經在各個不同的戰場上

Perhaps, for context, you could give us a couple examples of that work.

對抗流行病

Joia Mukherjee: Yeah, so Partners In Health

也許你可以舉一兩個例子 讓我們了解一下這個背景

is a global nonprofit that is more than 30 years old.

久雅．木克吉（JM）： 好的。「健康夥伴」

We started famously in Haiti in a squatter settlement,

是個創立已經 30 多年的 全球性非營利組織

people who were displaced.

眾所周知，我們是在 海地的違章建築區起步的

And when we talked to them,

那裡都是些流離失所的人

they wanted health care and education,

我們探訪後得知

houses, jobs.

他們要的是醫療、教育

And that has informed our work,

居所，和工作

that proximity to people who are suffering.

這些資訊有利於我們的工作

When you think about health care and the poor,

去接近這些受苦的人

there is always disproportionate suffering

想到醫療和低收入者

for people who have been historically marginalized,

受苦最多的

like our communities that we serve in Haiti.

總是那些傳統上被邊緣化的人

And so we've always tried to provide health care

正如我們在海地所服務的社區一般

for the poorest people on earth.

因此我們總是盡量提供醫療服務

And we were launched into an international dialogue

給世界上最貧苦的人

about whether that was possible

我們也投入國際間的對話

for drug-resistant tuberculosis, for HIV.

關於是否可能提供醫療給

Indeed, for surgery, for cancer,

抗藥性結核病患、HIV 病患

for mental health,

還有手術、癌症

for noncommunicable diseases.

心理衛生

And we believe it's possible,

以及非傳染性疾病等

and it is part of the basic human right to care.

我們相信這做得到

So when COVID started, we saw this immediately as a threat

而且這些醫療照護是 最基本人權的一部分

to the health of people who were the poorest.

因此 COVID 一開始

And Partners In Health now works in 11 countries,

我們就立即看出它威脅到貧民的健康

five on the African continent,

「健康夥伴」現正於 11 個國家服務

Latin America and the Caribbean,

5 個在非洲大陸

as well as the former Soviet Union.

還有拉丁美洲和加勒比海地區

And we immediately prepared to scale up testing,

以及前蘇聯國家

contact tracing, treatment, care,

我們立即著手準備擴充檢測

and then saw that it wasn't being done in the United States in that way.

接觸者追蹤、治療以及照護的能量

And in fact, we were just sitting, passively waiting for people to get sick

而且注意到美國國內 並沒有做同樣的事

and treat them in hospital.

事實上我們只是坐著 被動地等有人患病

And that message got to the governor of Massachusetts,

然後在醫院裡治療他們

and we started supporting the state to do contact tracing for COVID,

麻薩諸塞州州長得到訊息後

with the very idea that this would help us identify and resource

我們便開始支援他們做 COVID 的接觸者追蹤

the communities that were most vulnerable.

因為這樣可以幫我們 找出並提供資源給

CA: So it's really quite ironic that these decades of experience

最脆弱的社區

in the developing world and elsewhere,

CA：這真的相當諷刺

that that has now really been seen as a crucial need to bring to the US.

從發展中地區和別處 學來的數十年經驗

And especially to bring your expertise around contact tracing.

現在成了迫切需要帶回美國的

So, talk a bit about contact tracing,

尤其需要帶回你們接觸者追蹤的經驗

why does it matter so much,

因此，來說一說接觸者追蹤

and what would, I don't know,

它為何這麼必要

a perfect contact tracing setup look like?

還有，一個完美的接觸者追蹤系統

JM: Well, first I want to say that you want to, always,

設置起來是什麼樣的？

in any type of illness,

JM：我首先要說不管什麼疾病

you want to do prevention,

我們總是要

and diagnosis and treatment and care.

從預防

That is what comprehensive approaches look like,

到診斷、治療，以及照護

and that "care" piece, to us,

那才是全方位的做法

is about the provision of social support and material support

而「照護」的部分，對我們而言

to allow people to get the care they need.

是提供社會支援及實物支援

So that might be transportation, it might be food.

使人能夠得到他們所需要的照顧

So when you look at that comprehensive approach,

提供的可能是交通運輸 也可能是食物

for an infectious disease,

因此在一個全方位的做法中

part of prevention is knowing where the disease is spreading

針對傳染病

and how it's spreading and in whom it's spreading,

預防包括了要知道疾病在何處傳播

so that resources can be disproportionately put

如何傳播，和在哪些人群中傳播

to the highest-risk areas.

如此我們才可以將更多的資源

So contact tracing is a staple of public health

注入高風險的區域

and what it means is that every time a new person is diagnosed

因此接觸者追蹤是公共衛生的要務

with COVID or any infectious disease,

意思就是每當有新的

then you investigate and innumerate the people they've been in contacts with,

COVID 或任何傳染病的確診者

and call those contacts and say, "You've been exposed,"

你就要去調查並且列出 他們接觸過的人

or talk to them, "You've been exposed,

並且電話通知這些接觸者： 「你曾在有病毒的環境中。」

these are the things you need to know.

或者和他們談： 「你曾在有病毒的環境中，

First of all, how are you?

以下是你該知道的事情。

Do you need care yourself?"

首先，你好嗎？

And facilitating that.

你需要去就醫嗎 ?」

"Second of all, these are the information you need to know to keep yourself safe.

需要就幫他們安排。

About quarantine, about prevention."

「其次，你要知道這些可以 確保你本身安全的資訊。

And again, this would be with any infectious disease,

一些關於隔離以及預防的資訊。」

from Ebola, to cholera, to a sexually transmitted disease like HIV.

如前面所說，這適用於任何傳染病

And then we say,

從伊波拉病毒，到霍亂 到 HIV 之類的性病都是

"OK, knowing what you know,

接著問他們 ：

do you have the means to protect yourself?"

「這些你都知道了

Because often the most vulnerable

那你有辦法自我保護嗎？」

do not have the means to protect themselves.

因為這些高危險群

So that is also where this resource component comes in

通常也沒辦法保護自己

and where equity is so critical

接著上場的是資源這個要素

to making this disease stop

這時公平分配極度重要

and also getting the information and the resources

如此才能阻止疫情

to people who need them the most.

才能將資訊和資源

CA: And in a pandemic, the people who need them the most,

送到最需要的人手上

the most vulnerable, as you say,

CA：在全球大流行的時候，最需要的人

are probably also --

那些高危險群，如你所說

That's where the disease is spreading a lot.

大概也正是在

It's in everyone's interest to do this.

疾病流行最嚴重的地區

You're not just making this sort of, wonderful, equity moral point

這麼做符合所有人的利益

that we've got to help these people.

你並不只是主張良善平等的道德觀點

It's actually in all of our interest, right?

才說我們必須幫助這些人

JM: Yes.

這麼做其實是符合我們 所有人的利益的，對不對 ？

Yes, we are one humanity,

JM：是的

and any disease, any infectious disease that is spreading

我們同屬人類

is a threat to all of us.

任何疾病、任何正在傳播的流行病

And that is one of the pieces, there's the moral imperative,

威脅到我們每個人

there is the epidemiologic imperative,

那是其中一項要件，有道德要件

that if you can't control these diseases everywhere,

也有流行病學要件

that it's a threat anywhere.

如果不能在每個地方 都將這個疾病控制住

And so as we look to the kind of society we want to live in,

那它對任何一個地方都會造成威脅

good health is something that gives us all so much return on our investment.

看看我們想住的是什麼樣的社會

CA: Now, some countries were able to use contact tracing

對於健康的投資，會給 全部的人帶來巨大的報酬

almost to shut down the pandemic before it took off in that country.

CA：有些國家利用接觸者追蹤

The US was unable to do that,

幾乎在國內大流行之前便擋住了疫情

and some people have taken the view

美國卻沒做到

that therefore, contact tracing became irrelevant,

有些人所採的觀點是

that the strategy was mitigation, shut everything down.

既然如此，接觸者追蹤已經沒必要

You've argued against that,

而要採用減緩的策略，關閉一切

that even in a process of lockdown

你持反對意見

that actually contact tracing plays a key role.

認為即使在閉關之下

Help us understand the scale,

接觸者追蹤仍有其關鍵的角色

when there's a lot of cases,

跟我們解說一下需要的規模

the scale of tracing, both cases

當確診案例很多的時候

and everyone they may have been in contact with

同時要追蹤那些案例

and their contacts.

以及他們接觸到的人

It quickly gets to a huge problem.

還有那些人又接觸到的人

JM: It's massive.

很快就成了大規模的問題

CA: What sort of workforce do you need to make a difference

JM：超大的

at this moment, where the US is at?

CA：在當今美國的 情況之下，要能夠有效

JM: It's massive.

你需要多少人力？

I mean, the scale is massive,

JM：超大的

and we should not take that lightly.

我是說，需要的規模超大的

And we don't, at Partners In Health.

我們不能掉以輕心

I mean, we are willing to try to figure this out,

在「健康夥伴」我們從不掉以輕心

and I always feel that if we could stop Ebola

我是說，我們願意找出解決方案

in some of the poorest countries in the world,

而且我總覺得

of course we ought to do it here,

如果我們在世界上最窮的地區 能夠阻止伊波拉病毒

and was it too late when there were 28,000 deaths in Ebola?

當然在這裡也應該這麼做

Sure, it's always too late.

已經有 28,000 人死於伊波拉 病毒，我們是不是太慢了？

We should have started earlier,

是啊，總是太慢

but it's not too late to have an impact.

我們是應該早點開始

And so there's three aspects of timing and scale.

但現在開始也還不遲

First is, the earlier you start,

關於時機和規模可以從三方面來看

the better, right?

第一，越早開始

And that's what we saw in Rwanda.

就越好，對不對 ？

They went from early testing and contact tracing,

盧安達便是如此

the first two cases entered into the country on March 15,

他們做早期篩檢和接觸者追蹤

and in one month,

最初兩個案例 3 月 15 日入境

because of contact tracing, isolation and plenty of testing,

一個月的工夫

they had held that case rate to 134 people.

由於追蹤接觸者、隔離，及多做檢測

It's remarkable, it's remarkable.

他們將確診人數控制在 134 人

In the state of Georgia, where is home to the CDC,

很棒 ，很棒

similar population size, about 12 million,

疾管局所在的喬治亞州

from the first two cases in the first month,

人口數和他們差不多 大約一千二百萬

those cases became 4,400 cases.

從最初兩個案例，一個月內

And in the country of Belgium,

便達到 4,400 例

a similar population,

再看看比利時

those two cases became 7,400.

人口也是差不多

So you do have to make scale to stop this.

從兩例一下成為 7,400

But the earlier you do it,

的確需要投入大量人力來控制

the more benefits there are to your society

但越早開始做

and also to the other people who need medical services --

就能為社區帶來越多好處

women who are pregnant,

而這也有利於其他 需要醫療服務的人——

people who need their fracture repaired,

如懷孕的女性

because services themselves in the United States

或骨折需要處理的

have been, you know, really hampered by this huge amount of COVID.

因為在美國這些醫療服務

So the first point is,

都已經因為有太多 COVID 病例而受到影響

it's always late, but it's never too late.

因此，第一點就是

Why?

永遠都是太晚，但還是來得及

Because vulnerable populations are sitting ducks,

為什麼？

and so imagine if one of your contacts was a nursing assistant

因為高危險群是易受攻擊的目標

who worked in a nursing home.

想像如果一位接觸者是助理護士

We know that one nursing assistant can spread it throughout a nursing home.

在療養院工作

And is it important to identify that person as a contact

我們知道一位助理護士 可以感染整個療養院

and assure that he or she is able to remain quarantined?

因此找出接觸者

That is critical.

並且確保他們保持隔離十分重要吧？

And so it's hard to say,

這是非常關鍵的

"Well, it's not worth it if it's just one person, two persons."

所以不能輕易地說：

Every life matters,

「喔，那只是一兩個人 不值得大費周章。」

and all of their contacts in the community of that person matters as well.

每一條命都很重要

So that's one thing.

而且那個人在社區裡 接觸到的每個人也都很重要

The second about scale is people need jobs right now.

這是第一點

And they want to be part of a solution,

關於規模的第二點是 大家需要去就業工作

and some of the frustration we see,

大家都希望為解決方案做出貢獻

the antilockdown movement,

我們看到的一些挫敗感

is really out of anger and frustration

那些反封鎖的運動

and feeling, "What can we do?"

實際上是來自憤怒與挫折

And so this gives people this feeling that they're part of a solution

以及無力感： 「我們到底能做什麼？」

and can provide thousands of jobs.

做接觸者追蹤可以讓大家 感覺自己為解決方案出了力

And then third, I would say, for us to reopen our schools,

而且可以造就成千上萬的就業機會

our churches, our workplaces,

然後第三點我要指出的是

we have to know where the virus is spreading

要重開學校

so that we don't just continue on this path.

教堂、工作場所

And so contact tracing provides the platform to control,

我們必須知道究竟疫情在哪裡傳播

but also to see outbreaks in real time popping up,

如此才不會一再重蹈覆轍

and then respond promptly.

因此感染者追蹤是一個控制的平台

So there are many reasons that we have to bring this to scale now.

也讓我們即時看到疫情的發生

Even though it is tardy.

而能夠做快速的反應

CA: So especially as we have this pressure to go back to work,

因此我們有太多理由 必須做大量的接觸者追蹤

like, contact tracing has to be part of that strategy,

儘管現在已經慢了一步

or we're just inviting another disaster in a few weeks' time.

CA：尤其當我們 現在面臨復工的壓力

Whatever you make of what's happened during this mitigation process.

接觸者追蹤必須是策略的一部分

JM: Exactly, exactly.

否則我們幾週內又會迎來一場災難

Exactly, and so that's such an important part, Chris,

不管你對目前疫情控制的看法如何

and something that we are just really keen

JM：沒錯，沒錯

to look at the United States in a different way.

一點都沒錯，克里斯 那是非常重要的一部分

What are the long-term public health infrastructures

而且我們非常渴望

that we need to protect us for the second wave, the third wave

能夠換個角度來看美國

and in the future, for future pandemics?

要有什麼樣的長期公共衛生基礎設施

CA: Whitney.

才能在第二波、第三波 以及未來的大流行病

Whitney Pennington Rodgers: You know, to that point,

到來的時候保衛我們？

there is a question out there from one of our anonymous

CA：惠特妮

community members,

惠特妮．潘寧頓．羅傑斯（WPR）： 關於那一點，我們有個問題

about why contact tracing isn't already part of our public health system.

來自一位不具名的社區人士

It seems like it does make a lot of sense

為何我們的公共衛生系統 不是原本就有接觸者追蹤

its a way to mitigate the spread of disease.

似乎那樣才有道理

Could you speak a little bit to that?

畢竟它是用來控制 疾病傳播的一種方法

JM: I think many people have said --

你可以就這一點再講一些嗎？

and I am not a politician --

JM：我想很多人已經說過——

that our American health care infrastructure

先說我不是搞政治的——

is built on treatment and not prevention.

美國的醫療系統

It's built on procedures

是建立在治療而不是預防上

and not keeping people well.

它是建立在醫療程序上

And some of that was driven by profit,

而不是在人的保健上

and some of that was driven by need,

部分的原因是利益取向

but I think we need to rethink how we deliver care in this environment.

有一部分則是因為需求

WPR: "There is some fear and suspicion about privacy and contact tracing.

但我認為我們必須重新思考 在這個環境下要如何來做

How can we build trust in the process?"

WPR：「有人會擔心和猜疑 追蹤接觸者涉及的隱私問題

JM: Yeah, that's a great question,

要如何在這個過程中建立信任呢？」

and I think there's fear about privacy

JM：好問題

and part of it comes from the idea of what contact tracing is.

我想大家會擔心隱私問題

And I think that's why we feel strongly,

部分是來自於對接觸者追蹤的觀感

is if you lead with the idea that it's care

我們堅信

and it's trying to get resources and information

如果一開頭就讓他們 知道這是一種醫療照顧

and help to people,

這個攸關獲取資源和資訊

it seems very different

是為了幫助人

than just, oh, who's sick, and who's a threat.

就會給他們很不一樣的觀感

And so fundamentally --

而不是一來就告訴他們某人 得病了、某人可能會傳染

and that's why we're so pleased to be at this TED talk today --

所以這個基本上——