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  • My son was born in January 2020,

    我的兒子是在2020年1月出生的。

  • shortly before the lockdown in Paris.

    在巴黎封鎖前不久。

  • He was never scared of people wearing masks,

    他從不害怕戴面具的人。

  • because that's all he knows.

    因為他只知道這個

  • My three-year-old daughter knows how to say "gel hydro-alcoolique."

    我三歲的女兒知道怎麼說 "凝膠水醇"。

  • That's the French word for hydroalcoholic gel.

    那是法語中的水酒精凝膠。

  • She actually pronounces it better than I do.

    其實她的發音比我好。

  • But no one wants to be wearing a mask

    但沒有人願意戴著面具

  • or wash their hands with hand sanitizer every 20 seconds.

    或每20秒用洗手液洗手一次。

  • We're all desperately looking at R and D to find us a solution: a vaccine.

    我們都在拼命地尋找研發,為我們找到一個解決方案:疫苗。

  • It's interesting that in our minds,

    有趣的是,在我們的腦海中。

  • we keep thinking of the vaccine discovery like it's the Holy Grail.

    我們一直認為疫苗的發現就像聖盃一樣。

  • But there are a couple of shortcuts here that I'd like to unpack.

    但這裡有幾個捷徑,我想解讀一下。

  • I'm not a doctor, I'm just a consultant.

    我不是醫生,我只是個顧問。

  • My clients focus on health care --

    我的客戶專注於保健 -

  • biopharma companies, providers, global health institutions --

    生物製藥公司、供應商、全球衛生機構--------。

  • and they've educated me.

    他們教育了我。

  • We need to find the tools to fight COVID,

    我們需要找到打擊COVID的工具。

  • and we need to make them accessible to all.

    我們需要讓所有人都能獲得這些資訊。

  • First, one single vaccine will not get us out of this.

    首先,單一的疫苗無法讓我們擺脫困境。

  • What we need is an arsenal of tools.

    我們需要的是一個工具庫。

  • We need vaccines, we need therapeutics, we need diagnostics

    我們需要疫苗,我們需要治療,我們需要診斷。

  • to make sure that we can prevent, identify and treat COVID cases

    以確保我們能夠預防、識別和治療COVID病例。

  • in a variety of populations.

    在各種人群中。

  • Second, it's not just about finding a tool.

    其次,這不僅僅是找到一個工具。

  • What do you think will happen when one of those clinical trials

    你覺得當這些臨床試驗中的一個會發生什麼?

  • demonstrates that the tool is effective?

    證明該工具是有效的?

  • Do you think we can all run to the pharmacy next door,

    你覺得我們能不能都跑到隔壁的藥店去。

  • we get the product, we take off our masks

    我們拿到產品,我們摘下面具

  • and we go back to French kissing?

    然後我們再回到法式接吻?

  • No.

    不知道

  • Finding an effective tool is just one step in this big fight,

    找到一個有效的工具,只是這場大戰中的一步。

  • because there is a difference between the existence of a product

    因為產品的存在是有區別的。

  • and access to that product.

    並獲得該產品。

  • And now you're thinking,

    現在你在想。

  • "Oh -- she means other countries will have to wait."

    "哦--她的意思是說,其他國家將不得不等待。"

  • Well, no, that's not my point.

    好吧,不,這不是我的觀點。

  • Not only others may have to wait,

    不僅別人可能要等。

  • but any of us may have to.

    但我們中的任何一個人都可能不得不這樣做。

  • The humbling thing about COVID

    關於COVID的謙遜之處

  • is that because of its speed and magnitude,

    是,因為其速度和幅度。

  • it's exposing all of us to the same challenges

    這讓我們所有人都面臨著同樣的挑戰。

  • and giving us a flavor of challenges we're not used to.

    並給我們帶來了不習慣的挑戰的味道。

  • Remember when China got into lockdown?

    還記得中國被封鎖的時候嗎?

  • Did you imagine that you would be in the same situation

    你有沒有想過,你也會有同樣的情況?

  • a few weeks after?

    幾周後?

  • I certainly didn't.

    我當然沒有。

  • Let's go to the theoretical moment when we have a vaccine.

    讓我們到理論上有了疫苗的那一刻。

  • In this case, the next access challenge

    在這種情況下,下一個訪問挑戰

  • will be supply.

    將供應。

  • The current estimate of the global community

    目前對全球社會的估計

  • is that by the end of 2021 --

    到2021年底

  • so that's over a year after the discovery of the vaccine --

    所以這是一年多後 發現疫苗 -

  • we would have enough doses to cover one to two billion

    我們將有足夠的劑量來覆蓋一到二十億人

  • of the eight billion of us on the planet.

    我們地球上80億人中的一員。

  • So who will have to wait?

    那麼,誰將不得不等待呢?

  • How do you think about access when supply is short?

    供不應求的情況下,如何看待准入問題?

  • Scenario number one:

    第一種情況:

  • we let the market forces play,

    我們讓市場力量發揮作用。

  • and those who can pay the highest price or be the fastest to negotiate deals

    和那些能夠支付最高價格或最快談成交易的人。

  • will get access to the product first.

    將先獲得產品的使用權。

  • It's not equitable at all,

    這一點也不公平。

  • but it's a very likely scenario.

    但這是一個很可能的情況。

  • Scenario number two:

    第二種情況:

  • we could all agree, based on public health rationale,

    我們都同意,基於公共衛生的理由。

  • who gets the product first.

    誰先得到產品。

  • Let's say we agree that health care workers would get it first,

    比方說,我們同意醫護人員會先得到它。

  • and then the elderly

    然後是老人

  • and then the general population.

    然後是一般人。

  • Now let me be a bit more provocative.

    現在讓我再挑釁一下。

  • Scenario number three:

    第三種情況:

  • countries who have demonstrated that they can manage the pandemic well

    證明它們能夠很好地管理這一流行病的國家。

  • would get access to the product first.

    會先獲得產品的使用權。

  • It's a little bit extrapolated,

    這是一個小小的推斷。

  • but it's not complete science fiction.

    但這不是完整的科幻小說。

  • Years ago, when the supply of high-quality second-line tuberculosis drug was scarce,

    幾年前,當優質的二線結核病藥物供不應求時。

  • a special committee was established

    成立了一個特別委員會

  • to determine which countries had health systems that were strong enough

    以確定哪些國家有足夠強大的衛生系統。

  • to ensure that the products would be distributed properly

    以確保產品的正常銷售

  • and that patients would follow their treatment plans properly.

    和病人會正確地遵循其治療計劃。

  • Those select countries got access first.

    這些被選中的國家首先獲得了准入權。

  • Or, scenario number four:

    或者,第四種情況。

  • we could decide on a random rule,

    我們可以決定一個隨機的規則。

  • for instance, that people get to be vaccinated on their birthday.

    例如,人們在生日當天可以接種疫苗。

  • Now let me ask you this:

    現在讓我問你這個問題。

  • How does it feel to think of a future where the vaccine exists,

    想到未來有疫苗存在,感覺如何。

  • but you would still have to wear a mask and keep your kids home from school,

    但你還是要戴上口罩,讓孩子放學回家。

  • and you would not be able to go to work the way you want

    你就不能如願以償地去上班了。

  • because you wouldn't have access to that product?

    因為你無法獲得該產品?

  • Every day that passed would feel unacceptable, right?

    每過一天都會覺得無法接受吧?

  • But guess what?

    但你猜怎麼著?

  • There are many diseases for which we have treatments and even cures,

    有很多疾病,我們都有治療甚至治癒的方法。

  • and yet people keep being infected and die every year.

    但每年仍有人被感染並死亡。

  • Let's take tuberculosis:

    就拿結核病來說吧。

  • 10 million people infected every year,

    每年有1000萬人被感染。

  • 1.5 million people dying,

    150萬人死亡。

  • although we've had a cure for years.

    雖然我們已經有了多年的治療方法。

  • And that's just because we haven't completely figured out

    而這只是因為我們還沒有完全弄清楚。

  • some of the key access issues.

    一些關鍵的准入問題。

  • Equitable access is the right thing to do,

    公平準入是正確的做法。

  • but beyond this humanitarian argument

    但除了這種人道主義論點之外

  • that I hope we are more sensitive to

    我希望我們能更敏感地認識到

  • now that we've experienced it in our flesh,

    現在,我們已經經歷了它在我們的肉體。

  • there is a health and an economic argument

    有一個健康和經濟的說法

  • to equitable access.

    公平的機會;

  • The health argument is that as long as the virus is active somewhere,

    健康的說法是,只要病毒在某個地方活動。

  • we're all at risk of reimported cases.

    我們都有可能被再次進口的情況。

  • The economic argument is that because of the interdependencies

    經濟學上的論點是,由於相互依存性

  • in our economies,

    在我們的經濟中。

  • no domestic economy can fully restart if others are not picking up as well.

    如果其他國家的經濟沒有起色,國內的經濟就不可能完全重啟。

  • Think of the sectors that rely on global mobility,

    想想那些依靠全球流動的部門。

  • like aerospace or travel and tourism.

    如航空航天或旅行和旅遊。

  • Think of the supply chains that cut across the globe,

    想一想貫穿全球的供應鏈。

  • like textiles or automotive.

    如紡織業或汽車業。

  • Think of the share of the economic growth that is coming from emerging markets.

    想一想,經濟增長中來自新興市場的份額。

  • The reality is that we need all countries to be able to crush the pandemic in sync.

    現實情況是,我們需要所有國家都能同步粉碎這場流行病。

  • So not only is equitable access the right thing to do,

    所以,不僅是公平準入的正確做法。

  • it is also the smart thing to do.

    這也是明智之舉。

  • But how do we do that?

    但我們該如何做呢?

  • Let's make sure we're on the same page in terms of what "access" means.

    讓我們確保我們在 "訪問 "的含義上是一致的。

  • It would actually mean that the product exists;

    這其實就意味著產品的存在。

  • that it's working sufficiently well;

    它的工作足夠好。

  • that it's been approved by the local authorities;

    它已經被地方當局準許。

  • that it is affordable;

    它是可以負擔得起的。

  • but also that there is evidence that it works in all the populations

    但也有證據表明,它在所有人群中都有效。

  • that need it,

    需要它的。

  • and that can include pregnant women or immunodepressed people, or children;

    而這其中可能包括孕婦或免疫力低下者,或兒童。

  • that it can be distributed in a variety of settings,

    它可以在各種環境下分發。

  • like hospitals or rural clinics, or hot climate or cold climate;

    如醫院或農村診所,或氣候炎熱或氣候寒冷。

  • and that we can produce it at the right scale.

    並且我們可以以適當的規模進行生產。

  • It's a very long checklist, I know,

    我知道,這是個很長的清單。

  • and in a non-crisis situation,

    並在非危機情況下。

  • we would likely address these issues one after the other in a sequential way,

    我們可能會按順序一個接一個地解決這些問題。

  • which takes a lot of time.

    這需要大量的時間。

  • So what do we do?

    那麼我們該怎麼辦呢?

  • Access is far from being a new challenge,

    獲取遠不是一個新的挑戰。

  • and in the case of COVID,

    而在COVID的情況下:

  • I have to say, we're seeing extraordinary collaboration

    我不得不說,我們看到的是非凡的合作。

  • of international organizations, civil society, industry and others

    國際組織、民間社會、工業界和其他方面的意見。

  • to accelerate access:

    以加快獲取。

  • working things in parallel,

    平行工作的事情。

  • speeding up regulatory processes,

    加快監管進程;

  • engineering supply mechanisms,

    工程供應機制。

  • securing procurement, mobilizing resources, etc.

    確保採購、調動資源等。

  • Yet we are likely to face a situation where, for instance,

    然而,我們很可能會面臨這樣的情況,比如說。

  • the vaccine would need to be constantly stored at, let's say,

    疫苗需要持續儲存在,比方說:

  • minus 80 Celsius degrees;

    零下80攝氏度。

  • or where the treatment would need to be administered

    或需要進行治療的地方。

  • by a highly specialized health care worker;

    由專業性很強的醫護人員負責。

  • or where the diagnostic would need to be analyzed

    或需要分析診斷的地方。

  • by a sophisticated lab.

    由先進的實驗室。

  • So what more can we do?

    那麼我們還能做什麼呢?

  • Pushing further the logic that the global health community

    進一步推動全球衛生界的邏輯,即

  • has advocated for for years,

    多年來一直倡導的。

  • there is one additional thing I can think of that might help.

    我還能想到一件事,可能會有幫助。

  • There is a concept in product development and manufacturing

    在產品研發和製造中,有一個概念

  • that's called "design to cost."

    這就是所謂的 "按成本設計"。

  • The basic idea is that the cost management conversation

    基本思路是:成本管理談話

  • happens at the same time as the product being designed,

    在設計產品的同時發生。

  • as opposed to the product being designed first

    相對於先設計產品

  • and then reworked to bring the cost down.

    然後再進行改造,把成本降下來。

  • It's a simple method that helps ensure

    這是一個簡單的方法,有助於確保

  • that when cost has been identified as a priority criteria for a product,

    當成本被確定為產品的優先標準時,。

  • it's made a target from day one.

    它從一開始就成了目標。

  • Now, in the context of health and access,

    現在,在健康和獲取方面:

  • I think there is untapped potential

    我認為還有未開發的潛力

  • in R and D to access,

    在R和D中訪問。

  • the same way that manufacturers design to cost.

    和廠家設計成本的方式是一樣的。

  • This would mean that, instead of developing a product

    這就意味著,與其開發一款產品,不如開發一款產品

  • and then working to adapt it to ensure equitable access later,

    然後努力對其進行調整,以確保以後的公平準入。

  • all of the items on the checklist I mentioned

    所有項目

  • would be built into the R and D process from the beginning,

    將從一開始就被納入研發過程。

  • and this would actually benefit us all.

    而這其實對我們所有人都有好處。

  • Let's take an example.

    我們舉個例子。

  • If we develop a product with equitable access in mind,

    如果我們在開發產品的時候,考慮到公平獲取。

  • we might be able to optimize for scale-up faster.

    我們可能會更快地優化擴大規模。

  • In my experience, drug developers often focus on finding a dose that works,

    根據我的經驗,藥物研發人員往往專注於尋找一個有效的劑量。

  • and only after do they optimize the dosage or make adjustments.

    而後才會優化劑量或進行調整。

  • Now imagine that we're talking of a candidate product

    現在想象一下,我們正在談論一個候選產品。

  • for which the active ingredient is a scarce resource.

    有效成分是稀缺資源的。

  • What if instead we focused on developing a treatment

    如果我們專注於開發一種治療方法

  • that uses the lowest possible amount of that active ingredient?

    儘可能使用最低量的活性成分?

  • It could help us produce more doses.

    它可以幫助我們生產更多的劑量。

  • Let's take another example.

    我們再舉一個例子。

  • If we develop a product with equitable access in mind,

    如果我們在開發產品的時候,考慮到公平獲取。

  • we might be able to optimize for mass distribution faster.

    我們可能會更快地優化大規模分銷。

  • In high-income countries,

    在高收入國家:

  • we have strong health systems capacity.

    我們有強大的衛生系統能力。

  • We can always distribute products the way we want.

    我們可以隨時按照自己的想法來分配產品。

  • So we often take for granted that products can be stored

    是以,我們常常理所當然地認為,產品可以儲存在

  • in temperature-controlled environments

    在溫控環境下

  • or requires a highly skilled health care worker for administration.

    或需要高技能的醫護人員進行管理。

  • Of course,

    當然了

  • temperature-controlled environments and highly skilled health care workers

    溫控環境和高技能的醫護人員。

  • are not available everywhere.

    並非各地都有。

  • If we were to approach R and D

    如果我們接近R和D

  • with the constraints of weaker health systems in mind,

    考慮到較弱的衛生系統的制約因素。

  • we might get creative

    我們可能會有創意

  • and develop sooner, for instance, temperature-agnostic products

    並更快地開發,例如,溫度診斷產品。

  • or products that can be taken as easily as a vitamin

    或像維生素一樣容易服用的產品。

  • or long-lasting formulations instead of repeat doses.

    或長效製劑,而不是重複用藥。

  • If we were able to produce and develop such simplified tools,

    如果我們能夠生產和開發這樣的簡化工具。

  • it would have the added benefit

    這樣做的好處是

  • of putting less strains on hospitals and health systems

    減少對醫院和衛生系統的壓力;

  • for both high- and low-income countries.

    對高收入和低收入國家都是如此。

  • Given the speed of the virus

    鑑於病毒的速度

  • and the magnitude of the consequences we're facing,

    以及我們所面臨的後果的嚴重性。

  • I think we have to continue challenging ourselves

    我覺得我們要繼續挑戰自己

  • to find the fastest way to make products to fight COVID

    以最快的速度找到製作產品對抗COVID的方法。

  • and future pandemics accessible to all.

    和未來的大流行病,讓所有人都能獲得。

  • In my perspective,

    在我看來。

  • unless the virus disappears,

    除非病毒消失。

  • there are two ways this story ends.

    這個故事有兩種結局。

  • Either the scales tip one way --

    要麼是天平向一邊傾斜 --

  • only some of us get access to the product

    漏網之魚

  • and COVID remains a threat to all of us --

    而COVID仍然是我們所有人的威脅 -- --

  • or we balance the scales,

    或者我們平衡天平。

  • we all get access to the right weapons,

    我們都能獲得合適的武器。

  • and we all move on together.

    和我們一起繼續前進。

  • Innovative R and D can't beat COVID alone,

    創新研發單靠COVID是打不過的。

  • but innovative management of R and D might help.

    但創新的研發管理可能會有幫助。

  • Thank you.

    謝謝你了

My son was born in January 2020,

我的兒子是在2020年1月出生的。

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