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