在任何危机中，领导者都有两个同等重要的责任：解决眼前的问题并使之不再发生。 COVID-19大流行就是一个很好的例子。现在，世界需要挽救生命，同时还需要改善我们应对总体疫情的方式。第一点更为紧迫，但第二点则具有至关重要的长期后果。

长期挑战—提高我们应对疫情的能力—isn’新的。多年来，全球卫生专家一直在说，与1918年流感流行的速度和严重程度不相上下的另一种大流行是’t a matter of 如果 但 什么时候 。账单&梅林达·盖茨基金会（Melinda Gates Foundation）近年来已投入大量资源，以帮助世界为这种情况做准备。

现在，除了长期的挑战之外，我们还面临着紧迫的危机。在过去一周中，COVID-19的行为开始像百年一遇的病原体’我一直很担心。我希望它’并没有那么糟糕，但是我们应该假设情况会一直如此，直到我们知道其他情况为止。

There are two reasons that COVID-19 is such a threat. First, it 能够 kill healthy adults in addition to elderly people with existing health problems. The data so far suggests that the virus has a case fatality risk around 1%; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).

其次，COVID-19的传输效率很高。普通感染者会将疾病传播给另外两三个人。那’s an exponential rate of increase. There is also strong evidence that it 能够 be transmitted by people who are just mildly ill 要么 not even showing symptoms yet. This means COVID-19 will be much harder to contain than Middle East Respiratory Syndrome 要么 Severe Acute Respiratory Syndrome (SARS), which were only spread by those showing symptoms and were much less efficiently transmitted. In fact, COVID-19 has already caused 10 times as many cases as SARS in just a quarter of the time.

The good news is that national, state, and local governments and public health agencies 能够 take steps over the next few weeks to slow the spread of COVID-19.

For example, in addition to helping their own citizens respond, donor governments should help low- and middle-income countries prepare for this pandemic. The health systems in many of these countries are already stretched thin, and a pathogen like coronavirus 能够 quickly overwhelm them. And poorer countries have little political 要么 economic leverage, given wealthier countries’自然而然地把自己的人民放在首位。

通过 helping countries in Africa and South Asia get ready now, we 能够 save lives and also slow the global circulation of the virus. (A significant portion of the 承诺 我和梅琳达最近做出了帮助，推动全球对COVID-19的反应—总额可能高达1亿美元—特别针对发展中国家。）

世界还需要加快COVID-19的治疗和疫苗工作。科学家能够在几天之内对病毒的基因组进行测序，并开发出几种有希望的候选疫苗，而流行病防备创新联盟已经在准备多达八种有希望的候选疫苗用于临床试验。如果这些疫苗中的一种或多种在动物模型中被证明是安全有效的，那么它们最早可以在六月进行大规模试验。也可以通过利用已经过安全性测试的化合物库以及应用包括机器学习在内的新筛选技术来鉴定可以在数周内准备用于大规模临床试验的抗病毒药物，来加快药物发现。

All these steps would help address the current crisis. But we also need to make larger systemic changes so we 能够 respond more efficiently and effectively 什么时候 the next epidemic arrives.

It’这对于帮助中低收入国家加强其初级卫生保健系统至关重要。当您建立健康诊所时，’re also creating part of the infrastructure for fighting epidemics. Trained health care workers not only deliver vaccines; they 能够 also monitor disease patterns, serving as part of the early warning systems that will alert the world to potential outbreaks.

世界还需要对疾病监测进行投资，包括相关组织可以立即访问的病例数据库和要求各国共享其信息的规则。各国政府应有权访问准备立即应对流行病的受过培训的人员清单，从地方领导人到全球专家，以及在紧急情况下应储存或转移的物资清单。

In addition, we need to build a system that 能够 develop safe and effective vaccines and antivirals, get them approved, and deliver billions of doses within a few months of the discovery of a fast-moving pathogen. That’s a tough challenge that presents technical, diplomatic, and budgetary obstacles, as well as demanding partnership between the public and private sectors. But all these obstacles 能够 be overcome.

上 e of the main technical challenges for vaccines is to improve on the old ways of manufacturing proteins, which are just too slow for responding to an epidemic. We need to develop platforms that are predictably safe, so regulatory reviews 能够 happen quickly, and that make it easy for manufacturers to produce doses at a low cost and a massive scale. For antivirals, there will need to be an 要么 ganized system to screen existing treatments and 能够didate molecules in a swift and standardized manner.

Another technical challenge involves constructs based on nucleic acids. These constructs 能够 be produced within hours after a virus’基因组已测序；现在我们需要找到大规模生产它们的方法。

除了这些技术解决方案，我们’ll need diplomatic efforts to drive international collaboration and data sharing. Developing antivirals and vaccines involves massive clinical trials and licensing agreements that would cross national borders. We should make the most of global forums that 能够 help achieve consensus on research priorities and trial protocols so that promising vaccine and antiviral 能够didates 能够 move quickly through this process. These platforms include the 世界卫生组织&D Blueprint ， 国际严重急性呼吸道和新兴感染联合会 试用网络，以及 全球传染病防制研究合作 。这项工作的目标应该是在三个月或更短的时间内获得最终的临床试验结果和监管部门的批准，而不会损害患者’ safety.

然后是资金问题。这些工作的预算需要扩大数倍。完成三期临床试验并获得冠状病毒疫苗的监管批准还需要数十亿美元，并且还需要更多资金来改善疾病的监测和应对。

为什么这需要政府资助—can’私营部门可以自己解决这个问题吗？大流行性疾病产品是高风险的投资，制药公司将需要公共资金来降低其工作的风险，并使他们双脚投入。此外，政府和其他捐助者将需要资助—作为全球公益物—manufacturing facilities that 能够 generate a vaccine supply in a matter of weeks. These facilities 能够 make vaccines for routine immunization programs in normal times and be quickly refitted for production during a pandemic. Finally, governments will need to finance the procurement and distribution of vaccines to the populations that need them.

显然，数十亿美元用于抗大流行的工作是一笔巨款。但是那’s the scale of investment required to solve the problem. And given the economic pain that an epidemic 能够 impose—只是看看COVID-19破坏供应链和股票市场的方式，更不用说人们’s lives—这将是一个讨价还价。

最后，政府和行业需要达成协议：在大流行期间，疫苗和抗病毒药获得了’不能简单地卖给出价最高的人。他们’对于处于爆发中心且最需要的人们来说，这将是可用且负担得起的。这不仅是正确的事情，而且’也是使传播短路并防止未来大流行的正确策略。

这些是领导人现在应该采取的行动。没有时间可以浪费了。

该帖子最初出现在 新英格兰医学杂志。我在那儿写了关于 全球大流行应对系统 在2015年， 新型呼吸道病毒构成的威胁 在2018年。