《Nature》本期有一篇社論，標題是《Vaccine initiative marks bold resolution》，副標題是《Preparation against future epidemic threats is a welcome and essential move》。個人覺得是對現有全球化格局下，新發、再發傳染病疫苗的全球預防準備工作的一個很好的總結，特翻譯如下，並附原文於後：

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很多次了，在新發或再發傳染病流行之後，故事是一模一樣的。正式的審查委員給出世界得到的教訓——如何為下一次作出更好地準備。但隨著媒體和政治關注度的消失，得到的教訓也很少能真正成為教訓。

因此，令人鼓舞的是，在2014年西非可怕的埃博拉疫情之後，基金會和科學家們聚集在一起來解決疾病準備上的一個重大失敗：儘管已知的病原體有很多能夠造成大流行，但是針對這些病原體的批准疫苗幾乎不存在。

因此，令人鼓舞的是，在西非的可怕的2014年埃博拉疫情之後，研究資助者和科學家聚集在一起，解決一個疾病預防上的重大失敗：儘管已經有很多已知的病原體至少造成大流行的可能性，批准的疫苗幾乎不存在。

例如，2012年在沙烏地阿拉伯發現的引起致命中東呼吸綜合征（MERS）的冠狀病毒，目前並沒有認真努力開發針對它的疫苗。儘管病毒只在那些密切接觸的人之間傳播，但它標記了許多可能導致大流行的變異，以更容易地在人群之間傳播。同樣，2003年嚴重急性呼吸綜合征（SARS）的流行造成了全球性的嚴重破壞，並且是通過嚴厲的公共衛生措施才避免了進一步的大流行。但十多年後，SARS仍然沒有疫苗。

事實上，去年12月發表在《Emerging Infectious Diseases》（新發傳染病雜誌，美國CDC直屬期刊，傳染病領域頂級期刊）上的一篇文章中，科學家發現了迄今為止在人類中只引起有限爆發的37種病毒（包括一些你可能從來沒有聽說過的病毒，比如Bwamba，Oropouche，Junin和onyong-nyong），都似乎很有可能成為潛在的流行威脅（M. E. J. Woolhouse et al. Emerg. Infect. Dis. Assessing the Epidemic Potential of RNA and DNA Viruses; 2016）。

很長一段時間以來，世界已經無奈地默許現狀，因為針對可能永遠不會引起重大問題的病原體就沒有疫苗市場，因而在開發針對它們的疫苗方面也沒有足夠的投資。顯然，不能期望私人公司自己投資。但是政府有義務投資，從而與製藥公司合作來解決這一市場失靈（我似乎從這裡看到了社會主義優越性....）。

因此，令人鼓舞的是，現在有一個堅實的計劃來做這件事：1月18日在瑞士達沃斯世界經濟論壇上發起的流行病防範創新聯盟（CEPI）旨在開發和採用早期臨床試驗疫苗來防止潛在的威脅。目前已經有足夠的資金來先處理三個病原體——MERS，尼帕病毒感染和拉沙熱（MERS專欄文章，拉沙熱專欄文章，順便提醒了我將尼帕病毒列為下次介紹的對象）。

CEPI最初的4.6億美元中大約2億美元的資金僅來自兩個捐助者，惠康信託基金和比爾和梅林達·蓋茨基金會，剩下的來自挪威，德國和日本政府。其他一些國家的預算和選舉周期拖延了進一步的捐款，但更多的國家加入進來是至關重要的，這會允許CEPI選擇更多的研究目標。一些國家可能希望等待，CEPI首先應該證明其值得投資，但目前看來似乎很少有理由覺得CEPI不會成功。

開發針對艾滋病毒、結核病和瘧疾的疫苗的超高難度不應給現有計劃蒙上陰影（瘧疾疫苗回答）。正如研究人員指出，大多數病原體並不像HIV那樣多變和序列的多樣性，結核菌的高傳播性和休眠能力，或者瘧原蟲那樣通過產生替代表面蛋白的狡猾策略來逃避免疫系統。針對需求列表上的許多病毒來製作疫苗其實並非一個巨大挑戰。

CEPI是在疫苗研究領域已經進入了一個激動人心的時刻到來的——現在有針對任何一種疾病的單一疫苗方法，或者研發用於針對多種感染的疫苗骨架（EBOV疫苗專欄文章1， VSV-EBOV疫苗專欄文章）。這都有望大大加快疫苗的開發進度，甚至允許快速開發針對以前未知病毒的疫苗。

在短期主義和短視行為盛行、政治言論經常勝於實際行動的時代，CEPI的創始人提供了遠見和卓識——但最保險的是更多的政府，包括美國，最好被勸說回來加入其中。

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Vaccine initiative marks bold resolution

Preparation against future epidemic threats is a welcome and essential move.

Too often, after an epidemic of a new or re-emerging disease, the story is the same. Formal review committees lay out lessons for how the world can be better prepared the next time, but as the flurry of media and political attention fades, little comes of them.

It is therefore heartening that, in the wake of the horrific 2014 Ebola epidemic in West Africa, research funders and scientists have come together to address a major failing in preparedness: the fact that, although there is a long list of pathogens known to have at least the potential to cause major epidemics, approved vaccines exist for almost none of them.

For example, the coronavirus that causes deadly Middle East respiratory syndrome (MERS) was discovered in Saudi Arabia back in 2012, but there has been no serious effort to develop a vaccine against it. The virus』s spread between people seems limited to those in close contact, and yet it ticks many of the boxes for an agent that could cause a pandemic were it to evolve to spread more easily between people. Similarly, an epidemic of severe acute respiratory syndrome (SARS) in 2003 caused global havoc, with a pandemic narrowly being averted by drastic public-health measures. But more than a decade later there is still no vaccine.

In fact, in a paper published last December in Emerging Infectious Diseases, scientists identified 37 viruses (including some you may never have heard of, such as Bwamba, Oropouche, Junin and o』nyong-nyong) that so far have caused only limited outbreaks in humans, but which seem to fit the bill as potential epidemic threats (M. E. J. Woolhouse et al. Emerg. Infect. Dis. http://doi.org/bxnk; 2016).

For too long, the world has fatalistically acquiesced to a status quo in which, because there is no market for vaccines against pathogens that might never cause a major problem, there is no substantial investment in developing vaccines against them. Clearly, private companies cannot be expected to invest on their own. But it is incumbent on governments to invest, and thus address this market failure, in partnership with pharma.

It is therefore encouraging that there is now a solid plan to do just that: the Coalition for Epidemic Preparedness Innovations (CEPI), launched on 18 January at the World Economic Forum in Davos, Switzerland, aims to develop and take through early clinical trials vaccines against potential threats. It already has enough cash to work on three — MERS, Nipah-virus infection and Lassa fever.

Some US$200 million of CEPI』s initial $460-million funding comes from just two donors, the Wellcome Trust and the Bill & Melinda Gates Foundation, with the rest coming from the governments of Norway, Germany and Japan. Budget and election cycles in several other countries have delayed further contributions, but it is crucial that more countries come on board, allowing CEPI to take on additional targets. Some nations may wish to wait, and it is only right that CEPI should prove its worth, but there seem few reasons that it should not succeed.

The difficulty of developing vaccines against HIV, tuberculosis and malaria must not cloud expectations. As researchers point out, most pathogens don』t have the vast sequence diversity and mutability of HIV, the TB bacterium』s high transmissibility and ability to lie dormant, or the malaria parasite』s cunning evasion of the immune system by generating alternative surface proteins. Making vaccines against many of the viruses on the most-wanted list should not be a huge challenge.

CEPI comes at an exciting time in vaccine research. There』s a move away from a single-vaccine approach for any one disease, to developing vaccine backbones for use against multiple infections. This promises to greatly speed up vaccine development — and perhaps even to allow rapid development of vaccines against previously unknown viruses.

At a time when short-termism and shortsightedness are rife, and political rhetoric often prevails over action, CEPI』s founders are offering vision and foresight — it』s an insurance policy that more governments, including the United States, would be well advised to back.

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