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    【翻譯者】為什么我們可能得不到冠狀病毒疫苗?

    作者:重慶翻譯公司        發布日期:2020-05-25        點擊量:133
    Why we might not get a coronavirus vaccine

    為什么我們可能得不到冠狀病毒疫苗

    Politicians have become more cautious about immunisation prospects. They are right to be

    政治家們對免疫接種的前景變得更加謹慎,他們這樣做是正確的

    Vaccines are simple in principle but complex in practice.

    疫苗原理上簡單,實際上復雜

    It would be hard to overstate the importance of developing a vaccine to Sars-CoV-2 – it’s seen as the fast track to a return to normal life. That’s why the health secretary, Matt Hancock, said the UK was “throwing everything at it”.

    開發 Sars-CoV-2疫苗的重要性怎么強調都不為過——它被視為恢復正常生活的快速通道。這就是為什么衛生大臣馬特 · 漢考克說英國正在“全力以赴”。

    But while trials have been launched and manufacturing deals already signed – Oxford University is now recruiting 10,000 volunteers for the next phase of its research – ministers and their advisers have become noticeably more cautious in recent days.

    不過,盡管試驗已經啟動,制造協議也已簽署——牛津大學(Oxford University)目前正在為下一階段的研究招募1萬名志愿者——但最近幾天,部長們及其顧問明顯變得更為謹慎。

    This is why.

    這就是原因。

    Why might a vaccine fail?

    為什么疫苗會失敗?

    Earlier this week, England’s deputy chief medical officer Jonathan Van-Tam said the words nobody wanted to hear: “We can’t be sure we will get a vaccine.”

    本周早些時候,英格蘭副首席醫療官喬納森 · 范-塔姆說了一句沒人想聽的話: “我們不能確定我們會得到疫苗。”

    But he was right to be circumspect.

    但他的謹慎是正確的。

    Vaccines are simple in principle but complex in practice. The ideal vaccine protects against infection, prevents its spread, and does so safely. But none of this is easily achieved, as vaccine timelines show.

    疫苗在原則上是簡單的,但在實踐中是復雜的。理想的疫苗可以預防感染,防止它的傳播,并且是安全的。但是,正如疫苗時間表所顯示的那樣,這些都不是容易實現的。

    More than 30 years after scientists isolated HIV, the virus that causes Aids, we have no vaccine. The dengue fever virus was identified in 1943, but the first vaccine was approved only last year, and even then amid concerns it made the infection worse in some people. The fastest vaccine ever developed was for mumps. It took four years.

    在科學家分離出引起艾滋病的 HIV 病毒30多年后,我們還沒有疫苗。登革熱病毒是在1943年被發現的,但是第一種疫苗直到去年才被批準,即使在那時,人們還是擔心它會使一些人的感染更加嚴重。有史以來發展最快的疫苗是針對腮腺炎的。花了四年的時間。

    Scientists have worked on coronavirus vaccines before, so are not starting from scratch. Two coronaviruses have caused lethal outbreaks before, namely Sars and Mers, and vaccine research went ahead for both. But none have been licensed, partly because Sars fizzled out and Mers is regional to the Middle East. The lessons learned will help scientists create a vaccine for Sars-CoV-2, but there is still an awful lot to learn about the virus.

    科學家們之前已經研究過冠狀病毒疫苗,所以并不是從零開始。兩種冠狀病毒曾引起過致命疫情,即非典型肺炎和中東呼吸綜合癥,疫苗研究對這兩種病毒都進行了研究。但是沒有一種疫苗得到許可,部分原因是非典疫情消失了,而 Mers 是中東地區性疫苗。這些經驗教訓將有助于科學家研制 Sars-CoV-2疫苗,但是關于這種病毒還有太多東西需要了解。

    A chief concern is that coronaviruses do not tend to trigger long-lasting immunity. About a quarter of common colds are caused by human coronaviruses, but the immune response fades so rapidly that people can become reinfected the next year.

    一個主要的關注點是冠狀病毒不傾向于觸發長期免疫。大約四分之一的普通感冒是由冠狀病毒引起的,但是免疫反應消退得如此之快,以至于人們第二年就可能再次感染。

    Researchers at Oxford University recently analysed blood from recovered Covid-19 patients and found that levels of IgG antibodies – those responsible for longer-lasting immunity – rose steeply in the first month of infection but then began to fall again.

    牛津大學的研究人員最近分析了康復的新型冠狀病毒肺炎患者的血液,發現在感染的第一個月,IgG 抗體水平——那些負責更持久免疫力的抗體——急劇上升,但隨后又開始下降。

    Last week, scientists at Rockefeller University in New York found that most people who recovered from Covid-19 without going into hospital did not make many killer antibodies against the virus.

    上周,紐約洛克菲勒大學大學的科學家發現,大多數從新型冠狀病毒肺炎中康復的人沒有去醫院,也沒有產生許多終極抗體來對抗病毒。

    “That’s what is particularly challenging,” says Stanley Perlman, a veteran coronavirus researcher at the University of Iowa. “If the natural infection doesn’t give you that much immunity except when it’s a severe infection, what will a vaccine do? It could be better, but we don’t know.” If a vaccine only protects for a year, the virus will be with us for some time.

    愛荷華大學的資深冠狀病毒研究人員 Stanley Perlman 說: “這就是特別具有挑戰性的地方。”。“如果自然感染除非是嚴重感染,否則不會給你那么大的免疫力,那么疫苗能起什么作用呢?可能會更好,但我們不知道。” 如果一種疫苗只能保護一年,那么這種病毒將會伴隨我們一段時間。

    The genetic stability of the virus matters too. Some viruses, such as influenza, mutate so rapidly that vaccine developers have to release new formulations each year. The rapid evolution of HIV is a major reason we have no vaccine for the disease.

    病毒的遺傳穩定性也很重要。一些病毒,如流感病毒,變異如此之快,以至于疫苗研發人員不得不每年發布新的配方。艾滋病毒的快速進化是我們沒有疫苗來預防這種疾病的一個主要原因。

    So far, the Sars-CoV-2 coronavirus seems fairly stable, but it is acquiring mutations, as all viruses do. Some genetic changes have been spotted in the virus’s protein “spikes” which are the basis of most vaccines. If the spike protein mutates too much, the antibodies produced by a vaccine will effectively be out of date and might not bind the virus effectively enough to prevent infection.

    到目前為止,Sars-CoV-2冠狀病毒看起來相當穩定,但它像所有病毒一樣正在發生突變。在作為大多數疫苗基礎的病毒的蛋白質“峰值”中發現了一些基因變化。如果棘突蛋白變異過多,疫苗產生的抗體將無疑會過時,并且可能無法有效地約束病毒以防止感染。

    Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine, who helped identify some of the virus’s mutations, called them “an early warning”.

    倫敦衛生與熱帶醫學學院的新發傳染病教授 Martin Hibberd 幫助識別出了一些病毒的突變,他稱之為“早期警告”。

    Another challenge: making any vaccine safe

    另一個挑戰是: 使任何疫苗都是安全的

    In the rush to develop a vaccine – there are now more than 100 in development – safety must remain a priority. Unlike experimental drugs for the severely ill, the vaccine will be given to potentially billions of generally healthy people.

    目前已有100多種疫苗正在研制之中,在這種急于研制疫苗的情況下,安全性必須繼續成為優先考慮的問題。與針對重癥患者的實驗性藥物不同,這種疫苗將用于潛在的數十億普遍健康的人群。

    This means scientists will have to check extremely carefully for signs of dangerous side-effects. During the search for a Sars vaccine in 2004, scientists found that one candidate caused hepatitis in ferrets. Another serious concern is “antibody-induced enhancement” where the antibodies produced by a vaccine actually make future infections worse. The effect caused serious lung damage in animals given experimental vaccines for both Sars and Mers.

    這意味著科學家必須非常仔細地檢查危險副作用的跡象。在2004年尋找 Sars 疫苗的過程中,科學家們發現一種候選病毒會導致雪貂患上肝炎。另一個嚴重的問題是“抗體誘導增強” ,即疫苗產生的抗體實際上使未來的感染更加嚴重。這種影響在給予 Sars 和 Mers 實驗疫苗的動物中造成了嚴重的肺損傷。

    John McCauley, director of the Worldwide Influenza Centre at the Francis Crick Institute, says it takes time to understand the particular challenges each vaccine throws up. “You don’t know the difficulties, the specific difficulties, that every vaccine will give you,” he says. “And we haven’t got experience in handling this virus or the components of the virus.”

    弗朗西斯·克里克研究院全球流感中心主任 John McCauley 說,要理解每種疫苗帶來的特殊挑戰需要時間。他說: “你不知道每種疫苗都會給你帶來的困難和具體的困難。”。“我們在處理這種病毒或這種病毒的組成部分方面沒有經驗。”

    We should ‘end up with something’ … but what does that mean?

    我們最終應該會得出一些東西... ... 但這意味著什么呢?

    When the prime minister, Boris Johnson, told a No 10 press briefing that a vaccine was “by no means guaranteed”, his chief scientific adviser, Patrick Vallance, agreed, but added: “I’d be surprised if we didn’t end up with something.” Many scientists share that view.

    當英國首相鮑里斯 · 約翰遜(Boris Johnson)在唐寧街10號的新聞發布會上表示,疫苗“絕不是萬無一失的”時,他的首席科學顧問帕特里克 · 瓦倫斯(Patrick Vallance)表示同意,但他補充說: “如果我們最終沒有得到什么結果,我會感到不可思議”。許多科學家贊同了這一觀點。

    In all likelihood, a coronavirus vaccine will not be 100% effective.

    冠狀病毒疫苗很有可能不會100% 有效。

    Those in development draw on at least eight different approaches, from weakened and inactivated viruses to technologies that smuggle genetic code into the recipient’s cells, which then churn out spike proteins for the immune system to make antibodies against.

    那些正在研發中的病毒至少采用了八種不同的方法,從衰弱和失活的病毒到將基因密碼偷偷帶入受體細胞的技術,這些基因密碼為免疫系統制造出針對它的抗體。

    Ideally, a vaccine will generate persistent, high levels of antibodies to wipe out the virus and also “T” cells to destroy infected cells. But each vaccine is different and today no one knows what kind of immune response is good enough.

    理想情況下,疫苗將產生持久的、高水平的抗體來消滅病毒,同時也會產生“ T”細胞來消滅被感染的細胞。但是每種疫苗都是不同的,今天沒有人知道什么樣的免疫反應是足夠好的。

    “We don’t even know if a vaccine can produce an immune response which would protect against future infection,” says David Heymann, who led the response of the World Health Organization (WHO) to the Sars epidemic.

    “我們甚至不知道疫苗是否能產生免疫反應,從而預防未來的感染,”領導世界衛生組織(WHO)應對非典疫情的大衛 · 海曼說。

    Early results from two frontrunner vaccines suggest they might have some use.

    兩種領先疫苗的早期結果表明,它們可能有一定的用途。

    The US biotech firm Moderna reported antibody levels similar to those found in recovered patients in 25 people who received its vaccine.

    美國生物技術公司 Moderna 報告的抗體水平與25名接種了該公司疫苗的康復患者的抗體水平相似。

    Another vaccine from Oxford University did not stop monkeys contracting the virus, but did appear to prevent pneumonia, a major cause of death in coronavirus patients.

    牛津大學的另一種疫苗并沒有阻止猴子感染病毒,但似乎確實可以預防肺炎,這是冠狀病毒患者死亡的主要原因。

    If humans react the same way, vaccinated people would still spread the virus, but be less likely to die from it.

    如果人類也有同樣的反應,接種疫苗的人仍然會傳播病毒,但是死于病毒的可能性更小。

    How well a vaccine works determines how it is used. Armed with a highly effective vaccine that protects for several years, countries could aim for herd immunity by protecting at least two-thirds of the population.

    疫苗作用的好壞決定了疫苗的使用方式。擁有高效疫苗可以保護數年,各國可以通過保護至少三分之二的人口來實現群體免疫。

    Coronavirus patients pass the virus on to three others, on average, but if two or more are immune, the outbreak will fizzle out. That is the best-case scenario.

    平均而言,冠狀病毒患者會將病毒傳染給另外三個人,但是如果兩個或更多的人具有免疫力,疫情就會平息下來。這是最好的情況。

    More likely is we will end up with a vaccine, or a number of vaccines, that are only partially effective.

    更有可能的是,我們最終會得到一種疫苗,或者一些疫苗,而這些疫苗只是部分有效。

    Vaccines that contain weakened strains of virus can be dangerous for older people, but might be given to younger people with more robust immune systems to reduce the spread of infection.

    含有弱毒株病毒的疫苗對老年人來說可能是危險的,但可以給免疫系統更強大的年輕人注射,以減少感染的傳播。

    Meanwhile, older people might get vaccines that simple prevent infections progressing to life-threatening pneumonia. “If you don’t have the ability to induce immunity, you’ve got to develop a strategy for reducing serious outcomes of infection,” says McCauley.

    與此同時,老年人可能會得到簡單的疫苗,以防止感染發展成威脅生命的肺炎。麥考利說: “如果你沒有誘導免疫力的能力,你就必須制定一個策略來減少感染的嚴重后果。”。

    But partially effective vaccines have their own problems: a vaccine that doesn’t stop the virus replicating can encourage resistant strains to evolve, making the vaccine redundant.

    但是部分有效的疫苗也有自己的問題: 一種不能阻止病毒復制的疫苗可能會促進耐藥菌株的進化,使得疫苗變得多余。

    So, is the virus here to stay?

    那么,病毒會成為我們生活中的一部分嗎?

    The simple answer is: yes.

    答案很簡單: 是的。

    Hopes for eliminating the virus start with a vaccine but do not end there. “If and when we have a vaccine, what you get is not rainbows and unicorns,” says Larry Brilliant, CEO of Pandefense Advisory, who led the WHO’s smallpox eradication programme. “If we are forced to choose a vaccine that gives only one year of protection, then we are doomed to have Covid become endemic, an infection that is always with us.”

    消滅病毒的希望始于疫苗,但并不止于此。“如果我們有了疫苗,你得到的就不是彩虹和獨角獸了,”世界衛生組織天花根除計劃的領導者 Pandefense Advisory 的首席執行官 Larry Brilliant 說。“如果我們被迫選擇一種只能提供一年保護的疫苗,那么我們就注定會產生地方性流行病,這種感染會一直伴隨著我們。”

    The virus will still be tough to conquer with a vaccine that lasts for years.

    這種病毒仍然很難被持續數年研發的疫苗所征服。

    “It will be harder to get rid of Covid than smallpox,” says Brilliant. With smallpox it was at least clear who was infected, whereas people with coronavirus can spread it without knowing. A thornier problem is that as long as the infection rages in one country, all other nations are at risk.

    布里連特說: “擺脫 Covid 比擺脫天花更難。”。對于天花,至少可以清楚地知道誰被感染了,而對于冠狀病毒感染者,他們可能在不知情的情況下傳播冠狀病毒。一個更棘手的問題是,只要一個國家發生感染,其他所有國家都有危險。

    As David Salisbury, the former director of immunisation at the Department of Health, told a Chatham House webinar recently: “Unless we have a vaccine available in unbelievable quantities that could be administered extraordinarily quickly in all communities in the world we will have gaps in our defences that the virus can continue to circulate in.”

    正如英國衛生部前免疫接種主任戴維索爾茲伯里(David Salisbury)最近在英國皇家國際事務研究所(Chatham House)的一次網絡研討會上所言: “除非我們擁有一種數量驚人、可以在全球所有社區以極快的速度接種的疫苗,否則我們的防御系統將出現缺口,病毒將繼續流行開來。“

    Or as Brilliant puts it, the virus will “ping-pong back and forth in time and geography”.

    或者正如布里連特所說,這種病毒將會“在時間和地理上來回反復爆發”。

    One proposal from Gavi, the vaccine alliance, is to boost the availability of vaccines around the world through an “advance market commitment”. And Brilliant believes some kind of global agreement must be hammered out now. “We should be demanding, now, a global conference on what we’re going to do when we get a vaccine, or if we don’t,” he says.

    疫苗聯盟加維提出的一項建議是,通過“預先市場承諾(即疫苗計劃)” ,增加全球疫苗的供應。布里連特認為,現在必須敲定某種全球協議。他說: “我們現在應該要求召開一次全球會議,討論我們何時獲得疫苗,或者如果得不到疫苗該怎么辦。”。

    “If the process of getting a vaccine, testing it, proving it, manufacturing it, planning for its delivery, and building a vaccine programme all over the world, if that’s going to take as long as we think, then let’s fucking start planning it now.”

    “如果獲取以及測試、證明、生產和計劃交付疫苗的過程需要很久,如果在世界各地建立一個疫苗項目的過程也同樣像我們預想的那樣耗時久遠,那么讓我們現在就開始制定計劃吧。”

    How will we live with the virus?

    我們將如何與病毒共存?

    People will have to adapt – and life will change. Heymann says we will have to get used to extensive monitoring for infections backed up by swift outbreak containment. People must play their part too, by maintaining handwashing, physical distancing and avoiding gatherings, particularly in enclosed spaces. Repurposed drugs are faster to test than vaccines, so we may have an antiviral or an antibody treatment that works before a vaccine is available, he adds. Immediate treatment when symptoms come on could at least reduce the death rate.

    人們將不得不適應——生活將會改變。海曼說,我們將不得不去習慣去依賴以迅速控制疫情為支撐的廣泛的感染監測。人們也必須發揮自己的作用,保持洗手,身體距離和避免聚會,特別是在封閉的空間。他補充說,改變用途的藥物比疫苗測試更快,所以在疫苗可用之前,我們可能已經有了抗病毒或抗體療法。癥狀出現時立即治療至少可以降低死亡率。

    Yuen Kwok-yung, a professor of infectious disease at the University of Hong Kong, has advised his government that all social distancing can be relaxed – but only if people wear masks in enclosed spaces such as on trains and at work, and that no food or drink are consumed at concerts and cinemas.

    香港大學傳染病教授袁國勇建議政府,所有的社會距離都可以放松——但前提是人們在封閉的空間,如火車和工作場所戴上口罩,在音樂會和電影院不吃不喝。

    At restaurants, tables will have to be shielded from each other and serving staff will follow strict rules to prevent spreading the virus. “In our Hong Kong perspective, the diligent and correct use of reusable masks is the most important measure,” he says.

    在餐館,餐桌必須互相隔離,服務員必須遵守嚴格的規則,以防止病毒傳播。“從我們香港的角度來看,勤奮和正確地使用可重復使用的口罩是最重要的措施,”他說。

    Sarita Jane Robinson, a psychologist who studies responses to threats at the University of Central Lancashire, says people are still adapting to the “new normal” and that without more interventions – such as fines for not wearing face masks – “we could see people drifting back to old behaviours”.

    中央蘭開夏大學研究應對威脅的心理學家 Sarita Jane Robinson 表示,人們仍在適應“新常態” ,如果不采取更多干預措施——比如對不戴面罩者處以罰款——“我們可能會看到人們回歸舊習慣”。

    We might become blase about Covid-19 deaths when life resumes and the media move on, but the seriousness of the illness will make it harder to ignore, she says.

    當生活重新開始,媒體繼續報道時,我們可能會對新型冠狀病毒肺炎的死亡感到厭倦,但是疾病的嚴重性會讓我們更加難以忽視,她說。

    One last possibility could save a lot of trouble. Some scientists wonder whether the common cold coronaviruses crossed into humans in the distant past and caused similar illness before settling down. “If the virus doesn’t change there’s no reason to think that miraculously in five years’ time it won’t still cause pneumonia,” says Perlman. “But that’s the hope: that we end up with a much more mild disease and you only get a bad cold from it.”

    最后一種可能性可以省去很多麻煩。一些科學家想知道普通感冒冠狀病毒是否在遙遠的過去傳染給人類,并在站穩腳跟之前就引起了類似的疾病。“如果病毒沒有變化,沒有理由認為在五年內奇跡般地不會引起肺炎,”帕爾曼說。“但這就是希望所在: 我們最終會得到一種更溫和的疾病 —— 你只會因此得一場重感冒而已。”

    Heymann says it is too soon to know how the pandemic will pan out. “We don’t understand the destiny of this virus,” he says. “Will it continue to circulate after its first pandemic? Or will it, like some other pandemic viruses, disappear or become less virulent? That we do not know.”

    海曼說,現在就知道這場流行病將如何演變還為時過早。“我們不明白這種病毒的命運終將如何,”他說。“在第一次大流行之后,它會繼續流行嗎?或者它會像其他大流行病毒一樣消失或變得不那么致命嗎?我們不知道。”(西迪斯翻譯公司)

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