假期，流感再次悄然來襲。截至2019年12月11日，美國已經(jīng)有6名兒童因為流感而死亡，而正如美國疾病控制與預(yù)防中心指出的那樣，“流感季才剛剛開始?！痹诹鞲新有蝿莺棉D(zhuǎn)之前，情況只會更糟：2018年，共有143名兒童死于流感。

在流感病毒肆虐的同時，有關(guān)部門開始再次強調(diào)疫苗的重要性，而人們對疫苗的不滿情緒也日益凸顯。不是說疫苗不好，而是還不夠好。

“善變”的流感病毒，每隔一段時間就會發(fā)生變異，因此每年都需要對疫苗配方進(jìn)行調(diào)整。1918年的流感大流行在全球范圍內(nèi)造成約5000萬人死亡，雖然這只是個案，但突變毒株引發(fā)新一輪的流感大流行的可能性仍然存在。

人們經(jīng)常將流感與許多不太嚴(yán)重、癥狀類似的感染（“感冒”）混為一談，對其威脅也不以為意。但毫無疑問流感非常致命，僅在2017至2018年的流感季節(jié)，美國就有約61000人死于流感，比當(dāng)年死于過量使用阿片類藥物的人數(shù)還多。

白宮經(jīng)濟(jì)顧問委員會的最新報告顯示，流感每年會給美國造成高達(dá)3610億美元的經(jīng)濟(jì)損失，包括醫(yī)療費用、誤工損失和生命損失。而流感疫苗緩慢的生產(chǎn)速度以及10%至60%不等的整體有效率則使問題雪上加霜。在流感大流行期間，現(xiàn)有技術(shù)下的疫苗生產(chǎn)速度趕不上病毒傳播速度，導(dǎo)致?lián)p失大幅增加。以2009至2010年的流感大流行為例，按照白宮經(jīng)濟(jì)顧問委員會的估計，如果能夠提升疫苗生產(chǎn)速度，同時將疫苗有效率提升30%，那么僅通過接種疫苗就能增加約9530億美元的經(jīng)濟(jì)效益。

在近期的年度報告中，全球備災(zāi)監(jiān)測委員會的評估結(jié)果令人憂慮。該報告直截了當(dāng)?shù)刂赋?，各國政府“遇到流感爆發(fā)就不遺余力控制疫情，疫情稍退就又會放松警惕”，如此“好了傷疤忘了疼”的做法已經(jīng)形成了“恐慌與忽視的惡性循環(huán)”。

要更好地應(yīng)對流感威脅，我們需要新的、持續(xù)的金融和技術(shù)投資。而其中首要任務(wù)就是對現(xiàn)有流感疫苗生產(chǎn)進(jìn)行現(xiàn)代化改造，以便迅速實現(xiàn)靶向疫苗的規(guī)?；a(chǎn)，應(yīng)對未來新出現(xiàn)的流感毒株。薩賓-阿斯彭疫苗科學(xué)與政策小組在其近期發(fā)布的報告中指出，現(xiàn)有疫苗生產(chǎn)仍然主要基于20世紀(jì)40年代的技術(shù)。但人命關(guān)天，如果等到威脅出現(xiàn)才開始行動，后果將不堪設(shè)想。

而要消除流感的威脅，我們就必須開發(fā)出能夠長效對抗未來各種流感毒株的通用型疫苗。

流感防控的緊迫性和重要性要求我們盡快采取相應(yīng)措施，綜合使用科學(xué)、技術(shù)和金融手段，集中力量推動通用型流感疫苗的開發(fā)工作。

一方面，美國國立變態(tài)反應(yīng)和傳染病研究所正在開展多項研究，解決諸多基礎(chǔ)科學(xué)層面面臨的挑戰(zhàn)，包括全面了解人體免疫系統(tǒng)預(yù)防流感的機(jī)制及其評估辦法等。另一方面，私營部門和公共部門的投入對突破疫苗研發(fā)瓶頸也有著至關(guān)重要的作用。蓋茨基金會和流感實驗室也推出了“通用流感疫苗開發(fā)大挑戰(zhàn)”項目，呼吁科學(xué)界尋找新的疫苗開發(fā)策略。

大膽設(shè)想并果斷行動已經(jīng)刻不容緩。如果現(xiàn)在就進(jìn)行必要投資，那么未來就能大幅降低流感造成的高昂損失。（財富中文網(wǎng)）

哈維·V·費恩伯格博士、雪莉·M·蒂爾格曼博士是薩賓·阿斯彭疫苗科學(xué)與政策小組的聯(lián)合主席。

譯者：梁宇

審校：夏林

An unwelcome visitor during the holiday season has returned: influenza. As of December 11, 2019, six children have already fallen victim to the disease. And, as the Centers for Disease Control and Prevention (CDC) points out, “the flu season is just getting started.” It will only get worse before it gets better: Last year’s pediatric death total was 143.

With the spread of the virus comes the annual message stressing the importance of vaccination. Yet at the same time comes disappointment with the performance of current vaccines. They are good—but just aren’t good enough.

Influenza is a fickle virus. It regularly mutates, requiring adjustments to the vaccine’s formula every year. While only rarely do these unpredictable mutations turn the virus into an international killer on the scale of the 1918 influenza pandemic—which killed around 50 million people globally—the possibility of such a variant strain that could trigger a global pandemic looms each year.

The confusion of influenza with the many less serious, similarly symptomatic, infections that are commonly labeled “the flu” often contributes to complacency about the threat influenza poses. Make no mistake, influenza is a killer: In the U.S., the 2017 to 2018 season took an estimated 61,000 lives—more than the deaths from opioid overdoses that year.

Influenza extracts a heavy economic toll, costing the U.S. $361 billion each year, including health care costs, work missed, and lives lost, according to a recent report by the White House Council of Economic Advisors (CEA). Exacerbating this is the slow pace of manufacturing annual influenza vaccines combined with effectiveness rates that range from 10% to 60%. And these costs would increase considerably during a pandemic where the spread of the disease outpaces existing vaccine production technology. In the 2009 to 2010 pandemic, for instance, the CEA report estimates that combining an increased speed of production with a 30% improvement in vaccine effectiveness would have added around $953 billion in increased economic benefit from vaccination.

In its recent annual report, the Global Preparedness Monitoring Board (GPMB) gave a candid and urgent assessment, noting that governments have established “a cycle of panic and neglect when it comes to pandemics,” where there is a “ramp[ing] up efforts when there is a serious threat,” which is forgotten “when the threat subsides.”

To face down these threats, new, sustained investments—both financial and technical—are required. Modernizing the influenza vaccine manufacturing industry—and rapidly scaling up production of tailor-made vaccines to protect against newly-emergent influenza strains—is an important start. Current vaccine manufacturing remains largely based on 1940s technology, as our recent report from the Sabin-Aspen Vaccine Science & Policy Group highlights. But the stakes are too high to be satisfied with a response that begins only after a threat surfaces.

Eliminating the threat requires a universal influenza vaccine that provides effective, long-lasting protection against any future influenza virus strain.

The urgency and magnitude of the threat calls for an equally matched response—one that combines scientific, technical, and financial assets focused on the single-mission of developing a universal influenza vaccine.

In addition to current efforts by the National Institute of Allergy and Infectious Diseases (NIAID) to tackle the many foundational scientific challenges—such as a full understanding of how the human immune system protects against influenza and how to measure that protection—new private and public sector investments are essential to propel vaccine discovery beyond the current limitations. Efforts like the Gates Foundation and Flu Lab’s “Universal Influenza Vaccine Development Grand Challenge” call on the scientific community to find new, innovative strategies for vaccine development.

It is time for a bold vision and even bolder action. If the necessary investments are made now, the high costs that influenza will exact on the future would be radically diminished.

Dr. Harvey V. Fineberg and Dr. Shirley M. Tilghman are co-chairs of the Sabin-Aspen Vaccine Science & Policy Group.