五年前比尔·盖茨最害怕的事情真的发生了

在未来20年内，最有可能杀死超过1000万人的生命是什么？可能不是您想的那样。

这有可能是像战争一样糟糕的东西，有和战争一样多的人丧生的东西，而比尔·盖茨并不认为我们已经为此做好了准备。

他说：“看看20世纪的死亡图。”因为他是那种看得懂死亡曲线图的家伙。 “我想每个人都会说第一次世界大战一定会有一个高峰。当然，第一次世界大战死亡达到2500万。第二次世界大战一定会有一个大高峰，而且确实有6500万。但是然后您会看到紧接着第一次世界大战，与第二次世界大战一样大的另一个峰值，大多数人会说，那是什么？”

“那是西班牙的流感。”

在1990年有关“传染病人类学”的论文中，玛西娅·英霍恩（Marcia Inhorn）和彼得·布朗（Peter Brown）估计，传染病夺走的生命可能比战争，非传染病和自然灾害加在一起还要多。

传染病是我们最古老，最致命的敌人。

今天仍然如此。疾病控制和预防中心主任托马斯·弗里登（Thomas Frieden）博士说：“在较好的一年中，流感杀死了10,000多名美国人。” “在糟糕的一年中，它造成的死亡人数是五倍。如果发生大流行，情况将会更加糟糕。人们认为H1N1流感还没有那么严重。但是，有1000多名美国儿童死于H1N1！”

五年前比尔·盖茨最害怕的事情真的发生了！

00:00 Ezra Klein: why don't you describe for me as vividly as you can 00:04 what it is you're worried about. what it is nightmare scenario looks like? 00:09 Bill Gates: Fortunately, there's very few things and most of them are very low 00:13 probability 00:14 some big volcanic explosion 00:17 A giant earthquake, asteroid 00:22 At least in the nuclear case 00:24 you gotta say we take it quite seriously. We budget a lot of money, have a lot of 00:29 people who think about nuclear deterrence, 00:31 I'm very glad that works being done and 00:34 I rate the chance of a nuclear war in my lifetime has being fairly low. 00:39 I rate the chance of a widespread epidemic far worse than Ebola 00:43 in my lifetime as well over 50 percent. 00:50 If we look at the 20th Century, and we look at the death chart 00:53 of the 20th Century, I think everybody would say oh yeah there must be a spike 00:57 from World War I 00:59 and you know sure enough there it is like 25 million 01:02 and I must be a big spike for World War II, and there it is – like 65 million 01:06 but then you'll see this other spike that 01:09 is as large as World War II, right after World War I – and most people, a lot 01:14 of people say what? Wait a minute – what was that? 01:19 There's two kinds of flus: 01:21 There's flus that spread between humans very effectively 01:24 and there's flus that kill lots of people. And those two properties have 01:28 only been combined 01:31 I into a widespread flu 01:33 once in history. That is Spanish Flu. 01:38 We have no idea where it came from – it's called the Spanish flu 01:41 because the Spanish press was the freest, 01:43 they were the first to talk openly about it. 01:46 and so in the annals of epidemic history that's the big event. 01:52 I funded a disease modeling group that uses computer simulation 01:56 and that work has been phenomenal in helping us 02:00 target our polio eradication resources – which parts of nigeria should we 02:04 work harder on? And it's very natural if you have a group like that to say hey 02:09 look at something like the Spanish flu in the modern day. 02:13 Health systems are far better and so you'd think, hey that wouldn't be very bad. 02:17 Well, we tried it – and there are some assumptions we had to make – but what we showed is that the 02:23 force of infection, because modern transport 02:26 which be compared to 1918 is over fifty times as great, 02:30 if you get something like the [Spanish] flu and you look at that map 02:34 of how within days it's basically 02:38 in all urban centers of the entire globe 02:41 That is very, uh, eye-opening. 02:44 that didn't happen with Spanish flu in the past. 02:54 The opportunity in did do more than just 02:58 let it run its course is really only in the last decade 03:02 basically when you talk about drugs, you can talk about small molecules or you can talk about 03:06 these 03:06 complex biological protein like things which is a subclass called antibodies 03:11 antibodies are the molecules the immune system naturally builds to attack disease 03:16 Today, the idea that somebody says oh here's an antibody 03:19 make a lot of it made it very quickly that's right on the cutting edge. 03:23 and the Ebola epidemic showed me that we're not ready 03:27 for a serious epidemic. An epidemic that would be more infectious and would spread faster 03:32 than Ebola did. This is the greatest risk 03:36 have a huge tragedy. This is the most likely thing by far 03:40 to kill over 10 million excess people 03:44 in a year. We don't need to invest nearly what we do 03:47 in military preparedness. this is something where 03:51 less than a billion a year on R&D, medical surveillance, 03:56 on standby personnel, cross-training the military so they can play a role in 04:00 terms of all the logistics here. This can be done 04:03 and we may not get many more warnings like this one 04:07 to to say okay it's a pretty modest investment 04:10 to avoid something that, really, in terms of the human condition would be a 04:15 gigantic setback.

00:00 以斯拉·克莱因（Ezra Klein）：为什么不尽你所能地、生动地描述给我 00:04 您担心的是什么。（可能发生的）噩梦场景是什么样的？ 00:09 比尔·盖茨：幸运的是，这样的场景很少，而且大多数发生的可能性都非常低 00:13 可能性 00:14 一些大的火山爆炸 00:17 特大地震，小行星 00:22 至少在核威胁方面 00:24 你不得不承认我们非常重视。我们预算很多钱，有很多 00:29 想起核威慑的人 00:31 我很高兴这项工作已经完成， 00:34 我认为一生中发生核战争的机会非常低。 00:39 我认为瘟疫广泛流行的可能性远比埃博拉疫情严重 00:43 在我的有生之年（发生的）可能性也超过了50％。 00:50 如果我们观察20世纪的死亡曲线图 00:53 我认为每个人都会说20世纪20年代有一个高峰 00:57 那是第一次世界大战 00:59 而且你知道大概有2500万死亡 01:02 而且我一定知道第二次世界大战又又一个峰值，那是6500万 01:06 但是您会看到还有一个峰值 01:09 在一战之后，数值就和第二次世界大战一样大-大多数人 01:14 可能会说什么呢？（他们会说）：等一下-那是什么？ 01:19 有两种流感： 01:21 流感在人与人之间的传播非常有效率 01:24 流感会杀死很多人。这两个属性如果 01:28 仅合并一起 01:31 （就成为特大）流感了 01:33 历史上有一次。那就是西班牙流感。 01:38 我们不知道它来自哪里-这就是西班牙流感 01:41 因为西班牙媒体是最自由的 01:43 他们是第一个公开谈论它的人。 01:46 在流行病史上，这是一件大事。 01:52 我资助了一个使用计算机仿真的疾病建模小组 01:56 这项工作非常了不起，为我们 02:00 有针对性的分配消灭小儿麻痹症的资源提供了巨大的帮助-我们应该在尼日利亚的哪个地区 02:04 做更多地工作？如果你有一个这样的团队说，嘿，这是很自然的 02:09 看看现代的西班牙流感之类的东西。 02:13 卫生系统要好得多，所以您会想，嘿，还不错。 02:17 好吧，我们进行了尝试-我们必须做出一些假设-但是我们展示的是 02:23 感染力，因为现代运输 02:26 相较于1918年，这个数字大了50倍， 02:30 如果您有类似[西班牙]流感的症状，然后您查看该地图 02:34 几天之内 02:38 在全球所有城市中心（都感染了） 02:41 嗯，真是令人大开眼界。 02:44 过去西班牙流感没有发生这种情况。 02:54 有机会让我们做得更多，（而不是） 02:58 让流感病毒自由蔓延，实际上只是在过去的十年中 03:02 基本上，当您谈论药物时，您可以谈论小分子或您可以谈论 03:06 这些 03:06 复杂的生物蛋白（这样地东西）是称为抗体的子类 03:11 抗体是免疫系统天然构建的可抵抗疾病的分子 03:16 现在，大家有这样地想法，说：哦，既然这是一种抗体 03:19 我们可以充分利用它，我们使用最先进地科学技术手段，最快速度地制造很多出来。 03:23 埃博拉疫情向我表明我们还没有准备好 03:27 严重的流行病。传染性更强，传播速度更快的流行病 03:32 比埃博拉病毒更大。这是最大的风险 03:36 有一个巨大的灾情。到目前为止，这是最可能的情形是 03:40 可能一年内杀死超过一千多万余人 03:44 我们几乎不需要投资什么 03:47 跟军事准备上所投入的费用相比较来说。这写投资用于 03:51 每年在研发，医疗监控， 03:56 对待命人员进行交叉训练，以便他们可以在 04:00 后勤保障方面担当角色。可以做到 04:03 而且我们可能不会收到很多像这样的警告 04:07 可以说这是一笔不算多的投资 04:10 但在人类状况方面，确实是可以避免 04:15 巨大的挫折。