疫苗探究欲:从一场约会看公众的真实疑虑
2018年夏天,我去参加了一次初次约会。当时我已经三十出头,这当然不是我人生中的第一次约会。因此,除了啤酒和卷饼,我并没有抱太大期望。直到我喝了太多的啤酒,并陷入了深度对话。在夜幕降临时,我向他提出了一个问题:“你打算给你的孩子们接种疫苗吗?”(笑声)他的回答是:“当然,除了流感疫苗,因为流感疫苗里有病毒,每次我接种后都会生病。”我想他大概没有意识到,坐在他桌子对面的,是一位刚刚发明了一种新型流感疫苗,并且该疫苗当时已计划进行临床试验的女性。(笑声)
但与此同时,我还是美国国家卫生研究院(National Institutes of Health)疫苗研究中心的博士后研究员。所以通常情况下,这个回答会让我打包走人去寻找下一个初次约会的对象,但我喜欢这个家伙。所以我留了下来,在又拿了一杯啤酒后,我回答了他的几个问题。我告诉他,是的,流感疫苗中确实含有病毒,但这些病毒并不是活的,因此从技术上讲,它们无法“让你生病”。当然,在注射后你可能会感到有些浑身无力,但这只是你的免疫系统正在发挥作用的信号。我问了他一个简单的问题:他是否知道有200多种病毒都可以引起流感样症状或普通感冒?当然,他没有答案,但这就是你带一个疫苗学家去约会的结果。(笑声)
令人惊讶的是,他并没有生气,而是约我进行了第二次约会。从这个家伙身上,我得到的不仅仅是第二次约会,我还第一次理解了我现在喜欢称之为**“疫苗探究欲”**(Vaccine Inquisitiveness: 公众对疫苗持有的非恶意疑问与探索心态)的概念。他并不是单纯地不情愿让自己或未来的孩子们接种疫苗,而是他心底埋藏着疑问、担忧和被误导的信息,他需要像我这样的专家,在没有嘲讽和评判的情况下为他解答。
Original English
So in summer 2018, I went on a first date. Now, in my early 30s, this, of course, was not my first first date. And so I wasn't expecting much except for some beers and tacos. That was until I was too many beers in and too deep in conversation. My question to him at the end of the night: "Do you plan to vaccinate your kids?" (Laughter) His reply? "Sure, except for the flu vaccine, because the flu vaccine has viruses in it, and every time I take it, I get sick." I guess he didn't realize that he was sitting across the table from a woman who had just invented a novel flu vaccine that was then slated for clinical trial. But -- (Laughter) At the same time, I was a research fellow at the National Institutes of Health Vaccine Research Center. And so normally, that answer would have sent me packing onto my next first date, but I like this guy. And so I stayed and I answered a few questions after getting another beer. I told him that, yes, the flu vaccine does have viruses in it, but those viruses are not alive and so they technically cannot "make you sick." Sure, you may feel a little groggy after getting the shot, but that's just a sign that your immune system is working. And I asked him a simple question. Did he know that there are 200 or more viruses that can cause flu-like symptoms or the common cold? Of course, he didn't have an answer, but that's what you get when you take a vaccinologist on a date. (Laughter) Surprisingly, he was not offended and he asked me out on a second date. And I got more than a second date out of this guy. I got my first understanding of what I now like to call “vaccine inquisitiveness.” It wasn't that he was just reluctant to get himself vaccines or to get his future children vaccinated. It was that he had questions, concerns, misinformation buried deep down, for which he needed an expert like myself to answer without scorn and without judgment.
创纪录的突破:从实验室走向临床的mRNA疫苗
在这场约会促使我更深入思考公众对疫苗的态度后,另一场席卷全球的危机则将我和我的团队推向了抗疫的最前线。我回到了实验室,继续做我的本职工作——研发疫苗。接下来的第二年12月31日,有报告称中国武汉出现了一种神秘的病毒,已导致27人患病。这是我们团队一直在准备的时刻。你看,我不仅在流感团队中,同时也是冠状病毒疫苗团队的科学负责人。(欢呼与掌声)
你看到冠状病毒表面的那些橙色蛋白质了吗?那些被称为刺突蛋白(Spike Protein: 病毒表面负责结合宿主细胞并引发免疫反应的结构)。我们研发出了一种刺突蛋白,它带有一个微小的序列变化,使其在发生大流行时成为理想的候选疫苗。而这正是发生的事情。2020年1月,当时正在传播的病毒被确定为一种冠状病毒。我们与莫德纳(Moderna)公司联手,并向自己承诺,我们要在短短100天内进入第一期临床试验。顺便说一句,这纯粹是一个科学目标。但当我回顾并写下这篇演讲稿时,我想其中可能也有一些虚荣心作祟。但这没关系,因为我们做到了。(笑声)(欢呼与掌声)
我的意思是,在实验室度过了无数个小时,在小鼠和猴子身上测试了该疫苗,并确定其安全且足够有效以便进入人体测试后,这种疫苗——mRNA-1273,或者你们现在所熟知的Spikevax(Spikevax: 莫德纳研发的新冠 mRNA 疫苗商品名)——在短短66天内就进入了第一期临床试验,创造了世界纪录。(欢呼与掌声)到年底,该疫苗被确定对疾病的有效率达到94%。所以显而易见,我们为自己感到自豪。
Original English
Nevertheless, I went back into the lab and I did what I do, making vaccines. And then on December 31 of the next year, there was a report of a mysterious virus in Wuhan, China. It had sickened 27 people. This was a moment that my team had prepared for. You see, not only was I on the flu team, but I was also the scientific lead of the coronavirus vaccine team. (Cheers and applause) You see those orange proteins on the surface of this coronavirus? Those are called spike proteins. And those proteins are responsible for driving immunity. So we developed a spike protein with a small sequence change that made it an ideal vaccine candidate in case of a pandemic. And that's exactly what happened. In January of 2020, that virus that was circulating was deemed to be a coronavirus. We joined forces with Moderna, and we promised ourselves that we were going to get into a phase-1 clinical trial in only 100 days. A purely scientific goal, by the way. But as I look back and I write this speech, I think there was probably a little bit of ego attached to it too. But that's OK because we did it. (Laughter) I mean. (Cheers and applause) After countless hours in the lab, testing that vaccine in mice and monkeys and determining that it was safe and effective enough to go into humans, that vaccine, mRNA-1273, or what you now know to be called Spikevax, went into a phase-1 clinical trial in only 66 days, a world record. (Cheers and applause) At the end of the year, that vaccine was determined to be 94 percent effective against disease.
沟通的盲区:直面疫苗犹豫与科普失误
尽管我们在科学上取得了如此迅速且令人瞩目的成就,但走出实验室后,公众对这项新技术的反应却给我们泼了一盆冷水。对我来说,重重的一击是,有20%的人被世界卫生组织(WHO)称为疫苗犹豫者(Vaccine Hesitancy: 对接种疫苗持有迟疑、推迟或拒绝的态度)。疫苗犹豫 authority 并不是什么新鲜事。甚至在大流行之前,疫苗犹豫就被认为是全球十大健康威胁之一。全球十大健康威胁。而这是即使我能制造出疫苗也无法解决的问题。事实是,像我这样的疫苗学家长期以来忽略了这一群体,他们因为这样或那样的原因就是不肯接种疫苗。我们太忙于在世界知名期刊上发表我们的数据,有点像是在自说自话。
另一个事实是,我们在大流行期间犯下了一些诚实的沟通错误。而我将是第一个站出来谈论我自己的人。我第一次上电视时,我说疫苗将遏制传播。在当时,它确实做到了。但我应该说的是,随着时间的推移,随着病毒发生变异,疫苗在遏制传播方面可能不会那么有效。然后,我们本应该给予更多的一点关怀和温柔,去和人们谈论疫苗伤害(Vaccine Injury: 接种疫苗后可能出现的罕见不良反应或损伤)的可能性。即使疫苗伤害没有在我们的临床试验中显现出来,这种可能性也总是存在的,而对于那些正在阅读关于疫苗伤害的头条新闻,并决定是否要让自己或亲人接种疫苗的人来说,那些统计数据并不重要。
你看,有些人的疑问和担忧是真正合理的。有些人实际上也提出了真正合理的批评。除了有一次,当他们说我在 CNN 上的发型很丑时,互联网上一片哗然。(笑声)我觉得自己还挺可爱的。(笑声与掌声)严肃地说,主要的担忧之一是我们的速度太快了。所以我就站在这里——这是中间吗?——站在这个 TED 圆圈的中间说,在大流行之前就已经进行了如此多的研究。人们研究了冠状病毒的基础生物学。诺贝尔奖获得者研究了如何使 mRNA 可行,从而将药物输送到体内。我们也做了我们该做的事。尽管如此,所有这些研究都推动了冠状病毒疫苗能够更快、更安全、更有效地问世。尽管如此,有些人仍然有需要解答的问题。
Original English
So we were proud of ourselves, obviously. But what was the gut punch for me was that 20 percent of people were what the WHO would call vaccine hesitant. Now, vaccine hesitancy is not new. Even prior to the pandemic, vaccine hesitancy was deemed to be one of [the] top 10 global health threats. Top 10 global health threats. And that is something that even me, making vaccines, was not going to fix. And the truth of the matter is that vaccinologists, like myself, had long ignored this population of people who just were not going to take vaccines for one reason or the other. We were too busy publishing our data in world-renowned journals, kind of talking to ourselves. And the other truth of the matter is that we made some honest communication mistakes during the pandemic. And I'll be the first to just talk about myself. The first time I got on TV, I said that the vaccine was going to curb transmission. And at that time it did. But what I should have said is that over time, as the virus mutates, the vaccine may not be as good at curbing transmission. And then we should have taken just a little bit more care and tenderness to talk to people about the possibility of vaccine injury. Even if vaccine injury didn't turn up in our clinical trials, there was always this possibility, and those types of stats didn't matter to someone who was reading headlines about vaccine injury and deciding whether they were going to get themselves or their loved ones vaccinated. You see, some people had questions and concerns that were genuinely valid. And some people actually had criticisms that were genuinely valid, too. Except for that one time the internet went ablaze when they said my hair was ugly on CNN. (Laughter) I like to think that I'm pretty cute. (Laughter and applause) Seriously though, one of the major concerns was that we were moving too fast. And so I'm going to stand right here -- is this the middle? -- In the middle of this TED circle and say, there was so much research that was done prior to the pandemic. People studied coronavirus’s basic biology. The Nobel laureate studied how to make mRNA feasible to deliver medicines into the body. We even did our thing, too. Nevertheless, all of that research pushed the coronavirus vaccine out quicker, safer and more effectively. All of that notwithstanding, some people still had questions that needed to be answered.
科学与社区的融合:未来大流行防线的基石
在意识到沟通失误和历史局限性导致了当前的信任危机后,我们必须思考如何为下一场不可避免的大流行构建更为牢固的防线。有些人仍然对疫苗持有探究欲。不,他们不是反疫苗者,甚至也不是反科学者。他们只是没有被说服。而我们作为科学家的工作就是说服他们。然而,失败的沟通仍在继续,我担心一些失败的沟通可能是我们今天看到疫苗拒绝率上升的原因。幼儿园的小朋友去上幼儿园时没有接种完整的疫苗方案。麻疹在许多社区呈上升趋势。顺便说一句,麻疹是一种疫苗可预防疾病(Vaccine-preventable Disease: 可以通过接种疫苗有效预防的传染病)。对我来说,这真的很不幸,因为我知道有23个病毒科具有感染人类的潜力。所以这不是会不会有另一次大流行的问题,而是什么时候发生的问题。
所以我想我很幸运,因为我永远不用担心失业。但作为哈佛大学的一名疫苗发明人,我的实验室研究如何将纳米颗粒或微小的蛋白质球制成疫苗。我们把病毒蛋白放在这些纳米颗粒的表面,就像是“即插即用”的方式,通过微小的连接体,使我们能够将这些病毒蛋白直接引导到我们所需的免疫系统细胞中,从而制造出应对大流行的理想疫苗。我们几乎可以把任何类型的病毒蛋白放在表面,甚至可以同时放很多种,这样我们就可以制造出假设可以通过一针预防多种病毒的疫苗。
太棒了。疫苗技术将不断向前发展,但我相信疫苗犹豫并不需要随之不断发展。只要研究人员能够对疫苗探究欲敞开心扉,就像我们对科学探究欲敞开心扉一样。如果社区与科学相遇。这其实并不是什么革命性的想法。我们已经知道,当社区与科学相结合时,科学发展得更快,疫苗拒绝也会转变为疫苗接受。实际上,当一个对疫苗有探究欲的人与一个科学家相遇约会,它就会演变成一段婚姻。(欢呼与掌声)其中一件事是,我的丈夫在我们每次带孩子去接种疫苗时仍然会提出疑问。而我仍然必须找到答案。不仅是作为一个科学家,现在也是作为一个母亲,因为我关心我孩子的安全,而我孩子的生命取决于此。
Original English
Some people were still vaccine inquisitive. No, they were not anti-vax and no, they weren't even anti-science. They were unconvinced. And it was our job as scientists to make them convinced. Except that failed communication lingered on, and I'm afraid that maybe some of that failed communication is the reason why today we have a rise in vaccine refusal. Kindergartners are showing up to kindergarten without their full vaccine regimens. Measles is on the rise in many communities. And measles, by the way, is a vaccine-preventable disease. And for me, that's really unfortunate because I know that there are 23 viral families that have the potential to infect humans. So it's not a question of whether there will be another pandemic. It's a matter of when. And so I guess I'm lucky because I will always have a job. But as a vaccine inventor at Harvard University, my lab studies how to make nanoparticles or small protein balls into vaccines. We put viral proteins on the surfaces of those nanoparticles, kind of in a click-and-bait way, with small linkers that allow us to drive those viral proteins directly to the cells in the immune system that we need to make ideal vaccines for pandemics. We could put just about any type of viral protein on the surface, many of them at the same time, so that we can make vaccines that are hypothetically good against many viruses in one shot. Great. Vaccine technology is going to go on and on and on, but I like to believe that vaccine hesitancy does not have to go on and on and on with it. If researchers would just open their minds to vaccine inquisitiveness, in the same way that we open our mind to scientific inquisitiveness. If community and science were to meet. And that's not really that revolutionary. We already know that when community and science meet, science advances faster, vaccine refusal turns into vaccine acceptance. Actually, when [a] vaccine inquisitive meets a scientist on a date, it turns into a marriage. (Cheers and applause) You know, one thing about this is that my husband still has questions every single time we take our children to get their vaccines. And I still have to find the answers. Not just as a scientist, but now as a mother, because I'm concerned about my children's safety and my children's lives depend on it. Thank you. (Cheers and applause)
📌 文中提及的人物和组织
公司/组织: National Institutes of Health, Moderna, Harvard University
产品/模型: Spikevax