Until then, I had never seen a patient worsen so fast.

她患有很嚴重呼吸道感染的徵兆

In just two days she was connected to a respirator and on the third day she died.

直到那時為止我從未見過一個病人惡化得那麼快

Sol had whooping cough.

只在兩天裡，她就要接駁呼吸器

After discussing the case in the room and after a quite distressing catharsis, I remember my chief resident said to me, "Okay, take a deep breath. Wash your face.

第三天她就離世了索爾患上了百日咳 在房間裡經過一番討論

And now comes the hardest part:" We have to go talk to her parents."

經過很令人心痛的宣泄之後我記得我的總住院醫師曾經對我說：

At that time, a thousand questions came to mind, from, "How could a one-month-old baby be so unfortunate?" to, "Could we have done something about it?"

「好了，深呼吸，洗個臉吧現在才是最困難 我們要向她的父母解釋。」

Before vaccines existed, many infectious diseases killed millions of people per year.

那時候，我腦海裡出現很多問題從「怎麼一個彌月的嬰兒會這麼不幸？」

During the 1918 flu pandemic 50 million people died.

到「我們是否能做些甚麼呢？」在疫苗出現之前

That's greater than Argentina's current population.

很多傳染病每年奪去數百萬人的性命

Perhaps, the older ones among you remember the polio epidemic that occurred in Argentina in 1956.

1989年流感大流行時期5千萬人死亡

At that time, there was no vaccine available against polio.

比阿限廷現在的人口還多

People didn't know what to do. They were going crazy.

或許，在座有年紀大一點的會記得1956年在阿限廷

They would go painting trees with caustic lime.

發生了一場小兒麻痺流行病

They'd put little bags of camphor in their children's underwear, as if that could do something.

在那時候，沒有適合的疫苗對抗小兒麻痺人們都無計可施

During the polio epidemic, thousands of people died.

他們都快要被迫瘋了

And thousands of people were left with very significant neurological damage.

他們用生石灰畫樹

I know this because I read about it, because thanks to vaccines, my generation was lucky to not live through an epidemic as terrible as this.

他們將小包的樟腦放進小孩的內衣褲裡彷彿可以產生一些作用 在這場小兒麻痺流行病中

Vaccines are one of the great successes of the 20th century's public health.

有幾千人死亡

After potable water, they are the interventions that have most reduced mortality, even more than antibiotics.

另外有數千人患有影響非常大的神經損害後遺症我是因為閱讀而知道這事件的 因為感激疫苗的出現

Vaccines eradicated terrible diseases such as smallpox from the planet and succeeded in significantly reducing mortality due to other diseases such as measles, whooping cough, polio and many more.

我們這世代很幸運不用經歷像那樣恐怖的流行病 疫苗是20世紀公眾健康 其中一個很大的成就

All these diseases are considered vaccine-preventable diseases.

自從有了可飲用的水

What does this mean?

對降低死亡率有很大的幫助

That they are potentially preventable, but in order to be so, something must be done.

甚至比抗生素還大疲苗杜絕地球上很多可怕的疾病

You need to get vaccinated.

例如天花

I imagine that most, if not all of us here today,

更成功大大地降低

received a vaccine at some point in our life.

因其他疾病造成的死亡率，例如麻疹

Now, I'm not so sure that many of us know which vaccines or boosters we should receive after adolescence.

百日咳、小兒麻痺，還有更多以上所有疾病都被視為

Have you ever wondered who we are protecting when we vaccinate?

疫苗可預防疾病這是甚麼意思呢？

What do I mean by that?

即是它們是可預防的

Is there any other effect beyond protecting ourselves?

但要預防，必需做一點東西

Let me show you something.

你需要接種疫苗

Imagine for a moment that we are in a city that has never had a case of a particular disease, such as the measles.

我經常想，如果今天我們都不在這兒在我們人生中某個時候接種疫苗 現在，我不確定 我們當中多少人知道長大成人後

This would mean that no one in the city has ever had contact with the disease.

應該接受哪上疫苗或增壓劑

No one has natural defenses against, nor been vaccinated against measles.

你有沒有曾經想過當我們接種疫苗時

If one day, a person sick with the measles appears in this city the disease won't find much resistance and will begin spreading from person to person, and in no time it will disseminate throughout the community.

我們正在保護誰？我究竟想帶出甚麼意思？ 除了保護我們自身 有沒有帶來其他影響？

After a certain time a big part of the population will be ill.

讓我告訴你一些事試想像現在這一刻

This happened when there were no vaccines.

我們身處在一個城市裡

Now, imagine the complete opposite case.

那裡從沒有發生任何一種疾病

We are in a city where more than 90 percent of the population has defenses against the measles, which means that they either had the disease, survived, and developed natural defenses; or that they had been immunized against measles.

譬如麻疹即是說在城市裡 無一曾經和疾病扯上關係 無一擁有天然防禦力能 或者曾接種疫苗對抗麻疹

If one day, a person sick with the measles appears in this city, the disease will find much more resistance and won't be transmitted that much from person to person.

假若有一天，這個城市出現麻疹有一個人染了病 這個疾病的抗性不高 它會開始人傳人

The spread will probably remain contained and a measles outbreak won't happen.

而且很快就會廣泛地傳播到整個社區在一段時間之後

I would like you to pay attention to something.

很大部分的人都會染病

People who are vaccinated are not only protecting themselves, but by blocking the dissemination of the disease within the community, they are indirectly protecting the people in this community who are not vaccinated.

這種情形是發生在還沒有疫苗的時候現在，想像一下完全相反的情況 我們身處在一個城市 那兒有超過9成人口對麻疹是有防禦能力的 意思即是要不他們是曾經患有麻疹，幸而存活 有了自然的抵抗力

They create a kind of protective shield which prevents them from coming in contact with the disease, so that these people are protected.

要不就是他們本身就已經對麻疹免疫假如有一天 城裡有一個人罹患麻疹

This indirect protection that the unvaccinated people within a community receive simply by being surrounded by vaccinated people, is called herd immunity.

疾病的抗性較高不會那麼容易在人與人之間傳播 病情就可以受到控制 麻疹的爆發亦不會發生

Many people in the community depend almost exclusively on this herd immunity to be protected against disease.

我想請你們注意一點已接種疫苗的人 不單止保障了他們自身

The unvaccinated people you see in infographics are not just hypothetical.

更加阻止了疾病在社區內散播

Those people are our nieces and nephews, our children, who may be too young to receive their first shots.

他們間接保障了社區裡的未接種疫苗人

They are our parents, our siblings, our acquaintances, who may have a disease, or take medication that lowers their defenses.

他們創造了一個保護屏障來避免疾病闖進接觸到人們 因此那些人受到保障 這一種由已接種疫苗的人包圍群體內未接種的人

There are also people who are allergic to a particular vaccine.

令他們簡單地得到的間接保護

They could even be among us, any of us who got vaccinated, but the vaccine didn't produce the expected effect, because not all vaccines are always 100 percent effective.

叫群體免疫有很多在社群裡的人 幾乎只靠這種群體免疫來對抗疾病 你見到圖像裡未接種疫苗的人不只是個假設

All these people depend almost exclusively on herd immunity to be protected against diseases.

那些人是我們的姪女姪兒、我們的孩子他們都可能因為年紀太小 而不能接受首次疫苗注射

To achieve this effect of herd immunity, it is necessary that a large percentage of the population be vaccinated.

那些人或會是我們的父母、兄弟姊妹我們認識的人卻患有疾病

This percentage is called the threshold.

或者接受了藥劑反而會減低他們的防禦能力

The threshold depends on many variables: It depends on the germ's characteristics, and those of the immune response that the vaccine generates.

此外還有一些對於某種疫苗會過敏的人甚至在我們當中 有些人注射了疫苗

But they all have something in common.

但是疫苗達不到預期的效果

If the percentage of the population in a vaccinated community is below this threshold number, the disease will begin to spread more freely and may generate an outbreak of this disease within the community.

因為不是所有疫苗都百分之百有效這些人全部都幾乎 只靠群體免疫來對抗疾病 要實現群體免疫的效用

Even diseases which were at some point controlled may reappear.

必需要很大的人口比例接種疫苗

This is not just a theory.

這個比例叫作閾值數

This has happened, and is still happening.

閾值數取決於很多變數

In 1998, a British researcher published an article in one of the most important medical journals, saying that the MMR vaccine, which is given for measles, mumps and rubella, was associated with autism.

取決於種的特性和疫苗產生的免疫反應 但他們都有一個共通點 那就是，如果已接種疫苗社區的人口比例 低於這個閾值數

This generated an immediate impact.

疾病會更自由無礙地擴散

People began to stop getting vaccinated, and stopped vaccinating their children.

可能會導致該社區爆發疫症

And what happened?

即使之前已受控的疾病都可能再出現

The number of people vaccinated, in many communities around the world, fell below this threshold.

這個不止是理論是有發生過，而且仍然在發生

And there were outbreaks of measles in many cities in the world -- in the U.S., in Europe.

在1998年，一個英國研究者於其中一本很重要的醫學期刊中刊登了一篇論文

Many people got sick.

當中提及專門預防麻疹、腮腺炎及風疹的

People died of measles.

麻腮風三聯疫苗跟自閉症有關

What happened?

這產生了即時性的影響

This article also generated a huge stir within the medical community.

人們開始停止接種疫苗，

Dozens of researchers began to assess if this was actually true.

更不讓他們的孩子接種疫苗

Not only could no one find a causal association between MMR and autism at the population level, but it was also found that this article had incorrect claims.

然後結果呢？全世界很多國家接種疫苗的人數 下跌至低於閾值數 世界各國 — 美國、歐洲都爆發麻疹

Even more, it was fraudulent.

很多人患病

It was fraudulent.

很多人死於麻疹

In fact, the journal publicly retracted the article in 2010.

之後怎樣呢？

One of the main concerns and excuses for not getting vaccinated are the adverse effects.

那篇論文在醫學界亦牽起了巨大的轟動許多研究人員開始著手評估這是否屬實

Vaccines, like other drugs, can have potential adverse effects.

不單沒有一個找到麻腮風三聯疫苗與

Most are mild and temporary.

人口水平上自閉症的因果關係

But the benefits are always greater than possible complications.

更加發現那篇論文存在不實的言論

When we are ill, we want to heal fast.

更甚的是，它是騙人的

Many of us who are here take antibiotics when we have an infection, we take anti-hypertensives when we have high blood pressure, we take cardiac medications.

是欺詐的事實上，在2010年該期刊 公開聲明收回那篇論文 其中一個主要的顧慮和不接種疫苗的藉口 是不利的影響

Why? Because we are sick and we want to heal fast.

疫苗，就像其他藥物

And we don't question it much.

可以帶來潛在的反面影響

Why is it so difficult to think of preventing diseases, by taking care of ourselves when we are healthy?

多數是溫和及短暫的但益處一般都比可能存在的併發症多

We take care of ourselves a lot when affected by an illness, or in situations of imminent danger.

當我們患病，一定要盡快醫治許多人當被感染到傳染病時會服食抗生素

I imagine most of us here, remember the influenza-A pandemic which broke out in 2009 in Argentina and worldwide.

當高血壓時服用降壓藥有時候服食心臟藥 為甚麼呢？因為我們生病，需要盡快治理

When the first cases began to come to light, we, here in Argentina, were entering the winter season.

我們不會對此存疑那為甚麼當我們健康的時候將預防疾病

We knew absolutely nothing.

當作是照顧自己一樣就變得這麼困難呢？

Everything was a mess.

在我們患病時或者在危難迫近眉睫的情形時

People wore masks on the street, ran into pharmacies to buy alcohol gel.

我們懂得好好照顧自己

People would line up in pharmacies to get a vaccine, without even knowing if it was the right vaccine that would protect them against this new virus.

我想在座各位很多都記得2009年在阿根廷及世界各地爆發的流感大流行 當時第一批感染個案曝光時

We knew absolutely nothing.

我們在阿根廷正在步入冬季

At that time, in addition to doing my fellowship at the Infant Foundation, I worked as a home pediatrician for a prepaid medicine company.

當時我們一無所知簡直是一團糟

I remember that I started my shift at 8 a.m., and by 8, I already had a list of 50 scheduled visits.

街上的人們都戴上口罩走到藥房購買酒精液人們在藥房外排隊等候疫苗

It was chaos; people didn't know what to do.

他們甚至不知道那疫苗是否合適

I remember the types of patients that I was examining.

是否能夠保護他們對抗新病毒

The patients were a little older than what we were used to seeing in winter, with longer fevers.

我們完全是一無所知當時，我除了處理我在 嬰幼兒基金會研究金的審查

And I mentioned that to my fellowship mentor, and he, for his part, had heard the same from a colleague, about the large number of pregnant women and young adults being hospitalized in intensive care, with hard-to-manage clinical profiles.

我還在一間預付醫藥公司當家庭兒科醫生我記得當時從早上8時當值至晚上8時 已經有50個預定探訪的名單 那時一片混亂；大家都不知道怎麼辦 我還記得我很留意為哪些類型的病人作檢查 那些病人比我們往常在冬季見到的年紀大一點

At that time, we set out to understand what was happening.

發燒的時間較長一點

First thing Monday morning, we took the car and went to a hospital in Buenos Aires Province, that served as a referral hospital for cases of the new influenza virus.

我向我研究金的導師提及這一點他亦從他的同事聽聞過相同的情況 大量孕婦及年輕成人正在深切治療部留醫

We arrived at the hospital; it was crowded.

他們的臨床資料被歸類為複雜個案

All health staff were dressed in NASA-like bio-safety suits.

在那時候，我們著手瞭解究竟發生甚麼事

We all had face masks in our pockets.

在星期一早上

I, being a hypochondriac, didn't breathe for two hours.

我們駕車到布宜諾斯艾利斯省的一家醫院

But we could see what was happening.

那兒被劃為新型流感病毒個案的轉診醫院

Immediately, we started reaching out to pediatricians from six hospitals in the city and in Buenos Aires Province.

我們到達醫院的時候，那兒很擁擠所有醫護人員都穿上 像美國太空總署的生物安全服

Our main goal was to find out how this new virus behaved in contact with our children, in the shortest time possible.

我們全部在衣袋裡都有面罩我猶如一個疑病症患者，兩小時都不能呼吸 可是我們目睹這是甚麼一回事

A marathon work.

我們立即開始聯絡位於城市及

In less than three months, we could see what effect this new H1N1 virus had on the 251 children hospitalized by this virus.

布宜諾斯艾利斯省一共六間醫院的兒科醫生我們的主要目的是在最短到時間內找出 這種新病毒在接觸小孩時有甚麼表現

We could see which children got more seriously ill: children under four, especially those less than one year old; patients with neurological diseases; and young children with chronic pulmonary diseases.

是一場馬拉松式的工作在三個月內 我們見到新型H1N1病毒 在251個因該病毒而留醫的小朋友身上產生甚麼影響

Identifying these at-risk groups was important to include them as priority groups in the recommendations for getting the influenza vaccine, not only here in Argentina, but also in other countries which the pandemic not yet reached.

我們見到哪些小孩會病得較重：四歲以下，尤其少於一歲的小朋友； 有神經疾病的患者； 與及患上慢性肺部疾病的小朋友 識別這些高危人士很重要

A year later, when a vaccine against the pandemic H1N1 virus became available, we wanted to see what happened.

可以將他們囊括在建議 優先取得流感疫苗的一群裡不單只在阿根廷 在其它流感大流行尚未出現的國家都一樣

After a huge vaccination campaign aimed at protecting at-risk groups, these hospitals, with 93 percent of the at-risk groups vaccinated, had not hospitalized a single patient for the pandemic H1N1 virus.

一年後對抗流感大流行H1N1病毒的疫苗面世 我們想見到會發生甚麼事 在一個以保障高危一族為主的 大型疫苗接種活動後 那些醫院有9成3的高危人士接種疫苗

(Applause)

之後他們再沒有需要留醫H1N1流感的單一患者

In 2009: 251.

（拍掌）

In 2010: zero.

2009年：251宗

Vaccination is an act of individual responsibility, but it has a huge collective impact.

2010年：0宗接種疫苗是個人責任的表現

If I get vaccinated, not only am I protecting myself, but I am also protecting others.

卻帶來龐大的集體影響假如我一經接種，我不單只保障自己

Sol had whooping cough.

更保障了其他人

Sol was very young,

索爾罹患百日咳

and she hadn't yet received her first vaccine against whooping cough.

索爾還很年幼

I still wonder what would have happened if everyone around Sol had been vaccinated.

她不能夠注射首支疫苗來對抗百日咳我仍然在想

(Applause)

如果每一個在索爾身邊的人都已經接種了疫苗