70年後 在開發流感疫苗這件事上我們爲什麼進展緩慢

After 70 years, why aren’t we better at developing flu vaccines?

今年的流感疫情非常嚴峻。從去年秋天至今，已經有數千美國人死於流感，其中包括56名兒童。美國疾病控制與預防中心已經發布了流感預警，而現在我們纔剛剛進入二月，也就是流感疫情通常會集中爆發的月份。

This year’s influenza season is a serious one. Thousands of Americans — including 56 children — have died from the flu since last fall. The Centers for Disease Control and Prevention (CDC) has labeled the outbreak an epidemic, and we’re barely into February, the month that typically brings the peak of the season.

流感疫情如此嚴重的部分原因是，今年的流感疫苗注射效果是近十年來最弱的一次。這或許也可以解釋今年的流感疫情爲什麼如此早地就達到流行病級別。美國疾病控制與預防中心表示，今年的流感疫苗有效率只有23%，遠低於往年50%到60%的水平。

Part of the problem is this year’s flu shot has been one of the least effective in a decade, and it may account for why we are seeing the flu reach epidemic levels so early this season. The current flu vaccine is only 23% effective, compared to between 50% and 60% efficacy for a typical seasonal flu vaccine, according to the CDC.

流感疫苗並不是一項高新技術，早在1935年，人類就測試了第一支流感疫苗。僅僅7年後，也就是1942年，美國就開始在美軍基地裏進行大規模的流感疫苗研究。那麼經過了70多年的研究，爲什麼我們還沒有創造出一種持續有效的流感疫苗呢？

The flu vaccine isn’t a newfangled technology. The first human influenza vaccines were tested as early as 1935, and extensive flu vaccine studies were started on U.S. army bases in 1942. So, after more than 70 years of research, why aren’t we better at creating a consistently effective seasonal flu vaccine?

分析流感變種

Analyzing the strains

每年2月，世界衛生組織都會召集全球流感專家進行研討，以確定下一季流感疫苗所使用的病毒株。全球科學家和醫生都在努力收集和分析當前流行的病毒株，希望找到那些有可能演化爲新流感的病毒變種。

The answer to that question begins in February of every year, when global flu experts and the World Health Organization meet as part of an annual consortium to peg the influenza strains for the following season’s flu vaccine

美國疾病控制與預防中心的世衛合作中心負責人傑基o卡茨表示：“這是一個持續不斷的過程。一個病毒的變種會衍生出一系列變種。它是一種持續不斷的線性進化，但也是很難預測的。想獲得一支精確的流感疫苗，關鍵就在於及時獲得病毒樣本，這樣我們才能及時分析，準備下一年的疫苗。”

Scientists and doctors from around the world work diligently to collect and analyze the flu strains currently in circulation, looking to pinpoint mutations that could become ground zero for a new epidemic.

一旦這些病毒株被確定，專家就會針對其中的三到四種，來研製下一年的疫苗。這些病毒株會被大量生產，然後交給葛蘭素史克、諾華和賽諾菲等生產廠家來生產和銷售——這個過程需要顯著的提前期，才能保證疫苗在10月初到達各地的醫院。

“It’s a constant process,” said Jackie Katz, the head of the CDC’s WHO collaborating center. “One set of mutations will build on another. It’s a constant sort of linear evolution, but it’s one that is very hard to predict. One of the key features to get an accurate vaccine is having the viruses arrive in time, so we can characterize and analyze these viruses for the coming season.”

去年二月中旬開始的疫苗研製過程，也和往年沒有什麼差別。來自美國疾病控制與預防中心、美國食品藥品監督管理局(FDA)、美國國家衛生研究院和世界衛生組織和其他國際機構的官員在瑞士日內瓦召開會議，確定了下一年度可能在北半球流行的流感病毒株，然後將它們交給生產廠商。（爲了給南半球研製流感疫苗，去年9月也召開了另一場類似的峯會。）

Once those strains are identified, the experts choose three to four to include in the next season’s vaccine. Those strains are then produced and handed off to manufacturers, such as GlaxoSmithKline, Novartis and Sanofi, to produce and distribute — a process that requires significant lead time to ensure the doses reach doctor offices by early October.

到了去年三月，一種流感病毒的變種突然出現了，科學家們知道它有肆虐的可能，但爲時已晚。卡茨表示：“時間是我們研製流感疫苗最大的敵人。”

This same process happened in mid-February last year. Officials from the CDC, Food and Drug Administration, National Institute of Health, WHO, and other international bodies, met in Geneva, Switzerland, to pinpoint the strains that would be prevalent in the Northern Hemisphere then handed those off to manufacturers. (A separate but similar summit happens for the Southern Hemisphere in September.)

疫苗是如何生產的

The problem came in March when a mutation showed up that scientists knew would wreak havoc, but it was too late. “Time is one of our biggest enemies for the flu vaccine,” said Katz.

據葛蘭素史克公司介紹，最普通的流感疫苗生產方法往往會使用雞蛋，這個過程會持續5個月。幾百萬只受精的雞蛋會被用作流感病毒的培養基，然後病毒會被收集、提純並裝進藥瓶。在疫苗正式投放全國之前，生產廠家和FDA會測試它們的效能和安全性。

How vaccines are made

這個方法從上世紀50年代就開始採用。這是一個緩慢且冗長的過程，尤其是考慮到它面臨的挑戰。首先，生產過程依賴足夠的受精雞蛋。如果雞蛋的供給不足，那就會影響免疫血清的產量。其次，有些病毒變種在雞蛋裏成長得並不好，有的還會發生意想不到的變異，從而影響疫苗的效能。

The most common vaccine production method useschicken eggs. This process takes about five months, according to GlaxoSmithKline. Millions of fertilized eggs are used as a culture to grow influenza viruses, which are then harvested, purified and packaged into vials. Manufacturers and the FDA then test for potency and safety before shipping the lot releases around the country.

約翰霍普金斯大學布隆伯格公共衛生學院教授安德魯o皮克茲表示：“問題的關鍵在於要改變疫苗的生產方式，它是制約疫苗精確性的一個重要因素。其實，我們確定這些病毒株的速度是非常快的，尤其考慮到它對細節的要求。”

This method has been in practice since the 1950s. It’s slow and tedious, especially given the challenges. Firstly, manufacturing relies on the availability of enough fertilized eggs. If egg supplies were ever compromised it would affect our ability to produce enough serum. Second, some flu strains don’t grow that well in chicken eggs and undergo undesirable mutations that affect the potency of a seasonal vaccine.

從2013年1月起，一種新的疫苗生產方式開始進入市場。它的生產速度更快，不需要用雞蛋作爲培養基，而且它的效能可能會更高。這種疫苗被稱作“重組蛋白疫苗”，它採用了一種流感病毒蛋白質，這種蛋白質是通過改變一種感染昆蟲細胞的病毒的基因而合成的。它可以引發人體的免疫反應，生成保護性抗體。

“The question is about changing the way these vaccines are made. It’s the real factor limiting the accuracy,” said Andrew Pekosz, a professor at Johns Hopkins University’s Bloomberg School of Public Health. “The speed at which we can identify these strains, especially given the level of detail, is very rapid.”

FluBlok是第一支也是首支獲得FDA認證的重組蛋白疫苗。其製造商Protein Sciences公司的女發言人雷切爾o菲爾伯鮑姆指出：“生產出疫苗只需要幾個星期，而不是幾個月。另外它還含有三倍的抗原，能起到更好的保護效果。有了這項技術，我們基本上避免了時間上的拖延。”

As of January 2013, a new vaccine production method hit the market. It’s faster, egg-free and potentially more effective. It’s called a recombinant protein vaccine and uses an influenza virus protein that’s made by genetically altering a virus that infects insect cells. The resulting protein is what triggers the immune response in humans to make protective antibodies.

重組蛋白疫苗通常需要6到12周的生產時間。在發生流感大爆發的情況下，Protein Sciences只需要3到6個月的時間，就能向全美提供5000萬支流感疫苗。而用雞蛋培養的疫苗要想達到這樣的應急產量，則至少需要6個月的時間。

“It takes only weeks versus months to produce,” said Rachel Felberbaum, a spokeswoman for Protein Sciences, the maker of FluBlok, the first and only FDA approved recombinant influenza vaccine. “It also has three times the antigens, which helps protect better. We can do that without a time lag because of the technology.”

與時間賽跑

The recombinant vaccine typically takes between six to 12 weeks to manufacture, and in the case of a pandemic Protein Sciences is ready to provide 50 million doses to the U.S. government in as quickly as three to six months. Egg-based vaccines would require at least six months for similar emergency output.

重組技術通過基因手段在成長速度更快的昆蟲細胞中孵化流感蛋白質，從而可以爲科學家節省更多寶貴的時間，更精確地確定下一季可能爆發的流感病毒變種。它必定能夠幫助科學家更好地研製今年的疫苗。

Vying for time

皮克茲表示：“我們只需要花四五個星期的時間，就能信心十足地抓住即將流行的流感病毒變種的長尾巴。”

Recombinant technology — which uses genetic modification to incubate the flu proteins in faster-growing insect cells — could help carve out the vital time that scientists need to more accurately target influenza strains that will circulate during the upcoming season. It certainly would have helped scientists better target this year’s vaccine.

該技術有可能爲我們節省寶貴的時間，但它仍是一項新技術。爲了應對今年的流感季節，葛蘭素史克公司生產了約2400萬支基於雞蛋培養基生產的流感疫苗，在美國還有其他四家公司也在使用雞蛋培養基技術。相比之下，Protein Sciences公司今年只推出了30萬支FluBlok流感疫苗。

“All we need is to buy four to five weeks to have a high level confidence of catching the long tail of emerging variants,” said Pekosz.

目前整個行業都在大力投資重組技術，其中也包括葛蘭素史克。不過菲爾伯鮑姆表示，大多數廠商在這項技術上都落後了10到15年。Protein Sciences計劃明年將FluBlok疫苗的產量提高到120萬支，不過對於美國總體的流感疫苗需求量來說，這還只是一個很小的比例。

The technology has potential to buy that extra time, but it’s still new. For this year’s flu season, GlaxoSmithKline produced about 24 million vaccine doses using the egg-based method, and it is one of five companies producing traditional egg-based flu vaccines in the U.S. In comparison, Protein Sciences released 300,000 FluBlok doses this season.

科學家的終極目標是研製一種能夠治癒所有流感變種的疫苗。《財富》記者埃裏卡o弗萊正在深入研究科學家們將如何在接下來的大約10年內實現這個目標。

The industry as a whole is investing in this recombinant technology, including GlaxoSmithKline GSK -0.09% . However, most manufacturers are still about 10 to 15 years behind, said Felberbaum. Protein Sciences plans to scale up to 1.2 million FluBlok doses for the next flu season, though that’s still a small portion of the overall vaccine quantity needed for the U.S.

直到現在，全球科學家還在認真準備今年二月的流感峯會，他們希望在會上精確地確定明年的流感變種——這可能會拯救幾萬人的生命。

Ultimately, scientists hope for a universal vaccine — one shot that would cure all influenza une’s Erika Fry delved into how scientists are working toward that end goal, which remains nearly 10 years off.

皮克茲表示：“在大多數年份裏，我們的匹配工作都做得很好，這也是我們能夠獲得進展的情形之一，但這項工作需要各方齊心協力，不只是科學家，生產和監管環節也必須及時跟上才行。”（財富中文網）

Until then, scientists around the world are working diligently to be prepared for this February’s influenza summit when they hope to accurately pinpoint next season’s strains — potentially saving tens of thousands of lives.

譯者：樸成奎

“In most years, we have a pretty good match,” said Pekosz. “It’s one of those situations where we could improve, but it takes a really concerted effort. It’s not just science, but manufacturing and regulations.”

審校：任文科