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This article is part of Times Opinion’s reflection on the two-year mark of the Covid pandemic. Read more in a note from Alexandra Sifferlin, Opinion’s health and science editor, in our Opinion Today newsletter.
这篇文章是 Times Opinion 对武汉肺炎大流行两年标志的反思的一部分。在我们的 Opinion Today 通讯中阅读更多来自 Opinion 的健康和科学编辑 Alexandra Sifferlin 的说明。We cannot step into the same river twice, the Greek philosopher Heraclitus is said to have observed. We’ve changed, the river has changed.
我们不能两次踏入同一条河流，据说希腊哲学家赫拉克利特曾观察到。我们变了，河流变了。That’s very true, but it doesn’t mean we can’t learn from seeing what other course the river could have flowed. As the pandemic enters its third year, we must consider those moments when the river branched, and nations made choices that affected thousands, millions, of lives.
这是非常正确的，但这并不意味着我们不能从看到河流可能流过的其他路线中学习。随着大流行进入第三个年头，我们必须考虑河流分流的那些时刻，各国做出的选择影响了成千上万人的生命。What if China had been open and honest in December 2019? What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did? What if the United States had put appropriate protective measures in place in February 2020, as South Korea did?
如果中国在 2019 年 12 月保持开放和诚实呢？如果世界在 2020 年 1 月像台湾一样迅速而积极地做出反应会怎样？如果美国像韩国那样在 2020 年 2 月采取适当的保护措施会怎样？To examine these questions is to uncover a brutal truth: Much suffering was avoidable, again and again, if different choices that were available and plausible had been made at crucial turning points. By looking at them, and understanding what went wrong, we can hope to avoid similar mistakes in the future.
研究这些问题将发现一个残酷的事实：如果在关键的转折点做出了不同的可用和合理的选择，那么很多痛苦是可以避免的，一次又一次。通过查看它们并了解出了什么问题，我们可以希望将来避免类似的错误。[b]What happened in the first weeks: China covered up the outbreak.
最初几周发生的事情：中国掩盖了疫情。[/b]
Our information about what happened when the coronavirus apparently was first detected in Wuhan, China, in December 2019, remains limited. Reporters working for Western media have been kicked out, and even local citizen journalists who shared information during the early days were jailed. But evidence strongly suggests that China knew the danger long before it told the world the truth.
我们关于 2019 年 12 月在中国武汉首次发现冠状病毒时发生的事情的信息仍然有限。为西方媒体工作的记者被踢出局，甚至早期分享信息的当地公民记者也被监禁。但有证据有力地表明，中国早在告诉世界真相之前就已经知道了危险。The South China Morning Post, a newspaper owned by a major Chinese company, reported that Chinese officials found cases that date to Nov. 17, 2019. Several Western scientists said colleagues in China had told them of the outbreak by mid-December. Whistleblower doctors reported being silenced from mid-December on. Toward the end of December, hospitals in Wuhan were known to be quarantining sick patients, and medical staff members were falling sick — clear evidence of human-to-human transmission, the first step toward a pandemic.
一家中国大公司旗下的报纸《南华早报》报道称，中国官员发现的病例可追溯至 2019 年 11 月 17 日。几位西方科学家表示，中国的同事在 12 月中旬之前已经告诉他们疫情的爆发。告密者医生报告说从 12 月中旬开始就被禁言。到 12 月底，众所周知，武汉的医院正在隔离病人，医务人员开始生病——这是人传人的明显证据，这是向大流行迈出的第一步。Finally, on Dec. 31, 2019, as rumors were growing, the Wuhan health officials acknowledged 27 cases of an “unexplained pneumonia” caused by a virus, but claimed there was no evidence of “obvious human to human transmission.” The next day, a Chinese state media outlet announced that authorities had disciplined eight people for spreading rumors about the virus, including Dr. Li Wenliang, who had noted that the mystery pneumonia cases resembled SARS and warned colleagues to wear protective gear, and who would later die of Covid.
最后，在 2019 年 12 月 31 日，随着谣言越来越多，武汉卫生官员承认了 27 例由病毒引起的“不明原因肺炎”，但声称没有“明显的人传人”的证据。次日，中国官方媒体宣布，当局已对八名散布病毒谣言的人进行了纪律处分，其中包括李文亮医生，他指出神秘的肺炎病例与 SARS 相似，并警告同事穿戴防护装备，后来死于武汉肺炎。Not until Jan. 20, 2020, did Chinese authorities publicly admit that the virus was clearly passing from person to person. Three days later, they shut down the city of Wuhan.
直到 2020 年 1 月 20 日，中国当局才公开承认该病毒显然正在人传人。三天后，他们封闭了武汉市。At that point, the virus had had weeks to spread far beyond China’s borders and was beginning to establish outbreaks globally. A pandemic was on its way.
那时，该病毒已经有数周时间传播到中国境外，并开始在全球范围内爆发。一场流行病正在来临。What could have happened: China tells the world the truth and the pandemic is avoided.
本可能发生的事情：中国告诉世界真相，避免了大流行。China could have notified the World Health Organization sometime in early to mid-December that it had an outbreak of a previously unknown coronavirus similar to the dreaded SARS pathogen, and immediately sequenced the virus and shared the genome, allowing tests to be developed. The rest of the world would have had to act, too. Governments could have made sure tests were immediately developed to find as many cases as possible. Health authorities could have isolated infected people and traced and quarantined their contacts. Travel restrictions and testing could have been put in place to prevent the spread outside China.
中国本可以在 12 月初至中旬的某个时间通知世界卫生组织，它爆发了一种与可怕的 SARS 病原体相似的以前未知的冠状病毒，并立即对该病毒进行测序并共享基因组，以便开发测试。世界其他地方也必须采取行动。政府本可以确保立即开展测试以发现尽可能多的病例。卫生当局本可以隔离感染者并追踪和隔离他们的接触者。旅行限制和测试本来可以到位，以防止在中国以外的地方传播。It may seem like a fantasy to suggest that the outbreak could have been extinguished before it became a pandemic, but later outbreaks of this virus were contained. This first wave could have been, too, and the pandemic might have been completely avoided, saving millions of lives and much suffering.
暗示疫情本可以在成为大流行之前就被扑灭，这似乎是一种幻想，但后来这种病毒的爆发得到了控制。第一波也可能发生，大流行可能已经完全避免，挽救了数百万人的生命和许多痛苦。What happened after China covered up: The world failed to heed warnings and take action.
中国掩饰后发生了什么：世界没有听从警告，没有采取行动。On Dec. 30, 2019, ProMED, a service that tracks infectious disease outbreaks globally, warned of “unexplained pneumonia” cases in Wuhan. The veteran infectious disease reporter Helen Branswell shared the news alert on Twitter the next day and said it was giving her “#SARS flashbacks.” That same day, Taiwan’s Centers for Disease Control — with its close contacts on the ground in China — fired off an email to the W.H.O. with its concerns that patients were being isolated in Wuhan — a clear sign of an outbreak with person-to-person spread.
2019 年 12 月 30 日，追踪全球传染病爆发的服务 ProMED 警告武汉有“不明原因肺炎”病例。资深传染病记者 Helen Branswell 次日在 Twitter 上分享了这条新闻警报，并表示这给了她“#SARS 闪回”。同一天，台湾疾控中心及其在中国大陆的密切接触者向世界卫生组织发出了一封电子邮件。担心患者在武汉被隔离——这是人传人爆发的明显迹象。On Jan. 11, 2020, a Chinese scientist bravely allowed an Australian colleague to upload the virus’s genome to a gene bank, without official authorization. This meant that the whole world could now see this was a novel coronavirus, closely related to SARS. The next day the scientist’s lab was shut down.
2020年1月11日，一名中国科学家勇敢地允许一名澳大利亚同事未经官方授权将病毒基因组上传至基因库。这意味着全世界现在都可以看到这是一种与SARS密切相关的新型冠状病毒。第二天，科学家的实验室被关闭了。Doubts over whether the virus was capable of spreading from person to person should have been swept away in mid-January 20020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan seafood market that Chinese authorities had said was the center of the spread. Meanwhile, despite such clear evidence of the virus’s transmissibility, the number of cases that China reported remained at 44. (We’d later learn that medical professionals weren’t even allowed to report cases that weren’t connected to the seafood market.) Yet, the W.H.O. kept repeating China’s line that there was no evidence of human-to-human transmission.
20020 年 1 月中旬，有报道称泰国的一名妇女和日本的一名男子在没有去过中国当局设立的武汉海鲜市场的情况下检测呈阳性，有关该病毒是否能够在人与人之间传播的怀疑本应被扫除。说是传播的中心。与此同时，尽管有如此明确的证据表明该病毒具有传染性，但中国报告的病例数仍为 44 例。（我们后来了解到，医疗人员不允许报告与海鲜市场无关的病例。）然而，世界卫生组织不断重复中国的说法，即没有人传人的证据。It wasn’t until China shut down Wuhan on Jan. 23, 2020, that the rest of the world could see how serious the threat was — even then, global response remained feeble.
直到中国于 2020 年 1 月 23 日封闭武汉，世界其他地区才看到威胁的严重性——即便如此，全球反应仍然微弱。What could have happened: The world sees through China’s deception and takes action.
本可能发生的事情：世界看穿了中国的欺骗并采取了行动。How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.
各国如何绕过中国的烟幕？他们本可以做台湾做过的事。On Dec. 31, 2019, the same day Taiwan officials sent that email to the W.H.O., they started boarding every plane that flew there directly from Wuhan, screening arriving passengers for symptoms like fever.
2019 年 12 月 31 日，也就是台湾官员向世卫组织发送这封电子邮件的同一天，他们开始登上从武汉直飞那里的每一架飞机，对抵达的旅客进行发烧等症状检查。“We were not able to get satisfactory answers either from the W.H.O. or from the Chinese C.D.C., and we got nervous and we started doing our preparation,” Foreign Minister Joseph Wu told Time magazine.
“我们也未能从世界卫生组织那里得到满意的答复。或者来自中国疾控中心，我们很紧张，我们开始做准备，”外交部长约瑟夫·吴告诉时代杂志。Masks were rationed, to ensure there were enough for the entire population, and were distributed to schools. Soldiers were put on production lines at mask factories to increase supply. The country quickly allocated money to businesses that lost customers and revenue.
口罩是配给的，以确保有足够的口罩供所有人使用，并分发给学校。士兵被安排在口罩工厂的生产线上，以增加供应。该国迅速将资金分配给失去客户和收入的企业。For most of 2020, Covid was rare in Taiwan. On 253 consecutive days that year there were no locally transmitted cases there, even though there had been extensive travel to China, including Wuhan, before January 2020. With extensive testing and tracing, they squashed two major outbreaks — one that started in March 2020, and more impressively, a major outbreak of the more transmissible Alpha variant in summer 2021 — bringing local cases back to zero. That shows what was possible with an early and robust response.
在 2020 年的大部分时间里，武汉肺炎在台湾很少见。尽管在 2020 年 1 月之前曾多次前往中国（包括武汉），但该年连续 253 天没有本地传播病例。通过广泛的检测和追踪，他们遏制了两次重大疫情——一场始于 2020 年 3 月，更令人印象深刻的是，在 2021 年夏天，传染性更强的 Alpha 变种的大规模爆发——使当地病例恢复到零。这表明早期和强有力的反应是可能的Taiwan has suffered 853 deaths. If the United States had suffered a similar death rate, we would have lost about 12,000 people, instead of nearly a million.
台湾有853人死亡。如果美国遭受类似的死亡率，我们将失去大约 12,000 人，而不是近 100 万人。Taiwan shows that even in early January, there was enough information to be concerned about the virus, and the potential to suppress any outbreak.
台湾表明，即使在 1 月初，也有足够的信息来关注这种病毒，以及抑制任何爆发的潜力。What happened after the outbreak went global: The real contagious threat was ignored.
疫情走向全球后发生了什么：真正的传染性威胁被忽视了。On the precipice of a pandemic, too many important officials failed to understand how the virus was spreading, despite emerging evidence, keeping them from effectively limiting its spread and costing thousands of lives.
在大流行的边缘，尽管新证据不断涌现，但太多重要官员未能了解病毒是如何传播的，这使他们无法有效限制其传播并导致数千人丧生。On Feb. 3, 2020, the cruise ship Diamond Princess was ordered to stay in Yokohama harbor, in Japan, two days after a passenger who had disembarked in Hong Kong tested positive for Covid. After 10 other people on the ship were found to be infected, the ship was quarantined. Eventually there would be 712 cases, about 19 percent of those on board, with 14 deaths.
2020 年 2 月 3 日，在一名在香港下船的乘客武汉肺炎检测呈阳性两天后，钻石公主号游轮被命令留在日本横滨港。在发现船上另外10人被感染后，该船被隔离。最终将有 712 例病例，约占机上病例的 19%，有 14 人死亡。Nine public health workers attending to the ship were infected. It seemed quite unlikely, the Japanese virology professor Hitoshi Oshitani noted, that all these professionals with expertise in infection control had failed to take the recommended precautions.
九名在船上工作的公共卫生人员被感染。日本病毒学教授 Hitoshi Oshitani 指出，所有这些具有感染控制专业知识的专业人员都未能采取建议的预防措施似乎不太可能。At that point the guidelines from the W.H.O. and the Centers for Disease Control and Prevention were based on the assumption that this virus was spread by large droplets from the nose and mouth that quickly fell to the ground or to surfaces, because of their size. People were advised to keep enough distance from others to stay out of the range of these droplets, and to wash their hands in case they picked them up from surfaces.
那时，世界卫生组织的指导方针。疾病控制和预防中心的假设是，这种病毒是通过来自鼻子和嘴巴的大飞沫传播的，由于它们的大小，这些飞沫迅速落到地面或表面。建议人们与他人保持足够的距离，以远离这些飞沫的范围，并洗手以防他们从表面捡到它们。If the workers became infected despite those precautions, and if passengers were infected even when they were quarantined, Oshitani suspected that the virus was probably spread by airborne transmission of tiny particles — aerosols — that could spread more widely, float around and concentrate, especially indoors.
如果尽管采取了这些预防措施，工作人员还是被感染了，如果乘客在被隔离时也被感染了，Oshitani 怀疑这种病毒很可能是通过空气传播的微小颗粒——气溶胶——传播的更广泛、漂浮和集中，尤其是在室内.This case for aerosol spread strengthened after 61 people attended a choir practice in Skagit, Wash., on March 10, 2020. The church followed droplet-based guidance by propping the door open so nobody would touch the door knob and avoiding handshakes or hugs. No one was six feet in front of the person suspected to have been the single initial source. Nevertheless, 52 people — 85 percent of those present — became infected.
2020 年 3 月 10 日，在 61 人参加了华盛顿州斯卡吉特的唱诗班练习后，这种气溶胶传播的案例得到了加强。教堂遵循基于液滴的指导，将门撑开，因此没有人会触摸门把手并避免握手或拥抱。没有人在被怀疑是唯一初始来源的人前面六英尺处。尽管如此，仍有 52 人（占在场人数的 85%）被感染。Many Western experts, including in the United States and Europe and at the W.H.O., discounted these and other evidence of airborne transmission. Countries like the United States did not require masks to limit airborne spread but worried instead about germs spreading on people’s mail and groceries.
许多西方专家，包括美国和欧洲以及世界卫生组织的专家，都对这些和其他空中传播的证据不以为然。像美国这样的国家并不要求戴口罩来限制空气传播，而是担心细菌会在人们的邮件和杂货上传播。After more evidence, and organized attempts by hundreds of aerosol scientists, minor course corrections started later in 2020, but they were halting, incomplete and underpublicized. For example, it wasn’t until December 2020 that the W.H.O. started recommending that masks be worn indoors regardless of distance, and even then only if the space was poorly ventilated, and it wasn’t until December 2021 — two years after it all began — did it recommend highly protective masks for health care workers.
在获得更多证据以及数百名气溶胶科学家有组织的尝试之后，2020 年晚些时候开始进行小幅修正，但它们处于停顿、不完整和未公开的状态。例如，直到 2020 年 12 月，WHO开始建议无论距离多远都在室内佩戴口罩，即便如此，只有在空间通风不良的情况下，直到 2021 年 12 月——这一切开始两年后——它才向医护人员推荐了高度防护的口罩。It was also assumed that only people with symptoms — like fever — would be infectious, even though evidence to the contrary had emerged early.
还假设只有有症状的人——比如发烧——才会具有传染性，尽管相反的证据很早就出现了。On Jan. 26, 2020, the Chinese minister of health gave a news conference warning that people without symptoms could transmit the virus. The same week an article in The Lancet had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. An article published in the New England Journal of Medicine, also the same week, noted cases presenting only mild symptoms, with the authors stressing that this would make it easy to miss them. Multiple reports from German scientists soon disclosed similar conclusions based on cases there.
2020 年 1 月 26 日，中国卫生部长在新闻发布会上警告说，没有症状的人可能会传播病毒。同一周，《柳叶刀》上的一篇文章记录了一个病例，在该病例中，一名无症状患者的肺部可见感染。同一周发表在《新英格兰医学杂志》上的一篇文章指出，病例仅表现出轻微的症状，作者强调这很容易错过它们。德国科学家的多份报告很快就根据那里的案例得出了类似的结论。However, many health authorities ignored, denied and even belittled evidence of spread without symptoms. It took until well into March for officials in the United States, for example, to accept that people without symptoms could be infectious.
然而，许多卫生当局忽视、否认甚至贬低了无症状传播的证据。例如，直到三月份，美国官员才接受没有症状的人可能具有传染性。The failure to acknowledge this type of transmission meant that the urgency for mass testing wasn’t realized and the virus spread silently, without critical precautions being taken, until explosive growth occurred in places like New York City. The need to identify and quarantine people who had come in contact with those who were infected was considered unnecessary and alarmist in the United States. The C.D.C. and the W.H.O. initially recommended masks only for the sick.
未能承认这种传播方式意味着没有意识到进行大规模检测的紧迫性，病毒在没有采取关键预防措施的情况下悄无声息地传播，直到纽约市等地出现爆炸性增长。在美国，识别和隔离与感染者有过接触的人的必要性被认为是不必要和危言耸听的。疾控中心和世界卫生组织最初建议只给病人戴口罩。Another crucial misstep was the failure to recognize the virus’s dominant pattern of spread, in large bursts.
另一个关键的失误是未能认识到病毒的主要传播模式，即大规模爆发。That February, Oshitani and his colleagues concluded that a vast majority of infected people didn’t transmit at all, while a small number of individuals were superspreading, in closed indoor settings like restaurants, night clubs, karaoke bars, gyms and such — especially if the ventilation was poor. They developed new approaches to trace infections to their origin, to find cluster transmission and thus look for other cases.
那年 2 月，Oshitani 和他的同事得出结论，绝大多数感染者根本没有传播，而少数人正在超级传播，在封闭的室内环境中，如餐馆、夜总会、卡拉 OK 酒吧、健身房等——尤其是如果通风很差。他们开发了新的方法来追踪感染源，发现集群传播，从而寻找其他病例。What could have happened: Officials could have put in place effective and early mitigation strategies.
本可能发生的情况：官员们本可以制定有效的早期缓解策略。The rest of the world could have understood the virus as Japanese officials did. Based on their understanding, which was arrived at in February 2020, that Covid was airborne, spread without symptoms and driven by clusters, by early March they were recommending mask-wearing, emphasizing the need for ventilation and advising the public to avoid the three-Cs: closed spaces, crowded places and close-contact settings.
世界其他地方本可以像日本官员那样理解这种病毒。根据他们于 2020 年 2 月达成的理解，即 武汉肺炎是通过空气传播、无症状传播并由集群驱动的，到 3 月初，他们建议戴口罩，强调通风的必要性，并建议公众避免三Cs：封闭空间、拥挤场所和密切接触场所。Americans on the other hand were disinfecting their groceries, and the W.H.O. kept emphasizing hand-washing and social distancing, or remaining six feet apart. Japan has had about 25,000 Covid deaths, which would be the equivalent of just under 66,000 in a country the size of the United States.
另一方面，美国人正在对他们的杂货进行消毒，而世卫组织也在为他们的杂货消毒。一直强调洗手和保持社交距离，或者保持六英尺的距离。日本有大约 25,000 人死于武汉肺炎，这相当于美国面积的国家不到 66,000 人。Mass testing could have detected people who were infectious before they even knew they were sick and sometimes those who never had symptoms at all. Ventilation and air filtration could have kept indoor spaces safer.
大规模检测甚至可以在他们知道自己生病之前检测到具有传染性的人，有时甚至可以检测到那些根本没有症状的人。通风和空气过滤可以使室内空间更安全。Instead of closing parks, activities could have been moved outside weather permitting, since natural ventilation more effectively dissipates the virus. The key role of masks would have been understood earlier, along with the benefits of higher quality masks. Rather than wasting money on plexiglass barriers — which can’t fully block aerosols and can even create dead zones for ventilation, increasing infection risk — schools would have begun updating their ventilation and HVAC systems, and installing HEPA air filters, which can filter viruses. Japan’s cluster-busting strategy could have been adopted.
与其关闭公园，不如在天气允许的情况下进行活动，因为自然通风可以更有效地驱散病毒。口罩的关键作用以及更高质量的口罩的好处早就被理解了。与其把钱浪费在有机玻璃屏障上——它不能完全阻挡气溶胶，甚至会造成通风死区，增加感染风险——学校应该开始更新他们的通风和 HVAC 系统，并安装可以过滤病毒的 HEPA 空气过滤器。日本的集群破坏战略本来可以被采用。Also, even though epidemics are easier to suppress with early action, it’s silent spread and superspreading that make a timely response even more important, as shown by South Korea’s early response.
此外，尽管疫情更容易通过早期行动来抑制，但正是无声传播和超级传播使及时应对变得更加重要，正如韩国的早期应对所表明的那样。South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.
韩国在 2020 年 2 月经历了重大的超级传播事件，其中包括发生在一个秘密教堂中的事件，该事件造成了 5000 多例感染，其中一个人被怀疑为传染源。当时，该国是中国以外病例最多的国家。South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.
韩国官员迅速采取行动，推出了一项大规模检测计划——他们自 1 月以来就一直在准备检测能力——提供免下车选项和强有力的接触者追踪。South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate into fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.
韩国击退了那次潜在的灾难性疫情，并继续大大限制其病例。他们在 2020 年全年的死亡人数不到 1,000 人。在美国，这将转化为 2020 年因武汉肺炎死亡的人数不到 7,000 人。相反，据估计死亡人数超过 375,000 人。What happened: When vaccines were developed, rich countries hoarded them.
当疫苗研制出来时，发生了什么：富裕国家囤积了它们。The greatest scientific achievement of the pandemic may have been the speedy development of safe, effective vaccines.
这场大流行的最大科学成就可能是迅速开发出安全、有效的疫苗。In January 2020, the C.E.O. of BioNTech, Ugur Sahin, started designing vaccines as soon as he read The Lancet study noting the case without symptoms, which convinced him that a pandemic was likely. He then persuaded Pfizer, his initially skeptical investor, to back him.
2020 年 1 月，C.E.O. BioNTech 的 Ugur Sahin 博士在阅读《柳叶刀》研究报告后立即开始设计疫苗，该研究指出该病例没有症状，这使他确信可能会发生大流行。然后，他说服了他最初持怀疑态度的投资者辉瑞（Pfizer）支持他。On May 15, 2020, the United States began Operation Warp Speed, which financed the development of six vaccine candidates. Five of them quickly proved to be highly effective — not at all a given. The first to deliver spectacular results was that produced by Pfizer and BioNTech. Moderna’s quickly followed.
2020 年 5 月 15 日，美国启动了“曲速行动”，资助了六种候选疫苗的开发。其中五个很快被证明是非常有效的——完全不可思议。辉瑞（Pfizer）和 BioNTech 率先取得了令人瞩目的成果。 Moderna 紧随其后。Supply was an immediate problem. Pfizer initially estimated it could make as many as 1.35 billion doses in 2021 — enough for about only 8.5 percent of the world’s people to get two doses. Moderna, a much smaller company, wasn’t expected to exceed that. AstraZeneca’s vaccine, too, would not cover the gap quickly enough.
供应是一个直接的问题。辉瑞最初估计，到 2021 年，它可以生产多达 13.5 亿剂疫苗——仅够全球约 8.5% 的人接种两剂疫苗。 Moderna 是一家规模小得多的公司，预计不会超过这个数字。阿斯利康的疫苗也无法足够快地弥补这一缺口。There also was too little commitment to how vaccines could be distributed fairly around the world.
对于如何在世界范围内公平分配疫苗的承诺也太少。Instead, wealthy countries that had preordered or financed research got most of the initial doses.
相反，预先订购或资助研究的富裕国家获得了大部分初始剂量。Vaccine production grew, but too slowly. There was no consortium or sharing of resources to ramp up supply. Technology wasn’t transferred to lower- and middle- income countries. Patents were left in place. The W.H.O. initiative to get vaccines to poorer countries, known as Covax, was not able to buy enough doses, and what donations were made were insufficient and haphazard.
疫苗产量增长，但速度太慢。没有财团或资源共享来增加供应。技术没有转移到低收入和中等收入国家。专利留在原地。 WHO。向较贫穷国家提供疫苗的倡议（称为 Covax）无法购买足够的剂量，而且捐赠的资金不足且随意。Then, in a largely unanticipated plot twist, dangerous variants of the coronavirus started emerging in late 2020 — Alpha, Delta and then Omicron.
然后，在很大程度上出乎意料的情节转折中，冠状病毒的危险变体在 2020 年末开始出现——Alpha、Delta 和 Omicron。Widespread earlier vaccination could have helped limit the possibility for these variants emerging. Plus, many variants may have arisen through persistent infections in immunocompromised people — like those who have untreated H.I.V., another terrible legacy of global health inequity.
广泛的早期疫苗接种可能有助于限制这些变体出现的可能性。此外，许多变异可能是由于免疫功能低下人群的持续感染而产生的——比如那些未经治疗的艾滋病毒，这是全球健康不公平的另一个可怕遗产。What could have happened: Vaccine supply ramps up, with sensible distribution.
本可能发生的情况：疫苗供应增加，分配合理。Political leaders in wealthy countries should have brought together vaccine manufacturers to arrange conditions and deals that can likely be struck only with government prodding: sharing manufacturing facilities, training experts, sharing intellectual property. Technology transfer to poorer countries could have achieved the ultimate goal: a world with many countries that can produce effective vaccines. Existing vaccine manufacturers could still profit handsomely — especially considering they, too, benefit from publicly funded research.
富裕国家的政治领导人应该召集疫苗制造商来安排可能只有在政府推动下才能达成的条件和交易：共享制造设施、培训专家、共享知识产权。向较贫穷国家转让技术本可以实现最终目标：一个拥有许多可以生产有效疫苗的国家的世界。现有的疫苗制造商仍然可以获得可观的利润——尤其是考虑到它们也受益于公共资助的研究。Countries may want to first vaccinate their own citizens, even those at much less risk. But to save the most lives, priorities should have been set globally. Health care workers, the elderly and those at high risk throughout the world should have gotten the first vaccinations.
各国可能希望首先为本国公民接种疫苗，即使是那些风险低得多的人。但为了挽救最多的生命，应该在全球范围内确定优先事项。全世界的医护人员、老年人和高危人群都应该接种第一针疫苗。Trials could have been immediately started to assess whether delaying second doses might work well while allowing doses to be spread more widely geographically. Early results on the protective effect of first doses were encouraging.
本可以立即开始试验，以评估延迟第二剂是否可能有效，同时允许剂量在地理上更广泛地传播。关于首剂保护作用的早期结果令人鼓舞。A few countries like Canada and Britain did lengthen the interval between doses as a strategy to protect more of their citizens — to great results. More of their vulnerable population got protected quickly. Plus, longer intervals, as some immunologists had predicted earlier, still left people protected — the unusually short three- and four-week period between the two initial shots had been put in place partly to speed up the trials. In the United States, though, such adaptive strategies could not be studied or rolled out.
加拿大和英国等一些国家确实延长了给药间隔，作为保护更多公民的策略——取得了很好的效果。他们的更多弱势群体迅速得到保护。此外，正如一些免疫学家早些时候预测的那样，更长的间隔仍然可以保护人们——两次初始注射之间异常短的三到四个星期的时间间隔已经到位，部分原因是为了加快试验速度。然而，在美国，这种适应性策略无法研究或推广。What needs to happen
需要发生什么When the pandemic is over, the temptation will be to move on and reclaim what had been normal life. For individuals that will be fine. But the cracks revealed in our governments and public health institutions by two years of inertia, mistakes and resistance to evidence make it crucial that a broad, tough dissection of what happened take place if we are to choose the correct course in future challenges.
当大流行结束时，诱惑将是继续前进并恢复正常生活。对于个人来说会很好。但是，如果我们要在未来的挑战中选择正确的路线，我们的政府和公共卫生机构两年来的惯性、错误和对证据的抗拒所暴露出的裂痕使得对所发生的事情进行广泛而艰难的剖析至关重要。National and international commissions need to help us see where we went wrong, without scapegoating, and how to respond to future outbreaks, without defensively excusing what public health authorities and national leaders did this time, even if well-meaning. In some countries, it would be easy to focus only on political leaders like President Donald Trump, who severely damaged America’s response. But top public health officials, high-level scientists and state governors made many missteps along the way. At a time of growing international distrust we need to work to increase trust and mutual cooperation. We need to better understand how to rapidly incorporate evidence into scientific policy and to better understand human response to such major, complicated events.
国家和国际委员会需要帮助我们找出我们错在哪里，而不是找替罪羊，以及如何应对未来的疫情，而不是为公共卫生当局和国家领导人这次的所作所为辩解，即使是善意的。在一些国家，很容易只关注唐纳德·特朗普总统这样的政治领导人，他们严重破坏了美国的反应。但高级公共卫生官员、高级科学家和州长在此过程中犯了许多错误。在国际不信任日益增加的时候，我们需要努力增加信任和相互合作。我们需要更好地了解如何将证据迅速纳入科学政策，并更好地了解人类对此类重大、复杂事件的反应。If we can do that, to save lives and ease suffering in the future, it will not make up for all the loss and hardship we have endured in the last two years. But we can at least say we did our best to learn from it, and let that be the one positive legacy of all this.
如果我们能够做到这一点，为未来挽救生命、减轻痛苦，也无法弥补过去两年我们所遭受的所有损失和艰辛。但我们至少可以说，我们已尽最大努力从中吸取教训，并让它成为这一切的一个积极遗产。标红字体均为楼主更改，与原文作者无关。[/b]
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