Análisis de los criterios de valoración utilizados para casos de pensión vitalicia en un niño con Autismo. Reporte de un caso con enfoque médico legal / Analysis of the evaluation criteria used for life pension cases in a child with Autism. Report of a case with a forensic medical approach

El Trastorno del Espectro Autista (TEA), es trastorno del neurodesarrollo que se caracteriza por algún grado de dificultad en la interacción social y la comunicación, que comienza en el periodo de desarrollo temprano, y se clasifica según el grado de severidad en grado 1, 2 y 3, según lo establecido en el DSM-5. Dicho Trastorno se encuentra abarcado por la Ley 7125 de Pensión Vitalicia para Personas con Parálisis Profunda, y su reforma 8769. Con el objetivo de analizar los criterios establecidos para la valoración de estos procesos, se presenta el caso de una persona masculina de 6 años con diagnóstico de TEA, de quien se interpuso demanda para ser tomado en cuenta dentro de dicha Ley. En el mismo y tras el análisis respectivo, de acuerdo con los datos de la literatura científica actualizada, y de los criterios establecidos, se pudo constatar que si calificaba según lo indicado en la Ley 7125.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by some degree of difficulty in social interaction and communication, which begins in the early development period, and is classified according to the degree of severity in grade 1, 2 and 3, as established in the DSM-5. Said Disorder is covered by Law 7125 of Life Pension for people with deep cerebral palsy, and its reform 8769. In order to analyze the criteria established for the assessment of these processes, the case of a 6-year-old male person with diagnosis of ASD, of whom a lawsuit was filed to be taken into account within said Law. In it and after the respective analysis, according to the data of the updated scientific literature, and the established criteria, it was possible to verify that if qualified as indicated in Law 7125.

Directrices de la OMS sobre intervenciones de autocuidado para la salud y el bienestar, revisión 2022: resumen ejecutivo / WHO guideline on self-care interventions for health and well-being, 2022 revision: executive summary

Se estima que para el 2030 habrá una carencia de aproximadamente 18 millones de profesionales de la salud en todo el mundo. En la actualidad, el número de personas que necesitan asistencia humanitaria asciende a una cifra récord de 130 millones y, además, las pandemias, tal como la de COVID-19, representan una amenaza mundial. Al menos unos 400 millones de personas en todo el mundo carecen de acceso a los servicios de salud más esenciales y, cada año, unos 100 millones de personas se ven sumidos en la pobreza por los gastos que implica costearse la atención de salud. Por ello, es necesario encontrar urgentemente estrategias innovadoras que vayan más allá de las respuestas convencionales del sector de la salud. Estas intervenciones también son pertinentes para las tres áreas del 13.° Programa General de Trabajo de la Organización Mundial de la Salud (OMS). La OMS recomienda que se utilicen las intervenciones de autocuidado en todos los países y entornos económicos como elementos críticos para lograr la cobertura sanitaria universal (CSU), promover la salud, preservar la seguridad mundial y servir a las poblaciones vulnerables.(AU)

Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 / Stratégie et plan d'action sur la promotion de la santé dans le contexte des objectifs de développement durable 2019-2030 / Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030

El objetivo de esta Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 es renovar la promoción de la salud por medio de acciones sociales, políticas y técnicas que aborden los determinantes sociales de la salud, con el fin de mejorar la salud y reducir las inequidades en el contexto de la Agenda 2030. Este documento está vinculado a la Estrategia para el acceso universal a la salud y la cobertura universal de salud de la OPS y se centra en el trabajo con todos los niveles de gobierno, en particular el nivel local, para empoderar a las personas y comunidades en sus entornos y territorios. Dada su importancia, la intersectorialidad y la participación social se consideran como dos ejes transversales en todo el plan de acción y deberían reflejarse en las actividades para alcanzar cada línea estratégica (véase el anexo A). El compromiso con los principios del respeto de los derechos humanos, la equidad y la inclusión, teniendo en cuenta específicamente las cuestiones de género, la etnicidad, la interculturalidad y las discapacidades entre otros aspectos, es la base de todas las líneas estratégicas de acción. Cada país deberá adaptar la respuesta nacional, subnacional y local a su propia situación, contexto y prioridades. El presente plan de acción se basa en cuatro líneas estratégicas de acción que se refuerzan mutuamente, a saber, fortalecer los entornos saludables clave; facilitar la participación y el empoderamiento de la comunidad, y el compromiso de la sociedad civil; fortalecer la gobernanza y el trabajo intersectorial para mejorar la salud y el bienestar, y abordar los determinantes sociales de la salud, y fortalecer los sistemas y servicios de salud incorporando un enfoque de promoción de la salud.

The goal of this Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030 is to renew health promotion through social, political, and technical actions, and addressing the sustainable development goals in order to improve health and reduce health inequities within the context of the 2030 Agenda. This document is linked to PAHO's Strategy for Universal Access to Health and Universal Health Coverage and focuses on work with all levels of government, but particularly the local level, to empower people and communities in their settings and territories. Given the importance of intersectoral action and social participation, these are considered as two cross-cutting axes throughout the Plan of Action and should be reflected in actions to achieve each strategic line. Commitment to the principles of respect for human rights, equity, and inclusivity, with specific consideration of gender, ethnicity, interculturality and disabilities, among others, underpins all the strategic lines of action. Each country will need to tailor its national, subnational, and local responses to its own situation, context and priorities. This Plan of Action is based on four mutually reinforcing strategic lines of action: strengthening key healthy settings; enabling community participation and empowerment and civil society engagement; enhancing governance and intersectoral work to improve health and well-being and address the social determinants of health; and strengthening health systems and services by incorporating a health promotion approach. The Strategy and Plan of Action on Health Promotion are aligned with the Universal Access to Health and Health Coverage 2014, the Astana Declaration 2018 and the Sustainable Development Goals.

Le but de la Stratégie et plan d'action sur la promotion de la santé dans le contexte des objectifs de développement durable 2019-2030 est de renouveler la promotion de la santé grâce à des mesures de nature sociale, politique et technique qui agissent sur les déterminants sociaux de la santé, afin d'améliorer la santé et de réduire les iniquités en santé dans le contexte du Programme à l'horizon 2030. Le présent document est lié à la Stratégie pour l'accès universel à la santé et la couverture sanitaire universelle de l'OPS et est axé sur la collaboration avec tous les niveaux de gouvernement, mais en particulier le niveau local, visant à accroître l'autonomie des personnes et des communautés dans leurs milieux et leurs territoires. Étant donné l'importance de l'action intersectorielle et de la participation sociale, ces deux aspects sont considérés comme représentant deux axes transversaux dans l'ensemble du plan d'action et devront se traduire par des mesures destinées à réaliser chaque axe stratégique (voir l'annexe A). L'adhésion aux principes de respect des droits de l'homme, de l'équité et de l'inclusivité, en tenant compte plus particulièrement du sexe, de l'appartenance ethnique, de l'interculturalité et des handicaps, entre autres facteurs, sous-tend tous les axes stratégiques d'intervention. Chaque pays devra adapter les réponses qu'il met en œuvre aux niveaux national, infranational et local à sa propre situation, à son propre contexte et à ses propres priorités. Ce plan d'action se fonde sur quatre axes stratégiques d'intervention qui se confortent mutuellement : renforcer des milieux sains névralgiques ; permettre la participation et l'autonomisation des communautés et la mobilisation de la société civile ; consolider la gouvernance et l'action intersectorielle en vue d'améliorer la santé et le bien-être et d'agir sur les déterminants sociaux de la santé, et renforcer les systèmes et les services sanitaires par l'intégration d'une approche de promotion de la santé.

Boletín epidemiológico 13 - 2022. Semana epidemiológica del 27 de marzo al 2 de abril del 2022 / Epidemiological bulletin 13 - 2022. Epidemiological week from March 27 to April 2, 2022

La cobertura universal en salud implica que todas las personas y comunidades puedan acceder a servicios integrales de salud (incluidos la prevención, promoción, tratamiento, rehabilitación y cuidados paliativos) adecuados, oportunos, de calidad, de acuerdo con sus necesidades, sin discriminación alguna y sin riesgo de exponerse a dificultades financieras. Sin embargo, en la Región de las Américas alrededor de un tercio de la población no accede a la atención de salud debido a diferentes barreras de acceso, especialmente, aquellos que se ubican en el quintil de riqueza más pobre

El sistema de salud público, único y universal / The public health system: unique and universal

Con regocijo leí el artículo del autor Francisco Rojas Ochoa, publicado en el 2019, titulado Debate teórico sobre salud pública y salud internacional,(1) el que consideré oportuno, porque encontré un marco histórico de la salud pública internacional, y las causas que la han llevado a sub deterioro a lo interno de muchos países, fundamentalmente en los latinoamericanos, que han sido muy golpeados en la actualidad por la pandemia de laCOVID-19.Según Rojas Ochoa, en la salud pública ha existido una fragmentación que ha estimuladola colaboración entre los sectores público y privado e incluso desde organismos que deben procurar la salud global. Además, hace un análisis histórico del origen de la Organización Mundial de la Salud (OMS) (la que surgió como Conferencia Sanitaria Internacional en París en 1851 donde se realizó el primero de estos encuentros, y desde su inicio ha tratado de ayudar, influir y orientar la salud pública de la mayoría de los países). También se refierea la Conferencia Internacional sobre Atención Primaria de Salud, efectuada en Alma Atá en 1978, de la cual, se rescata su lema: Salud para todos(AU)

Esperança e desespero: reflexões sobre o acesso na Atenção Primaria à Saúde / Hope and despair: reflections on access in Primary Health Care / Esperanza y desesperación: reflexiones sobre el acceso en la Atención Primaria de Salud

Objetivo: refletir sobre o acesso na Atenção Primária à Saúde (APS) através de analogias entre dois programas televisivos brasileiros. Método: trata-se de uma reflexão teórica sustentada em elementos da cultura televisiva popular brasileira, a partir dos programas: a porta da esperança e a porta dos desesperados. Resultados: o acesso à saúde no âmbito da APS pode ser analisado na perspectiva de três portas: esperança, na solução de suas necessidades; desespero, voltada aqueles que não conseguem encontrar soluções as suas demandas; e a prioritária, pautada nas atribuições que lhe constitui e no direito à saúde. Conclusão: a APS precisa superar a tipologia de porta da esperança e dos desesperados para efetivação da sua atribuição ordenadora da rede de atenção à saúde.

Objective: to reflect on access in Primary Health Care (PHC) through analogies of two Brazilian television shows. Method: this is a theoretical reflection based on elements of Brazilian popular television culture, based on the shows: the door of hope and the door of the desperate. Results: the access to health within the scope of PHC can be analyzed from the perspective of three doors: hope, in the solution of their needs; despair, aimed at those who cannot find solutions to their demands; and the priority, based on the attributions that constitute it and the right to health. Conclusion: PHC needs to overcome the typology of the door of hope and of the desperate for the achievement of its ordering attribution of the health care network.

Objetivo: reflexionar sobre el acceso en la Atención Primaria de Salud (APS) a través de analogías entre dos programas de televisión brasileños. Método: se trata de una reflexión teórica a partir de elementos de la cultura popular televisiva brasileña, a partir de los programas: la puerta de la esperanza y la puerta de los desesperados. Resultados: el acceso a la salud en el ámbito de la APS puede analizarse desde la perspectiva de tres puertas: la esperanza, en la solución de sus necesidades; la desesperación, dirigida a quienes no encuentran solución a sus demandas; y la prelación, con base en las atribuciones que la constituyen y el derecho a la salud. Conclusión: la APS necesita superar la tipología de la puerta de la esperanza y del desesperado para cumplir su tarea de organización de la red de atención a la salud.

Semana de la Salud internacional 2021: Presentación

¿Por qué una semana de Salud internacional ? Propuesta como un espacio de análisis, intervención e investigación que provea sentido a las prácticas de gobierno y permita analizar el lugar de la Provincia de Buenos Aires en el mundo y desde dónde la Provincia invita al mundo a pensar en clave de Salud Internacional. Organizada por la Diplomatura en Salud Internacional, una herramienta para la soberanía sanitaria de la Universidad Nacional de José C. Paz, la Escuela de Gobierno en Salud Floreal Ferrara de la Provincia de Buenos Aires y su Comité de expertas y expertos.

Política Nacional de Recursos Humanos en Salud del Paraguay 2020-2030 / National Health Human Resources Policy of Paraguay 2020-2030

La Política Nacional de Recursos Humanos en Salud (PNRHS) 2020-2030 constituye el instrumento de más alto nivel del Paraguay que enmarca y define de manera integral e integradora las estrategias y las acciones para el desarrollo y la gestión de los Recursos Humanos en Salud (RHS). Se construyó en consonancia con los valores, principios y estrategias de la Política Nacional de Salud (PNS) 2015 -2030, que busca avanzar hacia el Acceso Universal a la Salud y la Cobertura Universal de Salud (AUS-CUS) para reducir las inequidades y mejorar la calidad de vida de la población en el marco de un desarrollo humano sostenible

Mapa de Evidencias - Estrategias para Reducir las Desigualdades en Salud

Este mapa distribuye gráficamente los estudios de acuerdo con una matriz con 38 intervenciones y 39 hallazgos. La mayoría de los estudios incluidos estuvieron enfocados en población en general, población vulnerable y poblaciones en minoría (grupo étnico o racial). El tema de salud en general (26.5%) y estilos de vida saludables (16.3%) fueron los más abordados por las RL incluidas. Adicionalmente, el 63.3% de las estrategias evidenciadas en las RL estuvieron enfocadas en el sector salud y el 36.7% fueron de carácter intersectorial.

WHO Director-General Dr Tedros message: COVID-19 anniversary and looking towards 2021

December 31, 2020, marks the first anniversary of a report of a cluster of cases of “pneumonia of unknown cause” in Wuhan, China, which was later identified as a new coronavirus, SARS-CoV-2, and led to the COVID-19 pandemic. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, says there is light at the end of the tunnel in the fight against COVID-19. But going into 2021, he urged countries and communities to invest in strengthening health and emergency preparedness systems, ensure the equitable distribution of vaccines globally, adhere to proven public health measures to protect people from the virus, and work together, in solidarity, to overcome this and future health challenges. More information www.who.int/COVID-19

Media briefing on COVID-19 - 01/02/2021

00:00:14 FC Hello, all. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 1st February. Today's press conference will include special guests who are joining to discuss the launch of a new campaign by FIFA and WHO in support of COVID-19 vaccines, treatment and diagnostics. Dr Tedros will introduce our special guests shortly. We have simultaneous interpretation in the six official UN languages plus Portuguese and Hindi. Let me introduce to you the WHO participants. Present in the room are Dr Tedros, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, our Chief Scientist, Dr Bruce Aylward, Special Advisor to the DG and Lead on the ACT Accelerator, Dr Kate O'Brien, Director, Immunisation, Biologicals and Vaccine, and Dr Semira Asma, Assistant Director-General for Data, Analytics and Delivery. Welcome all. Now without further delay I would like to hand over to Dr Tedros for his opening remarks and to introduce our guests. Dr Tedros, you have the floor. 00:01:45 TAG Thank you. Thank you, Fadela, shukran. Good morning, good afternoon and good evening. For the third week in a row the number of new cases of COVID-19 reported globally fell last week. There are still many countries with increasing numbers of cases but at a global level this is encouraging news. It shows this virus can be controlled even with the new variants in circulation and it shows that if we keep going with the same proven public health measures we can prevent infections and save lives. However we have been here before. Over the past year there have been moments in almost all countries when cases declined and governments opened up too quickly and individuals let down their guard only for the virus to come roaring back. As vaccines are rolled out it's vital that all of us continue to take the precautions to keep ourselves and each other safe. Be a role model. It's vital that governments enable people to make the right choices whether it's making quarantine easier to adhere to or making workplaces safer. Controlling the spread to the virus saves lives now and saves lives later by reducing the chances of more variants emerging and it helps to ensure vaccines remain effective. 00:03:25 The COVID-19 pandemic has created an unprecedented demand for high-quality health data. Timely, reliable and actionable data is essential for governments and health providers to make the best decisions to promote and protect health. The pandemic has pushed even some of the most advanced health information systems around the world to the limit as they try to keep track of COVID-19 on top of other health priorities. Strengthening health information systems is an important part of WHO's work for detecting and responding rapidly to alerts and outbreaks as well as many other health threats. Today WHO launched the SCORE global report on health data systems and capacity which provides a snapshot of the state of health information systems around the world. This is the first report of its kind, covering 133 country health information systems and about 87% of the world's population. It assesses countries according to the five aspects of SCORE; survey, count, optimise, review and enable. The report shows that globally four in ten deaths remain unregistered. This highlights the urgent need for investments to strengthen health information systems in all countries to support the COVID-19 response and recovery and progress towards universal health coverage and the Sustainable Development Goals. 00:05:12 This report doesn't only identify the problem; it also offers solutions. The SCORE package is a set of tools that I call on all countries and partners to use to urgently address the data gaps. We can only make progress if we measure progress. We would like to thank all countries who contributed to the report and our partners including Bloomberg Philanthropies for their support. Strengthening health information systems has been a key part of WHO's transformation process over the past three-and-a-half years. Another key part of that process has been a new approach to partnerships. WHO recognises that we can only achieve ambitious goals by working with organisations who reach audiences we traditionally haven't. Last year WHO entered a new partnership with FIFA to leverage the enormous power of football to promote health. FIFA has been a strong supporter of global efforts to protect football fans from COVID-19. Last year FIFA contributed US$10 million to the COVID-19 Solidarity Response Fund and conducted several campaigns to raise awareness of how to stay safe from the virus, be physically active and to stop violence against women. 00:06:48 Today I'm honoured to be joined by two of the biggest names in the world of football; Gianni Infantino, the President of FIFA, my good friend, and Michael Owen, one of the most prolific strikers of the past 20 years who won the Ballon D'Or for the world's best player in 2001. Gianni and Michael have joined us today to support the Act Together campaign to promote equitable access to COVID-19 vaccines, treatments and diagnostics as part of a comprehensive approach to controlling the pandemic. Gianni, thank you and welcome once again. You have the floor. Thank you, my brother. GI Thank you. Thank you very much, dear Tedros, my dear friend; really heartfelt thanks for the opportunity to be here at the WHO today. First and foremost on behalf of FIFA and on behalf of the global football community I would like to express my condolences for all the victims of the coronavirus across the world and I extend my deepest sympathies to the families and friends of those who have lost their lives. Of course our thoughts are also with all those who are suffering or who have suffered in the last year due to this terrible pandemic. 00:08:31 Health is of course the number one priority for everybody all over the world and we feel at FIFA that it is vitally important that we work and that we act together to defeat COVID-19. FIFA is honoured to support global efforts to protect people from the coronavirus and to end this pandemic. Fairness and team spirit are key values of our sport. Football's beauty is of course that the sport is open to all people; girls and boys, women and men all over the world. These same key values - fairness and team spirit - are needed for today's great challenge; overcoming COVID-19. If we act together as a team we can play our part in the fight against coronavirus and in that way football is also calling the international community to act together, to ensure that a level playing field exists in relation to access to vaccines, to treatments, to diagnostic tests and that this is the case all over the globe. 00:10:08 We have to get this message to a global audience through football, using football as a very powerful tool for good. FIFA is proud to use the upcoming platform of the FIFA Club World Cup, starting in three days from now, and more generally FIFA's global impact to promote the importance of fair access to vaccines, treatments and diagnostics as part of the ACT Accelerator initiative, an incredible initiative, and to remind people watching our games and to remind the global football community of the importance of adhering to vital public health measures. We all know that the coronavirus does not discriminate and we ask everybody to play their part in eliminating the threat that this disease poses to all our lives by maintaining the key steps to stop transmission and stay safe from the virus, including of course physical distancing, wearing masks and hand hygiene. There are many tactics which are needed to win a football game. At the same time we must take a comprehensive approach to defeating COVID-19. We must do it all and do all it takes and we must remembered that the only way we will all be safe is if we make sure that everyone is safe. Equity, equity, team spirit, fairness can make this happen and with this in mind I'm also delighted that FIFA can once more count on the support of a true football legend to spread this message even in a more powerful way than anyone else can do. 00:12:14 Michael Owen is here with us and he will help definitely to amplify the message together with many other FIFA legends so thank you, Michael, for being with us. Thank you, Dr Tedros, for giving us this opportunity and the floor and we are on the same team. TAG We are in the same team. Thank you so much, Gianni, and thank you for your continued partnership and support. Now it gives me great pleasure to introduce Michael Owen, who scored more than 400 goals in a 17-year career for club and country. Michael, it's an honour to have you with us today. Over to you. MO Thank you very much. We are all aware that there have been challenges throughout the coronavirus pandemic and equally I would like to share my deepest condolences on behalf of the FIFA legends to all the victims who have lost their lives as a result of COVID-19. Our thoughts are with their families and friends at this difficult and challenging time. 00:13:23 It is important that football remains in tune with society and plays an important leadership role in addressing issues that affect us all. It has been clear from day one that health comes first and this remains the case but almost in a different way than before. As individuals we need to remain committed to the six-step process. The message is consistent and I am delighted that FIFA's return to competitive football through the FIFA Club World Cup is also being used to remind a global TV audience watching our game of the importance of adhering to vital public health measures; wash your hands frequently, cover your nose and mouth if you sneeze or cough, avoid touching your face, stay at lest 1m distance from others, if you feel unwell stay at home, wear a mask and open a window when inside closed rooms. Over and above that it is important that both of you, Dr Tedros and Gianni, remind the powers that be that there needs to be equity and fairness in access to vaccines. This has been a global pandemic and globally we need to give access to vaccination. Thank you both for your efforts. 00:14:54 TAG Thank you. Thank you so much, Michael, and thank you for using your voice and influence to support the Act Together campaign. If there is one thing we have all learned in the past year it's that when we act alone we're vulnerable but when we act together we can save lives. Fadela, back to you. FC Thank you, Dr Tedros. I would like now to open the floor to questions from journalists. I remind you that you will need to raise your hand using the raise your hand icon in order to get in the queue. I would like to start these questions and answers by inviting Graham Denver from Associated Press to ask the first question. Graham, are you online? GR Yes, I am, Fadela. Thank you. Thank you very much, everyone, for being available to us. A question about the World Cup qualifying games that resume or start next month. We have more than 150 national teams due to be playing with players scattering all around the world from their clubs to go to their home countries to join up with their national teams. Is this an acceptable risk to be taking at this stage in the pandemic and is it realistic to keep asking governments to make exemptions for professional sportspeople in terms of quarantine to make the games work? 00:16:37 FC Thank you. President Infantino, please. You have the floor. GI Thank you very much. Thanks for the question, which indeed is an important one. We have been developing together with the World Health Organization already in the course of last year a so-called back to football protocol. It is obvious and I want to repeat this here once and for all again that health is priority number one. When we play football we want to protect the health of all those involved; the players, the coaches, the referees, the officials, the fans and whatever we do and whatever we will do as well in the next qualifying games for the World Cup or some continental competitions, we will do by adhering to a clear health protocol which will not put at risk the health of anyone. It is always of course a balance that we have to take but we need to respect the legislation, the decisions of the governments all over the world. In many countries football has come back; in some not yet; in some with spectators; in others without spectators so the situation is very, very different all over the world. 00:18:03 When you organise national team games you also give hope and joy to people but everything needs to be done respecting health conditions so we have our protocol. It is put in place. We will monitor the situation of course in the coming weeks. We can say - and we were hearing it earlier today from Dr Tedros again - that the situation is evolving week by week or day by day. The international games will be in March. By then we'll assess the situation, we'll see where we can play, in what conditions but we'll certainly not take any risk with the health of anyone when we play football. FC Thank you. I would like now to invite Sophie Mkwena from SABC, South Africa, to ask the next question. Sophie, you have the floor. SO Thank you. My question is directed to the President of FIFA, Gianni Infantino. President, can you elaborate, in terms of ensuring that we use football - or soccer as we normally call it in South Africa - to mobilise the nation and show that the world is safe from COVID-19, what is it that FIFA will be doing to ensure that the world is safe from COVID-19 using its footprint around the world but its popularity as one of the most popular sports around the world, particularly on my continent, Africa? 00:19:52 GI Thank you very much for the question and, by the way, speaking about Africa and speaking about also the question that was asked just earlier, for the national team games in Africa in November last year players were coming not only from the 54 African countries but also from 61 countries around the world back to Africa in order to play football - or soccer, as you call it. What are we doing or what do we want to do? We want to be a responsible organisation at FIFA. This is a new FIFA and we are aware of the responsibility that we have. We are aware of not only the magic of football, which of course is very important to millions, hundreds of millions or even billions of people around the world, but also about the power of football and we need to use this in a responsible way. Last year, I think it was on 11th March 2020 when the WHO declared that COVID-19 was a pandemic; the day after in the morning I was sitting in the office of Dr Tedros asking him, what can we do to help? We are facing an unprecedented situation for everyone, for football of course as well but we want to help, we want to be able to do something. 00:21:23 So we started immediately of course only maybe with campaigns, with messaging, with supporting and helping through the voice of football, of FIFA legends, the messages that the WHO and all governments were spreading because it is true that many children, boys and girls all over the world, listen maybe more if you have Michael Owen, who is here today, or other football legends saying that you have to wash your hands than if it is a big personality of whatever, politics or health or a doctor. We need to put this power at the service of the community and that's what we do here as well today. Last year we have been supporting several campaigns together with WHO. Today we are here to again give our support to the Act Together process to have equality, to have fair access to vaccines. It is important that a message comes as well from the football community. Football means so much to so many people. We are all locked down more or less everywhere. We need to come back to normality and football can help definitely a little bit to show to the people that we are coming back to normality. 00:22:57 That's why we are here, to co-operate, to pass the messages that the WHO is also passing and all the governments around the world are passing and to help and to be part of the team to win this match against COVID-19. FC Thank you, President Infantino. Let's come back to Geneva; Laurent Zero from ATS, Swiss news agency. Laurent, are you online? LA Yes, Fadela, thank you for taking my question; also a question to Gianni Infantino on vaccine because you mentioned fair and equitable access. There's been a debate around the Olympics on whether the athletes should be vaccinated earlier than they are supposed to in order for them to be able to participate in the Olympics. There will be two World Cups of Clubs this year; there are these national qualifiers that were mentioned, the World Cup next year so what's your position on that for the players? Do you think it will be possible to have full attendance at the World Cup next year? Thank you. 00:24:21 GI Thanks again, thanks for the question. Let me answer the last question first. Yes, next year at the World Cup 2022 in Qatar from 21st November to 18th December we will have full stadiums. We must have this; COVID will be defeated by then and we all will have learned to live with it. But if in two years from now we are not there yet then I think we will have a bigger problem than the World Cup. We will not have because there are many, many very competent people working on it starting from here, WHO so I'm very, very confident that the World Cup next year will be incredible and will be the same magic World Cup as all World Cups, really bringing the world together and uniting the world. After a year or more of confinement, of lock-downs, of travel restrictions I think we are back and we will be back to where we have to be. With regard to to your question about the vaccines, again if we are here today, if I am here today it's to amplify the message in relation to fair access to vaccines all over the world. I've been travelling a little bit in the last few weeks to Asia, to Africa. We need to guarantee that everyone can be safe and for this we are here to support WHO, to support COVAX and all the other organisations. 00:26:04 But let me answer very clearly to your question; in terms of priorities the priority for the vaccines is of course for the people at risk and for the health workers. This is very clear in our mind. I don't consider, we don't consider football players as a priority group in this respect. Of course for safety reasons in the months to come in the context of international competitions, of travel and so on vaccination might be recommended at some point and the Olympic Games, as you mentioned, are of course only in the summer. But all this will happen of course respecting the established order of the solution and there are people who are at risk and these people should have priority of course to have the vaccines and it's not the football players or officials. FC Thank you. I would like now to invite Shalid Nahar, I believe a reporter from German Sport TV channel, to ask the next question. You have the floor. 00:27:27 SH Hello. Mr Infantino, can you hear me? FC Yes, we can. You can ask your question. SH I have a question about the Club World Cup that has been postponed in China this year. Is there already availability for a date to get this edition of the Club World Cup which was planned this year? GI Thanks for the question as well. Since you are from Germany you know that we are starting the new Club World Cup together with Bayern Munich being the European participant in three days from now in Qatar. Of course it's not yet the big Club World Cup which should have taken place in the summer of 2021, this summer, in China. We needed - and we did so of course very quickly - to make space for the postponed European Championship and for the postponed Copa America, which will take place this summer. So we have not yet fixed a new date for the new version of the Club World Cup. 00:28:37 What we know is that the current version, the reduced version with the champion of each continent takes place next week or this week in Doha and then at the end of the year, in December 2021 in Japan and then we are looking at next year or the year after to see when the new Club World Cup will take place and this will be again an amazing competition, again bringing people together from all over the world. FC Thank you. I would like now to give the floor to Stephanie Nebahe from Reuters. Stephanie, you have the floor. ST Thanks very much. Can you hear me? FC Yes. Go ahead, Stephanie. We can hear you perfectly. ST Thank you. I wondered if Dr Tedros might give us an update of his assessment of the situation in Wuhan so far in terms of access to sites and quality of information or research received from Chinese colleagues there and whether you still expect them to visit the Institute of Virology. I also note that Secretary of State Blinken said earlier today that China is - quote - falling short in allowing access. Do you share that assessment or have any comment, please? Thank you. FC Thank you, Stephanie. Dr Ryan will take this question or Maria Van Kerkhove. Maria will start. 00:30:12 MK Yes, thank you, Fadela. Thank you for the question, Stephanie. The team is on the ground, as you know, and there is quite a media coverage following them around so you've seen some of the visits that they have made. They are having very productive discussions with Chinese counterparts, visiting different hospitals around Wuhan. They've had a very good visit to the market, seeing first-hand the stalls and walking through and we've had some good feedback from them of the importance of being able to physically walk through. They've also met with counterparts at the Wuhan CDC and other different levels of the Chinese Centre for Disease Control and they're having very good discussions but, as you know, the plans and the visits that they have provide detailed information and all of this detailed information requires analysis, which is ongoing between the international team and the Chinese counterparts and all of that detailed analysis leads to more and more questions. 00:31:10 So anyone who's ever been on a mission like this before - and I know there are many scientists watching this as well - knows that the more detail you have on the ground the more questions you have. The teams will follow the information, they will follow the science and continue to ask questions and analyse data. They will visit the Institute of Virology; that is being planned but we do leave them the freedom to decide the visits that they need to make throughout the course of the mission that they have. Their focus is on the early cases and they're having very good discussions around that and we will wait to make an assessment, for the team to do that themselves. We need to give them the space to be able to carry out this scientific study. MR Just again may I remind everyone that this is an international mission and a mission that was mandated through the World Health Assembly by a unanimous resolution asking that the DG send such a mission, which he has done; a preliminary mission in July and the full mission now. There are experts from ten countries across a range of all of the key areas needed. 00:32:25 Maria has outlined what the team are doing and progress is being made but as we've always said, all of the answers may be there on this occasion; they may not be. We continue to ask the questions, we continue to push for more data because as part of any investigation of any infectious disease event as you gather more information you get some answers and then it creates more questions. It's a detective story and you go through again and you answer more questions. The fact that you have to ask a different question two weeks later to a different person doesn't mean that someone is holding back information. It means you haven't asked the right question yet so that's the process and that's the scientific process of discovery and finding things out; that's what we're trying to do; push back the window so we can see the origin of this virus, which is important for everyone. The other thing I would say; many people externally are making references to the fact that they won't accept the report when it comes out or the report is already not a report they will accept or that there's other intelligence available that may show different findings. 00:33:31 I would ask right now as I sit here; no other country has provided any documentary intelligence or other information to WHO. We are out there looking for it. We are in the field with experts from ten countries looking to find the answers. If you have the answers, if you think you have some answers please let us know. We've had this here before at this very press conference; people making allusions to intelligence that was available that had the answers that was never provided. So who's responsible here and who's acting responsibly? To say that you won't accept a report before it's even written, to say that you have intelligence that is not being provided. I think we need to recognise that at the moment the international community - not WHO, the international community under the World Health Assembly of 194 countries has a team in the field that Dr Tedros has put in the field. It deserves the support of the international community and it deserves to be able to finish its work. Not that all the answers can be found this time but it's certainly, for me, time for people who say and think they have information to start providing it. 00:34:42 FC Thank you. Now I would like to invite Bianca Rauthier from Oglobo to ask the next question. Bianca, you have the floor. BI Hi, Fadela. Can you hear me? FC Very well. Go ahead, please. BI Thanks a lot. Good afternoon, everyone. My question is about Brazil because the Ministry of Health said that COVAX would send ten to 14 million doses of the Oxford vaccine to Brazil from February but at the same time PAHO said COVAX would deliver 35 million doses to 36 Caribbean and Latin American countries from mid February. It would mean that Brazil would get at least a third of doses from the region. I think there is confusion with these figures. Could you please clarify? We have the plan for Brazil. What can Brazil expect from COVAX in terms of doses and distribution dates? Thanks a lot. FC Thank you, Bianca. I think we will start with Dr Aylward. Bruce, you have the floor. 00:36:02 BA Thank you so much, Bianca. As we mentioned last week, the COVAX facility now is getting a better sight line on the timing for the emergency use listing of the products that it has in its portfolio and the key ones are going to be the AstraZeneca products that are going to come out and hopefully be available from February. What Bianca's referring to, just so everyone is aware, is over the weekend the COVAX facility has looked at the available volumes and then it's calculated for all of the participants in the COVAX facility, all 190 countries what they call indicative allocations so how much of that product should be available to those countries starting from late February and then running into March and right through the first half of the year. Bianca, I wish I could give you the exact numbers but as there were 190 letters that went out yesterday I'm afraid I can't remember exactly what's being allocated to which and for clarification on that I think the information's just gone out to the countries over the last day. They need a couple of days to reconcile that and remember as well, the numbers that went out are indicative volumes so they're ranges so for one country it could be from two million to three million depending on what the final volumes from the producers are, whether or not all these products get through emergency use listing, etc. 00:37:42 So I don't know what's exactly happened in terms of the numbers you're referring to but sometimes people read the top end of the numbers and another audience may read the bottom end of the numbers but there may be a couple of different reasons if they're not aligning. In the case of Brazil you may also be aware that they have bilateral arrangements on the AstraZeneca product so again I'm not quite sure of the absolute specifics but I think the good news is that the COVAX facility has been able to go out to all the countries that are part of the facility over the weekend, give them the indicative volumes and a sight line on what they look like from February, which is a clear indication of course that that is the timeline to start delivering from the facility to multiple countries. FC Thank you, Dr Aylward. I would like to invite Dr Simao to add some elements. Dr Simao. 00:38:39 MS Thank you, Fadela. Very, very briefly, Bianca, because this indicative allocation is actually based on projections of what's in the contract but also we will have to take into account the regulatory aspects. These vaccines will also need to be approved for emergency use authorisation in the countries. Also we are still waiting to see the actual projection of how many doses will be available in February and March from the manufacturers because you will have seen, there are some glitches in the manufacturing of the different vaccines at this stage and there may be less volumes to be allocated - you'll know that - in the next few weeks. But, as Bruce said, this is an indicative allocation, there is a range and we put it out so that countries know it will be coming but the volumes have still to be addressed, the number of doses will still need to be taken into account according to the supply when the time is ready. Thank you. FC Thank you, Dr Simao. Dr O'Brien, you have the floor. KOB Yes, I'd just like to make one other point; for self-financing countries in the facility countries also informed the facility what fraction of the population they wanted to cover and not all countries elected to cover 20%; some of them went lower, some of them went higher. 00:40:21 So the indicative allocations for any one country also represent, if they were a self-financing country, what their desire was that they communicated to the facility at the time when they committed to the facility. I think it's just important that when any comparisons are being made across countries there are a number of features that go into these indicative allocations. Thank you. FC Thank you, Dr O'Brien. I would like now to invite Tamara from Georgia to ask the next question. Tamara, you have the floor. Tamara, you have the floor. Can you please unmute yourself? TA Yes, thank you for this opportunity. I'm from Georgian TV company Formula, a Georgian journalist. I wanted to ask you; two days ago the Prime Minister of Georgia, Mr Giorgi Gakharia made a statement that he had a conversation with Mr Tedros and that Georgia can expect the first batch of vaccines at the end of February. 00:41:38 Can you tell us more details about this conversation and of course about the vaccine, when we can expect it, how many doses we can expect and also which vaccine can Georgia expect? Thank you for this opportunity. FC Thank you, Tamara. TAG Thank you very much. I think this is a very detailed need for information and it's very difficult to communicate with countries on details of things through media. We have a channel to communicate with each and every one of them so I'm really sorry but it would be better to communicate through that channel, not through media. Thank you. FC Thank you, Dr Tedros. I would like now to invite John Zaracostas to ask the next question. John, you have the floor. JO Good afternoon. Can you hear me? FC Yes, very well. Go ahead, John. JO My question is basically - perhaps Dr O'Brien can answer it; I would like to know, what is the current production capacity for COVID vaccines; what have the manufacturers conveyed to the WHO will be scaled up and if we have a time period because in previous influenza crises or pandemics we had a good picture from industry where they were on the production. It doesn't seem to be the case right now. 00:43:22 MR John, I'll take the floor only to wish you a Happy New Year and then to pass on to someone who'll have a much better answer for you than me. KOB Let me start off and there may be others who would like to contribute as well. The COVAX facility has committed supply of over two billion doses for 2021. The month-by-month indicative supply projections are available on the COVAX facility website; we'll be happy to post those so that you can easily access them. They are based on - not just for the COVAX facility but frankly the supply projections for all countries are based on projections from manufacturers about what their expectations are for yields of the vaccines and for the timeline of those yields and being able to produce the vaccines. 00:44:21 As you know, for biological products there is no certainty around being able to secure those yields with 100% surety and we are hearing about challenges that manufacturers are having on their production so again we have to emphasise that those month-by-month projections for the vaccines that have secured contracts are what they are, they are projections and we are all in the place where we hope that those production expectations are met. In addition to the over two billion doses there are also first-right-of-refusal options on another billion doses in the COVAX facility for products that have not yet completed their clinical efficacy trials that are supported for research and development and therefore as part of the contracts for support of that R&D have the right of first refusal for the COVAX facility. Then thirdly there are negotiations that are ongoing with additional manufacturers by the COVAX facility to secure additional doses. I hope that gives you a sight-line for where you can find the month-by-month information and what that information actually means. I'll turn that over to anybody else who might want to contribute. FC Thank you, Dr O'Brien. Dr Aylward. 00:45:59 BA Hi, John. It's Bruce here. Yes, the simplest thing, guys; there's a fantastic resource on the web; the simplest thing is just Google COVAX supply forecast and then you can go and click on it and it gives a great break-down; I just thought it'd make it a little easier for people to find it. What it shows is by quarter what the projections for that 2.2 billion doses look like and then it also provides you break-down in terms of WHO regions, an AU view, a view by product. So it's quite a nice document that GAVI has posted by the best part of the document is what's on the right-hand side of each page because on each page it has caveats and it explains what the challenges are around the licensing of those products, the yields, etc. So I think GAVI and the facility have done a great job trying to give people as much visibility as possible on the pipeline and will continue to do so as they go forward. That can be found there but with the caveats on the right-hand which are so important. We're dealing with a biologic process here. All the manufacturers are working flat-out to try and optimise their volumes but at the end of the day there are challenges as you move from developing clinical trial lots that you use for your trials to the commercial-scale production. 00:47:23 Often you run into problems with yields and other aspects that just mean your volumes end up being lower, as we've seen to the disappointment of many recently but that's part of the challenge. Everyone's working very hard to get as much product as possible out there but there will be setbacks and bumps along the road as we go. SS Just to supplement that, as Kate and Bruce have said, manufacturing at this scale is a challenge. We're wanting billions of doses suddenly and the world is not used to manufacturing this many vaccines so one thing we would like to encourage is for developers who now have vaccines that have passed the clinical efficacy trials to really explore how they can expand manufacturing capacity by partnering with other manufacturers that have spare capacity in different parts of the world. This is something that would be useful for this pandemic but also beyond that because I think it would be building capacity in different parts of the world and we set up a mechanism; the Director-General announced the creation of something called the COVID technologies access pool way back in May 2020 and that was really to encourage and enable anybody who had products, who had technology, who had knowledge or data that they wanted to share to do it through that, thereby linking producers and developers who have the know-how with those who actually have the capacity. 00:48:58 We also have to remember that vaccines need the raw material, they need to be filled and finished and packed but they also then need the syringes and the vials and everything that goes with getting the vaccine into people. So side-by-side with investments in manufacturing of the actual vaccines we also need to make sure that we have the syringes and needles and the other materials that are needed. The COVAX facility has been focusing on making sure that all of that happens as well but I think more sharing of technology and looking at innovative ways of increasing production would help meet some of the shortfalls that we're seeing today. 00:49:38 FC Thank you, Dr Swaminathan. I would like now to invite Isabel Sacco from EFE to ask the next question, maybe the last one. Isabel, you have the floor. IS Good afternoon, everyone. I would like to ask Dr Aylward; maybe he has in mind information on the number of vaccines, the indicative allocation that he mentioned by volumes; maybe he can provide this information. I understand that it was said last week that this information will be publicly available so I would like to know where and when this information will be accessible to all of us. Thank you. BA Hi, Isabel. Thank you for the question and sorry I may not have been clear enough in an earlier comment. About ten days ago the COVAX facility published on the GAVI website the indicative allocations by region and by month starting from the February/March period right out through so if you go onto the GAVI... Actually the easiest way to find it is Google it; just Google the COVAX supply forecast. If you Google that then you will find there's a link to a document which is updated regularly. We're going to try and update that every week or two weeks as numbers change. 00:51:12 What that document will provide is the indicative allocation by month and by region so you'll be able to see for each of the six WHO regions how many doses they can expect during each of the months. As mentioned in the answer to the last question there're a lot of caveats or potential considerations that we have to bear in mind because producers may have smaller volumes than they're hoping for, there may be delays in providing emergency use listing of a product, etc, so these may change. But the indicative allocations are being published now on the site and they can be found there so if there's any trouble just contact our media folks, who will be able to make sure you have access to that important information, again with the caveats that these are very much indicative numbers and you're all seeing the challenges some manufacturers are having reaching the volumes that they've committed to so these are subject to some change as we go forward, especially in the short term. The other thing that was referred to by some of our earlier speakers was indicative allocations at the country level but as the Director-General said, those are direct communications to the countries, to the Ministries of Health, between the facility and them and best is working directly with them to understand what their indicative numbers could look like. 00:52:37 But again bearing in mind all the caveats so I think it's going to be so important and helpful also if the media - I'm not going to tell you your job but I think the more we can help populations understand that this is indicative, this is if everything goes right. If there're problems then the numbers will be lower and smaller but everybody's doing everything possible to optimise those numbers. It all comes back to what Mike has been saying all along, Dr Tedros and Maria though; in the meantime we've got social distancing, we've got masks, we know how to prevent the spread of this disease and we have to rely on those during this period, as tough as that is. FC Dr Ryan, you have the floor. MR Thank you, Bruce; you're absolutely correct in terms of what we need to continue doing but just also on that with relation to vaccines, certainly Kate and her team and the vaccination team and our teams working in terms of country support with the regional platforms and the World Bank have been working on these vaccine readiness plans at country level. 00:53:41 They're all being currently uploaded into the public domain too so everyone can see, especially donors and others, what it's going to take to deliver those vaccines because again we've seen even with small numbers of vaccines in some countries part of the problem has been actually delivering those vaccines, generating the vaccine demand, doing the proper and safe vaccination, monitoring the implementation and doing it properly. So vaccine is one part of the solution; being able to deliver those vaccines efficiently... So we would ask all donors and all investors and all financial institutions to look at those national vaccine plans and see where you can invest. It's not just an investment in vaccine we need. We need an investment in the country's capacity to deliver those vaccines sustainably and also that will obviously help strengthen core immunisation programmes as well at country level. So I think there's a good investment there for everybody to support. 00:54:36 FC Dr Van Kerkhove. MK Yes, I don't want to answer the question. I just want to take the opportunity, as the least sports person up here, to thank Mr Infantino for the leadership that sports players play around the world. One of the things we're learning is about being a good role model and you brought it up in your answer; that sports professionals, at the professional level but also at high school level, university level, even the little kid level; being a good role model is what we really need to see right now. It's very, very hard to keep up all of the hand hygiene and the mask wearing but if we have sports players, we have leaders all over the world to show us that it's cool to do it helps and we can use all the help we can get. So as the least sports person up here I wanted to say thanks because I didn't have an opportunity to say it before. FC Thank you. Dr Tedros, you have the floor. TAG Maria has already said what I wanted to say so thanks, Gianni. I also thank all who have joined today; thank you so much and all the best until we see you in our next presser. Bye. Gianni, would you like to say something as we are closing? 00:55:50 GI The last word before we go? Of course. Tedros, thank you very much to all the team here. How should I say? As a normal person who, like billions of those following this conference, is watching every day what is going on I would simply like as well to commend all those persons here and all those who work to make our lives better, to save our lives. We want to play a little part in that but what these ladies and gentlemen here are doing, the medical staff are doing; this is just incredible; we cannot underline it enough. Let me just say as well, when I hear sometimes criticisms here and there - someone mentioned even today, I can just appeal to everyone, this is an unprecedented situation. We all have to work together. We all make mistakes, everyone makes mistakes but we have to work all together. When I hear that vaccines have been developed in less than one year, this is incredible. This would not have happened without the great work of many people. We have to recognise that. 00:57:05 Now today I heard that there are around 2.2 billion vaccines available. It's not enough; we need to do more, which means we have to work together. Let's join forces, let's work all together, let's support WHO but all those who are working to save our lives. That's why we are here, that's why many, many players, football players, legends, sportspersons, famous or not famous are embracing this challenge and this fight all together because united we'll overcome this. For me this is the most important message; let's continue and let's win this match. Thank you very much. TAG Thank you. Thank you very much. FC Thank you, President. Just reminding journalists, you will receive the DG's speech and the audio file of this press conference just after the press conference and the transcript will be on the WHO website tomorrow. Thank you all for your participation and see you next time. 00:58:10

Media briefing on COVID-19 and Migrants Day - 18/12/2020

00:00:40 TJ Hello to everyone from Geneva, WHO headquarters. My name is Tarik and I welcome you to this regular COVID-19 press briefing. It's not so regular because today is International Migrants' Day and Dr Tedros will say more about that as well as our guests. Before I give the floor to Dr Tedros, just to remind journalists, this press briefing has simultaneous translation into six UN languages plus Portuguese plus Hindi. We will open the floor to questions immediately after the opening remarks. We would ask journalists to be brief and ask one question at a time. I would also like to use this opportunity to thank our interpreters who are helping us with the interpretation for today. I will briefly say who is in the room here and then I will also later announce who is online to answer any questions. In the room we have Dr Tedros, WHO Director-General. We have also our special guest who Dr Tedros will introduce a little bit more in detail; it is Mr Antonio Vitorino, Director-General of the International Organisation for Migrations. We have Dr Mike Ryan, who is our Head of the Emergency Programme. We have Dr Maria Van Kerkhove, Technical Lead for COVID-19. We also have Ms Jacqueline Weekers, who is the Director of the Migration Health division with IOM and we have Dr Santino Severoni, who is our Director at WHO of Migration and Health. Bruce Aylward is also with us, who is working with the ACT Accelerator. I'll give the floor to Dr Tedros for his opening remarks and then we will introduce other experts who are online with us. TAG Thank you. Thank you, Tarik. Good morning, good afternoon and good evening. On Monday I ended our press conference by sending my best wishes to UNHCR, the UN refugee agency, for its 70th birthday and today is International Migrants' Day and I'm delighted to be joined by Antonio Vitorino, Director-General of the International Organisation of Migration. Welcome to him. IOM is our next-door neighbour here in Geneva and our very close partner. In recent years we have witnessed the largest population movements and displacement since the end of the Second World War. Too often migrants and their families remain outsiders in their adapted communities even years after migrating. 00:03:39 They face discrimination, social exclusion and lack of access to health services and yet migrants make enormous contributions to our societies with new ideas that drive economic and social innovation. That's also true in the COVID-19 response. It was Turkish migrants to Germany who founded the company that developed the first COVID-19 vaccine to be approved and rolled out. It was a nurse from the Philippines who administered the first dose of that vaccine in the UK. All around the world many health workers are migrants, especially women, who account for 70% of the global health workforce. When the World Health Assembly designated 2020 as the International Year of the Nurse and the Midwife none of us had any idea how much we would rely on nurses, midwives and other health workers to keep us safe in the face of a global pandemic. We all owe a huge debt of gratitude to the nurses and midwives who are often the first and only health professionals present to treat and comfort the sick and dying and bring new life into the world. 00:05:04 Together with Women in Global Health, the International Council of Nurses, the International Confederation of Midwives, the United Nations Population Fund and Nursing Now we yesterday launched a list of 100 outstanding women nurses and midwives from around the world who have made an exceptional contribution to nursing and midwifery. They represent millions of nurses and midwives who use their knowledge and expertise on a daily basis to protect the health and lives of others, at times putting themselves in harm's way to do so. To better understand the impacts of COVID-19 in refugee and migrant populations WHO and the research consortium led by Ghent University and the University of Copenhagen has conducted a global survey called Apart Together. The survey was supported by several partners and included almost 30,000 migrants and refugees in almost all WHO member states. 00:06:17 It shows that people living on the streets and in asylum centres are less likely to seek care if they have symptoms of COVID-19. Of those who reported not seeking healthcare 35% said it was because of financial constraints and a further 22% said it was fear of deportation. More than half of those surveyed said that COVID has caused them depression, worry, anxiety and loneliness. These findings paint a bleak picture but they also point the way forward. There are several measures countries can take to include refugees and migrants in response plans and public health measures. Access to care must not be linked to legal status. Improving internet access for migrants is also important for improving access to information and most crucially we call on all countries to remove financial and other barriers to care for migrants as part of their journey toward this universal health coverage. Health for all means all including migrants. That means increasing investments in health, especially in primary healthcare to create health systems that are sensitive to migrants' needs, their language and their health problems. 00:07:56 These include reproductive and child health, mental health, trauma from injuries, violence, sexual abuse and assault, investing in the health of migrants is not just the right thing to do; it also has long-term benefits for social cohesion and economic development. Exclusion is costly in the long run but inclusion pays off for everyone. It's also vital that migrants and refugees are included in plans for the roll-out of vaccines against COVID-19. As you know the ACT Accelerator, which includes the COVAX facility, was established to ensure access to vaccines for the world's poorest and most vulnerable people, many of whom are migrants. Earlier today WHO and our COVAX partners, GAVI, CEPI and UNICEF announced that we have secured agreements for access to a billion doses of several promising vaccine candidates. I would like to thank Canada and Prime Minister Trudeau for committing to share surplus doses of COVID-19 vaccines. These unprecedented agreements mean that all 190 countries and economies participating in COVAX will be able to access vaccines to protect vulnerable groups in their populations during the first half of next year. 00:09:34 This week I have spoken with CEOs of pharmaceutical companies and met with European Commission President Ursula and President Charles Michel in Brussels to ensure that we start vaccination as soon as possible in the new year. WHO and our COVAX partners are working non-stop to start vaccination as soon as possible in the new year and WHO remains committed to working closely with IOM and many other partners to support countries in improving the health of migrants during the pandemic and their end [?] after it's over. It's now my great pleasure to introduce Antonio Vitorino, Director-General of the International Organisation of Migration, to say a few words. Antonio, mi fratelo, you have the floor. AV Thank you so much, Tedros. It's a great pleasure for me to be here today with you not just as a neighbour but as a close partner in International Migration Day. Because of all the reasons that you have just mentioned it is indeed critical that we join forces to ensure that the most vulnerable including, as you have said, migrant refugees, asylum seekers, internally displaced persons and in general people on the move are not left out of our global efforts to fight back against COVID-19. 00:11:10 I must say that, contrary to the political rhetoric, most of these forcibly displaced persons live in low and middle-income countries which tend to have weaker health systems and struggle to meet the health needs of their own population. Access to health is a human right. It's a human right of migrants too but the list of barriers and difficulties that migrants face in assessing healthcare is far too long. That said, I believe that in some countries being a regular migrant is a prerequisite to access to healthcare. But this lives quite a large number of irregular migrants, stranded migrants, migrants who cannot return back home and we estimate that we have three million stranded migrants all over the world, and leaves also migrants in detention uncovered. Too often health information is not given in a language that is understood by migrants. Last but not least, as you have mentioned, migrants are particularly prone to anxiety, to insecurity, to mental health and psychosocial problems and especially women and girls who are particularly vulnerable. 00:12:44 To be honest, what I have found particularly intolerable in this current crisis is that while being so often left behind migrants have also been on the front line of the response to the pandemic, taking personal risks for everyone's well-being. This is across many critical sectors, not just the healthcare sector but also transport, food, retail, research, IGN and homecare; you name it. So I'm happy to be able to tell you that many countries have understood the importance of universal health coverage. Already before the pandemic about 43% of all countries offered health coverage to all migrants no matter their legal status and in this year of public health emergency several host countries have temporarily introduced new policies or relaxed requirements to grant access of migrants to healthcare. But this is not enough. One of the crucial issues is that migrants sometimes are suspicious to look for healthcare because they're afraid that, contacting health services, they might be detained or even deported. 00:14:12 Building a mutual trust relationship between public health services and migrants will be crucial, especially now as we are going to have a true test case. As we collectively gear up for one of the world's largest vaccination campaigns I believe that we must be vigilant and ensure that access to the vaccine is fair and equitable. I praise the efforts of WHO in the COVAX environment and the WHO partners, GAVI and the Vaccine Alliance on this front. Therefore I want to take this opportunity to call on governments to count and include all migrants present in their territories no matter their legal status in their national vaccination plans. Let me be very clear; as governments prioritise health workers on the front lines they need to ensure that migrant front-line health workers are also vaccinated. As governments prioritise people above a certain age then all migrants above that same age should be prioritised in the same way. It's not a question of creating any preference or privilege to migrants; it's guaranteeing access to the vaccination on an equal footing with the nationals. 00:15:47 It remains vital that migrants in vulnerable situations have access to immunisation and essential primary healthcare services including mental health in humanitarian settings as much as in urban slums or border communities. From our side, Tedros, you can count on IOM engagement and support for the efforts to guarantee a successful vaccination process so that we finally defeat the virus. Thank you. TAG Thank you so much, Antonio. Tarik, back to you. TJ Thank you very much, Mr Vitorino and Dr Tedros, for these opening remarks on this very important day. Before I start calling on journalists for questions, just to let you know, we have online also Dr Soumya Swaminathan, who is the WHO Chief Scientist. We also have Kate O'Brien, Director for Immunisation, and we have Mariangela Simao, who is Assistant Director-General for Access to Health Products and Medicines. With that I will start with the Philippines, Philippines Daily. We have Yovik Yi online with us; I think it's the first time we've had Yovik with us. Yovik, please unmute yourself. YO Hi. Can you hear me? 00:17:28 TJ Yes. Please. YO Hi. I would just like to ask about the public's preference for some candidate vaccines. Pfizer, Moderna and AstraZeneca earlier released the efficacy data on their vaccines which naturally excited everyone but of course these firms can't be expected to supply the entire world with their vaccines. So my question is, what can WHO say to those people who might be questioning or having doubts about their governments' decision to enter into deals with manufacturers that have yet to release their data or are still completing their phase-three trials? Thank you. TJ Thank you, Yovik. The line was not really the best. If we were able to hear, it's about candidate vaccines and data, in particular about the AstraZeneca vaccine. If Dr Swaminathan is online maybe you can try to answer this if you heard the question correctly. SS Thank you, Tarik. Actually I couldn't hear the question very clearly. Is it possible to repeat it? 00:18:52 TJ I think the question was about the data that we are getting from different manufacturers and I think there was a question about the AstraZeneca vaccine in particular. Yovik, if I'm wrong please correct me because we were not able to hear correctly. YO Hello, can you hear me now? TJ Yes, please try again. YO My question is, I would like to ask about the public's preference for some candidate vaccines because Pfizer, Moderna and AstraZeneca have already released their efficacy data but of course these firms can't be expected to supply the entire world with the vaccine. So my question is, what can WHO say to those people who might be questioning their governments' decisions to enter into deals with manufacturers that have yet to release their data or are still completing their phase-three trials? Thank you. SS Okay, I think that was clearer. I can start and Mariangela or Kate or Mike might want to come in. The first thing I would like to say is that the WHO really wants to support as many vaccine candidates as possible to go through clinical trials because, as you just pointed out, there are a number of different properties or characteristics of a vaccine that may make it more or less suitable for different settings. 00:20:26 Ideally one would like to see a vaccine that's a single dose, that can be stored at room temperature, that gives long-lasting protection, that's safe, effective and is also manufactured easily and can be scaled and is affordable. So that would be a really ideal vaccine and there are so many candidates in development including innovative products like a combined influenza and SARS-CoV-2 vaccine. There's a measles platform, there's an intranasal vaccine, a couple of them that are coming along. So we would like to support the research and development and we'd like to support companies and countries and encourage them to continue with clinical trials. I think that's the first message. The second is about the question of when is a vaccine good enough to be used and again there are very clear criteria which we've laid down that regulatory agencies like the FDA and the EMA have laid down. 00:21:25 These criteria have benchmarks for both efficacy as well as safety as well as things like the quality of manufacturing, which needs to be checked before WHO or any of the regulatory agencies would endorse a vaccine either through an emergency use listing or ultimately through a full licensure or a pre-qualification as the case may be. So I think the criteria are clear. Now it's up to regulatory agencies in countries to make the decisions and they make decisions based on benefits and risks because in a situation... When you're in a pandemic there's obviously an urgency and a need to get vaccines out to people and therefore one has to weigh the benefits and the risks at a particular time. WHO will examine all the dossiers that are submitted to WHO. Mariangela's division is accepting these on a rolling submission basis so that we are up to speed, we can move quickly and we would provide either emergency use authorisation or pre-qualification as the case may be based on the data that we're able to examine. Thank you and maybe somebody else would like to add. 00:22:43 TJ Thank you, Dr Swaminathan. I understand Dr O'Brien would like to add something. Dr O'Brien. KOB Yes, just very briefly. Because of the supply situation most countries are likely going to have to use more than one product and so we do need multiple products in the marketplace, they do need to meet efficacy and safety and manufacturing standards but most countries are going to have to be juggling more than one product and getting that supply security is really important. I think those are just elements from a delivery perspective that we also have to keep in mind. Thank you. TJ Thank you, Kate. I understand also Dr Aylward and Dr Ryan would like to add something. Dr Aylward, Senior Advisor to the Director-General. BA Yes, just a very quick response. Recognising this challenge WHO right at the very beginning of the pandemic and very early on established what we call our target product profile which says, these are the standards that a vaccine should hit. These were published broadly, it's what all the vaccine manufacturers have been working toward and as countries are assessing vaccines they're looking at, do they hit these standards. 00:24:01 Then we have also put in place, of course - to the specific question about what WHO is doing; we have a whole pre-qualification/emergency use listing process that looks in detail at all of the detail that companies generate as part of these trials to ensure that they meet the necessary standards. These standards as well as the criteria are published on our website where again the general public can look and say what are the kind of standards, how do we ensure that these are hitting these standards, what is the process to get there. All of that is laid out very clearly, very transparently. This aligns very, very closely as well with what what we call the stringent regulatory authorities around the world are also using as they assess the vaccines. So when you ask about the general public, the general public should have great confidence in products that have been looked at by stringent regulatory authorities and the WHO process because they take those through all of those measures systematically; the efficacy, the safety, the quality of the product but also the programmatic suitability to make sure that this is something that is going to suit the circumstances in which these are going to be used. 00:25:21 MR Bingo, Bruce. I'd say something very similar. I think it's important that when citizens are looking to governments now and saying, we're not getting the vaccine and there's vaccine in some countries and governments have made choices; they've been looking at price and the profile of the product, the production capacity of the product and their access to it because of that. I think it's an important moment for us all. There are going to be many vaccines coming on-stream at different times. Some will have advantages over the others; some can be used at higher temperatures, Bruce, and some will be produced in higher volumes. Countries will be more used to working with a single product over a long period of time so where you may lose in a certain part of the early part you may gain in speed and you may gain in effectiveness later. 00:26:06 So I don't think we should be seeing this as a game of winners and losers right now. We're at the beginning and, yes, the products that are coming through now are in low volume. They're very expensive products but they're low-volume. They've come through first but other products will come through, we hope, early next year. So I think this idea of talking about good or bad vaccines or better or worse approaches and we start to hold or judge governments against one another; I think governments, COVAX, partners have been negotiating in good faith with manufacturers to make the best deals they can against what Bruce has laid out very clearly, against things like the profile of the product, the production capacities, the state of data available about the product and its likely performance and ultimately about the price of that product. These are complex decisions and I think it could be very disruptive for us all to transition to some kind of nationalistic foot race to who does what. We all have to get there together. We simply have to finish this race in a line together and someone getting there first doesn't necessarily help everybody else. 00:27:18 So I think we're all going to have to just be a little bit patient and a little bit tolerant that things are going to move at slightly different paces in different situations and that we don't politicise this. Again we've seen this again and again in this pandemic; issues that should be about collective responsibility and moving forward together turned into comparisons and turned into, he did good, she did bad... This is not the way, quite frankly, that we need to move forward right now. We need to move forward in solidarity to find these solutions. Science has delivered. Now we need solidarity to deliver the ultimate solution which is to stop this virus transmitting and killing the people we love. TJ Science, solidarity and solutions. The next question, Bayram from Anadolu News Agency; Bayram. BA Thank you, Tarik, for taking my question. My question is for Mr Antonio Vitorino but Mr Tedros can also add something on it. According to official UN figures Turkey continues to host the largest number of refugees worldwide. Turkey currently hosts some 3.6 million registered Syrian refugees and 370,000 persons of other nationalities. 00:28:38 Of course Turkey had lots of challenges during the COVID-19 pandemic, maybe more than any other country as they host millions of migrants and refugees. So today, Mr Vitorino, will you call on European or Western, rich countries to open their borders to migrants and to share the burden of Turkey? Thank you very much. AV The answer is, absolutely, we think that there is a shared responsibility of the international community to support countries that have the responsibility of hosting large numbers of refugees, asylum seekers and migrants. The good news I have for you is that fortunately in most of the refugee and migrant camps all over the world the virus has been contained. The number of casualties in camp settings, which was my worst nightmare, has fortunately been rather low, sometimes even lower than in the host communities. But that does not mean that there is no need for a specific approach to the vaccination when it comes to the people in the camps because the camps are... You cannot have social distance in the camps; let's be honest. 00:30:03 People wear masks and that's very positive but social distance is impossible so the efforts of IOM and other UN partners - WHO, UNHCR and other agencies - are precisely to deliver health support and health services to these populations and to help host countries in dealing with the challenge that represents, guaranteeing that those migrants and refugees are safe, are screened, are traced, are quarantined and now beginning next year are vaccinated. Thank you. TJ Thank you very much, Mr Vitorino, for this. We will go to our next question. It comes from Adrian, who works for Sumedico. Adrian, I think it's also the first time you're with us. Adrian. Can you please unmute yourself, Adrian? TR Hello. In Mexico City an emergency's been declared, as well as in other cities in the country and there's been a high amount of infections and deaths. What has Mexico done to end up in this situation? 00:31:35 TJ I think we were able to hear your question about Mexico and the latest situation in Mexico. MR Yes, Maria may add; I don't have the Mexico numbers with me today but we have spoken about Mexico in the last number of days and Brazil and other countries in Central and South America and we have seen worrying increases. In fact Mexico, like other countries in North America, never really exited its first surge or first wave; it managed to get some degree of control and the disease has surged again in many places and we've seen that same phenomenon happen in other countries like Brazil as well; the United States. Over three-quarters of the cases we're seeing globally now are occurring in the Americas. It's a very, very high and intense period there and it really does come back to being able to implement all of the measures that are needed, having strong co-ordination and governance, having a do-it-all approach in terms of both public health and social measures, advice to people on wearing masks and personal hygiene and having a very strong focus on surveillance and testing and having a health system that can cope with the cases when they do occur. 00:33:00 It's been tough for all countries but where countries have not been able to implement a comprehensive strategy and sustain that over time and gain the buy-in and support of their population and provide that support back to their population it's been tough for many countries to get through their first and second surges or waves of this disease. We've said that here too; vaccine is on the way, it is a source of great hope and we should celebrate that vaccines are coming but the next three to six months are going to be tough. Countries that currently have intense community transmission are likely for that transmission to intensify. Countries that have had good control on the disease may struggle to maintain that control of the disease and you've seen that in a number of countries. Even in East Asian countries that have done well up to now they are really having difficulties in containing certain particularly urban outbreaks at the moment. 00:33:59 So past success is no guarantee of future success; past failure is no guarantee of future failure. It is really what you do now and what everyone does now. We have to bring vaccines in as a tool that puts an end to this virus but the vaccines alone won't do it and we don't have these vaccines at a level yet that they can actually affect the transmission dynamics of this organism. So Mexico's no different to other countries; many, many countries are facing up a very serious mountain again at a very difficult time with the prospects for increased transmission. Other countries are maintaining their capacity to control the virus and some are struggling even at that. We've been saying it here for a very long time so at the risk of repeating ourselves again and again, there is no magic to this, there are no unicorns here, it is a very simple commitment to just doing very simple and direct things that need to be done and continuing to do that. They're very hard miles; it's a very difficult thing to do. Sustaining government effort, sustaining cohesion, sustaining community compliance and participation; they sound easy. They're the hardest things to do in public health and we're sorting out the sciency bits but we're really not doing well at sorting out the social bits, the leadership bits and the co-ordination and the support we need to our communities to be able to contain this virus. Maria, you may wish to add something. 00:35:36 Thanks, Mike. Just looking at the numbers, we are seeing an increasing number of cases being reported from Mexico over the last three weeks. We're seeing a stabilisation of the deaths over the last three weeks with more than 4,000 deaths being reported each week. When we look at the numbers - and what we're seeing from the data from Mexico is that there is detail that's being provided at the sub-national level and I think that's a really important factor. If you look at things at a national level you miss the details of what is actually happening in terms of transmission in specific geographic locations. If you have the systems in place, the surveillance in place, the testing in place, the data management in place you can not only find the virus and take the public health actions to keep people safe in terms of isolation, clinical care, contact tracing, cluster investigation, supporting quarantine then if you know where the virus is you know how you can use your resource and your capacities to the best of their ability. 00:36:34 So if we look at some of the breakdown we can see that there are differences in transmission based on different parts of the country and this is true for Mexico but it's true for every other country. It's breaking down the problem into actionable interventions that can be targeted, can be tailored and using the resources wisely. So it's not just about the comprehensive approach; it's about using that in the most appropriate way based on the situation that you have at hand. We are seeing that but unfortunately we are seeing an increase in cases across Mexico but you have the tools at hand right now that can turn it around. I think that's what's really critical right now. Again, as Mike has said and as the team keep saying, we have vaccines and more importantly vaccination that is starting to come online but it will take some time to reach everyone so please know that there are tools that you have now. Each one of us has a role to play as well as leaders at political level or community leaders or youth leaders to take the necessary steps to not only know where the virus is but take the necessary steps to lower your risk of exposure, which will lower your risk of infection. 00:37:44 So stay the course, use the measures that you have at hand in the most appropriate way you can and you will get through it. TJ Thank you very much, Dr Van Kerkhove and Dr Ryan, for this. Now we will go to Agence France Press. We have Nina Larsson with us. Nina. NI Hi, thank you for taking my question. I wanted to ask you about the international mission going to China next month, which has been announced is going to happen next month. Could you tell us specifically when the experts will go if you have the dates and where they'll be going in China, under what conditions they'll be working, if they'll be under Chinese supervision and if they'll need to quarantine before starting work, which will obviously impact, I guess, how long they have to stay? Thank you. MR Maria can provide more of the details. We still don't have a take-off date. We're working on the logistics around visas and flights but we do expect the team to leave in the first week of January. 00:39:03 There will be quarantine arrangements; obviously, as ever, we will have to comply with whatever the arrangements are for risk management in travel and on arrival in China itself. The team will visit Wuhan; that's the purpose of the mission. Clearly the team will pass through and by Beijing, as is the necessary part of any mission that's considered to be a joint approach and we will show good courtesy to our colleagues in China in doing that. But the purpose of the mission is to go to the original point at which human cases were detected and we fully expect to do that. The question regarding the team; the team is a WHO team, it's a team of international experts of international renown who will work with our Chinese colleagues. They will not be, as you say, in quotes, supervised by Chinese officials. I sometimes wonder at some of the language that some of our journalistic colleagues use and how things tend to be characterised through the question, not through the answer that's given. We will operate as we would operate in any member state; at their invitation, with gratefulness for their support to that and with the full intention of pursuing the scientific principles that his organisation has always stood for. We will continue to do that and provide all the support necessary for the international team that we have brought together in order to find and learn more about the origin and source of this virus. TJ Many thanks, Dr Ryan. The next question is from Radio France International, Jeremy Launch. Jeremy. Jeremy, if you hear us please unmute yourself. We don't have Jeremy on the line now so let's go to Simon Ateba. Simon. SI Yes, thank you for taking my question. This is Simon Ateba from Today News Africa in Washington DC. My question is about seriousness in Africa and it goes to Dr Tedros. Do you think the African continent continues to take COVID-19 seriously? I know that Africa is not one country; 55 countries, 1.3 billion people, 2,000 languages. But it seems to me that the social distancing, use of masks and the rest are no more the way they were months ago. Thank you. 00:41:59 MR I can start. Yes, Africa is a very diverse continent and, Simon, it's great that you recognise that; many don't. It tends to be seen as one amorphous continent, which never ceases to irritate me. The reality is that Africa is not out of the woods yet and we've seen South Africa continue to battle higher numbers; we've seen countries around; Eswatini; I think we've seen in Namibia, we've seen Botswana, we've seen southern Africa has had a continued issue. We've seen small but... The trajectory in West Africa and in parts of East Africa is actually upwards; the trajectory in South Africa. So while the absolute numbers may not be huge the trajectory is worrying so Africa does need - countries in Africa need to maintain their vigilance. There is no question about that but it's also a very, very long road and many people in Africa live in a situation where they have to work to live, they have to work to eat and therefore there are more limited choices for people in that situation. They don't necessarily have government structures that can put aside trillions of dollars to pay people to stay at home and therefore people don't have the same choices. 00:43:20 I have seen a pretty high compliance with mask wearing and other stuff in Africa. We've seen some excellent examples of surveillance and investigation. Our colleagues in South Africa have been tracking the evolution of this virus and genetic variations and state-of-the-art work and I keep saying that; that surveillance in Africa is, in terms of the ability to do contact tracing... Some of the work done in Nigeria by Nigeria CDC is global state-of-the-art work; in Rwanda and other places. So Africa is actually showing the way, showing the way in community engagement, showing the way in community-based approaches. It's showing the way in keeping this disease, as you said, in terms of migrants and in terms of refugee camps and other places and remembering that the vast majority of migrants and refugees in the world are being hosted in countries who don't necessarily have the resources that others do. There are millions and millions of refugees and migrants hosted in Africa and on the African continent and without the terrible complaints we hear from others about hosting hundreds or thousands. 00:44:26 So from my perspective, yes, Africa is not out of the woods but Africa is also leading, on the leading edge of this response and showing the way for how you can deal with one of many emergencies at a single time. I think at one point last month Sudan was dealing with ten different epidemic emergencies at the same time - imagine if that was the case in other countries - and doing it with a high level of quality. So, yes, as there are in every country, there are things that we'd like to see more of and very clearly Africa's not out of the woods and there's every chance that things can get worse on the African continent. Therefore it's really important that we also make sure that vaccines and other interventions, new diagnostics and new therapeutics, are shared equitably across the world based on risk and on vulnerability. DG, you may wish to add. TAG Thank you. I think the seriousness of Africa was clear from the start, Simon. Many countries - the majority of them - started their actions as early as possible, their social measures and so on. You remember when many countries, when they didn't even have any cases, were taking serious measures. I think that prevented serious problems from happening in many countries in the continent. 00:46:10 You can actually see the situation not only from the specific country early preparedness but the continental action they were taking. I remember having a meeting with the Ministers of Health in February, March, preparing the continental strategy and the political leaders, the AU Commission, Musa Faki and the current President of the African Union, the Chair of the African Union, heads of state, also President Ramaphosa co-ordinating the overall response. So not only the immediate or early action by individual countries but the continental strategy and the co-ordination of the leaders to implement the continental strategy; I think that really helped. If you see the major - the countries that are contributing the most, 12 countries globally, none of them is from Africa in terms of cases or in terms of deaths. Of course there could be not only the early response but other reasons to explain this but we believe that Africa has really done its best. The seriousness you said is there and we hope that will continue. 00:47:56 As Mike said, there is good hope now for vaccines and that's an additional tool but all countries should continue to do the basics and follow a comprehensive approach in order to defeat the pandemic. So because of vaccines which are still rolling out now we shouldn't lower our guard and we should continue to be very vigilant and implement all the measures we need to implement based on the toolbox that we have been implementing. Thank you. TJ Thank you very much, Dr Tedros. We received a question; you mentioned South Africa; we received a question about news from a South African scientist on a new variant of the virus so maybe Dr Van Kerkhove can comment on that, please. MK Yes sure. Thanks, Tarik, for the question. Yes, we are aware that South African researchers have identified some virus variants from sequencing of patients across the country and I should first and foremost say that South Africa has worked incredibly hard to increase sequencing capacity across the country, which is really commendable. We are seeing increases in the ability of sequencing all over the world so that's first and foremost; that's really important. 00:49:30 So yes, we're in touch with researchers and scientists from South Africa who've identified some virus variants. The variants have mutations in them and, as you know, this is a virus that mutates; all viruses mutate, all viruses change over time and these mutations are expected but having the ability to sequence will allow them to actually look at those changes. So what they're doing right now - and we are working with our SARS-CoV-2 virus evolution working group; they're growing the virus in the country and they're working with researchers to determine any changes in the behaviour of the virus itself in terms of transmission; does this virus transmit more easily than the others, are there any differences in severity, are there any differences in the ability of a person who is infected with these variants to develop antibodies and are there any differences in the diagnostics or therapeutics or vaccines? 00:50:31 So far we have no indication that there are any changes in the virus' behaviour but these studies are underway and so that's what's really important; that South African researchers as well as researchers in the UK - because there are other mutations that are identified in the UK; there have been mutations identified in other countries - there's a system in place, there's a process in place to evaluate each one of these mutations, each one of these variants so that we understand what is their importance in terms of the virus' behaviour. These are studies that take some time to be conducted in a lab and we have the mechanisms, the trust, the collaborations that are in place with the researchers in South Africa and in other countries to work on to determine if there are changes and what those changes mean. As soon as we learn anything about this we will let you know. South Africa had a press conference, I believe, at the same time as we were doing this press conference here providing the information openly and this is a good sign. This is what we need to see but the more opportunity this virus has to spread the more opportunities this virus has to change so it's really important that we do everything that we can to minimise the spread now with the tools we have. We can't emphasise that enough so we thank our colleagues in South Africa as well as colleagues in the UK and Denmark who alerted us to mutations that they've identified and who are carrying out the scientific studies to help us understand the implications of these. 00:52:07 MR Maybe a shout out too to those who work in the likes of Genbank and GISAID and others who accept and post all of these sequences as well and thanks to those who continue to do that. Keeping this information in the public domain is really important and having all scientific eyes on that to look for any changes that are significant. It's really important; this is a collective process, this is collective intelligence that's applied to a complex problem and it requires a lot of people to have input so it's great to see this kind of collective intelligence put to work. TJ Many thanks. We are getting close to the hour so let's try one or possibly two questions. Stephanie from Reuters; Stephanie. Stephanie, you will need to unmute yourself. 00:53:10 ST Sorry, I had my hand up to ask about the same issue about the South African variant, which Maria has already addressed so unless she has something more to say about it I think we're good. Thank you. TJ Okay. That's very good, that we managed to answer your question in advance. With this we will conclude today's press briefing. Big thanks to our guests, Mr Antonio Vitorino, Director-General of the IOM, and Jacqueline Meekers from the Migration Health Division of IOM and to our WHO guests. The last word as always goes to Dr Tedros. TAG Thank you. You have said what I wanted to say, to appreciate my fratelo, DG Vitorino and also director Jacqueline for joining us today and look forward to working even more closely. Thank you for your partnership and friendship. Grazie mille. Thank you also to all who have joined us today and bon week-end. See you next week. 00:54:32

Media briefing on COVID-19 - 25/01/2021

00:00:19 FC Hello, all. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 25th January. We will welcome two guests who will tell us more about compelling research on the economic benefit of funding efforts to ensure equitable access to COVID-19 vaccines. Simultaneous interoperation is provided in the six UN languages plus Portuguese and Hindi. Let me introduce to you the WHO participants. Present in the room are the WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to the Director-General and lead on the ACT Accelerator. Joining us remotely are Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist, and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome all. Now without further ado I will hand over to Dr Tedros for his opening remarks and to introduce to you our guests. Over to you, Dr Tedros. TAG Thank you. Thank you so much, Fadela, shukran and happy birthday to you. Over the past year our staff have been working very hard and no birthday, no New Year, no break so Fadela is one of the examples and again, happy birthday, our sister. Shukran. 00:02:21 FC Thank you. [Inaudible] TAG It's a birthday for another colleague of ours, Sophia, who is in the room so happy birthday to both of you, Fadela and Sophia. Good morning, good afternoon and good evening. A year ago today fewer than 1,500 cases of COVID-19 had been reported to WHO including just 20 cases outside China. This week we expect to reach 100 million reported cases. Numbers can make us numb to what they represent. Every death is someone's parent, someone's partner, someone's child, someone's friend. Our response must be twofold; to mourn those we have lost and to resole that each one of us will do everything we can to stop transmission and save lives. 00:03:35 Vaccines are giving us hope, which is why every life we lose now is even more tragic. We must take heart, take hope and take action. I have called for vaccination of health workers and older people to be underway in all countries within the first 100 days of the year. But there is so much we can all do to navigate our way out of this pandemic while we all wait our turn to be vaccinated; physical distancing, avoiding crowds, masks, hand hygiene, ventilation and more. You might be sick of hearing it; you might be sick of doing it but this virus is not sick of us. Please do your part for yourself and for others. As I said, numbers can be dehumanising but behind every number is a person, a story. One of the ways WHO is helping to tell stories about health is through the WHO Health For All film festival. Last year almost 1,300 films were submitted from all over the world, telling heart-warming and inspiring stories about health and health workers. This year we're inviting entries in three categories matching each of WHO's three strategic priorities; universal health coverage, health emergencies and better health and well-being. More details about the categories and the festival are available on our website. 00:05:46 As a reminder, the deadline for submitting films for this year's festival is this Saturday 30th January so get your films in and I look forward to seeing them. Last week I said that the world stood on the brink of a catastrophic moral failure if it doesn't deliver equitable access to vaccines. Two new studies show that it wouldn't just be a moral failure; it would be an economic failure. A new report from the International Labour Organisation Analyses the impact of the pandemic on the global labour market. It finds that 8.8% of global working hours were lost last year, resulting in a decline in global labour equivalent to $3.7 trillion. The report projects that most countries will recover in the second half of 2021 depending on vaccination roll-out. It recommends international support for low and middle-income countries to support vaccine roll-out and to promote economic and employment recovery. 00:07:12 The second study commissioned by the International Chamber of Commerce Research Foundation makes a strong economic case for vaccine equity. It finds that vaccine nationalism could cost the global economy up to US$9.2 trillion and almost half of that, $4.5 trillion, would be incurred in the wealthiest economies. In contrast the financing gap for the Access to COVID-19 Tools Accelerator is US$26 billion. If fully funded the ACT Accelerator would return up to $166 for every dollar invested. Vaccine nationalism might serve short-term political goals but it is in every nation's own medium and long-term economic interests to support vaccine equity. Until we end the pandemic everywhere we won't end it everywhere. As we speak, rich countries are rolling out vaccines while the world's least developed countries watch and wait. Every day that passes the divide grows larger between the world's haves and have-nots. Less than an hour ago I spoke to President Ramaphosa of South Africa and on Wednesday I will be speaking with Ministers of Health and Ministers of Finance from the African Union. I will tell them that we're doing everything we can to accelerate the roll-out of vaccines in Africa to save lives and get their economies back on track. 00:09:12 The rest of the world must play its part. The COVID-19 pandemic has reminded all of us that health and economics are closely connected and that we're all in this together. We are family. Today I'm delighted to be joined by the author of this new study, Professor Sebnem Kalemi-Ozcan, Professor of Economics at the University of Maryland. Professor, thank you for this important work and thank you for joining us today. You have the floor. SKO Thank you very much for having me today. This is an amazing honour and privilege, to be among such distinguished guests, panellists and participants. Let me start by saying that this is a study of a team of five so we are five people; I'm just one of the authors. It is joint work with my co-authors, [names]. All right now reside in Turkey; Cort [?] University. They are professors there. What we did in this paper actually goes back to our conversations in April 2020 and we really want to understand; a shock of this magnitude; how will that affect emerging markets and the world economy since we are all of Turkish origin? 00:11:00 That's how we started working on this thing because we realised for a small open economy there would be several dimensions of this shock economically coming from external demand, coming from the important intermediate inputs, capital flows, exchange rate so that's how we started working on it. Then later on we did two papers - the latter one is the one we are talking about today - thanks to the support from ICC. I will get to the point very quickly; what we want to do in this paper is to marry the sectoral heterogeneity in infection dynamics with the sectoral heterogeneity in global trade and production networks. We know that there is a sectoral heterogeneity on the infection part; the jobs, occupations, sectors where you need close proximity of people are going to have higher infection rates. Old people are going to be more vulnerable so we already know of this thanks to the work of epidemiologists and the like and also economists; that this is not your standard shock and certain sectors are going to be very much more affected than the other sectors; at the origin of course services sectors relative to manufacturing sectors because services sectors require close proximity. 00:12:26 But there is an economic side to this, a global, international trade and production network that also works through amazingly complex sectoral linkages and that's what we want to do. We want to bring that and then we want to marry these two dimensions of the sectoral heterogeneity in infection dynamics and sectoral heterogeneity in trade and production and that's what we did. We have an SIR model. We borrowed that from epidemiologists. We bring very rich data from every country. We do this for 65 countries and 35 sectors so we have an R number for every country and then we combined that epidemiological side using real-time data on infection dynamics from WHO, from Johns Hopkins university, combining that with economic data on trade and production networks that comes from OECD on multi-country, multi-sector economic linkages that tells us how each sector in each country imports and exports with other sectors in other countries. 00:13:35 So again we have a total of 65 countries and 35 sectors and then we tried to estimate several scenarios and several different specifications. The numbers just quoted by Dr Tedros are our most extreme scenario, the upper bound estimate if you like, where we assumed there won't be any vaccination at all in emerging markets and developing economies in 2021 while advanced economies are going to be fully vaccinated. This may be not that realistic so we look at other scenarios in the paper too where there might be some vaccination in emerging markets or developing economies, still more vaccinations in advanced economies. But the point here is that even if you achieve universal vaccination in advanced economies, meaning your restaurants are open, your life's back to normal, your services sectors are going to work fine, you are going to have a huge hit in your tradable sector. Then because advanced economies are very large and very connected to global trade and global production networks they are going to not only feel this hit; as Dr Tedros mentioned, in the worst-case scenario they are going to bear half of this global cost even if they manage to vaccinate all their citizens. 00:15:03 This is very important because this is a full-fledged trade and international production network channel. That's what we want to focus on, disconnected from whatever domestic problem you have in your own country. This is why we work out this case where advanced economies finish the pandemic, they vaccinate everyone; the other countries don't. This is going to highlight the fact that no economy is an island; economies are interconnected through trade and production linkages and when we bring them in as they are we don't also allow any changes to those relationships so you want to estimate this very short-term cost. Then there will be important economic costs even for the countries who are vaccinated, which would be the advanced economies, which is why we emphasise the economic side of an equitable global vaccine distribution by making sure vaccinations are done also in emerging markets and developing economies so that global economies can recover as a whole. We're saying no economy can recovery fully until every economy recovers. Thank you very much. 00:16:24 TAG Thank you. Thank you so much, Professor. It's my sincere wish that all governments pay careful attention to this study. The study was commissioned by the Research Foundation of the International Chamber of Commerce, which represents more than 45 million companies in over 100 countries. Today I'm very pleased to welcome John Denton, the Secretary-General of the International Chamber of Commerce. John, you have the floor. JD Dr Tedros, thank you very much; great to be with you all. It's an honour to participate in this discussion and it's great to be on the panel particularly with you, Tedros, but also with one of the analysts who worked so hard on this report. The reason that the ICC is involved is generally driven by our purpose which is to enable business worldwide to secure peace, prosperity and opportunity for all. Just as we identified early on the tragedy of the attack not just on human lives but also on the economic well-being of so many individuals and citizens on a global basis we sought at that time to intervene on this crazy issue around the failure of distribution of PPE and ventilators. 00:17:44 We identified there that one of the great risks was that the failure to engage the private sector early on was simply exacerbating the tensions and problems. We actually predicted at that point in time that unless the private sector was more involved - particularly we saw the issue and the contours start emerging around vaccines and distribution of vaccines - then we're heading towards a problem, a real problem. But our hypothesis was that governments had failed to understand the interconnectedness and in particular, as the previous speaker just said, the impact of trade in goods and services and the interconnectedness of supply chains and the failure of those to continue to operate effectively until all are vaccinated effectively would actually exacerbate the economic damage to the globe. But importantly that economic damage would not be visited just upon developing countries but would actually be effectively visited upon developed countries as well. The headline number was $9 trillion of economic damage which will continue to flow unless the COVID-19 vaccines and therapeutics were distributed equitably. 00:18:50 But the point which we wanted to understand better and which is clearly made here and has just been identified as well was that about half of that actually affects developed countries. If you actually want to fix your own economy you're going to have to get involved in fixing the global economy and part of that is ensuring that vaccines flow globally and equitably. This is not an act of charity. This is economic common sense. If you want to ensure that the trillions and the hundreds of billions that you are spending on domestic stimulus is more than ephemeral you need to ensure it's durable. It can only be durable if you also support access to vaccines and vaccinations and therapeutics in the developing world as well, across the globe and equitable access there. That's because the failure of exports cost jobs; that's because of a failure to understand that a lot of jobs for example in the US are a consequence of intermediation of trade where you get tyres for the auto industry being delivered and developed out of Thailand. Of course if Thailand can't deliver and develop those tyres into the US market which causes a slowdown and impairs the auto industry then there's actually economic loss. 00:20:06 Why can't they do that? Because they're being affected by COVID-19 and they're being restricted in their capacity to actually get their factories moving, get their workers to work, which is actually undermining their effectiveness because they can't get access to vaccines and therapeutics. It's in your interests; it's in the interests of finance ministers and governments in developed countries to ensure the equitable access and which is really the full funding of the COVAX ACTA facility. Frankly the shortfall at the moment is 28 billion. When you add up all the stimulus packages it's less than 1%, it's a rounding error and this is a very sensible investment. And we already see the contours globally of a K-shaped recovery and we know that's exacerbating inequality but do we understand until we see this report that we're actually taking those contours and actually making them real and concrete in economies like the US? 00:20:58 It's not Wall Street that's going to be affected here, it's Main Street, it's mums and dads, it's small and medium enterprises, it's workers in service sectors who are actually already hit hard, they're going to be hit even harder again so frankly this report is a wake-up call and we're sick and tired of hearing governments say, as an act of generosity we're giving to the COVAX facility. Frankly it's an act of economic rationality to do so. It's incredibly important that we actually understand that there's economic independence and there's mutual interest here in getting this right and there are governments who can do more. We are very happy and we've praised the US Government for stepping up and getting involved again but more needs to be done if they want to ensure that the stimulus package that's working its way through from the White House at the moment and into the US economy is actually effective and durable. They need to get behind and show leadership with other countries. Japan can frankly do more; Canada can do more; Australia can do more; the constituent members of the European Union must do more as well. Wealth countries; this is not an act of generosity. If you want to ensure a durable recovery in your economies you need to step up and actually pay up help her because the developing world stands ready and willing to distribute the vaccines and vaccinations and therapeutics. They simply need access to them and that's where the ACTA facilitator comes in. 00:22:24 So we welcome the opportunity to participate. The private sector is stepping up, as we have on issues like global mobility where we not only talked about, we developed tools like digital authentication to ensure that we can risk-manage access to global travel again and get economies moving, which is why we created ICC AOK pass. We do practical stuff, we set policy, we set standards. The private sector is committed to enabling business worldwide to secure peace, prosperity and opportunity for all and this report is an important part of shifting the policy framework to understand that funding COVAX Accelerator A is actually in the mutual interests of all parties, not just developing countries. Developed countries must stand up with the private sector. TAG Thank you. Thank you, John. Maybe to quote you, this is not charity, it's an economic common sense. Thank you so much indeed and thank you for your partnership and support over the past year. With that, Fadela, back to you and happy birthday again to you and Sophie. 00:23:34 FC Thank you, Dr Tedros. I will now open the floor to questions from journalist. I remind you that you need to use the raise your hand icon in order to get in the queue and please don't forget to unmute yourself. I will start by giving the floor to Politico; Ashley Furlong. Ashley, can you hear me? AS Thanks, Fadela. Can you hear me? FC Very well. Go ahead, please. AS Thank you. My question is about the deal announced on Friday between COVAX and Pfizer BioNTech for 40 million doses of their vaccine. That number seems quite small to me given the size of the other deals that have already been made for this vaccine. We've seen the EU has reserved 600 million doses; the US has 200 million. I want to know if you could explain that discrepancy? Would you also be able to explain how this limited number of doses will be prioritised across countries participating in the COVAX facility? Thank you. 00:24:41 FC Thank you, Ashley. Just looking, who can answer this... Dr Bruce Aylward will take this question. BA Thank you very much, Ashley. One of the most important things as the COVAX facility put together its portfolio of vaccines, just as they were put together in for example the European Union and other places was to ensure that you had a diversity of products that you could rely on both today but also in the future. Part of the deal on Friday was to ensure that the COVAX facility also had access to and experience with MRNA vaccines because the importance that these have played in the initial roll-out in high-income countries in particular but may also play as we go forward and we look at a need to potentially adapt the vaccines as well. But there're a few things to realise in putting this deal in place even with relatively small doses of vaccines because this is a vaccine that we anticipate - because it's already licensed, already in use, we already have recommendations from the World Health Organization on how to use it globally - that this could be launched very, very rapidly and earlier possibly than some of the other products that are currently available. 00:26:01 Rolling this out even in small quantities has multiple major advantages. Number one, because you'll remember, Ashley, even in the Western countries the Pfizer vaccine was rolled out with very small quantities initially but what that does is it gets the whole system working, it gets your indemnification process in place, your no-fault compensation processes, your cold chain in place, your training in place; all the other things that will be absolutely vital to the products that come before it. The other thing was even with a relatively small number of doses - and we look at this quite closely - it was clear that we could make a real difference in protecting some of the most highly exposed, highly at risk healthcare workers, particularly in some of the AMC countries that the facility serves. Then the other important element of it was by having a framework agreement in place with Pfizer for this important vaccine - because remember, of all the countries that are currently vaccinating which are over 50 now more than 45 of those countries are actually using the Pfizer vaccine and after that the next one is much, much fewer, down around seven countries. 00:27:13 So the other big advantage by putting the framework agreement in place is that we can then open the door to donations in a much more potentially seamless manner with other countries that have contracts with and substantial quantities of the Pfizer vaccine. So there are multiple advantages from the experience we will get, the learning experience, the protection to this vital health worker infrastructure in low-income countries, which is highly exposed obviously; opens the door to donations, etc. In terms of where it would be used first, back on 6th January the head of the COVAX facility actually wrote out to all of the participating countries, all 190 countries, explained that we would have access, we were negotiating to have access to the Pfizer product and then invited countries that might like to be part of a very early small-scale roll-out as part of, as I said, a learning and reproduction activity. 00:28:22 So we've now received applications from a number of countries that are interested to do that. There's a large readiness assessment ongoing to see who has the infrastructure and requirements in place to be able to use that product. Then over the coming week or week plus there will be a process then to try and look at what is the best order of countries to roll out the products so that'll take place through what's called the allocation mechanism of the COVAX facility. So by starting with this product an awful lot of learnings and really make sure the system can move the larger doses of other products that we expect will come in right behind it in February. FC Thank you. Dr O'Brien, you have the floor. KOB Yes, just to add to Bruce's really comprehensive reply to that. I think it's also really important to recognise that the deals that the facility is doing right now are based on the projection of the target for 2021 which is two billion doses and so it is that mix of the portfolio for two billion. But that aspiration, which we have achieved, for two billion is not the end of the COVAX role and the COVAX facility. I think it's becoming very clear that, as many countries are aspiring to do, coverage beyond 20%... 00:29:57 20% was always the target for those most essential groups and the COVAX facility is really the means for global allocation of vaccines beyond 20% and I think that's really the message that is very clear, that this was the minimum and so putting in place a contract with Pfizer to get started with doses especially as the mix of products continues to mature is a means also to expand the number of doses and the proportion coverage through donations and by raising additional funds, through additional volumes. Thank you. FC Thank you. Now I would like to invite Nina Larson from AFP to ask the next question. Nina, can you hear me? NI Yes. Thanks, Fadela. Can you hear me? FC Yes, very well. Go ahead, please. NI Thank you. Thanks for taking my question. I had a question about the Olympics. The French National Olympic Committee said today that it would be extremely difficult for athletes to participate in the Tokyo Olympics if not vaccinated. 00:31:17 So I was wondering if you think athletes should in any case be prioritised for vaccines to allow the Olympics to go ahead. Thank you. FC Thank you, Nina. Dr Ryan. MR Thank you for the question. We obviously wish that everyone could be vaccinated but Bruce and the DG before have clearly laid out and we have over many days and weeks that we face a crisis now on a global scale that requires front-line health workers, those older people and those most vulnerable in our societies, to access vaccine first. That doesn't in any way negate the desire or the will to have the Olympics and to come together and celebrate a wonderful global sporting event where all countries come together to share that and what a wonderful symbol those games are for our shared humanity. However we have to face the realities of what we face now. There is not enough vaccine right now to even serve those who are most at risk and it's not about saying it's putting one priority in front of another. We should address all of these issues over time. 00:32:29 Right now we're laser-focused on solving our biggest problem which is vaccinating health workers in all countries and allowing people who are vulnerable to dying from this infection to access vaccine. We will continue to work with the IOC, we'll continue to work with the host city, we will continue to work with the Ministry of Health, Labour and Welfare as part of their taskforce to offer risk management advice right through the process. The final decision on the risk management measures for the Olympics and the final decision regarding the Olympics themselves is a decision for the IOC and for the Japanese authorities. FC Dr Aylward. BA Thanks, Fadela. Just further to Mike's point, this is not an issue about the Olympics. It's an issue about how we use a scarce resource to try and combat what has been one of the most devastating - obviously - health crises of our time and it has been disproportionately affecting certain parts of our populations. 00:33:35 Our healthcare workers, as Mike said, have been in some places devastated by the numbers that have been infected and seriously ill or even died as a result. But most tragic is what we've seen among our older populations and our populations living in longer-term institutions. I thought one of the more heart-warming things I saw, Mike, was an interview or a quote from an athlete who was an Olympic athlete who said, there are a lot of people who need to be vaccinated before I am. Really that's what it all comes down to; making sure that the people who need these products most... And this is again coming back to what the Director-General said; in every country and every corner and every population of the world there are older people everywhere, there are healthcare workers everywhere. We need to make sure they're protected everywhere and right now we have a real stretch on the available vaccines just to get into those populations and protect them. FC Thank you. I would like now to invite Drew Henshall from the Wall Street Journal to ask a question. Drew, can you hear me? 00:34:55 DR Yes, I can hear you just fine. Can you hear me now? FC Yes. Go ahead, please. DR My question's specifically about Europe, if I can focus on the EU region; just to provide some specificity when we say wealthier markets are recovering in the second half of 2021. Because even with all the resources that the EU has here we're a month into vaccination, France, Germany have barely vaccinated more than 1% of their population and some of that is supply constraints but, as you guys have noted, those constraints remain extremely tight for the foreseeable future. Then you have 30, 40% of people who in poll after poll refuse to get vaccinated. So I guess when we talk about Europe or the global north recovering how much do we mean that transmission will be at zero? I guess my question is, how would you rate the likelihood that this disease will remain endemic to Europe even at the current rate of vaccination? Thanks. 00:36:04 FC Thank you. We have several questions here. Let's try to address them all. MR Just to address the issue of endemicity and the issues around vaccines and other things, I think there's always a risk that any disease will become endemic to human populations; in fact that is the history of epidemic diseases in humans. We very often are affected in the first waves of a new infection with high-impact epidemics; they've gone back through history. Very often the disease - and this is a sad fact - in historical terms very often killed many, many people and then as the disease moved into younger people as older people became immune the only new susceptibles were in younger kids as they were born. That's why we've seen many diseases become diseases of childhood, because in effect the diseases have moved into those age groups and continued to kill over centuries. The issue for us in terms of looking at endemicity regarding a disease like COVID is that there are a number of factors that would allow us to believe that such a disease could be eradicated. 00:37:14 However there're a number of factors right now that we face and there are headwinds. One is the absolute presence of the disease in so many countries, the fact that we're not seemingly able to implement comprehensive long-term measures to contain and control the disease. The availability of vaccines right now is not optimal and in that sense the current availability and for the foreseeable future the coverage of vaccines will not reach a point where it will stop transmission necessarily so we're likely to have continued transmission. The advantage we have right now based on the targets that the vaccine has in terms of its efficacy is we can significantly and very, very greatly reduce mortality, reduce severe illness, reduce the impact this has on our societies and on our loved ones and on those who are most vulnerable. In that sense we can return to normal life. Will this disease continue to transmit? Most likely for a long time unless we find the kind of compliance and the kind of vaccine coverage that would be required to achieve that. 00:38:23 If vaccine coverage lags behind, particularly in younger adults, then yes, we will struggle to eradicate this disease but remember, we've only ever eradicated one disease on this planet, smallpox, and we're struggling against polio and we're struggling to eliminate measles. So the availability of a vaccine, the availability go the will to eradicate or eliminate does not guarantee success so I don't believe we should start setting elimination or eradication of this virus as the bar for success. That is not the bar for success. The bar for success is reducing the capacity of this virus to kill, to put people in hospital, to destroy our economic and social lives. We have to reach a point where we're in control of the virus, the virus is not in control of us and that we have countermeasures in place that keep the capacity of this virus to cause harm to a minimum level and we are back in control. I would look at that as success. If we look to eradication as the measure of success I think we're going to struggle. Bruce. BA Thanks, Mike. Listening to the question I was just trying to untangle it, as Mike was a little bit, but really the way I heard it was, how much do we expect vaccines may change the shape of this epidemic or this pandemic? 00:39:42 In some ways we don't know but what we do know in 2021 is that we should be able to substantially change the human cost of this crisis through the use of vaccines. We know that this virus disproportionately affects certain populations; the older, as we've talked about, people with comorbidities, people who are highly exposed like healthcare workers. So the real goal of vaccination this year is to take the heat out of this epidemic or this pandemic, is to, as Mike said, reduce the human toll in terms of deaths and severe disease. That comes back to the theme you're hearing again and again and again; we can only do that if there is sufficient equitable allocation of these products in a way that those populations at highest risk get reached everywhere. I thought what was staggering today were the numbers that were released by the study that you heard presented and in the comments from the head of the ICC as to the economic case for doing what we know is the right thing from a moral or a health or a health equity perspective. 00:41:00 So the real goal this year; could we take the heat out of this pandemic with these products? That was always the goal and very definitely we think by the end of this year we could do that by it is going to take making some tough choices about how we equitably allocate and use what is right now a scarce product and will be for some months to come. FC Thank you, Bruce. This is a good bridge. Inviting now our experts to answer the economic angle of this Wall Street Journal question. Professor Sebnem, do you want to answer? Mr John Denton, you will have the floor to. Over to you. SKO Sure. I would like to highlight the global interconnection point again that Dr Denton made forcefully because here if we look at two scenarios we did in the study - one is that extreme scenario that gives you the nine trillion number, there is no vaccination whatsoever in the rest of the world but advanced economies recover immediately, right away, the beginning of 2021. So the total cost is higher there, world cost because the rest of the world is bigger and then close to half is borne by advanced economies. 00:42:23 We got the more realistic scenario we worked out; advanced economies still had the disease in 2021, going back to the question from Wall Street Journal, but we still assume that they are done with vaccination mid-2021 and by the end of 2021, early 2022 half of emerging market and developing economies' population is vaccinated. So there is more realism to this; we might not be there by the end of 2021 but in this scenario there is still disease going on in advanced economies half of the year. Very interestingly the global costs go down; you go down from nine to four but also very interesting the share advanced economies bear goes up. Why is that? Because in this scenario we allow some vaccination also in developing market and emerging economies. That helps with exports and imports of advanced economies and advanced economies are larger so the world costs go down but they are going to bear a higher share because now they also have to deal with the disease in their own economies. 00:43:26 So these global interconnections both on the export side and also imported, intermediate input side can be really important in amplifying economic cost so it is extremely important to highlight again that there is an economic case to be made here on top of the moral case. Thank you. FC Thank you, Professor. Mr Denton, you have the floor. JD Thanks very much. Just picking up on a couple of things I'd make three quick points. First of all one thing Mike said which has really struck me; what we're seeing is with the history of epidemics and the way they work, with all the things that are happening the developed world and rich economies have a greater chance of actually managing the trajectory and, as you say, eradication is not mark of success here for where we are. But what we're really worried about without the equitable distribution is developing countries and the history is they will not be able to manage that trajectory and so you'll likely end up potentially with a managed trajectory in the north but actually an unmanaged trajectory in the south. 00:44:32 This is a real concern and will simply exacerbate, particularly with the new variants coming in and the speed with which they're moving and so that's why we really want to emphasise the output of our study, which has been so eloquently described by the previous speaker; that there's an economic case - and it's a compelling economic case, not just persuasive - to actually fully fund the COVAX facility. The reality here is I've called out a number of countries but Japan, Australia, Canada and China and the US need to continue to step up and all the constituent parts of the European Union. Two other quick points; first the issue the WSJ made about distribution. One element that we see - and we'll be mounting a global campaign on the involvement of the private sector to step up here and we'll be launching that during the course of the next week, which will cover multi dimensions including the output of this study. The first is if you're going to have a successful national vaccine action plan you must involve the private sector. The wisdom and the knowledge and the innovation of the private sector in distribution can never be underestimated and it's the genius of the innovation of the private sector which will help on this distribution not just in developed countries but also in developing countries. 00:45:41 It's really important for those national vaccine action plans to involve deep engagement with the private sector. That was missing in the pandemic action plans of so many countries; engagement with the private sector and it's taken us a while to actually help get countries to realise the importance of that. I shout out to Dr Tedros for realising the importance of engaging with the International Chamber of Commerce as a conduit to actually reach out to the private sector. The third point - and if you look at the most recent trust index development [?] on vaccines and ensuring this 30 to 40% of people in Europe who are so suspect about taking a vaccine actually get confidence, the people that individuals trust, the entities they trust; it's not government, it's not international organisations, it's business. Business; people have trust and confidence and we want to use that trust and confidence to help individuals and citizens understand the importance of accessing and actually utilising vaccinations as well and that will be part of the ICC's global campaign involving the private sector on a continual basis in the debate and the implementation of an effective, fair and equitable distribution of vaccinations and vaccinations across the globe. FC Thank you both. I would like now to call on Gabriela Sotomayor from Proceso to ask the next question. Gabriela, can you hear me? GA Hola. Happy birthday, Fadela. I have a question on Mexico. Mexico is betting everything on the vaccine, like my countries but it is one of the countries that does the least number of tests and now for example in Mexico City hospitals are at their maximum capacity, we have record numbers of cases and deaths. Until January 12th for example an average of eight people died every hour. So my question is, do you think it's possible that one of the new variants is circulating and has not been detected due to the very low number of tests they do? And on vaccines, medical personnel are in danger of missing their second dose due to Pfizer's problem with temporary suspension of shipments. Also the Government decided to vaccinate 20,000 teachers in Campeche, a state of Mexico, instead of health personnel. 00:48:10 So my question is, what is your assessment and that's it. Thank you. FC Thank you, Gabriela. Dr Van Kerkhove will take this question and then maybe Dr Ryan. MR Thank you and our best wishes to the President of Mexico. I know Dr Tedros sent a message earlier today but from all our staff here, we wish you a speedy recovery. The situation in Mexico - we've hit 1.75 million cases and approaching 150,000 deaths and 19% of those cases require hospitalisation. You're right, the positivity rates are high which probably does - and I've said this again and again - does represent under-testing over many, many months and probably not the extent of testing that would have picked up even more cases. Again there're over 200,000 cases amongst healthcare workers, 47% of whom are doctors and 40% are nurses and the rest are the support workers so again this has had a big impact on healthcare workers around the country. 00:49:26 We've seen similarly too indigenous populations; relatively low numbers, under 15,000 cases but that includes 2,000 deaths; that's one in seven people from indigenous communities who are sick dying so we've seen very important impacts on those groups. In general bed availability in Mexico is quite good and there's 60% availability of COVID beds and about 40 to 50% availability of ICU beds so the health system in general is coping in Mexico. With regard to vaccination policies, I think Bruce may speak to this. All countries are struggling with the issue of getting vaccine and then deciding the scheduling and whether they go for giving one dose to everybody and then trying to delay the second dose a little. All countries are trying to do this pretty demanding arithmetic for what is the best combination so maybe Bruce or other colleagues online can speak to how we're advising there. 00:50:30 I would say in general that we're seeing a pattern in Central America that's stabilising. We're still seeing a pattern in South America, not just in Brazil; in Amazonas and other Amazonian provinces we've seen big impacts but we're also seeing rising cases in Colombia, in Peru. While we're seeing stabilisation and falling-off of cases in places like Chile and Argentina and the southern cone there are parts of those countries that have intense outbreaks. So I would say the overall pattern in the Americas is beginning to stabilise. The increases are not as stark as they have been but the health systems across the whole region are under pressure and people in the rest of the world are very, very tired. So I'm sure vaccination couldn't come quick enough for people in the Americas and again remember, the Americas has been one of the most deeply and persistently affected regions in this whole pandemic. Other regions have had a relative break; there was summer in Europe when there was a relatively small number of cases. We've seen for example in south-east Asia, Western Pacific, even in Africa smaller numbers but the Americas and particularly Central and South America have had a punishing pandemic in terms of the persistence and the relentless impact of the disease. 00:51:59 As such systems are under pressure and people need help and we hope the vaccine... As I said in answer to the previous question, vaccination can't come soon enough both to take pressure off those health systems and to protect those highly vulnerable people and countries are facing difficult choices. I can't comment on the specifics of where Mexico has prioritised its specific patches of vaccine; I'm sorry, I don't have that level of detail but we can certainly check that out with our PAHO team and I will do so. Bruce. BA Thanks, Mike. Gabriela, I thought one of the most important points you highlighted was right at the beginning of the comment when you talked about betting everything on the vaccine because of course if any country bets everything on the vaccine we're going to lose; that's the bottom line, certainly in 2021. The vaccine is one tool but we need a full armamentarium if we're going to beat this virus. We need to make sure we've got our first, second, third lines of defence all working and your vaccine is going to be your first line of defence to help prevent people getting infected but people are still going to get infected. 00:53:09 We know we're in a scarce situation in terms of vaccine supply, you've got a virus that's changing all the time, you've got suboptimal uptake and hesitancy with the vaccine; there are many, many issues that'll affect coverage and the ultimate protection from the vaccines. So that makes essential the second line of defence; you've got to be able to test, find that infection so that you can isolate people who are infected, quarantine those who are in close contact and then you have to have your third line of defence. You've got to have the ability to treat and give high-quality care with oxygen, dexamethasone, other life-saving therapies that we know can really, really reduce the rate of death to this disease. So now the good news in 2021 is we've got vaccines, we've got new rapid diagnostic tests that we know work, we know the combination of corticosteroids and oxygen and other interventions can substantially reduce the probability of dying. 00:54:08 So we have an extraordinary armamentarium when you compare us to where we were certainly when Maria and I were in China last year. But the reality is you need all three of those lines of defence if this is going to be successful. Again when it comes to the use of the vaccines, these vaccines have gone through clinical trials and they've been tested a certain way. They've been tested as two-dose schedules for the vaccines that you mentioned; they've been tested with certain intervals and that's how we know they work; that's how they need to be used. So we strongly recommend - and I think this has been a strong international consensus from the advisory boards, the big international advisory boards like SAGE that advise WHO - that we need to respect the interval that has been recommended for the use of these products. That said, there are reasons there're going to be delays. Someone might get their first dose and there can be many, many reasons that they are not getting the second dose exactly at the right time. This can be because of many reasons that are out of people's control. 00:55:11 They're also out of the control of suppliers. We're dealing with a biologic process, with new products here so it is a new challenge to meet what are very, very demanding production schedules. But the important thing then is make sure you do get the second dose, to the point that you were saying, Gabriela, even if it is delayed; that is the message. But the recommendation is use these vaccines the way they've been approved, the way they've been trialled because that's what we have data for and that's how we know they work best at this point. That knowledge is evolving all the time. We'll get more knowledge and we also respect that certain countries will do things slightly differently - Mike, as you said - to try and address the circumstances in their particular environments. FC Thank you. Dr Van Kerkhove. MK Thanks, just to add a couple of small points because you mentioned the variants and I know that there are a lot of people that are concerned about the virus and changes in the virus and what this means and does this totally change the game. 00:56:11 I just want to reiterate that everything that we are learning about these variants doesn't change our approach to controlling COVID. There are four elements that countries are working towards and you hear us talk about these all the time; prevention, control, treatment, vaccination; all of these elements that you've heard us talking about. Now we have vaccines and vaccinations. It will take longer than all of us want for vaccinations to have the impact that they will have but we have other tools. We have to right now prevent as many cases as we possibly can for all of the reasons that you know very well; not only to make sure that we keep ourselves safe but we keep our loved ones safe, those who have more underlying conditions, who are at higher risk of developing severe disease and dying. We have options for control. It's all of those elements of active case finding, rapid, reliable tests, making sure that individuals know if they are infected or not, making sure that they are put in a clinical care pathway and receive quick assessment, oxygen, dexamethasone if they are severe or critical and more therapeutics that are coming online. 00:57:22 We need to make sure that we prevent infections through vaccination, we make sure we do individual-level measures like hand hygiene and physical distancing. All of that still holds true. Don't forget that we still have some power over this virus no matter where we live and as these vaccines come online you still have some control over what you up do during your day, over the exposures that you may or may not have and you have information, you have knowledge, you have tools that you can take to prevent yourself and your loved ones from getting infected so I don't want you to forget that. Even with these variants and what we understand with these variants, these control measures work. We are seeing reduced incidence in a number of countries that have different virus variants that have been identified; in South Africa, in the United Kingdom, in Ireland, in Denmark the control measures work. So don't forget that we still have this control and countries are doing what they can. I am struck by the conversations we are having one year into this and thinking, I want people to remember that there's still a lot that we've learned and that there's a lot that we can do. So prevention, control, treatment, vaccination. Thanks. 00:58:43 MR Just to add specifically that we don't have specific information on sequences in Mexico per se. I'm sure that Mexico has uploaded some sequences to some of the platforms but we haven't any indication as yet of any unusual or variant strains on the Mexico side of things. It is though important - and you mentioned the point - that the more testing you do the better and that's good for control, that's good for understanding the epidemiology. But a proportion of those samples should be sequenced so it should be done as systematically as possible but not every single test needs to be sequenced, not every single virus and you need targeted sequencing when you see unusual clusters or unusual patterns of transmission or unusual clinical presentations. 00:59:29 So what we're trying to do with variant surveillance is to ensure that we're just watching out over all of the disease that's happening in the world of COVID, trying to pick out any unusual signal and ensuring that we're specifically targeting not only testing but sequencing in those areas. Maria and the group here are working on a systematic framework for doing that with countries and we hope that all countries who wish to enhance their genetic sequencing capacity and contribute that data to the global knowledge will be able to do so. If they wish to make that commitment and wish to buy into that we are certainly in a position to help connect them with the necessary technology and training to achieve that. FC Thank you. Maybe we can take a last question from South Africa; Sophie from SABC. Sophie, can you hear me? Sophie? Can you please unmute yourself, Sophie from SABC? Sophie? If not maybe we can close with the last question from Kai from Science. Kai. KA Yes, thank you very much for taking the question. It follows neatly from the last one. I wanted to ask; Moderna announced today some good results in terms of their vaccine against the South African variant and the UK variant but they also said that they were working on updating, on developing a booster shot essentially both based on the normal virus and based on the variant that was first described in South Africa. 01:01:28 I would just like to get an opinion from WHO on what you would like to see from other manufacturers in terms of doing this and is the regulatory approval - do you feel it is clear what the regulatory approval will be if indeed it becomes necessary to update a vaccine? FC Thank you, Kai. Dr Aylward. BA Hi, Kai. That's a great question and in fact one of the things that we're doing right this week in the area of the ACT Accelerator is we're revising the whole strategic plan or refreshing it, let's say, in light of what's going to be necessary in 2021. Some of the big drivers of that of course are the increasing detection of the mutations, of the variants that we're seeing, the variants of concern, let's say, with particularly the changes in the spike protein. The other big driver of course that we're working against is just the demand for vaccine so these are the big things affecting the work. 01:02:33 While our first priority going forward is going to be the roll-out of the vaccines that we have - because as you've reinforced and as Maria said earlier, we know that these are working against the variants at this point so the important thing is to get those things out, as much coverage as possible, protect as many people as possible. But the second priority that we're building into that is how we bolster the whole R&D agenda and it's really the agenda across the research and development, across the product assessment work that we do. And then of course regulatory pathways work, exactly to the point that you mentioned, Kai, because what we have to define is what is the regulatory pathway if necessary for strain changes so that's exactly the programme of work that's kicking off right now. In terms of from the manufacturer side what we're going to be looking for is the same kind of collaboration in the early stages of this disease that we saw last year where there was a great sharing of information and alignment around what are the assays we're going to be using, what are the correlates of protection, what are going to be the key strains that we'll be using. 01:03:46 So all of that you want to get as standardised as possible and then the trial design standardised, etc, so that you can compare across products as well. So I think we're going to be going into a period where we'll want to be seeing even more collaboration across producers to try and then together look at how we both assess the changing environment we're in with the variants but then also how we respond to it in terms of R&D, product assessment work, regulatory work when it comes to strain changes. So very much at an early stage in that but fantastic that Moderna and others are already looking at what does it actually mean for their products as they go forward because as we've seen over the last year - and science has done an extraordinary job in this crisis and again to the point that Maria made a little bit earlier, variants of concern are there indeed but I think we've got the science now, if we harness it properly, to stay in front of it as the nature of this pandemic and the virus unfolds. 01:04:57 MK Thanks. I just want to take it a step up from that as well because it does link to this monitoring framework that we are establishing and then linking to exactly what Bruce just described. What we're trying to do is working with partners around the world to make sure that we have an enhanced system to detect a change in the virus when it emerges. But we also want to be more proactive so if we're looking at different types of mutations that we are seeing we want to look at combinations and we are seeing some of these different variants identified in different countries. Those need to be evaluated properly so we're doing this through enhanced epidemiologic surveillance around the world, making sure that we have robust systems to track this virus and who is infected with this virus so first and foremost we can reduce transmission but also so that we can look for any changes, any significant changes in transmission where we wouldn't expect it; for example in an area where interventions are in place and we're still seeing transmission. That was how the United Kingdom identified their virus variants in November and December - but also if there's a change in severity. We want to increase sequencing surveillance around the world and we have incredible sequencing surveillance, increased over the last year but that needs to be stronger. 01:06:14 So we're looking t to leverage existing systems and we already are doing so so we're not starting from scratch. We have the GSRS global flu network in which 89 labs are currently doing full genome sequencing for SARS-CoV2 already and we want to increase that. We're very thankful for our flu partners. We have the SARS-CoV2 network, many of which are overlapping with the flu network of course. We want to harness the expertise of the polio networks, our HIV networks, our TV networks because there are systems in countries that can do sequencing and the more sequencing that we have the more sequences that can be shared. So in addition to doing that we are working with our partners to share those sequences on platforms like GISAID and others, with metadata so that we can analyse them and carry out bioinformatics and phylogenetics. 01:07:07 We have our virus evolution working group that is tracking each of these mutations and understanding and designing and collaborating on which lab studies need to be done. This is just looking at mutations, looking at variants of interest and then variants of concern. Then of course we need to link with the manufacturers, with the animal model working groups and Bruce outlined what those studies need to look like. This is a process. This is something that needs to be done in a robust, transparent, co-ordinated manner and we need or make sure that partners are being utilised to be able to carry this out. Again we are leveraging existing systems, we are not starting from scratch. We have the R&D blueprint for epidemics. We held a meeting a few weeks ago to outline all of the studies that need to be done again in a co-ordinated manner. We had a meeting a few days later again organised by the R&D blueprint looking at vaccines so this is something that will continue, this is something that will be enhanced over time. Viruses do change but I go back to what I said previously; we still need to focus everything we can on preventing as many infections as we can while monitoring virus circulation globally. FC Thank you all. I would like now to hand over to Dr Tedros for final comments. Over to you, Dr Tedros. 01:08:33 TAG Thank you. Thank you, Fadela and my appreciation again to John and Professor Sebnem for joining us and thank you also to all colleagues from the media who joined. See you in our next presser. FC Thank you, Dr Tedros. You will receive the DG's remarks and the audio file of this press conference just after this press conference. The full transcript will be posted tomorrow morning and for journalists who were not able to ask questions please don't hesitate to contact the media team of WHO for any pressing questions you have. Have a nice evening and see you next time. Bye. 01:09:25

Asociación entre gastos de bolsillo de salud y pobreza utilizando datos de la Encuesta Permanente de Hogares en Paraguay en el 2014 / Association between out-of-pocket health expenses and poverty using data from the Permanent Household Survey in Paraguay in 2014

La cobertura y acceso universal de salud requiere de protección financiera, lo que puede evaluarse a través del gasto de bolsillo ante una enfermedad. El objetivo del trabajo fue analizar la asociación entre el gasto de bolsillo de salud y la pobreza en Paraguay. Se utilizó la Encuesta Permanente de Hogares del 2014 para determinar la razón entre gasto de bolsillo ante una enfermedad con los ingresos del hogar, con las transferencias estatales para pobres, con la canasta básica de consumo y de alimentos. Fueron incluidos 5.165 hogares de los cuales 21,49% eran pobres. Hubo gasto de bolsillo en el 45,19% de los hogares asociándose significativamente con la pobreza (OR: 1,8; IC95%: 1,57 a 2,06). El 1,99% de los hogares tuvo gasto de bolsillo mayor a 25% de sus ingresos y el 5,98% mayor a 10% de sus ingresos, ambos indicadores se asociaron significativamente con la pobreza (OR: 3,70; IC95%: 2,50 a 5,50 y OR: 3,04; IC95%: 2,40 a 2,06, respectivamente). Hubo empobrecimiento en el 1,44% de los hogares, y la brecha de la pobreza pasó de 34,58% a 37,67%. Entre los hogares pobres el gasto de bolsillo fue equivalente a 4,9 días de consumo, a 11,5 días de alimentación y a 42% del valor de transferencias estatales. Estos hallazgos reflejan una insuficiente protección financiera del sistema de salud en Paraguay

Universal health coverage and access requires financial protection, which can be assessed through out-of-pocket costs for illness. The objective of the study was to analyze the association between out-of-pocket health spending and poverty in Paraguay. The 2014 Permanent Household Survey was used to determine the ratio between out-of-pocket expenses for illness and household income, state transfers for the poor, and the basic consumption and food basket. Five thousand one hundred sixty five households were included, of which 21.49% were poor. There was out-of-pocket spending in 45.19% of the households, significantly associated with poverty (OR: 1.8; 95%CI: 1.57 to 2.06), 1.99% of households had out-of-pocket expenses greater than 25% of their income and 5.98% greater than 10% of their income, both indicators were significantly associated with poverty (OR: 3.70; 95%CI: 2.50 to 5.50 and OR: 3.04; 95%CI: 2.40 to 2.06, respectively). There was impoverishment in 1.44% of households, and the poverty gap went from 34.58% to 37.67%. Among poor households, out-of-pocket spending was equivalent to 4.9 days of consumption, 11.5 days of food, and 42% of the value of state transfers. These findings reflect insufficient financial protection for the health system in Paraguay

Oral health for healthy aging / Saúde bucal para um envelhecimento saudável

During the 74th World Health Assembly, a resolution was passed aiming to achieve better oral health as part of universal health coverage, with plans to draft a global strategy and action plan. Oral diseases are a significant problem globally, with implications for older people's health and quality of life. Oral health is important for healthy aging. Integration of oral health into primary care settings and use of a life-course approach have been shown to be effective in the 8020 campaign in Japan. Accurate data on prevalence of oral disease is required to monitor effectiveness of public health approaches, which should be segregated based on setting, sociodemographic status, and comorbidities. These public health approaches should also be adapted and tailored for implementation during the current COVID-19 pandemic. These considerations are essential to progress the agenda of oral health for healthy aging.

Durante a 74ª Assembleia Mundial da Saúde, foi aprovada uma resolução com o objetivo de alcançar melhores resultados orais saúde como parte da cobertura universal de saúde, com planos para esboçar uma estratégia global e um plano de ação. As doenças bucais são um problema significativo em todo o mundo, com implicações na saúde dos idosos e qualidade de vida. A saúde bucal é importante para um envelhecimento saudável. Integração da saúde bucal no primário as configurações de atendimento e a utilização de uma abordagem ao longo da vida mostraram-se eficazes na década de 8020 campanha no Japão. Dados precisos sobre a prevalência de doenças bucais são necessários para monitorar eficácia das abordagens de saúde pública, segregadas com base na localização, status sociodemográfico e comorbidades. Essas abordagens de saúde pública também devem ser adaptadas e adaptadas para implementação durante a atual pandemia de COVID-19. Essas considerações são essenciais para progredir na agenda da saúde bucal para o envelhecimento saudável.

Salud oral integral para adultos de 60 años: un análisis territorial de su cobertura a 12 años de su implementación / Comprehensive oral health for adults 60 years of age: a territorial analysis of its coverage 12 years after its implementation

INTRODUCCIÓN. Las personas mayores en Chile tienen alta carga de morbilidad oral y de déficit funcional que afecta directamente su calidad de vida. El programa universal GES Salud Oral Integral del adulto de 60 años, implementado desde el 2007, permite a las personas de 60 años acceder a tratamiento odontológico integral, aunque a la fecha se tiene pocos antecedentes de sus resultados. El objetivo de este estudio es estimar la cobertura del programa GES 60 para el año 2019 de los beneficiarios FONASA y su variabilidad territorial desagregada por Servicio de Salud (SS), sexo y tipo de prestador (público o compra de servicios). MATERIALES Y MÉTODOS. Se realizó un estudio observacional ecológico, utilizando fuentes de datos secundarios de uso público (DEIS, FONASA). Se estimó la cobertura nacional total y por sexo, estratificada para cada SS. RESULTADOS. La cobertura del programa en el sector público de salud fue de un 22,8% el año 2019. La menor cobertura se observó en el SS Arica (5,3%) y la mayor en el SS Arauco (37,9%). La cobertura nacional fue significativamente mayor (valor p=0,001) en mujeres (27,1%) que en hombres (17,9%). La compra de servicios a proveedores externos totalizó el 12,2% de las altas dentales, siendo esta proporción heterogénea entre SS con relación inversa entre Compra de servicios y Cobertura. DISCUSIÓN. La cobertura para el año evaluado fue baja, siendo insuficiente para poder resolver la alta carga de morbilidad de las personas mayores chilenas. Existe una amplia variabilidad territorial de la cobertura, presentando diferencias por sexo y en la compra de servicios.

INTRODUCTION. Elderly people in Chile have a high burden of oral morbidity and functional deficits that directly affect their quality of life. The universal GES program: "Comprehensive Oral Health for the 60-year-old adult", implemented since 2007, allows 60-year-olds to access comprehensive dental treatment, however there is limited evidence of its results to date.The aim of this study is to estimate the coverage of the program for the year 2019 of the public health insurance FONASA beneficiaries and their territorial variability disaggregated by Health Service (HS), sex and type of provider (public or purchase of services). MATERIALS AND METHODS. An observational ecological study was carried out, using secondary data from public sources (DEIS, FONASA). Total national coverage and by sex was estimated, stratified for each SS. Results. The coverage of the program in the public health sector was 22.8% in 2019. The lowest coverage was observed in Arica HS (5.3%) and the highest in Arauco HS (37.9%). National coverage was significantly higher (p-value = 0.001) in women (27.1%) than in men (17.9%). Purchase of services from external providers totaled 12.2% of the dental discharges, this pro-portion being heterogeneous between SS with an inverse relationship between "Purchase of services" and "Coverage". DISCUSSION. The coverage for the evaluated year was low, being insufficient to be able to solve the high burden of morbidity of Chilean elderly. There is a wide territorial variability of coverage, presenting differences by sex and in the purchase of services.

Media briefing on COVID-19 - 11/12/2020

00:03:06 FC Hello, everybody. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Friday 11th December. Present in the room are the WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Ed Kelley, Director, Integrated Health Services, Dr Bruce Aylward, Special Advisor to the DG and who leads on the ACT Accelerator. Joining us remotely are Dr Soumya Swaminathan, our Chief Scientist, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals and Mr Joe Kutzin, who leads the WHO Health Financing team at WHO. Welcome, all. Simultaneous interpretation is provided in the six official UN languages plus Portuguese and Hindi. Now without further delay I would like to hand over to Dr Tedros for his opening remarks. Dr Tedros, the floor is yours. TAG Thank you. Thank you so much, Fadela. Good morning, good afternoon and good evening. This week vaccines against COVID-19 have started to be rolled out in the United Kingdom and we expect more countries to follow. To have safe and effective vaccines against a virus that was completely unknown to us only a year ago is an astounding scientific achievement. 00:05:02 But an ever greater achievement would be to ensure all countries enjoy the benefits of science equitably. WHO and our partners are focusing on three priorities. First we face an immediate funding gap of US$4.3 billion to procure vaccines for the most needy countries. I urge donors to fill this gap quickly so that vaccines can be secured, lives can be saved and a truly global economic recovery is accelerated. Second we have worked hard to secure political commitment from world leaders for equitable access to vaccines but we would like to see that commitment being translated into action. Third we're preparing countries to deliver countries by assessing gaps in infrastructure. Already almost one billion doses of three vaccine candidates have been secured as part of the COVAX facility and 189 countries are now participating. Our COVAX partner, GAVI, is in discussions with several other manufacturers and further deals will be announced in the near future. 00:06:25 Simultaneously WHO is working with GAVI and UNICEF to evaluate the first set of requests received from countries who are eligible for assistance through the COVAX facility. Addressing the financing gap is an urgent priority. On Monday WHO and the European Commission are reconvening the facilitation council for the ACT Accelerator with our co-chairs, Norway and South Africa. The council will scrutinise our strategic priorities and a draft financing framework to close the ACT Accelerator financing gap for 2021. This is crucial to ensuring all people everywhere are protected. We have all seen images of people being vaccinated against COVID-19. We want to see the same images all over the world and that will be a true sign of solidarity. Yesterday was Human Rights Day and tomorrow is Universal Health Coverage Day. These two days coming so close together at the end of this very difficult year are a reminder that as we rebuild from this crisis we must do so on the foundation of human rights including the rights to health. 00:08:03 2020 has reminded us that health is the most precious commodity on Earth. In the face of the pandemic many countries have offered free testing and treatment for COVID-19 and promised free vaccination for their populations. They have recognised that the ability to pay should not be the difference between sickness and health, between life and death. This year Universal Health Coverage Day takes on even more importance than usual. Apart from the death and disease caused by the virus itself millions of people have suffered and died as a result of disruption to essential health services. This week WHO is launching two initiatives to support and rapidly accelerate countries' journey towards universal health coverage. The first is a global programme to strengthen primary healthcare, better equipping countries to prevent and respond to emergencies of all kinds from the personal crisis of a heart attack to an outbreak of a new and deadly virus. The second is a new UHC compendium designed to help countries develop the packages of services they need to meet their people's health needs. WHO is also launching a new report that provides the first analysis of how global health spending has changed during 2020 in response to the COVID-19 pandemic. 00:09:46 Many governments have responded to the pandemic with exceptional budget allocations for their health systems and even larger allocations for economic stabilisation and social protection. At the same time COVID-19 has triggered a deep global economic crisis that could have a long-lasting impact on health financing. Public revenues are declining, forcing many countries to take on additional debt which will impact lower-income countries whose economies were vulnerable before COVID-19 struck. The report warns that higher debt servicing could make it more difficult to maintain public spending on health. But this is precisely the moment for investing in health. The pandemic has demonstrated that health is not a luxury. It is the foundation of social, economic and political stability. Indeed today's report highlights that the COVID-19 crisis provides an opportunity for a reset in countries with weak health financing systems. It makes six key recommendations for a new health financing compact. To draw more attention to universal health coverage we have also made it one of the main categories in the second WHO health for all film festival. 00:11:22 We're inviting all film-makers, whether professional or amateur, to submit short films focusing on access to quality care for any health need by 30th January 2021. Several hundred films have already been submitted and the two other categories for the festival are health emergencies, in which we invite short films about COVID and other humanitarian crises, and better health and well-being, in which we invite films about climate change, pollution, sanitation, nutrition, gender issues and more. We know that although children are less at risk of severe disease and death from COVID-19 than older adults millions of children have suffered from the pandemic in other ways including disruption to their education. According to data collected by UNESCO classrooms for nearly one in five schoolchildren globally or 320 million were closed as of 1st December, an increase of nearly 90 million in just one month. 00:12:41 In some places children have been out of school for nine months or more. Prolonged school closures are presenting an unprecedented challenge to children's education, health and well-being. Today WHO has released a new checklist to support schools in reopening and in preparing for resurgences of COVID-19 and similar public health crises. It lists 38 essential actions; a new checklist to support schools in reopening and in preparing for resurgence of COVID-19 and similar public health crises. It lists 38 essential actions to be considered by different stakeholders as they work to agree school reopening plans. More than 66 million cases of COVID-19 and 1.5 million deaths have now been reported to WHO. In the past six weeks the number of weekly deaths has increased by around 60%. Most cases and deaths are in Europe and the Americas. The festive season is a time to relax and to celebrate but we must not relax our guard. Celebration can very quickly turn to sadness if we fail to take the right precautions. As you prepare to celebrate over the coming weeks please, please consider your plans carefully. If you live in an area with high transmission please take every precaution to keep yourselves and others safe. That could be the best gift you could give; the gift of health, life, love, joy and hope. I repeat; the gift this season, the best gift this season you could give is the gift of health, life, love, joy and hope. I thank you. Happy holidays. 00:15:15 FC Thank you, Dr Tedros. I will now open the floor to questions from members of the media. I remind you that you need to use the raise your hand icon in order to get in the queue to ask your question. I think we will start with Laurent Zero from ATS, Swiss news agency. Laurent, can you hear me? LA Yes, thank you, Fadela. Can you hear me? FC Very well. Go ahead, please, Laurent. LA Very good. We have observed in recent weeks a trend downwards in countries like Switzerland and some of its neighbouring countries but then more recently since one week ago there is a kind of plateau at a high number of cases despite strong measures that have been taken by the different governments. How do you explain that? Thank you. 00:16:20 FC Thank you, Laurent. I'd like to invite Dr Van Kerkhove to take this question. MK Thank you for the question. Indeed across many countries in Europe we have started to see a decline in cases and I think that's a result of the measures that have been put in place and individuals who are adhering to those measures. But as you've said, it's starting to plateau in some locations and what this means is that we need to stay the course, we need to follow through, we need to continue to practise the physical distancing, staying home if asked, teleworking, following all the measures that are put in place to keep ourselves safe whether these are individual-level measures such as physical distancing, the wearing of masks, cleaning your hands, practising good respiratory etiquette, whether you are asked to stay at home; continue to stay at home. But we have to follow through. I think one of the lessons we can learn, especially across Europe, is over the summer Europe showed us that they brought transmission under control. In many countries cases were down to single digits and that can and that will be done again but we really must be vigilant and we really must stay the course. 00:17:26 Given the holidays that are coming up, as the Director-General just said, it is a time when many people want to come together but we really need to make very careful decisions about how we celebrate this year. We will celebrate but maybe it means we celebrate with just our households and maybe we do another type of Zoom celebration, as we will do with my family this year. But we do need to stay strong and we do need to make sure that we keep ourselves separated from others for the time being while we have the good news of vaccines coming online. But again just to repeat, we need to stay the course. It's very easy for us to go up quickly in case incidence. It takes quite some time to actually come down the other side of the mountain, as you've heard Mike say, in the spring so we have to follow through but we will do it, Europe will do this again and they will show us how to bring it under control. 00:18:24 MR I think, Maria, you're absolutely spot-on. I'll just repeat two of your words; follow through, make sure this time that we follow through on the measures. If we continue to build public health surveillance, we continue to work with communities to maintain those measures around physical distance, personal hygiene, avoiding crowds and then we add vaccines gradually in the coming year we can avoid the lock-downs. So this is about us all following through on our commitments as individuals, as communities and as governments in the coming months. FC Thank you. I would like now to call on Jason Bobia from NPR to ask the next question. Jason, are you with us? JA Yes, thank you very much. You mentioned, Dr Tedros, that the UK has now started vaccinating and the US appears to be on the verge of authorising the Pfizer vaccine and you talked about the need for equitable distribution but obviously that distribution can't start in many places until the WHO authorises a vaccine. Can you give us an update on when we can expect the WHO to authorise a vaccine that can start being distributed through COVAX? FC Thank you, Jason. We have with us remotely Dr O'Brien and Dr Soumya Swaminathan. Kate, do you want to start? Or Dr Swaminathan. 00:19:57 SS I don't think Kate is connected. FC Okay. Dr Swaminathan, you have the floor. SS Thank you, Fadela. Yes, I can start. The WHO has put out our criteria for emergency use licensing and we are open to receiving submissions from all manufacturers who are interested. In fact we've received several and it's a rolling submission so as more data is accumulated from the different phases of trials it's provided to WHO so that we're up to date and we can stay as updated as possible. We are now going to be looking at the Pfizer dossier followed by a couple of others as they come in and we expect that... We work quite closely with the European Medicine Agency along with some of the other national regulatory agencies and so we expect that in the next couple of weeks our committees will be reviewing the Pfizer BioNTech dossier and coming out with an opinion. Thank you. 00:21:11 FC Thank you. I think Dr Aylward would like to add something. BA Yes, thanks so much and, Jason, thanks for the question; super-important. When we established the COVAX facility to make sure that there would be absolutely no barriers to the most rapid access to vaccines possible for all countries in the world we're actually using a slightly different process and we are indeed looking at these products though the WHO emergency use listing procedure. At the same time we have an exceptional procedure in place where some products that are approved by what we call a stringent regulatory authority can also be considered by the COVAX facility so there will be no barrier to the speed with which these products could potentially be used globally. FC Thank you. I would like now to call on Isabel Sacco from EFE, the Spanish news agency. Isabel, you have the floor. IS Yes, good afternoon. I have more or less the same question as the previous one. I would like maybe to ask again if Dr Soumya can identify the vaccine candidates that WHO is reviewing and for the general public if she can explain the importance of this review by WHO, taking into account that we all know that there are many other national regulatory agencies that are doing the same procedure. Thank you. 00:22:59 FC Thank you, Isabel. Dr Swaminathan. SS Yes, thank you for that question. Indeed it's a bit confusing because, as you rightly pointed out, national regulatory authorities do have the mandate and the jurisdiction to make these assessments and decisions for use within their own countries so every national regulatory authority has the authority and the mandate to do that but that's limited to their own countries. Several countries rely on WHO's pre-qualification service for vaccines and for drugs and that's a service that WHO provides also for global procurement agencies like UNICEF and GAVI because it's a stamp of quality, safety, efficacy and manufacturing quality. 00:23:54 In the case of the emergency use licence of course we base this assessment on limited amounts of data and that's clearly laid out in the criteria so what should be the minimum efficacy, what's the minimum safety data that's needed as well as of course all the manufacturing details around the quality of the product. So, as I mentioned, we have opened the expressions of interest several weeks ago, I think it was about four to six weeks ago and we have been receiving both enquiries as well as submissions of dossiers from several companies, at least ten companies have either expressed an interest or submitted initial dossiers. The data will only be considered for an emergency use licence when there are some phase-three clinical trial results available and so there are only a couple of companies now that have those phase-three results and those are interim results. So we've started with the Pfizer dossier; we expect also to have the Moderna followed by the AstraZeneca dossiers examined in the next few weeks and we will be coming out with the decision, whether it is receiving an emergency use licence or not. The other thing that we're doing is of course working with the regulatory agencies, the International Coalition for Medical Regulatory Agencies, the ICMRA, with whom we have a letter of agreement now on how we would work together so that we can speed up things further. 00:25:36 We have regulators from several countries actually who have stepped up and volunteered to help the assessments that WHO will be performing so these will be joint assessments done with national regulatory agencies. We have asked countries also to prepare for licensing of vaccines by either accepting the WHO EUL or PQ procedures or by accepting one of the stringent regulatory authorities, as Bruce was just mentioning, so that they are in a position to receive vaccine doses from the COVAX facility. They have to accept either of these. What we don't want is for every country to start an assessment process for every vaccine because that's just going to take far too long and so therefore it is important to rely on a few regulatory agencies globally plus the WHO process. Thank you. FC Thank you, Dr Swaminathan. Dr Ed Kelley would like to add something. 00:26:35 EK Yes, thanks, Fadela. Just to complement the points made by Soumya on this, one of the pieces of work certainly is getting the vaccine through the regulatory process and getting it reviewed here at WHO but as we've always said, it's not the vaccines but vaccinations and vaccination programmes that will end up protecting people and there's tons of work going on right now; in fact the entire ACT Accelerator in many ways, as the person doing a lot of the work on the Health Systems Connector, has pivoted to support the assessment in countries. We were targeting 100 countries; we've now got 105 assessments already in and the picture of what is going on and how countries are preparing not just on the regulatory work, which does need some more work, but also on safety monitoring systems. We've got over 65% of countries that have already got safety monitoring systems in place so all of that work will be as important as the work that Soumya just mentioned. FC Thank you. I would like now to invite Jeremy Lunge from Radio France International, RFI, to ask the next question. Jeremy, do you hear me? JE Yes, I can hear you, Fadela. Thank you so much. A question about testing; a lot of people are thinking about getting tested ahead of Christmas. In France the Health Minister advised against it, saying that it might provide a false feeling of safety. I would like to know, do you have any comment on that, do you advise against or for testing before Christmas? Thank you. MR We certainly advise that all patients who are suspected of having COVID-19 are tested and that we expand testing through the use of rapid diagnostic tests in specific circumstances. Maria can go into details of how we see the strategic expansion of testing but we need more testing, not less. I think the Minister may have been relating to the specific issue of individual risk. Finding as many infected people in the community is very important but when you get a test and you test positive or negative on a certain day it doesn't mean you will test negative the next day or the next day. So doing more testing to find infected people; yes, good. Relying on a single test to guide your behaviour in the coming days or who you can meet or what you can do is problematic because knowing your status today does not guarantee your status tomorrow. 00:29:17 So we must sustain the behaviours of physical distancing, wearing masks, avoiding crowded spaces, ensuring we're using appropriate ventilation and doing all those things to minimise risk in those environments. That does not mean that targeted, strategic testing is not a good idea. We want to see an expansion of testing but we want to see it done for public health purposes. Individuals who have the resources to have themselves tested; there is nothing wrong with getting a test. It's really how you interpret that result and how that affects your behaviour and how it should or shouldn't affect your behaviour. Maria. MK Yes, thanks. Just to supplement what Mike has said, we encourage, we advise, we recommend strategic testing. We have since the beginning and anyone who meets the suspected case definition should be tested. We work very hard through our regional offices and our country offices to build testing capacity. This has been a PCR-based testing capacity and now all countries are able to test for COVID-19, test for SARS-Co-V-2 infection, the virus that causes COVID-19 and that is really quite an incredible feat. We now have antigen-based rapid diagnostic tests that are coming online. These are cheaper, quicker, easier to use and we recommend these be used in areas where there's a lot of virus, where there's a lot of virus circulating, where there are outbreaks that are happening, in areas potentially screening individuals like health workers who are at a higher risk of exposure because they had direct contact with known patients. 00:30:48 Those are really helpful to alleviate some of the pressure on the PCR-based system but testing for testing's sake must be linked to public health action, it must be linked to isolation of cases, clinical care of cases, contact tracing, supported quarantine of those contacts. As Mike has said, a test result gives you the result of that sample that was collected at the time of testing. You could become infected between the time that you took that test and the time you get that result back, which is why it's really important that we not only get tested with a high-quality either PCR or antigen-based test but that you get that result back quickly and you follow through with the public health actions that are there. 00:31:32 So in some countries testing will be expanded and this is good and we have seen a global expansion of testing but again it needs to to be fit for purpose, it needs to be linked to cluster investigations and case finding and making sure that you're working towards your goal of reducing transmission and you're breaking chains of transmission. So there are good products that are coming online. These rapid antigen-based tests are a game-changer in many ways because they can be used in lots of different settings and take the pressure off the PCR systems. But again we still, all of us, need to adhere to all of the measures that keep ourselves safe, keep our loved ones safe so keep up that physical distancing, keep following all of the measures that are put in place in the local area where you live, which is based on the transmission that's happening around you. FC Thank you. Moving now to Cancun in Mexico I would like to invite Paulina Alcazar from Ancadena News to ask the next question. Paulina, do you hear me? TR Yes, Fadela. Can you hear me? Thank you. Good day to everyone from Cancun. What considerations should be taken into account with the high number of reinfections or is it considered as a long COVID, a persistent COVID when someone is positive again at a test several months later? What do we consider it as? 00:33:07 MK Thanks for the question. There're two aspects to the question that you've asked. One is about reinfection and I think the other one is about long COVID so these are two separate things and let me just break them down very briefly. We do know that there are some individuals who may be reinfected with this virus and this has been detected in a number of countries that have good lab systems, that have been able to do a sequence of the first infection and a sequence of the subsequent, second infection and they can tell that there's a difference in that virus, a slight difference because the virus changes and that is indeed a subsequent infection. This is now starting to be picked up in a number of countries and we have more than 69 million cases that have been reported globally but the number of reinfections is a lot smaller than that. We're working with countries to help them better define what a reinfection is and to help them look to see how often this is happening. 00:34:04 So it doesn't seem to be happening very often but we can't quantify that at the current moment. The question around long COVID is that there are individuals who've been infected with the SARS-CoV-2 virus, they have an acute disease where they're very unwell or they're mildly unwell and then they seem to recover but they're having longer-term effects. We are learning more and more about what long COVID is in terms of the effect on the body. It seems to affect many different organ systems. It's not just a respiratory illness of two weeks; it seems to persist for months. We're working with many different patient groups, we're working with many different researchers to better understand what is happening. We have met and the Director-General has met with patient groups and the patient groups have said to us what they need is recognition that this is real and this is real and there's now an ICD code for what's called post-COVID syndrome. We're working with them because we need better research to understand the extent of this in different populations, to understand what disease looks like in terms of the long-term effects and the different effects on the organ systems and also rehab. 00:35:20 So we're working with clinicians to better design and work on rehabilitation for individuals who are suffering from this, to ensure that we give them the best care possible so we have a lot to learn in this area. There was a forum that was organised this week by ISARK [?] and partners which WHO participated in and we have seminars and working groups that have been established specifically to look at this so that we can provide adequate care. MR Let me just emphasise what Maria's been saying; it is best that we all try to avoid this infection and not to have to be concerned about your health going forward; also to reassure people, yes, the vast majority of people do have an infection that doesn't result in ongoing specific effects. But there's a significant minority of people who are suffering very, very long into a post-COVID period and our hearts go out to them as they approach this Christmas period because sometimes in life mortality and death is recognised and we all sympathise. It's very hard when you're carrying the after-effects of an illness; it can be a very lonely experience and people don't want to attract attention to themselves because people may think, I'm infected and I'm still coughing. 00:36:40 So people are going through a lot of psychological trauma as well as having those lingering effects so I think we should all be very kind to each other and particularly kind to those who've had to fight through very difficult infections and have the continued concern of the long-term impacts on their family. To our journalist I would say, given the weather here in Geneva we would love to be with you in Cancun. FC True. Let's go to Georgia; I think it's cold in Georgia. I would like to invite a journalist from Georgian television, Imeda, Kitivan Kardava, to ask the next question. Kitivan, are you with us? KI Yes. Good evening. Can you hear me? FC Very well. Go ahead, please. KI Thank you very much for this opportunity, Mr Director-General. When you were talking about vaccine and about the news about vaccine you said recently that a beam appeared at the end of the tunnel. How bright is that ray today, can you tell us? 00:37:48 As I represent Georgia I want to ask you about Georgia. Thousands of people are infected in my country every day. What would you say to the population of Georgia? They are watching your statements carefully every week. Also I have a question about information campaigns; how should information campaigns about vaccination be conducted so that the people have a confidence in the vaccine? We all know that vaccine will be effective in the case when people have confidence and trust in it. Thank you very much. FC Thank you. These are three questions. Maybe Dr Aylward would like to start. BA Sure, and Soumya may wish to come in on the issue around the confidence and everything that's being done to build that but in terms of the comment the Director-General made last week about the light at the end of the tunnel, I think was the phrase, and how bright that is, that light is getting brighter in fact. 00:39:00 If you look week by week at the number of companies that are announcing positive results in terms of the efficacy of vaccines that number is increasing and what's important is it's increasing not just in terms of the number of products but also the different technology platforms that they are being built on. As we're seeing now, there're three different technology platforms, as we'd call them, that have reported very positive efficacy and safety data. We haven't seen and scrutinised all of the data behind that, as we've emphasised multiple times. Some of this is still in press reports but it's positive which means that beam is looking brighter, to the point that you asked. But at the same time there're other considerations and Mike emphasises this repeatedly and Maria. I think it's so important an that is that there are real challenges with volumes; these are still very, very scarce products and just as some companies are announcing successes there are others - and we've had two over the last few days - that have said they have challenges with their product either in terms of the volumes they can produce or in terms of some of the trial results. 00:40:09 So this reminds us that while the beam, as you said, or light at the end of the tunnel is getting brighter over time it's still a long tunnel to get out of the battle against COVID and we still have a long winter in front of us. I think, to the points that Mike emphasises again and again, we have to do everything and we need to continue doing everything for the foreseeable future because with that light at the end of the tunnel we should have a new energy now to do the case finding right, do the contact tracing right, do the isolation right. So what this really should give us is the hope and the stamina to be managing this disease and implementing those measures that much more strongly in the near term. Perhaps Soumya'd like to comment to the broader agenda of work on confidence building. FC Thank you. Dr Ryan. 00:41:01 MR No, with specific reference to Georgia itself, Georgia's had a tough time over the last number of weeks. It's had a very steep rise in cases and has reached pretty high cases per million population overall although that's stabilised in the last week; there's been a 9% increase in cases in the last week and, I think, an 8% increase in deaths. So Georgia's had - certainly in the first wave earlier in the year Georgia managed to avoid a good deal of the impact of the first elements of this pandemic but has been hit quite hard this time around. I think the positive answers or news are that the case fatality rate has been relatively low and again credit to front-line doctors and nurses who continue to maintain front-line services. But I think the story here too for Georgia - and I think it's something that every country needs to look at; past success or past avoidance of a given scenario does not mean that that scenario can be avoided the next time around. You may have dodged a bullet the last time; you may get hit hard this time and therefore it's really important that you understand in a given setting... You see situations like for example at the moment in Korea and in Japan; they've been dealing with a bounce in cases in the last couple of weeks. Korea's been an extremely high performer in the area of disease control but it's going to have to turn and fight that disease again and each and every time there may be different risk groups, it may be a different part of the country, it may be a different age group. 00:42:35 Each time you fight this battle there are slightly different tactics required and that's why you need to be agile, you need to look at what's happening in your country, you need to not make assumptions about what's going to happen or things are going to go away or going to disappear or whatever all the other euphemisms are for this. You've got to fight what you see; knowledge and data drives that, understanding what's happening and then giving people the right information, intervening aggressively in the right places, adapting your control measures to the situation you see on the ground, expanding your testing and improving your capacity to understand clusters and amplification events and then supporting people in avoiding crowded settings and doing all of the other things we need to do. 00:43:16 The DG keeps saying it again and again; do it all. But I would also say, do it smart, when you have limited resources do it smart as well and use those resources and drive your public health interventions with the intelligence that comes from using science and using data, a data-driven, science, driven approach. Again Georgia is turning that corner. It is not an easy time and we've seen in Europe that as the disease has come under control in many of the Western European countries, many Central European countries, in the Caucasus and even in central Asia have continued to have a difficult time and then that shows how this disease is in a different... We're not in an epidemiologically stable situation. The virus is still working its way through the human population. The vast majority of people remain susceptible so it has not settled down into a pattern that you can predict and say, oh, this is what's going to happen next week and the week after. That is not the case and there are potentially unique aspects of every country's culture and behaviour and set-up that can drive transmission one way or the other. Maria. MK I just want to say, it's moving around from your question a little bit but I just want to highlight some of the things Mike has just said there. 00:44:31 It is about being in a state of readiness. We know so much more now, we're using data to drive our actions and if a country is having an increase in cases as we're seeing in Georgia you still have experience. There's a lot of experience and knowledge that is being used to help tailor the approach to what needs to be done, where it needs to be done and for the amount of time that it needs to be done. That's done at a political level, it's done at a community level, it's done at an individual level and with the example of Korea - and we could choose a number of countries that have seen a resurgence - it's about that state of readiness. If you use the system that you have in place - the world is not in the same place we were in a year ago. Many countries have built up this public health infrastructure, some at a faster rate than others but we still need to continue to invest in people in a workforce that can do active case finding, that can carry out those tests and that strategic testing so that lab results get back quicker, so that we carry out the contact tracing and the cluster investigations. 00:45:32 This virus likes people, it needs people to transmit between. It's primarily transmitting between people in close contact with one another. If you put a lot of people together, you're in an enclosed space, you add poor ventilation you are providing an ample opportunity for this virus to spread. We can take actions that can prevent all of that from happening and I think that's what's really critical right now. As Bruce said, as the vaccines are coming online there's a lot of hope that we have but I think many people will also feel a little bit frustrated because we won't be able to get to that light at the end of the tunnel as fast as we want to. We have to remain vigilant and your question was what should we tell the people of Georgia. Hang in there, do everything that you can to protect yourself and to protect your loved ones. You have individual-level measures that you can have. You have knowledge about where this virus is, how it spreads and you have the power to take decisions. 00:46:27 Each of these decisions that you take can minimise your risk. We are telling everyone, know your risk and take steps to lower that risk. We want people to feel empowered, that there's a lot you can do and again, especially as we're seeing in this holiday season, please make the right decisions to keep yourselves safe. While we are seeing in many countries across Europe a decline in cases, as the Director-General has said, the percent increase in deaths globally, as the Director-General said, has been a 60% increase in the last six weeks; a 60% increase in deaths in the last six weeks. That is not evenly distributed around the world where we've seen in EMRO a 10% increase, in AFRO a 50% increase, in EURO almost a 100% increase in deaths over the last six weeks, SIERO 7.5%, PAHO 54%, WPRO 15% so it isn't evenly distributed. This virus is still circulating. Most of the world remains at risk. We can take steps to protect ourselves. Please do everything you can to protect yourself and your loved ones. FC Thank you. Dr Tedros. 00:47:40 TAG Thank you. This is a rare treat from Georgia so thank you and greetings to Georgia first of all. That question is very important. As Bruce said, the light at the end of the tunnel is getting brighter - I fully agree - with more vaccines now in the pipeline. At the same time we have to also focus on some of the challenges we're facing to make the light really completely bright. There are three major areas where we're focused and the challenges we're facing are associated with those. Number one, funding. There is a need for immediate funding of up to US$4 billion; that's one. Second, we have all followed what has been happening in the last few months. Many world leaders, our political leaders have pledged to make vaccines a global public good. That pledge has to be translated into action so that's second. We expect our leaders to really honour their pledge. We see some concerns but I hope we will have the vaccines on the ground based on the pledges that have been made. Third is infrastructure; the whole supply chain, especially of developing countries, has to be strengthened, has to be prepared; the supply chain, training of health workers and so on. We're doing that and that's the other area where we're focusing because when we do these three things - the funding, the political commitment translated into action and preparing the infrastructure - then the vaccines that are coming into the pipeline will lead into vaccination. 00:49:49 At the end of the day the most important part of the whole process is when you see people vaccinated, when they have the inoculation and when that is done fairly and when that's done globally. When that's done then the world can recover faster and, as we said many times, sharing the vaccine and having the inoculation everywhere in all countries means faster recovery and it's in the interests of each and every country in the world. Lives and livelihoods will get back to the new normal and we believe that's what the world wants. Thank you. FC Thank you, Dr Tedros. Dr Swaminathan, you have the floor. SS Thank you, Fadela. Very quickly on building confidence in vaccines, which was the third question. It's really important that governments and public health officials start communicating with citizens in their countries to explain to them the process of the deployment of the vaccines because things are happening extremely fast and people are anxious for information, they have a lot of questions and very often it's genuine questions that people have that need to be answered. 00:51:23 They may have some fears that need to be allayed but a lot of times it's questions and doubts which really need to be addressed and it's only a minority of people, I think, who are anti-vaccine. The surveys that have been done showed that the majority of the world's people actually want a vaccine, they're waiting for a vaccine, they can't get it soon enough. At the same time they may have questions so this is the time to explain to people who are the population groups who have been prioritised, why have they been prioritised, when are the doses likely to come. The fact is that we are going to have limited doses in the first half of 2021 all over the world. Dose supplies are going to be limited. We need to prioritise those who are at the highest risk of getting the infection or dying from the infection. These are our front-line workers, our healthcare workers and the very elderly who are the most susceptible. 00:52:19 The rest of us have to be a little more patient. We have to continue with all the measures that we've talked about and these are the things that governments need to communicate so it's important to have a national vaccine deployment plan and a strategy. One of the key elements of that is the communication to the public and the more open and transparent we can be the more likely it is that people will have the trust and the confidence and will not only want to take the vaccine but will also be patient and wait for their turn. Thank you. MR Just very practically on that, we've been working very, very closely; the Immunisation Programme with Kate and the Emergencies Programme on our side have joined together with UNICEF and the International Federation of the Red Cross and Red Crescent Societies on a common service around risk communication and community engagement and specifically in the area of vaccination. 00:53:15 So if countries require more integrated systems and services and support there is the planning part but then there's the implementation so we take this deadly seriously. This is a science and this is a moment of translating our knowledge and communications into behaviour and action and demand and it doesn't happen by itself. It requires a dedicated and committed investment in social engagement so we stand ready as three organisations and others to support member states and people and nongovernmental organisations in the field in doing that and we are specifically investing in a strand of activity to support the implementation of the ACT Accelerator and the preparation of countries for successful vaccination campaigns. Kate O'Brien, Sylvie Briand and others are leading on that internally here at WHO. We have many excellent colleagues in UNICEF and Red Cross working with us on this portfolio. FC Thank you so much to all of you. I would like now to invite Sophie from SABC South Africa to ask the next question. Sophie, are you with us? 00:54:22 SO Yes, I'm here; Sophia Mkwena from the South African Broadcasting Corporation. The topic of vaccines on the African continent at times can be very controversial because there's a perception that the continent is being used for all the trials. There's a heated debate in South Africa currently. The Chief Justice of the Constitutional Court yesterday - a very religious person - when he was praying he prayed that there shouldn't be a vaccine that is being manufactured based on gammon [?]. Therefore that has generated a heated debate and it has instilled fear in some people, questioning, particularly after he also pointed out, why do you give people vaccine when they are not necessarily infected. I just want to check from Dr Ryan and Dr Tedros; this will demand a serious discussion and perhaps senior leaders to deal with the issue of perception. What is your advice to the African continent, particularly South Africa, at a time when the numbers are currently going up? We are in the second wave of the infection. FC Thank you, Sophie. Dr Ryan. 00:55:59 TAG Dr Tedros and Dr Aylward or Soumya may wish to comment but if we take a step back and look at it from the perspective of Africa, Africa has used vaccines as one of the single most effective public health interventions over the last 30 years on the continent. Africa has just recently eradicated the wild polio virus; it has put the wild polio virus to death on the continent using vaccination. The way in which African nations, even with weaker health systems, have prioritised immunisation of children; this has been the single biggest life-saving intervention on the continent. Therefore I think Africa is to be commended for the way in which immunisation has been used, has been trusted by populations and has been instrumental in reducing mortality rates. When a new vaccine is introduced there are always concerns and there are always questions and increasingly there are people who will distribute disinformation and misinformation and anti-vaccination information. The dialogue is needed at community level in order to address those concerns and we were just speaking about that, how we can deal with that. But certainly we need leaders and others to be very consistent in their messaging to people. We need people not to be raising fears but we need people at the same time not to be, in a sense, ignoring fears. You have to address people's fears with knowledge and with information and allow people to make up their own minds. 00:57:30 I have great faith in people in Africa in general. South Africa and other countries - and again in this African countries have actually shown the way in this response, in community engagement; they've led the way on community-led responses. African countries have - for example the laboratories in South Africa, in Senegal have been reference centres for diagnostics and even the development of diagnostic tests within Africa. Africa CDC and our African regional office have worked and the African Union have taken a big leadership role - the DG may wish to speak to that - on the continent. So Africa's doing well and Africans should be proud of what's being achieved. The next move of bringing in vaccines - and again South Africa, I believe, has participated in vaccine trials and has been at the leading edge of science and other types of trials for other diseases over many years. 00:58:23 It is really important though that countries that do support vaccine trials and countries that do participate in advancing science and innovation have fair and equitable access to the products that come from that process. That's another issue; the DG speaks to that process of equity but in this I think African nations and particularly South Africa are partners in science, they're partners in the innovation but communities have genuine questions that need to be addressed. Bruce may wish to speak or Soumya or others but again I think we need to be very rational in how we approach this discussion. Vaccination, immunisation are life-saving interventions, they have saved hundreds of millions of lives on this planet. We need to maintain our standards, we need to be sure that everything is safe and efficacious but we also need to trust in vaccination as a potentially game-breaking and game-changing intervention in this pandemic. Bruce. BA Thanks, Mike, and thanks, Sophie. These are such important questions and hardly unique to South Africa; you highlighted a couple of times specifically in the context of South Africa but in fact it's not just a South Africa issue - Mike alluded to this a little bit - but in every country there are people who raise questions. 00:59:42 But at the same time there's no question that vaccines are one of the most powerful public health tools that we have and certainly no population, no people would want to be disadvantaged in terms of being able to access them. That's what the entire COVAX facility, the ACT Accelerator is all about. At the same time we're got to make sure that when there are questions raised they get listened to and they get addressed and it's so important to create the fora for discussing these things, to listen to the concerns and then to use the science and the data available to be able to answer those. One of the striking things - Dr Tedros talked about in his opening remarks - was the speed with which science has created tools now and vaccines, it appears, to be able to tackle this disease. But at the same time as striking has been the amount of transparency and the amount of scrutiny that's been given to these products. It's extraordinary and I think one of the great advantages here - I'll come back to South Africa - is that in South Africa you have such experts in the area of vaccines and vaccination, really world leaders in fact, whose counsel we take. 01:00:56 So I think the country's in a very, very strong position, like all countries, to create those fora for the discussion, to listen to the issues and to address them but this has got to be anchored in what is now decades and decades of experience with vaccines, the power of vaccine and the countless millions of lives that have been saved as a result of them and that will be saved from COVID-19 as a result of these vaccines as they're proven and as they come eventually to market and to use. But again, as Dr Tedros said in his last intervention, a vaccine only saves lives when it's actually in someone, not in a vial so the big key now is making sure these products get out, get scaled to people as rapidly as possible. FC Dr Tedros, you have the floor. TAG Thank you. Thank you, Sophie, for those questions and I fully agree with what my colleagues said, especially with regard to some wrong perceptions of the vaccine, that's not just in Africa but it's all over the world. 01:02:01 Then when we come to the testing, especially the vaccines for COVID have been tested outside Africa more than in Africa. Having the testing, as long as the right protocols are followed, is very important and that's what has been done and the testing, I don't think, has been focused in Africa actually; it's more outside but the most important thing is whether it has followed the right protocols or not, whether it's done in Africa or other places but it's done in many places. Then when vaccines are introduced, whether they get emergency use least or finally pre-qualifications, the safety is central in addition to efficacy. So we follow that and other organisations, regulatory bodies also follow that and we will make sure that whatever vaccine is available the two important criteria are met; the safety first and then of course the efficacy. Then the issue you raised with religion; I remember when HIV reached its climax and some medicines started to appear and some people were saying, either you follow your religion or you follow the medicine, the two can't go together. 01:03:48 But religion and science can go together and I remember during that time religious leaders themselves came out and told the public that taking the medicine and doing their religious practices actually don't contradict one another. Many accepted that and many took medicines and they saved their lives. So for our religious leaders it's very important to see from the right authorities whether the right safety and efficacy measures; based on those the medicine or the vaccine is being provided or not; that's what they should focus on. Actually I would like to use this opportunity; it's the role of leaders - religious leaders, community leaders, political leaders - to be models and examples, to convince their followers to do the right thing. I hope our religious leaders will do their best to fight the pandemic, to fight the virus using the tools we have at hand and when vaccines are provided to also help their followers to benefit from the vaccines. I thank you. Thank you, Sophie. MR The DG mentioned something there and I think it was important. I think there are vaccine trials ongoing of different types in more than 50 countries around the world and only three are in Africa right now. The vast majority of trials are occurring in South America, in Central America, in North America, in Europe, in East Asia, in the Western Pacific, in Southern Africa and also, I think, in Kenya as well. 01:05:52 So the vaccine testing is distributed... In fact it's a wonderful example of the absolutely global collaboration. It's the most amazing thing to look at a world map and see the number of therapeutic trials, the number of vaccine trials that are going on and the way in which that data is being shared between the public and the private sector, the way that data is being shared between academics and WHO. So I think it's an actual sign of tremendous faith in the global system that such collaboration exists and Africa is part of that. FC Thank you so much. We will take a last question from China Daily. Chen from China Daily, you have the floor; last question. CH Hi, thank you very much for the opportunity. This year, 2020, looks quite bleak obviously. You mentioned about the light at the end of the tunnel. Could you give us a picture of what the coming year, 2021, will look like, how many miracles this vaccine will do? Are we still going to get our lives back or see new wave after wave of cases, lock-down after lock-down and travel restrictions still there? What's the picture in your mind? Thank you. 01:07:17 FC Thank you, Mr Chen. Dr Ryan. MR I suppose it's one of these moments where you say to everyone, let me give this to you straight. The situation globally is still very epidemiologically unstable. The vast majority of the world's population remains susceptible to this infection. Some countries are on a very negative trajectory in terms of the incidence and death rates for this disease and most countries even at low levels are still at risk of a disease resurgence. It's clear though and what we have learned and the hope is that many countries have demonstrated that this disease can be suppressed and controlled and that control can be maintained at low levels. But some countries face the current challenge of intense community transmission in the context of a seasonal period when it's very difficult to separate people adequately. For those countries who are not in that situation and are achieving lower levels of transmission avoiding intense community transmission must be an absolute objective in the coming weeks and months; avoiding going back into situations that require a lock-down because if that can be avoided and when we have now a vaccine coming online it can give great hope. 01:08:42 So our strategy is we must continue with a comprehensive approach to controlling this disease; control, containment, suppression and mitigation together while introducing vaccine in a stepwise way. Testing needs to continue to be expanded, we need more testing but strategic testing that tells us where the virus is. We still need more and better therapeutics. We tend to forget a little bit, we're all jumping on the vaccine story but actually dexamethasone and other drugs are saving lives so we need better and new therapeutics and that's another big piece of ACT at the moment. But vaccines will make a huge difference. I'll let Bruce speak to how that will and can happen. They're a massively valuable tool but vaccines by themselves will not equal zero COVID. They will have a major impact on morbidity and mortality, who gets sick and how sick people get and whether they die as we vaccinate those high-risk groups. 01:09:42 But the impact on transmission will not come until a much higher proportion of the population of a country is vaccinated and, as I said, as the DG says, we have to continue to do it all, we have to continue to do it smart but vaccine represent a major light at the end of the tunnel but we have much work to do to make that a reality. I'll hand over to Bruce or others who wish to comment and then the DG may wish to wrap up on that. BA Yes, thanks, Mike. I like the way Mike started when he said, I'll give it to you straight, because we'll go into the coming year with more hope definitely. We're in a completely different position in terms of the knowledge of this disease, the knowledge of the enemy and also the tools with which we'll fight the enemy; there's no question as well. But we also know that there're going to be challenges to scale up those tools, to get them out, to get them applied and to see them make the difference we want so you use that metaphor as well; the light at the end of the tunnel. 01:10:43 It's a long tunnel, to give it to you straight, it is a long tunnel and when we look at the epidemic curve - remember now, the world is used to looking at these curves and you'll remember, they don't go up like that and come straight down, do they? They go up and then they peak and then they come down slowly and they come down over time. Some of the tools will help us drive those curves down faster but it's not going to change, boom, like that overnight, which means again, to the point Mike, Maria and Dr Tedros make repeatedly, this should give us hope and with that hope we should have a new energy, a new stamina to apply the measures that can make a difference. There's no reason for us to see the same epidemic next year because we know how to beat this disease but we've got to apply the knowledge that we know in a way that we haven't to the degree possible in 2020. When you look at the places that have they had a very different epidemic. That's what we should be looking at. 01:11:43 FC Thank you. I think Dr Kelley would like to add something. Dr Kelley, you have the floor. EK Yes, just a quick thing to add to those two good comments. Next year IMF and World Bank are predicting that 3% of the world economy will contract and that we will have millions, 30 million people who will be put into poverty so on the eve of universal health coverage day next year for WHO certainly and for a lot of countries will be the year of trying harder. We'll have to continue on this push for the response, just as Mike was saying, just as Bruce was saying but we will also have to be continuing to work and expand this idea of what is essential; expanding access to healthcare to ensure that people have access for COVID but also to ensure that when this is all over we're able to say that we were able to treat those people that needed essential services as well. That, I think, will be something that will be coming through in the next year. FC Thank you, Dr Kelley. Dr Van Kerkhove would like to add something. MK I'm sorry. I know we shouldn't all answer the same questions but it's a really great question and I just want to talk at the individual level. We see countries right now that have brought COVID under control, that are opening up, that have stadiums full of people who are at sporting events and I've been getting a lot of questions lately at the end of the year thinking at the year round-up of, what is this going to look like. 01:13:09 You've heard us say before that it is completely in our hands. We have the tools now to bring this virus under control. Vaccine and vaccination is an additional tool that we will have but I think everyone needs to start to think about the patience that we will need in 2021 to get us through this, to see us through the end of this and what is our motivation to get there. I've seen a lot of really excellent interviews lately about people saying, I didn't think about this for me, I wasn't worried about me getting infected but I was worried about my most favourite person in the world, I was worried about the person that I love most in the world and I would do anything I could to keep them from getting infected. I think whatever it is that motivates you to protect yourself but even moreso to protect that person that you love most in the world, do that and do it now because that's what 2021 is going to look like. That is what is going to help us bring this under control and the vaccinations coming online is incredibly hopeful but we need the patience to get us to that endpoint and it will take some time. 01:14:17 So we don't have that exact end date but if you think of some of the countries that have actually brought it under control they're almost there. They have to keep it up, they have to remain vigilant and keep it down so that it doesn't resurge because no-one - you've heard Dr Tedros say this so often - no-one is safe until everyone is safe. But find your motivation that will help keep you and your loved ones safe because that is what 2021 means to me. FC Dr Tedros, you have the floor for your final comments. TAG Thank you. Thank you, everyone for joining and see you next week in our next presser. Bon week-end; have a nice weekend. FC Thank you, DG. Just to remind journalists, we will be sending the opening remarks of Dr... 01:15:07