Functional availability of medical oxygen for the management of hypoxaemia in Cameroon: A nationwide facility-based cross-sectional survey.

Background: Medical oxygen is essential for managing hypoxaemia, which has a multifactorial origin, including acute and chronic lung diseases such as pneumonia, asthma, and severe malaria. The coronavirus disease 2019 (COVID-19) revealed substantial gaps in the availability and accessibility of safe medical oxygen, especially in low- and middle-income countries (LMICs). This study aimed to assess the availability and sources, as well as the barriers to the availability of functional medical oxygen in hospitals in Cameroon. Methods: This was a nationwide cross-sectional descriptive study conducted from 26 March to 1 June 2021. Using a convenient sampling technique, we sampled accredited public and private COVID-19 treatment centres in all ten regions in Cameroon. Representatives from the selected hospitals were provided with a pre-designed questionnaire assessing the availability, type, and state of medical oxygen in their facilities. All analyses were performed using R. Results: In total, 114 hospitals were included in this study, with functional medical oxygen available in 65% (74/114) of the hospitals. About 85% (23/27) of the reference hospitals and only 59% (51/87) of the district hospitals had available functional medical oxygen. Compared to district hospitals, reference hospitals were more likely to have central oxygen units (reference vs. district: 10 vs. 0%), oxygen cylinders (74 vs. 42%), and oxygen concentrators (79 vs. 51%). The most common barriers to the availability of medical oxygen were inadequate oxygen supply to meet needs (district vs. reference hospitals: 55 vs. 30%), long delays in oxygen bottle refills (51 vs. 49%), and long distances from oxygen suppliers (57 vs. 49%). Conclusions: The availability of medical oxygen in hospitals in Cameroon is suboptimal and more limited in districts compared to reference hospitals. The cost of medical oxygen, delays related to refills and supplies, and long distances from medical sources were the most common barriers to availability in Cameroon.

Coletiva de imprensa: anúncios do Governo - 07/04/2021

O Governador João Doria anunciou nesta quarta-feira (7) a ampliação da campanha de vacinação contra COVID-19 para idosos com idade entre 65 e 67 anos ainda em abril. O novo grupo totaliza 1,11 milhão de pessoas. O avanço da campanha depende da chegada das vacinas da Fiocruz ainda nesta semana para êxito no cronograma definido pelo PEI (Plano Estadual de Imunização). O objetivo é iniciar a vacinação de pessoas de 67 anos (350 mil pessoas) no próximo dia 14. Uma semana depois, no dia 21, outras 760 mil pessoas com 65 e 66 anos poderão receber a primeira dose. “Tenho visitado postos de vacinação pela manhã, logo na abertura, e a cada vez fico mais sensibilizado ao ver pessoas de mais idade sendo vacinadas, felizes e alegres. São pessoas que querem viver e estar protegidas com a vacina”, afirmou o Governador. “Agora a vacinação está avançando para as pessoas de 65, 66 e 67 anos e vamos continuar impulsionando o máximo possível, com a vacina do Butantan e outras que puderem ser adquiridas pelo Ministério da Saúde”, reforçou Doria. Nesta quarta, São Paulo ultrapassou a marca de 7 milhões de doses já aplicadas na população do estado. Às 12h45, o Vacinômetro marcou 7.026.192 doses, somando 5.157.980 de primeira dose e 1.868.212 da segunda, o que significa que mais de 1,8 milhão de pessoas já estão com o esquema vacinal completo. Os resultados incluem novos públicos integrados à campanha em abril: os idosos de 68 anos, desde o dia 2, além dos profissionais das forças de segurança que atuam em São Paulo e começaram a ser vacinados na última segunda (5). Na próxima segunda (12), o cronograma inclui os trabalhadores da educação básica de escolas públicas e privadas a partir de 47 anos. ”Como disse o Governador, é a vacinação chegando ao braço de quem realmente precisa e da população mais vulnerável à doença”, declarou a Coordenadora Geral do Programa Estadual e Imunização, Regiane de Paula. Todas as pessoas que integram os públicos da campanha podem acessar o site Vacina Já (vacinaja.sp.gov.br) para confirmar o pré-cadastro. O preenchimento do formulário leva de um a três minutos e economiza até 90% do tempo de atendimento nos postos de vacinação. O pré-cadastro não é obrigatório, mas facilita o trabalho dos profissionais da saúde e beneficia a população atendida. Na manhã desta quarta, Doria participou da entrega de mais 1 milhão de doses da vacina do Instituto Butantan contra o coronavírus para o Brasil, totalizando 38,2 milhões fornecidas ao PNI (Programa Nacional de Imunizações). A cada dez vacinas utilizadas no país, pelo menos oito são do Butantan. O montante já distribuído representa 83% das 46 milhões de doses contratadas pelo Ministério da Saúde até o final de abril. O Butantan trabalha para entregar outras 54 milhões de doses até o dia 30 de agosto, totalizando 100 milhões de vacinas.

Media briefing on COVID-19 - 06/04/2021​

00:00:17 CL Hello, good day and welcome, wherever you are listening today. It is Tuesday 6th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference ahead of World Health Day, which we celebrate on 7th April. Therefore we have a list of very special guests online with us today. We'll start with Her Excellency Prime Minister Mia Mottley from Barbados, His Excellency President Carlos Alvarado Quesada from Costa Rica, His Excellency President Hage Geingob from Namibia and His Excellency President Ilham Aliyev from Azerbaijan, who will join us through a video statement. Simultaneous interpretation is provided again in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus we will have Portuguese and Hindi. Now let me introduce the participants in the room here. We have Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director for WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator and last but not least Dr Rogerio Gaspar, Director for regulation and Pre-Qualification. Welcome all. Let me now hand over to the Director-General for his opening remarks. 00:02:08 TAG Good morning, good afternoon and good evening. Tomorrow is World Health Day. COVID-19 has exacerbated inequalities both between and within countries. While we have all undoubtedly been impacted by the pandemic the poorest and most marginalised have been hit hardest both in terms of lives and livelihoods lost. In the year ahead the world needs to make five vital changes. First we need to invest in equitable production and access to COVID-19 rapid tests, oxygen treatments and vaccines between and within countries. At the start of the year I made a call for every country to start vaccinating health workers and older people in the first 100 days of 2021. This week will mark the 100th day and 190 countries and economies have now started vaccination. COVAX itself has already delivered 36 million doses to 86 countries and economies. Supply chains are up and running and health systems primed. 00:03:38 Scaling up production and equitable distribution remains the major barrier to ending the acute stage of this pandemic. It is a travesty that in some countries health workers and those at risk groups remain completely unvaccinated. The effort to achieve vaccine equity will not stop this week. WHO will continue to call on governments to share vaccine doses and fill the US$22.1 billion gap in the ACT Accelerator for the equitable distribution of vaccines, rapid tests and therapeutics. We will also look to find new ways to work with manufacturers to boost overall vaccine production. This month individuals around the world will also be able to get involved in accelerating vaccine equity via a new fund-raising campaign. Developed by the WHO Foundation and a range of partners, the campaign will enable individuals an companies to get one, give one and close the overall COVID-19 vaccine gap. Further updates will be shared around the launch. Second, there must be a serious investment in primary healthcare and getting health services to every member of every community. The pandemic has exposed the fragility of our health systems. As essential services were paused many diseases came roaring back. At least half of the world's population still lacks access to essential health services and out-of-pocket expenses on health drive almost 100 million people into poverty each year. 00:05:36 As countries move forward post COVID-19 it will be vital to avoid cuts in public spending on health and other social sectors. Such cuts are likely to increase hardship among already disadvantaged groups. They will weaken health system performance, increase health risks, add to fiscal pressure in the future and undermine development gains. Instead governments should meet WHO's recommended target of spending an additional 1% of GDP on primary healthcare which is central to improving both equity and efficiency. And they must reduce the global shortfall of 18 million health workers needed to achieve universal health coverage by 2030. Third, prioritise health and social protection. Some countries have already put in place expanded social protection schemes to mitigate the negative impact of the pandemic on poverty, education, nutrition and overall health. These schemes should be extended until essential services are up and running again and they must include marginalised groups in planning and implementing future schemes. 00:07:05 Fourth, build safe, healthy and inclusive neighbourhoods. City leaders have often been powerful champions for better health, for example by improving transport systems and water and sanitation facilities. Access to healthy housing in safe neighbourhoods is key to achieving health for all but too often the lack of basic social services for some communities traps them in a spiral of sickness and insecurity. That must change. Meanwhile 80% of the world's populations living in extreme poverty are in rural areas where seven out of ten people lack access to basic sanitation and water services. So countries must intensify efforts to reach rural communities with health and other basic social services. Finally data and health information systems must be enhanced. High-quality and timely disaggregated data by sex, wealth, education, ethnicity, race, gender and place of residence is key to working out where inequities exist and addressing them. Health inequity monitoring has to be an integral part of all national health information systems. At present just half the world's countries have any capacity to do this. 00:08:50 Today I'm happy to welcome four heads of state and government to talk about health equity and changes they have made to achieve it. First Her Excellency Prime Minister Mia Mottley of Barbados will start proceedings and I'm keen to hear of Barbados' experience in the last year and the way ahead. Prime Minister, you have the floor. MM Thank you very much, my brother, Dr Tedros, Your Excellency, Hage Geingob, President of Namibia, who I have not seen since Nairobi in December 2019 - we didn't expect the last year - and to my other brother, Your Excellency, Carlos Alvarado Quesada, we spoke a couple of months ago and equally we didn't expect that this journey would be as long as it is. Also President Aliyev, I want to say how pleasant it is this morning for me to join you because 73 years ago tomorrow the World Health Organization was formed and therefore the commemoration of this day through World Health Day is most appropriate. 00:10:20 It would have been appropriate in any scenario but more relevant and more critical at this point. In the Caribbean we love our proverbs; short, clever phrases packed with the knowledge to last a lifetime and I suspect those in Africa are the people from whom we've got that love of proverbs. One favourite amongst us and especially our schoolteachers in the region was the one that simple said, Peter pays for Paul and Paul pays for all. I start here this morning because it is in the recognition that this is a collective battle that we will win the victory. We have come together globally to try and fight a pandemic but we have to ask ourselves whether we did it in sufficient time and on sufficient scale. We have to ask ourselves whether the five priority actions being focused on this morning - equitable access to COVID-19 vaccines, tests and treatments both within and between countries is being achieved by the countries of the region and the countries of the world. In the Caribbean our journey has been tortuous over the past year and, Dr Tedros, I know that you have tried to intervene on numerous occasions to assist us but the bald reality is that our market size in many instances is simply too small to command the attention of global pharmaceutical companies or indeed of other suppliers of goods in the normal supply chain that will lead the therapeutics distribution, vaccine distribution. 00:11:58 The bottom line is that we have also separately been regarded by the global community as countries that have come out of the depths of poverty and therefore are not deserving of assistance in the traditional ways normally reserved for the most vulnerable. This has made life difficult. We've held on to the promise of COVAX and I've come to you this morning having received the first trance of Barbados' vaccines, 3% of our population with respect to the COVID vaccines this morning. But for many globally this has been a difficult exercise because, as we have seen, the spikes can literally grow. We've not had access even when we are prepared to pay. It is against this background therefore that the first call to action of equitable access to COVID-19 vaccines, tests and treatments within and between countries is one with which we can relate. 00:12:57 Secondly the post COVID-19 recovery budget and plans to protect and prioritise health and social sectors is one that is truly being felt by the majority of us and why? The World Bank estimates that global GDP will fall by about 4% this year with between 40 and 60 million people entering extreme poverty. But our reality also is as a tourism and travel-dependent country the fall in our GDP last year was not 4%, was not 8%, was not even 12 or 16%; it was 18%, threatening to take our country back more than a decade as a result of the loss of production and productive capacity. Regrettably we continue to be treated globally as one of those countries that is not deserving of concessional capital even as we face the most difficult crisis that we have faced in a century. These are issues that I hope that the development committee of the World Bank and the International Monetary Fund that meets later this week and I have the honour of chairing will begin to start to put our case for the need to use different criteria for determining how countries should access serious concessional capital most needed now in order to stave off the worst aspects of this pandemic but more importantly to deal with the long-lasting consequences of the pandemic, which are the social and economic losses that have been sustained in the last decade. 00:14:29 The third aspect of the call to action; equitable services and infrastructure in all communities both urban and rural; this is absolutely critical particularly for the larger countries in the region and globally but even within a small country such as ours we recognise that there are differences and that part of the problem particularly in the urban setting is the density of housing that has existed in many instances pre-independence and post-independence largely because most developing countries in the world have had a significantly broad agenda reflected by many in the SDG agenda but a significant broad agenda that makes it difficult for us to have corrected all of the wrongs that we've needed to correct since independence. It means that in urban communities the density and the exposure is far greater regrettably than in most but equally in rural communities the lack of access to available healthcare for larger countries, not so much small island developing states but larger countries remains a major issue. 00:15:39 Fourthly, the call to action looks at the issue of primary healthcare for everyone everywhere but I like to make the point that the Caribbean more than most has in the post-independence era determined that for us to leave anyone behind is a travesty because our modern settlement was based on discrimination and exclusion and therefore the reality and the imperative of inclusion as well as transparency are absolutely vital if we are to bring our people out of these difficult times in which we live. Finally better data collection and reporting in countries so that we know where the health equalities [sic] are and can address them. My friends, this will not be the last pandemic, it will not be the last one for us. History is replete with examples and we have to determine what we will learn from our experience over the course of the last year. For many the 1918-1920 Spanish flu pandemic is too far in the recesses of our recent memory, such that we made fundamental mistakes that we should never allow anyone to make again. Dr Tedros, you asked me to serve as the Co-Chair on the One Health Global Initiative, which we have dubbed the slow-motion pandemic because we fear that by 2050 more people will die from these super-viruses that the antibiotics and other medication that we have are not allowing us to treat sufficiently. 00:17:13 I pray that we will take in front, as we would say, before in front takes us. What do I mean by that? That we will so sensitise the global population that the basic things that we need to take action, the basic policy instruments necessary to remove people from poverty or necessary to remove the juxtaposition of animals and humans in living conditions, not just working conditions, that have given rise to so many diseases that have caused so much death and so much concern in the world. If we do not get the fundamental development equation correct, if we do not work together, if we do not appreciate that we can only work together if we are to achieve a fairer and healthier world then we run the risk of seeing millions of persons die again in circumstances where different policy responses or similar policy responses with different scale and different pace of execution can hopefully have a different result in ensuring that fewer and fewer people will become victims to awful epidemics and pandemics. 00:18:25 They say politics is the art of repetition and I said so this morning. Over he course of the last year we have said the same thing more often than at any other time. There is no magic bullet and there is no magic recipe. The answer is simply for us to work together to get that fairer world and for there to be a level of global moral leadership, recognising that the singular pursuit of individual countries will not rid the world of the major problems because human beings cannot be contained behind boundaries easily in this globally interdependent world. I pray that we will across the world summon the courage to be able to have co-ordinated action, not just acting together but co-ordinated action such that we are in a position to be able to see the end of this pandemic because we are acting collectively with shut-downs, we're acting collectively with protocols, we're acting collectively with the kinds of policy responses that we now know after a year are critical if we are to put this behind us. I thank the World Health Organization and all of its staff members, the Pan-American Health Organization that serves us in this hemisphere and all of its staff members for continuing to keep the battle on but I recognise that the ball lies in the courts of the political will of member states of the global community. Thank you and may we rise to that point where we summon the courage for that globally co-ordinated action to make a fairer, healthier world. Thank you. 00:20:13 TAG Thank you. Thank you so much, Your Excellency Prime Minister Mottley. Moral leadership and co-ordinated action; I fully agree. Barbados' experience suppressing COVID-19 as well as investing in universal health coverage is an example for the region and the world so thank you so much again. I will now turn to His Excellency, President Carlos Alvarado of Costa Rica, who has been working closely with WHO on how to ensure that new health technologies are available in all countries through his idea, the CTAP, which we have started implementing together. President Alvarado, very nice to see you again even if it's online. The floor is yours. CA Thank you very much, Dr Tedros. TR Thank you very much, Dr Tedros. My greetings to Your Excellency Prime Minister Mia Mottley from Barbados, President Hage Geingob from Namibia and those who are joining us today at the press conference. Indeed, Dr Tedros, the principles of CTAP, which is the technology for healthcare pool; it's continuing this year, one year after the start of this pandemic and one day before World Health Day. 00:21:48 This is linked to access to technologies or treatments in an equal and fair way for people throughout the world without any distinction. As Prime Minister Mottley was saying, this has a great deal to do with moral leadership and with commitment to progress along this way. This pool can bring along technologies to make them available to all countries and to all governments throughout the world. As Dr Tedros has said, we need to keep pushing for this. There's already a team set up within the WHO for this so what we need is governments and the private sector to commit to making it a reality. The first point that was raised by the call of Dr Tedros on equitable access; I'd like to mention two central subjects. One is linked to the strengthening of social security and universal healthcare in countries. In Costa Rica it has been the strength of our universal healthcare system that has protected us and this has ensured that we reduced the differences between those on higher and lower incomes because we've ensured that anyone in any part of the country has the same access to testing, vaccine, treatment and even to hospitalisation with no distinction on geography. 00:23:26 This is difficult and is expensive but this is what makes a difference in a world that needs greater equality and the pandemic, as Dr Tedros has said, has increased inequalities between countries and within countries. The inequalities also have an impact on health. Societies which are more unequal are societies which are most violent and the most violent societies also bring about other phenomena such as migration or clearly the loss of human life. Another very important point in terms of equitable access is the drive that many countries are making for the international treaty for preparation and response to pandemics. Before COVID-19 the globalised world had not experienced such an impact in the effects of a pandemic and we need to learn from this experience and be ready. Above all being ready means being ready for co-ordinated action and action in solidarity which does not distinguish between greater or less development, greater or less wealth, whether one is in an urban or rural area. 00:24:50 We hope that this treaty will achieve these principles but we will also work towards ensuring that the treaty includes principles such as those that we have used in CTAP. On the budgets for post-COVID recovery it has remained clear that health is not just a matter of illness. Healthcare is an all-encompassing subject. We cannot take care of our populations if we don't have guarantees for budgets that provide support to the health sector, community sector and to the infrastructure. It's so important that multilateral organisations can provide means of financing for poor countries, for emerging countries and to assist them in facing up to the medium and long-term effects of the pandemic. Today developed economies have managed to achieve special packages to help their countries to overcome the effects of COVID but that's not something that poorer countries can do. The fact that there will not be a global recovery from COVID whilst the whole planet is not vaccinated; we won't see economic recovery in the planet if the whole world is not economically vaccinated. 00:26:24 So it's extremely important that we look for the subject of financing, whether it's in debt forgiveness or financing in the long term with zero rates or stable rates of interest so that countries can have a margin for manoeuvre. We also need to finance the development and public health infrastructure and recovery so this is more than a subject of finance; it's one of health as well. That's why it's so important that we deal with this. Costa Rica has launched the FACE initiative fund [?] to alleviate... from economics within the United Nations and also with ECLAT [?] to cover those funds to help emerging economies. To give a specific case, the opinions of the qualifying agencies are not taking into account the efforts being made by governments to maintain stable economies and also to assist our populations and every time that there's a negative qualification that makes access to finance more expensive for our countries. 00:27:51 We need to take into account the impact of COVID when countries are assessed because we have to think about the effect of the pandemic on countries' economies. In terms of data collection and the assessment of data mentioned by the Director-General, Costa Rica has a system which is the digital document where each citizen has their digital record and that helps us to keep track of progress whilst maintaining the confidential nature for each citizen. But it helps us to have the management of this data so we can deal with this pandemic and future pandemics. I'd like to turn now to showing my gratitude to the WHO for all its work and I'd like to thank Dr Tedros and mention once more our support from Costa Rica and my support to ensure that treatments, diagnoses and vaccines arrive in an equitable and rapid manner to all those who need them. Once more my greetings, Dr Tedros. TAG Muchas gracias, Your Excellency President Alvarado. I wholeheartedly agree. Equitable sharing of rapid tests, therapeutics, oxygen and vaccines are key to ending the acute phase of the pandemic. That means tech transfer, sharing know-how and waiving intellectual property rights. Thank you so much for your leadership on this, especially on CTAP. 00:29:43 I look forward to now hearing from His Excellency President Hage Geingob of Namibia on their all-of-society efforts to tackle COVID-19 and lessons going forward on health equity. Your Excellency, you have the floor. HG Thank you very much. Your Excellencies, greetings. I saw you last in [inaudible] so as usual, glad to listen to you, [inaudible]. Your Excellencies, it's a great pleasure for me and this important [inaudible] World Health Day. Given the devastating pandemic of the world [inaudible] it is timely [inaudible] regarding this [inaudible] and indeed the ways and means [inaudible] a fairer, healthier world post COVID-19. The fact that the Director-General of WHO has invited us to be part of this year's event speaks to the urgency of fostering the recovery for the entire world from the economic devastation caused by the COVID-19 pandemic. Building a fairer and healthier world will demand joint and concerted action. It will require that we as members of the human family stand resolutely together to do everything that is required to return our societies to normalcy. 00:31:42 Our people young and old have been traumatised. Lives and livelihoods have been disrupted, leaving a country that has been deeply scarred. [Unclear] and racial oppression [inaudible] and healthier societies is an objective that [inaudible]. [Inaudible] Have been aimed at building an equitable [inaudible] in which no-one must feel left out. We here in Namibia applied equally [inaudible]. We got help from our good friends in China and India, who gave us vaccines so far. We had an advance payment at least [?] but there is this exclusion; the COVID apartheid now we're facing [?] [inaudible]. CL Your Excellency, please allow me to come in. The sound is interrupting quite a lot. Is there a chance that on the technical side something can be done? It seems to be interruption in the sound signal at your end. Apologies. We can try again and if possible have your talking points and your elaborations that we can again share in writing also. Please continue, sir, Your Excellency. 00:34:12 HG What I'm trying to say is to address to your number one point; equitable to COVID-19 vaccines, tests and treatment within and between countries. We did apply and paid our deposit for the COVID vaccine but there is a vaccine apartheid, I'm saying, that we, a small country, have paid a deposit but up to now we didn't get any vaccine. What we got were vaccines donated by our friends, China and India, and I really thank them for that. [Unclear] I sense there is a conflict [unclear] spells harmony. We were left out [inaudible]. That I call apartheid [inaudible] and we fought against apartheid for many [inaudible]. After [inaudible]. Am I audible or what is going on? Because we believe that [inaudible] where the wounds of the past are healed [?]. This has laid the foundation [inaudible]. Every tragedy brings [inaudible]. 00:36:02 TAG Your Excellency... When you restarted it was okay and then it started to break up so I think there is a problem in the audio system. The video is okay but the audio system is breaking up so we have heard up to the vaccines you got from India and China. Later I think there was some break-up again. HG Yes, I was talking about vaccine apartheid; I want to make that very clear as a man who suffered from apartheid [?]; that we are here, we [inaudible] but we didn't get any vaccine. Can I talk? TAG Yes, still breaking up but can you go on? Let's see. HG Okay. Every tragedy [inaudible] new insights. This is true for the COVID-19 pandemic. By its speed, velocity the pandemic compelled humanity to act in unison to overcome a common enemy. The public health measures adopted in most if not all countries around the world demonstrated that the international community achieved consensus to address their common [inaudible]. It demonstrated that [inaudible] the world. We are able to stand together [inaudible]. This, I believe, should be a springboard for the concerted efforts and common purpose to address other equally important challenges facing humanity [inaudible]. 00:38:13 The manner in which [inaudible] responded to the COVID-19 pandemic demonstrates the old adage that says where there is a will there is a way. As world leaders [inaudible] the necessary political will to address the devastation brought by COVID-19 [inaudible] meant that we were able to [inaudible] in various aspects such as expanding [inaudible]. [Broken audio] A fairer and healthier world also means that our global approach necessarily address the root causes of unfairness and poor health in all their manifestations. The social [unclear] of face masks [?] therefore received our full attention. In this regard we must speak not only of availability of facilities and health services but of equitable access to essential tools such as COVID-19 vaccines, as I already said. There is no other alternative [inaudible] pandemic and by so doing to get a fairer and healthier world. Since I am being sabotaged I will end here [unclear]. TAG Thank you. Thank you so much, Your Excellency. Where there is a will there is a way, I fully agree and it's great that Namibia is rolling out vaccines. I was informed also that through the COVAX facilities you will have your share in two weeks. 00:40:40 But I fully agree with the problems we're facing with vaccine equity. As you know, we said vaccine nationalism or vaccine apartheid, as you said, is actually the problem with regard to the pandemic response now because unless everyone is safe no-one will be safe. So it's in every nation's interest or in every country's interest to make sure that there is vaccine equity so I fully agree with you. I now welcome His Excellency President Ilham Aliyev of Azerbaijan to reflect on his experience of the pandemic and what's critical to end the acute phase as quickly as possible. He couldn't join us in person so he sent us a video. Please. TR Every year since 1950 we celebrate World Health Day on April 7th but 2021 is a year when the importance of health became even more significant. Having a modern, sustainable, high-quality healthcare system is a priority for every country. Healthcare in Azerbaijan is currently going through a significant change. With implementation of mandatory health insurance Azerbaijan is strengthening the primary healthcare, renovating the emergency medical care services, facilitating the digitalisation by starting an e-health platform and national health accounts within the country. 00:42:28 In the meantime the second year of the COVID-19 pandemic is continuing to put enormous pressure on healthcare systems around the world. Azerbaijan was among the first countries to mobilise global efforts against the COVID-19 pandemic. We initiated the summit of the Turkic Council in April 2020, the summit of the non-aligned movement in May 2020 and a special session of the United Nations General Assembly at the level of the heads of state and government in December 2020. Honouring its international responsibility, Azerbaijan has made voluntary contributions to the World Health Organization in the amount of US$10 million. We have also provided direct humanitarian and financial assistance to more than 30 countries in their fight with the coronavirus. This year's World Health Day is dedicated to building a fairer and healthier world and the question of equal and fair distribution of vaccines is of paramount importance for this cause. 00:43:39 Yet we all are deeply concerned by the unequal and unfair distribution of vaccines among developing and developed countries. Some countries hoard several times more vaccines compared to their actual needs. It is clear that in such circumstances other countries will face vaccine shortage. Supporting fairness in vaccine distribution, Azerbaijan put forward a draft resolution ensuring equitable, affordable, timely and universal access for all countries to vaccines in response to the coronavirus disease pandemic at the UN Human Rights Council. The resolution was adopted by consensus on March 23rd this year. Azerbaijan was also among the first countries to join and support the COVAX initiative. We and the whole international community expect this initiative to become a model of co-operation and solidarity in response to the pandemic. Only together will we overcome the pandemic and return to normal life. Happy World Health Day. TAG Thank you. Thank you, President Aliyev and I welcome your leadership calling for equitable, timely and universal access to vaccines at the UN Human Rights Council and agree we must do more to ensure vaccines are fairly distributed. 00:45:08 Again thank you so much to all heads of state and government for joining us today. We have a lot to do to achieve health equity but I'm proud to see heads of state leading from the front, which will be key to us strengthening health systems overall and preparing for future pandemics. I thank you. If you have a few minutes more, if you join us for the Q&A with the media we would appreciate it. If not we fully understand. Thank you so much again. Christian, back to you. CL Thank you very much, Director-General. Let me now open the floor to questions from the media. We have a long list already but in case you want to get into the queue please press the raise your hand icon on your screen. First is John Miller from Reuters. John, please unmute yourself. JO Thanks for taking my question. Today we heard from EMA officials, who seemed to suggest that there may well be a link between the AstraZeneca vaccine and the rare complications that occur. I'm wondering if you can give us an update on the WHO's own progress in assessing the potential link and when you expect to make your own announcement public. Thanks. 00:46:50 CL Thank you very much. Let me give the floor to Dr Rogerio Gaspar, Director for Regulation and Pre-Qualification. RG Good afternoon. Let me just start by being clear and correct. You mention the European Medicines Agency. As you know, as we were here in the meeting already in this press briefing, there was a denial from the European Medicines Agency concerning the existence of the link. What happens is that there are a number of committees right now and regulatory authorities looking at data - and new data is coming every day - and assessing those data. So there's no link for the moment between the vaccine and the thrombolytic events with thrombocytopenia. Of course it's under evaluation and we wait for some feedback from those committees in the coming days and the coming hours. Just to give a full assessment - probably it is good to give also an assessment with some numbers in it - the data are coming, as I said, every day so we are looking at the pharmacovigilance networks globally and WHO of course is relying heavily on the national pharmacovigilance systems but also on the assessment committees from national regulatory authorities and also from regional regulatory authorities like the European Medicines Agency. The two EULs that were issued by WHO on AstraZeneca-based technologies - one from the manufacturer SKBio in the Republic of Korea and an emergency use authorisation given by the Republic of Korea Regulatory Authority, MFDS, and the second one from the SII in India with the correspondent authorisation also for the Indian regulatory authorities. Both of them are based on the core clinical data that was submitted by AstraZeneca to the European Medicines Agency so the regulatory alignment currently is that we'll rely first on the assessment done by the pharmacovigilance risk assessment committee of the European Medicines Agency which started today at 11:00 and is supposed to continue tomorrow and probably the day after, or not; that will depend on the committee. 00:49:14 We are following that meeting, we have observers on the meeting and we are looking at the data jointly and at the same time, as you know, the Medicines and Health Products Regulatory Authority from the United Kingdom, the MHRA, is also looking at the same set of data. So what we can say is that the appraisal that we have for the moment - and this is under consideration by the experts - is that the benefit/risk assessment for the vaccine is still largely positive. We continue to see a number of events that are rare events linking thrombocytopenia to thrombolytic events and those rare events are now being categorised in terms of the diagnostics, in terms of the population, in terms of the distribution within the population. The expert committees will come to decisions in the coming hours and the coming days about what will be the regulatory status of the vaccine. For the time being there's no evidence that the benefit/risk assessment for the vaccine needs to be changed and we know from the data coming from countries like the UK and others that the benefits are really important in terms of reduction of mortality of the populations that are being vaccinated. So one important issue to say also is because in the media and also on the regulatory committees we tend to stress too much the risk when we are discussing these issues and we have to do that, we have also at the same time to balance this with the benefit coming from the vaccine and I think it's important to reiterate this once again. 00:50:48 Another issue which is also important - and that's why WHO is at the same time having a number of information sessions, groups of experts; even this morning we had meetings with several regulatory agencies; during the mid-day break we had a global meeting with experts from different committees for information sharing and disseminating the totality of information that is available. In parallel with current meetings at the European Medicines Agency and the Medicines Health Product Research Authority in the UK we will convene tomorrow also our global advisory committee on vaccine safety that together with other experts will look at those data. So we expect that probably by the end of today or the day after so Wednesday or Thursday we might have a fresh conclusive assessment from our experts but, as I've said already, at the present moment and under the assessment that we have from the data submitted up to yesterday we are confident that the benefit/risk assessment for the vaccine is largely still positive. Thank you. 00:51:54 CL Let me ask Dr Simao... MS Very quickly just to complement because it's very important that everyone is aware, just reinforcing what Dr Rogerio said, that we are collecting data from all regions; the data we have so far is some data observed in the European region because millions and millions of AstraZeneca doses have been distributed and used in Latin America and in Africa, in India and in other countries in Asia. So we are very proactively collecting data from different national regulatory authorities and let me say that we are also in touch with AstraZeneca because AstraZeneca also has an obligation to report, to monitor the safety data and also to report not only to the regulatory authorities but also to WHO. CL Thank you very much. The next question goes to Carmen Pound, Politico. Carmen, please unmute yourself. 00:53:00 CA Thank you so much for giving me the floor and hi, everybody. There've been quite a few reports over the last few days about a number of countries, specifically in Africa, that have received doses through COVAX, in some cases more than a month ago, and either have not deployed them at all or the roll-out is super-slow due to different issues ranging from hesitancy to logistical issues. So I wanted to see if there's any plan to ramp up support for deliveries, if you're looking at what are the specific issues that are impeding the roll-out or faster roll-out in those countries because I've seen that there're even concerns that some of the doses might expire before certain countries are able to inoculate. Thank you. CL Let me ask Dr Bruce Aylward. BA Carmen, thanks so much for the question. It's so important; our goal in rolling out vaccines is to ensure everywhere in the world no doses or vials lie idle and they're out to work as rapidly as possible. 00:54:08 So recognising the challenge it might pose to roll out these vaccines because you're targeting different age groups, different populations than we normally do in many countries that are used to childhood vaccination programmes. As a result there was a huge amount of work that was initiated last fall actually in especially low and low/middle-income countries to try and help first with an assessment across all the different parameters that would need to be optimised to roll out these vaccines, then the development of what we call a national vaccines deployment plan across all of these countries and then a tracking at the international level by region and by country, where countries were in terms of preparedness. So the most important part of this was the huge amount of work that was done in advance and credit really goes to a group of agencies across WHO, UNICEF, the World Bank and others that work together in a concerted effort across countries. Even of course the best-laid plans are going to have challenges. We've seen that in every country in the world that's introduced these vaccines, whether high-income, middle, low-income countries; everyone has struggled in rolling out these vaccines. Part of it is logistical; part of it is related to some of the challenges I just spoke of so in every single country WHO, UNICEF - but not only, also with a broad range of partners - are working with ministries and with communities to try and optimise the roll-out, rapidly identify what are the bottlenecks and as you said even in the question you asked, Carmen, it's a range of issues. 00:55:50 Sometimes it's logistical, sometimes it might be hesitancy. We know that one country suspended the use of one vaccine or didn't want to until some of its concerns were reconciled so there've been a whole range of issues and it really is exactly what you said; a tailored approach in each country to try and help get past any bottlenecks to use so that as rapidly as possible these products can be protecting healthcare workers, protecting in particular the older populations and those at highest risk of the most severe disease. CL Thank you very much, Dr Aylward. With this we come to the next, Gabriela Sotomayor from Notemex, Mexico. 00:56:31 GA Hola, Christian, thanks for taking my question. It's on behalf of Proceso. 2,400 health workers have died in Mexico so my question is about the vaccination of health workers. It is clear that the priority is those who are in the first line of fire, treating patients with COVID. But what happens with the rest of the health personnel, when should they be vaccinated? In Mexico for example 65% of health personnel is under 50 years old and 50% are under 40 so they will be at the end of the line of regular vaccination so there are around one million health workers in this situation. My question is, what is your recommendation because many of them are the first contacts of patients with COVID? Thank you. CL Thank you very much. I will give this to Dr Aylward again, please. BA Thank you, Christian, and thank you, Gabriela, for the question. Clearly, as you've seen and as we've been discussing now for some weeks, certain populations are at higher risk of being exposed to this disease and then certain populations at highest risk of severe disease and death. Of course healthcare workers at the front line are one of the populations that are at highest risk of being exposed and often having high exposures and repeated exposures to the disease. That's the reason that the allocation framework that's been put together prioritises the healthcare workers. 00:58:13 That's healthcare workers irrespective of age. It's actually any healthcare workers that are going to be providing front-line services and at risk. In every country they're sometimes making adjustments in terms of their goals and whether or not the first goal is going to be to reduce the risk in the oldest population and then the healthcare workers or vice versa or by age across both so there is some adaptation or adjustment by country. It's all based on the strength of the healthcare system; it's sometimes based on the clinical outcomes that they're seeing in populations with severe disease in their countries. But in terms of rolling out the healthcare workers generally this has been irrespective of the age. But again as always, Gabriela - and you highlight it - part of the challenge here is just finding the balance with the amount of vaccine that you have available. As everyone knows, we're in an extremely supply-constrained situation so each country has got to make a decision sometimes across these populations; how will I be using these vaccines? 00:59:29 But again healthcare workers, as the Director-General said repeatedly and also our guests today, have to be a top priority as they cannot often protect themselves from being exposed to the disease. CL Thank you very much, Dr Aylward. With this we move to Jamil Chad from Estado Sao Paulo. Jamil, please unmute yourself. JA Hello. Can you hear me? CL All good. JA Dr Tedros, good afternoon. You had a meeting on Saturday with the new Minister of Health of Brazil. My question to you; what was your recommendation to him at this point in time? Thank you very much. TAG Thank you. Thank you so much. Of course we have discussed the measures - starting from the situation, how the situation is serious in Brazil. He started actually by describing the situation, which is really dire, and also what he would like to do. 01:00:48 We agreed on the way forward but to continue also to engage and committed from our side to help him in any way possible. Of course that was my first meeting with the Minister since he was appointed and we will have follow-up meetings, especially to discuss details of the actions that should be taken there will be senior expert-level engagements. Thank you. CL Thank you very much, Dr Tedros. We move to Jenny Layla-Medlow from Devex. Jenny, please unmute yourself. JE Thank you for taking my question. WHO released a statement last week on Ivermectin but as you know, debates continue in a lot of countries. I just want to know, are there plans to include Ivermectin in the Solidarity trials or are you considering other drugs for further trials? Also quickly what are the criteria for including treatments in the Solidarity trials? Thank you very much. CL Thank you very much, Jenny. Who do we have? We were looking to have a colleague online who can answer this. We do not have a colleague available right now to answer this. We'll take your question offline and reply to you by email. With this we move to the next and that will be Jamie Keaton from AP. Jamie, please unmute yourself. 01:02:49 JM Thank you, Christian. Good afternoon, everyone. This question, I think, is for Bruce. Bruce, today all four countries that were represented at this briefing are expected to get AstraZeneca vaccines from SKBio according to GAVI but many other countries are still expecting AstraZeneca vaccines from SII, the Serum Institute. Today we spoke to the CEO, Adar Poonawalla and he said that its exports for COVAX could now resume in June even though GAVI had expressed hope for a resumption in May as the spike in case counts worsens in India. My question; how concerned are you that COVAX will be facing severe supply shortages in the coming months from SII and what can be done about it and how does COVAX survive this major setback that could even last beyond June? Thank you. CL Dr Aylward, please. BA Thanks, Jamie. I think first of all let's not speculate on what's going to happen in terms of future deliveries from any of the companies that we're working with. Right now every country we talk to, every company is trying to make sure that they prioritise COVAX and that we get the vaccines that we need. 01:04:14 Obviously if we have an interruption with any one of our suppliers for a short time, a month or so we can find ways to try and manage as best we can with the countries but if it's longer than that obviously it would be a big challenge. We actually have had some good news over the last few days that some of the additional deliveries from SII have been opened up. You'll remember that there was a challenge but there were some deliveries that have been opened up over the last few days, which will be important to all countries being able to start vaccination by the end of the 100-day period that the Director-General has highlighted. But what I meant by that point, Jamie, was, as you can see, this is a very fluid situation. We've had multiple reports that sometimes vaccine supplies have been cut back by this much or increased by this much and in fact because of the work by the companies and by the governments to increase supply additional supplies have come through. 01:05:20 You'll remember on the AstraZeneca side where we had real challenges with supplies over the last few months, there's been a real pick-up in deliveries with now over 45 countries supplied just from the AstraZeneca side of the supply. So it's a fluid situation; that's the reason why we try and have as robust a portfolio as possible. As you also know, we have got deals with J&J on the Novovax product and other products so part of trying to ensure that if there's a problem with one product, one supplier... making sure that you have other options as well that will come online in the coming weeks and months hopefully. So a range of things to try and address that but clearly were there to be an interruption from any supplier that would be a real problem and that's the reason we're doing so much work to try and look at, as the Director-General said, improving production capacities in the existing suppliers, bringing new suppliers onboard, doing the emergency use listing assessments for yet additional products. All of these steps are to try and mitigate any potential interruption in supply from any supplier. CL Thank you very much, Dr Aylward. Let me call upon Sophie Mkwena from SABC. Sophie, please unmute yourself. 01:06:48 SO My question is around vaccine access, particularly to the developing south or poorer countries. The issue of vaccine passports is becoming more popular and many people are looking at using that to ensure that they are able to manage the spread of COVID-19. What is the position of the WHO on this vaccine passport and also travel restrictions? It's linked also to naming viruses after countries where they are being detected. The issue of 501YV2 still being called a South African virus by even very senior experts in science like Dr Fauci of the United States of America; is this not stigmatising a country that has done so much to try and contribute? CL Thank you very much, Sophie. Dr Van Kerkhove, please. MK Thanks, Sophie. I could start with the second part of your question. I think you know I've been on record talking about the naming of these virus variants and WHO for years has been talking about not including a location as part of a name of a virus, pathogen or the disease caused by that pathogen and SARS-CoV2 variants are no different. 01:08:26 We continue to see people name the variants country X variant or country Y variant and we have been working hard actually on developing a nomenclature with a large group of scientists around the world including the three groups that have developed different nomenclatures for the viruses. I have to admit, I foolishly thought this would be a very simple thing to do. I thought it could be done in a week or two and we're now into, I think, our second month of doing this. We hope to be able to announce the nomenclature very soon because we need to make sure that any of the names that are used do not further stigmatise a person or a last name or a location inadvertently. So we're still working on that but we do hope that countries do not say, the South African variant, including scientists. Unfortunately I hear that on many teleconferences that I'm on and we spend a lot of time talking about these virus variants that are being detected around the world. The more you look the more you will find and with the increases in genomic sequencing that are happening worldwide there are a lot of regional platforms that are being enhanced to make sure that we can find different mutations and different virus variants. 01:09:39 There are a lot of research groups that are out there that are studying each of these mutations and the combinations of mutations, which is what these variants are, to determine if there are any changes in transmissibility, in severity and any potential impact on our available and future diagnostics, therapeutics and vaccines. So it is really important that we do have names of these virus variants. Right now what we're using is the B117, the virus variant first identified in the United Kingdom; the B1351, the virus variant that was first identified in South Africa, and the P1, which is the virus variant that was first detected in Japan but is circulating in Brazil. There should be no stigma associated with these viruses being detected and unfortunately we still see that happening. Countries that are conducting surveillance, that are carrying out sequencing, that are sharing those sequences on publicly available platforms, that are working with WHO and scientists around the world should not be stigmatised for sharing this information. 01:10:39 In fact we need more of this to be happening worldwide and we will continue to work with partners to ensure that that happens. CL Dr Ryan, please. MR Just on your question regarding certification of vaccination, WHO does support certification of vaccination, be it paper or electronic, as a means of providing personal health information to people who are vaccinated and to give them a record of that vaccination but also for monitoring and evaluation purposes and quality assurance purposes in the healthcare system so having proper certification and recording of vaccination is very important. That's a different consideration to what those certificates are used for outside the health space and that would be certification of vaccination being used to attend work, to attend school, to attend events, to travel nationally or internationally. They are not necessarily related to the health of the individual but to other factors. 01:11:38 This is a complex issue. It has both considerations around how such certification could be utilised to reduce transmission but also around knowledge around the impact of vaccination itself and the way in which vaccination may or may not prevent transmission. There are ethical issues here regarding equity. We already have a huge issue with vaccine equity in the world. The imposition of requirements for certification of vaccination before travel could introduce another layer of such inequity. If you don't have access to vaccine in a country then you effectively become isolated as a country as vaccine passports kick in so there are many, many issues. Currently WHO through the emergency committee of the International Health Regulations have made temporary recommendations to the Director-General that proof of vaccination should not be a requirement, be required for purposes of international travel. 01:12:39 That group will meet again, I believe, on 15th April and I'm sure that recommendation will be under consideration. In the meantime we are bringing together our strategic and technical advisory group on infectious hazards with the strategic advisory group on immunisation and the ethics advisory group of WHO together to look at these issues. Currently we have an internal working group really pulling together the scientific data, the social data, the ethical data so we can come and get the best possible external advice in order to advise our member states regarding the potential use of vaccine passports, as you call them. Thank you. CL Thank you very much. For the last question we go to Robin Niya from AFP. Robin, please unmute yourself. RO Hello. Thank you. Can you hear me? CL Yes. Go ahead. RO Thank you. Within the European Union some countries like Spain and Germany have relatively low rates of new infections whilst other countries like Poland, Estonia and Hungary are seeing some of the highest rates in the world. My question is, in big, big areas like, say, Brazil or in this case the European Union would it make sense to divert vaccines away from areas of low infection and concentrate on areas of high infection to tackle the fire where it's burning most strongly? Thank you. 01:14:15 CL Thank you very much, Robin. Dr Simao, please. MS Let me start and then colleagues can complement. I think it's very important, Robin, to clarify that vaccines are not necessarily a good response to an acute problem because vaccines take time to reach immunity and everything else. So it's extremely important that when you have a lot of community transmission, as we're seeing in some of these countries, what we call the public health measures are taken into account and they're strictly followed. These are the consistent use of masks, hand hygiene, ventilation, avoiding crowds and in some specific cases even lock-downs, as we're seeing in Europe. So we have discussed last year what would be the role and whether we should have a buffer for emergency response related to spikes in transmission. The decision that we made collectively last year was not to do that at this stage because, as I said, vaccines are not a good response for immediate situations. 01:15:38 What you need in the case of high transmission in the community is to decrease the possibilities of transmission. That means avoiding that people get in touch with each other and avoiding crowds and everything else. Also from the epidemiologic perspective no-one can predict where it's going to be rising next; we have seen that, that even in countries that have reached a higher vaccination already we are seeing peaks in communities and peaks in cities and provinces. So it's very difficult to predict what's going to happen next, where the next surge will come. So I think the approach right now is that we're pushing for equitable access to vaccines and that we're pushing, as was discussed already today, to ensure that people at high risk of infection or people like, as was mentioned before, the healthcare workers and also people at higher risk of dying, older people and people with comorbidities, associated diseases are put first. We think this should happen; WHO's position is that this should happen in all countries, not only specific countries. Thank you. 01:17:10 CL Thank you very much for this. We have an add-on from Dr Van Kerkhove. MK Yes, thank you. I do want to come in on this because I think we need to remind everybody that vaccination is one element of the response strategy and, as Mariangela has said and as you have heard us say repeatedly, over and over again, we are accused often of being a broken record and we will be happy to continue being this broken record until this pandemic is over. But there are a number of elements, interventions that can be used that drive down transmission. Globally we have passed the sixth week in a row when we have seen a consecutive increase in cases around the world. Last week there were four million new cases reported to WHO and that is likely an underestimate of the true infections that have been occurring globally. We are seeing this in all of our regions. There's a slight decline in Europe but there are still significant increases in a number of countries like France, Turkey, Italy, Ukraine. The US continues to have increased.... Sorry; the Americas continues to have increased transmission driven by Brazil, Canada, Argentina, Colombia, the US; the same thing in South-East Asia, a number of countries; we can go on and on. 01:18:24 All of this data is in our dashboard but we continue to see increases in transmission and we have to remind everyone that there are a number of interventions. This the tried and true measures, these public health measures that drive transmission down. It's this all-of-government, all-of-society approach. It's about knowing where the virus is circulating so having good, strategic testing linked to public health action, ensuring that cases are isolated, that they receive appropriate care. It's contact tracing of contacts of known cases that are in supported quarantine so that they, if they are infected, do not have the possibility to transmit the virus onward. It's about getting into the clinical care pathway early so that individuals who are infected with the SARS-CoV-2 virus are seen and are assessed so that they are treated and cared for appropriately. It is making sure that we have engaged, informed, empowered communities so that they know what they need to do. We understand that the situation is evolving. The situation where you live change so following guidance and following the local recommendations is really important. 01:19:36 There is very good information out there that tells you in the area where you live, in the area where you work what is safe to do and what is not. At an individual level it's about physical distancing, it's about wearing a mask, it's about practising respiratory etiquette, making sure you have clean hands, making sure that you have good ventilation, you avoid crowded areas. All of this matters. This will not change until this pandemic is over so we cannot rely all on vaccines and vaccinations. We have to continue to put in the individual-level measures. We need communities that are supportive. If there is a stay-at-home measure in place we need governments to support individuals to be at home. All of this still matters so we will continue to be this broken record and remind the world that there is a strategy out there about suppressing transmission. 01:20:26 This guidance, this strategy was issued on 4th January last year and it still is the maintained strategy of what we have now to drive transmission down, adding vaccines and vaccination into the mix so that we keep transmission low and we open up our societies. So we cannot forget that there are a number of measures that are in place that we have the power to use now. CL Thank you so much for this and thank you all for your participation, especially our special guests. We will be sending the audio files right after this and we hope to include the speech of the President of Namibia. With this let me hand over to Dr Tedros. MR Christian, can I just... CL Pardon me. MR Just an update on our previous question regarding Ivermectin; just to confirm that Ivermectin is not currently included in the Solidarity trial but there are trials ongoing in other countries. The latest recommendations from WHO indicate that the evidence on the use of Ivermectin is not conclusive and further studies are recommended, particularly in large-scale randomised-control trials. 01:21:46 With regard to the progress within the Solidarity trial an independent panel of experts uses a set of defined criteria to pre-select potential drugs into the trial. A prioritisation working group then reviews the panel of experts' recommendations and then finally what gets through that group goes to the trial steering committee who then endorse those recommendations and introduce those drugs into the trial. So there are three different independent panels of experts who filter all the potential drugs. There's a series of criteria that are used around pharmacokinetics, plausible evidence on the mechanism of action, animal data, safety data, availability of the drug. Currently a number of drugs are under consideration for the trial including three new drugs and we've been really trying to get to this, moving not away from old drugs because old drugs, as we've seen, like dexamethasone have proved life-saving, but really beginning to test the newer molecules and drugs that are coming online so we look forward to the next selection of drugs for the Solidarity trial. 01:22:57 CL Thank you so much, Dr Ryan. This was in clarification to a question from Devex. Now with this let me hand over to the Director-General for closing remarks and to thank the guests. TAG Yes, thank you very much. I would like to invite Her Excellency Prime Minister Mottley to say a few words to close this session. Your Excellency, you have the floor. MM Thank you very much, Dr Tedros. I was very engaged during the course of questioning. This is very much still a fluid event for all of us in the world but it is one that really has the capacity to upend developing countries and we need to ensure that as we fight the pandemic we also put down the tools to avert a debt crisis which is potentially on us if we do not get it right. As I speak to you, the Chairman of the Caribbean Community has regrettably tested positive, Prime Minister Keith Rowley. I know that you have been in contact with him recently and I would therefore want to express our deepest concerns for his urgent and quick recovery. 01:24:10 But this just drives home the point that until we deal with this with all people we haven't dealt with it and I trust and pray that these continued works and the World Health Day tomorrow will remind us of the urgency of co-ordinated action and of the urgency of acting together. We look forward to the continued support of WHO and PAHO, particularly for those countries who have limitations in terms of the depth of technical resources and it is for that we continue to pray that we have access because that makes all of the difference to people living. We heard very clearly that global transmission has increased over the last six weeks and to that extent we continue to remind persons that there is no mechanism at the individual level that is too much to protect your lives from the personal protocols right back through to what we will do at the global level and at the national level to give people access to vaccines ahead of time, ahead of the battle with the variants. 01:25:21 So thank you very much, Dr Tedros, and I look forward to continuing to work with the World Health Organization on PAHO as we come on top and win this battle against COVID-19 which has done so much to decimate so many. The tail of it regrettably is long and we work towards ensuring that we can reduce the consequences of that tail on our people as well. Thank you. TAG Thank you. Thank you so much, Your Excellency. I fully agree with what you said and also I join you in expressing my wishes for fast recovery to His Excellency Prime Minister Rowley. I would also like to thank all heads of state who have joined today; His Excellency President Geingob, His Excellency President Alvarado and also His Excellency President Aliyev. Thank you so much once more and thank you so much for your leadership. Finally tomorrow we will publish an additional shortlist of films for the Health For All film festival. This fourth shortlist is dedicated to health equity. I invite the public to post questions in the comments section of the shortlisted videos, which are available on YouTube and through the WHO website. Some of your questions will be asked to the jurors and winners during the awards ceremony, to be streamed on WHO's YouTube channel on 13th May 2021. Thank you to all journalists also finally for joining and see you in our upcoming presser. Thank you so much. 01:27:26

Governo de SP adquire mais 2 mil cilindros de oxigênio

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

Governo de SP distribui cilindros de oxigênio

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

Media briefing on COVID-19 - 12/03/2021

00:00:00 CL 12th March 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. We have as usual simultaneous interpretation available in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi. Let me now introduce to you the participants. Present in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director at WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist and finally Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator. Online we also have Dr Peter Ben Embarek, WHO Expert on Food Safety and Zoonosis and the International Lead of the WHO-convened global study on the origins. With this let me hand over to the Director-General. TAG Thank you. Thank you, Christian, danke schön. Good morning, good afternoon and good evening. As countries roll out COVID-19 vaccines WHO is continuing to keep a close eye on their safety. WHO is aware that some countries have suspended the use of AstraZeneca vaccines based on reports of blood clots in some people who received doses of the vaccine from two batches. 00:01:50 This measure was taken as a precaution while a full investigation is finalised. It's important to note that the European Medicines Agency has said there is no indication of a link between the vaccine and blood clots and that the vaccine can continue to be used while its investigation is ongoing. WHO's global advisory committee on vaccine safety systematically reviews safety signals and is carefully assessing the current reports on the AstraZeneca vaccine. As soon as WHO has gained a full understanding of these events the findings and any change to our current recommendations will be communicated immediately to the public. More than 335 million doses of COVID-19 vaccines have been administered globally so far and no deaths have been found to have been caused by COVID-19 vaccines. But at least 2.6 million people have been killed by the virus and more will continue to die the longer it takes to distribute vaccines as rapidly and as equitably as possible. 00:03:08 The Access to COVID-19 Tools Accelerator which includes COVAX was launched almost a year ago as the international vehicle for the equitable distribution of vaccines, diagnostics and therapeutics. The emergence of new viral variants, the limited supply of vaccines, the lag in uptake of new diagnostics and oxygen and the lack of funding to support the distribution of these life-saving tools are a major challenge for the global control of the pandemic. Today WHO has published its new strategy and budget for the ACT Accelerator in 2021. So far US$11 billion has been committed to the ACT Accelerator but we still face a funding gap of US$22.1 billion. The longer this gap goes unmet the harder it is to understand why given it's a tiny fraction of the more than $13 trillion the IMF estimates that high-income countries have spent on fiscal stimulus to date. We urge countries to fully finance the ACT Accelerator as the best investment in the global recovery. Today WHO gave emergency use listing to Johnson & Johnson's COVID-19 vaccine, making it the fourth vaccine to receive WHO's approval. Emergency use listing is the green light for a vaccine to be procured and rolled out by COVAX. 00:05:02 As you know, the J&J vaccine is the first to be listed as a single-dose regime. WHO will convene its strategic advisory group on immunisation experts next week to formulate recommendations on the use of this vaccine. As new vaccines become available we must ensure they become part of the global solution and not another reason some countries and people are left further behind. We hope that this new vaccine will help to narrow vaccine inequalities and not deepen them. The COVAX facility has booked 500 million doses of the J&J vaccine and we look forward to receiving them as soon as possible. Health workers and older people all around the world need this vaccine. COVAX is ready to deliver it and countries are ready to roll it out. In total COVAX has now delivered almost 29 - 30 million doses of vaccine to 38 countries. Globally 335 million doses of vaccine have been administered in 144 economies. 76% of those are in ten countries. 00:06:36 The inequitable distribution of vaccines remains the biggest threat to ending the pandemic and driving a global recovery. As I said last week, one of the major challenges we need to solve is how to dramatically increase production of vaccines. This week WHO and our COVAX partners met with industry representatives and other stakeholders to identify issues and solutions. Manufacturing any vaccine requires a lot of supplies including glass vials and plastic filters and the raw materials needed to make them. The sudden increase in demand for vaccine production has led to a shortage of these and other supplies, which is limiting the production of vaccines for COVID-19 and could put the supply of routine childhood vaccines at risk. Some countries have posed legal restrictions on the export of critical supplies. This is putting lives at risk around the world. We call on all countries not to stockpile supplies that are needed urgently to ramp up production of vaccines. In a global pandemic no country can go it alone. We're all interdependent and no country can simply vaccinate its way out of this pandemic. 00:08:18 We cannot end the pandemic anywhere unless we end it everywhere. The longer the virus circulates the higher the chances that variants will emerge that make vaccines less effective. But variants don't make physical distancing less effective. They don't make hand hygiene, masks, ventilation and other public health measures less effective. We must continue to do it all. Christian, back to you. CL Thank you very much, Dr Tedros. With this we're opening the floor for questions from the media. We remind you, in order to ask a question or put yourself in the queue raise your hand. We already have a good list of hands up. Then when I call upon you please don't forget to unmute yourself. With this we're starting with the first question. This goes to Nina Larson from AFP. Nina, please unmute yourself. NI Thank you. Can you hear me? 00:09:35 CL Go ahead. NI Thanks so much for taking my question. I was wondering on the approval today of the Johnson & Johnson vaccine; you've been promised 500 million doses. How quickly do you expect those to arrive, are they already ready to go? Thank you. CL Dr Bruce. BA Thank you very much for the question about the important new development today with the announcement of the WHO emergency use listing of the Johnson & Johnson vaccine. With this product now we have not only an expanded armamentarium of vaccines to use against the COVID-19 virus but we also have a vaccine that is even better suited to some of the countries that are worst hit and affected by the pandemic. Because this is a vaccine, as you've seen, that can be used with a single dose, that doesn't require the same ultra-cold-chain requirements, etc, so we're very keen to get this into the programme and into use as rapidly as possible. As you know, COVAX has an agreement for over 500 million doses of this product. What we're trying to do is work with the company to bring that forward as early as possible and we're hoping by at least July that we have access to doses that we can be rolling out, if not even earlier. Mariangela may want to add. 00:11:15 MS Just some quick information - thank you, Nina - that WHO's strategic advisory group on immunisation will be assessing the recommendations for the Johnson & Johnson vaccine on Monday so this is more welcome news. Also the fact that J&J has already announced that it's expanding its manufacturing capacity to other countries including developing countries is good news in terms of not the short term but in the medium and long term it's good news for the provision to the COVAX facility. Thank you. SS Just to add very briefly again and to re-emphasise the point made by the Director-General, the WHO welcomes any company that would like us to support or help in any way the expansion of the manufacturing capacity either in terms of fill and finish if there is already bulk production - our partners in COVAX, CEPI have identified fill and finish capacity that is immediately available to any company that would like to use it to expand supplies - and then potentially also of course for further technology transfer agreements. 00:12:28 So we are ready and willing to help J&J and any other company that would need our support. Thank you. CL Thank you. We will also make the findings of the SAGE meeting on Monday public, most likely on Wednesday. We'll give a statement out about this. The next question goes to Jason Bobian from NPR. Jason, please unmute yourself. JA Great. Can you hear me okay? CL Go ahead, please. JA I'd like to follow up on the AstraZeneca situation. Can you just be a little bit more clear about exactly what your position is on this? Is it similar to the European Medicines Agency, which is that people should just continue using it, or do you support some of the pause that's going on? Also can you clarify the difference between the AstraZeneca that is being used through COVAX and the AstraZeneca that is being distributed in Europe, coming from different manufacturing facilities? 00:13:31 CL Thank you, Jason. Dr Simao, please. MS Thank you very much, Jason. You know that we have an active surveillance system for safety and adverse events following immunisation. It's very active and we're working across all regulatory networks in the world so WHO does rely on EMA information but WHO also has a global advisory committee on vaccine safety and this advisory committee is already assessing the data that has been provided by the European Medicines Agency and by the countries as we speak. So WHO is very much aligned with the position that we should continue immunisation until we have clarified the causal relationship and just to remind everyone, people die every day. We have more than 300 million people who have taken the vaccines, have been immunised globally so there will be people who have been immunised who will die of other causes. So far the preliminary data we have seen doesn't lead to a causal relationship because what we see is that it's not different from the thromboembolic - which is a blood clot disease - event. The percentage we have seen is not different from what is seen in the general population, the deaths and the occurrence of these events. 00:15:09 So this is being investigated as we speak and we'll probably have a statement on this mid next week as the investigations are concluded. CL Thank you very much, Dr Simao. We move to the next; that's Catherine Fiancon from France 24. Catherine, unmute yourself, please. CA Thank you, Christian; nice to hear your voice. Good afternoon to all of you. I would like to come back on the AstraZeneca vaccines and the countries that have decided to stop using it. I remember well, WHO and the EU did recommend the AstraZeneca vaccines that were manufactured in India and in Korea. So I'd like to know if the other sites where the vaccine is produced have been investigated or checked by your experts and I'd like to know if the batches that were used in the eight or nine countries are coming from the same site. Thank you. CL Thank you. That goes to Dr Simao, please. 00:16:35 MS And apologies, Jason, because I forgot to respond to that second part of your question; thank you for the question. We're talking for the moment about two batches that are produced in Europe so this is important because it's important to clarify that the COVAX facility is distributing vaccines that are produced in India by the Serum Institute of India and from the Republic of Korea, producer SKBio. We have had lots of requests today to clarify this so these batches were being used only in some countries in Europe so they're not the same batches. They are not being used elsewhere. We're talking about two batches; I don't have the information right now, whether they come from the same manufacturer but they are manufactured in Europe. As I said before, we're still checking and investigating if there is a causal relationship or not so some of the countries have suspended just the use of these batches, not all vaccination and some other countries have suspended the vaccination but it's related to specific batches. Thank you. CL Dr Swaminathan, please. 00:17:55 SS Just to make the point that adverse events following immunisation obviously are very important and the public is keen to know because it affects their own perceptions and the uptake of the vaccine. So I think it's important to put in perspective; the adverse events which are reported after vaccination have to be seen in the context of events which occur naturally in the population. As Dr Simao was saying, there is a background rate for all these things; people get sick, people get serious illnesses, people die every day due to a variety of causes. So there is a background rate for each of these illnesses, whether it's the thromboembolic events or pulmonary embolism or nerve palsy, Bell's palsy or other neurological diseases or in fact deaths. We know what the normal rate is and so when the WHO subcommittee on vaccine safety or any of the regulatory agencies look at the relationship they look to see whether there is a trend of an unusual pattern of events occurring with a vaccine. They also look to see whether there's a causal relationship between receiving the vaccine and the event and so it is quite important to explain also to people that just because it's reported following a vaccination it doesn't mean it's because of the vaccination. It could be completely unrelated and it's reported because people are keeping a close watch on those who are vaccinated; the pharmacovigilance systems that Dr Simao talked about and the reporting systems are making sure that it's being reported on those who are vaccinated. But again it's important to then do the proper, full investigations before we react and to explain to people in a very transparent and open manner what is happening and explain when it becomes really something concerning. Thank you. CL Thank you very much both. With this we come to Jamil Shad from UL Brazil. Jamil, please unmute yourself. JM Yes, Christian. Can you hear me? CL Very well. Go ahead. JM Thank you. Dr Tedros, last week you mentioned the case of Brazil, that you were worried. Since then cases only rose, records day-by-day are beaten both on deaths and cases. My question to you; is Brazil sort of a sanitary threat to the region and to the world and what else can be done to stop this situation? Thank you very much. 00:20:57 CL Dr Ryan, please. MR Yes, Maria may supplement. Certainly the situation in Brazil has worsened; there's very high incidence of cases and increasing death incidence across the country and certainly a very, very rapid increase in ICU bed occupancy with many areas around the country running out of ICU beds and interestingly in Amazonas actually an improving situation with ICU beds as the wave passes through and the health system recovers. Other parts of the system and other parts of the country are coming under extreme threat. The mid-west and south regions have ICU bed occupancy of more than 96% so 96 out of 100 ICU beds are occupied. There's very little resilience and capacity left in the system. There's also worryingly an increase in positivity of cases, especially people with severe acute respiratory illness - the proportion of them testing positive for COVID-19 is going up - and a significant increase in the case fatality rate, the number of people dying who present with illness, which will reflect the pressure on the system and the lack of time that healthcare professionals have. 00:22:24 But we also in the back of our minds also have the constant concern regarding transmissibility and the inherent virulence or lethality of the virus itself. Maria may speak to how we're tracking that. Brazil is a great nation and an important anchor in South America, in the Americas and globally. What happens in Brazil matters and it matters globally and Brazil has always been a very positive example of strong public health action; one of the first countries in the world to eliminate measles as a public health problem, one of the first countries in the world to eliminate polio. So there's no question; what happens positively in important and prominent nations matters globally and what happens negatively in such nations also matters. We certainly would like to see Brazil going in a different direction but it's going to take a huge effort for that to happen. The system is considerably pressurised right now and while many, many countries in Central and South America are moving in a good direction Brazil is not. 00:23:45 I think - and the DG said it - that this needs to be taken very seriously in Brazil. I have no doubt that Brazilian health and Brazilian science and the Brazilian people can turn this around. The issue is, can they get the support that they need to be able to do that. Maria can speak to what we know and increasingly know about particularly the P1 variant in Brazil. With that in mind all variants of concern are important nationally and all variants of concern are relevant globally because we don't call them variants of concern because of their national impact. We call them variants of concern because they have potential implications beyond national borders. Maria. MK Thanks, Mike. Yes, that's right. The P1 variant, the variant that is circulating in Brazil is of concern because it has a number of mutations that can increase transmissibility and there are some studies that suggest that there is increased transmissibility associated with this P1 variant. That is important because the more cases that you will have the more cases that will require care and need hospitalisation and in the situation in many states that are already overwhelmed and overburdened that will put more pressure on the system and there could potentially be more deaths associated with that. 00:25:06 There are several studies underway of this P1 variant, this virus that has these different mutations, looking to quantify transmissibility and looking to quantify severity. There are some suggestions of increased severity as well but again that complicates a system and states that are already overwhelmed from a lot of transmission to begin with. I should say, what we do know about the P1 variant as well as what we know about the B117, the variant that was first identified in the United Kingdom, and the B1351, the variant that was first identified in South Africa; the public health and social measures, the physical distancing, the masks, the hand hygiene, the ventilation and the IPC measures that are put in place in health facilities as well as outside of health facilities work against these virus variants. We have seen in a number of countries the application of these individual-level measures, the community-level measures, the diagnostics still work. These are driving transmission down and so these virus variants still can be controlled. 00:26:09 It complicates matters if you have a virus that spreads more easily but they still can be controlled. WHO; we expect that there will be more virus mutations, we expect that the virus will continue to evolve which is who we've put a system in place to track evolution, to track these mutations and this has been in place since the beginning of this pandemic more than 14 months ago. That tracking system has grown into a global monitoring and assessment framework that includes many different elements, first starting with surveillance; making sure we have good epidemiologic surveillance, we have strong virologic testing, we're using PCR testing, we're using antigen-based tests in countries so we know where the virus is. We take a subset of those and those are sequenced so we can look at the different mutations within countries. We are working with our regional offices and the regional platforms that have been established to enhance sequencing surveillance around the world. We're leveraging our flu system, the GISRS system which has labs in 150 countries, leveraging HIV, TB, polio networks, labs that are doing sequencing so that they can also be doing sequencing for SARS-CoV-2. 00:27:25 Not only the sequencing itself; making sure that those sequences plus supporting data about the epi, about the clinical can be uploaded to platforms like GISAID so that analysis can be done to understand the evolution. We are also working with our partners as part of this global risk assessment framework to evaluate transmissibility of each of these variants of interest as well as the variants of concern to understand any impact on increases in transmissibility as well as severity. We're linking with partners around the world to co-ordinate studies that need to be done to evaluate the impact on available and future diagnostics, therapeutics and vaccines. This framework will inform vaccines' composition if any changes need to be made for vaccines, for therapeutics and also for diagnostics. 00:28:20 So it's a huge system that is in place. It involves partners all over the world. We're not starting from scratch because we're enhancing and strengthening existing systems that are in place gut we know there are gaps. Sequencing is a big gap right now because not every country is able to do this and in fact most of the sequence that have been shared on platforms like GISAID; I didn't check today but there are more than 600,000 full genome sequences that have been shared. Those come from a handful of countries so we need more countries to be doing sequencing of the viruses in their country but this needs to be intelligent. Not every case needs to be sequenced. We need to look at which cases need to be sequenced. Perhaps they are cases that are involved in a cluster or the disease presentation may be slightly different. So we've outlined guidance on which cases should be sequenced and we're working with our partners to make sure that all of this information informs different decision-making points. But as I said, right now the public health ad social measures, the infection prevention and control, our diagnostics, our vaccines work against these virus variants. It's really important that we continue to drive transmission down and we prevent as many infections as we can to begin with and if we are infected we take measures to prevent transmission onward. 00:29:48 CL Director-General. TAG I would just like to add a bit. I have been to Brazil a number of times and actually the Brazilian health system; I have already considered it as a model because of its strong emphasis on primary healthcare. I think many people know about their family health teams. I remember from my visits how they map their areas of responsibility and even marking each and every household and they know who has what health problems by household. The number of times I visited - I always preferred to go to the clinics to see how the family health teams work. Because of that I actually expected that the Brazilian health system could even perform better because a strong community-based approach can fare better in outbreaks because that could have a strong surveillance system, identifying early and addressing them. 00:31:14 So it's really puzzling to see now that it's actually contrary to our expectations and the situation is very concerning. We're deeply concerned actually because not just the number of cases but the number of deaths is also increasing. So to have a dent on the transmission, to make a significant impact there should be very serious social measures that should be taken and with the participation of the community and there should be clear message from the authorities on what the situation is and what measures should be taken and enforce those measures with the full participation of the health system and the population. Unless serious measures are taken the upward trend which is now flooding the health system and which is becoming beyond its capacity will result in more deaths. I think it was yesterday's data I was looking at; it had already caused 2,000 deaths per day so it's getting very serious and I think starting from the Government all stakeholders should really take it seriously. I said last time, Brazil neighbours many countries in Latin America, almost all of them except a couple and some countries share doing better in the neighbourhood but if the situation in Brazil continues to be serious like this then the neighbouring countries will be affected. 00:33:11 It's not about the neighbouring countries but it could go even beyond. This virus; unless it's suppressed everywhere there will always be some threshold somewhere that will allow it to continue and with changing variants the risk could be even higher. So I think all three of us said, the situation is deeply concerning and the measures that should be taken should be as serious as possible in order to have some significant progress. Thank you, Christian. CL Thank you very much, Dr Tedros; thank you, all. With this we move to Simon Ateba from Today News Africa. Simon, please unmute yourself. SI Thank you for taking my question. This is Simon Ateba with Today News Africa in Washington DC. You seem to be saying that the AstraZeneca vaccine is generally safe. Millions of people have taken it and a few negative reactions should not lead to hasty conclusions. I'm just saying this because that's the main vaccine being rolled out in Africa under COVAX, which brings me to my question. 00:34:33 Can you give us an update on the vaccine roll-out in Africa and when do we expect all countries in Africa to receive their first doses? Thank you. CL Thank you very much, Simon. Let me look around. Dr Aylward, is that...? BA Thank you very much, Simon, and thank you for the question. We probably should have commented earlier when the question was asked about the J&J vaccine. The great thing that we're finding in the whole area of vaccines in COVID of course is that so many of the approaches that are being taken, so many of the products that are being developed are proving ultimately to be successful and good, effective and safe products in the fight against COVID-19. So we're developing quite a broad armamentarium, all of them demonstrating so far good efficacy, those ones that have been licensed - or, sorry, received emergency use listing and good safety profiles. 00:35:41 Among these the AstraZeneca vaccine has also stood out as one of the great products that has had a great profile in its use in so many different settings right now so, Simon, we have great confidence in this product. Of course when you hear anything about any product that you're giving to healthy populations you always want to make sure that that confidence is well-founded and that's what's happening but as Mariangela's already explained, we have strong confidence in this. In terms of the roll-out of COVAX on the African continent it's been very fast. So far 24 countries have received vaccine already on the continent from COVAX, over 15 million doses and this is just in the last few weeks. There's another number in the pipeline that'll receive it during the coming weeks so we'll be up around 35 countries on the continent and closer to 20 million doses. So what we're really focused on now, Simon, is this is a really great start but, as the Director-General said, it's just a start because there're a lot more than 24 million people on the Continent obviously and we need to get a lot more vaccine into not just the countries that have already received it but the ones who are in the pipeline. 00:37:00 The good news is that of the countries that have not yet received vaccines on the continent almost all of them now have the indemnification work in place so the legal frameworks, they've got the regulatory pathways sorted out, they have great plans in their countries to make great use of these vaccines. The crucial thing now is making sure that the global supply chain continues to prioritise the COVAX facility so that it can get vaccines equitably distributed to all the countries that need them because we are still lagging. When you look at the maps - and I'm so glad you highlighted, Simon - Africa still has a number of countries that have not yet received vaccines or not yet been able to start vaccination and that's a situation we have to change very, very quickly. We continue to be deeply concerned about the supply chain globally. As you have seen in the press and other accounts recently there're lots of challenges and AstraZeneca's had challenges maintaining its supplies. We need to make sure that despite those challenges we continue to prioritise getting this vaccine into the continent. Thank you. 00:38:14 CL Thank you very much, Dr Aylward. Now we move to Helen Branswell from Stat News. Helen, unmute yourself, please. HE Thank you very much, Christian. My question is about Ebola. I wonder if you have any [inaudible] you can make about the reports that the virus has been isolated from [inaudible]. CL Helen, you have a very bad sound in the background. Let me go to another question and we'll come back to you after this and maybe you can sort this in the meantime. Thank you very much. Let me call upon Ketevan Canava for now. Ketevan, please unmute yourself. KE Hello. Can you hear me? CL Please go ahead. KE Thank you very much. We have finally good news from Georgia; the first batches of vaccine we will receive tomorrow and from next week we will be ready to start vaccination and we are very happy. Thank you very much, Dr Tedros, for your personal commitment and for your support. 00:39:38 This vaccine will be AstraZeneca vaccine and I have a question about AstraZeneca again because there are some doubts in Georgia. So what can you recommend people who are going to vaccinate against COVID-19 and the assessment of the situation in Georgia? Thank you very, very much. CL We had similar but Dr Swaminathan, please. SS Just to reiterate again that we're looking very closely at the safety data and so is the European Medicines Agency and we're working closely with them, analysing the information that's coming from these reports. I just want to remind everyone of what the DG said, which is that COVID has killed over 2.6 million people so far globally; just the known and documented deaths; we believe that there must be more than that. Of the 330 million vaccine doses that have been deployed we're not aware of any one confirmed COVID vaccine-related death. There have been deaths following vaccination in people but people die of diseases every day so there hasn't been a single confirmed one. 00:41:07 Most of the vaccinations to date have been done in countries with very good safety monitoring and pharmacovigilance systems, the high-income countries so there's very good reporting and each of these reports is being amplified in the press. So I think it's very important to reassure people especially in the countries that the vaccine that is being rolled out in. This a time when we want people to take the vaccines that are available because all the vaccines are proved to date, do prevent severe disease and hospitalisation and they're definitely preventing people dying of COVID-19 and that's what we want. So I think it's key that public health officials in all countries that are vaccinating or beginning to vaccinate must amplify the right messages based on the science and as the science and knowledge evolves things could change. We have to keep our eyes and ears open and we will keep communicating to you as things happen but as of now we are confident that we should go ahead. Thank you. 00:42:08 CL Thank you very much and thank you, Ketevan, for this opportunity to reiterate this important point. Now we'll try again with Helen Branswell and sorry for the disturbance before. Helen, please go ahead and unmute yourself. HE Thank you, Christian. I don't know where that music was coming from but it wasn't coming from my end. I wanted to ask about a report that has come out about the Ebola virus causing the outbreak in Guinea. An analysis has been done of this sequence data and it shows that there're only about 12 to 14 nucleotide differences from the 2016 outbreak, which is a very stunning thing to see at this point. I was hoping you might be able to explain what the thinking is about what's going on there. Thank you. MR Thanks, Helen. Yes, we're aware of the report and very grateful to the different groups who've done the sequencing and done such good analysis. In that sense the results are quite remarkable; the branch ancestral to this cluster is very, very similar to the original virus that caused the outbreak from 2014 to 16; far less than you would expect based on the evolutionary rate of the virus that it displayed at that time. Bruce is here and he knows how quickly that virus evolved. 00:43:49 In a sense what this really says, Helen - and we have to be very careful here because more studies are going to be needed but certainly this is unlikely right now based on the genetic sequencing to be linked to a fresh zoonotic reservoir and much more likely to be linked to persistence or latency of infection in a human subject. That would be probably the longest period of time between two such events. I'm cautioning here, these are the first so more studies are needed and again it's great to have this data but in that sense we're not dealing, as far as we understand right now, with a breach of the species barrier. It really does speak to the importance of following up and supporting survivors and finding better ways to help survivors and let me say this again. The vast majority of people who survive Ebola clear the virus from their system and they recover within six months. 00:45:01 An even tinier proportion of people end up potentially carrying the virus. They're not infectious to other people except in very particular circumstances and a tiny proportion of them can relapse in their infection and become sick again and even in those the percentage of those people who have the haemorrhagic symptoms is less. So it's very important that we follow up survivors to support them but it's extremely important at this moment because these are scientific results but ultimately there are people at the heart of this and there are thousands of people who have survived Ebola in West Africa and their lives have been put back together. They have suffered hugely and so have their communities so it's extremely important that we look at the scientific data, that we do not allow any form of stigmatisation around this subject. Survivors deserve our support. They've been to hell and back. Their families have been to hell and back. We need to better understand how this happened. It's really important for the future but just to reassure, survivors of Ebola do not represent a threat to their communities or to their families. We have a duty to them to follow them up properly, to ensure they get access to the right care and to do everything possible to find new ways of ensuring we can clear infections in those very, very few people who may carry the virus for a longer period of time. 00:45:34 But you're right, Helen; it is a remarkable result. It's a testament to the scientists who work on this in Guinea and around the world and just to remind everyone, WHO has launched a readiness and response plan for all of the surrounding countries including Guinea, working with our partners and with the Governments to bring this disease under control. We have 18 cases there at the moment and we now have over 30,000 doses of vaccine in the field. We've vaccinated a large number of contacts and contacts of contacts. We'd like to pay testament to pay tribute to the Ministry of Health and the President in Guinea and particularly to Dr Sakoba for his leadership at the national level. We encourage all partners to work under the co-ordination of Dr Sakoba and the UN system in order that we can deliver the best services on the ground. We have vaccinated nearly 3,000 individuals so far in a targeted ring vaccination. We don't vaccinate the whole population; we vaccinate contacts, contacts of those contacts. 00:47:50 It's a very targeted vaccination along social and contact networks. It was highly successful in the last outbreak in Congo and we're making very good progress with that right now. Again this disease causes fear in communities and again those communities in West Africa who went through the horrors of the West Africa outbreak deserve our support now first and foremost to stop this virus dead in its tracks but, two, to support them at the community level in terms of dealing with the genuine fear they have around this disease potentially spreading. I don't know; Bruce, you have the institutional memory for West Africa and did so much in your leadership role there. You may have a comment as well. Helen, we'd be very happy to follow up with you with more details. Dr Pierre Formonti leads on the technical side here; Dr Salam Gay is our Regional Emergency Director and I think we have Michel Yao online. Michel is not with us, no. Michel is embedded; he's in Guinea and working very, very closely with Dr Sakoba under his leadership. Bruce, you may have a comment to make; I don't know. 00:49:02 BA Thanks, Mike, and thanks, Helen, for the comment. I think Mike really hit the nail on the head. In the West Africa Ebola outbreak we learned so much. It's interesting; we'd known this disease for dozens of years at that point. This was a new environment, it was a whole new scale as well and one of the things we learned, as Mike highlighted, was just how there could be persistence and longer-term shedding of the virus than we'd originally realised. It was also one of the first - the first outbreak, if I remember correctly, where we were able to apply molecular tools in real time. That was really toward the end of the crisis to help us understand how it was evolving, how to tackle it and also manage some of the risks. In that vein I would want to reinforce a little bit what Mike has said. These are some new results that we have just seen and the biggest mistake we could make would be to jump to conclusions about what this means about the outbreak and its evolution and the risk. 00:50:02 We know how to tackle this disease very, very well and I tell you, in West Africa, in Guinea, in this area where I spent a lot of time with Dr Sakoba and the colleagues, these people really know what they're doing when it comes to managing this disease. I think we will understand in the near term what the genetic results that we're seeing mean but again the important thing is we have the tools we need to tackle this, we have the community that knows how to tackle this and we have new tools and I think we just need to be careful that we don't over-interpret what is the evolving information. We made a couple of mistakes in that regard in West Africa back three or four years ago and we don't need to do that again. Thanks for raising it though; super-important that we had this discussion. CL Thank you very much. MR May I just add that donor countries out there may consider supporting the Governments of Guinea and the surrounding countries as they implement these response plans. To date everyone I know... It's very tough. There are so many issues out there for donors to consider, not least of which are Yemen and Tigray and so many other desperate tragedies and also COVID. 00:51:12 But the Ebola outbreak is one and we've seen in the past, if Ebola is left to burn slowly it can quietly expand and it can cause a problem. Prevention is the best cure in this particular case. We saw the investment in preparedness in Uganda last year; we saw the value of that. Uganda ended up with two importations of disease; it had no secondary cases; it nailed it, it absolutely did the right thing and so did the other surrounding countries. Now we need to make sure the countries surrounding Guinea and Guinea itself have the resources and what we've seen is a remarkable increase in human capacity, in technological capacity in countries in Africa in particular. What they sometimes need is quick resources in order to be able to scale up the response and WHO is out there asking countries to consider funding this regional plan to contain this disease in support of the Ministries and we'll be delighted to provide more information on that in the coming days. 00:52:16 BA Christian, sorry to jump in again but Mike made this comment earlier that people who've suffered this disease have been to hell and back and their families have and this virus is really a devil of a virus, to use Mike's metaphor and that support to Guinea, which could easily be forgotten at this time, is going to be absolutely vital. These people know what they're doing but they're going to need the support to be able to implement, especially in the areas which are being hit. These are some of the most vulnerable and needy areas. CL Thank you, Drs Ryan and Aylward, for this very important appeal to the donor community. With this we move to Naomi O'Leary from the Irish Times. Naomi, please unmute yourself. NA Hi. Thank you very much for taking my question. My question is, how much of a concern are US restrictions on vaccine exports given its importance in manufacturing particularly the Johnson & Johnson vaccine but also the AstraZeneca vaccine? There are reports that tens of millions of doses are already stockpiled ready to go but not being exported anywhere. Thanks very much. CL Thank you very much, Naomi. Let me give a quick look around. Dr Simao, please. 00:53:31 MS Let me start. As we mentioned previously in pressers the WHO is always very concerned about export bans on products that will help to end the acute phase of this pandemic and this is related also to the vaccines, to the ingredients to produce vaccines and to any other products. We have seen increased moves from some countries to put bans and restrictions on exporting goods that are actually very much needed globally at this point. So WHO very much discourages the use of this type of measure which can decrease the chances that we achieve better and more equitable access to vaccines around the world. Maybe someone else wants to... CL Dr Aylward, please. BA Thank you, Christian. Naomi, thanks for the question. One of the great things about this response and now the vaccines being available has been the emphasis of every country, every manufacturer to ensure that no vial lies idle. In fact that's a bit of a theme that we're hearing again and again and as people look at where vaccines can be best used people are talking to us about how they can make donations. 00:55:05 This goes back almost to December and as the Director-General's been calling for. We've been pushed very hard from the COVAX side to ensure that any vial that comes to us will be used and put to work immediately. That is really the mantra we're trying to drive right throughout the entire response, that every vial of vaccine as it comes off the production lines, as it becomes available you immediately put to work. The fantastic thing has been the attention around the world to that. There're always going to be situations where you end up with some vaccine being held or maybe not rolled out as rapidly as possible but everybody recognises the need to be working to the common good of getting all of these to work as rapidly as possible. The great thing now the COVAX facility's been up, it's been delivering for over two weeks now and I think everybody's seen it's moving vaccines and moving the orders, the demand and getting them to people even faster than the manufacturers can keep up with. 00:56:05 So if anyone does have vials, Naomi, back there on their shelves we can put them to good work. CL Thank you very much for this. Now we move to Latika Embourg from the Sydney Morning Herald. Latika, please unmute yourself. LA Thank you very much. Just asking about Italy's decision to block the authorisation of the EU AstraZeneca vaccines to Australia, one of the reasons cited was that Australia has a very low outbreak and that Europe needs those vaccines more. Is that a fair enough reason, in your view, to block the export of vaccines? CL Let's start with Dr Aylward, please. BA Thanks and thank you for the question. At the beginning of this crisis we had to sit down and as the vaccines were being developed put together a framework for how to ensure their optimal use as they rolled out, the equitable and fair allocation of these products. 00:57:08 Dr Mariangela Simao has led that work and would be a good person to comment on it but as we looked at how we roll these things out as fairly and equitably as possible we looked at the threat and risks around the world. We're dealing with a virus which is distributed ubiquitously; it's all over the world at this point and at the same time we have older populations, we have healthcare workers all over the world so the people who are vulnerable, who are going to be most highly exposed, most at risk of severe disease also distributed. So what we're looking at is how we reduce that risk of severe disease and with it the risk of death obviously but also the risk of ICUs getting clogged. So what we're trying to do is ensure we roll these vaccines out everywhere around the world because every country has populations that are at risk, every country needs access to these products. So that is what underpins the strategy behind the roll-out of these products and the reason that we give such emphasis to ensuring that every country has access to these. Every country has healthcare workers; every country has older populations and as we've seen as well, although a situation may look quiet in one country or another it can explode very, very rapidly. We've seen countries with very few cases all of a sudden reporting hundreds within days. So for that situation you want to make sure that you reduce that risk everywhere to the degree possible. I don't know if Mariangela wants to add. 00:58:43 MS Just a quick comment because we are also always pushing that this virus is present everywhere and that the risk of outbreaks even in situations where it's apparently under control has been proven over and over again, that it can happen again. So no-one is safe yet and so it's needed; we need to prioritise the vaccination, as Bruce said, for the older groups and for healthcare workers and for people who are at risk of dying. We are talking about it across the world, in all countries. CL Dr Ryan, please. MR On Australia, I think it's probably a good lesson for many of us. Australia had two peaks in transmission, daily peaks. They never exceeded 1,000 cases a day. Australia's had fewer than 30,000 cases overall; fewer than 1,000 deaths. The last peak was last July. Australia not only flattened that curve, it destroyed that curve and it has kept it at that really low level since. 01:00:01 That didn't happen by accident, it didn't happen because of luck. That happened because the Australian Government applied a comprehensive strategy to suppress this virus, to track contacts, to test, to test, to test and they went after this virus in a way that was just truly impressive as a public health operation and it was done in the face of a lot of criticism at the time. There were good days and bad days and there were genuine dilemmas at community level and there were many times when, I think, Australia took very severe action in response to a very small number of cases, small clusters, very big responses. But I think there are some real lessons to learn from the experience of Australia. For Australia though right now because they've managed to do just that the seroprevalence of this disease is very low so the Australian population remain overwhelmingly susceptible to this virus because they have been protected by their Government, protected by their public health system, protected by the strategy that was used by Australia. In my view, I'm not comparing countries but that success in protecting your population should not result in you lacking access to that which will give more permanent protection to that population. 01:01:25 But I think it's an important reflection to look at just... I would point many countries to look at Australia's experience in how to contain, suppress and a lesson for the future, I think, as we move forward. Vaccines alone will not be the answer. I think we need to use vaccines and then look at the strategies implemented by countries like Australia and New Zealand. For me the magic is bringing equitable access together with comprehensive public health strategies. You put those two together; we'll make this pandemic history. So I do hope that Australia can access the vaccines from whatever source they can but I must say, chapeau; they've really shown us all how to use public health to kill a virus. CL Thank you very much. With this we come to the end of our briefing; we are already over one hour and we actually made it to nine questions, which is extremely good. Thank you all very much. Before I hand back to Dr Tedros for the final words let me remind you again that the comments will be sent right after this briefing and of course the full transcript will be posted tomorrow morning on the WHO website during the day. For any other follow-ups please send an email to media enquiries. Thank you. Dr Tedros. TAG Thank you. Thank you, Christian. Thank you for joining us today and bon week-end and see you next week. 01:03:11

Media briefing on COVID-19 - 15/01/2021

00:00:00 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, Friday 15th January. We will update you about COVID-19 but also about the recommendation of the sixth emergency committee meeting regarding the outbreak of COVID-19 that took place virtually yesterday. The emergency committee statement and a press release were sent to the media an hour ago and are also posted on the WHO website. I will let Dr Tedros introduce our guest, the Chair of the emergency committee, later on. Present in the room are Dr Tedros, Director-General of WHO, Dr Mike Ryan, Executive Director, Health Emergencies and Dr Maria Van Kerkhove, Technical Lead for COVID-19. Joining also are Dr Jaouad Mahjour, Assistant Director-General, Emergency Preparedness, and Dr Carmen Dolea, Unit Head, International Health Regulation. Both can talk about the emergency committee recommendation. We have also Dr Mariângela Simão, Assistant Director-General, Access to Medicine and Health products, Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator. Joining online is Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome, all. Simultaneous interpretation is provided in the six UN languages plus Portuguese and Hindi. Now without further delay I would like to invite Dr Tedros for his opening remarks. Dr Tedros, the floor is yours. 00:02:15 TAG Merci beaucoup, Fadela. Shukran. Good morning, good afternoon and good evening. The emergency committee met this week and made a series of recommendations about the COVID-19 outbreak. It will come as no surprise to you that variants and vaccines were heavily discussed as well as the current epidemiological situation. Some countries in Europe, Africa and the Americas are seeing spikes in cases with multiple factors driving transmission risk. This is because we're collectively not succeeding at breaking the chains of transmission at the community level or within households. We need to close the gap between intent and implementation at the country and individual level because at present there is immense pressure on hospitals and health workers. 00:03:15 With almost two million deaths and new variants appearing in multiple countries the emergency committee emphasised the need for governments to do all they can to curb infections through tried and tested public health measures. The more the virus is suppressed the less opportunity it has to mutate. We need to be more efficient than the virus and reach excellence in everything we do. There is only one way out of this storm and that's to share the tools we have and commit to use them together. The committee called for upgrading national sequencing capacity so that as the virus changes we can effectively monitor and respond to new challenges. This is a defining moment in the pandemic and I was pleased that the emergency committee put a major emphasis on rolling out COVID-19 vaccines equitably. Health workers are exhausted. Health systems are stretched and we're seeing supplies of oxygen run dangerously low in some countries. Now is the time we must pull together as common humanity and roll out vaccines to health workers and those at highest risk. This is key to saving lives, protecting health systems and driving a fair recovery. 00:04:51 We have also developed updated guidance about how to best protect people in long-term care facilities and recognise that if they are isolated it has a profoundly negative impact physically and mentally. The guidance aims to prevent the COVID-19 virus from entering the facilities and ensure our loved ones remain safe. I was really pleased to see refugees in Jordan start to be vaccinated this week. I truly appreciate the approach taken by the Jordanian Government to ensure that refugees are not left behind. It's critical this momentum on equitable vaccine roll-out continues in the weeks ahead. I came into public health because I wanted to ensure that everyone everywhere has access to quality health services. I know what it's like to come from a continent where not all health services are available. When AIDS drugs first rolled out they were only available in rich countries until a historic movement of health advocates, civil society and manufacturers provided a roll-out of low-cost antiretroviral drugs. 00:06:21 In the H1N1 pandemic by the time low-income countries received vaccine supply the pandemic was over. We don't want this to be repeated. COVID-19 vaccines are a major scientific breakthrough and I know through COVAX that we will distribute them a lot more effectively than in the past. We're working hard but we must also do more to ensure that vaccines reach those that need them most. I will keep repeating this over and over again during the coming weeks because, as I said on Monday, I want to see vaccination underway in every country in the next 100 days so that health workers and those at high risk are protected first. I'm looking forward to the executive board next week and working with manufacturers and countries to ensure that vaccine supply is available and distributed equitably around the world. I now want to turn to the Chair of the emergency committee, Professor Didier Houssin, to discuss the recommendations from the committee. Professor, you have the floor. DH Thank you very much, Dr Tedros, and good morning, good afternoon, good evening to you all. The Emergency Committee met yesterday and I want to thank first the members of the committee for their work and contribution to these recommendations. 00:08:07 It's a sad anniversary because nearly one year ago the emergency recommended - and it was followed - in considering [inaudible] be even considered a public health emergency of international concern. Since that time, as Dr Tedros said, 19 million people contaminated, nearly two million people have died and the committee focused on two things. The first is a worry, a worry about the variant which starts circulating in some places in the world. This variant requires a strong and quick effort in research in collaboration between research teams in sharing of information as suggested and mentioned by Dr Tedros and also about data sharing. I think we are in a race between the virus which is going to continue trying to mutate in order to spread more easily and humanity which has to try to stop its spreading. This effort of research needs to be very, very quick and very intense. 00:09:30 Fortunately there is also good news. The good news is about the vaccine but this good news should not be transformed into bad news and we should remember the objective for 2021 is 20% of the population vaccinated not only in rich countries but also in low and middle-income countries. It's extremely important not to transform this good news into bad news. For the vaccine of course some of the recommendations of the emergency committee are about trying to know more about the efficacy of the vaccine, the efficacy against the new variants, etc. I will not go into the detail. I would like to add a final point about the situation in which the world is presently. We are a little bit paralysed, we are a little bit confused and clearly the question of travel inside the world, around the world by air, by road, by sea needs to be perhaps better possible and organised. This is why one of the recommendations of the committee to WHO was to take a strong lead in order to produce clear and scientifically based guidance about how best to facilitate and permit the circulation of people in a safe manner by air, by sea and by [inaudible]. I thank you for your attention. 00:11:13 TAG Thank you. Thank you so much, Professor. These recommendations are very important as the world fights COVID-19. The greater the solidarity we have the more lives we will save and the quicker we will end this pandemic. Thank you so much again, Professor. I thank you and back to you, Fadela. FC Thank you, DG; thank you, Professor Houssin. I would like now to open the floor to questions from journalists. I remind you that you need to raise your hand under the raise your hand icon in order to get in the queue. I would like to start with Christophe Vogt from Agence France Press. Christophe, can you hear me? Christophe. Can you please unmute yourself, Christophe? We cannot hear you. CH Okay, it should be done now. Can you hear me now? FC Very well. Go ahead, please, Christophe. CH Okay, I'm really sorry about that. I have a question about what Dr Houssin just said and what has been said in the last few weeks since the vaccines arrived and now with the variant. It's a bit confusing. We had a light at the end of the tunnel at the end of the year and then two or three days ago Dr Ryan talked about how this year could be even worse than last year was. 00:12:56 So how can we reconcile the fact that now we have efficient vaccines and still have this idea that things could get still worse? FC Dr Ryan will start. MR Thanks for your question. I think this is a matter of deciding the future. We have an element to control of the future we want to have and we did also warn in 2020 that if we were to rely entirely on vaccines as the only solution we could lose the very control measures that we had at our disposal at the time. I think to some extent that has come true for different reasons; because people are more inside in the northern hemisphere, because the holiday season pushed and brought people together and people mixed in a way that they might not otherwise have done. We've seen northern and southern hemisphere increases; it's not just in the northern hemisphere. If you go to the southern cone of the Americas, in Argentina, in Chile, in Paraguay and Uruguay and in Brazil we're seeing difficulties there. This phenomenon of rapid acceleration of cases is in the Americas, it is in Europe, it is in some countries in Africa and it is in some countries in every region. 00:14:22 That is the reality and that's happening for a reason. A small proportion of that may be due to the emergence of variants that are fitter but the large proportion of that transmission has occurred because we are reducing our social, physical distancing, our behaviour is... As the DG said in his speech, we're not breaking the chains of transmission. The virus is exploiting our lack of tactical commitment, our fatigue, the breaking down of our behaviours. The vaccine is light at the end of the tunnel, it is a massive advance but it doesn't answer and it won't address every question that we have. We have to continue doing the other measures and even with that - and Bruce will speak to this - if vaccination is going to be successful people have got to be vaccinated and for people to get vaccinated countries have to get vaccine. Therefore it's not just an equity issue about countries getting vaccine. It's about protecting those around the world who are most vulnerable; our front-line workers. 00:15:29 So we want to start the year on a hopeful note. I think what the Director-General is trying to do is start the year on a realistic note. We need to be real with ourselves, we need to be honest. We're not doing as well as we could. We've learnt so much about the virus, we know more than we've ever known before, we have more tools, we have to sustain the effort. It's tough. We've got to pick ourselves back up. Many of us in the northern hemisphere in the new year where people have been celebrating holidays; many people in the southern hemisphere similarly; they're confused because they think, oh, this disease is seasonal, it shouldn't the here, we're in the middle of summer. Again this idea that we've assigned seasonality to a virus; we assign these values to the virus that were never proven scientifically. We need to recommit ourselves to the basic measures. We need to decide that this disease stops with me. Individuals need to protect... let the disease stop with them. Communities need to ensure that the disease stops with them in clusters. Governments need to support communities and individuals to do that and I've said it before; we're expecting our communities to do extraordinary things, to separate themselves in extraordinary ways, to make huge sacrifices. 00:16:50 In order for that to be successful governments need to support communities in extraordinary ways and within all of this none of us are doing enough to make this all work. Everyone's go to recommit themselves and increase the level of commitment. We're all working hard, everyone's working hard. We're just not working hard enough. Bruce. BA Thank you, Mike, and thanks for the question. We do have efficient vaccines but remember, we're in a situation with an escalating virus right now in terms of numbers and transmission in many parts of the world. We have a virus that's also evolving and we have against that background, as Mike said, we have a decrease in what we call stringency in the application of the measures that we have. When you put those three things together you're making it easier for the virus and the virus is taking off so things can get worse, numbers can go up and we're seeing that. 00:18:02 Against that we have vaccines, yes, but we have limited supplies of vaccines that will be rolled out slowly across the world and also vaccines are not perfect, they don't protect everyone in every situation, as you know. So as a result the situation could definitely get worse in the short term and we also have hesitancy against the vaccines in places. So it is not the silver bullet, as the Director-General and Mike have reaffirmed multiple times but there's very good news of course because now we have three lines of defence but we have to use them all. The first line of defence we're starting to roll out is the vaccine that can protect people from getting infected. Then we have diagnostics and we have new rapid diagnostics that work well. They give a second line of defence so you can find the ones who get infected, you can rapidly isolate, rapidly quarantine. Then we have the third line of defence for those people who are infected and get sick. We have dexamethasone, oxygen, as Maria lays out all the time; very, very good clinical pathways and you can save lives if all of that is applied. But no one part of this works; you have to use all there lines of defence or the situation will continue to be very bad and that middle line of defence is still about finding cases, getting them isolated very rapidly, not just hospitalised but the mild and moderate cases at home. 00:19:26 We have to make it easier for people to isolate so that they don't infect other people. You need all of that. Vaccine's such an important part of the solution but this is a complex situation and we need all pieces of this working together. FC Thank you. Maria. MK Thank you. I just wanted to highlight the point you made about the light at the end of the tunnel. There is a light at the end of the tunnel but that tunnel is a long tunnel right now and it's dark and it's dangerous and it's a challenging one that we have to get through but we have the tools to help us get through that and more and more and more are coming online. But please don't forget about the tools we have in hand. We're all in a challenging situation, we're tired, we're frustrated, we want this to be done but we have to be part of the collective action towards ending it, we have to be part of the collective action to prevent ourselves from getting infected and if we do get infected the virus stops with us, we don't allow this virus to pass from us to someone else. 00:20:34 We have the tools in hand to do that, whether this is related to a virus variant; these variants will be detected and it's confusing and it's scary but the virus itself is enough to scare us into action. We need individual information to turn into action. We need knowledge to turn into action. We need intent to turn into action and all of us have a role to play but it's not just up to individual-level measures. We need our families, we need our communities, we need governments to provide supportive environments in which we can take those actions. We need not only good testing with rapid turn-around results; we need those tests to link to public health action so that we know where the virus is circulating, we know... If I'm infected or if I'm a contact of someone who's been infected I need to know what to do and I need to know that I will be supported in being in quarantine and that I can protect my loved ones. 00:21:34 We have a very different situation around the world. Many countries have shown us the hope that by doing all of this collective action, by putting in the hard work through a comprehensive strategy, not one measure alone, many measures together, applying them in a comprehensive way with strong national plans, implemented, adapted, agile at the local levels, tailoring it to the specific needs of the local level. They've shown us the way. We have outlined guidance in support of all of our member states, in support of everyone everywhere about what needs to be done and we know it's hard but we have seen, we've had it demonstrated over and over again that it works. This is why we sit up here and repeat that there are many things that we can do. Vaccines and vaccination are another tool that will help us get to that light at the end of the tunnel but it will take time. So there is a frustration and I understand that and all of us understand that because we feel it too but it will take some time. But let's look at the hopeful angle here and that we are lucky in the sense that we do have tools. We need to make sure that that luck and that hard work and these vaccines reach all people all over the world and the COVAX facility and the commitments that we have seen across the world to make sure that that turns from just words into action, becomes a reality. 00:22:59 So there's a lot that we can do so I just wanted to highlight your light at the end of the tunnel. There is a light at the end of the tunnel and everyone that's listening to us today needs to know that there's something they can do. They need to feel empowered and if you don't know what it is you can do come to our website or reach out to find out, how can I help, because all of us can be part of the solution to a very challenging situation that all of us are in together. FC Thank you. I would like now to invite Toni Waterman from Asia News Channel to ask the next question. Toni. TO Thank you very much for taking my question. It's on the WHO team of experts that has now arrived in Wuhan. I believe the video meetings began today with Chinese counterparts. I'm just wondering if there's any update on these initial meetings or if you could provide any more specific information about what sort of co-operation is going to be carried out and how the potential identification of patient zero in Italy from November will play into this investigation into the origins of the pandemic. Thank you. 00:24:13 FC Dr Ryan. MR Yes, the team did immediately begin work and will be working with Chinese counterparts to implement the terms of reference as we've agreed and getting more specific on the specific data and the studies that we want to see and the follow-up studies that need to be carried out. But at this stage I think it's very important... the team are going to have the need to be able to engage with their scientific counterparts in China. We can't debate this every day; what did they do today; tomorrow; what do they do the next day. They have to have the space to be able to do the work and therefore Maria can outline in more detail the overview of what we want to achieve but this can't be paced on a daily basis and litigated in press conferences. I'm sorry; this is not the way we would do outbreak response or outbreak investigation or origins investigation in any situation. 00:25:13 However our team will be in touch with the media in the field, there will be regular briefings and I'm sure that we will be able to keep you updated on the day-to-day activities but forgive me for not getting into the detail of what the team is achieving on a daily basis. MK Thanks. I'm not going to give you any very detailed response either because, as Mike said, the team needs to do the work. The Chinese counterparts and the international team have been meeting regularly and been talking by teleconference and now the team is in Wuhan they're going through their quarantine period but they're meeting again by videoconference. Once they finish that quarantine period they'll be able to meet face-to-face. Anyone who's ever been involved in visiting the field or in these outbreak-type investigations knows these studies takes time. Mainly what will happen is a series of studies - and this series of studies has already begun - looking at some of these initial patients from December and epidemiologic studies, seroepidemiologic studies, studies and review of past work that has happened in the markets, that has happened with patients. So it's a number of things but we won't be giving a day-by-day update of what the team is doing. What we do need to do is let them do the work and carry that out and put the information that all of them are learning together into context in planning the next series of studies. 00:26:40 You mention a report from Italy and you refer to this person as patient zero. We need to be very careful about the use of the phrase patient zero, which many people indicate as the first initial case. We may never find who the patient zero was. What we need to do is follow the science, we need to follow the studies and make sure that they are done comprehensively. Any report of cases that were detected through either looking at stored clinical samples or stored sera into 2019 we are following up on. We are reaching out through our global networks, contacting the researchers directly to find out more information and set up collaborations for potential further work of any samples or studies that remain. So we will continue to follow that and we will report as much as we learn when we learn it to you but it will be put in a collective understanding of the science. 00:27:42 So the team is there, they're very happy to be there, they're very happy to be working with their Chinese counterparts and we're thrilled for them to be able to have this time. But Bruce and I spent some time in China and we are grateful for the opportunity to have worked directly scientist-to-scientist to be able to have that level of interaction. So let's let them do the work, let's let them follow the science and we will report when we can. MR Fadela, can I just follow up again because I think it's important. The Director-General in his mission to China in January 2020 - as early as that and before that in terms of the various meetings here - the issue of the origin of the virus and the animal/human interface was on the agenda. The mission to China in February; the animal/human interface and the origin of the virus was on the agenda. The World Health Assembly in May formulated a resolution asking the Director-General to deploy a team to follow up on that issue of designing studies that would allow us to reach some better knowledge on this. 00:28:49 A team was deployed in June/July that went to the field to do that preliminary discussion with Chinese colleagues on the ground. Subsequently we've been planning that mission. That mission has now been deployed and has arrived in Wuhan. That mission has ten of the finest scientists I've ever worked with on it from different countries around the world, covering a huge range of skills, supported by WHO team and in the context of the Global Outbreak Alert and Response Network support. The global scientific community has come together in a network with GOARN at the request of the Director-General to deploy a team to work with Chinese counterparts to find the scientific answers we need so we can learn more about the origin of this virus. They are in Wuhan today. I think we do need to give them the time and the space to do that work. We do thank our colleagues in China for working with us to achieve this. These things are not always easy to achieve and we do thank them for that. 00:29:47 We thank our colleagues in Singapore for facilitating the transit of our team and all of those who are working so hard to ensure that we all get the scientific answers that we need so we can protect public health now and into the future. So in that regard we should see today as the culmination of a lot of work to put together this process and, as Maria said, there are no guarantees of answers. We've seen the same in previous epidemics of emerging disease. It is a difficult task to fully establish the origins and sometimes it can take two or three or four attempts to be able to do that in different settings. I wish the mission luck in the field. They're a wonderful group of people and we trust with the co-operation and the hospitality of the Chinese Government and the Chinese people and the authorities in Hubei and Wuhan we will have a successful mission. FC Thank you both. I would like now to invite Jamie Keaton from Associated Press to ask the next question. JA Thank you, Fadela. Can you hear me? FC Yes, very well. Go ahead, please. JA Happy New Year to you all; always nice to see you again. I'd just like to say that I think that I speak for much of the Geneva press corps in saying that I hope that we'll also see WHO spokespeople return to the UN briefings here. 00:31:10 My question is for Dr Houssin. I'd just like to thank you for your recommendations. They're very illuminating. I just want to ask you about the recently announced travel bans that we've seen in places like the UK or in other places of particularly travellers coming from South Africa or the UK in particular. You mentioned in your recommendations that countries should apply evidence-based approaches with regard to international travel. Could you just elaborate a little bit on that and could you help us understand if, in your view, these bans on travel are justified by the science? Thanks so much. FC Thank you, Jamie. Professor Houssin. DH Thank you very much, Mr Keaton. This is not an easy question because we tend to live with of course the lessons from the past with regard to travel in the context of the International Health Regulations. 00:32:19 But with coronavirus things have changed and it's necessary to reconsider perhaps some of the orientations which were commonplace in the context of the IHR. This is where the science base can perhaps modify some strategies. At the moment what we see is that there is a great disparity in the behaviour of the member states about testing, about quarantine, about bans, about suppression of visa, etc. This is why we didn't go into the details of what should be done but our recommendation to WHO was that it was really time to reassess what could be recommended, what guidance could be provided with regard to air travel, sea travel, land borders considering the new scientific information provided with coronavirus. This is our recommendation. Of course I cannot give you a precise response about what should be recommended but the recommendation was really to put a strong focus on this difficult topic, which may lead us to see things a bit differently from the previous years, for example at the time of the H1N1 influenza pandemic. Thank you. FC Thank you, Professor Houssin. I would like now to give the floor to Dr Carmen Dolea, Unit Head, EHR, to complement the answer. Dr Dolea, you have the floor. 00:34:02 CD Thank you very much, Fadela, and thank you very much for the question. To complement what Professor Houssin said, the Chair of the emergency committee, we welcome the continued advice and recommendations from the emergency committee that build on the current work that we have been doing. Just to let you know, we have published recently updated guidance on considerations for implementing travel-related measures to address transmission of SARS-CoV in the international context. This guidance is promoting a risk management approach for countries whereby they take into account when they issue the measures a number of elements that can influence the suppression and the risk of transmission via travel of the disease. So we propose that in this guidance there are basic approaches that continue to be done in terms of self-monitoring, travel advice. There are also additional approaches that can be done based on an assessment of the risk in the arriving country, of the capacities of destination countries and of the health system surveillance and response. 00:35:31 We will continue to refine this guidance and these approaches based on what we begin to learn from countries on the effect of these measures in actually suppressing or influencing the transmission of the disease at the international level. The recommendations of the... Again the review [?] committee will continue to work with partners in the aviation and transportation sector to calibrate better the measures and the advice that we give to countries based on the assessment and the evidence that these measures can have on reducing the international spread of the disease. I hope this answers your question. I don't know if Mike can supplement. MR Hi, Jamie, and Happy New Year to you as well. Maybe let me give you one example because you're asking specifically about the science-based approach and, as Carmen has outlined quite correctly, a risk-based approach. If you look at the recommendation made by the committee around vaccination for travellers it says, at the present time the committee does not recommend to include a requirement for proof of vaccination for international travel - not because that won't be a good idea in future but because we are lacking critical evidence regarding whether or not persons who are vaccinated could be infected or continue to transmit disease and because nobody in the world beyond health workers and very vulnerable people have access to the vaccine. 00:37:06 The committee is not saying don't. What the committee is saying is, at this present time scientific evidence is not complete, there isn't enough vaccine and therefore we shouldn't do that now and create an unnecessary restriction to travel, a barrier to travel that's artificial until such a time as we have the evidence and the vaccine. I think that's the way the committee has approached things. This is about taking the principles of science and precaution, using the best evidence one has, using a risk management approach and we appreciate the recommendations of the committee at this time. 00:37:41 But that will change over time and there may be different reasons in future to do that. So we're trying to protect the travel space and ensure that economies are not entirely isolated but recognising that a small island nation is very different to a nation that's land-locked in the middle of a continent. The consequences economically or socially of preventing or stopping travel are different for each individual family, community and country. It can only be made as a decision at that level. There are attempts and very laudable attempts amongst economic integration organisations like the European Union to try and harmonise the rules around travel and I think that's a very positive thing and we should encourage that. Taking a regional and subregional risk management approach is a very positive thing but we have to recognise that it is very difficult to legislate risk management measures at a global level that cover all types of travel in every situation between every country because circumstances change. So therefore taking this risk management approach, applying science as best we can and working within and between governments to ensure that we align those measures in the best possible way, we believe, is the best way forward. 00:38:46 So we do thank the committee for their careful recommendations related to travel and all of the other matters. MK Thanks. I just want to come in on the first part of your comments, Jamie, around the UN press briefings. I just wanted to say I for one have been very proud to sit up here next to Dr Tedros, Dr Ryan and so many other amazing colleagues here at WHO. My first press conference for this pandemic was about a year ago as of yesterday and as of today we've done more than 130 press conferences, we've done more than 50 live Q&As where we answer direct questions. Our press conferences are translated by amazing translators who are sitting in the room and I note, I try to speak more slowly for them as they try to translate our answers to you; six different UN languages plus Hindi, plus Portuguese and we have live captions that are ongoing as well. 00:39:46 It's a privilege for us to do these briefings, to be able to answer these questions to all of you, to journalists, to people in the general communities. We will continue to do so because these are important ways in which - one of the ways in which we get information out so thanks for mentioning that. We will continue to find different ways in which we can communicate but I for one am very proud to sit up here with this amazing group of individuals day in and day out. FC Thank you. I would like now to invite Brazilian journalist, Bianca Rathier from Globo, to ask the next question. Bianca. Can you unmute yourself, please? Bianca, can you hear me? You are muted. Can you please unmute yourself? If not I will move on to ask Sophie Mkwena from SABC, South Africa, to ask the next question. Sophie, can you hear me? SO Yes, I can hear you loud and clear. The Director-General spoke about a need for ensuring that all countries receive these visuals [?] where the front-line workers and the vulnerable people are receiving the vaccine. But it looks like it's doom and gloom to a continent like Africa unless the wealthy nations, particularly the G20; their conscience tells them that, as you often say, Director-General, no-one is free until all of us - no-one is safe until all of us are safe. 00:41:59 It looks like there's no movement from particularly the G7 and the G20 to really invest in COVID. And perhaps with the new incoming President of the United States of America, Joe Biden, next week are you hopeful as he has indicated that his priority will be to rejoin the World Health Organization that perhaps world leaders with America back on board will see a different approach? FC Thank you, Sophie; well understood. I would like to invite Dr Swaminathan to answer your question. SS Thank you, Sophie, for that very important question. This is exactly what the Director-General and the WHO have been saying from the beginning; it's a question of solidarity, finding solutions and then sharing them equitably. Science has played a major role. In the last year we've had amazing progress in diagnostics, in a lot of clinical trials for drugs and of course for vaccines. We are in a position where today a year after the discovery of a new virus we have not one but we have several vaccines that are in development, several the have been approved in certain countries and deployed, one of course that has WHO emergency use listing. 00:43:30 But I was looking at the landscape document that we have on our website and there are over 170 candidates still in preclinical development and 65 in clinical development, 15 of them in phase three clinical trials. That gives a lot of hope. There are more tools, more vaccines coming down the pipeline. In April the Director-General along with many leaders around the world and several global health agencies set up the ACT Accelerator exactly to address the issue of how to accelerate the development of tools but equally, if not more important how to ensure equitable access. So from the very beginning we have recognised and advocated for equitable access and the COVAX facility which WHO runs jointly with GAVI and CEPI was set up to ensure equitable access. As of now we do have a guarantee of at least two billion doses and perhaps a lot more than that at the moment, by the end of 2021 and that's going to go to the 190 countries that have signed up for COVAX. 92 of these are what we call the AMC countries; the countries that are eligible for distribution of vaccines at either no cost or very low cost by GAVI. 00:44:57 We anticipate that the first tranches of vaccines will start going out in the first quarter of this year even though they may be in small volume because we also need to recognise that vaccines do need to go through the stages of testing, they need to complete trials, they need to have data on efficacy and safety, they need to be manufactured in a quality-assured facility. Dr Simao's team has been working hard with a number of manufacturers around the world, anticipating results from the trials, already preparing for the regulatory processes and approvals that need to be put in place. We have at least 13 manufacturers who've expressed an interest and five of them currently in conversation with WHO but these things take time. We cannot rush the elements that need to be fulfilled because billions of people are going to receive vaccine so on the one hand we have to make sure that the vaccines we deploy are safe and efficacious and quality-assured and on the other hand of course countries are preparing to deploy this and WHO, UNICEF, partners, the World Bank have been working closely with countries. 00:45:04 We had a goal of 100 countries to be ready for deployment and that's been done by intense work over the last several months. So we have to wait now for the supplies to get ramped up, to start coming into the facility. We're very hopeful that that's going to start happening very soon. As I mentioned, several vaccines are currently under assessment by our regulatory team and so in the second and third quarter of this year is when we're really going to start seeing volumes but I think people should continue to be hopeful. Vaccines are going to arrive in countries, people are going to get vaccinated, starting with the most at risk group, as Dr Tedros said; all health workers to start getting vaccines in the next 100 days. That's the goal and that's what we are going to get to. Thanks. Bruce might want to add or Mariangela. MS May I complement. I think this is a great question and it's really a moral issue at the stage we live in because I think in an ideal world we would be seeing a different scenario; we would be seeing a scenario where we're understanding that we're living through a global crisis and that no-one's safe until everyone is safe. 00:47:20 In an ideal world we would not be seeing what we're seeing right now. WHO and partners worked for days and days and days to ensure that we put a framework in place that would allow for timely access to all countries, independent of income or availability of resources. But the world we live in is not a fair world and I'm saying this because the COVAX facility is a way for us to reach fairness. We're going to get there and, as Dr Soumya was saying, there are vaccines that are friendlier to the low and middle-income countries' environment. The logistics that are needed to ensure coverage and to ensure that the countries can actually use the vaccine in the priority populations and so on... These vaccines are on the way so what we have is a gap in time when we have now, I think, 46 countries which have started vaccinations and out of these I think 38 are high-income countries. The COVAX facility is there to ensure we can correct the course and make sure that all countries have access to safe and effective vaccines. 00:48:50 This is not happening now in January but it's happening quite soon and we hope to have good news for you on this in February this year. Thank you. FC Thank you, Dr Simao. I would like to make a second attempt to reach Bianca Rathier from Globo. Bianca. BI Hi, Fadela. Can you hear me? FC Now very well. Go ahead, please. BI My apologies; I had a technical problem here. Thanks a lot for trying again. My question is about Brazil. As the UK suspended new arrivals from Brazil over fears of a new coronavirus variant that was detected in Japan from travellers from Amazonas, Brazil's largest state - because in the same state Amazonas hospitals are overwhelmed, collapsing; we have reports of patients dying of suffocation without oxygen. So the state made an urgent call for help from abroad. Is WHO aware and prepared to help? Does WHO believe that the new variant could be contributing to the sharp rise in cases there and what do you know about this new variant, is it more contagious than the UK variant for example? 00:50:20 It seems like a lot of questions but they are all related. FC Thank you, Bianca; very well understood. I'd like to ask Dr Ryan. MR Hi, Bianca. Yes, a lot of questions in there. Yes, we do have a WHO team on the ground in Manaus and we have been working very closely with state-level and federal-level authorities over the last number of months. Our Regional Emergency Director, Sero Orgarte [?], our Incident Manager, Sylvan Aldigeri [?], our Country Representative and others are working very, very closely with our colleagues in Brazil at federal and state level. You are correct; the situation in Amazonas and particularly in Manaus has deteriorated significantly over the last couple of weeks but that's not the only area. Other areas in association with the Amazon have had big problems in terms of their ICU capacity; Rondonia, Amapa; very high rates of positivity, in this case 54 and 46% respectively. 00:51:28 So this isn't just an issue in Amazonas; it's not just an issue in Manaus. This is an issue in many areas of Brazil and in many countries in Central and South America. Again a bit like some of the countries in Europe like my own the holiday period has probably resulted in many people mixing in ways they hadn't mixed before and certainly this is not the winter period in these parts of the world so that's not the factor driving things. It remains to be seen to what extent variants are driving that disease and Maria will speak to that in a minute. There has been a rapid rise in hospitalisations reported in Amazonas since the middle of December. Most of those cases are in Manaus, the capital of the state but they're increasing in other municipalities as well. Clearly if this continues we're going to see a wave that is greater than what was a catastrophic wave in April and May in Amazonas and particularly in Manaus, which is a tragedy in itself. The ICU occupancy right now in Manaus is 100% over the full last two weeks. This is a health system under extreme pressure. More than 4,000 new COVID-19 cases and 50 confirmed COVID-19 deaths per day have been reported, over 2,000 people hospitalised, both suspected and confirmed and over 400 people waiting to be hospitalised who already have COVID. 00:52:54 There are many, many responses going on; the local response team, the incident management team and many others are doing all that they can to continue support but you are correct; there is a shortage in supply of oxygen, there's a shortage in gloves and basic PPE and there's difficulty in transporting oxygen from other states into Manaus. Oxygen is not an easy thing to transport; it's heavy, it's usually in these big cylinders, they're weighty and I'm sure other states and the federal government will come to the assistance of Amazonas and Manaus. Brazil is a country of great solidarity and I think we will see that happen. Another problem - and this is one thing that happens; we've seen before front-line health workers being infected. Of note here is that many, many surveillance officers are now affected by COVID-19; many of the laboratory staff have been affected through community transmission. 00:53:49 This is a situation where your whole system begins to implode because your hospital system, your public health system, your laboratory system; those people are part of the community themselves and they begin to become infected and you go into a negative spiral. There's, I think, a backlog of 7,000 or more samples. This is not a situation that other places didn't face. What I've described there could have been described from New York or northern Italy or any number of places on this planet over the last year. The issue now is how do we get the necessary support both within and outside Brazil to support but if you look at the epidemic curves and, as I said, in Paraguay and Uruguay and Chile and in Argentine, the whole southern cone and all the way up to the Mercosur countries in Central America as well; we've seen a rapid, exponential increase in cases in a number of countries in the Americas, again likely driven, as the DG said in his speech, by that breaking down of basic behaviour, the increased social mixing, the reduction in physical distancing, fatigue and exhaustion with having to manage those measures is driving this. We're going into waves where, as you can see in the case of Manaus, the hospital and health system has already been weakened by previous waves and therefore it's harder for them to suffer a second, third punch. 00:55:12 So the situation is difficult and in this case, in the case of the southern cone and Central and South America it is not new variants driving this transmission. New variants may have an impact down the line and they may be having some impact now and Maria can speak to what we know about that but again it's too easy to just lay the blame on the variant and say, it's the virus that did it. Unfortunately it's also what we didn't do that did it and we have to be able to accept our share individually and as communities, as government, our share of the responsibility in this virus getting out of control while recognising the variants in the virus make it difficult. I've said it before; the opposition has put substitutes on the field, it has more energy. The virus has been energised by the ability to evolve and become better, fitter and better adapted to infecting us. We have got to get more efficient at fighting the virus. There are no easy or other answers and again our solidarity is with the Government and the people of Brazil. 00:56:20 It's entering - obviously with other countries in the Americas - a very difficult phase. We will as an organisation, as always, do everything to support our member states and everything to support the people of Brazil. Maria. MK Thanks, Mike. Just some comments on the virus variants that are being reported. There are some virus variants that have been reported from Brazil and we're working directly with researchers and scientists and amazing public health professionals in Brazil. They have very strong scientific work, sequencing capacities and, as Mike said, we met with our colleagues in PAHO today to get an overview of the current situation. With regard to the virus variants, there is a virus variant that has been reported. They're delineating this the P1 lineage. I won't go into many different names but just to say there are several in Brazil but also in other countries. This mutation, this variant has several mutations that have some known biological importance; the ones you've heard us talk about before; this 501Y mutation and the E484K mutation. 00:57:29 I think what we should do, Fadela, is we should plan a specific live Q&A on these so that we can get into the details of this and go point-by-point because it's a lot to cover in a very short answer. But just to say that WHO and partners have been monitoring these mutations so specific change, one change, or variants which are a collection of mutations and deletions and setting up a monitoring framework to evaluate these mutations and variants of interest and variants of concern. We've presented this to our strategic advisory group, we've presented this to our R&D forum for epidemics. We had an excellent meeting on Tuesday - I think it was Tuesday this week - where we developed a research agenda specifically related to the studies that are necessary to better understand each of these virus variants that are being reported because more and more will be reported. 00:58:30 There's pressure on this virus to change; the more it circulates the more opportunities it has to change so while we are trying to get transmission under control we still have to monitor for new variants. We presented this risk monitoring framework that we have outlined also to the emergency committee where we are working to increase surveillance for the SARS-CoV2 virus circulation using PCR tests, using antigen-based tests, increasing capacity for sequencing. There are a number of efforts that are ongoing around the world to increase sequencing capacity. There's an excellent network across PAHO to try to leverage existing systems. There's a system across Africa as well and we're looking at different ways in which we can enhance sequencing capacity around the world so that we can detect changes in the virus. We're also working with our virus evolution working group, which you've heard me mention many times, to set up a risk assessment framework to say, okay, we see something of interest, what does this mean, what are the studies that are needed to evaluate transmission, severity, neutralisation and any potential impact on diagnostics, therapeutics and vaccines, those that are available and those that will be available in the future. 00:59:52 We had the R&D research meeting this week to outline the suites of studies that are needed to be conducted and we're setting up the collaborations to ensure that our partners that work in labs with good biosafety and biosecurity can carry out the research that is needed to answer these questions. And lastly to make sure that all of this fits into a risk assessment that WHO carries out regularly - we call these our rapid risk assessments - just so that we can put into context what these variants mean. It's a lot of information for me to give in an answer but I provide this because it's not just as simple as to say, we've identified a mutation. There needs to be a system in place to understand what each of these mutations mean, what these variants mean and how it impacts the behaviour of the virus. But as you've heard us say, this virus is dangerous on its own, variant or not and even if it can provide increased transmissibility - and some of them do - we still have tools that could break chains of transmission. 01:00:58 The interventions that have been outlined by WHO, that many countries are using, implementing at a local level based on the local situation work at breaking chains of transmission. Variants and the detection of variants and the emergence of variants makes it harder but we still have some control over this virus. The emergency committee reinforced what we suggested in terms of monitoring this on a global level and said that this needs to be strengthened and so we will work very hard to strengthen that monitoring framework so that we have better eyes and ears on where these virus variants are and we will also be working on a nomenclature so that we will be able to describe these more eloquently to you as they emerge. So it's a work in progress, there's a lot to do but we all have to do as much as we can to prevent as many infections as we can and reduce the pressure on this virus. FC Thank you. Dr Simao. MS I have a very short intervention because I think what's happening in Manaus and Brazil is actually an alert for many countries because you have a resurgence but at the same time you have an enormous break-down of the health system, the structure. 01:02:19 We are seeing this, as Mike has mentioned, also in developed countries so it's not just a matter of poor-resource settings. Manaus had an infrastructure that was put in place for the emergency situation, the horrible, horrific situation we went through in the first months of last year. Because of a false sense of security this was let down and I think this is an important alert to all countries; don't let a false sense of security bring your guard down. If you have built up infrastructure - ICU beds and oxygen distribution points - don't shut it down because it's not over yet. I think we need to learn from what's happening, the terrible situation that Manaus is facing right now. Let's say we can prevent further damage if we take this further message forward and we take it strongly; don't let your guard down, we're not over yet. FC Thank you all for your participation. I would like now to invite Dr Tedros for his final words and also ask if Dr Houssin has any final comments to make; please do. Dr Houssin, do you have any final comments? 01:03:50 DH No, thank you very much, except to reinforce what Mike Ryan said; work, speed and realism are what is necessary at the present time. FC Thank you, Professor Houssin. Over to you, Dr Tedros. TAG Thank you. Thank you so much, Fadela, and thank you to those journalists who have joined us today and bon week-end. Thank you; until we see you in our next presser. FC Thank you, Dr Tedros. Reminding you that you will receive the audio file and Dr Tedros' opening remarks right after this press conference. The full transcript will be posted on the WHO website as of tomorrow. Thank you and have a nice weekend. 01:04:43

Media briefing on COVID-19 - 01/04/2021

00:00:49 CL Good day. Hello and welcome, wherever you are listening to us today. It is Thursday 1st April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference with a special focus on the impact of COVID-19, the success of the ACT Accelerator and the work needed to support equity, especially for the health workforce. For this we welcome two special guest today; first Dr Fahrettin Koca, Minister of Health from the Republic of Turkey, who is actively supporting the International Year of Health and Care Workers; and Carl Bildt, former Prime Minister of Sweden and recently named WHO Special Envoy for the ACT Accelerator. Simultaneous translation is provided in the six official languages, Arabic, Chinese, French, English, Spanish and Russian as well as Portuguese and Hindi. When we get to hear from Ankara we will have Turkish and then English consecutive translation. Now let me introduce the panel in the room. Present are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director of the Health Emergencies Programme of WHO, Dr Maria Van Kerkhove, the Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Bruce Aylward, Special Advisor to the Director-General and the Lead on the ACT Accelerator, Dr Kate O'Brien, the Director for Immunisation, Vaccines and Biologicals and last but not least, Dr Jim Kempel, the Director for Health Workforce. 00:02:38 With this let me hand over to the Director-General for the opening remarks and to welcome our guest. Director-General, the floor is yours. TAG Thank you. Thank you, Christian. Good morning, good afternoon and good evening. This week more than 25 leaders from the G20, G7 and from every region united behind the idea of a pandemic treaty. There is an acknowledgement and humility from those leaders that collectively the world was not prepared for the first coronavirus pandemic ever seen and that going forward we must collectively do better in future outbreaks. There has been a great deal of momentum since the President of the European Council, Charles Michel, and I spoke about this at yesterday's press conference. I am pleased that more leaders are now joining the call for a pandemic treaty which would be a generational commitment to keeping the world safe. 00:03:46 There will always be new pathogens with pandemic potential. It's not a matter of if but when. One key aspect that could be enshrined in the treaty is to... a stronger health workforce which is the very essence of health systems' resilience. An effective health workforce is the key element to pandemic-proofing our health systems. Health and care workers are at the forefront of the response to the COVID-19 pandemic and they play the critical role in protecting us all. Far too many health and care workers have died in the pandemic. Millions have been infected and the pandemic has taken a huge toll on their physical and mental health with devastating effects on their families and communities. Anxiety, depression, insomnia and stress have all increased. Exhaustion is commonplace and there have been cases of stigma and even abuse. I give thanks to those that have stood up in one of humanity's toughest periods. This is the year of the health and care worker and we know that even before the pandemic there was a shortfall of at least 18 million health workers and we work to end the pandemic and recover together. Health and care workers must come first. We must make sure that they're trained, protected and supported to do their job safely and effectively. 00:05:40 As recognised in last week's UN financing for sustainable development report a true recovery from the pandemic requires additional investment in health and in people. These two priorities can be achieved if we invest in the health workforce. Investing in the health workforce is an investment in women and youth. Almost 70% of the global health workforce are women. In particular we must support countries with fewer resources to expand their workforce capacity and pay decent salaries and we must ensure that they are at the front of the line for COVID-19 vaccines. I would now like to turn to Health Minister of Turkey, Dr Fahrettin Koca. Turkey has been a strong champion of 2021 being the year of the health and care workforce. Dr Koca, the floor is yours. FK [Turkish language]. TR Distinguished Director-General, Mr Prime Minister and distinguished participants, COVID-19, which has been a part of our lives for over a year, is the biggest pandemic that the entire world has fought against within the past 100 years. This disease has not only been a health threat but it has also affected our lives in many ways. 00:08:32 Since day one of the pandemic each and every country has been putting up a fight against it within the bounds of their healthcare capacities. Although the methods adopted by countries vary the whole world has become more aware of an idea about the importance of healthcare workers in our lives. This powerful idea has led to the birth of a new set of ethics for healthcare workers. To elaborate,i would like to refer to a principle from the fourth century BC from the Hippocratic Oath which reads, primum non nocere. In Turkey and in other countries people have witnessed one thing; healthcare workers whose main principle is not to harm the patient, embrace the possibility that they can be harmed themselves. It is this testimony that is the foundation of the new set of ethics that is beginning to develop and this is the very testimony that has improved the status of healthcare workers and societies. The heroes of these times when people seek trust in fear are healthcare workers. 00:11:41 There is another factor in the background for this newly emerging ethics. Before the pandemic healthcare was between the individual and the healthcare worker. However with the pandemic this relationship morphed into a broader and more encompassing one. In line with all of this we are aware of the fact that societies are willing to take healthcare workers to a higher position. What decision-makers will do for healthcare workers is what societies demand. Distinguished participants, Turkey's response to the pandemic is well-known both to our people and the world and we have been taking strength from our well-trained, equipped, dedicated and selfless healthcare workforce. We all know that when the need arises healthcare workers rush to the fronts by the very nature of their profession. This pandemic has been the proof of this. While they perform their work various roles and duties fall upon the rest of society and on the decision-makers. 00:13:59 Societies that can adopt necessary policies bearing in mind this responsibility will be able to offer great support to boost the morale and motivation of healthcare workers and to relieve their burden. As a demonstration of this understanding we have introduced and implemented timely and effective policies in a variety of issues such as supplying high-quality and sufficient protective equipment, offering timely and science-based information about current developments and providing socio-economic and moral support. Alleviating the burden on healthcare workers by employing new people has been a priority for us. Another priority has been to take measures to improve the productivity of healthcare workers such as redefining and redistributing roles and responsibilities and delaying non-urgent procedures. Of course none of these steps can make up for the selfless efforts of our healthcare workers. Their selfless efforts should definitely go down in history. Societies are aware of the need to honour such work. This is the very motivation behind the idea of declaring 2021 the international year of health and care workers, for which we have been a strong advocate since day one. 00:17:59 Esteemed participants, Mr Director-General has posted about a very important issue recently, noting that healthcare workers had saved the world and it was now the world's responsibility to protect them. He underlined that health and care workers around the world should have access to a COVID-19 vaccine as soon as possible. I support this call wholeheartedly. With this understanding I have to note that we have completed vaccinating one million healthcare workers in our country in only 45 days. Even though we have yet to produce our own vaccine I would like to note that we have shared a portion of the vaccines we have supplied with other countries to be delivered to healthcare workers. We have another responsibility which is to ardently advocate for the access of healthcare workers to vaccines. As Turkey we have taken on a facilitating role by building diplomatic bridges between vaccine-producing countries and those having problems accessing them. 00:20:11 I am glad to say that we have achieved concrete results out of these initiatives. Distinguished Director-General, I would like to also highlight that our own vaccine production efforts are still ongoing at full speed. We believe that we will soon be producing our own vaccine and when that happens rest assured that your call on vaccine-producing countries will be met with a clear response in Turkey. Distinguished participants, not only one single day but the whole year of 2021 has been dedicated to health and care workers. Many activities will be held on this occasion throughout the year. We are committed to making the most active contribution to these events. We will continue to advocate for the process through ideas, projects and events on international platforms, especially the platforms of the United Nations. Together we will mobilise the sense of duty and gratitude of the whole world. We will try to further improve the status of healthcare workers, the status of their professions as required by our ethical responsibilities. Stories of heroism are being told from large cities to the most remote corners of the world in hundreds of different languages. These stories are now needed to be told in the common language of humanity. 00:23:29 The battle against the pandemic is also fought in uniforms. These uniforms bring out compassion in people and right now is the time when we should write down history. For this purpose as a first step we are working on creating a digital platform with WHO to serve as a memorial dedicated to health and care workers. Tedros, my dear friend, I expect your personal support for this platform. As I conclude I would like to give the following message to all healthcare workers around the world. The whole of humanity is grateful to you right now and humanity will find the best way to express this gratitude. Thank you. TAG Thank you. Thank you so much, Your Excellency, Dr Koca. I'm glad that vaccines are rolling out to health workers in this difficult period in the pandemic and look forward to working with you closely. Thank you so much. Teşekkür. 00:25:28 The clock is still ticking on vaccine equity. We have nine days left until we reach the 100th day of the year and the target of starting vaccine roll-out to health workers and those at risk in all countries remains in our grasp. COVAX has already delivered 35 million doses to more than 78 countries but there is still a serious challenge on vaccine equity and availability. Last week I made an urgent request to countries with doses of vaccines that have WHO emergency listing to share ten million doses immediately with COVAX. The extra ten million doses will be an urgent stopgap measure so that 20 countries which are ready but haven't got the supply needed to start vaccinating their health workers and older people could begin before the 100th day, 10th April. I also requested manufacturers help ensure that the countries that step up can rapidly donate those doses. This challenge has been heard but we've yet to receive commitments for these doses. I'm still hopeful that some forward-looking and enlightened leaders will step up. I know this is a challenging time for many countries as cases and hospitalisations are spiking but conversely it's when cases are spiking that it's the most important time to share vaccines equitably and protect health workers and at-risk communities. The race is on to get vaccines to those places and groups where they can have the greatest impact. We're not in a race against each other. We are in a race against the virus and over the last year the ACT Accelerator has been critical for ensuring that new vaccines, life-saving oxygen, corticosteroids for severe disease and rapid tests are being shared more equitably. Today I'm happy to welcome former Prime Minister of Sweden, Carl Bildt, who I appointed as WHO Special Envoy to the Access to COVID-19 Tools Accelerator. Carl will help lead the collective advocacy for the ACT Accelerator, mobilising support and critical resources so it can deliver against its strategy for 2021. My friend, Carl, the floor is yours. Tack så mycket for joining us. CB Thank you, Director-General. I have to start by saying I'm honoured and I'm humbled by the fact you have appointed me Special Envoy to start working with the ACT Accelerator. I am thoroughly impressed with what has been achieved in an absolutely unique situation where we have a global challenge of a magnitude that we haven't seen in living memory anyhow if we look at how things are. 00:29:02 I think the ACT Accelerator has been a critical instrument in mobilising resources and in co-ordinating the activities of a very diverse set of actors. Without that co-ordination mechanism I doubt that what has been achieved would have been possible to achieve. Then of course we're all in a situation where we would like everything to be done by now in terms of vaccines, [unclear], treatments, and whatever but we are in a phase where efforts are in a phase of acceleration all over the world. I'm convinced that everyone is doing their very best to make this as fast and as secure and as safe as is possible. I hope that I can make my contribution to this work as well. I'm certainly not a medical expert; no-one expects me to have any firm views on that but I have a fair amount of experience on working in politics and working in the international community, trying to get the different parts of that wide community to work towards the same goal. 00:30:11 I think that is of course more important now than on perhaps any other of the global challenges that we have been seeing during the last few decades. Lots on the agenda; mobilising resources, distributing vaccines, as the Director-General mentioned; COVAX, the ramping-up of production and all of that but also mobilising resources. We still have a funding gap with the ACT Accelerator different efforts [?] in the order of $22 billion. That's a fair amount of money but if you compare it with the amount of money that the government are spending - rightly so - in order to sustain their economies it's less than 1% of that money. We know of course that if we don't get the pandemic under control that money's not going to be enough so I hope it will be possible to mobilise that money. It's an effort with the co-chairs of the facilitation council, Norway and South Africa being very active but I hope I can make my contribution to that as well. I leave the Director-General with that; much ahead; I look forward to it. It's a task that is, mildly speaking, urgent and all efforts by everyone are welcome. 00:31:38 CL Thank you. Thank you so much indeed and thank you for your inspiring words and look forward to working with you very closely. I couldn't agree more and believe that with your support we can take the ACT Accelerator to the next level, overcome vaccine nationalism so that we defeat this pandemic and recover together. Tack så myckete again. Christian, back to you. CL Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. We have a long list already and therefore I ask you to only ask one question at a time. We'll start with Bayram Ayturk from Anadolu agency. Bayram, in case you want to ask in Turkish I would ask you to please also immediately after ask your question in English to make it easier for us here. Thank you very much. Bayram, please unmute yourself. BA Can you hear me? Hello, Christian. CL Yes. Go ahead, please. BA Thank you for taking my question. I'll ask my question in English. My question is for the Minister of Health of the Republic of Turkey. Mr Koca, Director-General Dr Tedros has spoken man times of the importance of having solidarity across the world in using resources to fight the COVID pandemic. How do you assess Turkey's contribution to this process and what has its contribution been to the world? 00:33:15 Also Turkey is a leading country giving priority to vaccinating health workers so can you comment on where Turkey is regarding the production of vaccines and supply of vaccines? Thank you. CL Thank you very much. Your Excellency, Dr Koca, please. Your Excellency, Dr Koca, could I ask you to reply. TR [Turkish language]. FK [Turkish language]. TR Thank you for the question. Yes, as you have mentioned, Mr Director-General has stressed many, many times since the start of the pandemic the importance of solidarity and international co-operation. 00:37:50 In that regard I would like to say that Turkey has supported 158 countries with personal protective equipment, diagnostic kits and ventilators. Also we have cooperated very closely with 14 international organisations including the WHO and I myself personally held meetings with the Ministers of Health of 20 countries throughout this period. Also we have a COVID-19 scientific board here in Turkey and they have shared their experiences with experts of 13 countries. So in terms of your question about the vaccine, we have 18 vaccines right now that are in WHO's list and one of these vaccines is in phase two right now and we will proceed to phase three in about a month. This is an inactive vaccine, by the way. Also we have four vaccines that are currently in phase one and we believe that by August or September we will have the first vaccine complete and ready. Our President has also sent a clear message. He said that more than 1,000 countries have yet to have access to a COVID-19 vaccine. That's why he said that when Turkey is able to produce its own vaccine that vaccine will definitely be offered for the use of the whole of humanity. Right now 100 countries do not have access to a COVID-19 vaccine, which is why the vaccine to be produced in Turkey will be offered for the whole of humanity. By the way, we will also work on not only the inactive vaccine but also MRNA vaccines, virus particulate-based vaccine and also we are working on an intranasal vaccine which will be in phase two in two to three weeks. Thank you. 00:40:15 CL Thank you very much, Your Excellency. Let me move to the next question from Gunila Van Hal, Svenska Dagblad. Gunila, please unmute yourself. GU Can you hear me? CL Very well. Go ahead. GU Thank you. Thanks for taking my question. It is to Carl Bildt and it is about access to vaccine. WHO is urging governments to share excess vaccine doses with low-income countries in need once their own risk groups have been vaccinated. How do you think this could be perceived as reasonable and motivated in countries like Sweden and others that have waited for a long time to get vaccines at all and where many people below 65 are waiting to be vaccinated? 00:41:03 If I may just squeeze in one short question to you, how are you going to convince countries to contribute more to the ACT Accelerator? Thanks. CL Mr Bildt, can I invite you. CB Yes, two questions. Certainly first the money, as I said, a huge amount of money but if you compare it with the money that is now spent on sustaining economic recovery it's really a very limited amount; it's less than 1% of the stimulus money that is available, be that in the US or in the EU, to take those two big ones. Of course most of this money, although we would like everyone to contribute, will have to come the major rich countries. So lots of money but if you compare it with the other money that we were forced to spend as a result of the pandemic not very much. Second question, yes; I don't need to tell this to you, I've been in politics for some time and I can see the pressures that every political leader, every prime minister; every health minister is under pressure in every country because everyone wants to have the vaccine and wants to have the vaccine yesterday. 00:42:19 But I think it's very important also that they all are ready to take the broader perspective, that they really understand that no-one is really safe until everyone is safe and we have a self-interest, be that in Sweden or the United States or India or Portugal or South Korea, that the pandemic is brought under control because the risk is, as we know, that otherwise we might get new mutations, new variations which might even undo what we have already done. If I look at the figures of course the EU has been exporting quite a lot during the past few months, which I think has been positive if I take it only from the EU perspective that you ask about. CL Thank you very much, Mr Bildt. We'll now move to the next and that's Nina Larson from AFP. Nina, please unmute yourself. NI Hi, can you hear me? CL Very well. NI Great. Thank you for taking my question. I have question for Dr Tedros. In your briefing to member states about the origins report earlier this week you said it was a very important beginning but not the end. Has it been agreed that the next phase in this process also must involve investigations in China and when do you think this phase two could get underway? Have you had talks with Beijing about a fresh international expert mission to the country? Thank you. CL Dr Tedros, please. TAG Thank you very much for that question. Of course there are many recommendations made by the team from the report - I hope you have read the report so there will be follow-up assessments - so that's what we expect but we haven't yet discussed because the report was just released last Tuesday. We will start engagements as soon as possible. Thank you. CL Thank you very much, Director-General. Now we'll move to Sara Teofilo from Cabreo Brasiliense. Sara, please unmute yourself. SA Hi. Thank you for taking my question. In Brazil we're seeing our worst moment in the epidemic. Yesterday we had more than 3,800 people killed by COVID, which was a record. States and cities have implemented some restrictive measures in recent weeks, which were widely criticised by our President but many have already backed down and as we all know, we are the second country in total number of victims of COVID. Knowing that we have a slow pace of vaccinations because we don't have enough vaccines, what results should we expect if aggressive measures are not taken? 00:45:19 Are we going to have more people killed by COVID than the US and how could international organisations and governments help Brazil with vaccines and medicines? Thank you. CL Dr Van Kerkhove, please. MK Yes, I will start and then I'm sure others will come in. There was a very important live Q&A that occurred earlier this week with Dr Mariangela Simao and others in Portuguese so I do encourage you to look at that if you haven't had a chance to talk about the situation. Indeed there's a very serious situation going on in Brazil right now where we have a number of states that are in critical condition. I understand that the Brazilian Ministry of Health has stated that six states are in critical condition and nationwide the hospitals are overwhelmed with most ICUs are over 90% capacity. 00:46:14 We're aware of a recent survey that was carried out by the National Council of Health Secretaries finding that more than 6,000 people were waiting for an ICU bed, 6,000 people with COVID-19 waiting for an ICU bed so indeed there is a critical situation there. The challenges are many in terms of increased transmissibility with this P1 variant that has been detected, that is circulating in the country. If you have increased transmission or a more transmissible virus you'll have more cases, which can overwhelm a health system that is already overwhelmed. Our regional office in PAHO with our country office are working with the states, working with the country to make sure that they have the right provisions in place to be able to care for patients, to get oxygen in, to provide the support that is necessary but indeed it is a critical situation. We do know that with this P1 variant that it is predominant in about 13 states, I think it's about 13 states as of right now and we do see that hospitalisations and ICU are increasing across all age groups, including younger age groups between 20 and 60 years old requiring hospitalisation and also ICU so there's a lot underway. 00:47:32 I do know that vaccination is increasing so someone else may want to comment on the proportion of the population that is receiving vaccination because I don't have those latest numbers there. I'll pass to Mariangela but it is important that the measures that are in place include vaccination. We still need to make sure that the public health and social measures, the distancing, the mask-wearing, the hand hygiene and making sure when you do wear a mask that you wear a mask with clan hands, that you touch the mask, you put it on, you take it off, you wash it, you dispose of it if it's a single-use mask appropriately, that you avoid crowded spaces, you limit the number of contacts that you have, try to just mix with the individuals within your household. All of those measures, I know, are incredibly difficult to still adhere to 16 months into a pandemic when everybody is exhausted but those measures are still in place in addition to vaccination. Mariangela, maybe you want to comment on the vaccination. 00:48:33 MS Thank you. I'm going to speak in Portuguese. TR Thank you very much for the questions and of course the WHO is very concerned with what is going on in Brazil. On the one hand the local production of vaccines is very important right now in Brazil. Despite the fact that Brazil is receiving vaccines through the COVAX facility Brazil can actually create its own vaccines and produce them via Butanta and Fia Cruz [?]. This is essential right now considering the pressure that is being put on supplies of vaccine. I wanted to just support what was said by Dr Maria Van Kerkhove. We need to not just be placing all our bets on the availability of vaccines. Even when there is greater vaccine coverage it is also very important that the authorities say that it is necessary to still stick to prevention measures such as avoiding crowded spaces, using masks, hand washing. That means that it is very important that we do not fall into a false sense of security regarding the quantity of vaccines. I think right now healthcare professionals and those over the age of 68 have now started being vaccinated. 00:50:18 Nonetheless it is right now when there is high transmission that we need to continue to be very vigilant, especially in urban centres. Thank you. CL Thank you very much both. Let me move to Mariella Skukta from [Unclear] TV, Albania. Mariella, please unmute yourself. MA Hello, everyone. CL Please go ahead. MA First of all I want to start by saying thank you for always being so professional and answering all of our concerns. I know this might sound a bit bizarre but on 5th April Albania will be going into the parliamentary elections and our Prime Minister, Edi Rama, has often stated that if the opposition wins the election the Albanian citizens will no longer have access to vaccine. As I said, it sounds bizarre but the general public might be concerned about this statement being true so my question is, is the statement true or false? Will or will not the Albanian citizens have access to vaccines in the case of the opposition winning the election? Thank you very much. 00:51:42 CL Thank you very much, Mariella. I don't think we can give a political answer here but I could ask Dr Aylward if there's anything about vaccine supply in general through COVAX. BA Thank you, Christian. The question just reinforces the importance of ensuring all peoples everywhere have access to vaccination, especially healthcare workers, as we heard from His Excellency, the Minister from Turkey today and others, the Director-General, and then of course the older population and then onward through the high-risk populations. The goal of the COVAX facility of which Albania and others are members is to ensure that all countries and all populations have access. That is the key to getting out of this irrespective of the situation or circumstances of an individual country or economy. CL Thank you very much, Dr Aylward. We move to Catherine Fiancon of France 24. Catherine, please unmute yourself. 00:52:47 CA Thank you, Christian. Good afternoon to all of you. I have a question about treatments. At the beginning of the pandemic we spoke a lot about treatments and vaccines but during the conferences we don't talk a lot about treatments so I would like to know a bit about that, particularly about preventive nasal treatments. There are some products that have been manufactured by Israel and Canada. What is your opinion about that, is it useful? Thank you. CL Thank you very much, Catherine. I have Dr Van Kerkhove to start. MK I can give a general answer to that and in fact Mike and I did a live yesterday where we were asked quite a lot about treatments because there is much more work that needs to be done on treatments for COVID-19. We do have the dexamethasone for patients who are severe and critical. This saves lives and we know that there are other measures that can be put in place that save lives so first of all it's prevention. 00:53:52 Secondly if people are ill that they enter the clinical care pathway early so that they receive the appropriate care depending on the severity of their illness, that they have their oxygen saturation checked, that they receive oxygen. Oxygen saves lives and WHO with partners has been working around the world to ensure that oxygen reaches countries around the world so that patients can receive this life-saving care. There are a number of therapeutics that are in developing looking at early-stage treatment. More work needs to be done in this area, there's no question about that. Our clinical teams are evaluating the studies that are coming out through these clinical trials and as the data come out they will be able to make recommendations as the data allow in terms of enough numbers and results so that they can activate the system to start to pool together the data from all of the clinical trials so that we have enough cases to be able to assess their efficacy. So that is something that is underway. CL Dr Aylward, please, to add. BA Thank you, Chris, and further to the point that was just made by Maria, the question is so valuable because the reality is we don't talk enough about treatments and what can be done for people suffering with COVID and particularly severe COVID-19. 00:55:19 Because, as Maria highlighted, dexamethasone is now available, saves lives combined with oxygen can have a tremendous impact and these simple interventions, we're learning more and more, are not available in enough places to be able to ensure the maximum impact. So as we talked about a couple of weeks ago with the launch of the new strategy for the ACT Accelerator for 2021, a huge part of the emphasis will be on not only ensuring that the vaccines are getting out there and getting to all populations but that we're also getting the rapid diagnostic tests out there to guide treatments and of course we're getting the oxygen and the dexamethasone. So just a thank you for the question because the reality is we do not talk enough about some very simple, relatively inexpensive and certainly unaffordable interventions that could make a huge difference for people suffering severe disease. 00:56:14 CL Thank you very much both. With this we've come to the end of our question-and-answer session. I would like to invite our special guests to give their closing remarks and we of course would like to start with His Excellency, Dr Fahrettin Koca, Minister of Health of the Republic of Turkey. The floor is yours, sir. FK [Turkish language]. TR Thank you very much. I believe that in terms of access to vaccines the world is faced with a very difficult condition and an obstacle so I think we should be able to produce vaccines everywhere, all over the world without intellectual property rights being a problem. That's why I think we need to be taking concrete steps about this issue. Thank you very much for your attention. CL Thank you very much for these remarks. I'll ask Carl Bildt, the former Prime Minister of Sweden and now WHO Special Envoy for the ACT Accelerator, for his comments. CB Yes, I can only say related to the question that was coming in from Albania related to the election campaign that is underway there that I think we all recognise that this is a race; humanity versus the virus. 00:58:16 We live in a world where there are a lot of political tensions between different countries and certainly within countries between different political parties, be there elections or not. But this is a time when these things should be put aside and the fight against COVID should be above all of this and should not be used for political purposes, be that a political purpose of an external nature, foreign policy or be that of a domestic nature, one way or the other. This is all of us, humanity versus the virus and it's important that it's seen in that context. CL Thank you so much, Carl Bildt, for these words. Before I hand to Dr Tedros for the final remarks thank you all for the participation. We will be sending the audio file and the remarks of our special guests and Dr Tedros right after the press conference. The full transcript will be posted on the WHO website tomorrow morning. Any further questions, please don't hesitate to contact mediaenquiries@who.int With this, Dr Tedros, the floor is yours. 00:59:27 TAG Thank you. Thank you so much. I fully agree with what former Prime Minister Carl Bildt said on this virus; the most important weapon is national unity and global solidarity. We have been saying this for a long time and I fully agree with him that this fight is humanity against the virus, directly quoting him of course. So any country should actually unite around the fight against this virus. Any divisions or cracks between us will only give opportunity to the virus. Then to what the Minister said I fully agree; local production is very, very important and WHO is ready to help countries. I think going forward the vaccine equity could be addressed by increasing local and regional capacity in production and we have been calling also for intellectual property waivers to help expand the production capacity significantly. With that, thank you so much to our guests, thank you for joining us today and also thank you to the media members for joining us. I look forward to seeing you next week. Happy Easter and also have a nice weekend. Thank you so much.

Coletiva de imprensa: anúncios do Governo - 31/03/2021

O Governador João Doria anunciou nesta quarta-feira (31) a antecipação, para esta sexta-feira (2), do início da vacinação contra a COVID-19 para idosos com idade acima de 68 anos. Dados do Plano Estadual de Imunização (PEI) indicam um total de novas 340 mil pessoas aptas a receberem a primeira dose no Estado de São Paulo. “Vamos acelerando a vacinação nas faixas etárias a partir dos 60 anos e tendo a possibilidade hoje de anunciar que, já nesta sexta-feira, as pessoas com 68 anos estarão sendo imunizadas nos postos de vacinação em todo o estado de São Paulo. A vacina no braço é a vacina da vida”, disse Doria. Também em abril, 530 mil profissionais de Educação e forças de Segurança também poderão receber vacinas. A campanha ocorre com uma grande operação logística montada para a distribuição das vacinas disponíveis no país, com envio de remessas semanais pela Secretaria de Estado da Saúde para todas as regiões do estado. Nesta quarta-feira (31) ocorreu a liberação de mais 3,4 milhões de doses da vacina do Instituto Butantan contra o coronavírus para uso em todo o país. Somente essa semana foram entregues 8,4 milhões ao PNI (Programa Nacional de Imunizações) do Ministério da Saúde. No mês de março o montante chega a 22,7 milhões de doses, quantitativo maior do que o disponibilizado em janeiro e fevereiro juntos. O pré-cadastro no site “Vacina Já” (vacinaja.sp.gov.br) economiza 90% no tempo de atendimento para imunização: leva cerca de 1 a 3 minutos para quem preencheu o formulário. Presencialmente, em média, a coleta de informações leva cerca de 10 minutos. A ferramenta ajuda a agilizar o atendimento e a evitar aglomerações. Não é um agendamento e o uso não é obrigatório para receber a vacina, mas utilizá-la contribui para melhorar a dinâmica dos serviços e a rotina do próprio cidadão. O pré-cadastro pode ser feito por familiares de idosos ou de qualquer pessoa que participe dos públicos previstos na campanha.

SP amplia a produção de oxigênio

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

SP não corre o risco de ficar sem oxigênio nos hospitais

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

Coletiva de imprensa: anúncios do Governo - 22/03/2021

O Vice-Governador Rodrigo Garcia anunciou nesta segunda-feira (22) que o Hospital Vila Penteado, na zona Norte da capital, será exclusivo para atendimento de pacientes com coronavirus. “São 196 leitos dedicados a pacientes COVID. A medida ajuda na logística da distribuição de oxigênio e de insumos”, disse o Vice-Governador. om 10 novos leitos de UTI, o hospital passa a ter 55 leitos. A enfermaria passa a dedicar seus 141 leitos para estes pacientes, o que representa 91 leitos a mais reservados para COVID-19. A partir desta terça-feira (23), o Pronto Socorro passa a atuar de forma referenciada, ou seja, recebendo exclusivamente pacientes levados por Samu e Resgate ou transferidos de outros serviços de saúde. Banners estão sendo fixados nas entradas do serviço para orientação à população. O único serviço mantido como não-COVID no Hospital Vila Penteado será a UTI de queimados, em espaço separado e seguro para estes casos, para os quais a unidade é referência. Com o recrudescimento da pandemia, o hospital tem atuado com taxas de ocupação de 100% nas últimas semanas. Todas as demais patologias que eram atendidas no hospital já começaram a ser absorvidas por outros hospitais de alta complexidade da zona Norte. O Conjunto Hospitalar do Mandaqui e os hospitais Gerais de Taipas e Vila Nova Cachoeirinha receberão os casos de Ortopedia, Buco-maxilo, e gestantes, que contam com assistência também na Maternidade Municipal Cachoeirinha, com apoio da Prefeitura de São Paulo. Mais leitos Nesta semana também ocorre a ativação de 90 leitos de UTI e 106 de enfermaria em hospitais estaduais da Grande São Paulo. Na Capital, as expansões ocorrem nos Hospitais de Guaianazes, Grajaú, Regional Sul, Ipiranga, Instituto Emílio Ribas e no Dante Pazzanese. Nas cidades vizinhas, as ampliações englobam o Hospital Geral de Pirajussara, em Taboão da Serra; o Hospital Geral de Carapicuíba; o Hospital Padre Bento, em Guarulhos; e o Hospital Geral de Franco da Rocha. Todos estes leitos fazem parte da expansão da rede de saúde anunciada no começo do mês pelo Governo de São Paulo, que prevê mais de 1 mil novos leitos e 12 hospitais de campanha. O resumo com as informações anunciadas durante a entrevista coletiva desta segunda-feira está disponível no link: https://issuu.com/governosp/docs/apresenta__o_sa_de_0b20e37450de87.

AFN Acessibilidade - Semana de 25/01 a 29/01

Com o objetivo de ampliar a divulgação de notícias sobre Covid-19 para pessoas com deficiências auditivas, a Coordenação de Comunicação Social (CCS/Fiocruz) lançou um programa semanal que reúne as principais notícias publicadas na Agência Fiocruz de Notícias (AFN) traduzidas para a Língua Brasileira de Sinais (Libras) e com áudio em português.

Meeting oxygen requirements of rural India: A self-contained solution.

Addressing oxygen requirements of rural India should aim at using a safe, low-cost, easily available, and replenishable source of oxygen of moderate purity. This may be possible with the provision of a self-sustaining oxygen concentrator (pressure swing adsorption with multiple molecular sieve technology) capable of delivering oxygen at high-flow rates, through a centralized distribution system to 100 or more bedded rural hospitals, with back up from an oxygen bank of 10 × 10 cylinders. This will provide a 24 × 7 supply of oxygen of acceptable purity (~93%) for the treatment of hypoxemic conditions and will enable hospitals to specifically provide for high-flow oxygen in at least 15% of the beds. It may also serve as a facility for a local refill of oxygen cylinders for emergency use within the hospital as well as to subsidiary primary health centers, subcenters, and ambulances, thereby nudging our health-care system toward self-sufficiency in oxygen generation and utilization.

A feasibility study evaluating a reservoir storage system for continuous oxygen delivery for children with hypoxemia in Kenya.

BACKGROUND: Supplemental oxygen is an essential treatment for childhood pneumonia but is often unavailable in low-resource settings or unreliable due to frequent and long-lasting power outages. We present a novel medium pressure reservoir (MPR) which delivers continuous oxygen to pediatric patients through power outages. METHODS: An observational case series pilot study assessing the capacity, efficacy and user appraisal of a novel MPR device for use in low-resource pediatric wards. We designed and tested a MPR in a controlled preclinical setting, established feasibility of the device in two rural Kenyan hospitals, and sought user feedback and satisfaction using a standardized questionnaire. RESULTS: Preclinical data showed that the MPR was capable of bridging power outages and delivering a continuous flow of oxygen to a simulated patient. The MPR was then deployed for clinical testing in nine pediatric patients at Ahero and Suba Hospitals. Power was unavailable for 2% of the total time observed due to 11 power outages (median 4.6 min, IQR 3.6-13.0 min) that occurred during treatment with the MPR. Oxygen flowrates remained constant across all 11 power outages. Feedback on the MPR was uniformly positive; all respondents indicated that the MPR was easy to use and provided clinically significant help to their patients. CONCLUSION: We present a MPR oxygen delivery device that has the potential to mitigate power insecurity and improve the standard of care for hypoxemic pediatric patients in resource-limited settings.

Covid-19 ­ uso racional do gás oxigênio (O2) / Covid-19 - rational use of oxygen gas (O2)

A pandemia do novo coronavírus trouxe grande sobrecarga aos sistemas de saúde de todo o mundo, especialmente aos países de baixa e média renda (BONG CL et al, 2020). O atraso da vacinação tem agravado a situação nestes países, aumentando o índice de novos casos e a mortalidade pela doença (WHO, 2021). Um dos problemas enfrentados tem sido a escassez da oferta de oxigênio (O2) hospitalar. Agências internacionais como Wellcome Trust, Unitaid e MS criaram uma força tarefa em busca de uma resposta emergencial para a situação, estimando a necessidade de um aporte financeiro de cerca de 90 milhões de dólares, a fim de se evitar mortes preveníveis pela falta de oxigênio para o manejo clínico dos pacientes hospitalizados por COVID-19 (USHER AD, 2021).

The pandemic of the new coronavirus has brought great burden to health systems around the world, especially to low- and middle-income countries (BONG CL et al, 2020). The delay of vaccination has aggravated the situation in these countries, increasing the rate of new cases and mortality from the disease (WHO, 2021). One of the problems faced has been the scarcity of hospital oxygen (O2) supply. International agencies such as Wellcome Trust, Unitaid and MS have set up a task force in search of an emergency response to the situation, estimating the need for a financial contribution of about US$90 million in order to avoid preventable deaths from the lack of oxygen for the clinical management of patients hospitalized by COVID-19 (USHER AD, 2021).