Saúde Baseada em Valor / Value-based health

A maneira pela qual o recurso financeiro é alocado ao prestador de serviços de saúde pode ocorrer por diferentes formas (brevemente descritos abaixo) e a Saúde Baseado em Valor (SBV) é uma opção que surgiu acompanhando a tendência de ampliação da produção de experiências e conhecimento relacionados ao financiamento da atenção a saúde, à implementação de modelos alternativos de pagamento baseados em valor, vinculados ao aumento da qualidade assistencial e à necessidade de redução de desperdícios na prestação dos serviços de saúde

The way in which the financial resource is allocated to the health service provider can occur in different ways (briefly described below) and Value-Based Health (BVS) is an option that emerged following the trend of expanding the production of experiences and knowledge. related to the financing of health care, the implementation of alternative value-based payment models, linked to the increase in the quality of care and the need to reduce waste in the provision of health services

WHO’s Science in 5 on COVID-19 : medical oxygen

Medical oxygen is an essential medicine in the treatment of COVID-19. How is it used? Why is there a shortage in some countries and what are WHO, partners and Governments doing about it? WHO’s Dr Janet Diaz explains in Science in 5.

Media briefing on COVAX starting COVID-19 vaccine rollout

Media briefing on COVID-19 with Dr Tedros & Dr Keith Rowley, Trinidad & Tobago Prime Minister - 18/02/2021

00:00:09 FC Good afternoon, everyone. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Thursday 18th February. We have simultaneous interpretation in the six official UN languages plus Portuguese and Hindi. Today we are pleased to be joined by Dr Keith Rowley, the Prime Minister of the Republic of Trinidad and Tobago. Let me introduce to you the WHO participants. Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals, Dr Peter Ben Embarek, International Team Lead on the WHO-convened global study on the origin of SARS-CoV-2. Now without further delay I would like to hand over to Dr Tedros for his opening remarks and to introduce our guest. Over to you, Dr Tedros. TAG Thank you. Thank you, Fadela. Good morning, good afternoon and good evening. Just over a year ago WHO launched its first strategic preparedness and response plan for the COVID-19 pandemic. 00:01:52 The SPRP outlined the comprehensive response needed and which many countries have followed successfully to suppress transmission, protect the vulnerable and save lives. With an ask of US$1.7 billion the first SPRP saw an unprecedented response. With the support of member states and donors we raised US$1.58 billion, over 90% of which was allocated to countries and regions, getting vital funding to those at the front line of the pandemic and supporting WHO's core scientific and technical work. It also enabled WHO and our partners to ship millions of tests and items of personal protective equipment and to support thousands of ICU beds around the world. We deployed 191 emergency medical teams, supported seroepidemiological studies in 58 countries, offered 150 online training events reaching 4.7 million participants and much more. 00:03:06 Today we're proud to launch the strategic preparedness and response plan for 2021. The new plan builds on last year's SPRP with six objectives; suppress transmission, reduce exposure, counter misinformation and disinformation, protect the vulnerable, reduce death and illness and accelerate equitable access to new tools including vaccines, diagnostics and therapeutics. The financial need to meet these objectives is US$1.96 including $1.2 billion for the WHO component of the ACT Accelerator and 643 million will go towards supporting people in need of humanitarian assistance in fragile, conflict and vulnerable settings. The SPRP also recognised the need to fully integrate the COVID-19 response into planning for health and development programmes. Fully funding the SPRP is not just an investment in responding to COVID-19. It is an investment in the global recovery and in building the architecture to prepare for, prevent and mitigate future health emergencies. At the beginning of the year I issued a call to action to ensure that vaccination of health workers was underway in all countries within the first 100 days of the year. Tomorrow marks the halfway point and we have made progress but we are not there yet. 00:04:54 With the emergency use listing of two versions of the AstraZeneca vaccine this week COVAX is ready to roll out vaccines and is waiting for several manufacturers to make good on their commitments. The world is moving closer to delivering the promise of vaccine equity. Vaccine equity will be on the agenda at both the G7 leaders' meeting and the Munich Security Conference tomorrow. Tomorrow WHO will also launch a new declaration focused on vaccine equity and I have been encouraged by the support we have received from hundreds of organisations and thousands of people. Health worker groups, international agencies, religious groups, youth movements, sporting bodies and others have all signed the declaration. The declaration calls for action from several groups. It calls for political leaders to increase contributions to the COVAX facility and to share doses with COVAX in parallel with their own national vaccine roll-out. 00:06:07 It calls for vaccine manufacturers to share know-how with the COVID-19 technology access pool to scale up vaccine manufacturing and dramatically increase the global supply of vaccines. It calls for regulatory bodies to accelerate the approval processes in a safe and effective way. It calls for ministries of health to work with WHO and others to invest in and prepare their primary healthcare systems for distribution of COVID-19 vaccines to health workers and to develop data systems on vaccine supply, distribution and update. And it calls for all governments to ensure that COVID-19 vaccines are distributed free at the point of care without risk of financial hardship, starting with health workers. Vaccine equity is especially important for fragile and vulnerable groups and for small island states like those in the Pacific and Caribbean with small populations who can miss out on vaccines because they have less bargaining power than bigger countries. Everywhere needs everywhere; nowhere should be left behind. Today we're privileged to be joined by the Honourable Dr Keith Rowley, the Prime Minister of the Republic of Trinidad and Tobago. Prime Minister, thank you for your leadership and thank you for joining us today. You have the floor. 00:07:48 KR Dr Tedros, Director-General of the World Health Organization, other members of the WHO team, journalists, a very good morning to all the viewers and listeners who are tuned in to this programme on vaccine equity. Today as Prime Minister of Trinidad and Tobago I represent our twin-island Caribbean nation as well as the region of CARICOM, being Chairman of that regional body at this time. I'm really honoured to be invited and afforded the opportunity to participate in this public conversation on our world's ongoing challenge of responding to a virus which for more than a year has been ravaging our populations, destroying our economies and killing us indiscriminately across the world. At the onset I want to thank you, Dr Tedros, and the broad spectrum of staff at the WHO for the leadership, guidance, care, comfort and hope that you have consistently provided all the way from the beginning of a perilous journey through this very dark night. 00:09:10 Your pivotal role underscores the obvious need for this global organisation's existence and sustenance and we trust that you will always be there to hold a candle to us all wherever and whenever we on this planet are confronted by microbes or any other form of human health challenges. After a period of disbelief it is with great satisfaction that we welcome the news of the intention of the United States of America to return to this place of science and world leadership in this vital and fundamental business of human care. Dr Tedros, colleagues, fellow citizens of the many countries, I trust that it is clear to us all by now that, large or small, rich or poor, powerful or feeble, none of us will be free from the devastation and propagation of this virus until all of us are free of its grasp and have overcome the direct and indirect destructive dominance of this microbe. One year ago when the full nature of the pandemic was realised we were very unsure of its reign but among our fervent hopes even then was that our collective scientific know-how would lead us to a vaccine in the shortest possible time and we prayed for its efficacy. 00:10:50 Today thankfully we are at that place where we now have tested and proven vaccines. A brightening light is shining on our way towards the most successful response to the still marauding virus. Even as we breathe a sigh of collective relief we acknowledge the logistical difficulties associated with instantly satisfying the needs of all of the people. But we do have models of sharing and caring which would allow all of us to be beneficiaries of fair and equitable access as WHO go on to hopefully certify more and more of the life-saving vaccine. Our history as people is littered with instances of destructive behaviour, disrespectful dominance, imbalances and other forms of man's inhumanity to man. But on this rare occasion when we are all yoked to an invisible destroyer it is my hope and plea that when the journal of this experience is written it will deviate from what is mostly the norm and record that on this occasion the rich took care of the poor and the small and impecunious were not trampled with disdain by those who could have done so simply because they had the wherewithal to do it. 00:12:23 Today on behalf of all small island states, of which the Caribbean's CARICOM group is probably the best example of those with fragile economies, small populations with limited technical and financial resources as well as other vulnerabilities who disproportionately are being ravaged and threatened by COVID-19 and all its variants, we are to remind that we need the systems of fairness, caring and sharing to work according to a plan so that we can all come out of this dreadful experience guided by principles of equity and compassion. As there is the understandable rush to receive the vaccines and inoculation of our various populations we are more than a little bit concerned that there is or is to be hoarding and price gouging as well as undue preference in some quarters. This being so, we at CARICOM have recently called upon WHO to immediately convene an international convention of the world's people's representatives to commiserate, explain, assist and commit to a fair sharing of the available vaccine resources for the benefit of all humankind and not just the privileged, well-heeled few. Today we continue to make that call. We are also wary of the many charlatans who are increasingly emerging as they stalk the vulnerable with offers of opportunities that seem to good to be true only because they really are but are protected by their many disguises. 00:14:13 On this day the work of WHO is far from over. Now more than ever you are required to protect us from the many offshoots of the viral era and encourage the science not only to further understand the biology, physiology and management of the virus but the defeat of its power through equitable distribution of its nemesis, the vaccine. Mr Director-General, small states such as ours have made and continue to make high and huge sacrifices in an endeavour to protect our populations from the worst ravages of the virus. We anxiously anticipate the promised relief and general benefits that a successful early vaccination programme can bring to each of us. All we ask as members of the family of nations is that we not be forgotten, ignored or worse taken advantage of in this business of life and death. Director-General, the CARICOM once again acknowledges your good work and dedication and looks forward to receiving you in the healthy Caribbean in the very near future. 00:15:33 We hold out great hope as we thank all healthcare givers at every station and location and to you all we say thank you. TAG Thank you. Thank you so much, Prime Minister. It's such a great honour to have you and I fully agree, we have models of sharing, we have models of caring and this invisible destroyer, as you have said, a common enemy, cannot be defeated without solidarity. Thank you so much indeed. I would also like to recognise that Trinidad & Tobago, your country, has done very well in this pandemic and this is because of your leadership. Even without vaccines using simple public health solutions we can see from your own experience that this virus can be controlled. So thank you so much for your leadership, Your Excellency, and I welcome your solidarity. I am pleased that your first health worker was vaccinated today. The record-breaking pace of COVID-19 vaccine development shows that where there is a will there is a way. If people everywhere demand vaccine equity it can be done. Let's join His Excellency, the Prime Minister and show that the models of sharing and caring can work. Thank you and, Fadela, back to you. 00:17:16 FC Thank you, Dr Tedros and thank you, Prime Minister. I would like to add that we have been joined in this press conference by Dr Michel Yao. Michel Yao is Director of Strategic Health Operations at WHO. Now I would like to open the floor to questions form members of the media. I remind you that you need to raise your hand using the raise your hand icon in order to get in the queue and please don't forget to unmute yourself. I would like to invite the first journalist, Gunila Van Hall, Svenska Dagblat, Swedish journalist, to ask the first question. Gunila, you have the floor. GU Hear me? FC Yes. Go ahead, Gunila. 00:18:09 GU I'm sorry for that. Thanks for taking my question. It is about the South African variant as it's spreading more and more and is in about 16 European countries now too. How worried should we be about this variant? What do you know about how much more contagious it than the original virus? Does it create more serious disease and specifically do the vaccines we have today give enough protection against the South African variant? How pressing is it to create second-generation vaccines that include this variant? Thanks. FC Thank you, Gunila. Dr Van Kerkhove will take the first part of your question. MK Thanks. I will begin and maybe, Kate, you want to come in specifically around the vaccines. There are a number of virus variants that WHO is tracking with global partners around the world, one of which has been identified in South Africa. I would urge us not to call these the South African variant or the UK variant. Really we need to try to remove any of the stigmatisation against any of the countries that are working hard to recognise any mutations and changes in the virus. As you know, the virus evolves, it mutates, it changes; this is evolution and this is natural. The variant that was identified in South Africa, the 501YV2 or the B1351, is being studied right now, looking at transmission, looking at severity and looking at any impacts on neutralisation and diagnostics, therapeutics and vaccines. 00:19:44 All mutations and variants of interest and variants of concern will undergo the same type of research so that we better understand what all of these changes mean and WHO with partners is setting up a global risk monitoring framework to make sure that we are tracking the changes in the virus and that we are studying these with a robust process that is done quickly and in a co-ordinated manner around the world. The variant that was identified in South Africa through great work across the country and the sequencing capacities that they have increased over the last year; there is increased transmissibility that has been identified with this variant, similar to what we've seen with the variant identified in the United Kingdom, suggesting that it's more transmissible. It does have the same mutations that we've seen in some other variants which increase its ability to bind to cells, to infect cells but it's similar along the same order of magnitude of what we've seen from the variant identified in the UK. 00:20:45 I should say that even with increased transmissibility South African has shown that with the introduction of the public health and social measures that they have been using since the start that this virus, this virus variant can be controlled and we have seen reduced incidence over time. We do not see any changes in disease presentation or severity or change in in-hospital mortality with this variant as opposed to the other viruses, the SARS-CoV-2 viruses that have been circulating. There is a suggestion of some reduced neutralisation capacities for the variant B1351 and there have been some studies, as you've heard, that have been looking at differences in vaccines and vaccine efficacy. I should say that we don't see any changes in diagnostics, in our ability to detect this virus variant as well as other virus variants identified in Brazil, in the United Kingdom and other mutations that have been picked up around the world. But I do just want to emphasise that it is really critical that we increase our surveillance for mutations and changes in the virus through good epidemiologic surveillance, good case detection with molecular testing and antigen-based testing as well as increasing our sequencing capacity around the world. 00:22:07 We are looking to leverage and build from existing sequencing capacity systems around the world with our SARS-CoV-2 lab network, our global influenza surveillance and response system, our GISRS system around the world as well as leveraging our HIV labs, our polio labs, etc. In areas where we don't have that capacity in country we're looking to see where we can support sequencing capacities through private labs or academic labs and through regional collaborations, which are growing. We have good regional labs in Africa, in the Americas, in the EMRO region, across the Pacific. But again this is part of building back better; it's making sure that we have sustainable systems in place going forward. Kate. KOB Just to address the question of the vaccines and the variants, I think the first thing to say is that this is a very dynamic, a very evolving area of information. As you know, throughout this pandemic we have a set of information that comes in in real time and we're following it really carefully and this is of course one of the areas that we're looking at extremely carefully. When it comes to the variants of concern and the vaccines there are really two kinds of pieces of information that are relevant. The first piece of information that is most relevant is actual measurements of whether or not vaccines in the face of wide circulation of variants are preventing disease as they have been demonstrated to do in the clinical trials when variants were not present. Some of the clinical trials were conducted in countries, in settings, in time periods when there were variants that were very common in the community and so from those clinical trials we do have some evidence about the performance of vaccines against variants. In general what we're seeing across a number of the vaccines - that includes the Johnson & Johnson vaccine, the Novovax vaccine and the AstraZeneca vaccine - in the B1351, the variant first identified in South Africa, is that there is a lower efficacy than was demonstrated in other parts of the world where that variant wasn't circulating. 00:24:41 As you can probably appreciate though the certainty about that is relatively low because the number of cases that were identified in one setting, the South Africa setting, was lower than in the aggregate data from around the world and in particular for the AstraZeneca vaccine, the clinical trial that was conducted during the period of circulation of that variant was a small clinical trial that was not designed to address this question. Furthermore that clinical trial did not include anybody who... There were no events of severe disease that occurred in the people who were enrolled in the clinical trial so we don't have information about whether or not there was efficacy against severe disease, only information that was not conclusive about the reduction in efficacy against mild and moderate disease. The reason I point that out is that generally speaking for respiratory viral vaccines and the evidence in some of the vaccines for COVID we do see that there is higher efficacy against severe disease than there is against mild and moderate disease so this is an important caveat to the evidence that's out there. 00:26:00 The second piece of evidence that is available and continuing to grow in terms of the number of studies that have been done and the number of vaccines for which these kinds of studies have been done are the lab-based studies. Those are studies where a laboratory will grow the virus and then test the sera from people who have been immunised so the sera that was collected after immunisation to see whether or not that serum can actually neutralise the virus, can stop it from replicating. Those studies again in general have shown that for the variants of concern, the B1351 and the B117, the variant first identified in the UK, there have been reductions in the ability of those post-vaccination sera again across a variety of the vaccines, a reduction in the ability of those sera to neutralise the virus or stop the virus from replicating. What's important about that is that in fact we don't have full clarity that neutralisation of the virus is the component of the immune system that alone is the thing that is stopping people from getting disease. So we're still in these early days of interpreting the evidence and again the most important thing is to get more information about what's actually happening with respect to disease. In general we see that the vaccines retain efficacy against disease albeit at a lower level than in settings without the variants highly prevalent. 00:27:50 So our big message is that we should get on with vaccination as quickly as possible and at the same time do everything possible to reduce transmission because the more these viruses transmit the more likely they are to have additional mutations occur and more likely to have issues that could emerge that relate to reduced impact of the vaccines. So as we're quickly rolling out these vaccines it's ever more reason for transmission to be reduced through every means that we have available including masking, hand washing, physical distancing, ventilation, avoiding crowded... engaging with people outside your household. Thank you. FC Thank you, Dr O'Brien. I would like now to call on Jamil Chad, Brazilian journalist, EOL, to ask the next question. Jamil, you have the floor. JA Thank you, Fadela. Good morning or good afternoon. This is probably a question to Dr Ryan. We've seen in the last weekly reports by WHO a fall in the number of new cases around the world and a fall as well in deaths. 00:29:16 However we do see a persistent high number in Brazil both of new infections and deaths. I would like you to comment a bit on this insistence on the numbers being high and whether for example events such as Carnival; although it did not happen in a public way we've seen many parties and beaches very full; how much that contributes. Thank you so much; all the best. FC Dr Ryan. MR Yes, it's difficult to make a specific comment but it's certainly true that in countries that have had very intense outbreaks and a country as large as Brazil where the disease has penetrated so deeply into the community the virus still has and had a lot of energy. You're obviously also dealing with an urban/rural situation. In urban settings many people still live in areas that are overcrowded, in multi-generational, multi-family homes. It is very difficult to break the chains of transmission in a complex society so some countries are coming down the hill more quickly than others. 00:30:36 But I think the important trend is that in almost all countries and certainly all regions we're seeing the downward trend and that needs to continue and needs to continue to be supported. Yes, we are coming up increasingly now again with... As spring arrives in the northern hemisphere people will want to celebrate more. Obviously the celebration in Central and South America, all over the world on Tuesday of Mardi Gras and other things; very important celebrations; very important in terms of people's hope for the world. But we will have other things like Easter; in my own country we'll have St Patrick's Day; we'll begin to want to celebrate these things again and I would just caution that we have to be very careful and we're certainly not out of the woods yet. I think as we move into the springtime we need to drive towards higher levels of vaccination, getting equitable distribution of that vaccine, getting rid of the deaths and the hospitalisations and the suffering but continuing to drive the case numbers down. 00:31:51 Kate has said it and I think Maria has said it; the best way for us to avoid the emergence of variants is to drive and suppress transmission now and to use the vaccines that we have. But in the case of Brazil - and the patterns in Brazil differ by state so it would be difficult to go into a complex discussion. Mariangela is sitting beside me and she may have more detail. I'm always nervous because I have a very accomplished Brazilian scientist sitting beside me when I speak about Brazil. So I will leave my comments at that and again it is really important; Brazil is a very, very large country in a very important region of this world and what Brazil does matters. Brazil has always led the Americas in the science and in combatting infectious diseases. It has a very proud history in that so therefore what happens in Brazil does matter and as Brazil gets better control over this virus it will be a beacon of hope for the rest of the Americas and for the rest of the world. MS Just complementing, Jamil, what Mike was saying, also it's important that even though we see the total numbers globally coming down and we must get today's... no, this week. We have already mentioned during the last presser that this is not the time to let our guard down because we have seen the numbers coming down in some countries before just to see a recurrence of the numbers going up again. So it's still too early for us to say anything and, as Mike has mentioned, Brazil is like a continent so the epidemic is moving differently in the different states and it moves in ups and downs so don't let your guard down yet. It's a moving target. We need to be sure that we keep watch and we keep doing the right things, as WHO recommends. MK Very briefly to just support that because I think so many countries are in a situation where case numbers are coming down and five weeks in a row we've seen incidence reduce and that is wonderful. It means that what we are doing, what all of us are collectively doing together is driving down transmission. As Mariangela has just said and as Mike has said and you've heard all of us say many times, now is not the time to let your guard down. We can continue to drive transmission down. Recall where you were a year ago, eight months ago, ten months ago where transmission was going down in many countries around the world. 00:34:39 We cannot let ourselves get into a situation where the virus can resurge again. Remember where we were, remember what we need to continue do to drive it down, get cases down into single digits. We do see the situation in Brazil; I'm looking at the weekly numbers and there is a decline that we're seeing here. We just need to stay the course, hold on to what is working consistently, deliberately as we roll out vaccines and make sure that vaccines and vaccinations start in all countries and we all call upon vaccine equity around the world to those who are most in need at this time. FC Thank you. Now I would like to call on Joshua Collins from the New Humanitarian. I think he has a question to Prime Minister Rowley. Joshua, are you online? JO Hello. Thank you for taking my question. Yes, I have a question for the Prime Minister. I recently read your comments that the vaccine will be offered to any human being in Trinidad and Tobago regardless of their status. I was curious if you could describe the plans of the Government for addressing the sizeable informal migrant community, particularly among Venezuelans. 00:35:53 FC Thank you. Prime Minister, you have the floor. KR Thank you very much. We in Trinidad and Tobago have a fairly significant number of migrants within our border and we acknowledge the nature of the problem. We will only be successful in protecting our local population if everybody within our border gets the same kind of treatment because to have a migrant population that is not covered by our concerns and our response is to maintain a population within which the virus will be a permanent feature and from which it can be transmitted continuously to everybody else. So our effort of contact tracing will identify persons, whether they're migrants or not and if they are persons of interest with respect to our effort we have to treat them so that they do not suffer from the infection and also will not pose a threat to the rest of those who are not persons of interest at the time. So we do have to look at everybody and we are open [?] to do that fortunately. We have had relatively low levels of spread and we have not had an overbearing number within that particular population so we are not separating and discriminating against persons because that would make a nonsense of our effort. 00:37:29 FC Thank you, Prime Minister. I would like now to invite Helen Branswell from Stat to ask the next question. Helen. HE Thank you very much, Fadela. I was hoping we could get an update please on the Ebola situations in DRC and in West Africa. Have there been cases found outside of Guinea in West Africa, please? MR Helen, we have Soce Fall and Michel Yao online. To date we have not found cases outside Guinea in West Africa and again all countries in the area are on super alert at this stage. Our Regional Director for Africa, Dr Tshidi Moeti, has had discussions with the Ministers of Health from the West African Health Organisation and a lot of work is underway to create an integrated strategic preparedness and response plan for the subregion that would include all countries that are potentially threatened and specifically help drive a strong, co-ordinated response in Guinea under the leadership of the Government of Guinea with all partners supporting. 00:38:47 But I will hand over to Michel or Soce. They may be able to... Just to confirm, Helen - I know you had asked this in text - we can confirm that this is Ebola Zaire with further sequencing to be carried out at Institut Pasteur over the coming days. Michel or Soce, if you can give us the latest in terms of numbers and operations. SF Thank you, Mike. This is Soce. Thank you, Helen, for the important questions. We don't have additional cases in West Africa including Guinea and neighbouring countries but the most important thing is that we consider the risk as very high in other countries and we have already started working with all neighbouring countries for preparedness and readiness, including using our Continental Fund for Emergencies. We just finished a call with our team from the regional office. There are seven countries and all of us agree that this is a great emergency, the highest level of emergency in WHO so we are going to continue working with countries to make sure that any new case can be detected both in Guinea and neighbouring countries and a rapid response be implemented to contain it. Thank you. 00:40:03 FC Thank you, Dr Soce Fall. Michel, do you want to add something? MY Yes, thank you very much. I will just have to add that at least for this outbreak we have some assets. We work in DRC with different new tools and we have effective vaccine, therapeutics but at least the preliminary lab analysis showed that it could be the same strength so these tools could be effective. As we are speaking there are vaccines on the way to Guinea so vaccination will start soon with mainly health workers as well as high-risk contacts. In DRC also vaccination has started. Taking also a lesson learned from COVID we will remain proactive in mobilising different aspects. We still have some work to be done, for example in vaccination to ensure that at least the immunity remains strong when those people vaccinated are exposed again to the virus so some work and research still need to be done. So all these different components WHO will be supporting. We have already deployed staff on the ground around the epicentres supporting Government and also mobilising different partners in respective areas including community mobilisation with UNICEF and also NGO partners working in this area. Thank you very much. 00:41:48 MR Can I just come back in to recognise the very strong response also from partners and the Global Outbreak Alert and Response Network, our colleagues in MSF, CDC, ALIMA, UNICEF, Red Cross. Classically in many of these responses the Government is supported in safe and dignified burials very often by the Red Cross movement, in IPC and community engagement by Red Cross, by UNICEF, by other INGOs; MSF; obviously hugely skilled across all aspects of the response. We're all agreed that what we have done in Congo in supporting the Government-led response and having a single co-ordinated plan with all partners playing their part to support those responses both in terms of inside Guinea but then the preparedness and readiness... I think the Director-General has said many times that the Ebola response in Congo was not just a response in Congo. It was a preparedness and readiness response in 13 other countries surrounding Congo, especially nine high-risk countries. 00:42:53 We saw the disease imported twice into Uganda and it did not create a single chain of transmission because the disease was managed very, very well by the Ugandan Government and the Ugandan authorities, who had prepared exceptionally well for the imminent arrival of the virus. So this is a time when we have an opportunity to prepare and be ready. The DG has spoken many times about windows of opportunity. We have that window of opportunity in West Africa; we have an early alert. It is sad to think that it has to be the death again of a health worker that triggers the system to respond and it's a sad event for that family and the extended family around that person. But we do have the opportunity to do better this time and we also, as Michel said, have the vaccines and we have the monoclonal and polyclonal antibodies. It is very, very important that we have a coherent vaccination strategy across the subregion. 00:43:58 The classic vaccination strategy that has proven effective in Congo and previously in the clinical trials in Guinea was a ring vaccination strategy based on the exhaustive identification of cases and then the identification of contacts and contacts of contacts, in a sense social rings, the rings of transmission around an individual. That has proved to be highly effective in stopping the outbreaks before. The vaccine we use for that is produced by Merck and we have stockpiles for that en route, as Michel and Soce have said. We also have the opportunity to potentially use the J&J vaccine which is a two-dose vaccine, likely to give longer protection and probably better adapted for vaccinating health workers far away from the epicentre and giving them a protection that may last for even longer. So we would look and are working with the governments in the area to come up with a coherent vaccination strategy that could utilise both products under an expanded use, expanded access protocol but those activities will require enhanced surveillance and enhanced data gathering so we're working with the governments to ensure that we can implement all of that. 00:45:13 Again remember that these Governments are currently responding to COVID-19 outbreaks in their own countries while having to either respond to Ebola or prepare for the potential arrival of Ebola. So we would ask our donors to look very, very carefully at providing extra support to those countries, to the NGOs and to the UN agencies supporting those countries in the coming weeks. Your investment will pay off. We saw that in Uganda over the last two years. Thank you. FC Thank you. I would like now to invite a Japanese journalist from Asahi Shimbun, Kiyoko Jeiji, to ask the next question. Kiyoko, are you with us? KI Yes, I'm here. Can you hear me? FC Very well. Go ahead, please. KI Thank you for taking my question. I would like to ask about the frozen food transmission. In the past press conference Dr Ryan said there was no evidence that food or the food chain is participating in the transmission and we should not fear food or food packaging. I was a bit confused when the China mission team mentioned cold-chain transmission last week. Could you please clarify WHO's view on that? Thank you. 00:45:34 FC Thank you. I would like to invite Dr Peter Ben Embarek to take this question. PBE Thank you and thank you for your question. Yes, the frozen food issue is a little bit complicated because here we're talking about two very different situations. The first one is the possibility of reintroduction of the virus through the frozen food chain and through imported product back into China where the virus has been more or less eliminated so that's a situation for 2020/2021 where the virus is widely circulating in the world and where we know that there are multiple outbreaks in food factories in countries where the virus is circulating. So that's one line of interest, particularly for China and other countries in a similar situation. It's a very, very rare event. Even China, through their extensive search for positive, contaminated products through the food chain supply have found only very few positive cases of contaminated products. 00:47:46 Now for 2019, where we're focusing on the origin of the virus. This is a very different situation. At that time the virus was not widely circulating in the world, there were no large outbreaks in food factories around the world and therefore the hypothesis or the idea of importing the virus to China through that route is not something that we're looking at. There we are focusing on the Huanan market in Wuhan in December 2019, where a lot of frozen products were traded in that market. There we're focusing on the local trade of frozen, farmed wild animals, being farmed and produced particularly in southern China. So this is a very different possible line of introduction of the virus into the market environment in Huanan and that's a very different focus compared to the discussion about international trade of frozen products. Thank you. FC Thank you, Dr Ben Embarek. I would like now to invite a journalist from Devex, Vince Chadwick, to ask the next question. Vince. VI Hello. Thank you. My question is for Dr Tedros. I'd like to get your response to comments from Emanuel Macron in the Financial Times this afternoon, who's calling for Europe and the United States to immediately allocate 5% of their COVID vaccines to Africa. He says he's discussed it with Angela Merkel. I'm wondering if he's discussed it with you, how it will work, if your understanding is that this will be through COVAX and if not, if it doesn't undermine COVAX, the fact that Europe is now starting to be more concerned about geopolitical competition. 00:49:42 Related, I wanted to ask about the EU sharing mechanism which was discussed in Brussels a few weeks ago. I understand some European countries are interested in choosing which countries their doses go to and that there're currently some discussions going on about that. I wanted to understand what your messaging is around that. Thank you. FC Thank you, Vince. I would like to ask Dr Aylward to answer this question. BA Thank you very much for the question, a really important one. There've been multiple approaches taken to try and ensure we find solutions to the sharing of scarce resources and especially vaccines as rapidly as possible and throughout the crisis. Remember, this is not novel to vaccines. 00:50:33 At the outset of the crisis we had real challenges around equitable allocation of PPE, of PCR, of oxygen, of ventilators. This has been a recurring problem and that's the reason so much effort went into the establishment of the COVAX facility and then also the allocation mechanism that would underpin it to ensure we got equitable allocation of vaccines as well. As we started to roll out even in December many countries approached us, thanks to the Director-General who advocated for this, with an interest in sharing vaccines through the COVAX facility so by mid December we had established a dose-sharing set of principles and a process for countries to share doses through the COVAX facility, especially through AMC countries or the low/low-middle-income countries that are part of COVAX. That was set up at that time. There was a lot of interest from many member states of the European Union, from Canada, from other countries that were interested to look at if they could dose-share so that mechanism was put in place back then. Those conversations have continued. Unfortunately we've not seen yet the translation of that interest, those commitments to vaccination to COVAX. The reasons for that have been myriad. Some have been related to the outbreaks in countries themselves, the interruptions in vaccine supply to some of the countries interested, the mechanics of doing it so there've been many challenges. 00:52:09 But I think what has been really encouraging was President Macron's message today and last week the Director-General actually had the opportunity to discuss vaccines, the scarcity of vaccines, how to optimise the distribution with President Macron on two occasions to ensure that increasingly the global community could be aligned on this and find solutions. In terms of the EU's dose-sharing mechanism we've also been in discussion with the Commissioners at the EC about this, the Director-General has and we have and again are working through the process of trying to ensure that products that can be shared through the European Commission or from EU member states or others can be shared as equitably as possible. For equitable allocation the best mechanism, the only global mechanism set up to do that is the COVAX facility. There are some countries that other countries may have special arrangements with in terms of regulatory arrangements and financing arrangements and others and may seek to do arrangements outside that. 00:53:24 But even now we are encouraging that in the interests of equity the most equitable distribution possible those doses go through the COVAX facility because that we we can co-ordinate across a massive number of countries and ensure that everyone is getting served and that we get close to, if not achieve the goal the Director-General has set out; that all countries in the world are vaccinating their healthcare workers within 100 days of the start of this year and ideally by World Health Day on 7th April. That's our goal. So this could be one part of the solution and having leaders like President Macron stand up and make that challenge to the world is a fantastic development. TAG Yes, thank you so much. I just would like to add a bit. As you may know, from the start President Macron has supported the ACT Accelerator and when the ACT Accelerator started it had two objectives. One is accelerated development of products including vaccines and the second objective was fair distribution. So what he's calling for is in line with the objectives of the ACT Accelerator and, as Bruce said, we had a call with President Macron last week and he stressed the importance of sharing, which WHO and other partners have been advocating for. 00:55:02 One of the areas we have been focusing on was actually donation and we have asked many high-income countries to donate. As Prime Minister Rowley said, sharing and caring is important but that is actually in the interest of all countries. Countries who are sharing will benefit and countries who are receiving will benefit because we can drive out this virus sooner and also that would help us in faster economic recovery. So we support his call and not only for the donation, the immediate needs but we discussed also about the long-term distribution of vaccine, especially in terms of increased coverage. One of the bottlenecks is production capacity. We have discussed with President Macron the bottlenecks or the barriers to increased production and we have agreed that we identify the solutions to the barriers and address them and increase production so there will be more production that can make sharing easier. 00:56:28 So the President is also working on addressing the long-term challenge we're anticipating, especially which is going to be in some months from now. As you know, countries in Europe are now targeting to vaccinate 70% of their populations by summer and the target so far was 20, 27% globally if we can cover that. So if Europe is targeting this in the rest we should also target increased or higher coverage and for that to happen we have to increase production and we have to address all the barriers in order to increase production so there is enough to share. Then on the second one, choosing countries, as long as the support goes through COVAX it's actually welcome if some countries prefer to give their donations to certain countries because they are their neighbours or because they have some relationship. What we can do is if this comes through the COVAX the earmarked donation can go to those countries; then the COVAX stock could go to other countries so we can strike a balance. But one thing we have been asking from the start was that donations should go through the COVAX facility so we know what's going where and we can do a balancing act, we can balance it. 00:58:24 One thing which doesn't help is when countries on their own go and provide directly to other countries because the balancing act will be a bit difficult when it's not going through the COVAX facility that can help in balancing the distribution or sharing. Thank you. FC Maybe we have a little bit of time to take a last question from Katrin [Unclear], France 24. Katrin, you have the floor. KA Thank you, Fadela. Good afternoon to all of you. My question is related to Ebola and what Mike was saying before. I'd like to know a bit more about the research and development of vaccines for the other Ebola types because if I know well, there are six types and the one that we have now is the Zaire Ebola virus. I'd like to know what is the research doing now about other vaccines against the other types. Also why don't you organise a prevention vaccination campaign through the regions that are usually the most affected? Because we notice that it is always the same regions in DRC particularly that are hit by the Ebola virus. Thank you. 01:00:06 If Dr Soce or Dr Michel Yao could answer in French it would be nice so we can use it for French TV. Thank you. MR [French language]. TR I will leave the floor to Soce. Soce, please. Thank you very much. Thank you very much for this important question. I think we need to clarify that we have a vaccine just for Ebola Zaire. For the other ones unfortunately we do not have a vaccine in the pipeline so it's important and we need to be able to invest in R&D in order to have vaccines for the different forms of Ebola but also for other viruses that are as dangerous, for example [unclear]. So if we're talking about billions of doses for COVID-19 we're not thinking of Ebola and other viruses, which are neglected viruses and are still dangerous and still there. In terms of strategy we also need to keep in mind that the two vaccines that are available, Johnson & Johnson and Merck, were approved recently so there are still limited quantities. So we need to be very efficient. In the strategy of belt or ring vaccinations contacts, as was mentioned before, social contacts are vaccinated to prevent transmission. 01:01:39 In the future it will be important to continue to develop more vaccines in order to have more vaccines available to have a preventive approach for people in areas where we know there are reservoirs or people at risk of getting Ebola. That would be the efficient strategy but again for the time being the priority is contacts of contacts. Thank you very much. May I add? May I just add that for these vaccines we also need to mobilise resources as we've done for COVID. It's important for us to be able to increase capacity for manufacturing and produce enough vaccines. The second point is within the WHO we are working with all partners on a programme to fight Ebola and this programme will have different routes for vaccination, which will include vaccination through UNICEF. These programmes in the future will also allow countries to be better prepared to have their own health systems able to respond to this epidemic because the virus will continue to circulate in the ecosystem and it's only a question of time to be affected by it and then have emergencies arise in different countries. 01:03:09 So for the long term it is essential to address this in the same way that we've done for yellow fever. Thank you very much. MR Just to ad, I think this is one of those moments - and those of you who know me will know I don't say this very often but I would like to recognise the contributions made by the companies, Merck and J&J. The development, the research and production of these vaccines was never made with profits in mind and the company Merck have actually constructed a brand-new plant in Germany to produce this vaccine. Because of the production challenges for this type of vaccine it's in relatively low volumes so we would like to be able to expand that but I have to recognise that both companies have been very diligent and really are working to try and produce these vaccines that everybody thinks they need every four or five years but then in between everyone loses the will to continue their production and their development. So there's been a fantastic public/private partnership between the R&D blueprint for epidemics. We do have the target product profiles for all those other vaccines we need for the other Ebola strains. The work continues. 01:04:21 The ultimate endpoint for this - and I'm sure Kate would love this too and Annamaria and so many others - is a multivalent vaccine capable of protecting against multiple Ebola strains that we could certainly use in front-line health workers. We saw just now in this last outbreak in Guinea the first major case that was detected is a healthcare worker; again the mine canaries of this system but also occupational workers at risk, charcoal workers, people who work in the rainforest. There are many populations at risk who could be protected if we have enough vaccine that's safe and obviously at the appropriate cost. So this is really the holy grail of Ebola, to have those countermeasures in place and not just be responding to outbreaks but preventing their occurrence by the pre-emptive, proactive use of vaccination, which is always the best way to use vaccines. I'm sure Kate would agree. 01:05:18 FC Thank you, Dr Ryan. Before I give the floor to Dr Tedros I would like to invite Prime Minister Rowley if he has any final comments to make. You have the floor, sir. KR Thank you very much once again. It really is comforting to know that we're making the kinds of progress that we've made reference to today. We do have some pitfalls to avoid but I think the national populations are hopeful that in the not-too-distant future, maybe by the middle of this year we will have been receiving a certain level of vaccination that will allow us to believe that we are on a path where hopefully by the end of the year many of our populations will be comfortable in the kinds of progress that we're making. I'm also very pleased to hear that across the world our numbers are coming down and the curves are coming down because we genuinely believe that if there is failure in one area of the world because of the nature of the virus and the problem that we are facing, if there's this failure in any part of the system that is a failure for all of the system. So this is a classic case of the chain being as strong as its weakest link and we trust that none of our people will be that weak link. So thank you very much for looking out for small countries, looking out for small populations, those that are under-resourced and also for focusing on the science because that is what is going to give us the tool to treat the challenges that we're facing. 01:07:08 TAG Thank you. Thank you so much, Your Excellency. I don't want to add anything to what you said. I fully concur and thank you so much for your leadership; thank you for joining us. I know together we will make sure that vaccines roll out all over the world. Thank you so much again for your leadership and thanks to all colleagues and also journalists who joined today. I look forward to seeing you in our upcoming presser; I think that will be on Monday. Thank you so much. FC Yes, thank you, Dr Tedros. Just to remind journalists, we will be sending the audio file of this press conference and Dr Tedros' opening remarks as soon as we finish here. The full transcript will be posted on the WHO website tomorrow morning. I would also like to attract journalists' attention to a press release that was sent to you from WHO about the Ebola outbreaks in Guinea and DRC as this is of interest to all of you. Thank you all and have a nice evening. 01:08:14

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

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

Media briefing on COVID-19 - 05/02/2021

00:00:21 FC Hello, all. I am Fadela Chaib, speaking to you from the WHO headquarters in Geneva and welcoming you all to our global COVID-19 press conference today, Friday 5th February. We have simultaneous interpretation in the six UN languages plus Portuguese and Hindi. I would like to introduce to you the WHO participants. Present in the room are the WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the DG and lead on the ACT Accelerator, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome, all. Now without further delay I would like to hand over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor. TAG Thank you. Thank you, Fadela. Good morning, good afternoon and good evening. Earlier this week Captain Sir Tom Moore died with COVID-19. As you know, as he approached his 100th birthday last year Captain Sir Tom decided he would try to raise £1,000 for the United Kingdom's National Health Service by completing 100 laps of his garden. He ended up raising more than £30 million. 00:02:11 For me Captain Sir Tom represents two things. The first is that everyone can make a difference, whether that's raising money, inspiring others, informing the public or simply deciding to stay at home to keep others safe. The second is that Captain Sir Tom was a reminder of the value we should put on older people and everything they bring to our world. However there is a disturbing narrative in some countries that it's okay if older people die. It's not okay. No-one is dispensable. Every life is precious regardless of age, gender, income, legal status, ethnicity or anything else. That's why it's so important that older people everywhere are prioritised for vaccination. Those most at risk of severe disease and death from COVID-19 including health workers and older people must come first and they must come first everywhere. Globally the number of vaccinations has now overtaken the number of reported infections. In one sense that's good news and a remarkable achievement in such a short time frame. 00:03:51 But more than three-quarters of those vaccinations are in just ten countries that account for almost 60% of global GDP. Almost 130 countries with 2.5 billion people are yet to administer a single dose. Some countries have already vaccinated large proportions of their population who are at lower risk of severe disease or death. All governments have an obligation to protect their own people but once countries with vaccines have vaccinated their own health workers and older people the best way to protect the rest of their own population is to share vaccines so other countries can do the same. That's because the longer it takes to vaccinate those most at risk everywhere the more opportunity we give the virus to mutate and evade vaccines. In other words, unless we suppress the virus everywhere we could end up back at square one. On Wednesday COVAX published its forecast for the distribution of vaccines to participating countries. This is a very exciting moment. Countries are ready to go but the vaccines aren't there. We need countries to share doses once they have finished vaccinating health workers and older people but we also need a massive scale-up in production. 00:05:42 Last week Sanofi announced it would make its manufacturing infrastructure available to support production of the Pfizer BioNTech vaccine. We call on other companies to follow this example. Companies can also issue non-exclusive licences to allow other producers to manufacture their vaccine, a mechanism that has been used before to expand access to treatments for HIV and hepatitis C. The COVID-19 Technology Access Pool or CTAP enables the voluntary licensing of technologies in a non-exclusive and transparent way by providing a platform for developers to share knowledge, intellectual property and data. This sharing of knowledge and data could enable immediate use of untapped production capacity and help build additional manufacturing base, especially in Africa, Asia and Latin America. 00:06:50 Expanding production globally would also make poor countries less dependent on donations from rich ones. These are unprecedented times and we applaud those manufacturers that have pledged for example to sell their vaccines at cost. But manufacturers can do more. Having received substantial public funding we encourage all manufacturers to share their data and technology to ensure global equitable access to vaccines. And we call on companies to share their dossiers with WHO faster and more fully than they have been doing so we can review them for emergency use listing. Last Friday we heard from health workers in Uganda and Pakistan who're waiting to be vaccinated. Today we're pleased to be joined by two health workers from high-income countries who have been vaccinated. First I would like to introduce Professor Gabriel Gold, who works in a geriatric department at the Trois-Chene hospital here in Geneva. Professor Gold, thank you for joining us. Please share with us your experience during the pandemic and your hopes for your work and indeed the world now you have been vaccinated. You have the floor. GG Thank you very much for inviting me. I must say that vaccination for me was a huge relief. You mentioned the case of a centenarian who did so much and unfortunately suffered from the disease. 00:08:46 It's important to remember that the sickest people with COVID-19 are very often the oldest and the most frail. I work in a hospital that has provided acute care to people with COVID-19, perhaps over 600 patients, since the beginning of the pandemic. These people deserve top-quality care for their COVID disease but they also require a lot of help with other co-morbid diseases but most importantly sometimes with very simple things. It can be helping them sit up in bed, it can be helping them wash their face or brush their teeth or take a sip or water. It can be just a reassuring presence because sometimes they may be lost or confused because they are so sick in unknown surroundings. This means that there is a very close proximity when taking care of such patients between patients who have a very severe, infectious disease and healthcare workers. 00:09:54 Of course we use protection, whatever we need, the protective clothing and barriers and masks but the vaccine is really a key way to prevent the spread of the disease. Of course this is something that we worry about because we also have many other patients in the hospital who came in for other reasons who don't have COVID-19 and we want them to be able to go home without COVID-19 so we want to make sure that we do not transmit this to them. It also reassures us when we go home and we have our families, close ones as we want to be careful too about transmitting the disease there. Vaccination is also an opportunity for health authorities to recognise the immense dedication that healthcare workers all over the world have put in to provide care for people with COVID-19; long hours, forgoing vacation, month after month and probably for many months to come. The health workers are there as long as they are healthy. Vaccination is a way for healthcare authorities to first show their appreciation of these healthcare workers but also their understanding that if you want to provide care to people who really are very sick and need it you need trained healthcare personnel. They have to be healthy and vaccination is an important way to deal with that. 00:11:23 Vaccination enhances the motivation of people who have worked very hard and need to continue to work very hard to deal with this terrible pandemic. The pandemic occurs all over the world. People are getting sick all over the world. People need healthcare workers all over the world, they need healthy healthcare workers all over the world so we should vaccinate those people who are at risk so that we don't fill the hospitals and the care centres with as many patients. And we need to vaccinate of course, wherever they are all over the world, healthcare workers who are providing this care. Thank you. TAG Merci beaucoup, Professor Gold. Thank you so much and I welcome your support to accelerate vaccine roll-out globally. Now to our second guest, Cindy Frias. Cindy Frias is a mental health specialist nurse at the Hospital Clinic of Barcelona. Cindy, we look forward to hearing about your experience working on mental health during the pandemic and what it has been like for you to be vaccinated. You have the floor, Cindy. 00:12:38 CF Thank you very much for the invitation and for introducing me. Good afternoon, good morning and good evening around the world. My name is Cindy Frias and I'm a mental health specialist nurse at the Hospital Clinic of Barcelona, the child psychiatry unit. Today I'm here to explain my experience in this pandemic situation and all the vaccination process. I went to this public health emergency Spanish hospital and especially my hospital, the hospital clinic had to adapt a lot of measures that included the adaptation, reorganisation of clinical care units, hospitalisation units and even psychiatry units. All this change brought pressure and challenges for the nurses and all the healthcare workers. This experience and this current pandemic has had an important impact on our emotional well-being from the beginning and until now because of the unexpected upgrade [?] of the situation and the high rates of transmission. Likewise the increase of activity, the lack of staff, especially the nursing staff led to an increase in our working hours every day and that represented an important increase of stress for us. Even now I'm suffering these circumstances. 00:14:28 On the other hand regarding the direct contact with our patients, the measures; the nurses have had to reduce or limit the nursing care. The nurses have had to reduce the time for every visit to the patient rooms. We have had to use personal protective equipment for protection and maybe these measures have caused the nurse to express feelings of fear, anger and the sensation of less humanised care and lower quality of care. Added to this situation the hospital restricted or limited family visits and outside patient walks and for those reasons those measures affected the emotional well-being of patients and of the families too. However I think it's very important to highlight the adaptability to cope of all the nurses and all the healthcare workers, the resilience, the capacity of individuals to bounce back or cope in this new situation despite adverse circumstances. 00:16:13 The resilience and the capacity for adaptation of this health situation; it's important to understand as a process the positive adaptation to stress and adversity. In my case I think I also adapt to the situation, as most people or as most of my co-workers do but I have felt fear and anxiety because for example I have a three-year-old son and I live with my mum and I have especially been afraid of infecting them. I had to come to work every day and for that reason I think I was feeling that sensation or negative thoughts every day. Around the world a lot of nurses have been infected and many of them have died and a lot of them were young. For example I would like to share with you my own experience because my aunt died in August from coronavirus and she was a nurse. She was an extraordinary nurse and she was only 51 years old. In fact I'm a nurse for her because she was my role model and she was, I repeat, an excellent nurse. I always remember her as the best nurse in the whole world and she became infected while she was working. She died quickly because she had a comorbidity and she died a few weeks after the infection. She was [unclear] situation, very deep for me. This loss increased my fear, my anguish, my anxiety, especially for my mom. 00:18:38 Therefore I view [?] this vaccination process like a great change, enormous scientific advances in relation to my work and I think it's fundamental. I received the COVID vaccine, I received the first dose on January 9th and the second on January 30th and I haven't had any side-effects, just a local pain in the arm but some co-workers have experienced some side-effects, minor side-effects. Anyway, I have lived the vaccination experience as a light [?], a light of hope, a light of hope, a light on the road. I don't know if this is the right explanation or the right... I did a translation of my feelings. I see the process as reliable considering some negative aspects but I think the vaccination process is hope, is faith in the healthcare system. I think it's vital that healthcare workers around the world are vaccinated because we need to do our work with security, with confidence and we need to be confident in the healthcare system. My family are very happy, my mom is happier for me and my family is happy and hopeful for the future and see the vaccination process, the COVID vaccine as something safe, close and maybe as a tangible fact. 00:21:09 I think most of my co-workers see the vaccination process as something very positive for us and I think we need this vaccine for all the healthcare workers around the world. Thank you so much. FC Thank you. Thank you, Cindy, muchas gracias. We know many people have felt isolated during the pandemic and the work you do as a mental health nurse specialist is so critical. Thank you once again to both our guests today. We're glad both of you have been vaccinated and are able to keep doing your essential work. Thank you to both of you for the clear call you have issued for health workers everywhere to be vaccinated. Fadela, back to you. FC Thank you, Dr Tedros, and to our guests. I will now open the floor to questions from journalists, reminding you that you need to raise your hand using the raise your hand icon in order to get in the queue. First question goes to Shoko from [Unclear]. Shoko, can you hear me? 00:22:32 SH Hi, Fadela. Can you hear me? FC Yes, very well. Go ahead, please. SH Thank you for taking my question. COVAX announced two days ago its interim distribution forecast for the first half of the year, predicting its distribution to 145 economies. I do understand COVAX prioritises first of all countries which aren't able to buy doses for themselves. On the other hand I see some of the richest countries, such as Canada is expecting to receive doses in the first half of the year. I'm not trying to blame any specific country for receiving doses but why doesn't COVAX prioritise the economies which need doses the most? Thank you. FC Thank you, Shoko. Dr Swaminathan. SS Thank you very much for that question. As you know, COVAX was set up as a mechanism to provide equity in vaccine distribution across countries of all types; high-income, middle-income, low-income. It wasn't meant to only serve low-income countries and as you know, there are two types of countries participating in COVAX, the self-financing countries which pay in advance, make an advance commitment and then pay for the vaccines, and then the AMC countries, 92 of them, that get very subsidised or free vaccine. 00:23:57 It was also not clear at the beginning when the mechanism was designed that there would be so many bilateral deals so the idea was that there should be a global mechanism that was able to procure at the best possible price, have access to the widest range of vaccine candidates and then be able to distribute them globally based on the fair allocation mechanism that WHO set up with partners. Over the last few months of course things changed and many countries went ahead and did bilateral deals and have their own supplies but the COVAX facility is not going to penalise countries for doing that. However in the first wave of allocations we are looking at whether countries have started vaccinating already or not and those countries - the DG mentioned 130 countries have not got a single dose of vaccine. So there is prioritisation particularly for the early doses that are being shipped out in February and March for countries which do not have any vaccines at all. There's also the option for countries to opt out; countries that have got vaccines through other sources can opt out at any time of receiving so that those doses can then be reallocated to the other countries which may not have access to anything. 00:25:13 So it was set up to be a very fair mechanism. Things have changed over the last few months but we still want to stick to the original principles that we based it on. Thank you. I don't know if Drs Aylward or Simao want to come in. FC Thank you. I would like now to invite Helen Branswell from Stat to ask the next question. Helen, can you hear me? HE Yes, thank you, Fadela. Hello to you all. During your opening remarks this morning, Dr Tedros, you mentioned that the WHO would like companies to start sharing their dossiers faster to get emergency listings through WHO. Can you give us a sense of who has done it and who isn't coming to WHO to get an emergency listing fast enough? Thank you. FC Thank you, Helen. Dr Simao will take this question. 00:26:13 MS Thank you, Helen. That's a very good question. WHO has launched what we call an expression of interest for companies to submit their dossiers, phase 2B and phase three only, to WHO. In October last year we received 15 submissions, 13 that were considered eligible. We have issued one which was the Pfizer and we have four vaccine candidates in a very advanced stage. What I'm going to tell you now is public; you can find it on WHO's website. It's updated weekly; the stage of the assessment of each of these vaccine candidates is on WHO's website. So we have at a very advanced stage already the two Chinese manufacturers, Sinopharm and Sinovac. We have had a team of inspectors in China since the second week of January. They're waiting for the quarantine to finish and they will start inspections next week. We have two vaccines that should have a decision on 15th January which are two AZ-derived vaccines. One is the Serum Institute of India and the other one is the SK Bio in Korea, which are vaccine producers that will provide to the COVAX facility so we'll have a decision. What we want is that those vaccine manufacturers that have more advanced vaccine candidates, finalising phase 2B or phase three trials, to come to the WHO emergency use listing. Why is this important? 00:27:54 Because the WHO pre-qualification of vaccines has existed since 1986 so it's not a new product, it's not a new service that WHO does and it has pre-qualified 160 vaccines throughout all these years. This facilitates two things; firstly UN procurement by UNICEF and PAHO; and secondly it facilitates what we call the reliance mechanism. It facilitates that countries that do not have strong experience in assessing vaccines because they do not have production or whatever can rely on WHO's assessment to do an emergency use authorisation or to allow entry into the country. But WHO can only progress if it receives the information it needs from the companies; that's the call that we have. The criteria for the assessment are internationally agreed criteria and it does not differentiate whether it's a multinational manufacturer or a developing country manufacturer. These are internationally agreed criteria and they were published last year as well. 00:29:07 So we very much welcome that companies do provide the information according to these criteria that includes safety, quality, which you see in the clinical trials, but also good manufacturing practice. Thank you. FC Thank you, Dr Simao. I would like now to invite Nina Larson from AFP, Geneva to ask the next question. Nina. NI Hello, can you hear me? FC Yes, very well. Go ahead, Nina. NI Thank you for the question. The pandemic appears to be slowing across the world according to your latest epidemiological update. How much of that slow-down do you think is due to the vaccines that are out there now and how much do you fear the new variants could jeopardise that progress? Thank you. FC Thank you, Nina. MK You all looked at me to answer that question. Thank you, Nina, for the question. I think it's a good point to highlight the fact that we are seeing declines in incidence in a number of countries and this is certainly good news. This is due to a combination of factors, most notably the public health and social measures that countries are putting in. 00:30:28 It's about the tried and true, the tested interventions that we know work, that break chains of transmission, that prevent infections, that prevent those that are infected from passing it to someone else. What we're seeing is that the use of active case finding, finding where the virus is, using the testing systems that are in place, the PCR tests, the antigen-based tests that many countries are using now and we hope more countries will start to use - because these are easier to use and are welcomed in a number of different types of settings - making sure that testing is strategic, that results get back quickly to individuals so that public health action can be taken which includes isolation of cases. Good clinical care, making sure that patients enter the clinical care pathway and they're assessed rapidly based on their need. You heard from two amazing healthcare professionals about the importance of nursing and providing that direct care to patients in need. 00:31:29 Making sure that our health workers are protected, they're trained, they are trained in caring for patients with COVID, they are protected with the vaccine, they are protected with personal protective equipment and that they are trained in optimised care for individuals. This also includes contact tracing so of the individuals who are infected we carry out contact tracing so those who have come in contact with infected individuals can have supported quarantine so that if they are to become infected they can't pass the virus to somebody else. It includes governments and communities engaging and informing individuals about what they need to do. All of these different actions are really critical for breaking chains of transmission. Vaccines and vaccination are another incredibly powerful tool. Right now the use of the vaccines is focused on those most at risk from severe disease and those most at risk from infection. Again you heard from these health workers who are so happy to have been vaccinated but we need equitable vaccines around the world to ensure that health workers all over the world receive this vaccine. 00:32:38 So it's a combination of factors why we're seeing declines in incidence but I think what is really critical is that countries that are reducing transmission continue to take all measures they can to drive down transmission. Individuals have a role to play in this with physical distancing that must continue, the wearing of masks but making sure that when you wear a mask your hands are clean before you put them on, when you take them off you dispose of those masks appropriately if they're single-use masks, making sure that you open windows, you avoid crowded spaces. All of these actions are driving down transmission and all of these actions need to continue. It's a really critical period for countries that are having declined incidence, that they stay the course and that they continue to adhere to these measures that are in place and when appropriate based on the data, based on the localised situation open up very slowly and use this in a slow and a staggered way. 00:33:37 So it's really important to stay the course. There are a number of factors; there's no one solution, as you've heard us say many times. This includes the vaccine and vaccination. We keep saying, do it all, and we mean to keep doing it all. FC Thank you, Dr Van Kerkhove. I would like now to call on Ker Simons, NBC, to ask the next question. Ker, can you hear me? KE Yes, I can. Good afternoon. Could I ask a couple of questions about the origins investigation, one housekeeping if you like? You've published a terms of reference last year on the investigation but the latest terms of reference published, I believe, in January are behind a password. I'm sure there's nothing to it but could I ask that somebody just helps us by removing the password so we can see the latest terms of reference? Then more importantly, could I ask what you plan to publish at some point in the investigation and could I ask for a commitment that you will ensure that you publish more details than just conclusions, what questions were asked, what tests were done and what data was looked at? Thank you. 00:35:04 FC Thank you, Ker. MK I can answer the second part of the question. I can't answer the first part of the question related to the password so we'll have to look into that because I'm not aware of anything online that requires a password. [Inaudible] MK Okay, we'll come back to you on that. I'm sorry, I can't hear. The team is, as you know, working now with Chinese counterparts and carrying out several different field missions. They visited hospitals, they visited labs including the Wuhan Institute of Virology. They have been visiting several different Centres for Disease Control at different levels, at the provincial level and the district level for example, and they're having constructive discussions with their counterparts. There are many, many questions that are asked. Every question that is answered, there're always more questions that are asked. They are looking at data and analysing data together and they will be working on a report. After all of our missions we always have a report. The contents of that report are being drafted by the international team members as well as the Chinese team members. We don't have a view on that. That needs to be done by the scientists who are in the field. 00:36:21 The terms of reference, as you saw, that were published outline the suite of studies that are ongoing but as you can tell from that there are a number of studies that will be done and we will have some results but that's just the start; there will be more studies that will need to be continued. So the report itself will not provide all of the answers; it was never intended to because that's just not possible but it will provide a summary and a report of what was done during the mission and of the findings of some of these early studies. I think that's as much as I can say right now and so we will provide that report when it is available, as soon as it is available. MR There is no password associated with that link. Maybe the link is broken for you and I believe that on that webpage a paragraph was added to the web part but the terms of reference are there as before. So if you have a problem please contact our press team and they'll ensure that they help you through the process but it's not a protected file, never has been. 00:37:36 FC No, it wasn't. Ker, please do send me an email and we will try to fix this and to send you the right way to open the document. Thank you, Ker. I would like now to call on Catrine Fianco Bukonga to ask the next question. Catrine, can you hear me? CA Yes, Fadela, perfectly, thank you. Good evening. Good evening to all of you. I have a question regarding the use of vaccines. As there is a shortage of vaccines certain countries have decided to use a combination of different products meaning Moderna, Pfizer, Sputnik 5, Sinovac. Is it a problem? I would like to know, how is the follow-up organised to gather the data about the use of products for side-effects and other effects that have to be followed? Thank you so much. FC Thank you, Catrine. Dr Swaminathan, you have the floor. SS I think that's an excellent question and there are a couple of elements to that. The first one is what is recommended. Currently what is recommended is the second dose of the same vaccine; most countries are recommending that and WHO has made - SAGE has made recommendations for Pfizer and Moderna vaccines and will do for the others as well. 00:39:04 What is important is to do the studies, the research to find out if you can actually combine two different vaccines either using the same platform like a Pfizer and a Moderna both with the MRNA, or even more interesting would be to combine two different platforms so an inactivated vaccine followed by an MRNA or a spike protein vaccine. So these research studies are beginning and it will take us some time to get those results. Meanwhile we are aware that some countries have made in their guidelines the provision in very rare cases to be vaccinated with a second dose of a different vaccine but that's certainly not the practice. The WHO's had several rounds of discussions on this; we hosted a big research seminar with 2,000 people who attended two weeks ago. The idea was really to bring everyone together, the developers and manufactures as well as the scientists and academics working in the field, to identify the big knowledge gaps and the priorities going forward. Questions like this were identified as top priorities, as was the question of what does one do with the different variants, what are the assays that need to be done in the lab, what are the clinical studies that need to be done, what are the different designs. 00:40:28 So the plan is very soon, in the next few days to convene again perhaps a smaller group particularly including the vaccine developers to agree on what kinds of research studies need to be done, invite expressions of interest. Our partner in COVAX, CEPI, the Coalition for Epidemic Preparedness, has actually invited applications from people who want to do research studies but it would be a really good idea to co-ordinate that and we hope that WHO will play a role in actually bringing all of that evidence and data together as we did for therapeutics. It'll be important to really build that platform and the knowledge for vaccines as it's accumulating rapidly, information about vaccines both from the roll-outs that are happening now in countries and observational studies but also more randomised clinical trials are going to be needed to look at questions like the duration and the gap between doses as well as combining different vaccines. 00:41:33 The feeling I get is that many manufacturers are actually quite interested in participating in a thing like this because I think in the future it will be important for that data to be generated so we will make it as inclusive and transparent as possible. Thanks. FC Thank you, Dr Swaminathan. I would like now to invite Tomo Diguchi from Kyodo News to ask the next question. Tomo, can you hear me? TO Yes, perfectly. Can you hear me well, Fadela? FC Very well. Go ahead, please. TO Thank you. A question on the Olympic Games in Tokyo. The President of the Tokyo 2020 Organising Committee, Yoshiro Mori, said that the Olympic Games will be held in Tokyo this year no matter what happens, which means that he's not going to take into account how this pandemic unfolds in the coming months. I'm sure the WHO can see the great importance of a risk-based approach. What is WHO's advice to a leaders like Mori who makes such comments, not recognising the situation based on scientific evidence and reality? Thank you. 00:42:54 FC Thank you, Tomo. Dr Ryan. MR Thank you. I know there is a collective desire around the world on everyone's part to move ahead with the Olympics. We've said it here before; it's a massive, important symbol of unity and solidarity around the world. What I do know is that the Government of Japan, the organising city of Tokyo and the IOC have been working diligently together and I am absolutely sure that they're taking every ounce of data into consideration as they move towards the Olympics. We work with them and we input to the taskforce on risk management and we will continue to do so. The decision to host and continue with Games is a joint decision of the host country and the International Olympic Committee and I'm sure they will engage. The desire to have the Games is a laudable desire and the will to move forward is a laudable will but I am sure the Government of Japan and all its officials will take all of the data into account as they move towards the Games and they will make the correct decision on behalf of the people of Japan, the athletes and potential spectators. 00:44:23 FC Thank you, Dr Ryan. I would like now to invite Isabel Sacco from EFE to ask the next question. Isabel, can you hear me? IS Yes, good afternoon. Thank you very much, Fadela. My question is on [unclear] on treatment. This [unclear] is being widely used in many available countries as treatment for COVID patients and in several countries - for example in Latin America - is advised by the health authorities even if its efficacy is not completely proven, or its safety. Many many people, plain people [?] are using this [unclear] also as a preventive. I would like to know what is the position of the WHO on this issue and when do you expect to have results from the [unclear] involving [unclear] in the Solidarity trial? Thank you. FC Isabel, the last sentence was not very clear. Is it okay? IS The question regarding all that I said is I would like to know the position of WHO regarding Ivermectin [?] and when do you expect to have results from the trial involving this drug in the Solidarity trial? FC Thank you, Isabel. Dr Van Kerkhove will take this question. 00:45:58 MK Yes, I will start and Soumya's going to answer the second part of the question. Currently we haven't made a recommendation on the use of Ivermectin but we're closely following the research that is ongoing related to this drug, which has shown some promising results in some trials for the treatment of COVID-19. We're aware that there's currently data available of about 1,500 study patients, just slightly less than that, from 11 studies and there's data expected from up to more than 7,000 patients in 56 studies and these studies are of varying quality. We have a WHO steering committee that is tracking these studies and closely looking at them in order to trigger the guidance and when we have enough information to look at guidance and updating our guidance to change policy. This may begin in the coming weeks. So any of the changes that come from WHO-recommended treatments follow an expedited but an incredibly complex review which will be shared with the public at the earliest time that we can. Do you want to cover the second part? Thanks. 00:47:07 SS Thanks, Maria. Just to clarify that Ivermectin was not prioritised for inclusion in the Solidarity trial. As you know, we have an expert committee that looks at which drugs should go into the Solidarity trial and we're just in the process of finalising the next set of drugs that would be tested in the Solidarity trial but Ivermectin is not part of it. Just to add to what Maria was saying, we have this process of the living guidelines update which means that we're tracking all the developments in the treatment of COVID-19 in the different clinical trials that are going on all over the world and we do living updates of the meta-analysis so as every trial gets completed it gets added on and it adds to the weight to the evidence and then the guideline developing group actually looks at the evidence and then makes a recommendation and then that gets updated on the living guideline platform. They're now looking at aisle six inhibitors, they're looking at Heparin-like anti-thrombotic agents, they're looking at Ivermectin the next couple of weeks and then at a few other drugs. So we'll keep updating the guideline but it's really based on examining all the evidence from all the clinical trials. 00:48:26 The problem is there are many small trials which sometimes give you misleading results and people get either very excited or very depressed about a result which is actually scientifically not valid. So we have to be very careful when we interpret results from these small trials and we need to really review the evidence as a whole. Thank you. MR Again very often in situations like this - and this is where we need all of science to work together - we often see observations when you'll see it written in the newspapers in vitro you can demonstrate that a particular drug can kill the virus or inhibit the virus in vitro. That means in a test tube or on a dish. That doesn't necessarily mean in a human body and there are all kinds of issues there. Also astute clinicians over the years often observe that a drug that's been used in one disease, for one indication can potentially be used in another and they make observations on that and often they publish what's called a case study or a clinical series. They publish and say, look, I've observed this, I've treated a few patients, I think this might work. 00:49:37 That's then often picked up and put into small-scale clinical studies where you do prospective; you wait to get the patient, you use the drug and you collect your data. The difficulty we have with that situation is that can often, as Soumya said, lead to conflicting information; many, many small studies; one says it might work; others say it doesn't. What you need are large-scale clinical studies that can definitively answer the question. It doesn't mean the drugs are bad or good. It just means we cannot give a definitive answer on that but it is important to recognise too that all of these drugs - and you will hear people say, oh, these drugs are safe or they're well-tolerated. Most drugs are but all drugs have side-effects so therefore it's really important that we have evidence that shows that the benefit of taking a drug outweighs any risk of taking that drug. So the widespread use of a drug on the basis of a hunch is not necessarily the best way forward. Having said that, it's really important that physicians and doctors and nurses are out there observing because very often breakthroughs come from unusual observations so we want to see that continue but we also want to bring all of that data together in a way that it can drive long-term policy. 00:50:53 FC Thank you, Dr Ryan. I would like now to call on Abdullah Ohassan from Morocco; Morocco Media News. Abdullah, can you hear me? Abdullah? TR Yes, I can hear you. Good afternoon. Thank you for giving me the floor. I would like to ask, why are we not building a factory to create vaccines here in Morocco so that we can provide vaccines on the African continent? Thank you. FC Maybe Dr Simao will answer and, Abdullah, you have the translation too. MS Thank you very much, Abdullah. This is a key issue as we fight this pandemic, the need to increase manufacturing capacity in different parts of the world so your point is very well made. It depends a lot on the government interests and the investments that are needed but WHO is pushing for what we call the CTAP, which is a platform that allows for technology transfer, for voluntary licensing of intellectual property and that also fosters through the technology transfer the strengthening of capacity at country level. 00:52:33 Let me say, there is one global partner with WHO on increasing manufacturing capacity which is the Developing Countries Manufacturing Network. That comprises, I think, 50 manufacturers in developing countries. That can help also in this process but your point is well made and it's very important that all countries take stock and assess their technological capacity to receive technology transfer and also assess their legislation to allow for that. Thank you very much. FC Thank you, Dr Simao. I would like now to call on Shane from CCTV to ask the next question. Shane, can you hear me? SH Yes, I can hear you. Can you hear me, Fadela? Thank you. A question for Dr Mike Ryan and Dr Maria Van Kerkhove. [Unclear] the virus is a complex scientific issue. Then more recent studies and reports have shown that clues to the existence of the virus have been found in human environmental samples preserved in multiple places in the world before December 2019. At present an international expert team led by WHO is conducting the zoonotic source research with Chinese experts in Wuhan in China. Do you have plans to send similar expert teams to other relevant countries for global research co-operation, countries in the south as well? Thank you. 00:54:07 FC Thank you, Shane. MK Thank you for the question. There are a number of different pieces of work that WHO is working on. You mentioned the waste water. I think you've probably heard me say before, in any situation, any study that has been published, either waste water studies or sera or clinical samples that were collected and tested in 2019, we are following up on. We are doing this through our international laboratory network and we are reaching out to the individual researchers directly. We involve our regional offices as well and we're discussing with them the findings that they have, whether these are pre-print studies - because some of the reports that you're mentioning actually have never been published in peer-reviewed journals but nonetheless we're still following up with the researchers themselves to find out if we can do some further collaboration an further work if there are any remaining samples that exist and some follow-up. 00:55:05 So there are a number of collaborations that are underway but every one that has been reported that we are aware of we are following up directly with individual researchers. FC Thank you. I think I will take the last question from Ann Gilland, the Telegraph. Ann, can you hear me? Ann? AN Hi, yes, sorry, unmuted. Thanks very much for taking my question. I had a question for Dr Simao. At the beginning in the answer to Helen Branswell's question you said on January 15th - and I'm presuming February 15th - you're going to make an announcement about two vaccines. Is one of those the AstraZeneca vaccine, is that correct, whether you're going to issue the emergency use licence? Also I just wonder why it's taken so long because you've had the data for quite a long time. Thank you. MS Thank you, Ann, and apologies if I said... It's February 15th. Our technical advisory group that will assess it as independent experts meets in Geneva to assess two vaccines. One is the Serum Institute of India which is an AstraZeneca vaccine and the other is the SK Bio, which is also an AstraZeneca vaccine being produced in the Republic of Korea. 00:56:33 Actually let me make it very clear because we only received the dossier from the Serum Institute on 15th January so we didn't have this data for a long time. We received the full dossier for the India production on January 15th and last week, I think on 29th January, we received the last data for the AstraZeneca SK Bio. What we have are these rolling submissions so this data only came to WHO a very few weeks ago, just to make this very clear. What we had beforehand was the AstraZeneca core data because you know that AstraZeneca has eight manufacturing sites. We had, I think, early in January the regulatory authority in the UK assessing and giving a conditional use for some batches of the UK-based manufacture. Then we have the EMA assessing the core data for the two European-based manufactures. So what we do is, the core data we assessed and it serves for any of the AstraZeneca sites that will come to COVAX and apply for WHO. But WHO for the COVAX facility needs to assess the SII. It's an AstraZeneca-derived vaccine but it has a different production site, and also for the SK Bio. 00:58:11 So very clear that we only had this data very recently, the full dossier. Thank you. FC Dr Ryan, you have the floor. MR Just before the DG takes the floor I'm going back to the very first question that was asked because I think was a very pertinent question. We talked about, are we turning the corner. The problem sometimes with corners is you don't see what's around that corner and this virus still has a huge amount of energy. There's a massive force of infection still associated with this virus. This is like a floodwater; just because the floodwaters have dropped an inch or two it doesn't mean the flood's going to go away because it's still raining upstream. From our perspective communities around the world deserve huge credit. For the last number of weeks compliance and buy-in and participation from communities and lock-downs and stay-at-home orders and wearing masks and avoiding crowded places; that's what's pushed the virus down. 00:59:16 The virus isn't going away by itself and it won't. It will go away when we put it away and communities deserve credit for that. It's been a tough number of weeks for people of many countries and it's beginning to pay off and adding vaccine into that equation is going to double and triple the pay-off in the lives that we can save. But we have to follow through and we have to do everything to continue pushing that number down. Remember what happened the last time someone said, we're turning the corner. TAG Thank you. Thank you, Mike, for that intervention. I would like to add to that; since the vaccinations started, as Maria said, it could have some impact but there are some observations from our data even before starting the vaccine where there are significant declines in the number of cases and deaths. 01:00:25 I would actually like to bring one country especially with a very significant decline starting from September and that's India. On 14th September the weekly number of cases was 646,000 and now in the week of 25th January 91,000 per week so from 646,000 to 91,000 is significant so it was a constant decline. Then not only cases; if you take the number of deaths in September again, the week of September 14th the number of deaths per week was 8,166. Now in the week of January 25th it's 935 deaths per week. This is also very significant so continuous decline. This shows us that if we can do the simple public health solutions we can beat the virus. Now with the vaccination, with the vaccines added we would even expect more and better outcomes but the decline actually started before the vaccines started and this actually is good news because with the vaccines added the outcome could even be better. But our consistent advice to all countries is do it all; all the public health measures plus vaccine; better impact. Thank you so much and thank you for joining us today. See you at our next presser. Bon week-end. FC Thank you, Dr Tedros. I remind journalists that they will be receiving the audio file and Dr Tedros' opening remarks right after this press conference. The full transcript will be available to you tomorrow morning on the WHO web... 01:02:40

Media briefing on COVID-19 - 15/02/2021

00:00:31 FC Hello, everyone. This is Fadela Chaib speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 15th February. We have simultaneous interpretation in the six official UN languages plus Portuguese and Hindi. Let me introduce to you the participants. Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products. We are also joined today by an expert, Deusdedit Mubangizi; he's the Head of the Pre-qualification Unit at WHO; Dr Michelle Yao, Director, Strategic Health Operations, and Dr Sylvie Briand, Global Infectious Hazard Preparedness. Joining remotely are Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator, and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome, all. Now without further delay I would like to hand over to Dr Tedros for his opening remarks. You have the floor, Dr Tedros. TAG Thank you. Thank you, Fadela. Good morning, good afternoon and good evening. The number of reported cases of COVID-19 globally has now declined for the fifth consecutive week. Last week saw the lowest number of reported weekly cases since October. 00:02:28 So far this year the number of weekly reported cases has fallen by almost half from more than five million cases in the week of January 4th to 2.6 cases in the week starting February 8th, just five weeks. This shows that simple public health measures work even in the presence of variants. What matters now is how we respond to this trend. The fire is not out but we have reduced its size. If we stop fighting it on any front it will come roaring back. Every day with fewer infections means lives saved, suffering prevented and the burden on health systems eased just a little bit. Today we have even more reason to be hopeful of bringing the pandemic under control. Today WHO gave emergency use listing to two versions of the Oxford AstraZeneca vaccine, giving the green light for these vaccines to be rolled out globally through COVAX. 00:03:48 One of the vaccines is produced by SKBio in the Republic of Korea and the other is produced by the Serum Institute of India. Although both companies are producing the same vaccine because they are made in different production plants they required separate reviews and approvals. WHO emergency use listing assesses and assures the quality, safety and efficacy of COVID-19 vaccines and is a prerequisite for vaccines to be distributed by COVAX. This listing was completed in just under four weeks from the time WHO received the full dossiers from the manufacturers. In addition to the Pfizer BioNTech vaccine these are now the second and third vaccines to receive emergency use listing. We now have all the pieces in place for the rapid distribution of vaccines but we still need to scale up production and we continue to call for vaccine developers to submit their dossiers to WHO for review at the same time as they submit them to regulators in high-income countries. On Friday I mentioned WHO's new declaration on vaccine equity. Ensuring the rapid and equitable roll-out of vaccines globally is essential for saving lives and stabilising health systems but it's also essential for saving livelihoods and stabilising economies. 00:05:37 Fully funding COVAX represents the greatest possible stimulus and is a rounding error compared with the trillions of dollars that has been mobilised in G7 countries to support their economies. I am pleased that the G7 under the United Kingdom's presidency is meeting this Friday to discuss vaccine equity and I encourage all groups to sign WHO's declaration. We must continue to build the demand for vaccines by ensuring people have the right information. A year ago I said that we were not only fighting a pandemic, we were fighting an infodemic. In the past year we have seen the real harm that can be caused when people are overwhelmed by information, misinformation and disinformation. The answer is not just to fight misinformation and delete false or misleading statements. It is to listen to the real concerns and questions people have and to answer those questions with good information. That's part of the reason WHO holds these regular media briefings, publishes guidance, communicates on its social media channels and website, holds seminars with different community and professional groups and more. 00:07:15 Having the right information is essential in every outbreak situation. As you know, last week an outbreak of Ebola was detected in the Democratic Republic of the Congo. Four cases have now been reported and two people have died. Yesterday authorities in Guinea declared a separate outbreak of Ebola in the town of Goueke [?] in the south-east of the country. So far three cases have been confirmed among six people who reported Ebola-like symptoms after attending a funeral in late January. Two have since died while the other four are being treated in hospital. As you remember, Guinea was one of the three countries affected by the West Africa Ebola outbreak of 2014 to 2016, the largest Ebola outbreak on record. The outbreaks in Guinea and DRC are completely unrelated but we face similar challenges in both. Both outbreaks are occurring in areas that have recent experience with Ebola and are benefiting from that experience in terms of capacity for surveillance, rapid response, contact tracing, community engagement, clinical care and more. 00:08:45 But both outbreaks are also in hard-to-reach, insecure areas with some mistrust of outsiders. I'm pleased to say that vaccination started today in DRC and so far 43 people have been vaccinated out of 149 eligible contacts including 20 people who were vaccinated during the previous outbreak in 2019. WHO is working closely with health authorities in both contribute to engage with the affected communities to enhance trust and acceptance. Ebola and COVID-19 are two very different diseases. Both thrive on misinformation and mistrust but both an be stopped with proven public health measures, engaged communities, accurate information and vaccines. Fadela, back to you. Shukran. FC Thank you, Dr Tedros. I'd like to inform the media that they may have received by now a press statement on what Dr Tedros just announced in his opening remarks; WHO listing two version of the AstraZeneca Oxford COVID-19 vaccine for emergency use. It's also posted on our website. I will now open the floor to questions from members of the media. I remind you that you need to raise your hand using the raise your hand function in order to get in the queue. I would like to start by inviting Imogen Foulkes from the BBC to ask the first question. Imogen, you have the floor. 00:10:34 IM Hi, Fadela. Thanks for taking my question. This is about travel because traditionally WHO has always somewhat counselled against travel restrictions. I know we're well down the road in this pandemic but it's getting very confusing for people with different countries introducing different things. Your own WHO COVID-19 envoy this morning said he could foresee vaccine passports. Is that something the WHO thinks would be a good idea? FC Dr Ryan, you have the floor. MR Thanks, Imogen. The emergency committee made temporary recommendations in relation to a number of issues to the Director-General and I think we're quite clear that at this time - at the present time, I think they used specifically - they did not advise for the use of immunity certification as a prerequisite of travel. That is because, number one, vaccine is not widely available and it would actually tend to restrict travel more than permit travel. 00:11:48 Secondly we don't have enough data right now to understand to what extent vaccination will interrupt transmission and especially the risk of an individual to continue transmitting disease. So on that basis no but I think the envoy may have been referring to a future situation in which we have widely available vaccination and where we understand more about the impact of vaccination on transmission dynamics or if we get the second and third-generation vaccines where we may have more impact on transmission, at that point certainly. We've seen this with yellow fever and other diseases; vaccine can form part of a long-term strategy for disease control and for the prevention of disease potentially moving from one place to another as we've seen with yellow fever vaccination requirements, we have been in place for a large number of decades now. 00:12:43 So I would believe that that is a discussion that will be had in future. It will be based on emerging guidance from SAGE, on continuing discussions of the emergency committee and the technical programmes here. So no, we don't foresee this as an immediate requirement or need but certainly one that will have to be discussed in the coming months. FC Thank you, Dr Ryan. I would like to invite Simon Ateba from Africa News Today, Washington DC, to ask the next question. Simon, you have the floor. SI Thank you for taking my question. Can you hear me? FC Very well. Go ahead, please. SI Thank you for taking my question. This is Simon Ateba from Today News Africa in Washington DC. I would like you to react to the statement at the weekend by the Biden administration expressing concern over the first report that the WHO issued on the origin of COVID-19 in China. Thank you. FC Thank you, Simon. I think... 00:14:08 MK Thank you. Sorry, we were deciding who would start; apologies. The mission team from China has not actually issued their report yet. They have recently returned from China, arriving in their own countries and they are working on two reports, the first of which is a summary report which is shorter, just highlighting the work that has been done and some initial findings and recommendations. That will be followed by a longer report. The initial, summary report has not actually been issued yet. They've only done a press conference in Wuhan and they've answered some media questions but the idea would be that they would issue the summary report and then have a full press briefing themselves. MR Maybe I can also add that obviously there may be some misunderstandings here around the origins and the purpose do this mission. I think this mission was envisaged as a collaborative effort under the World Health Assembly Resolution where obviously working with China, a sovereign state and a member state of the WHO to better understand the origins of the virus so as to learn lessons for the future. 00:15:26 It was not as such an investigation of supposed wrongdoing or referring to any non-existent investigatory powers that WHO might have. WHO does not possess the mandate to enter uninvited into any nation state and must show due diplomatic respect to the process of engaging with governments but also the scientific process of working together with our Chinese counterparts to understand and make progress in the understanding of the origins of this disease. So as such this was and remains a collaborative process of discovery between scientists. Clearly there's a political layer on this that has been difficult for all parties to manage and it would be useful at this point if we could step back from that and really focus on what progress has been made scientifically in the understanding and to clearly identify where further progress will need to be made in the future in terms of future studies. So I think it is time that we look to the science now and look at that and then do our best collectively to work with all interested parties to identify further studies that will be needed to fundamentally and finally understand the animal origins of this virus. 00:16:58 FC Thank you, Dr Ryan. I would like now to call on Gabriela Sotomayor, a Mexican journalist from Proceso. Gabriela, you have the floor. GA Thank you, Fadela, thank you very much. My question is on treatment. I know vaccines are very important but my questions is on treatment. I would like to know, what is your assessment on the use of Ivermectin in the early stages of the disease? For example there is a group of specialists in the USA saying that they recommend the use of this very cheap and old drug so I don't know if you observed something on the use of this anti-parasite. Then a quick clarification; I would like to know if the hypothesis on the origin of the virus, the hypothesis of the laboratory incident is still alive. Thank you. FC Thank you, Gabriela. Dr Van Kerkhove will take the first question. MK I can take the first part of that. We also have Peter Ben Embarek online, who can answer the second part of that. 00:18:11 Yes, we have been asked the question about Ivermectin before and the clinical team is looking at data right now on different studies that have been evaluating Ivermectin. What they're doing is they're synthesising the data from different studies. Some of those studies had small sample sizes and the idea is to pool those together into a meta-analysis and apply what they call a grade framework to assess the certainty and the benefit or the risk based on each of those studies. They're using the same methodology that they've used for all of the living guidance that has been produced throughout this pandemic and they are hoping that they will have guidance in the coming weeks, in four to six weeks or so. They have a steering committee that are following the different results of clinical trials around the world and that is being used to trigger the development of the guidance by the WHO team so that has been triggered and that is currently underway. FC Thank you. Peter, are you online? Dr Ben Embarek, you have the floor. PBE Yes, Fadela, I'm online. 00:19:17 FC Thank you. PBE The question was with regard to the hypotheses we were looking at. It was a process to organise our thoughts and our planning of future studies. As you know, this mission was supposed to and did review all the work done under the phase-one studies that were agreed last July and in that process we were also planning to develop a series of hypotheses that we could explore further in the coming weeks and months through a series of new studies that we would recommend and put into motion and that's what we did. With regard to the four hypotheses we worked on and the hypothesis on the lab accident in particular, that one, based on the data and the discussion we had with our counterparts and colleagues in the different laboratories we visited in Wuhan and the amount of evidence that was presented to us from elsewhere as well, was not seen as a high-priority hypothesis for us, our joint China/WHO international team group, to move forward with. We decided to prioritise initially new studies on the more likely scenarios that we could easily set in motion since these are studies to enhance our understanding of the potential animal intermediate host, the bat origin issues, the persistence of the virus on frozen products, the entry into the Huanan market of farmed/wild animal products, etc. 00:21:14 Therefore the one on a laboratory accident was more seen as a lesser priority for us and therefore was categorised as an extremely unlikely scenario in our opinion based on what we had at hand. We also decided and agreed that all the hypotheses would be reviewed on a regular basis based on advance knowledge from our new studies and from evidence that could come up in the coming weeks and months. So that's the context under which this hypothesis and the others were designed and used and of course they're still all under consideration. In particular none of them were considered as impossible hypotheses otherwise we wouldn't even have considered them so they are on the table, we considered them. It's the first time we were able to put all these different hypotheses next to each other on the table and consider them in a rational way. So that's how we worked over the past months on these hypotheses. Thank you. 00:22:27 FC Thank you, Dr Ben Embarek. I would like to invite Dr Sylvie Briand to complement the first question we got from Gabriela about treatment. You have the floor, Dr Briand. SB Thank you very much, Fadela. Yes, just to complement on the issue of treatment. What is clear is that we may need to have many different treatments for COVID-19. The first studies were done on hospitalised patients, meaning patients with quite severe disease and we found that for instance dexamethasone was very useful for severe patients. But now there are many studies ongoing to see if we can treat patients that at out patients, not yet hospitalised, to prevent them from going to severe disease. So this treatment needs to be administered very early on in the disease and this is why those studies were more complicated, especially at the early stage of the pandemic. 00:23:26 But now we start to have more information on those treatments so Ivermectin is this type of treatment that is not specific. It's an antiparasitic drug, as you rightly said and this drug has a broad-spectrum activity and this is why it can be used at the early stage of the disease, trying to prevent further severe disease. So the studies are ongoing and we'll see if this treatment can be useful to prevent severe disease in COVID-19 patients. Thank you. FC Thank you, Dr Briand. I would like now to invite Esmir Milavich from Bosnian TV to ask the next question. Esmir, can you hear me? ES Hi, Fadela. I can hear you. Can you hear me? FC Very well. Go ahead, please, Esmir. ES My question is for Dr Tedros. In this year or so you spoke so many times about vaccine nationalism and big countries purchasing vaccines on their own and you highlighted the importance of the COVAX system. But even here in the region of the western Balkans we are seeing that countries are not relying on COVAX but they're purchasing vaccines on their own. How can you convince them to purchase and go through the COVAX system but also what kind of message does this send, that even countries like Bosnia are purchasing vaccines on their own? Thank you. 00:24:59 FC Thank you, Esmir. Dr Simao will take this question. MS Let me start and maybe colleagues will want to complement. I think, Esmir, you're raising a very important concern of many countries regarding access to vaccines and let me say that we have the facility up and running to start distributing vaccines this month, February and March and June and July. We have already secured two billion doses through the facility and the good thing about the COVAX facility is that actually countries don't need to go bilaterally. When we say bilaterally, countries don't need to go one-by-one to different companies trying to get the best price. With the announcement today of the emergency use listing of the two vaccines that are AstraZeneca vaccines that will be provided through the facility it also triggers a lot of the purchase orders and countries will be able to access, either through UNICEF or through the PAHO revolving fund, the early doses for the AstraZeneca. 00:26:18 Also countries already have been informed about indicative allocation from February to June this year so they can do the preparedness as soon as possible. There are several things that need to be ready at country level and these are two vaccines that have been approved today for emergency use listing. They are vaccines that are very easy to manage from a logistic perspective because they're vaccines that use what we call the cold chain, can use the usual refrigeration, two to eight degrees, in any health centre. So these are easy-to-use vaccines so the vaccines through the COVAX facility start to be rolled out from the end of February and there is the agreed number of doses that will be shipped to the different countries until June this year. So I think there's no need to panic and no need for countries to go buying in the market because they're going to pay more and they will have all the difficulties of ensuring the different contracts and that these vaccines will reach them in whatever time. But the facility is up and running as we speak. Thank you. 00:27:36 FC Thank you, Dr Simao. I would like now to invite the next journalist, Ker Simons from NBC. Ker, can you hear me? KE Yes, I can hear you. Can you hear me? FC Very well, Ker. You can go ahead. KE A question for the panel but also for Peter Ben Embarek. A couple of questions; there appear to be some slight disagreements between the team. Can you help me understand how you will reach a conclusive report or a report that everybody agrees on? What will the process be and how much will the Chinese side of the team have a say in what the final report says? Then a detailed question if I may; some confusion about the reporting referring to 13 sequences that were found, I think, in the 174 cases. Peter, were those 13 different sequences with slight differences or is it the case that eight of those sequences were the same and the others show slight genetic variations? Can you help unpick that piece of reporting and explain exactly what you found? 00:28:59 FC Thank you. Dr Ben Embarek, you have the floor. PBE Thank you. First responding to the last part of your question on the sequences, we identified 13 sequences in December 2019. These were mostly from cases but also from the market environment, as you probably know. These were mostly from different individuals but a few sequences were repeats from the same cases; we have in some instances several sequences from the same cases so it was not in total 13 different individuals. Some of them were very similar; these were the ones coming from cases who had a link with the Huanan market, indicating that the virus was circulating closely in that market environment and that's in line with the conclusions from the epidemiological studies. Some were slightly different and these were from cases with no link to the market. That suggested that the virus was circulating in Wuhan both in the close environment of the Huanan market but also in other parts of the city with some individual chains of transmission. That's again in line with the findings of the epidemiological investigations. 00:30:49 All that gave us the picture of a substantial circulation already in December, particularly in the second half of December 19 in Wuhan. With regard to the report the process is that the international team and the Chinese counterparts have already agreed on the summary report when we were in Wuhan on the last day of the mission and in particular on the key elements of that report in terms of key conclusions, key findings and key recommendations. Of course we will over the coming days and weeks finalise the technical parts, the background parts, the methodological parts of these reports, which are just descriptive material. The process is that the international team in the coming days together with our Chinese counterparts will finalise the interim report first and then work on the full report afterwards. It's a joint report. It will be two groups. We have worked on this together and therefore it's not a question of one side having a say on what the other side is concluding but more having a consensus document on our joint key findings, conclusions and recommendations because this is reflecting the nature of the work, as we discussed earlier today. 00:32:27 The mission was there to review a series of studies that were done in China over the past weeks and months as part of the phase-one studies we had agreed in July and make recommendations for future studies, more long-term studies to explore some of the hypotheses and advance our understanding of the origin of the virus. So it's a consensus document reflecting the joint activities. Of course the fact that we have different scientists from different backgrounds and different fields of experience means that everybody has their specific views, specific recommendations, specific interest in moving some studies forward in one direction or repeating some studies, etc. That's why we brought together a broad group of scientists with diverse backgrounds, diverse experience, diverse expertise, precisely to make sure that we have the best possible consensus, scientific and robust conclusions around this work. Thank you. FC Thank you, Dr Peter Ben Embarek. We are sorry, we had a small technical problem and we lost the video link to Dr Ben Embarek. Dr Ryan would like to add something. 00:33:59 MR I really congratulate the team and Peter's leadership and the work the whole team have done. In my experience particularly in field investigation or any scientific endeavour achieving an absolute consensus around every point is almost an impossibility in science. What we can do is reach a conclusion based on the evidence before us. We may not agree on whether there's enough data to make a decision. There may be differences in our understanding of the methodologies used to collect that data and even if we have enough data and we agree on methodologies we may differ in our interpretation of what that data means in the real world. So it is a difficult pursuit to achieve consensus between two scientists, never mind between 20 or 25 scientists around the same issue and again remembering there were different components to this; components around the environment, around animals, around labs, around the clinical, around the epidemiologic so it's a complex interweaving so a finding or a set of data in one area can affect how you look at information, at data in the other areas. 00:35:07 So I think this is a complex puzzle to put together. The team need the time to finalise that. They obviously are just tidying up that preliminary report. There will be a longer and deeper report but I think it's important for us to reflect on that fact. Again when we look at evidence for anything in public health or in science we have to make findings and conclusions but then we have to determine how strong the evidence is supporting that conclusion and what further data or evidence would help in further bringing certainty to that conclusion or to that finding. That's what we do all the time in science; we say, yes, we think the data tells us this but we'd be certainly happier to gather more data in this area to make us firmer in that conclusion. So I think we have to get away from the land of absolutes here; that's not how science works. Everything is relative; if the possibility of one hypothesis goes up the possibility of another hypotheses explaining the same set of facts actually goes down. So everything is moving dynamically and I think we need to give the team the space to be able to determine what their findings and conclusions actually are and then to determine what further data and what further studies would be helpful in further bringing certainty to those findings or conclusions or where conclusions cannot be reached what studies are needed to be able to generate the evidence needed. 00:36:36 I think we've always said that such a journey of discovery, certainly on the animal-human side, is difficult and it's fraught with obstacles in terms of being able to understand the true origins of any disease and I do believe it will take further studies for us to be able to fully understand that. I did say the last day that we certainly are making great progress thanks to the team and again recognising the scientists on both sides in that team and, Peter, your leadership in that group we've certainly made tremendous progress but we have to be very careful on the absolutes of declaring successes or missions accomplished. Mission accomplished is not a term we tend to use in public health. 00:37:27 TAG Yes, thank you so much, Mike. I just want to add a bit. As Mike said, reaching a consensus on everything may be difficult and it will not be possible, especially when you're just starting. So we would expect that, as Mike said, that there may not be consensus on all issues and there should not be consensus on all issues actually. So when the team faces that the solution is they can represent or indicate their differences in the report and that can help in proposing also future studies so that's what should be done. A joint report doesn't mean that we will have consensus on everything. A joint report can have a consensus on some issues but at the same time can have differences on other issues and the report can accommodate what was suggested by one group or one individual or another group or another individual. So that could be the solution and that, as I said earlier, can help in even proposing future studies so that's what we expect the team will do. But I think once the report is ready we will make sure that the team has the opportunity to have its own press conference either full, all experts, or as many experts as possible that they want to delegate if they want to but it will be up to them. 00:39:38 The last thing I would like to say is whatever conclusions come these are independent experts. Except two in the group the rest, ten of the members or experts are from different institutions, not even from WHO so they come from different institutions representing different countries actually; ten countries, ten institutions and they're independent and we don't tell them what to do. They will present their own independent report and that's what I think will of course make this study dependent on independent experts' opinion. Many times I hear that this is a WHO study or investigation. It's not. It's an independent study, a study which is composed of independent individuals from ten institutions and WHO's role here is co-ordination and that's what we should take into consideration too so that will be really helpful to understand. Thank you, Fadela. FC Thank you, Dr Tedros. I would like to invite Kate Kellan from Reuters to ask the next question. Kate, you have the floor. KA Thank you. I wonder whether you could give a more specific estimation of when the first vaccines that are being delivered via COVAX will get to countries and into the arms of people that are getting them through COVAX. 00:41:45 Also have you had any one of the countries that are due to receive AstraZeneca vaccines saying that they're not so keen now after the South Africa situation last week where they paused the roll-out? FC Thank you, Kate. Dr Simao. MS Let me start and then I'll ask Kate O'Brien or Dr Soumya to complement. Thank you, Kate, because this is a very important question right now. We don't have the exact date because at the moment there are purchase orders that are being put to the two manufacturers. For the Serum Institute of India I believe that there are seven or eight purchase orders that were already issued through the Serum Institute of India for some countries to receive that have been assessed as ready by WHO. Then there are the orders that will be placed for the Korean manufacturers, SKBio so we will publish the number of doses that will go now on the first round to the allocation quite soon, probably mid next week but the exact date each country will receive depends a lot on how the shipments will be made and the contracts that are being arranged through UNICEF and PAHO. Maybe Kate can address the second question. 00:43:13 FC Yes, Kate or Dr Swaminathan. KOB Sure, I can address the second question and then I'm happy for others to come in as well on this. We've spent quite a bit of time and effort both in this convening and with member states and in other convenings with them to clarify the recommendations from SAGE about the use of the AstraZeneca vaccine notwithstanding the very preliminary evidence that has started to come out about this product and a variety of the variants. Countries remain enthusiastic about receiving the AstraZeneca product while at the same time asking very relevant questions about what the evidence shows and what the evidence doesn't show. I'll just reinforce that three is no evidence on whether or not the AstraZeneca product against the B1351 variant has any change or that the change in that vaccine efficacy is a substantial change. 00:44:26 There are plausible reasons why we think that they will retain activity against severe disease. This is evidence that SAGE looked through and made that recommendation so in fact the engagement with countries has been with a lot of questions that they have had and I think what has been shared with them about what the evidence shows has reassured countries about moving forward and enthusiasm from countries to go ahead with the vaccination programmes with AstraZeneca vaccine. We are also working closely with the South African Government as they consider how they will accrue additional evidence on the AstraZeneca product in the setting of very wide distribution of the variant in South Africa. Remember that countries that have the variant in the countries; that does not mean that the majority of the strains that are circulating are from that variant. I'll end there and see if there's anybody who would like to add to that; Soumya or others perhaps. Thank you. FC I think you covered it fully. I would like now to invite a Chinese journalist from China Daily, Chen Wihua, to ask the next question. Chen, can you hear me? 00:45:57 CH Yes, thank you very much. Dr Tedros, you again mentioned misinformation and disinformation today. I don't know; are you actually referring to the war of words in the media? You have the US Government, a State Department official spokesman saying they're not going to accept the independent expert team report even before it comes out. You also have the other Peter, Peter Dazak from the expert team saying on Twitter, don't rely on US intel. Also he said, experts' words are being selectively used and also very angrily commented on the New York Times article, saying, shame on the New York Times. So I'm wondering what's the WHO's stance on the US' not going to accept the report and Peter here, Peter Ben Embarek, are you feeling [overtalking]? FC Can you just...? It's a very long question and comments. TAG Yes, okay. I will start. What I said today about misinformation and disinformation has nothing to do with any specific things that we heard yesterday or the day before yesterday. The reason we included it in our presser today is that it's the first anniversary since we started to advocate for the public to fight misinformation and disinformation and that's why also Dr Sylvie Briand is with us. 00:47:44 So we're actually celebrating the first anniversary of the initiative that we started. Sylvie can give you more background. Sylvie, please. SB Yes, thanks a lot, Dr Tedros. In fact it's because we have seen that every epidemic is accompanied by an infodemic which is a tsunami of information, accurate or not and that can be of course harmful if it's not accurate information. So WHO has done a lot of activities to make sure that people can access accurate information at any time during the outbreak and as you have seen, the difficulty with such a pandemic is that there's a lot of uncertainty. Science is moving very fast. Every day we have new findings and it's very hard for the public to understand what is going on and sometimes they are confused. Some people also use this confusion to send out information that is not completely accurate so what we try to do is really to listen to people and this listening is very important. We have developed not only tools to listen to people offline but also online and see what are their concerns and try to really answer their concerns and questions in real time and fill the void because we know that when there is a vacuum, when there is no information people will try to find this information wherever it comes from and sometimes it's not the right information. 00:49:28 This is why we wanted to celebrate somehow this one year because during this year a lot of organisations, UN organisation partners have been contributing to ensure that everyone on Earth has access to accurate information at any time. Thank you. FC Thank you, Dr Briand. I would like now to invite Helen Branswell to ask the next question. Helen, you have the floor. HE Hi. Thank you very much, Fadela. I'm wondering if we could have some information about the Ebola cases in DRC and Guinea. In particular is it known yet whether the virus in Guinea is Ebola Zaire and is there any thought that this is - is it known if it's a new spillover or if there might be an incidence of viral persistence? Thank you. 00:50:32 FC Dr Yao, you have the floor. MY Thank you very much. The first cases were confirmed and, as you know, the outbreak was declared yesterday by the national authorities so it's Ebola Zaire but the genotype has to be analysed and a sample has been sent to reference labs mainly in Senegal to do the sequencing so that at least we can know if it is the same virus that affected a few years ago or if it's a totally new one. So it's a bit early to answer precisely about this point but it's in process. MR If I can just add - thanks, Michel - again we would like to thank the Government in Guinea, the Governments in Sierra Leone, Liberia, Cote d'Ivoire and others who are taking immediate action both in terms of response and readiness. We saw similar responses in Congo before and the 14 and mainly in the nine really at-risk countries. This disease represents a regional risk and we very much welcome the regional and subregional response to that. I know our regional director, Dr Tshidi Moeti is already in touch with senior officials in many ministries and with the West African Health Organisation and many others in the region. 00:52:08 We do need a very coherent, co-ordinated response led by governments in country with the UN, other partners, NGOs supporting that response and WHO will do its part to support the Government. We already have, Michel, I think, I believe we have a team en route to Ensakore [?] right now to provide support. We are moving vaccines in country from both Geneva and US stockpiles. Those vaccines are still the investigational use doses. They will have to be used under investigational use protocol. We have previously approved protocols in the three countries. We're working with the Governments to have those updated. Currently vaccinators will be trained. We already have experienced vaccinators in all three countries but we have vaccinators and supervisors who've been working with us in Congo from Guinea and they're in Guinea already and will be working on this. 00:53:12 We also will be shipping therapeutics, both MAB114 and the Regeneron product, to the field and are working with ALINA and other colleagues and other NGOs, IMC and others, MSF, to see how best we can provide the higher standards of care that were achieved in Congo and transfer them to the management of patients in Guinea. We're not in the same situation we were a number of years ago. The disease is very much in the same area as before. It does threaten at least the three countries and therefore we have to be exceptionally vigilant, highly alert and we have to get surveillance, laboratory diagnostics, clinical management and all of the other things in place, much as we've had to do with COVID. WHO is ready to do its part and our systems are fully geared now to providing the absolute highest level of support to both the government of Guinea and Akri and to the surrounding countries so we've launched a comprehensive response. Michel Yao is our lead on that here but he is surrounded by a very competent team and Dr Socé Fall, our Assistant Director-General for Response, will also provide oversight to the response on behalf of Dr Tedros. FC Thank you, Dr Yao and Dr Ryan. I would like to give the floor for last question to Kai Kupferschmidt from Nature. Kai, you have the floor. 00:54:43 KI Hi, thanks for taking my question. I was wondering, given that we've seen five weeks of falling case numbers, whether you can give an idea, maybe Mike, how you think of this. Clearly there's a lot we don't understand about the virus but we are seeing a drop in a lot of places where fundamentally the public health measures haven't changed all that much. Could you just give us an idea of how you think about this drop and how you see the future also given the faster-spreading variants we're all concerned about? FC Thank you, Kai. Dr Ryan. MR Yes, I think the real expert on this will be Maria but, Kai, yes, thank you. I think we have to be very, very careful. When things go bad with an epidemic it's never all our fault and when things go well it's never all our doing because viruses have a natural cycle. They're ruled by seasonality, our behaviour and other things. 00:55:45 I think there has been a significant and global drop in disease week-on-week for the last four or five weeks. We haven't seen levels as low as this since last October. I do think a good proportion of that has been down to the huge efforts made by communities. There've been very swingeing lock-downs and stay-at-home orders and other things but also as part of that seroprevalence is rising, people are taking better care. We need to understand what is driving those transmission dynamics. Is it the natural seasonality and wave-like pattern of the disease, are we building up a level of immunity in the population that's preventing the disease finding the next case and are control measures having an impact on that? I think all of the above to an extent are true. I think the thing we have to remember is that this virus still has a high force of infection, a very high kinetic energy. There still are a large number of susceptible individuals out there and transmission will continue. I think as we look collectively at lifting some of the measures that are currently in place we're going to need to be exceptionally careful that we don't do the same thing as last autumn where we allow the disease to re-establish itself, reignite and re-accelerate. 00:57:08 I think it's the accelerations in this disease that have been the most worrying. The disease can move along at fairly low levels and then you see this really fast acceleration and spread. We need to avoid that the next time. We do believe that vaccines offer us an opportunity to reduce the hospitalisations and death and that's going to offer a different set of decisions in a number of months' time. If we can distribute vaccines equitable and the most vulnerable and the highest-risk people are protected then the decisions we make around this disease will understandably change because the consequence of transmission is different when we don't have death or hospitalisation as an endpoint and that's going to be a very important consideration going forward. So I think it's difficult to understand the dynamics but I would hate to think as these numbers drop that we're in any way about to declare some kind of victory. We've done that twice before. I don't think anyone has put up a victory flag but we collectively have taken a sigh of relief, moved on from a wave and then been very surprised two or three months later when we're in the middle of the next wave. 00:58:16 What we need to do - we said this many times last year; we need to avoid lurching from lock-down to lock-down, from peak to peak and get into a more stable relationship with this virus unfortunately. We need to get control on the virus. The virus still very much has control over us. We need to get to low, sustainable levels of transmission. We need to get to no deaths and minimal hospital admissions. If we achieve that then we will have other choices to move forward, possibly with second and third-generation vaccines and other opportunities to potentially eliminate or eradicate this virus. That is not on the immediate horizon. We need to take the heat out of this pandemic. We need to take the death out of this pandemic. We need to take the suffering out of this pandemic and I believe we can do that if we're really smart about continuing our own personal measures, continuing to reduce our own chances of being infected, if governments support people in being able to do that and if we can roll out vaccines in an equitable fashion so our most vulnerable and our most at risk are vaccinated as the highest priority. Maria. 00:59:25 MK Thanks, Mike, and thanks, Kai, for the question. I think the downward trend in cases and deaths is definitely a hopeful sign and there's likely a combination of factors that are pushing and driving transmission down and it comes down to individual-level measures, measures taken at the family level, the community level and by governments. We have reasons to be hopeful and I hope everyone is taking some comfort in the fact that we can drive transmission down, we do have the possibility to control transmission with our individual-level actions if we are enabled to do so. We do see that the public health and social measures are working across a number of countries including countries where the virus variants are circulating, where they are predominant, where they're being identified and that is good because we know what works and it's that combination of factors. 01:00:16 Getting down to the level of detail of which combination works where is what we're trying to better understand in terms of all of these public health and social measures but I think we have some challenges ahead. These virus variants and the changes, the natural evolution of the virus pose some uncertainty in terms of what is this virus going to do, how much is it going to change, are we in a position globally to rapidly detect these mutations, these virus variants and assess what they mean in terms of transmission, severity, impacts on diagnostics, therapeutics and vaccines. You know we are working with partners all over the world to set up this global risk assessment framework to be able to monitor them and study them in real time and that poses a challenge. The other challenge I think we have is while vaccines and vaccination is incredibly hopeful and an incredible achievement they will take time to roll out and they will take time to reach those who are most vulnerable and those most at risk in all countries. The third thing that I think is a big challenge that we have now is fatigue. The world is tired. All of us up here are tired as well and we want this to be over and we cannot become complacent. Even with downward trends we need to really stay the course and we need to hold on to what works and have some feeling of control, empowerment over what we can do. 01:01:46 There's a lot of work that is happening in this area and Sylvie may want to comment on this but working with communities, talking to communities, with communities, listening to communities, making sure that they are part of the solution, that they are informed, engaged and empowered, most importantly empowered and enabled to carry out the actions that are necessary. It's no good for us to lay out ten different things to do if a community is not enabled to do so so I think there're a number of reasons why we should be hopeful but it is no time to let down our guard. We need to really hold on to everything that we can do, take all of the measures at our own level to keep ourselves and our loved ones safe. FC Thank you. I would like to invite Mr Deusdedit Mubangizi, who's the Head of the Pre-qualification Unit, to say a few words about the important announcement made today. You have the floor. 01:02:51 DM Thank you, Fadela. Indeed today is a great day especially for COVAX. We started assessing these two vaccines hardly four weeks ago but when you look at the map that has been shown in various fora where you have continents that have access to vaccines and then other continents that don't have, I think any movement that increases capacity on the manufacturing and supply of vaccine is a great milestone for this world. If we are going to be safe, as the Director-General says, nobody will be safe unless everybody is safe and today's announcement of two vaccines, versions of AstraZeneca allows everybody to access vaccines. I would like to first of all use this opportunity to thank the experts that have been behind the assessment of these vaccines. I was excited yesterday; it was Valentine's Day but all the experts were around the table and assessing to make sure that today a final decision was made and people could access these vaccines. I want to assure people out there that experts have looked at this vaccine and it is safe, it's of good quality and it is effective. 01:04:42 Secondly we put a system in place that has assessors from every WHO geographical region to make sure that there is input not only from one part of the universe but all parts of the globe, to make sure that the input, the decision that goes into this decision that we've made today has a global input, has considered all the specificities of the different parts and and markets and health systems. We are confident that one of the concerns and the interests of the different populations have been considered but also that the aspects or ability to deliver this vaccine in the different health systems of the world has been considered. Therefore we now call upon our colleagues first of all in the national regulatory authorities. We have put in place a report that has had input from all parts of the world. Let's now make the quick decisions so that people can access these vaccines as quickly as possible. We will work with all of you to make sure that any questions that you have to facilitate quick authorisation at the national level are done and hopefully by the time we enter March the map will be different and everybody will have an opportunity to access this vaccine. Thank you very much. 01:06:19 FC Thank you. I would like to hand over to Dr Tedros for any final comment. You have the floor, Dr Tedros. TAG Thank you so much. I think Deus has said it very, very well on the vaccines and Valentine's. My colleagues didn't have a break even on Valentine's Day and it was also Sunday. Thank you so much for your hard work and for making it happen in a very short period, the approval of the AstraZeneca. This will help us to roll out quickly so thank you, Mariangela, for your leadership, Deus, Parwar [?] and... [Inaudible] TAG Carmen; okay. Thank you so much and I would like also to thank the media colleagues who have joined today. See you in our next presser. Thank you. FC Thank you, Dr Tedros. I would just like to let journalists know that we will be sending them the DG's opening remarks and the audio file of this press conference just after we close here. The full transcript will be available to you tomorrow morning. Thank you all. See you next time. 01:07:39

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 - 22/02/2021

00:00:24 FC Hello, everybody. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 22nd February. The virtual press conference today will include a special guest joining to discuss COVID-19 vaccine research, development and roll-out in conjunction with the COVID vaccine development strategy and implementation virtual global health symposium running from 22nd to 26th February. Our special guests are Professor Lee Bollinger, President, Columbia University, Dr Anthony Fauci, Director, US National Institute of Allergy and Infectious Diseases, Dr Nancy Messonnier, National Center for Immunisation and Respiratory Diseases, US Center for Disease Control and Prevention. We have simultaneous interoperation in the six UN languages plus Portuguese and Hindi. Before introducing to you the WHO experts present here with us I would like to make the following suggestion, if I may, to take full advantage of the presence of our three special guests. I would like to encourage journalists to devote the first round of questions to them and then we will take your questions to the WHO experts for a second round so please get your questions ready. 00:01:56 Let me introduce to you the WHO participants. Present in the room are the Director-General of WHO, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Soumya Swaminathan, our Chief Scientist, Dr Mariangela Simao, Assistant Director-General, Access to Medicine and Health Products, Dr Bruce Aylward, Special Advisor to the DG and Lead on the ACT Accelerator and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. We also have with us Dr Michel Yao online and Dr Soce Fall for any questions on Ebola. Welcome, all. Now without further ado I will hand over to Dr Tedros for his opening remarks and to introduce fully our three special guests. Over to you, Dr Tedros. TAG Thank you. Thank you, Fadela, shukran. Good morning, good afternoon and good evening. I'm deeply saddened and extremely concerned by the attack today on a humanitarian convoy in the Democratic Republic of the Congo which left three people dead including the Italian Ambassador to that country. I would like to express my deepest condolences to their families as well as to the Government and people of Italy. 00:03:27 On Friday leaders from several G7 countries and the European Union committed US$4.3 billion in new funding to finance the equitable distribution of vaccines, diagnostics and therapeutics for COVID-19. Several G7 countries also committed to sharing doses with COVAX. I would like to express my deep thanks to the G7 leaders for these contributions. These funds and donations move us one step closer to meeting our target to star vaccination of health workers and older people in all countries within the first 100 days of this year. The G7 countries have shown leadership but we need all countries to step up. We still face a gap of at least US$22.9 billion to fully finance the ACT Accelerator this year. It's important to note however that money is not the only challenge we face. If there are no vaccines to buy money is irrelevant. Currently some high-income countries are entering contracts with vaccine manufacturers that undermine the deals that COVAX has in place and reduce the number of doses COVAX can buy. 00:04:55 Even if we have the funds we can only deliver vaccines to poorer countries if high-income countries co-operate in respecting the deals COVAX has done and the new deals it's doing. This is not a matter of charity; it's a matter of epidemiology. Unless we end the pandemic everywhere we will not end it anywhere. The longer the virus circulates the more opportunity it has to change in ways that could make vaccines less effective. So it's in the interest of all countries including high-income countries to ensure that health workers, older people and other at-risk groups are first in line for vaccines globally. To achieve this we need more funding, we need countries to share doses immediately, we need manufacturers to prioritise contracts with COVAX and we also need a significant increase in the production of vaccines. Recently I had a very productive discussion with President Emanuel Macron of France and I would like to thank him for his commitment to share 5% of France's doses with COVAX. More vaccines are being developed, approved and produced. There will be enough for everyone but for now and for the rest of this year vaccines will be a limited resource. We must use them as strategically as we can. 00:06:33 Tomorrow I will be speaking at the Columbia University symposium on vaccine development, strategy and implementation. Today I'm delighted to be joined by Lee Bollinger, the President of Columbia University. One of the first - actually after I became DG the first major speech I gave was in 2017 in Columbia University. I was so honoured and that was at the invitation of President Bollinger. In that speech I said that we do not know where or when the next global pandemic will occur but we do know that it will exact a terrible toll both on human life and on the global economy. Three years later we're unfortunately learning that lesson the hard way. So, President Bollinger, thank you so much for joining us today and you have the floor. LB Thank you very much. It's really a pleasure to be here this morning in advance of the symposium on vaccines and global health and to be a special guest at this press conference hosted by Dr Tedros and the World Health Organization. 00:08:14 Columbia has had a long-standing relationship with the WHO and, as Dr Tedros said, he came to campus in 2017 shortly after becoming Director-General and in that speech at what we called the world leader forum Dr Tedros told the now eerily familiar tale of a virus that spread across communities and continents killing relentlessly and bringing economies to a halt. The pandemic he was describing of course was that of the 1918 Spanish flu but he used the example to emphasise the grave threat posed by these kinds of infectious diseases and he lamented the lack of global preparation that had been done to deal with another pandemic of that scope and scale. This has proved to be devastatingly prescient of course. We're here today because Columbia, the WHO and our partners at the United States NIH and CDC share a commitment to supporting and strengthening the multinational and multilateral work that is required to address the world's greatest health challenges, with COVID-19 chief among them. 00:09:33 Columbia takes very seriously its role as the convenor and host of forums like the vaccine symposium opening later today. The five-day event series is designed to highlight the important work being done across all sectors of society on what many would say is the defining issue of the pandemic at this moment and that is vaccines. I'm delighted to join the representatives from the NIH and the CDC here today, Drs Anthony Fauci and Nancy Messonnier. I'd also like to recognise Drs Marc Grodman, Wilma James, Laurence Sandbury and Philip La Rousa [?] for their leadership in organising the vaccine symposium which will begin, as I said, later on today. Thank you very much. TAG Thank you. Thank you so much, President Bollinger. Our next guest needs no introduction; Dr Tony Fauci. Dr Tony Fauci is one of the best-known names in global health and for good reason. For decades Dr Fauci has not only been one of the world's leading infectious disease experts; he has also been a fearless defender and articulate explainer of science and public health. 00:10:54 My friend, Tony, thank you for your leadership over so many years and especially during the past year and thank you for joining us today. You have the floor. TF Thank you very much, my dear friend, Tedros. I'd like to just spend a couple of minutes talking a bit about the scientific aspects of vaccine development which have allowed us to get to the point where we now have a number of vaccines that have been shown - and more to come - to be highly efficacious and safe in the prevention of disease associated with SARS-CoV-2. One of the most important aspects of the science that has emerged over this past year has been a realisation of the importance of the vaccine construct which really involves two major components; the immunogen itself and the vaccine platform. One of the really critical issues that has emerged was the understanding of the role of structure-based vaccine design which originated actually and got its maturity in a field that has not yet come up with a successful vaccine, namely HIV, where we've been trying to get the right confirmation of the molecule to be able to introduce broadly neutralising antibodies. 00:12:27 But it was this practice of structure-based vaccine design which allowed investigators at the NIH, particularly Barney Graham and Kizzmekia Corbett and their colleagues, to actually develop an immunogen in the form of a pre-fusion stabilised spike protein which has been used now in five out of the six vaccines that have been pursued within the context of the NIH's involvement, namely the development of and/or facilitation of the clinical trials of this vaccine. I think it is an extraordinary testimony to the fundamental basic science that has antedated that development; people often ask, we have a vaccine where the virus was made known in the first ten days of January when the Chinese published on a public database the sequence of the vaccine and only 11 months later we have vaccine going into the arms of individuals; a totally unprecedented accomplishment of something that would have normally taken years that actually was accomplished in months. Again what the world needs to realise is that this was a result of the extraordinary investment that has been made in fundamental biomedical research. The other point I'd like to bring out is at least for the trials that were supported by the US Government - and we all know that a number of other countries have done very good jobs in development and testing of vaccines. 00:14:20 But what we put in investment decades ago into a national and international clinical trials network that allowed us for years to test drugs for HIV, vaccine and prevention modalities for HIV were converted into the capability of testing vaccines for COVID-19 or SARS-CoV-2. There were three separate platforms that were pursued; the MRNA, the Adeno, both human and chimp, as well as recombinant protein and the results have been nothing short of spectacular. Now that the science has brought us there we have an extraordinary challenge and the challenge is clearly we need to get vaccines produced and distributed in an equitable way not only in the United States - because it is clear that each country must take care of their own - but also the equitable distribution, as mentioned by Dr Tedros, of vaccines so that we realise that this is a global pandemic requiring a global response. 00:15:45 I want to reiterate what Dr Tedros said, that an outbreak in any part of the world is an outbreak for the entire world and so we need over the next months to years to make a major commitment to not only continue with the science but to make sure that we implement the distribution of this vaccine so that we get a global control of this historic pandemic. I'll stop there; thank you very much. TAG Thank you. Thank you so much, Tony. Finally it's my honour to welcome Dr Nancy Messonnier, Director of the National Center for Immunization and Respiratory Diseases at the US Center of Disease Control and Prevention. Dr Messonnier is leading the CDC's efforts on COVID-19 vaccination and is one of the world's leading experts on vaccination. Among many other achievements she played a vital role in the development and implementation of a low-cost vaccine to prevent epidemic meningococcal meningitis in Africa. Dr Messonnier, thank you so much for joining us today and you have the floor. NM Hello. Can you hear me? TAG Yes, we hear you. NM I'm sorry, I had technical difficulties. Good morning and good afternoon. It's a pleasure to be here to speak with all of you today. 00:17:38 Although, as you've heard from Dr Fauci, remarkable advances have been made in science and medicine have been made during the past century we're constantly reminded that we live in a universe of microbes that are forever changing and adapting themselves to the human host and the defences that we create. It's remarkable that a year ago in the United States there were 14 COVID-19 cases and as of today we've had more than 500,000 deaths. Even though we've started to see decreasing cases and deaths here in the US and in many areas of the world the COVID pandemic is clearly not at an end; we still have a long way to go. Thankfully as soon as the virus that caused COVID-19 was discovered scientists around the world began working on vaccines to protect us. The use of a safe and effective vaccine worldwide will be a game-changer as we work together to beat the pandemic. 00:18:35 Like other countries the US has invested in multiple vaccines and because of the urgent need time between steps in clinical trial phases was shortened or eliminated and in some cases steps were done in parallel to accelerate the process whenever it was safe to do so. The US now has two authorised vaccines in use and another under review this week. While these and other COVID-19 vaccines have been fast-tracked the same processes to make and assess these vaccines are being used. Additionally, as Dr Fauci described, the type of vaccines that are being developed are not new. Both the Pfizer and Moderna vaccines use a platform, messenger RNA, that has been under development for years and other vaccines use viral vectors which use a modified version of a different virus to deliver important instructions to our cells. These vaccines have been well studied in clinical trials and were used to respond to recent Ebola outbreaks including to vaccinate pregnant women and children. As we use these vaccines we will continue to study their safety. CDC has put in place the most robust vaccine safety monitoring system in US history and of course we're sharing that information with our international colleagues. 00:19:56 In the US we've recommended those who have been disproportionately affected by COVID-19, like the elderly as well as those who we rely on to keep the country running including healthcare personnel and essential workers, to be prioritised for vaccination. We've engaged in several public/private partnerships to bring vaccine to where people are including nursing homes and assisted living facilities, retail pharmacies where people typically get medication, and mobile clinics to ensure equity in access for communities of colour who have borne a heavier burden of disease and death in the US. It's essential that as we roll out these vaccine programmes the people who need it most can have access but we know that doesn't matter if people are unwilling to get vaccinated. It's essential that everyone have confidence in the vaccination programme including having trust in the vaccine, the vaccinator and the system that produced it. 00:20:58 CDC has adapted our vaccinate with confidence strategy for COVID-19 vaccine, which is built on three pillars; building trust, sharing clear, complete and accurate messages about COVID-19 vaccine and taking visible actions to build trust, empowering healthcare personnel, to promote confidence in healthcare personnel in their decisions to get vaccinated and to recommend vaccination to their patients, and engaging communities and individuals in a sustainable, equitable and inclusive way. We're also working with communities throughout the US to rebuild trust, especially in communities of colour that have been disproportionately affected by COVID-19 and have experienced systemic racism and inequity in access to healthcare in the US. It's encouraging to see how many vaccines are being used worldwide and to know that more are on the way but just like one player on a football team cannot win the game alone we cannot beat this pandemic one country at a time. As others have said, no country will be safe from COVID-19 until all countries are protected. Diseases know no boundaries. We saw that two years ago when measles worldwide increased and it's certainly been true in the past year. Vaccination is a critical tool in bringing this unprecedented pandemic to an end. Thank you. 00:22:26 TAG Thank you. Thank you so much, Dr Messonnier, and thank you to all our guests for joining us today. I hope you will stay with us to answer some of the questions from the media. As we often say, it's not vaccines that save lives; it's vaccination. In 1798 Edward Jenner administered the first vaccine against smallpox. It took another 184 years for smallpox to be eradicated. In combination with proven public health measures vaccines give us the tools to control COVID-19. Whether we can is no longer a test of science; it's a test of character. Fadela, back to you. FC Thank you, Dr Tedros. I will now open the floor to questions from members of the media. I remind you that you need to raise your hand, use the raise your hand function in order to get in the queue. I will start with Sophie Mkwena from South African Broadcasting Corporation, SABC South Africa, to ask the first question. Sophie. 00:23:49 SO Thank you so much. My question is directed to Dr Fauci in particular. Doctor, in developing countries such as South Africa there's an attempt to ensure that they don't just import vaccine but they are able to develop vaccine. What can the international community do, particularly the developed nations such as the United States of America with its capacity, to help these countries who are saying, we want to be at the same level with the developed nations so that we don't rely on charity? TF That's a very good question. FC Thank you, Sophie. TF That's a very good question that gets asked often and I think the point that you're making is one that really is critical. The best way to have sustainable capability of being able to respond to outbreaks, not only the outbreak of COVID-19 but also the inevitable outbreaks that will also occur from the future, is to build capacity within country that's sustainable capacity. So one of the things that developed nations need to pay attention to is that in addition in the immediate sense, which you don't have the time right now to have something built in a week or two but to think for the future as well as in the intermediate time, to have countries like South Africa and other southern African countries have the capability to make their own vaccine so that they would be independent of having to rely on the donation of vaccines from other countries. 00:25:51 I think it goes not only for South Africa but so many other countries that if given the resources and the capabilities would really be quite capable of making vaccine to take care of their own population. FC Thank you, Dr Fauci. Dr Swaminathan, you have the floor. SS Just to add to what Dr Fauci said, what the Director-General has been calling for is for those who have the technology, manufacturers or the academic labs, to share with companies, production sites in different countries around the world to actually do that technology transfer and to build the capacity, especially with the new platform technologies that can be very quickly adapted to deal with other pathogens. WHO set up a mechanism, the COVID technology access pool, which can facilitate the tech transfer and so I hope that we will see a growing interest in this because I think it'll only help everyone if we have more sites across the world distributed geographically that are capable of producing vaccines at short notice. 00:27:07 It'll help this pandemic and it's also going to help for future pandemics as well as for other infectious diseases of public health importance. Thank you. FC Thank you. I would like now to invite Donato Mancini from the Financial Times to ask the next question. Donato, you have the floor. DO Hi. Can you hear me? FC Very well. Go ahead, please. DO Thanks for taking my question. It's about access to vaccines. We all know about CTAP. I've heard Dr Swaminathan's comments today but we also know that corporate interest in CTAP remains low. I'd like to ask your US guests what they make of calls to open up intellectual property and spur tech transfer in order to widen access to vaccines. Does the US have a view on CTAP, does the US have a view on opening up IP and more broadly what can be done to entice companies to share their IP? Thank you. 00:28:10 FC Thank you, Donato. Dr Fauci, do you want to take this question? Or any of our guests are welcome to interfere at any time. TF Yes, I'd be happy to give it a show but I'm sure that my colleagues from the United States also might be able to weigh in. That is obviously always a very sensitive issue but an issue that I think really does need to be addressed. We have some good examples dating back to the early years of HIV when drugs, antiretroviral drugs that were life-saving in the developed world, particularly for 1996 on, were the drugs that essentially could prolong the lives of people with HIV in a way that would have been unimaginable a few years before. But when the PEPVAR programme was started by the United States under George W Bush it was clear that in order to get the drugs to the countries and the individuals in those countries, particularly in Southern Africa, the Caribbean and other areas where it would be difficult for those countries and people within those countries to develop or even pay for the drugs themselves, there were things that were done with regard for example to the generic drugs. 00:29:46 There was a lot of discussion as to whether or not that would have been able to have been done and would that interfere with the appropriate profit of companies that made major, major investments in the development of their drugs. Actually it worked out very well because through the PEPVAR and Global Fund project we were able to get life-saving drugs to millions and millions of people, saving now well up to 17 million lives and it did not have a deleterious effect on the companies, who continued to do well financially and continued to make investments in research. So I'm not sure exactly what the model will be but I think at least we do have some precedent that you can make arrangements with companies that would allow them both to maintain a considerable amount of profit at the same time that areas of the world that don't have resources can share in a way that would be life-saving to literally millions of people. I'll stop but I'd be happy to hear what others have to say. 00:30:55 FC Thank you, Dr Fauci. We are very privileged to have several professors from the University of Columbia happy also to provide some response. I would like to call on Dr Marc Grodman, Professor at Columbia University, who would like to provide some comment to Donato. You have the floor, Doctor. MG Thank you very much. Just To go back both to this question and to the previous question, this very much strikes at the reason why there is a symposium in the first place. Vaccines are complex. New vaccines are complex but if you think about it the vaccine solution is logarithmically even more complex. How you go from the development to all the other issues that are there vis a vis both distribution, how you go in and overcome, as Dr Fauci just mentioned, many of the competitive business issues, how you overcome many of the political issues, how you address the ethical questions are all part of the overall solution. 00:32:02 The idea of the symposium was to bring in all these different aspects because this is what the solution all means. Many of the things that you mention are aspirational and because of the severity of what we've been through, the severity of the pandemic a lot of the conflicts which have occurred prior to this point in vaccine development; many of them have been overcome and blurred. The question and the challenge is going to be how we go from thinking about these threats as to what if to what if it happens again and what do we get out of this kind of massive co-operation, which we're still just on the brink of being able to overcome, to real solutions that are going to make future vaccines more equitable. That's why we wanted to put together a symposium to put together people not only to look at the full continuum of vaccine development but in science and the research and development and the ethical issues of distribution, but as well to be able to look at it from a global perspective. So I think the book very much is unwritten right now. The challenge is to use what we've been through and the experience and the perceived success to come into concrete solutions into the future. 00:33:24 FC Thank you, Dr Grodman, Professor at Columbia University. I would like to ask Dr Laurent Sandbury, Associate Dean for the International Programme in Global Health, Columbia University, also to provide some comment. You have the floor, Doctor. Dr Sandbury, you have the floor. Dr Sandbury, you have the floor. No? Now I would like to invite Dr Simao and we will come back to Dr Laurent Sandbury if he still wants the floor. Thank you. Dr Simao, you have the floor. MS Thank you. Thank you, Donato, for the question and thanks also to Dr Fauci for reminding us of the HIV response. I think it's a very good example because we don't have the time we had. We cannot afford to take ten years for medicines or vaccines to reach developing countries this time. I think it took too long with HIV and too many people died unnecessarily. Since then there have been mechanisms in place. We have for example the Medicines Patent Pool, which already has around ten years of existence and it's a proven method, a platform to ensure that both voluntary licensing and technology transfer can help to increase access to medicines for HIV, TB and malaria. 00:35:20 Why not use the platforms that we, WHO are putting in place like the CTAP, the COVID Technology Access Pool, to ensure that...? Intellectual property needs to be managed either through a voluntary licence or other measures but it's not enough. Intellectual property is not the endpoint. The endpoint is increasing manufacturing capacity and making sure the quality-assured, efficacious and safe vaccines reach developing countries. So this is a combination of things in this platform and I like the question also on the incentives; what are the incentives - and Dr Fauci pointed to some - that would bring into place a situation where we can have targets short-term, which is this year, mid-term next year and the following years also in preparation for future pandemics, as Dr Swaminathan mentioned before. Thank you. FC Thank you. I would like now to give the floor to Laurent Zero from the Swiss news agency. Laurent, can you hear me? LA Yes, thank you, Fadela. Can you hear me? FC Yes. Go ahead, please, Laurent. 00:36:39 LA Thank you so much. A question to Dr Fauci; the new US administration now has committed to fund COVAX but it has been quite reluctant so far to speak about sharing the US doses for developing countries. At the G7 President Emanuel Macron made a concrete proposal about 30 million doses that could be shared quite quickly to Africa in order to vaccinate the health workers. After that call can we expect another move from the US administration on that? Thank you. TF Thank you for that question. I don't think I can comment on that, not because I don't want to but because I'm really not sure. We had discussions, you might recall, when I addressed the executive committee of the WHO and made the announcement that we would join COVAX, which we did and the President has committed, as you know, over a period of time $4 billion, $2 billion right away and two billion to come. I would have to get back with you because there will be discussions about what else, if anything, will be done vis a vis COVAX. But I don't think... and I cannot really comment definitively about what the commitment would be regarding the sharing of doses as was proposed by President Macron. 00:38:13 I'll have to just pull back and perhaps get back to you on that because I'd be reluctant to make a statement in that regard. FC Thank you, Dr Fauci. I would like now to invite Paulina Alcazar from Encadena News, Cancun, to ask the next question. Paulina, you have the floor. TR Thank you, Fadela, and hello from the Mexican Caribbean region. People are asking about potential allergies to the components of the vaccines such as preservatives or coadjuvants. Are there lists of these so that people can calmly go and be vaccinated and we can ensure people such as asthmatic people can know what ingredients there are? Thank you. FC Thank you, Paulina. Dr Fauci, do you want to take this question, please? TF Yes, sure. We have seen some anaphylactic reactions that have been associated with the two vaccines that have been currently distributed in the United States and that is the Pfizer MRNA and the Moderna RNA. These are reactions that are likely - we're not 100% sure - to the polyethylene glycol in the vaccine preparation. 00:39:49 This has not been definitively proven yet but this is something that is being suspected. We're working on trying to find out what the genesis is and what the pathogenesis of these allergic reactions is. When you look at them they can be severe. We are telling individuals that unless you have a known anaphylactic reaction to a known component of the vaccine you should not get vaccinated [sic]. However for other people who have a history of allergic reactions that is not a contraindication to get vaccinated. We feel they can and should get vaccinated but if you have a history of anaphylactic reaction to get vaccinated in a particular location that has the capability of treating anaphylactic reactions. If you look at the numbers, a paper recently came out examining that and there are between four and five per million anaphylactic reactions to the Pfizer and between two and three per million to the Moderna. 00:41:12 So it's an unusual, rare interaction but it should not be a contraindication for someone to get the vaccine because the risk of getting COVID in the situation is likely greater than the risk of getting any kind of deleterious reaction. Thank you. FC Thank you, Dr Fauci. Dr Swaminathan, you have the floor. SS Just to add to what Dr Fauci said, I think this is an important question and that people would like to know how safety is being monitored, particularly since these vaccines were all developed so quickly. These questions are being asked by people so we need to reassure them that there are systems in place; I think Dr Messonnier mentioned within the US but every country has a system in place to do safety monitoring, what we call pharmacovigilance and the WHO coordinates this. There is a global vaccine safety committee that looks at this data, they look at it every week, data from all countries, from manufacturers, regulators and countries' systems. So far we've had over 200 million vaccine doses that have gone into people around the world and there have been no alarming safety signals but we will continue to monitor and update if anything changes. Thank you. 00:42:46 FC Thank you, Dr Swaminathan. I would like now to invite Christiane Ulrich from DPA, German news agency, to ask the next question. Christiane, you have the floor. Christiane, can you hear me? CH Hello, yes. Can you hear me? FC Very well. Go ahead, Christiane. CH Thank you, Fadela, for taking my question. I was going to direct it to Dr Messonnier and we broached it with Dr Fauci earlier but maybe the US Department of Health has a clearer answer. Is the US going to share doses of the vaccine that they have now secured for the US to follow the passionate appeals by Dr Tedros and others in the last few days? Thank you very much. FC Thank you, Christiane. Dr Messonnier, do you want to take this question? NM I can take it but my answer will be the same as Dr Fauci's. I think it's a very important issue. I know that there are ongoing discussions right now in the US about the importance of global COVID control and the role that vaccine will play in it but I don't have a specific answer in terms of any decisions or where the discussions are. We'll really have to get back to you on that. 00:44:23 FC Thank you, Dr Messonnier. I would like now to invite Carmen (not from POLITICO contrary to what was announced by the moderator) to ask the next question. Carmen. Carmen, you have the floor. Can you please unmute yourself? CA You can hear me. FC Yes, I can. Go ahead, please, Carmen. CA Thank you very much. I have a question also on anaphylactic shock. I have heard some people ask where is the difference because the [unclear] zero against allergic plants and so on. It is recommended after the injection to stay 30 minutes to see if something happens. So now in the theme of the vaccine it is recommended everywhere 15 minutes. The question is, what is the reason behind this time difference? 00:45:48 TF The recommendation is if you have a history of allergic reaction then you stay for 30 minutes; if you don't have any history of allergic reactions such as anaphylaxis then 15 minutes would be enough but Dr Messonnier is probably more experienced in that type of thing than I am so perhaps she can confirm or amplify that. NM I can definitely confirm what Dr Fauci said but maybe to add a little more context, we ask people how have had a history of anaphylaxis to stay 30 minutes because when we look at the onset of anaphylaxis in the cases in the United States they've all occurred within that 30-minute time frame. So out of an additional caution we're asking people with anaphylaxis to stay a little longer so that we can be sure that they're under medical supervision if there is any unfortunate onset of allergic reaction to the vaccines. FC Thank you, Dr Messonnier and Dr Fauci. I would like now to give the floor to Simon Ateba, Africa News Today, Washington. You have the floor, Simon. 00:47:13 SI Thank you for taking my question. This is Simon Ateba for Today News Africa in Washington DC. My question goes to Dr Fauci. Yesterday President Biden's National Security Advisor spoke about the report being prepared by the WHO and said the Biden Administration has little confidence in the report. He said he doesn't believe China gave enough data. Dr Fauci, what type of information do you still need from China or from the WHO, what type of report do you expect from the WHO? Thank you. FC Thank you, Simon. Just checking but I think that Dr Fauci left so we will make sure he has your question and see if he can respond in written form. Thank you all. I think it's already been one hour and I would like to ask our guests if they want to make any closing remarks before we close this press conference. Dr Messonnier, Professor Bollinger, you have the floor. LB Thank you. On behalf of Columbia, I'm just grateful to the WHO and all the US colleagues for being part of this at Columbia. FC Thank you, Professor Bollinger. Dr Messonnier, do you want to take the floor? No. I think now it's time to hand over to Dr Tedros for his final remarks. Dr Tedros, you have the floor. 00:49:35 TAG Thank you. Thank you so much, Fadela. I would just like to use the opportunity to thank Professor Bollinger, Dr Tony Fauci and Dr Nancy Messonnier for joining us today and not only for joining us today but I would like to use this opportunity also to thank you for our co-operation and partnership; the partnership between WHO and Columbia University, the partnership between WHO and CDC and NIH. Thank you so much for joining and we would like also to thank the media, the journalists who have joined us today. Thank you, Fadela, and back to you. FC Thank you, Dr Tedros. Just to remind journalists, we will be sending the audio file and Dr Tedros' remarks right after this press conference. The full transcript will be posted on the WHO website tomorrow morning. If you have any follow-up questions please do not hesitate to email mediainquiries@who.int Thank you to our guests, to you my colleagues here in the room and see you next time. 00:50:52

Media briefing on COVID-19 - 26/02/2021

00:00:00 FC Shortly. We have simultaneous interpretation in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi. Let me introduce to you the participants. Present in the room are Dr Tedros, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the Act Accelerator, Dr Peter Ben Embarek, WHO Expert on Food Safety and Zoonosis, and joining us remotely is Dr Soce Fall, who is our Assistant Director-General for Emergency Response. Welcome, all. Now without further delay I would like to hand over to Dr Tedros for his opening remarks and to introduce our special guests. Over to you, Dr Tedros. TAG Thank you. Thank you, Fadela. Good morning, good afternoon and good evening. On Monday the Governments of Sweden and Switzerland and the United Nations will host a virtual high-level pledging event for Yemen. Yemen is the world's largest humanitarian crisis with more than 20 million people in need of humanitarian assistance. 00:01:48 More than five million people are now at risk of famine and already half a million children under five could die from hunger in the coming weeks unless they receive urgent treatment. All of this even as the already fragile health system has been left to deal with COVID-19. This current crisis comes at a time after years of conflict when there is now a real opportunity for peace in Yemen. We have to act on it. Two years ago generous funding helped hold off famine. It's time to step up again. The situation now is even more grave. The 2021 response plan includes an ask of US$3.85 billion. I urge donors to be generous. On Wednesday Ghana became the first country outside India to receive doses of COVID-19 vaccine from the COVAX facility and the factory in India, the Serum Institute. Just a few hours ago Cote d'Ivoire received its first doses and more doses will be shipped to more countries in the coming days and weeks as we move towards our target of starting vaccination in all countries within the first 100 days of the year. 00:03:30 We now have 43 days left. I would like to thank our COVAX partners at GAVI, CEPI and UNICEF who have helped bring us to this point and the member states who have provided the resources. We have made progress but that progress is fragile. We need to accelerate the supply and distribution of vaccines and we cannot do that if some countries continue to approach manufacturers who are producing vaccines that COVAX is counting on. These actions undermine COVAX and deprive health workers and vulnerable people around the world of life-saving vaccines. Now is the time to use every tool to scale up production including licensing and technology transfer and where necessary intellectual property waivers and if not now then when? I understand full well that all governments have an obligation to protect their own people but the best way to do that is by suppressing the virus everywhere at the same time. It's also important to remember that although vaccines are a very powerful tool they're not the only tool. We still need to accelerate the distribution of rapid diagnostics, oxygen and dexamethasone. 00:05:08 In that regard we welcome the European Council's statement of solidarity today, committing to contributing the European Union's share of funding to the ACT Accelerator. We must also remember that for more than a year now many countries have successfully prevented or controlled transmission without vaccines and with proven public health measures. On Wednesday WHO officially launched our Strategic Preparedness and Response Plan for 2021 which outlines six objectives and the ten essential pillars of the response. The 2021 SPRP outlines how WHO will support countries in meeting their objectives and the resources we need to do it. Many countries used last year's SPRP as the basis for their national response, adapting and applying it to their own context. One of the countries that has averted a major crisis despite the predictions of various models is Nigeria. With Africa's largest population, its largest economy and its largest city what happens in Nigeria affects what happens in Africa. 00:06:34 Today I'm delighted to be joined by Dr Chikwe Ihekweazu, the Director of Nigeria's Centre for Disease Control and the Head of WHO's Country Office in Nigeria, Dr Walter Kazadi Mulombo. Dr Chikwe is one of Africa's and the world's leading public health experts. My brother, thank you so much for joining us today to talk about Nigeria's experience and response to COVID-19. You have the floor. CI Thank you, my dear colleague and big brother, Dr Tedros, and your team at WHO for inviting me to this important briefing. In Nigeria we are very grateful to WHO at global, regional and local levels - at country level for your support and strong collaboration throughout this response. Tomorrow, 27th February, actually marks exactly one year since Nigeria's first COVID-19 case was detected and since then we've had 150,000 cases with about 1,800 deaths. Although the numbers of cases in Nigeria and Africa have been lower than initially estimated this pandemic has had a devastating impact on our country. Millions of people have been exposed to the direct and indirect impacts of this pandemic. 00:08:19 However, DG, we have learnt many lessons from this response and I though to share only three. Firstly on co-ordination, political leadership has been critical in shaping preparedness and response in Nigeria. In March 2020 His Excellency, Mr President, President Mohammadu Buhari established a presidential taskforce on COVID-19 chaired by the Secretary to the Government of the Federation, Mr Gus Mustafa [?]. This PTF has really provided much-needed multi-sectoral co-ordination, providing clarity of vision and determination in delivery. Secondly I'd like to speak of collaboration. Nigeria's a big country; 200 million people, 37 federal states. Our response has been driven by strong collaboration across federal and state governments, multilateral organisations such as WHO and the private sector, Government and its citizens. So for the public health response we had an emergency operations centre hosted here at NCDC but bringing together all the other partners responding in one room. 00:09:33 Thirdly, DG, I'd like to speak on solidarity. This is a word you have used a lot over the last year and for us this is not just about governments working together but also about communities and individuals playing their part. Our campaign, take responsibility, really struck a chord in Nigeria as we pulled everyone, all Nigerian citizens into our response to become champions of the so-called public health measures; physical distancing, the wearing of masks, hand hygiene and avoiding crowded places. Now to vaccines, DG. We know that despite the best efforts of our Government it will still take a while to get vaccines to everyone. Therefore the solidarity among our population will remain very important throughout the year. In Nigeria our response has always been guided by an incident action plan that is adapted from WHO's Strategic Preparedness and Response Plan and while there's still some uncertainty about the year ahead of us, especially with the emergence of variants of concern, we recognise much clarity on what needs to be done - we recognise that we need more clarity on what needs to be done. 00:10:50 Our success this year will depend a lot on these three things; on co-ordination, on collaboration and on solidarity, whether at country level in Nigeria or globally. We must open up to learning from each other, sharing with each other and working towards global rather than country-level protection. Despite the challenges and hurdles we strongly believe that there are more voices out there that will stand and understand the need for global solidarity with each other. WHO's critical role in all of this is to bring us together; government, academia, private sector, industry; and we'll continue to look forward to WHO's leading role in co-ordinating our efforts. Thank you very much and I look forward to interacting with the rest of you. TAG Thank you. Thank you so much, my brother, Chikwe and thank you for your support, leadership and insight over the past year. At these press conferences every week the world's media see staff from WHO headquarters and our six regional offices also hold their own briefings. What you don't see often enough are our colleagues in WHO's 150 country offices, who are supporting countries every day to prepare for and prevent and respond to COVID-19. 00:12:20 Who does not just parachute into countries when there is an emergency. Our staff are there every day of every year working with the government and communities to address the full range of health threats they face. So today I'm very pleased to welcome Dr Walter Kazadi Mulombo, the WHO Representative in Nigeria. Walter, thank you for joining us and over to you. WKM Thank you very much, DG, for this opportunity to share our contribution to the COVID-19 response in Nigeria. As you know, since the onset of the COVID-19 pandemic and its first reported case one year ago, as Dr Chikwe mentioned, WHO country office has engaged the national authority through the Federal Ministry of Health, the Presidential Task Force and working hand-in-hand with NCDC to develop the tools that would be used later on to galvanise the whole community - donors, partners, the entire Government, the private sector and others - around a common goal, a common objective to prevent the spread, suppress transmission and prevent socio-economic disruption. 00:13:42 So WHO in Nigeria worked alongside the Nigerian CDC. It activated its incident management system alongside NCDC and repurposed all its workforce towards the early moments of the response. For this WHO Nigeria [unclear]. We have a huge field presence with all our staff who have been working on polio and responding to other health emergencies. So we used all our resources to support NCDC and the Government of Nigeria. Also an important dimension to the response is partnerships so we leverage upon the UN country team under the leadership of the UN resident co-ordinator to galvanise all effort within UNCD and to mobilise resources to support the multisectoral resource plan that was put forward by the Government. The UN were able to mobilise over US$73 million that were used to fly into Nigeria supplies, equipment, reagent which were used to save lives and try to control the epidemic from the beginning. 00:15:07 As you know, Nigeria has gone through two waves. There was the first wave, which was brought under control after August and then we had the second wave which started toward early December and which is currently being brought under control. When we saw the second wave WHO worked again with NCDC to conduct an inter-action review both in the capital and in all the states to readjust the strategy and readjusting the strategy has been a consistent strength of NCDC and the Nigerian Government so that the measures we take are commensurate to the risk we identify in the field. So it has been really responsive to the need based on the [unclear] of the epidemic. WHO more recently supported the country to develop its vaccine deployment and vaccination plan for COVID-19. It has been used to secure through the COVAX facility close to 14 million doses of AstraZeneca vaccine, four million of which are expected next week. Nigeria will join other African countries - Ghana and Cote d'Ivoire and several others - to be among those introducing the vaccine during the first 100 days of the year, as you said. So the launch of the new strategic preparedness and response plan by WHO is an opportunity for us to further work with NCDC and the Government to refine again the strategy based on evidence and on science. 00:17:04 I would like to recognise the great contribution and expertise of Dr Chikwe and his team and the whole of Government for an unprecedented commitment which make the WHO or the UN as a whole work even more interesting and a good learning case for other cities. Thank you and over to you, DG. TAG Thank you. Thank you so much, Walter. I send my greetings to all our colleagues in the Nigeria country office and you have my deep thanks and respect. I am very proud of you all and proud to be WHO. Fadela, back to you. FC I would like now to open the floor to questions form members of the media. I remind you that you need to raise your hand using the raise your hand function in order to get into the queue to ask your question and don't forget please to unmute yourself. 00:18:13 I would like also to encourage journalists to take the opportunity of the presence of our two special guests to address questions to them. They will stay with us for the entirety of this press conference. I would like now to invite the first journalist, Christophe Vogt, who is the Bureau Chief, IFP Geneva, to ask the first question. Christophe, you have the floor. CH Good evening. Can you hear me? FC Yes, very well. Go ahead, Christophe. CH Thank you for taking my question. It's to everybody who's there and who might have an opinion on it. The Security Council just voted to improve equitable access to vaccines. The vote just happened 30 minutes ago but at the same time the European Union stated a few days back that they want to vaccinate 70% of their population by the summer. So I was just wondering, are both possible, is it possible to have equitable access to vaccines but at the same time going so much higher than the maybe 20% that is needed to protect the most vulnerable populations? FC Thank you, Christophe. Dr Aylward, you have the floor. 00:19:47 BA Thank you, Fadela and, Christophe, thank you for the question. The resolution that was just passed is important indeed because what it does is it recognises the populations in very special circumstances that may not be reached by vaccines through the mechanisms that have been put in place to ensure equitable access around the world, especially targeting, as we've talked about previously, first healthcare workers and then older populations and then people who have comorbidities and other conditions, as we've spoken about. Of course these people can be found anywhere, in any country whether in the wealthy countries or the lower-income countries but also places affected by conflict and other circumstances which make it very difficult to reach them. So this is an important resolution because it recognises the need; it's a key piece of the equitable access framework. Of course for equitable access WHO, COVAX, all of our partners whom we work with still promote that all populations need to roll this vaccine out together. We need to get to the healthcare workers around the world together, then we need to get to the older populations, as we said, and beyond. 00:21:05 So if we have enough vaccine to do that... No, we don't right now in the world and so we are still calling very much for the equitable distribution of what continues to be a very scarce resource so that we can reach all of those populations in that right order. There is certainly enough vaccine in the world right now to be able to reach those highest-risk populations in all countries, in all areas and the challenge remains for all of us working together to make sure it is distributed equitably, as you highlight. FC Thank you. I would like now to invite Simon Ateba, Africa News Today, to ask the next question. Simon, you have the floor. SI Thank you for taking my question. This is Simon Ateba for Today News Africa in Washington DC. My question is to Dr Chikwe Ihekweazu, the Director-General of the Nigeria Centre for Disease Control. Director-General, as you said, Nigeria has recorded more than 154,000 cases of COVID-19 and over 1,800 deaths, the highest death toll in West Africa. That's still very small when compared to the rest of the world. Still, most people who contracted the virus in Nigeria have recovered. Can you explain why the recovery rate has been so high in Nigeria and how many people will Nigeria vaccinate since it's a big country of 200 million plus people? What's the vaccine acceptance like in Nigeria? Thank you. 00:22:46 FC Dr Chikwe, you have the floor. CI Thank you very much. I missed the very last part but I'll start from the beginning. When we started this response of course the whole world expected the continent of Africa and Nigeria with our population realities, our socio-economic realities to basically fall apart. So I think one of the reasons has to be that we did actually mount a very strong response in the beginning, took some very hard decisions in our country to lock down the economy fairly early, shut down international travel, stop all domestic travel. These were very hard decisions for our Government to make. They made those decisions in the best interests of our people and enabled us the time to build the response. 00:23:38 But even from the beginning we were very clear and our leadership was very clear that shutting down the economy is not really an ideal outbreak response and that was done because we needed to prepare the public health workforce to be able to respond more effectively. Then what really happened was that there was a real mobilisation of people across the country to take responsibility for the future of our country and so the public health measures that we speak about were really for a long time adhered to before some people got tired later in the year and we carried out an effective public health response. The things that might be new to some people; the details of contact tracing, identifying cases, isolating them; we'd unfortunately had the opportunity to do this severally for many outbreaks that we've faced in the past so it wasn't new to us. We mobilised our resources fairly effectively to deliver on this and thankfully we have the numbers that we have. But just recently we carried out a seroprevalence survey in four states in Nigeria and in Lagos State for instance we found a seroprevalence of 23%, of course with confidence intervals around that, meaning that there must have been a lot more infection than we had found through our surveillance system, meaning that there were a lot more mild cases of infection. 00:25:10 This might be as a result of the very young population in Nigeria. So there are many things that drive the response that we are still learning but the key thing is, unlike previously, we are part of the science, we're part of the discovery. We're learning as we're doing, we're iterating and using what we learn to shape the response in real time and that really is one of the most important parts of this response. Working together with WHO and with all our partners we have been active participants in our own destiny and not reliant on just support from the outside because the borders were closed anyway and we couldn't get as much support globally as we would normally have. On the second question on the number of people we intend to vaccinate, like every country in the world we want to vaccinate as many people as possible. That's a legitimate desire by any country and that's the same here but we also recognise the need for equity in distribution of access and that's why we have aligned very strongly with the African Union and Africa CDC's approach because even within the continent there are also differences in countries' abilities to support their citizens. 00:26:29 But Nigeria has been very firm in saying that we will not look for bilateral deals, we will work in a multilateral way with WHO, with COVAX, with the African Union to make sure that as we get vaccines into Nigeria the same happens in Benin [?], in Togo, in Ghana, in Cote d'Ivoire, in Senegal, in Ethiopia, across the continent. So we're working very hard to get as many vaccines as we can get into Nigeria, at the same time working with our brothers and sisters across the continent to enable them to get it [?] as well. So we're looking forward to our first deliveries. We've looked at the deliveries in Ghana and Cote d'Ivoire with a bit of excitement but also a lot of desire. We want to see the same happen in Nigeria over the next few days as the biggest country on the continent and I think getting the outbreak under control in Nigeria will serve the continent well, it will serve the world well and we look forward to receiving those vaccines soon in our city, in our country's efforts. 00:27:35 FC Thank you, Dr Chikwe. I would like now to invite Jamie Keaton, Associated Press in Geneva, to ask the next question. Jamie, you have the floor. JA Thank you, Fadela, thank you so much. Nice to see you all. As you may know, Pope Francis is scheduled to make a four-day visit to Iraq starting a week from today. There are expected to be masses both indoors and outdoors and trips to various parts of the country are expected to draw large crowds. The Vatican delegation and accredited media are all vaccinated but the Iraqis most at risk are not and Iraq recently went into a modified lock-down with schools and mosques closed and a night-time curfew due to a surge in cases, many of those linked to the variant that emerged in the UK. So my question; can you remind us of WHO's advice about mass gatherings, especially in countries facing severe outbreaks and the epidemiological wisdom of such a high-profile visit that is likely to draw big crowds? 00:28:51 What would you advise the Vatican about ways to ensure that it will not inadvertently provoke a super-spreader event? Thank you so much. FC Jamie, you are talking about Iraq. JA Correct. FC Yes. MK Thanks for the question. WHO has issued guidance on mass gatherings, whether these are gatherings that are planned or gatherings that are spontaneous, taking a risk-based approach. It depends on a lot of different factors that are happening with the country in terms of the epidemiological situation, the handling of the event itself in terms of if it's indoors, if it's outdoors, the nature, how many people will be the, if there can be physical distancing, the use of masks, etc, if there's a plan in place what the event-holders will do in the case of someone who is sick, someone who's symptomatic, someone who's a case, how they can carry out all the necessary public health actions. We have issued this advice many, many months ago, which all countries are using to take a risk-based approach on those decisions on if an event can happen and if so how it can happen safely and if not if that event can be postponed. 00:30:09 This is the same for mass gathering events that are large and it's the same advice we would give for gatherings that are happening at people's homes; if they're having birthday parties for example. It's all about managing that risk so there is no one short answer of if an event can be held or not. It's about looking at the epidemiologic situation in the country and then making sure that if that event is to take place that it can take place as safely as possible. FC Thank you. I would like now to invite Sara Teofilo from Coreo, Brazil to ask the next question. Sara, you have the floor. SA Hi. Thank you for taking my question. Brazil is having its worst moment during the pandemic with a high number of deaths and a lack of ICU beds in several states. The occupancy rate of ICU beds is above 90% in many of them. I wonder if you can blame the new variant for the collapsing health system and if increasing ICU beds is enough to solve the problem. Thank you. 00:31:28 MR I didn't quite hear all of your question but I think we spoke on this last week, both Mariangela and myself, that not all countries were in a downward trend and there was a persistent trajectory of cases in Brazil and certainly we haven't seen a prolonged downward trajectory. Mariangela explained at that time that there were different trends happening in different parts of Brazil. It's a very, very large country in a complex situation but there's no question that Brazil is not the only country facing this situation. There are many countries in which the downward trend is not... There are many countries thankfully where that is happening and there are many countries in which that downward trend is not being achieved. The contribution of variants to that situation is not fully understood in this particular case. What we do know in countries that are applying persistent and consistent measures in terms of public health and social measures and individual behaviour; that that is affecting the trajectory of all variants and even though some variants have shown a propensity for higher levels of transmission what is clear is that the control measures that have been designed are effective in driving that down. 00:32:47 We've seen in the past that just ramping up health systems' capacity is not enough. Your health system will be overrun if the force of infection; if the trajectory of cases is rising and your health system cannot cope today it will certainly not cope tomorrow if that pressure continues in the system. So yes, it is always good to shore up health capacity, it's always good to be able to open more beds and to move health workers from areas under less pressure to support staff in other areas. All of that is good but that in itself is not enough; you have to get to grips with the transmission as it's occurring at the community level and many parts of Brazil have suffered intense community transmission over a very prolonged period of time. It's been very tough for Brazilians and for Brazil in general and ait is very difficult in a populous country where people are very often living in multi-generational, multi-family homes, many living in periurban areas where poverty and lack of access is a major issue. 00:33:52 So it is easy to sit here and talk about what should be done; it's very difficult in reality to achieve that in some of the settings that the Brazilian authorities face and the communities themselves face but there is no other way. The only way out of this is to do that work. You heard Chikwe and congratulations, Chikwe; we have tremendous admiration. Nigeria is a very similar set-up; a large country with large urban areas and they really had to come to grips with some very, very difficult decisions and to remain cohesive and persistent in the application of those measures while taking into account and recognising the economic and social toll of that and finding the balance between those measures to keep the rates of transmission at a low enough level to prevent the health system becoming overwhelmed. So many countries have faced that reality. Unfortunately - and it is a tragedy for Brazil that Brazil is now facing that again and it is tough. This is the fourth time around for Brazil, I think, at least and the situation in Brazil has improved in some areas while it's disimproved in others so I don't think there's been a point in the last year where some part of Brazil has not been deeply affected by this pandemic. 00:35:05 So it is very tough and we should take a moment to show solidarity with the people of Brazil and to provide the necessary aid and support needed for them to be able to come to grips with this disease. But again Brazil is a very able country and has many fantastic public health and scientific institutions and I think Brazil knows what to do and many states are trying to apply the best measures but it's not straightforward, it's not easy. But I think it's a lesson now for all of us that this is not over; it's not over for anybody and any relaxation of our resolve is dangerous and we need to, as I say, be very aware; this virus still has a lot of energy and if the measures we apply are not persistent, comprehensive and aimed at continuing to suppress transmission while introducing vaccines we will pay a price and unfortunately our communities will pay a price as well. MK Very briefly I just want to take an opportunity to mention the variants because the question also said, is it due to the variants? You've heard us say that there are variants of concern that have been identified from some countries. 00:36:20 WHO actually issued some definitions yesterday on our website in our weekly epidemiologic update which outlines proposed working definitions. I say working definitions because these may change over time as we learn more about them but these are working definitions of variants of interest as well as variants of concern. This is mean to help guide countries in looking at the viruses that they are detecting in their countries and looking at the full genome sequences that are being conducted by countries to see if there are any changes in these viruses and using these definitions what actions they need to take to report to us, what studies need to be done in country. We've set the threshold for determining a variant of interest very low so that they're sensitive enough to capture potential important variants but we've also set the threshold for the determination of a variant of concern very high so that we can focus the attention and resources on variants with the highest public health potential. 00:37:24 This is important so this is on our website; we will provide the link in the chat below so that you can see this. We expect that there may be some modification of these definitions over time but this is meant to be a helpful guide to determine which of these mutations, which of these variants are interesting in the sense that they may have some public health importance, some public health impact potentially on some of the countermeasures as we go forward. This is a system that needs to be in place as we go forward as this pandemic evolves. Some of the virus variants that have been detected, the virus variants the WHO is tracking have shown some increased transmissibility and if you have increased transmissibility it means you have more cases. If you have more cases this means you could have more hospitalisations which could put some burden on the healthcare system and in some countries the healthcare system is overburdened to begin with and this could lead to an increase in severity and death. So we want to make sure that the measures that are in place are preventing as many infections as we can. So far based on all of the variants that we have seen, that are being tracked the public health and social measures, the infection prevention and control measures in health facilities and outside of health facilities work against these virus variants that are circulating. 00:38:44 We are seeing this in country after country as incidence declines. We are seeing this directly from studies that are being conducted in countries that have these virus variants that are predominantly circulating and this is good news. But we need to continually monitor this so we have a system, a global system in place to not only identify which of these mutations are important but what they mean in terms of transmission, in terms of severity and in terms of any potential impact on available and future diagnostics, therapeutics and vaccines. We are working with partners all over the world, in country as well as public/private partnerships with all of the different manufacturers to make sure that we can monitor these almost in real time. That is difficult because it takes time to do some of these studies but we are very grateful for all of the collaborations around the world and the institutions that are helping us track and monitor these. So do look on our website related to these definitions and we will be providing weekly updates in our sit reps that we release every week on our WHO website summarising what is being tracked globally. 00:40:02 FC Thank you. I would like now to invite Jeremy Launch from Radio France Internationale, RFI, to ask the next question. Jeremy, you have the floor. JE Thank you, Fadela. I'd like to go back to what you said at the beginning and what you're currently saying at every press conference; the fact that you're asking countries not to go directly to the manufacturers to get more supplies and bypass COVAX. My question may be blunt but is anyone listening, do you feel any country is actually listening? Because we hear every week - last week again the EU is getting more doses from Moderna. So do you actually have one example of one country that's saying, okay, we get it, we're not going to do it any more? Are you confident about next week's proposal at the WTO about the intellectual property waiver that could be a major success for COVAX? Thanks. 00:41:10 FC Dr Aylward, you have the floor. BA Thank you very much. I think I counted four questions but the key one is, are countries listening about the importance of making sure that we do not interrupt the supply inadvertently to other countries. Absolutely, countries are listening. It was a bit of a free-for-all quite frankly a few weeks ago and months ago as countries were pursuing deals that could have compromised the supply through COVAX. There are still conversations ongoing, yes, very much so but countries are definitely listening, which was your first question; countries are definitely listening. Some countries are still pursuing deals that will compromise the COVAX supply, without a doubt so while, let's say, all countries are listening not all are acting on what we are asking for and that is that they respect the supplies to COVAX. Some of the major suppliers to COVAX like the Serum Institute of India in particular, as the Director-General said, are being approached by multiple countries that had not originally intended to supply from that site and as that site was originally thinking to supply COVAX and to supply India any other demands on it do put a strain potentially on the supply, to be very frank. 00:42:39 But your first question was the most important one; are they listening? I think probably the Director-General's highlighting of this issue and others'... Yes, they are and I think that's great but once again I think we have to recognise every country's just under tremendous strain and demand. It's tough. Politicians, as Mike and the Director-General have said repeatedly, are under incredible expectation from their populations to deliver vaccines as rapidly as possible and what we have to remember is that's not politicians in just some countries; it's everywhere and what we need to ensure is that the health workers and then the older people in populations and then of course those with other risk factors receive vaccine as rapidly as possible. So people are listening, some are acting on that, we hope more will and just over the last few days we've been able to lock in through the COVAX facility and the great work being done by GAVI, UNICEF and others, through all that partnership been able to lock in the volumes that we're going to need over the coming weeks. 00:43:42 But there's never enough supply, quite frankly. We need more countries acting in support of COVAX as we go forward. The last point you raised about what will happen at the WTO next week; I don't think anybody's confident about what the outcome will be so I think next week we'll all hear. Again what we're encouraging all countries and companies at this point is to be doing everything possible to expand their production. That's going to require a range of solutions, as the Director-General highlighted. The most successful and rapid way, we believe, to expand production is through technology transfer; sharing the know-how, through voluntary licensing if needed with other manufacturers that can fill and finish product, that can produce product. That is usually the most successful way to do it. It's when that fails and we're in an emergency like this and we can't expand production that people want to look to other measures. 00:44:42 FC Dr Simao, you have the floor. MS A very quick complement on the TRIPS waiver. We heard earlier today a question about the Security Council and WHO very much welcomes that the discussion around the provision and making equitable access a reality is happening in different bodies at the UN so we very much welcome the discussion on the TRIPS waiver at the WHO TRIPS council. That said, just complementing because of course intellectual property is always a very sensitive topic in anything that's related to access to medicines and to vaccines and other health products and we're living through a situation where there's an extreme concern by countries looking for alternatives to increase production capacity. Of course this includes how to manage the intellectual property rights and this could be managed through various forms including through voluntary licence, as Dr Aylward mentioned. Just to say that WHO does co-ordinate the COVID Technology Access Pool which is working with 44 countries now to include not only the sharing of technology but also the voluntary licensing of the technologies that can help us to address the acute phase of this pandemic. 00:46:18 So of course we are very interested in the outcomes of this discussion at the TRIPS council, as we welcome any movement from countries to decrease and to address current barriers to access and also barriers to access that could be seen at mid and long term so this is quite an important discussion. Thank you. FC Thank you, Dr Simao. Dr Ryan. MR Just a very short point; I think we need to continue to close the gap between the rhetoric and the reality and I believe there's a healthy debate going on in many countries and that's great but there are some countries where there isn't even a debate. I'm afraid, as the old adage says, you can't have your cake and eat it too. I'm afraid some countries think that they can. FC Thank you. I would like now to invite a journalist from BBC Africa. I hope I pronounce your name well, Charles Mbunu. Charles, you have the floor. CL Thank you. That was a good effort; you tried. Thank you. My question is to Dr Chikwe. I just wanted to know; you've mentioned that the vaccines are expected in a few days. I want to know because there have been questions about storage of this vaccine and more general handling of the vaccines. How confident are you that there is enough facility on the ground or if there is enough facility on the ground to handle the storage of these vaccines? 00:48:03 Also what's the plan in terms of the other vaccinations? We are seeing in local media that politicians may be given vaccines ahead of others, perhaps health workers so just help to clarify that. Thank you. FC Dr Chikwe, you have the floor. CI Yes, thank you very much. The whole country really is looking forward to the vaccines, that's for sure but having said that, we've had many challenges in Nigeria but some of those challenges have also brought opportunity. Last year we finally eliminated wild polio virus in Nigeria and therefore on the African continent. 00:48:47 It meant that over the last few years I don't know any country that has done more vaccination campaigns than Nigeria. The people involved in doing micro-planning, delivering of the vaccines, planning logistics; they do this in their sleep. We have an agency responsible for this, the National Primary Healthcare Development Agency. They have a well-fuelled system delivering to the states, then the states to the facilities and all of these have been in preparatory mode for the last few weeks, working very hard to cross the Ts and dot the Is. So we were very anxious when it looked as if we would get the Pfizer vaccines in the beginning because of obvious challenges around storage outside of our major cities but once it became clear that the first set of vaccines would be the AstraZeneca Oxford vaccine we became fairly confident that with the infrastructure we have, with the human resources that we have and with the delivery... Nigeria; we deliver at critical times so we are confident that we will be able to do this. On your second question on prioritisation, everyone - I think we would be remiss to get this wrong. Every country; people are looking. We have a very open, vibrant media space. Government has actually been very transparent in the work that we've done. We've been very open in communicating to Nigerians and globally in terms of our challenges and opportunities so we've been clear; we will prioritise our healthcare workers absolutely first. 00:50:36 There will be some others prioritised for various reasons but I think we must trust the leadership around this. We're making some very hard decisions. I think at the end of the day the key thing is we all recognise that we can only impact on transmission and reduce the burden on our hospitals if we target the right people initially at the right pace and at the right distribution. So everything will come into play, not only the priority population groups but geography as well. We have a very uneven outbreak in Nigeria. Lagos State for instance has 40% of all the cases in Nigeria so it won't be a surprise if they are prioritised to such an extent but at the same time we need to get some vaccines to every state in Nigeria. So it's a big country, a complex country but a lot of detailed planning is going into ensuring that the vaccines get to the right people as quickly as possible so that we can get the outbreak under control in Nigeria. 00:51:45 FC Thank you, Dr Chikwe. Dr Kazadi Mulombo, if you want to speak you are welcome any time. WKM Regarding the preparation and the prioritisation, the healthcare workers are the first priority for this first batch of the vaccines and then there are actually four stages in this vaccination so the health workers are definitely the priority. Then we have people with underlying conditions which is the next priority, then the elders and the other groups including those living in IDP camps and vulnerable populations and those working in difficult-to-reach areas where we could use our experience with polio to reach the outer areas and to reach those who are currently living in inaccessible areas due to some security concerns, as you know. WHO, UNICEF, the World Bank and other UN agencies have been working hand-in-hand with the Government. We are part of the planning, we are monitoring and we are ready to continue to support the country to roll out the vaccine in an as equitable as possible way so that we can achieve the benefit of the vaccine. If we are able to vaccinate enough to get the necessary coverage and achieve herd immunity that would be great but for this year, 2021 we are targeting 40% of the population, 20% coming through the COVAX and an additional 20% through Government funding. 00:53:49 The donors are prepared to chip in and help Nigeria get all the support needed including for operational and logistics. FC Thank you so much. I would like now to invite John Zaracostas from France 24 English service to ask maybe the last question. John, you have the floor. John, can you hear me? You are unmuted, John. JO Fadela. FC Yes. JO Okay, good. My question is to Dr Ryan and to Maria on the podium. I don't want to sound like a Cassandra on a Friday evening but is there a black swan situation where we could have a second pandemic threat in parallel with the current pandemic? 00:54:56 My concerns were raised about the Russians notifying to the WHO the new cases of H5N8. FC Thank you, John. MK Hi, John, nice to hear your voice. There are possibilities and there are possibilities. WHO, as you know, is an organisation that is constantly looking at the potential pandemic threats from a large number of known pathogens as well as new pathogens. This is why we have a health emergencies programme. This is why we work on preparedness and response and why we have people all over the world who are setting up surveillance for known pathogens and viruses and the unknowns. We work very closely with our partners at FAO and OIE to be tracking different viruses in animals that have the potential to spill over into human populations. What we do is we work in countries to make sure that we have good surveillance in place for rapid detection, for early rapid response and making sure that we have systems in place, laboratories in place, public health systems in place to be able to detect and respond and act. You have an excellent example today in Nigeria with our WR, our WHO Representative and Nigeria CDC showing that years of preparedness for infectious diseases are put to good use for the latest disease X, which happened to be COVID-19, SARS-CoV-2, the virus that causes COVID-19. 00:56:34 So we are always looking at the possibilities that there could be additional threats against our planet, against the human race and of course there may be. We have a flu division, our global influenza programme that are tracking influenza viruses, seasonal influenza viruses, looking at avian influenza viruses constantly. That work has not stopped. We have teams that are looking at nipah viruses, that are looking at Ebola viruses, that are looking at lassa, that are looking at chikungunya and zika; I could go on and on. That work doesn't stop and I think it's important to mention - I'm giving a long answer here because you hear us speak a lot about COVID-19 but there's work by WHO and our thousands of staff around the world in our 150 country offices and our six regional offices as well as our partner agencies and ministries of health, ministries of agriculture, ministries of the environment that are constantly on the lookout. 00:57:33 So yes, there's laws the possibility that there could be additional threats but what is important is that we have those systems in place and that we use the time right now and this traumatic experience that all of us are in for COVID-19 to make sure that we don't lose sight of what could happen in the future and we're building back systems that are sustainable for any infectious threat that could come our way. We are tracking this H5N8. There was a disease outbreak news that was released a few days ago looking at some asymptomatic cases in Russia. Our flu team this week is actually discussing vaccine composition for the next influenza season so all of this work is happening in the background. You don't get to see them up here every day but they will be releasing their findings from that deliberation this week. So yes, we are constantly tracking these and you will hear about this through our disease outbreak news and we will follow up with any advice that is necessary as quickly as possible. MR Just to maybe add that WHO is announcing the recommendations for influenza strains to include in the vaccines for the 2021/2022 northern hemisphere season and again expressing huge gratitude to the hundreds of labs in the network who constantly track the evolution of influenza viruses around the world including the genetic sequencing and characterisation of those viruses both epidemiologically and clinically, which leads to the instructions to the manufacturers for the best components for vaccines every six months. 00:59:15 That process is in place and we're looking to create a very similar and linked system for SARS-CoV-2 as well so the world is being well watched over in that regard but again reflecting on the power of partnership between scientific institutions, the power of our member states and partners, public and private sector, who work together constantly to keep the world safe from influenza. It's more important than ever; the current pandemic has led to... In effect, the same measures that have stopped SARS-CoV2 have also effectively suppressed transmission of influenza. That means there's a lot of potential energy left in the influenza virus, especially as normal and natural immunity will wane. So there will be at some point a rebound in influenza so it's exceptionally important that we continue to work on that and that we reiterate that influenza vaccination remains the best tool for prevention of influenza and we should plan now while we're procuring vaccines for COVID-19; it's very, very important. 01:00:21 But also governments need to continue to plan for their influenza season and remain vigilant for influenza in all its forms. Part of the reason for tracking the avian strains - and this again reflects a tremendous amount of work that goes on in tracking these viruses that cross the species barrier mainly through avian strains. The virus associated with the H5N8 incident in Russia is currently being fully characterised and part of that process with industry and with the WHO collaborating centres is to constantly produce candidate vaccines. We talk about vaccine production happening for SARS-CoV-2; it's very important. But remember, there are manufacturers out there and our collaborating centres who as soon as there's a signal of a new virus or a virus with potential to infect humans immediately begin to produce potential vaccine lots so that if we see any shift towards human transmission or towards an epidemic in humans of a new virus we have the immediate capacity to begin scaling up vaccine trials and vaccine production. This is really, really important health security work. 01:01:36 Just while I have the floor to say to Dr Chikwe that Nigeria's Centre for Disease Control and your personal leadership there both in public health and in science reflects something, I think, that's not recognised globally. I look to Dr Chikwe in Nigeria, to Dr Sakoba, the Head of the National Agency for Health Security, who's leading the fight against Ebola in Guinea, to Drs Moembe and Sabwe and Ahuka in INRB in DR Congo, who co-developed the monoclonal antibodies that are now curing this disease in Guinea. The leadership, Dr Chikwe, you've shown in developing the research roadmap for lassa fever and all of those other diseases... There is a perception out there that disease X and all of these sophisticated emerging diseases are being responded to and all of the science is happening in the north. That is not true. The first line of defence is in the areas most at risk, in the areas of high biodiversity, in areas where this disease can cross the species barrier and it is to the great comfort of the world to know that there are such wonderful scientists working in the front line who understand how to do this business extremely well and I think we need to do more of that. 01:02:59 We need to build the capacity, to understand the tech, to characterise and develop countermeasures as close as possible to the point of emergence and we need to invest in institutions like the Nigeria CDC and in individuals and science and public health leaders in these countries who do an amazing job with very little resources. I also congratulate Austin Demby, who's the new Minister of Health in Sierra Leone, who himself has a massive historical background in the study of emerging diseases. I don't know if there's ever been such a concentration of expertise in any given subregion of the world of true leaders in the area of science and emerging diseases and I think it's a wonderful thing for us to be able to recognise today. FC Thank you, Dr Ryan. We have gone over one hour since we started this press conference. Before handing over to Dr Tedros I would like to invite our guests if they have any final comment to make; over to you, Dr Chikwe or Dr Kazadi Mulombo. You have the floor. 01:04:10 CI Thank you very much. I'll start; then my brother, Walter, will close. Just to say thank you very much. There've been discussions about the role of WHO at various points in this outbreak and I think for us on the African continent it's unfathomable for anyone to even think about minimising the role this organisation plays to pull us together, to hold us together, to guide us as we develop our own capacities to look after ourselves, which we've been doing over the past few years. I think the way this outbreak and pandemic has panned out has really brought to life how interdependent we are on each other. When we spoke about this in the field previously it seemed like a hypothetical scenario but this outbreak has really shown, whether you're in the north of the world or in the south, west, east, rich, poor, we are all at risk and it's in our own individual best interests to make sure that all of the world is protected against the threats that we face. 01:05:17 So as we get to the point of rolling out immunisation, vaccination campaigns in our countries and we focus on the tools that might take us to the end of this outbreak it's important that we don't lose focus on the broader issues, on how we collectively think about how to make our world a safer place for all of us. Walter. FC Thank you, Dr Chikwe. WKM Thank you again, DG, and thank you, my brother, Dr Chikwe. To close this session I would like to recognise the type of relation I can see between WHO and the Nigerian CDC and even the Government. Their relationships are very strong and WHO is really a trusted partner, particularly when it comes to ensuring that co-ordination is effective among several players. When I resumed in June last year that was the main assignment I was given by the authorities; to ensure that there is co-ordination among players and we believe as WHO so far we played that role. We managed to rally many stakeholders, private sector, the government, the community around one purpose; to suppress transmission and to save lives. We've learned a lot so far through this pandemic response and we think there is now an opportunity. It's time to re-engineer the health security agenda and the way we implement it alongside universal health coverage as the other side of the same coin, like DG Tedros used to say. Thank you so much for this opportunity to share our experience.01:07:20 TAG Thank you. Thank you, Chikwe; thank you, Walter. Thank you so much indeed. Maybe I would like to say a few things given the UN Security Council's vote earlier today. We can't beat COVID without vaccine equity. Our world will not recover fast enough without vaccine equity; this is clear. So sharing the vaccine which is being produced is actually the best way to bring lives and livelihoods back to normal. So it's in the interest of all countries to co-operate. In terms of vaccines especially there is what they call an elephant in the room; some of the measures we need to take. For instance the sharing problem can be addressed effectively if production is increased and to increase production there are trade barriers or other barriers that have to be addressed. I think a good number of them have been listed before; could be technology transfer, could be voluntary licensing and temporary waiver of intellectual property. 01:09:08 Especially when temporary waiver of intellectual property is raised we see lack of co-operation and even serious resistance. To be honest, I can't understand this because this pandemic is unprecedented. The virus has taken the whole world hostage. This thing happens probably once in 100 years and in the TRIPS agreement there is a provision for a waiver of intellectual property but there are people who don't even want to discuss this issue. If this provision cannot be applied now then when? If we cannot apply provisions for a difficult time like now, during unprecedented conditions then when? I think this is serious. I'm glad the UN Security Council has voted in favour of vaccine equity and at the same time if we're going to take practical solutions then waiver of intellectual property should be taken seriously and the UN Security Council can do it if there is political will. Voting for vaccine equity is important and we appreciate that but the concrete steps should be taken and waive intellectual property to increase production, increase coverage of vaccine or immunisation and get rid of this virus as soon as possible. If we're going to suggest in concrete terms I think this is one. Of course we should not just focus on this. There are also other practical steps that can be taken and where the UN Security Council has a big influence and bring vaccine equity as soon as possible to defeat this pandemic. 01:12:05 So the choice is in our hands. This is something that can be done. I repeat again; if it cannot be done now in unprecedented times, in times of crisis like this that happen once in 100 years maybe, when is it going to be used, when? I hope we will make the right choices and in addition to the voting we take concrete action. Thank you so much and I would like also to thank Fadela. She has been moderating our pressers for some time now. Her and her colleagues do it in rotation so one of her colleagues will come to help, Christian, but I would like to use this opportunity to thank Fadela in a big way. Thank you so much; Shukran jazeelan, Fadela. FC Thank you, Dr Tedros. I would like to thank also our journalists who follow us very regularly. I remind you that we will be sending the DG's opening remarks plus the audio file as soon as we finish here. The full transcript will be posted on the WHO website tomorrow. Thank you for the opportunity of moderating these press conferences for the last five months. I'm sure you are in very good hands with my friend and colleague, Christian Lindmeier, as of next week. Thank you all and have a nice weekend. 01:13:52

Media briefing on COVID-19 - 05/03/2021

00:00:30 CL Hello and today wherever you are listening today, this Friday 5th May [sic] 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. As usual we'll have simultaneous interpretation provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, as well as Portuguese and Hindi. We'll have a special guest whom Dr Tedros will introduce to you shortly. Present in the room today are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director of WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General on Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist at WHO, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator. Online we further have Dr Soce Fall, Assistant Director-General for Emergency Response, Dr Michel Yao, Director for Strategic Health Operations, and Dr Peter Ben Embarek, the WHO Expert on Food Safety and Zoonosis and the International Lead of the WHO-convened global study of the origins of SARS-CoV-2. Without further ado let me hand over to the Director-General for the welcoming remarks. 00:02:13 TAG Thank you. Thank you, Christian; vielen dank. Good morning, good afternoon and good evening. As you know, this was a landmark week for COVAX with the first vaccinations starting in Ghana and Cote d'Ivoire. In addition to those two countries COVAX has now delivered vaccines in Angola, Cambodia, Colombia, the Democratic Republic of the Congo, the Gambia, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines, the Republic of Korea, Rwanda, Senegal, Sudan and Uganda. In total COVAX has delivered more than 20 million doses of vaccine to 20 countries. In the next week COVAX will deliver 14.4 million doses to a further 31 countries. That brings the total number of countries to 51. Earlier this week COVAX published the first round of allocations covering the majority of economies participating in the COVAX facility. This is encouraging progress but the volume of those being distributed through COVAX is still relatively small. 00:03:38 The first round of allocations covers between two and 3% of the populations of countries receiving vaccines through COVAX even as other countries make rapid progress towards vaccinating their entire populations within the next few months. One of our main priorities now is to increase the ambition of COVAX to help all countries end the pandemic. This means urgent action to ramp up production. We currently face several barriers to increasing the speed and volume of production of vaccines, from export bans to shortage of raw materials including glass, plastic and stoppers. WHO is working on four approaches. The first and most short-term approach is to connect companies who are producing vaccines with other companies who have excess capacity to fill and finish. This could help to speed up production and increase volumes. For example part of the deal between Johnson & Johnson and Merck announced this week is for Merck to provide fill and finish for the J&J vaccine. We need more partnerships like this and we need them in all regions. WHO can support this process by identifying gaps and providing a match-making service between vaccine producers and companies with capacity. The second approach is bilateral technology transfer through voluntary licensing from a company that owns the patents on a vaccine to another company who can produce them. 00:05:25 A good example of this approach is AstraZeneca, which has transferred the technology for its vaccine to SKBio in the Republic of Korea and the Serum Institute of India, which is producing AstraZeneca vaccines for COVAX. The main disadvantage of this approach is the lack of transparency. The third approach is co-ordinated technology transfer. This would involve universities and manufacturers licensing their vaccines to other companies through a global mechanism co-ordinated by WHO which would also facilitate the training of staff at the recipient companies and co-ordinate investments in infrastructure. This provides more transparency and a more coherent global approach that contributes to regional health security and it is a mechanism that would increase production capacity not only for this pandemic but for future pandemics and potentially for the production of vaccines for routine immunisation programmes. 00:06:39 In fact WHO has done this before. After the spread of H5N1 influenza in the mid 2000s WHO supported technology transfer for the production of pandemic flu vaccines to 14 countries, increasing global capacity by more than 700 million doses. Fourth, many countries with vaccine manufacturing capacity can start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement. Those provisions are there for use in emergencies. If now is not a time to use them then when? These are unprecedented times and WHO believes that this is a time to trigger that provision and waive patent rights. We thank South Africa and India for their proposal to the World Trade Organization to waive patents on medical products for COVID-19 until the end of this unprecedented pandemic. Next week WHO and our COVAX partners will meet with partners from governments and industry to identify bottlenecks in production and discuss how to solve them. To speak more about the potential for technology transfer today I'm delighted to be joined by Dr Marie-Paule Kieny, the Chair of the Medicines Patent Pool Foundation. Marie-Paule is no stranger to WHO. Until 2017 she served as WHO's Assistant Director-General for Health Systems and Innovation. She is now the Director of Research at INSERM, the National Institute of Health and Medical Research in Paris. Marie-Paule, it's always a pleasure to welcome you back to WHO. You have the floor. 00:08:49 MPK Thank you very much. Thanks so much, Dr Tedros. As usual, it is a great pleasure to come to WHO, albeit virtually, and to contribute to the work of the organisation. As requested by President Macron of France when he recently convened the principals of ACT A in trying to address production issues, what is clear is that we need to be looking at what can be done now in the short term while we are also looking at the longer term. So as you said, in the short term while manufacturers with vaccine currently approved seem to have fulfilled capacity to fill all the bulk vaccine they can produce there are many other products which are in the process of being tested or considered for approval for which the supply of bulk vaccine is likely to exceed filling capacity. 00:09:40 For these manufacturers access to filling lines at drug facilities around the world may greatly increase output. Then there is a medium-term strategy. Existing manufacturers have already established a number of bilateral technology transfer agreements and many of the vaccines registered in at least one country are already being produced or are in preparation therefore for production in other countries. While this is enabling an increase in the global supply this supply still falls short of demand and this actually must be increased. Finally there is a longer-term strategy which will draw from the experience of WHO with influenza vaccines. Those of you who knew me in the years 2006 to 2017 know that this technology programme, now headed by Martin Freely, remains one of my legacies at WHO. Under the leadership of WHO many partners would need to be involved in this work including many that are already active in COVAX. The Medicines Patent Pool is pleased to support this three-pronged approach by leveraging our close relationships with generic manufacturers across the globe to help identify suitable partners to fill and finish needs and potential recipients of technology transfer. 00:11:07 Of course we have a long experience of the licensing process which will be needed to facilitate this partnership and allow that the licenses which are issued maximise the benefit to global public health. More distributed manufacturing can be pushed front and centre by the pandemic but this is something that we need to address anyway if we are to increase both supply security and the green agenda drive for shorter supply lines. Once again the pandemic is forcing us to both think outside the box and to move beyond the status quo and this is what is on the table today. Thank you, Dr Tedros, for pushing this agenda forward. Christian, back to you. TAG Thank you, Marie-Paule, and thank you so much for your continued support and collaboration. Merci beaucoup. Christian, back to you. CL Thank you, Director-General, and thank you, Marie-Paule Kieny. With this we open the round of questions. I remind everyone to raise their hands with the raise your hand button and the of course to unmute yourself when it's time and only please one question per person. We'll come back to you in case we have a second round. With this I call upon Kamran from Azerbaijan, Real TV. Kamran, please go ahead. 00:12:34 KA Hello. Thank you. A question for the connection [?]. Do you hear me? CL Very well. Go ahead. KA Thank you very much. WHO is one of the founders of the platform COVAX but we have information delivery of vaccines within the platform COVAX is delayed to many countries, one of them Azerbaijan. Our Government paid $21 million for these vaccines but at this time we haven't received vaccines from COVAX platform. We asked the question of them but they refused to answer our question. How can you explain it, when will we receive vaccines through the platform COVAX? Thank you so much. CL I'll hand over to Dr Swaminathan, please. Or Dr Aylward. Please go ahead. 00:13:40 BA Thank you very much, Christian. We're at a point now with the start of the roll out of COVAX which comprises 190 countries in which obviously not every country unfortunately can be served at exactly the same time. So one of the great challenges has been how do we make sure the available vaccine is allocated as rapidly and as efficiently and effectively as possible. There're a number of challenges to getting from what we call the emergency use listing or licensing of a product right down to its use in the country and this involves activities that have to happen at the international level with the suppliers as well as at the country level. Some of the biggest challenges that we've seen for countries have been putting in place the regulatory authorisation for these products as well as what we call the indemnification and liability provisions for the use of these products. The regulatory authorisations have to be in place, the indemnification processes have to be in place, the national vaccine plans have to be in place and then once all that's in place we've got to be able to link it up with the shipments, the logistics, the purchase orders, etc. 00:14:55 So it's quite a complex process and what we're trying to do now and you'll see on various websites is make as transparent as possible when we think the products will be able to arrive and when countries are fully ready to receive them. So on the UNICEF website now they've put an excellent site with a map that shows the delivery dates for upcoming shipments of vaccines. On the GAVI site, the COVAX site you can see when they've actually rolled out. But while we're not in a position, especially through a press conference like this, to talk about the specifics of any one country usually it's a combination of the factors. The good news is that these factors that I just mentioned around indemnification, around regulatory authorisation, the plans, getting your purchase orders in place; these things are getting worked out for almost every country and now of the 190 countries that are part of COVAX we're down to only, I believe, 24, about two dozen where we don't have all of these pieces in place. For the other ones it's simply a matter now of making sure that the manufacturers can keep up with the schedule of shipments that we're putting in place. So if all this country-level pieces are in place, the vaccines have been reserved, it's just the time and it may take a week, it may take two weeks to actually get the packaging, labelling, shipping in place to get them into your own country. 00:16:23 KA Thank you. CL Thank you very much. With this I call upon Michael Boziutkiv of CNN. Michael, please go ahead. MI Thank you. Thank you for taking my question. It's Michael [Unclear] here. I'm a regular contributor to CNN Opinion. My question is, I guess, in a way, a theoretical one. I know WHO has been over the recent years prioritising mental health and I'm wondering if we're getting to the point in the pandemic, especially in developed countries, where there's now concern between of course the pandemic and the sickness that is happening but also the impact on mental health especially when people are at the end of the rope in terms of hope. 00:17:11 Many are losing their businesses, many have been furloughed. My question is the following; do you think that governments should now be perhaps in their calculations on reopening taking more into account the impact on the economy and on mental health? I'll give you a quick example. Egypt seems to be a country where they put more of a priority on the economy, not downgrading the public health but putting a lot of emphasis on the economy because a lot of the economy there is made up of small businesses. So should governments be recalibrating in order to prevent a mental health crisis up the road? Thank you. CL Thank you very much, Michael. I'll hand over to Dr Van Kerkhove. MK Thanks very much for the question. It's an excellent question and the answer is absolutely yes. There's a lot of work that the organisation is doing looking at mental health and we have been for years but in particular with this pandemic really recognising the incredible toll that this has taken on every single individual no matter where you live and no matter what age you are. 00:18:15 There are variations in terms of the impact that this has had on individuals, whether you have lost a loved one or a family member or a friend to this virus, whether you've lost your job, children who haven't been in school, people who are forced to stay home in very difficult situations. The organisation through our department on mental health have been working to find ways in which we can support people through this but it goes beyond the acute phase of where we are right now but also thinking long-term. So absolutely, there needs to be a lot more emphasis by governments, by communities, by families, by individuals to look after our well-being. Some of that we can do ourselves but for some of it we need support. Just to also say, for anyone out there who is feeling the pressure of this - and of course all of us are feeling that too - if you need help please reach out. Those of you who have friends and loved ones who you know are struggling, also reach out to them every day. You should make a phone call, make a connection with individuals to reach out and make sure people are okay. 00:19:23 Ask the question once; are you okay? Ask the question again; are you okay? And find ways to connect. We say physically distant, not social distancing because we want to make sure that people remain socially connected while they are physically distant. We also recognise the duration of this pandemic, in our 14th month now without having the hope of vaccines and vaccinations and that should definitely be a sign of hope. Other signs of hope are that we can control this virus, we can bring transmission to its knees with individual-level measures supported by communities, leaders at different levels. We have some power in that and find ways to find joy every day no matter what you can do, whether it's making that phone call, making the connection, listening to some music, getting some sun on your face if you can; find ways to smile every single day. CL Thank you very much. Dr Ryan. MR Just going beyond the absolute impacts of the disease itself on people and on families and the mental health strain of having a loved one ill and not being able to see them in hospital and the terror and the tragedy associated with that, the mental stress that front-line workers, health workers have been under, communities and so many others have been under, it's one thing to say that mental health and psychological health is under pressure; that's true. 00:21:00 But also the opposite of that has to be what we're doing to provide support and psychosocial support to people and communities and I think that's what we really need to talk about, not measuring... We need to measure the mental health impact and understand truly what's happening but I think there's a point where it just becomes unethical to continue to call something out as an issue but not actually focus on solutions for people and communities. I'd just like to recognise the work that Devorah and Mark and the people here do in the mental health programme; they've been outstanding. This has been a Cinderella area in health, in public health for too long and certainly in the work that we do in humanitarian settings; mental health and psychosocial support is a huge part of humanitarian intervention and it's a very practical issue. 00:21:53 If individuals and communities are not physically and mentally healthy it is very difficult to absorb the strain and stress of an epidemic. It is very difficult to sustain behaviours that stop the epidemic. There's one thing this virus seems to love and that's the despondency and incapacitation of our ability or willingness to stop the virus. I sometimes wonder whether it is that impact that is the most profound. When it comes to recovery plans and as we all hopefully begin to look in this year, I hope, at how we're going to recover from this pandemic the mental health and psychosocial support to individuals and communities must be central to all recovery plans and it must be costed into those plans. TAG Thank you. I would just like to add a bit on mental health. I think all has been said; just one dimension only. As the world remembers - may remember; it's a long time now - after the Second World War the world has experienced mass trauma because the Second World War affected many, many lives. Now even with this COVID pandemic, with bigger magnitude more lives have been affected; almost the whole world is affected, each and every individual on the surface of the world actually has been affected. 00:23:29 That means mass trauma, which is beyond proportion, even bigger than what the world experienced after the Second World War and when there is mass trauma it affects communities for many years to come. So the mental health problem is not an issue of just current, during the pandemic but even for many, many years to come and countries have to see it as such and prepare for that and WHO will support in any way possible to address mental health as a big proportion which is the mass trauma. Thank you. CL Thank you, DG and all. With this we come to Jeremy Loche from LFE. Jeremy, over to you. JE Thank you, Christian, and to everyone. A quick one about the interim report that was scheduled for the Wuhan mission. It seems it's not going to be available any time soon and I was wondering if it comes as a personal disappointment for you. 00:24:50 CL I believe we had Dr Peter Ben Embarek online. In this case we'd like Dr Ben Embarek to take this. Peter. PBE Yes, I'm here. Can you repeat the question, please? CL It's basically about why the interim report will not be issued but when will the final report come over? PBE Yes, we decided to go for publishing and issuing both reports at the same time, both the summary report and the full report because they follow each other and it makes sense to issue them together at the same time. The current timing is that the week of 14/15th March which is not next week but the week after; that's when we plan to be able to release the reports, during that week. We don't yet have an exact date but we are looking to that week. CL Jeremy, does this cover your question? JE Mostly. I would like to know why. I understand it makes more sense but what is the main reason for postponing the release? CL Thank you very much. I'll hand over to Dr Ryan for this. MR Just to clarify, there was never a plan, I believe, for an interim report, first of all. It was hoped that we would get a summary report out. 00:26:30 Given the interest in this area and given the tremendous demand for detailed information we saw with that a huge and understandable demand for information. The team itself felt that getting the full report done - the full report could have taken a lot longer. What the team have done, to their credit, is really worked hard to try and come up with their full report so we can have a proper discussion around a full report rather than having two discussions, one on a summary report where you'll ask all the questions that need to be answered in a full report. So there was no scrapping of an interim report; there was never a plan for an interim report. This is really trying to facilitate a good discussion with the international community, with media, with public around what will be a full report and then we can discuss where we go from there. The Director-General will receive that report from the team, we hope, in the near future and obviously we will respond to the recommendations in that report. 00:27:32 CL Thank you very much, Dr Ryan, for this important clarification. With this we go over to Helen Branswell from Stat News. Helen, please unmute yourself. HE Thank you, Christian. I was hoping we could get an update please on the Ebola outbreaks in DRC and Guinea. Thank you. CL Thank you very much, Helen. As we have Dr Soce Fall online I'll hand over to him. SF Thank you. Thank you, Helen, for the question. As you know, we are fully involved in supporting Guinea and DRC to respond to the Ebola outbreak in addition to the response to the COVID-19 pandemic. In DRC so far we have recorded 11 cases including three new cases in the last week and we are implementing all pillars of the response using a community-based approach, making sure that also we implement the ring vaccination, contact tracing and treatment of patients using the available therapies. So far the situation is stable but as you know, the risk is still high for expansion to other health areas or neighbouring countries. 00:28:52 The situation in Guinea in terms of number of cases; we have now 18 cases reported in the N'Zerekore area. Over the last week we have recorded eight new cases so the response is also ongoing. We have a number of contacts identified and we started implementing the ring vaccination a week after the beginning of the outbreak, merely one day after the vaccines arrived in the country. It was really important because we have the capacity in Guinea to conduct ring vaccination. Most of the experts in ring vaccination are either in Congo or deployed from Guinea so we are using this local capacity in addition to the people we deploy. We have around now 100 people deployed. As you can see, Dr Michel Yao, who's the Director of Health Operations, is right now in Guinea, N'Zerekore reviewing all the pillars of the response to make sure that with partners we are on track using our key performance indicators. 00:29:51 But we are not only working with Guinea; we are working with all the six neighbouring countries, improving readiness based on our assessment and I'm sure Michel can add more on this. CL Yes, Dr Michel Yao who, as we heard, is in Guinea right now is Director, Strategic Health Operations. Please go ahead. MY Thank you very much. Speaking from N'Zerekore, close to Cote d'Ivoire and Liberia borders so this is what actually increases the threat of spread to all these neighbouring countries. In Guinea on Tuesday we had a quite good meeting with Ministers coming from neighbouring countries and we agreed on some of the processes to increase preparedness because from our assessment countries were more or less half prepared. This is higher compared to 2014 but we still need to quickly work on some of the response areas, mainly for testing, to ensure that regulations are updated, people are trained for vaccination as well as new therapeutics. This is the key element in this response; innovation that we need to bring to people that at least have some experience from the last outbreaks. So all these countries agreed on information exchange and also to prepare themselves for this innovation to ensure that they have also simulation exercises but also make sure that they more and more have a sustainable system within the health system to deal with Ebola that could be recurrent based on increased contact of human beings with different forests. 00:31:47 Now in N'Zerekore where I'm based now the good thing is that at least all the response areas have kicked off. Now we need with all the partners to collectively scale up and ensure that we have a comprehensive and very sensitive alert system, that we have also capacity to quickly isolate, confirm and isolate cases and we have also a capacity to ensure infection prevention and control this with the community because this is the critical part; working closely with the community is part of the lesson learned in the eastern Congo. So all this processes are ongoing. The DRC situation is more or less stable but here in N'Zerekore it's too early to say. We had one case yesterday and we need to ensure that all the components are up to speed so this is what we are doing as WHO and all the experts deployed on the ground. 00:32:56 CL Thank you very much, Dr Fall and Dr Yao. With this we move to Sarah Teofilo from Coreo Brasiliense. Sarah, please, unmute yourself. SA Hi. Thank you for taking my question. We are seeing here in Brazil a change in the profile of ICU admissions. Before the patients were older and now the authorities from Brazilian states say they are seeing younger patients in the ICU. I'd like to know if this has been seen in other countries and what could explain this change in the profile. Could it have anything to do with the variants? Thank you. CL Thank you, Sarah. Let me hand over to Dr Van Kerkhove, please. MK Thanks, Sarah; thanks, Christian. I will begin. We have seen similar patterns in other countries where there's a slight shift in the age profile when we have additional waves of infection, additional peaks of infection in different countries. Part of this is due to the nature in which populations mix. In some countries when interventions and stay-at-home measures and other measures have been lifted the first groups to lift those measures tend to be younger individuals heading back to work and whatnot and we see a shift in the epidemiology because those who are out and about tend to be younger and those are the ones that are getting infected. 00:34:23 With increasing case numbers in individuals you will see increased hospitalisation and you will see increases in ICU so that is something that we have seen in other countries. Remember, in the beginning of the pandemic most of the cases that were being detected were severe cases because this at the beginning of any epidemic, any pandemic is focused on those who seek healthcare. So most of the individuals who are identified as cases in the beginning of any outbreak tend to be older because they're the ones that are at higher risk of severe disease and those are the individuals who seek care. With the situation in Brazil and in other countries that are seeing increases in cases - and you mentioned the variants; there are different virus variants that are circulating. The three virus variants that we are tracking, the B117, the B1351 and the P1 that is circulating in Brazil is associated with increased transmissibility there; some preliminary studies that suggest that there's increased transmissibility. 00:35:26 If you have increased transmissibility you will have increased case numbers, increasing numbers of patients that will require hospitalisation, you'll have increases in those that are developing severe disease and that can have an impact on the burden of the healthcare system which can result in increases in deaths and unfortunately we have even that in a number of countries as well. The best thing that we can do right now even with these virus variants; we know that the public health and social measures work against these virus variants including the infection prevention and control measures inside healthcare facilities as well as outside healthcare facilities. So the best thing we can do now is try to drive down transmission everywhere we can and prevent as many infections as we can so that we don't have as many cases that are progressing to severe disease and death. CL Dr Ryan, you want to add. 00:36:22 MR Just to emphasise what Maria said; there's clearly been a nationwide increase in Brazil and that's north to south. Manaus and Amazonas was really in a very, very difficult situation quite recently. The number of cases and the intensity of that has dropped but the problem is still very, very much there and even in Amazonas right now we're still talking about 80% plus ICU occupation and overall COVID-19 bed occupancy is nearly 60%. That's in the context of falling numbers so that pressure is still there but what we've seen is similar patterns starting to emerge in other parts of Brazil, particularly in the north-east and even all the way down to the south we see similar patterns. What Maria said, I think, is key; the public health and social measures, the behavioural measures stop all of these strains or variants and now is not the time for Brazil or anywhere else for that matter to be relaxing. I have the same feeling myself. The arrival of vaccine is a moment of great hope but it potentially also is a moment when we lose concentration. If I think I'm going to get a vaccine maybe in the next few weeks or the next six weeks or the next two months maybe I'm not so careful any more, maybe I think I'm through this. 00:37:56 You don't need a whole lot of people to start thinking like that to give the virus opportunities to spread. We saw that in Europe, we saw it coming up to the Christmas period; small changes in the behaviour of a large number of people can lead to huge changes in the epidemiology of this virus. I think we need to have learned that by now but when we change our behaviour the virus changes in terms of its capacity so we need to adapt our behaviour carefully, systematically and we need to be very careful when exiting public health and social measures however difficult they are. States and municipalities - there're 5,600 municipalities in Brazil, I think; Mariangela will tell me if I'm wrong. It's a complex country. Each and every one of those municipalities is unique. They all fighting very, very hard and they all require, the states and the Government of Brazil require our full support but the story in Brazil can be and will be repeated elsewhere if we stop implementing the measures as we need to implement them. We need to support communities to do that, not criticise communities who do that and this is going to be the case in the Americas, in Europe and everywhere else. 00:39:17 The process of realising the benefits of vaccination is going to be about doing the other things really well; keeping up our own personal behaviour, maintaining public health measures where we need to until we're sure we can control the disease, getting our public health and surveillance measures back in place. Many countries have stopped doing case finding and contact tracing because they had such intense community transmission. Are you ready to start again as these numbers fall, as vaccines start to get rid of the deaths and of the hospitalisations and the pressure comes on to open up again, are governments ready to go back to doing cluster investigation, expanding testing, extending rapid testing to as many people as possible? These are the things we're going to have to put in place if we're going to exit the kinds of lock-downs or the kinds of measures that have all affected our lives so much. We need to put in place strong continuation of our own behaviours, strong surveillance, very powerful vaccination for all who need it and if we get those three things right then I believe countries can begin to think about how they exit these very severe public health and social measures. 00:40:33 I'm really concerned right now, I really am very concerned that all of us, governments and individuals alike, think in some ways psychologically and I understand what's driving that. We think we're through this. We're not and countries are going to lurch back into third and fourth surges if we're not careful. I hate to be the party pooper here but that's unfortunately the way I see it. We should not waste the hope that vaccines bring, we should not waste the precious gift that vaccines will bring by dropping our guard in other areas. It's really, really important. TAG Yes, I fully agree. The situation in Brazil is very, very concerning. If we check the figures, maybe compare what the number of cases was in November, the week of November 2nd, 114,000. It has been continuing to increase constantly and reached in the week of February 22nd around 374,000 cases. It's not the number of cases, if you take the number of deaths, in the week of November 2nd it was 2,538. in the week of February 22nd it's 80,000 deaths per week from 2,500; constantly increasing again. 00:42:19 When we saw some declining trends in many countries in the past six weeks the situation in Brazil was either on the increase or just flat but of course more of a tendency to increase. I think Brazil has to take this very, very seriously and as my colleagues said, while doing everything to roll out vaccines but in the whole country aggressive use of the public health measures, social measures will be very, very crucial. Without doing things to impact transmission or suppress the virus I don't think we will be able in Brazil to have the declining trend. So I'd like to underline that the situation is very serious and we're very concerned and the public health measures that Brazil takes should be aggressive while also rolling out vaccines. Thank you. MR Just one thing I forgot to add because I think the journalist asked this question about the variants. There are many variants that have circulated in Brazil but the P1 variant has become dominant. We are concerned about the P1 variant. It carries some very specific mutations that confer on the virus very particular advantages, particularly around transmission. 00:43:56 There is no question that it has added to the complexity of the situation that Brazil faces and equally Brazil would have been one of the areas - and particularly around Amazonas and Manaus - that had intense previous outbreaks. So again there is no question that a proportion of these cases that are occurring now are reinfections, potentially due to waning immunity or due to the fact that new variants may be evading the immunological protection of natural immunity, which in itself means we have to be very careful with vaccines and ensuring that the vaccines work against these strains. It's really important - for example there's a really, really good genomic sequencing network in Central and South America. We need to support those networks now to do really intensive genomic sequencing, to share that information, to link that information to the metadata around clinical and epidemiologic factors. We need to be able to support those superb scientists and I've seen some wonderful presentations over the last couple of days. There're some excellent papers in pre-print really around the situation in Brazil and surrounding countries. 00:45:06 So South America in particular and the scientists in South America deserve our full support to fully understand the dynamics because this is important for the rest of the world. We need to fully understand the disease transmission dynamics, the variant dynamics occurring in Brazil and in other countries so we can fully understand the implications of this going forward both for our control measures and for our vaccination and diagnostics. But what we can say based on what we've observed is that the public health, the behavioural measures, the things that protect you against the original strains still protect you and your community from a P1 strain or any other strain. It is still our best bet. Unfortunately or fortunately is still in our hands; our risk to an extent is still in our hands but it's very hard for communities, particularly in countries like Brazil where you have large urban populations and people may not have access to services; it's very hard to ask people to physically distance and wear masks and do all of these things when they don't have the resources to do that without the support of the state. 00:46:12 So I think this is a moment where all countries need to re-examine how much support they're giving to communities to sustain these behaviours. Thank you. TAG Sorry for coming back again but maybe just one last thing. The situation in Brazil; of course we say we're very much concerned but the concern is not just about Brazil only. Brazil neighbours almost the whole of Latin America; many countries except two or so. That means if Brazil is not serious then it will continue to affect all the neighbourhood there and beyond. So this is not just about Brazil; I think it's about the whole of Latin America and even beyond so application of serious public health measures is very, very important. CL As it's such a hot issue let me hand over to Dr Swaminathan as well. SS Thank you, Christian. I just wanted to add a point to what's already been said about trying to understand more about the disease. You asked about young people being in ICUs and what could be the potential reason for that. We've learnt a lot about this disease and it's happened because of international collaboration and sharing of data and information. 00:47:40 The WHO has a patient clinical data platform that we encourage countries, encourage doctors to provide the patient information. Currently I think we have 80,000 patient records there. The advantage of a system like that when we share data globally is we start understanding much more about the disease. What we know about the risk factors; for example one of the major risk factors for severe illness is obesity and unfortunately many countries in the Americas have very high obesity rates among adults, as do other parts of the world. So that is definitely a risk factor; even if you're young if you have obesity then you could be at risk for severe illness. So by pooling data from different parts of the world, from patients at different stages of the disease we understand much more and that can then be applied to trying to protect them at an earlier stage. 00:48:39 We had a meeting here on Wednesday, on 6th [sic] to discuss the gaps in the knowledge about therapeutics and why therapeutics have not advanced as much as vaccines have. When we find ourselves in a situation like this where lots of people are in hospitals and you're trying to save lives it's not vaccines we need but it's treatments. Really there are only a handful of things that we know work; we know dexamethasone works in people who require oxygen or mechanical ventilation so we hope that that's a standard of care in all countries now. WHO did the guidelines for corticosteroids way back in September of last year. Since then we've provided recommendations, mostly negative recommendations on hydroxychloroquine, on lopinavir/retanovir and we're currently looking at the IL6 inhibitors, for which there is some emerging evidence from trials, as well as drugs like ivermectin, which still has very poor-quality evidence but our guideline development group is looking at it. We're constantly updating our clinical management guidelines; it's a living review, a living guideline. Every time there's new evidence it's put on there. This will help clinicians and those who are looking after patients to provide the best available care. 00:49:58 But again we need a focus on developing better treatments for COVID-19 because we will have the vaccines, we will have people covered with the vaccines. Hopefully we will reduce significantly the number of people who get ill but there will be still people who catch COVID and who get ill and they would need to be treated. So again a call for more global collaboration; we haven't advanced as much on treatments as we have on vaccines. We need drug developers, we need academics, we need global funding agencies to support this area of work and Brazil is a leader in research and innovation. It has several very strong institutions and they can contribute to this global quest. Thank you. CL Thank you very much, all for these important points. With this we move to Christophe Vogt from Agence France Press. Christophe, unmute yourself, please. CR Good evening. Thank you for taking my question. Just one remark, if I may; there was talk of a preliminary report from China experts on February 12th. 00:51:15 But my question is about production. I was just wondering; there have been several deals that have been made in the last couple of weeks; Sanofi, Merck, with Johnson & Johnson and Pfizer. Do you have any idea how much those deals represent in rise of production? And I would just like if you could give us a little bit more information on the summit on production that you're going to have next week. Who will be there and what is it going to be exactly about? Thank you. CL Thank you, Christophe. Dr Swaminathan, please. SS Thank you for that question, Christophe, and perhaps Dr Kieny might want to add. Your first question; we haven't seen the data on what those increases in volumes are going to be but it's very welcome. This is exactly what we want to encourage. As the Director-General pointed out, there are several mechanisms by which we can increase supplies. In the short term this is one of them; finding, making those deals or collaborations between companies, one that's producing and has the raw materials and supplies of the bulk and the other one that does the finishing and filling, can definitely serve to increase so it's very welcome and we would like to see more of this happening in all parts of the world. 00:52:46 We need to explore the fill and finish capacity in Asia and Africa and Latin America and use those facilities to increase supply. On the summit, this is being convened on Monday and Tuesday, 8th and 9th. It's by the COVAX partners so CEPI with GAVI and WHO but also with the IFPA, International Federation of Pharmaceutical Manufacturers and Developing Country Vaccine Manufacturers' Network. It's essentially to look at... It'll have government representatives, companies as well as experts to shine the light on the gaps that we have currently in the supply chain of reagents, of raw materials, of products that you need to make vaccines and these are things that... The manufacturers know what they need. There are global supply chains which are not working so well any more as well as the unprecedented demand for things like plastic and glass and stoppers and vials and also the raw materials, the chemicals. All of this will be discussed so the gaps will be identified but also what the solutions could be; where do we source these materials from. 00:54:03 Hopefully we can do some match-making, find some solutions to fill that gap because that can make a difference again in the short term even as we're looking at more medium and longer term. So the summit is really focusing on that upstream area of the gaps, how they can be filled and for solutions to be found. Then WHO will also continue a stream of work on technology transfer that we're now developing with the partners where we would like to encourage the transfer of technology, be it MRNA platforms or viral vectors, to those recipients in different parts of the world which might have infrastructure and capacity available but may not have this particular technology. So if we can arrange the technology transfer in a voluntary manner through interested capacity we can build capacity not just to make vaccines for COVID but for other infectious diseases for future pandemics, to address pathogens that kill a lot of people every year like tuberculosis. So this is really an area which I think, while the pandemic has provided an opportunity, can have an impact beyond the pandemic but it's going to require a lot of technical work and of course collaboration and co-operation from those who currently have these technologies that have been proven to work or that are currently in the pipeline and transfer those to areas which can accept and become hubs. 00:55:38 This will also help to build regional health security for the future. We would like to see production happening in a distributed manner in all regions in the world. I'll stop there. Maybe either Mariangela or Marie-Paule might want to add. CL Let me look at Dr Marie-Paule Kieny first. Marie-Paule. MPK Thank you. Just one comment - I think that Soumya commented very extensively - is that we need to move beyond just IFPMA so it's excellent that IFPMA companies help each other but we need also to go beyond and there are many generic drug manufacturers who have a high record in terms of being able to operate under good manufacturing practices which could also help on this process. 00:56:32 CL Dr Simao, please. MS Just to complement because we're talking about increasing capacity - increasing number of doses, availability to the world, which is excellent so these bilateral agreements and all whole movements to increase capacity are welcome. However we would like to see more of a commitment to equitable access, that once these vaccines are available and there's an increased capacity they don't all go to high-income countries, that there is a strong commitment to ensure that the COVAX facility has access because through the COVAX facility we have a mechanism to make these vaccines go to lower-middle-income countries, upper-middle-income countries, everyone on this planet. So it's very important that this type of increased capacity helps the world to achieve greater equity and our Director-General has called many times for industry to commit to ensuring that there is equitable access to the vaccines that are produced. So it's a very good point, thank you. CL Thank you very much and thank you very much also, Dr Kieny. We have time for one, maybe two more questions. No, we have one more question. Again we change continent; we go to Latika Bourke from Sydney Morning Herald. Latika, please. 00:58:16 LA Thank you so much to be lucky last; much appreciated. Just to push the friendship I'm going to ask two questions. Dr Tedros, you will obviously have seen this letter by the two dozen scientists saying they believe there should now be an investigation held independently of the WHO's own probe because they don't have confidence in what the WHO has been able to unearth in China. Would you agree with that? Secondly, you no doubt saw Italy blocking supply of vaccines to Australia. They have cited the reason that Australia has eliminated coronavirus so it doesn't need the vaccines as quickly as possible. Is that, in your opinion, a fair and reasonable excuse and justification for blocking supply of vaccines to other countries? Thank you. CL Dr Ryan, please. 00:59:13 MR On the specific issue of the letter from scientists on China, yes, it is as ever thankfully a free world and scientists and others are encouraged to speak out on all matters where they see fit. Just to remind you that the missions to China were part of a scientific and collaborative effort that the Director-General was asked to undertake in consultation with the 194 member states of WHO and he has done so, bringing together a multinational, multidisciplinary team that have in good faith worked, gone, spent a great deal of time and a huge amount of effort to go and advance our knowledge regarding the possible origins of this virus. As we've said previously, progress has and is being made. Nobody is declaring successful outcomes as yet. We await the report of the team. We thank them for their hard work and for their acumen and we will await that report. In parallel if others want to call for anything else they're perfectly within their rights to do so. I would though suggest that people maybe just take a few days to wait and examine what the outcomes are. There will certainly need to be more work. There is no question of that and that was envisaged in the resolution of the World Health Assembly. 01:00:42 Again let me remind you, the World Health Assembly is a meeting of 194 Ministers of Health from around the world and that health assembly envisaged scientific and collaborative missions; it was in the plural. There was a fundamental understanding even at that time that it was going to take time and potentially multiple missions to fully understand this. We have said this again and again in the past with regard to previous emerging disease outbreaks, that it is very difficult and sometimes takes years if not decades to understand disease origins. I've alluded to Ebola. We don't fully understand yet the origins issues in Ebola. We don't understand all of the pathways into humans. We certainly don't understand that for SARS-1. We don't fully understand that for SARS-CoV-2. This is a process of discovery and it is a process of working in new ways with all countries and as we come together to try and face these pandemic threats I think we all have to recognise that all of us have to do better in terms of how we collaborate and how we share and how we face these common threats. It's a journey of learning, a journey of solidarity and I believe that the mission will demonstrate progress and the Director-General will receive that report and he will have his view as to what further work needs to be done and that will be reported to the Assembly in due course in May. Thank you. Bruce, I don't know if you want to take the issue of... 01:02:17 TAG Thank you. Thank you, Mike. Maybe I will just add a bit because he wants to hear from me too. You have covered almost everything but just a bit. As you know, when any outbreak happens - forget about a magnitude like what we have now, a pandemic - knowing exactly what happened is the basics of public health and as a public health expert I have done it myself many times, going into the field, understanding what happened when we encounter outbreaks so that it will not repeat again. With a magnitude of this unprecedented pandemic that makes it even more important to understand exactly what happened and what the origin is because we need to understand that so it won't happen again. For that the crucial thing will be transparency so what I would like to assure you is that you will know. We're waiting for the report, I'm waiting for the report like you. I don't have access; still waiting because these are independent experts. Then you will see for yourself but what I would like to assure you is that everything that happened during the trip will be presented transparently. 01:03:59 So I assure that there will be transparency and see exactly what happened, what were the gains, what were the challenges and then where do we take it from here. That's what I would like to assure you because that's what is going to help the world; transparency, openness and see exactly what happened and learn from it. Thank you. CL Thank you very much both and Dr Tedros. We overshot time and we covered a good number of questions ranging from Ebola to COVID and others. Before I hand back over to Dr Tedros for the final comments let me remind everyone that the audio files and the remarks of the Director-General will be sent right after the briefing. The full transcript of the briefing is available tomorrow morning on our website. Any other follow-ups please direct to mediaenquiries@who.int I want to thank our special guest, Dr Marie-Paule Kieny, today and of course everybody who participated and you online. Dr Tedros. TAG Thank you. Thank you very much, Christian, and thank you to all who have joined today. I look forward to seeing you in our upcoming presser and have a nice weekend. Bon week-end. Thank you. 01:05:36

Media briefing on COVID-19 - 01/03/2021

00:00:43 CL Hello, good morning, good afternoon, good day and welcome to today's global COVID-19 press conference out of WHO headquarters in Geneva. My name is Christian Lindmeier and I am welcoming you to today's briefing. We have simultaneous interpretation as always in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi available. On the podium today we have of course 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 on Access to Medicines and Health Products, Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Senior Advisor to the Director-General and Lead on the ACT Accelerator, Dr Peter Ben Embarek, WHO Expert on Food Safety and Zoonosis and International Leader of the WHO-convened global study of the origins of SARS-CoV-2. And online we are joined by Dr Kate O'Brien, Director for Immunisation, Vaccines and Biologicals. With this I hand over for the opening remarks to Dr Tedros. TAG Thank you. Thank you, Christian, and welcome. Good morning, good afternoon and good evening. Today Ghana and Cote d'Ivoire started vaccinating health workers against COVID-19, becoming the first countries to start vaccination campaigns with doses supplied through COVAX. 00:02:39 A further 11 million doses will be delivered this week. Between now and the end of May 237 million doses of vaccines will be allocated to 142 participating economies and countries in COVAX. Tomorrow COVAX will publish the first round of allocations covering the majority of economies participating in the COVAX facility. It's encouraging to see health workers in lower-income countries starting to be vaccinated but it's regrettable that this comes almost three months after some of the wealthiest countries started their vaccination campaigns and it's regrettable that some countries continue to prioritise vaccinating younger, healthier adults at lower risk of disease in their own populations ahead of health workers and older people elsewhere. 00:03:45 Countries are not in a race with each other. This is a common race against the virus. We're not asking countries to put their own people at risk. We're asking all countries to be part of a global effort to suppress the virus everywhere. WHO and our partners in COVAX will continue to work day and night towards our vision of seeing vaccination start in every country within the first 100 days of this year. There are now 40 days left. We can only realise this vision with the support and co-operation of all partners. Even as vaccines continue to roll out we urge all governments and individuals to remember that vaccines alone will not keep you safe. In the past week the number of reported cases of COVID-19 increased for the first time in seven weeks. You remember that I reported the virus was on a decline for six consecutive weeks but for the first time in seven weeks we have a COVID increase. Reported cases increased in four of WHO's six regions; the Americas, Europe, South-East Asia and the Eastern Mediterranean, while we don't report increases in Africa and Western Pacific. This is disappointing but not surprising. We're working to better understand these increases in transmission. Some of it appears to be due to relaxing of public health measures, continued circulation of variants and people letting down their guard. 00:06:06 Vaccines will help to save lives but if countries rely solely on vaccines they are making a mistake. Basic public health measures remain the foundation of the response. For public health authorities that means testing, contact tracing, isolation, supported quarantine and quality care. For individuals it means avoiding crowds, physical distancing, hand hygiene, masks and ventilation. This is a global crisis that requires a consistent and co-ordinated global response and we must remember that for millions of people COVID-19 is just one threat they face on a daily basis. As I mentioned on Friday, today Sweden, Switzerland and the United Nations are hosting a high-level pledging event for Yemen, seeking to raise more than US$3.8 billion for more than 20 million Yemenis in need of urgent humanitarian assistance. More than five million people are now at risk of famine and already half a million children under five could die from hunger in the coming weeks unless they receive urgent treatment. We thank those donors who have made contributions so far. These contributions must be sustained. 00:07:57 We're also concerned about the reported arrest of health workers in Myanmar, that could affect the response to COVID-19 and the delivery of other essential health services. And in Ethiopia the ongoing conflict in the Tigray region has put many health facilities and hospitals out of action. We're deeply concerned about the risk of diseases due to lack of food, clean water, shelter and access to healthcare. Finally today marks Zero Discrimination Day, a day to draw attention to the numerous barriers that stand between people and the health services they need. All over the world inequality, stigma and discrimination are and have always been drivers of disease of all kinds and it's a timely reminder to maintain our focus on health equality for World Health Day this year, with the theme of building a fairer healthcare world. Ultimately health is not just a matter of science and medicine. It's a matter of human rights. Christian, back to you. CL Thank you very much, Dr Tedros. We will now open the floor for questions. Let me remind everyone to raise their hand in order to be put in the queue and also let me remind everyone to please only ask one question. 00:09:47 If we have time at the end, which I don't assume, we will happily come back to you. The first question is from Sophie... We don't have her on; sorry. Simon Ateba from Africa News Today. SI Thank you for taking my question. This is Simon Ateba for Today News Africa in Washington DC. Dr Tedros has mentioned that Ghana and Cote d'Ivoire today became the first two countries in Africa to administer COVID-19 under the COVAX facility. I would like to have feedback; how is it going, are there any reasons why those two countries were chosen and what is the next phase of vaccination in Africa after Ghana and Cote d'Ivoire? Finally can you update us on how t he vaccination efforts are taking place in the Tigray region in Ethiopia with all the crisis going on there? Thank you. 00:10:55 CL Thank you, Simon. A couple too many questions. Let me start with Dr Swaminathan, Chief Scientist, please. SS Thank you very much, Simon. Yes, I can start and my colleagues can come in. We're delighted, as Dr Tedros just mentioned, that the first vaccination campaigns have started using vaccines supplied through COVAX. As you know, the COVAX facility was set up in order to accelerate the development of as many vaccines as possible so that the world has a diverse supply of different vaccines to choose from and to suit different conditions and also to ensure that there is access to everyone around the world. So this is just the beginning and, as you heard, we will have increasing delivery of vaccines this coming week. We know that there'll be at least 11 million doses being shipped from the Serum Institute of India to countries, not just in Africa but in other parts of the world as well. We will also have shipments going out from the AstraZeneca facility in South Korea so in the coming weeks we hope to see more and more people, priority groups, healthcare workers and other high-risk groups in countries being vaccinated, getting protected. 00:12:15 We've seen early data from countries where vaccination campaigns started two months ago the impact that this is having on reducing hospitalisation, reducing death, particularly in the older age groups, amongst the vulnerable. We've even seen very encouraging data on reduction of infections among healthcare workers who have received a vaccine. So these are still early days but the signs are encouraging, the safety profile is encouraging, about 250 million doses have been given worldwide and so far there have been no major safety signals so that's reassuring as well and we're getting more vaccines coming through phase three trials and hopefully will get into the COVAX facility. As you know, the J&J vaccine and the Novovax vaccine both have agreements with the COVAX facility to supply doses. So of course we're in a rush, we are in a hurry, we would like even more vaccines to go out so that people can get vaccinated earlier but it think this week marks the beginning of what we hope will be the start of a massive vaccination campaign and, as you can imagine, this is the largest vaccination campaign the world has ever seen. 00:13:32 So we should not minimise also the preparations that countries need to make, the fact that adult vaccine programmes do not exist in many countries, that health systems really need to gear up and do many things to prepare themselves, not the least of which are training people, making sure the cold chain is there, making sure that the regulatory approvals are in place. We also have specific requirements on indemnification and liability that countries need to sign. I'll turn it over to my colleague, Dr Simao, to explain why certain countries are in the list. There's a reason for this. MS Thank you, Simon, and thank you, Dr Swaminathan, for the explanation. The issue of why some countries are receiving it earlier than others is related to two things. One of them is the preparedness because it's not only... We have, I think, more than 60 purchase orders already issued by UNICEF and by PAHO to different countries to address the needs of different countries. However some of the countries had all of the documentation ready beforehand so these two countries received it last week and we have, I think, maybe 11 receiving it this week coming up and in the next two weeks a large number coming up. You know that after you have the emergency use listing by WHO you also have to have the regulatory authorisation at country level and you also have to have what we call an indemnification liability signed by the country that's going to receive the vaccines and this takes some time. Fortunately most countries now are up and ready to move with the documentation and we should see by the end of March all 142 countries that are part of the COVAX facility and eligible for the AstraZeneca vaccines receiving vaccines in the next weeks upcoming. CL Dr Aylward. BA Yes, Simon, thanks for the question. Your phrasing was interesting; why were certain countries chosen? In fact we're not choosing countries. What we're doing is taking countries in the order that they are prepared and the shipment can go; it's as simple as that so, as Mariangela and Soumya mentioned, we have 15 more countries that'll be shipped to this week. 14 of those will be on the African continent; that's at a minimum and then we have another similar number that will go out next week. 00:16:23 We're hoping to bring a number of those forward. So when you ask about the challenges to getting them out, part of it is the in-country challenges but part of it is just getting so much vaccine labelled, packaged, shipping space and getting it shipped. It's a massive logistical operation that UNICEF and PAHO, the Pan-American Health Organization, are managing right now. You asked a question as well about accessing conflict-affected areas. Part of the detailed planning for every single country, every single area involved in the roll-out of these vaccines is to look at how do we ensure all populations are reached everywhere. Indeed this was even a concern of the Security Council last week, which passed a resolution ensuring that all countries prioritise all areas. So this is part of what we call the national vaccines deployment plan of each country to make sure all areas can be reached. With that hopefully we've given you a bit of a flavour of the challenges at the national level to be prepared but then at the international level to manage the demand. 00:17:39 CL Thank you very much. For the second part of the question we go to Dr Ryan. MR Thanks, Simon. Yes, the situation in Tigray in Ethiopia remains of grave concern. There's been disrupted access to water, to sanitation, to food, to safe shelter and to essential health services including commodities and drugs that are life-saving. There's also been disruption of the COVID-19 intervention. WHO has worked to provide essential supplies to cover 450,000 people - that's less than 10% of the population - for three months but several health services including maternal and child health services have been very, very disrupted and drug supplies remain critically low. The Ministry of Health is working with health cluster partners to try and make that situation better but many are also living in overcrowded conditions in displacement camps with a greater risks of diarrhoeal and other diseases including sexual and gender-based violence. 00:18:50 The overall risks of diarrhoeal disease, malaria and other important infectious diseases will continue to rise as the population remains in these circumstances. Our primary aim as an organisation wherever we work is to ensure that all people have access to the basic essential human right of access to basic healthcare. Within this situation in Ethiopia, in Tigray, whether it be in Yemen, whether it be in Syria, whether it be in Libya, Somalia, South Sudan our primary concern is to ensure the human beings, Ethiopians who live in Tigray are given that basic access. We will work with the Ministry of Health, we will work with health cluster partners and anybody else who can help us to provide better access to the population there. So from our perspective we are very concerned. A number of the factors, particularly the malnutrition status; people already had issues of malnutrition before and particularly water and sanitation. This is a recipe for epidemics, it's a recipe for malaria particularly in malnourished children; the risk of malaria and malnutrition and those of you who've worked in situations like that know what terrible and awful bedfellows malnutrition and malaria are. 00:20:23 So there are significant, growing and extending risks to the health of people in the region and we will continue, as I say, to work with our partners in the NGOs, in the health cluster. We currently have staff based in Mekelle and we are completing a full survey of all the health facilities that we have access to in order to assess the absolute functionality of those centres. But safe to say is the majority of healths services in the region are disrupted and not capable of delivering the essential healthcare package that is currently life-saving. CL Thank you all very much. The next question goes to Jenny Le Ravelo from Devex. Jenny, go ahead, please. JE Hi. Thank you for taking my question. First of all congratulations on the first deliveries of vaccines in the past week. I wanted to ask about the use of vaccines as a diplomatic tool so donations of vaccines are being made to low and middle-income countries. 00:21:33 I wanted to ask if WHO as co-lead of COVAX see this as complementing the work of COVAX or undermining the work of COVAX. Also just very quickly I want to ask, of the 1.3 billion doses targeted for COVAX AMC countries for 2021, how much of those have already been paid for, knowing that purchase is dependent on supply and funding availability? Thank you. CL Thank you, Jenny. I think, Dr Aylward... Are you...? Thank you. BA Thank you, Christian. On the issue of how much of the doses are paid for, at this point we still have a financing gap for the COVAX facility of about $3 billion. There were very generous contributions you saw announced at the G7 just over ten days ago, if I remember correctly, which brought additional financing. The important thing there is that that financing will allow us to procure all of the vaccines that we currently have contracted right through the second quarter and into the third quarter so we still have time to be mobilising the additional resources that are needed to be able to get to the full 1.3 billion and even more that we are looking for this year. 00:23:00 On the first question about donations, you saw back in December we announced the mechanism now for ensuring that countries can donate vaccines through COVAX if they have surplus or additional amounts. There are a number of principles that were outlined, including that those vaccines would have to have WHO emergency use listing or from a stringent regulatory authority they would have to have approval and a number of other major principles you saw outlined. But the reason we put that in place was to try and further our goal of the most equitable access to vaccines possible and, as we're seeing now in the roll-out of vaccines around the world, we continue to have a highly inequitable situation. Nearly a quarter of a billion doses of vaccines have been administered as of today and they've been administered in 104 countries and territories which means that almost the same number have not received any vaccines. 00:24:06 For vaccine donations to have the greatest possible impact we co-ordinate them through a mechanism - and there's only one global mechanism; that's the COVAX facility - we're going to have the greatest possible opportunity to ensure that those are equitably allocated. For various reasons some countries will be doing donations bilaterally and we continue to be in conversations with them to look at how we align that with the COVAX facility to ensure again the most equitable roll-out possible. There're a lot of good intentions still in that regard but we have not optimised the situation so far. CL Thank you very much, Dr Aylward. The next question goes to Bayram Altug Anadolu agency. Bayram, please unmute yourself. BA Thank you, Christian, for taking my question. It's very good to hear from you again after a long time. Actually, I have a short question; can you see an end in sight for this pandemic by year's end or is it likely to continue through 2022? What is WHO's new update on this issue? Thank you. CL Dr Ryan, please. 00:25:30 MR I think there might be a few people with comments to make on this. I think it would be very premature and, I think, unrealistic to think that we're going to finish with this virus by the end of the year but I think what we can, if we're smart, finish with is the hospitalisations, the deaths and the tragedy associated with this pandemic. So WHO's singular focus at the moment is to keep transmission as low as possible, to suppress that transmission which will help prevent the emergence of variants and will also reduce the number of people who are sick and arrive in hospital and more importantly to get as many people as possible vaccinated, particularly those in the front line and those who are vulnerable so we can take the fear and the tragedy out of the pandemic. The questions remain. I believe we're beginning to see data, important and significant data that shows that many of the vaccines do appear to impact and adjust the way in which the virus transmits and decrease the risk of individuals being infected or passing on that infection. That is really, really encouraging and we need to look obviously at that data more, we need to see how each vaccine does that but that is very encouraging and if the vaccines begin to impact not only on death and not only on hospitalisation but have a significant impact on transmission dynamics and transmission risk then I believe we will accelerate towards controlling this pandemic. 00:27:01 I think we have to separate in our minds the issue of us being in control of the virus and the virus being in control of us. Right now the virus is very much in control. We've seen some good weeks over the last six weeks. We've seen some good news about the roll-out of vaccines and equally at the same time we still this week see the flattening-out of that progress and potentially disease increasing in a number of countries and again we still face a huge challenge in rolling out vaccines equitably and fairly to those who most need them around the world. So it's much better to be in the situation we are now than we were ten weeks ago when we didn't have vaccines moving around, when we had the disease continuing to rise so we're in a much better position than we were but nothing is guaranteed. I think, as I say, it would be premature to begin talking about dates. We need to look at numbers. We need to focus on what our targets are. We should be targeting getting hospitalisations down to the lowest number possible, targeting getting deaths down to the lower number possible, targeting getting cases down to the lower number possible. When we get to those low numbers we'll be in control and not the virus. MK Just to add to that, we won't predict the future but what we can say is that we've outlined the next 12 months in terms of our strategic preparedness and response plan and what we've done is we've issued this last Wednesday; it's on our website. We've added an additional pillar to the overall global plan to suppress transmission, save lives, save livelihoods and that is vaccination. So it's all of the elements that have been outlined since February 4th 2020; looking at active case finding, contact tracing, cluster investigation, isolation and clinical care of all cases, supported quarantine of contacts, reducing your individual actions to make sure that you keep yourself and your loved ones safe with physical distancing, with hand hygiene, with wearing of masks, with avoiding crowded spaces, good ventilation - open up your windows - etc. 00:29:10 All of that needs to remain in place while we roll out vaccines. We are seeing encouraging trends in terms of reduction in incidence but if the last week tells us anything it's that this virus will rebound. We need to have a stern warning for all of us that this virus will rebound if we let it and we cannot let it. We've all been in a position previously where we've got transmission down to very low numbers and we cannot allow it to take off again especially as we have vaccines rolling out and especially as more vaccines are coming online and as COVAX is starting to distribute the vaccine around the world. So what you can do is you can limit your contacts with others, you can limit who you come into contact with outside of your home, outside of your immediate family, of the people you live with. Many countries right now are starting to open up schools again. We need to prioritise the opening-up of schools while we reduce the possibility of increasing our infection risk and that means we reduce social mixing with other families, it means we prioritise opening schools while we still sacrifice our social gathering with others. We can continue to do that virtually while schools get opened. 00:30:28 We can make sure that we keep our distance from others; make sure that you wear a mask with clean hands and that you wear an appropriate mask over your nose and your mouth with a good fit, with good filtration and that you dispose of that mask appropriately if it's a single-use mask or you clean that mask if it's a fabric mask. Make sure that you avoid crowds; please continue to avoid crowds. In the area where we live we've had a couple of weeks of really beautiful weather, unseasonably warm weather and we see a lot of people wanting to pretend that it's summer in the northern hemisphere but we still need to reduce our contact with others. This will not allow the virus to spread amongst others. So if you're a case you need to isolate; if you're a contact you need to quarantine; if you are vaccinated make sure you still follow those public health and social measures that are in place until we learn more. 00:31:20 While we are seeing some good news with the vaccine in terms of reduction in hospitalisation and severity and potentially in transmission risk there's still a lot to learn of these vaccines and not everybody has the vaccine so please continue to keep yourselves safe and keep your loved ones safe. We cannot allow the virus to resurge. CL Thank you. We also have Dr Kate O'Brien joining online. Kate, please. KOB Yes, I just want to add to what Maria was explaining that it really is incredibly important at this time when the vaccine is rolling out in so many countries that this is not the time to allow transmission to increase. As we are increasing viral transmission that puts a risk to the vaccines and so especially at this time when vaccines and coverage is low, is ramping up and is going to continue to ramp up in all countries beginning with vaccination in many African countries and other countries that have not started vaccination yet, this is absolutely the time to make sure that transmission does not start to increase. That's the thing; anywhere where the virus is transmitting and transmits in increasing numbers is going to increase the chance that there are changes to the virus that would also put the vaccines at threat. 00:32:48 So this is really, really important, that as vaccines are rolling out people continue to pay attention and be as vigilant as they possibly can be to assure that transmission is as low as it possibly can be and that gives the vaccines their best possible opportunity for impact as well. Thank you. CL Thank you very much. I'm looking around the room. One more; Dr Swaminathan, please. SS A very quick point just to add to what Mike was saying; I think the goal of COVAX was to bring an end to the acute phase of the pandemic by the end of 2021. We know we cannot completely eradicate the virus by the end of the year but we can reduce hospitalisations, deaths and severe illness but we can only do that if people at risk around the world get a vaccine and at this point of time they're not. 00:33:39 So again just to remind that that's what COVAX was set up to do. If we can share the vaccines we have equitably to vaccinate the 20% of the population approximately that are at risk of getting severe illness and death we can stop those bad outcomes from happening. While then as production increases we can then expand the vaccination campaigns to cover healthier, younger adults so that we can really start bringing down transmission. But I think our goal really should be to protect people's lives and do it as quickly as possible by sharing the vaccines that we have today. CL Thank you all. Next question goes to Laurent Sierro from the Swiss News agency. Laurent, unmute yourself, please. LA Thank you, Christian, thank you for taking my question; a question on the variants that you mentioned at the beginning of the press conference. In your weekly epidemiological overviews, there are a number of countries where we can find the variant and then there are national breakdowns on the share of the new variants among the new cases. Do we have a broad idea of that share worldwide, of the share of the variants among the new cases? Thank you. 00:35:04 MK Thanks for the question; it's a really great question. Our teams are tracking the circulation of different variants of concern and also some variants of interest that have been reported and identified from a number of countries. Our ability to track these variants of concern really depends on the surveillance that's in the countries and also the genomic sequencing that is taking place in countries. These variants are detected through full genome sequencing and we know globally while sequencing has increased over the last year and there are more than 600,000 full genome sequences that have been submitted to publicly available database those sequences are really coming from a handful of countries. WHO is working through our regional offices and our country offices, through our partners around the world, our different laboratory networks to increase genomic sequencing worldwide. We're linking with different pathogen groups, with the vet sector, with private and public partners to be able to increase our ability to see where these variants are. 00:36:09 So we're limited in terms of our ability to detect this worldwide. Trying to account for this, we are working with partners to see how we can support countries in doing full genome sequencing in the countries themselves by either tapping into laboratories like our GISRS network, our global influenza surveillance and response network, as well as our SARS-CoV-2 lab network, our polio network, etc. If we can't find that ability in country, we're looking to see how we can support that through a partner lab and we have mechanisms in place to be able to share samples to do that. So, this is something that we are looking and have been working on to increase globally. We will continue to do so but it is dependent on our ability to do the sequencing. We also issued working definitions last week of what is a variant of interest and what is a variant of concern depending on the mutations that are identified and any changes or perceived changes in epidemiology or severity. So there's a global system that is in place to not only track variants of interest and variants of concern but also to study them to better understand what potential impacts they have on any diagnostics, therapeutics and vaccines. 00:37:26 So this is a work in progress and we're making sure that we are taking appropriate steps to improve genomic sequencing, which will help not only for SARS-CoV-2 but also for any infectious pathogen worldwide. CL Thank you very much, Dr Van Kerkhove. Next question goes to Maria Cardim, Correire Braziliense, Maria , please unmute yourself. Apparently, she's dropped off. Then we go on to Robin Millard from Agence France Press. Robin, please unmute yourself. RO Thank you. Dr Tedros, just following on from your opening remarks, a growing number of wealthy nations, among them Israel, UAE, Britain and the USA have now administered first vaccine doses to well beyond just healthcare workers and the extremely vulnerable, over-80s. 00:38:42 CL Let me look around the room. Maybe Dr Aylward. BA Thank you, Christian. That's such an important question and it's a theme that we've spoken about earlier today and on previous days. Our collective goal, everyone's, is to get out of the acute phase of the pandemic as rapidly as possible, to get the pressure off our healthcare systems, to get our societies open and functioning again like normal so we aren't wearing masks and physically distanced, and to get our economies fully functional again as well. The fastest way to do that, the most efficient way to do that is to ensure we protect our healthcare workers and we protect our older populations, our people with co-morbid conditions, which we've talked about multiple times now. That's going to be the fastest way to get out of this epidemic. It's not our recommendations; it's every study, whether an economic analysis of the situation or otherwise, that's shown that the best possible return on any country's investment is to ensure that those same populations are protected everywhere. That's difficult; it's difficult for leaders in countries that have access to vaccines and more substantive numbers of vaccines with tremendous expectations of populations on those leaders. But again the recommendation of the World Health Organization, our allocation principles and the principles on which the whole COVAX facility and the response is anchored is to make sure we roll out these vaccines in the most equitable manner possible. 00:40:26 Indeed when we set up the COVAX facility what we said in negotiation with all the participants is that we would roll the vaccine out first to up to 3% of the population to cover the healthcare workers and then an additional proportion right up to 20% of the population to be able to cover those at highest risk of severe disease or illness or death, as Mike laid out. That remains our position and I think there's more and more evidence that that is the best way to roll out these products. We can't tell individual countries what to do. We make our recommendations and countries will, we hope, come together, as the Director-General's been calling for again and again, to make sure we roll these out in the most equitable manner globally. CL Dr Simao, please. 00:41:16 MS I'll be very brief, just complementing because there are two things at hand here. One is the solidarity and the understanding that no-one is safe until everyone is safe and that means that all countries should be vaccinated. I would say that the second thing that needs to move this agenda, the equitable vaccine immunisation agenda is related to self-interest because it's not enough that you cover your population because you won't be able to reach enough coverage to actually close down your country and be free of this disease. On the other hand by vaccinating the priority groups you are protecting the health systems and you're averting deaths and this is what we need across the world. So I would say it's not only about solidarity but it's very much in every country's self-interest to ensure there's equitable access to vaccines in the world. CL Thank you very much. Dr Swaminathan. SS Just to add to what Drs Aylward and Simao just said, there are scientific reasons why we should do this because you don't want viruses transmitting and mutating and creating new variants in some parts of the world while in other parts of the world people think they're protected but they may not be if the variants evolve to the extent where the vaccines become ineffective. 00:42:43 The second are the moral and ethical arguments and then there are the economic arguments as well where it's clear that unless everyone is protected around the world that global economic recovery cannot start. There are things countries can do; the high-income countries can donate vaccines; after they're finished vaccinating their high-risk groups they could provide some proportion of the vaccines they have to the COVAX facility for distribution in other countries. And they could help with scaling up manufacturing and production capacity. There are many facilities around the world that are probably capable of manufacturing some of these vaccines. What is needed is technology transfer and transfer of know-how and if we can move on that, if we can identify those facilities in countries that have spare capacity and the companies which have the technology, especially on the new platforms, are able to transfer that within a few months we can ramp up production to meet the demands of the world. 00:43:45 So there are many actions that can be taken now and we should seriously think about moving on some of those. Thank you. CL Thank you very much. The next question goes to Duyang from the Xinhua Agency. Duyang, please unmute yourself. DU Can you hear me? CL Yes. Please. DU Thank you for taking my question. My question is, has the global pandemic reached a turning point with the administration of vaccinations? What are the issues or hidden dangers to be watched out for after the restart of social activities? Thank you. CL Dr Van Kerkhove, please. MK I can start with that. I think the biggest worry that I have is a relaxation of the individual-level measures as we see them roll out, a complacency. I know everyone is very excited about the introduction of vaccines and vaccinations as they roll out and they should be because this scientific achievement of having multiple safe and effective vaccines that are capable of reducing hospitalisations, are capable of reducing severe disease and death is astonishing. 00:44:59 But we need to make sure that as these vaccines are rolling out - we keep hearing that not all countries have access to the vaccine, not all vulnerable populations, not all front-line workers have access to the vaccine yet, it will take time. So in the time it take to roll out we still as individuals, as government leaders, as leaders in our communities need to provide supportive and enabling environments so that individuals can still carry out these measures as we open up societies. As we get schools back online, as some businesses start to open up we need to ensure that as individuals we take steps every day, that we know what our risk is and we lower our risk and that is about physical distancing, it's about avoiding crowds. It's about doing the things that we need to do every day to feed our families, to put food on the table and to make sure that we have an income whole holding back on some of the things that we want to do. 00:45:56 I know that's very hard but all of us are in the same position up here, as you are as well. If we can stay the course, if we can continue to the public health and social measures we can drive transmission down, we can drive transmission down to very, very low levels as we roll out the vaccines, while we are making the world safe. That for me is one of the biggest worries that I have. If we look at some of the mobility data we are seeing some slight ticks up in mobility, which means people are out and about and they're moving around. While we understand this because some of the transmission is still remaining low we have to continue to make sure that we do everything we can to limit the number of contacts that we have outside of our home. So for me it's about staying the course, it's being vigilant, it's being persistent, being determined to do what we can to keep transmission low, keep ourselves safe and our loved ones safe. CL With this we come to the next question. I'd like to go to Abdella Wahassan from Morocco News and I think we will need translation here in the room for that. 00:47:05 TR Good day. Thank you very much for having given me the floor. My question is linked to vaccination. Is it possible to ensure the broadest possible coverage for vaccination? Thank you. CL Dr Aylward, please. Thank you for the question. BA Yes, thank you for the question. Yes, absolutely, it's possible to ensure the broadest possible coverage but only through global co-operation on this. If you look at any of the maps that are widely available on the internet today what you see is a very different picture around the world and it's not the picture that we want to see, it's not the picture that's going to get us out of this pandemic because we're seeing parts of the world where we've got much better coverage but more use of the vaccine than other areas. So fundamental to getting to, let's say, an equitable distribution around the world is going to be the success of mechanisms like the COVAX facility - in fact that's the only one - which is designed to ensure the equitable roll-out so we truly get global coverage. 00:48:24 At the beginning that coverage is going to be low because we're going to be constrained in the amount of vaccines that can be made. As Maria said earlier, it's a miracle that we have these vaccines already but we have relatively limited quantities so it's going to take some time to get to coverage that'll cover all of the healthcare workers and then all of the older people at greatest risk, etc. But there is enough vaccine in the world to be rolling it out in a way that could protect the highest-risk populations and hopefully get us out of this acute phase of the pandemic as rapidly as possible but it's going to require that commitment to the goal of equitable distribution. Over time - again Dr Swaminathan mentioned earlier, there is a lot of work going on now to how can we expand production even further to get to higher levels of coverage around the world because there won't be enough vaccine to cover everyone this year but there will be enough, as Mike and others said, to make a big dent in this epidemic if we use this vaccine smart. That's the most important thing; use it in a smart way, use your weapon in a way that is going to have the greatest possible impact. 00:49:41 CL Thank you very much. We go for one more question to Esmer Milavic from N1 Bosnia. Esmer, please unmute yourself. ES Hi. Thanks for taking my question. My question is, in light of what we just addressed when it comes to vaccine and everything else, many are discussing COVID passports or COVID certification. What is WHO's stand at this point on potential options, how we can manage those passports or certifications? Because we see the different areas such as the European Union and countries are discussing all these options. How to avoid discrimination or having someone left out because of different regulation in a different area or country? Thank you. MR Thank you. Yes, it is an important consideration. In the last emergency committee meeting the emergency committee at that time advised against the requirement for vaccine certification as a requirement for travel, understandably given that vaccines were not widely available. As we see vaccination become more and more widely available in society clearly there will need to be considerations around how public health, social measures, individual behaviours can be adapted according to that. But as we do that we have to keep in mind the very important human rights issue; if you don't have access to a vaccine then should that affect your rights as an individual? 00:51:27 There are important ethical and human rights considerations when it comes to that as well. We have a working group, an internal task force working with external partners on the public health and the policy considerations for our member states when it comes to adapting public health measures in the light of vaccine introduction, and also a group working with the project on the electronic or the e-certification of vaccination. We are looking at different options for that but certainly WHO would be in a position to provide some kind of global clearing house and looking at blockchain and other technologies for the provision of private keys and other mechanisms by which governments can at some point verify vaccination status of individuals as they potentially move around the world. But again taking into account that in the absence of universal access to vaccination there are serious human rights and ethical issues regarding the application of restrictions on travel on that basis and again going back to this idea of getting as many people vaccinated as possible. 00:52:43 So we will be working with our member states and providing them with advice. Each and every member state has a sovereign duty to its own population and makes its own national health policies. We will try inasmuch as we can to provide advice, recommendations for governments to make proper decisions based on science and evidence and in the context of ethics and human rights being preserved. You'll see advice coming from WHO in that regard in the coming days and weeks and just while I have the floor, I can't remember who said it but we were talking about turning points a few minutes ago. I think someone once said that a turning point is the moment of naked acceptance of the truth. So when we talk about turning points we need to accept the naked truth that vaccines need to be distributed in an equitable fashion. If we get that done then we are at a turning point. Until that is achieved we haven't turned any corners. CL Dr Aylward, please. BA Just to complement Mike's point, I think we all understand the interest about vaccine passports and the like but again, to Mike's last point, just to reinforce it, it's all about the equitable access, making sure we get these products to the right people and we do not want to do anything that would create an incentive that all of a sudden people are looking for these vaccines for reasons other than the fact that they're treating people and exposed healthcare workers to people with the disease or older people or others who're at highest risk of dying from this disease. We want to make sure that those are the people that get vaccinated and anything that might compromise that goal is something that we have to think about very, very carefully. CL Thank you very much, both. We come to probably the last question from Lisa Schnirring | CIDRAP Lisa, unmute yourself, please. LI Hi. Thanks for taking my question. Just a quick one about Ebola and I want to thank your African regional office for all the updates with cases. I see there's a little up-tick in Guinea, an increase by six cases or so over the weekend to 15 and I'm just wondering if you have any information on where those are from, if they're from the more remote area or from cities. Any information you could share would be helpful. Thanks so much. 00:55:25 CL This goes to Dr Ryan, please. MR Thank you. I think we have Dr Soce Fall online as well; he may have joined and Soce can supplement. We have as of yesterday 17 cases, 13 confirmed and four probable, in Guinea. The most recent cases are in the Gouéké in N’Zerekore area; they're not outside that area so the disease remains in that sense contained in these areas although surveillance is being ramped up in other areas and in surrounding countries. We now have 20,000 doses of vaccine in country and over 1,100 gene expert cartridges have arrived for the diagnosis of the disease, including drugs from Regeneron and from INRB in Congo for the treatment of cases. We've been beefing up our presence on the ground with national experts and WHO experts. We now have 65 WHO staff on the ground. 00:56:37 I think the key issue right now is getting those contacts and contacts of contacts vaccinated. We've identified approximately 500 contracts and 99% of them are currently tracked and followed so we're doing well in terms of contact tracing and in rolling out vaccination we've over 1,100 contacts and contacts of contacts vaccinated and again our thanks to the leadership of Dr Sekova and his teams in Guinea and the Ministry of Health teams in Guinea who are driving this response with the support of partners. Our Director of Strategic Health Operations, Dr Michel Yao, and our Regional Emergency Director, Dr Salam Gey, are on the way to the region as well to provide further support. We're deploying more support for risk communication and community engagement activities including supporting the Ministry of Health with their socioanthropology and other issues. So the response is moving. We are concerned about the surrounding countries and we've carried out readiness assessments in the surrounding countries and find that all countries require support in order to increase their preparedness benchmark, in order to be ready for any possible introduction. Again we're deploying laboratory PCR-based diagnostic capacity to all of the surrounding countries and are in the process of finalising a regional response plan with all of those countries through our African regional office. 00:58:17 So yes, the increase in the number of cases is concerning. What is good is that we are on the ground and tracing and tracking all of the contacts. It is absolutely important that we have exhaustive investigation of each chain of transmission and quality vaccination of contacts and contacts of contacts as well as maintaining good infection prevention and control in surrounding health facilities in all of the surrounding countries as well as strong community engagement practices underpinning the whole response. So we're confident at this point that the Governments are very alert, they're moving, they're investing in their own capacities with the support of international partners but we're not out of the woods yet by any means. We need to remain collectively extremely vigilant for any further chains of transmission to be detected. I'd just give the floor to Dr Soce if he has anything to supplement. CL Yes, indeed, we have Dr Soce Fall, Assistant Director-General for Emergency Response, with us online. Dr Fall, please. SF Thank you. Thank you, Mike. Just [inaudible]. Can you hear me? CL It's interrupting but it's okay. Go ahead, please. SF Just to say that we're expecting to have [inaudible] on this but there has been more work to find any additional [inaudible] and it's good that we are finding alive cases, meaning that the surveillance and investigation is working very well. We need to make sure that we don't have secondary cases from these cases because we have detected them early enough and identified all contacts and vaccinated them in a timely manner. So we expect to see additional cases but the good thing is that we have an experienced team working with local communities and engaging with community leaders like religious leaders, traditional leaders to make sure that the community are in [?] the response. So we continue seeing cases but we are confident the responses were set up including in neighbouring countries. Thank you. 01:00:32 MR Can I just supplement for DR Congo and the resurgence of disease in North Kivu; there are currently eight confirmed cases including four deaths and we have had no new reported cases since 22nd February. CL Thank you very much. With this we've come to the end of our briefing and before I hand over for the final comments to Dr Tedros let me just remind everyone we'll be sending out the audio files and the Director-General's remarks right after the press conference and the full transcript will be posted on the WHO website tomorrow morning. For any other questions or follow-ups please contact mediaenquiries@who.int Dr Tedros, please. TAG Thank you. Thank you so much, Christian. As I said in my statement, it's very good news that Ghana and Cote d'Ivoire have started vaccination but in our campaign, in WHO's campaign the target is to start vaccination in all countries within 100 days of this year and we're left with 40 days. I hope the world will push to make sure that we achieve this goal of starting vaccination in all countries in the next 40 days. Again thank you so much to all who have joined us today and back to you, Christian. Thank you. CL Nothing more to add. Thank you very much and goodbye. 01:02:14

Media briefing on COVID-19 - 22/01/2021

00:00:12 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 22nd January. Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Soumya Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Joining us remotely is Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health products. Welcome, all. We have simultaneous interpretation in the six UN languages plus Hindi and Portuguese. Now without further delay I would like to hand over to Dr Tedros for his opening remarks and to introduce our guests. Over to you, Dr Tedros. TAG Thank you. Thank you, Fadela, shukran. Good morning, good afternoon and good evening. Yesterday the United States of America announced that it plans to retain its membership in WHO. I want to thank my brother, Dr Tony Fauci, once again for addressing the executive board so early in his morning. I was also honoured to speak with Vice-President Kamala Harris in the first hours of her first full work day. Thank you again, Madame Vice-President. 00:01:59 The United States has long played a vital role in global health. The US was a founding member of WHO and has been a leader in the fight against many diseases from smallpox to polio and malaria to HIV. The US contributes an enormous amount to global health but it also benefits from WHO's work on a range of disease both infectious and non-communicable. American public health professionals who work at WHO and in other global health agencies gain valuable experience and lessons to use at home. A healthier, safer world is a healthier, safer America so we welcome President Biden's commitment not just to remaining part of the WHO family but to working constructively with WHO, its member states and the multilateral system to end the pandemic and address the many health challenges we face globally. 00:03:06 In that sense we welcome the Biden administration's commitment to protect women's and girls' sexual and reproductive health and reproductive rights around the world. It comes at a critical juncture as the world prepares for the 25th anniversary of the landmark Beijing Declaration on Women's Rights that helped shape gender equality and women's movements globally. We also welcome the United States' commitment to rejoin the Paris Agreement on climate change, which will have major benefits for the health of our planet and for human health. We look forward to working with the United States and all member states as we prepared for a successful COP-26 climate conference later this year. We welcome the United States' commitment to support the Access to COVID-19 Tools Accelerator and to join COVAX. Vaccines are giving us all hope of ending the pandemic and getting the global economy on the road to recovery but we can only end the pandemic anywhere if we end it everywhere. To do that we need every member state, every partner and every vaccine producer on board. That's why today I'm glad to announce that COVAX has signed an agreement with Pfizer BioNTech for up to 40 million doses of its vaccine. 00:04:46 Additionally, pending WHO emergency use listing, we expect almost 150 million doses of the AstraZeneca Oxford vaccine to be available for distribution by COVAX in the first quarter of this year. Together these announcements mean COVAX could begin delivering doses in February provided we can finalise a supply agreement for the Pfizer BioNTech vaccine and emergency use listing for the AstraZeneca Oxford vaccine. COVAX is on track to deliver two billion doses by the end of this year. This agreement also opens the door for countries who are willing to share doses of the Pfizer BioNTech vaccine to donate them to COVAX and support rapid roll-out. In my remarks to the WHO executive board on Monday I called on the international community to work together as one global family to ensure the vaccination of health workers and older people is underway in all countries within the first 100 days of this year. The commitment of the United States to join COVAX together with this new agreement with Pfizer BioNTech mean that we're closer to fulfilling the promise of COVAX. 00:06:14 Today I'm pleased to be joined by Albert Bourla, the Chairman and Chief Executive Officer of Pfizer. Albert and I have had several conversations as we have worked together to make this agreement happen. Albert, thank you for your partnership. You have the floor. AB Thank you very much, Dr Tedros. Thank you very much, Tedros. Let me start by thanking you, Seth and Henrietta. This is an exciting day for global health and we wouldn't have got to this point without the leadership and partnership of all three of you. At Pfizer we believe that every person deserves to be seen, heard and cared for and of course we are committed to helping reduce healthcare disparities around the world and healthcare disparities around the world are true. Since the very beginning of our vaccine development programme Pfizer and BioNTech have been firmly committed to working toward equitable and affordable access to COVID-19 vaccines for people around the world. We fully support and we are in alignment with the guiding principles of the COVAX facility and we believe that GAVI's co-ordination of the COVAX advance market commitment that supports the participation of 92 lower-middle and low-income economies is an important tool that will help to ensure that developing countries have the same access to vaccines as the rest of the world. 00:07:52 We will provide the vaccine to COVAX for these countries on a not-for-profit basis. In this context I'm very pleased to say that Pfizer and BioNTech have reached an advance purchase agreement with the COVAX facility for up to 40 million initial doses of our COVID-19 vaccine. We expect the first doses will be delivered in the first quarter of this year once we finalise agreements with UNICEF and PAHO, who are co-ordinating procurement to support the delivery of these vaccines. On December 31st, the last day of last year our COVID-19 vaccine was the first to be granted a World Health Organization emergency use listing and today we are proud to have this opportunity to provide doses that will support COVAX efforts towards vaccinating healthcare workers at high risk of exposure in developing countries and of course other vulnerable populations. 00:09:01 This is just one step in our long-term commitment to supporting developing countries. As we work to deliver these first doses we are also bringing resources and expertise that will help to strengthen the global healthcare infrastructure, building on our recent innovations in packaging to manage cold chain requirements and ensuring that solid systems are in place for vaccine delivery. Establishing the infrastructure needed to deliver breakthrough MRNA vaccines in low-income countries will not only help the world fight this pandemic - because as Tedros said, in this world we are as protected as our neighbour - but also make us more prepared for the next pandemic. We believe that this is a collective responsibility that calls for highly co-ordinated and collaborative actions by public and private stakeholders alike. I want once more to thank the COVAX partners, I want to thank GAVI, WHO, CEPI, of course UNICEF, PAHO and the Bill and Melinda Gates Foundation among many others involved for their leadership and commitment to equity in this fight to end the COVID-19 pandemic. We look forward to continuing to work with them to realise this important shared vision. It is because of the efforts of everyone here today and many more across the global health community, the pharmaceutical industry and other partners, that we are one step closer to ending this global health crisis, proving that science will win and will win for everyone, everywhere. 00:10:57 I'm about to turn things over to you, Seth, but I just couldn't avoid the temptation to say that I'm very glad that this conference is happening the day that the United States is rejoining the WHO organisation. I think it's a symbolic, great day for us. Seth, I would like to turn things over to you now. SB Thank you so much, Dr Tedros, and thank you, Albert, for your commitment to the COVAX facility and for what it stands for. COVAX of course was launched last year because we wanted to avoid the mistakes that we had seen in the H1N1 pandemic when a small number of high-income countries bought up the global supplies of vaccine and poorer countries as well as other countries were left to fend for themselves. 00:11:47 So today, just over six weeks since the beginning of the first non-clinical trial vaccine doses being used against the COVID-19 pandemic, we face the prospect of very soon being able to deliver, as you heard from Dr Tedros, nearly 150 million doses in the first quarter of the year via a global equitable access initiative. This has been made possible by a collective effort by the international community that has helped COVAX raise over US$6 billion and secure access to over two billion doses. Of course we can do more and we need to do more. By our calculation with the right level of funding in place COVAX could procure 2.3 billion doses of vaccines in 2021. This would equate to close to 1.8 billion doses for the 92 lower-income countries in the COVAX advance market commitment or AMC, as we call it. That's enough to protect about 27% of the population in those low or lower-middle-income countries, which is in excess of the initial targets we laid out to protect those at highest risk. And we have the prospect of more doses to come through both other deals and the dose-sharing principles that we announced in December. Continuing with fund-raising efforts and advancing further deals with manufacturers will remain a top priority for COVAX in 2021. This includes working with CEPI, our co-lead in COVAX, to exercise first rights of refusal on other vaccines, if proven successful, that are in their R&D portfolio as well as looking at second-generation vaccines that may be important going forward. Of course we are also open to other vaccines that are not in the CEPI portfolio if they bring characteristics that are important into the portfolio. But back to the present question; what everybody wants to know is when will we be able to start delivering doses. As I mentioned, we are close for the Pfizer BioNTech doses with the advance purchase agreement signed. We need to conclude some of the supply arrangements so we can start shipping doses. The nearly 150 million doses of the AstraZeneca Oxford vaccines are ready to ship pending the WHO pre-qualification process which is critical to make sure that vaccines are safe and efficacious for countries. I won't pre-empt anything here and my colleagues on the panel will certainly answer any questions you have on this to the best of their ability but the latest guidance is that this is likely to happen in February. 00:14:50 In the meantime we're working with countries to prepare for vaccine roll-out. In about one week's time we're looking to provide all 190 participating economies with an indicative allocation of how many doses we hope to be able to provide in the early part of this year. Somebody once said, the darkest hour of the night comes before the dawn. As a scientist I know this is not true but I believe it's a useful proverb to describe the situation we're in today. The virus is running out of control in many parts of the world, health systems and economies are being stretched to a breaking point. We cannot end this pandemic fast enough and people and governments are panicking. We share this impatience. We're working tirelessly to deliver doses to the people that need them the most. When we do start delivering the volumes initially will be small, for health workers and for the highest-risk, but they will grow quickly. We are publishing our supply forecast on our website so you can have as clear a view as possible on how we are progressing towards our goal. Of course these will be updated regularly given the challenges in vaccine approvals and scale-up and ultimately delivery. 00:16:12 I thank you all for the ongoing interest in the COVAX initiative and I look forward to answering any questions you may have. I don't know if I'm going back to you, Dr Tedros, or if I'm supposed to be introducing Henrietta. Is it Henrietta next? TAG It's Henrietta but I can introduce if you would like me to. Thank you, Seth. SB Thank you. TAG As we have often said, it's not vaccines on their own that will help to end the pandemic, it's vaccination. Thank you so much, Seth, for your excellent intervention. As you know, UNICEF is playing a vital role in preparing countries for the delivery and roll-out of vaccines and I am pleased to welcome Henrietta Fore, the Executive Director of UNICEF. Henrietta, thank you as always for your close partnership. You have the floor. 00:17:04 HF Thank you very much, Tedros. It is really a delight to be with you and with Albert and with Seth today on this panel. I think, as we've just heard from Seth and each of you, COVID-19 has turned everyone's life upside down and children in particular will bear its consequences for years. The pandemic has disrupted their education, their health and their protection and it's affecting their mental health and pushing their families into poverty. They need their lives back and COVID vaccine is a key step towards that recovery. With today's announcements we draw one step closer to the beginning of the vaccination efforts under the COVAX facility, one step close to extending the fight against COVID-19 into more of the world's poorest countries and one step closer to achieving the goal of making sure that no country is cut off from the COVID vaccines. But there's plenty of work yet to do. UNICEF is currently assessing a series of bids in the COVID-19 vaccine tender that we launched in November. We are negotiating long-term supply agreements with a number of manufacturers, agreements that will pave the way for the world's poorest countries to have access to doses of quality-assured vaccines. 00:18:35 As part of this effort I'm pleased to announce that UNICEF has awarded Pfizer a contract following the tender and we are now in discussions to finalise the supply agreement. Thanks to UNICEF's negotiations and our decades of experience procuring and delivering vaccines in every corner of the world we have the expertise and know-how to do the job. Although today represents a milestone moment important challenges remain. For the unprecedented logistical exercise of rolling out vaccines in every corner of the globe UNICEF and our partners are working with governments around the clock to ensure that countries are ready to receive the vaccines, that there is appropriate cold chain equipment in place, that health workers are trained to dispense them. UNICEF is also playing a lead role in efforts to foster trust in vaccines by tracking and assessing and addressing misinformation; Tedros, to your point that we actually need people to get the vaccinations. 00:19:48 In the coming weeks UNICEF will begin transporting vaccines together with syringes and safety boxes to countries around the world and we are working with airlines and freight and logistics providers to ensure safe and timely delivery. Last year we saw truly unique human ingenuity at work to successfully develop effective and safe vaccines in record time. This year we turn to the biggest logistical challenge the world has ever seen and we need all hands on deck. With that in mind may I join everyone to say how pleased I am that the United States is set to join the COVAX facility. I'm confident that with its expertise and resources the United States will give this global effort and UNICEF's role in it a major boost. The global unity, commitment and support for the COVAX facility is truly a remarkable demonstration of what we can accomplish when we all - governments, NGOs, pharmaceutical companies and members of the private sector as well as the UN itself - work together because we know that in the race to vaccinate the world there are no winners unless we all win, every country together. Thank you very much, Tedros. Back to you. TAG Thank you so much, Henrietta, and thank you once again to Albert and Seth. It's important we all remember that vaccines will complement but not replace the proven public health measures that have been shown to suppress transformation and save lives. 00:21:40 We still have a lot of work to do but the light at the end of the tunnel continues to grow brighter. I thank you and back to you, Fadela. FC Thank you all. I will now open the floor to journalists' questions. I remind you that you need to raise your hand in order to get in the queue and please don't forget to unmute yourself. I would like to start with AP, Maria Chang. Maria, are you with us? MA Hi. Yes, I am here. I have a question. It's not about the COVAX announcement. I wondered if you could comment on whether or not WHO's advising the International Olympic Committee on whether or not the Olympics in Tokyo should be held or if you're providing any kind of risk assessment information to the Japanese. Thanks. FC Dr Ryan. 00:22:39 MR Hi, Maria. Happy New Year. Yes, with regard to Tokyo 2020 and with regard to many mass gathering events around the world including World Cups, the Olympics, the Hajj, WHO has a specific mass gatherings group in the emergencies programme and we provide, with our regional colleagues, ongoing technical, operational and risk management advice to many, many mass gatherings around the world, especially the International Olympic Committee and usually the host government of any particular Olympics. With regard to 2020 we provide risk assessment tools that the IOAC and the Government of Japan have used to make their ongoing assessments around the Olympics and we've been collaborating with the International Olympic Committee and several Japanese institutions and participating in an all-partner taskforce on COVID-19. We think there have been about 14 meetings thus far in the whole process. We are an observer on the IOAC independent expert panel and as such we don't contribute to the decision-making regarding the holding or not holding of the Olympics but we provide technical input and advice. We encourage and have encouraged this risk management approach to mass gatherings events and have issued guidance on that and updated that guidance as well. 00:24:01 With respect to the Olympics in Japan itself, we have the host city but we also have the Government and particularly the Minister of Health, Labour and welfare because as Olympics are not just held in a city - very often it involves people coming and visiting a whole country, multiple airports, multiple subnational entities involved. Clearly all parties and all stakeholders will have to come together and make the appropriate decision. We all hope - and we were speaking about it with Dr Tedros before; none of us would like anything more than to see the Olympics move ahead as a symbol of our world coming together. But again, like everything we've had to face in the last year, we've had to make decisions based on the evidence and based on the science and based on the risks at that moment. At the present time I believe and the IOAC and the Government of Japan are constantly re-evaluating those risks and I would say to us all, the best way we can get to an Olympics is get on top of this disease. That is the pathway to any mass gathering event in the future and the DG and Henrietta and our colleagues have said, there is hope. 00:25:14 So yes, we are working very hard. We will continue to offer that advice. We remain available for all technical advice to the Government of Japan, to our colleagues at the IOAC but we will not be part of the decision or arbitrating any decision in relation to hosting the Olympics or going ahead with them or not. Thank you. FC I would like to ask journalists if they'd prioritise their questions to our guests because some of them will have to leave early. I would like to ask Helen Branswell to ask her question. Helen, are you with us? HE Yes. Thank you very much, Fadela. I have a question in two parts, one part for Mr Bourla and the other for perhaps Seth. I'm wondering how much vaccine the world can actually anticipate seeing produced this year. I believe some of the early estimates were overenthusiastic. It's harder to make vaccine than anybody would like. 00:26:26 I would like to know how much Pfizer, at this point, feels it can make and how much GAVI thinks is going to be made over the course of the year, please. FC Thank you, Helen. Mr Bourla, you have the floor. AB Thank you very much for your question. I can only comment on Pfizer's capabilities and on Pfizer's manufacturing projections. Last year we announced that we believe we will be able to produce 1.3 billion doses of our COVID vaccine in 2021. Recently we announced that we have developed plans that make us quite comfortable right now to say that we will be able to produce at least two billion doses this year. Obviously there are always factors that can play into a massive production and a logistical challenge but the two billion that we have announced are based on a very robust plan and I feel quite confident that we should be able to deliver. FC Thank you. Dr Berkley. 00:27:34 SB Hi, Helen. Happy New Year. The answer of course is we don't know. Wee can add up what different companies have announced as Albert has just done, and the figures have gone up but of course many of these companies have not had approval yet and we don't know the yields of their products. So I think initially we were worried that many vaccines wouldn't work and so far we have now a number of vaccines that show promise and of course that means that it's likely that other vaccines that are similar in the way they work will also be able to ultimately be brought forth. So I think we're talking about numbers in the range of six to even billion doses but, as Albert has said, much can go wrong and it is really difficult to predict that in terms of time so I think we will have to watch over time where the world is able to go. I think it is - and Henrietta said this - remarkable how quickly - and 303 days from the tie the sequence was published to the first approvals. Now I think we're seeing the same type of scale-up across the world and it's incredibly exciting to watch but I suspect we'll have bumps in the road and those numbers may come down but very substantial amounts. FC Thank you both. I would like now to call on Tomo Dagushei from Kyodo to ask the next question. Tomo, you have the floor. 00:29:17 TO Hi, Fadela. Can you hear me well? FC Very well. Go ahead, please. TO Thank you. Tomohiro Diguchi with Japanese news agency Kyodo. Sorry; a question again on the Olympics. Japanese citizens are more and more concerned over holding Olympic Games under this pandemic. Our poll showed 80% want it to be postponed or cancelled but Japanese Prime Ministers, both former and incumbent, have repeatedly insisted that we'll hold the Olympics in July - quote - as proof of victory over the virus - unquote. Does WHO see that we can achieve this kind of so-called victory or the drastic improvement of the situation in six months? Thank you. MR Thank you for the question. Yes, Japan has beaten this disease before and I'm absolutely convinced that Japan can do that again but it's as many countries have found around the world in the last couple of months; that things are tough and difficult. Communities are fatigued and tired and sustaining these efforts while we bring vaccines online is a real challenge. 00:30:30 But I have every confidence in the Japanese people and in their public health and governmental authorities that that will happen. Again Japan led the way in understanding how this disease spreads, in actually showing the techniques that could contain this disease even in very, very densely packed urban environments. So Japan has actually shown the way in the world in many cases in how to deal with this disease and I'm sure you will again. It is difficult to think about the Olympics in the context when you have an emergency situation ongoing in Tokyo and you have the prospect of the Olympics. I can fully understand people's concerns and we can fully understand the desire of the Government to move ahead with what is a very symbolic global event and one of great prestige, I'm sure, for the Japanese people. So there are many trade-offs here and I've said this before; there are no easy answers. Science and policy are not the same thing. Data drives science. Science can advise government. Governments make policies. Policies are in the real world; they must balance scientistic realities against the social realities, the economic realities and the political realities. 00:31:41 The Japanese Government is in a difficult position but I am sure the Japanese Government will consult with its own society, it will consult as it always does and it will come to the appropriate decision at the appropriate time. We all hope in the Olympics but we all recognise that everyone right now is a little afraid as we enter the new year with some uncertainties. I believe that he Japanese Government will, like all governments, I hope, always act in the best interest and according to the will of its people. FC Thank you. I would like now to invite Ker Simons from NBC to ask the next question. Ker, are you with us? KE Yes. Can you hear me? FC Very well. Go ahead, please. KE Hi. A number of Chinese scientists have said that they believe that the coronavirus originated outside of China. Surely it's too early to reach that conclusion and if you have agreed, as your terms of reference for the investigation suggest, that you will look at countries outside China have you also agreed with the Chinese that your team will have access to the labs in Wuhan? 00:33:00 MR Thank you. Yes, I'm always very afraid in any process where the conclusions start looking for the evidence to support them and we're dealing with a lot of that in the last few days around here. The difficulty, I think - and I think we have to say this quite plainly; all hypotheses are on the table and it is definitely too early to come to a conclusion of exactly where this virus started either within or without China. There are different observations and I will call them observations; scientific operations in different parts of the world, virus been cultured off different surfaces, virus in sewage, potential serology in some places potentially implicating earlier infection. All of that's very important because it builds up a picture. This is a big jigsaw puzzle and you cannot tell what the image says by looking at one piece in a 10,000-piece jigsaw puzzle. You can guess and you're entitled to your guess and you're entitled to your opinion but that doesn't make you right. So I think we all have to - again we keep saying this; let's step back, let's follow the evidence, let's follow the science. Our team are on the ground, they're having a good experience working with our Chinese colleagues. We're working through the data. The data will lead us to the next phase, where we need to go next to look at the origins of this virus. So yes, it is too early to come to any conclusion but again we believe we are making some progress and we hope to continue to do so in the interests of public health in future. FC Thank you. I would like now to ask Naomi from Bloomberg News to ask the next question. Naomi, can you hear me? NA Yes, I can. Thanks very much. I just wanted to ask; UK Prime Minister, Boris Johnson, just said that the more contagious strain of virus that has been spreading there may be linked to higher mortality. I wanted to get your view on that and ask how concerned you are in general about the variants that have been spreading, whether these may have some resistance to the vaccines that have been approved so far. Thanks. 00:35:17 MK Thank you for the question. I understand that that press conference in the UK is happening at exactly the same time as we're having the press conference here so we're learning a little bit about that but we don't have that full information yet. Your question around the virus variants is something, as you know, we have been tracking for quite some time. Viruses change and we all know that but in recent weeks and recent months we've been hearing about these virus variants in a number of countries which have been identified through looking at their epidemiology and doing sequencing and identifying viruses that have a number of mutations. All mutations are somewhat worrisome in the sense that we need to evaluate them properly. Most of these mutations and variants will have no impact on the virus itself but each of them deserves attention, deserves a robust framework to analyse them and what we are looking for for each of them - and there will be more - is looking at transmissibility, looking at the severity, the disease presentation and the severity caused in those who are infected with those variants, looking at the body's ability to develop neutralising antibodies and any potential impact on available and future diagnostics, therapeutics and vaccines. 00:36:34 As you know, there are a number of variants that have been identified; the one in the United Kingdom, the variant of concern 2012-01. We have been working daily with our colleagues in our European regional office as well as across the United Kingdom at Public Health England and many academic institutions, looking at transmission, looking at severity. From the information we have seen from them there are studies that are ongoing looking at hospitalisation rates, looking at mortality. From the data we've seen - and we do need to get the information that you just reported on - they haven't seen an increase in severity but again we need to find out what you are referring to. We should say that if you have increased transmissibility you will have more cases. I know that might sound obvious but you'll have more cases, you'll have more hospitalisations and you'll have an overburdened healthcare system. 00:37:26 In a situation where you have an overburdened healthcare system you can have increased deaths because the system is overwhelmed and doctors and nurses who are working incredibly hard to save as many lives as they can don't have as much time with patients; they're overburdened. So we emphasise that no matter what virus is circulating - virus variants or not - we have to do everything we can to reduce transmission, everything we can to reduce transmission. We are encouraged by the signs of decreased transmission across the United Kingdom and also in Denmark, in Ireland and also in South Africa, which has a different virus variant, the 501YV2, that they identified recently. We see decreasing trends in incidence and this is a good sign and it tells us that the public health measures that are in place work against these viruses. As you've just heard Mike say, we have to stay the course. The interventions that are in place that we've seen across so many countries reduce transmission, they break chains of transmission; everything from finding cases, isolating cases, good clinical care, supported quarantining of contacts, individual levels of mask-wearing, physical distancing, hand hygiene, avoiding crowds, opening windows; all of that. 00:38:43 We need to stay the course, we need to make sure that we adhere to all of those measures and especially in countries that are seeing decreases in transmission; really important that the measures that are in place continue to be applied but as they are lifted they're lifted in a slow and steady way. They can't be lifted very, very quickly or else you will see a resurgence again. The virus likes people, it needs people to circulate between so we need to put that into context. So with the variants there are a number we are tracking through our virus evolution working group and through a much larger risk assessment framework where we are working globally to increase sequencing capacities, leveraging existing systems like the GISRS flu system that's in place but also making sure that the proper studies are done so that we can evaluate each of those. I will end. Mike. 00:39:35 MR Can I just add on that specific issue because I think it's an important point on how we count. There is a big difference between the lethality of a virus, how many people on average a virus kills, versus the mortality of the virus in terms of if I have one million people infected and my lethality is 1% and I have two million people infected with a lethality of 1% twice as many people will die. That's the issue with mortality in this case. We're not seeing so far - and again we wait to... this is at this point - that the disease is more lethal. What we're seeing is if you infect more people more people will get very sick and if more people get very sick more people will die. We've shown that, we've seen the graphs; increasing incidence leads to higher mortality. The number of deaths grows but the absolute lethality of the virus does not need to grow for the number of deaths to grow. We've seen that already over the last year. If your cases get out of control your deaths will get out of control as your health system comes under pressure. That's why we have to protect our health systems and keep the numbers low and I think any virus that transmits more readily will drive those kinds of problems. We will look, as I say, as Maria says, at any new UK data that shows... because they are signals, they're very important to track. 00:41:03 But I think it's again important that at the present time we all remain calm around the issues of these variants. We need to monitor, we need to measure, we need to be very sure what they're doing or what they're not doing but we also need to focus on what we're trying to do to stop them. The good news is from what we can see the measures that are being put in place around the world are turning the situation around in most countries. However it remains to be seen whether that will continue. KOB There was also a question embedded within your question about whether or not any of the variants and any of the vaccines would be affected. I think it is important to address this from at least two dimensions and probably three dimensions. The first is that this is really evolving information and there are a number of ways that evaluations can be done to understand whether or not any of the vaccines are less effective against the variants. 00:42:12 I think it's important to say that it's too early at this point to really have clear information on that. There are studies that are starting to come out on small numbers of samples and variants and so this is really a place that is a place in motion but each of the variants is not necessarily going to have the same answer with respect to each or every vaccine. So I think we just really have to acknowledge that this is an important area and it's important for several reasons. One is that we really need to understand this but the risk of variants relative to the vaccines is ever greater when the transmission is very high in communities, not only because of variants that have already occurred but because of the possibility of additional variants emerging under the pressure of vaccines. So it's just a second reason beyond what Maria and Mike have emphasised; we have these amazing tools at hand now and the urgency is to deploy them but we risk something about those tools if we're also not suppressing transmission to the maximum degree possible where those tools can be effective in settings where there is limited transmission. 00:43:39 I think this is just a second point that we have to emphasise about the importance of really crushing transmission now, especially while we're rolling out these new vaccines which are really the tool that we need to add to the toolbox that we already have and take best advantage of them for the maximum impact. Thank you. FC Thank you. I would like now to call on Anna Pinto, Brazilian journalist from Folha de Sao Paulo. Anna, are you with us? AN Hi, Fadela. Thank you for the opportunity. Can you hear me? FC Yes, very well. Go ahead, please. AN Okay, thanks. My question is about the new variant also and about the use of FFB2 masks that were made mandatory in Austria and parts of Germany on public transportation and in shops. According to those Governments regular masks are not safe enough against the new coronavirus so I'd like to know if there is any evidence that the regular fabric masks are less efficient at preventing the new variants and if so if WHO will revise its guidelines for use of masks against COVID-19 and if there's any concern about a shortage of that kind of mask or the fact that it's probably too expensive for poorer people. Thank you very much. 00:45:15 FC Thank you, Anna. MK Yes, thank you very much for the question. This was one of the questions that we had directly to our colleagues in countries that are detecting these virus variants and are carrying out the studies that we were just describing and in particular the research that's underway in South Africa and in the United Kingdom is looking at the increased transmissibility and why that may be but also looking at rates of infection among different populations and modes of transmission. From both of our colleagues in the United Kingdom but also in South Africa we have no indication that the modes of transmission have changed; it spreads the same way. Some of these variants - not all of them, some of these variants may have increased transmissibility where one person may infect more than they would if it was the wild-type virus but still not to an extent where things are drastically different. 00:46:09 We are seeing that the interventions that are in place are working but I should say with the use of masks, masks are one aspect of control, one aspect of reducing the spread of this virus and they can't be used alone. We need to emphasise that because not one solution is enough; not masks alone, not physical distancing, not hand hygiene; you've heard us say that quite a lot. Our colleagues are having discussions right now with our European office and ECDC together with the two countries that you mentioned and also we have had conversations this evening with USCDC and ECDC as well looking at this. Countries are free to make decisions as they see fit. We will continue to look at the evidence that we've seen but the data that we have seen from the countries that have these virus variants; there's no change in the modes of transmission and so we will look at our guidance and we have no intention of changing it right now but if anything changes we will modify and we will update accordingly. 00:47:12 But it is important to note that the measures that are in place in countries where the virus variants are circulating are working. It takes a comprehensive approach, it takes adherence to the measures that are in place to make sure that we follow through with the measures that are advised so that we can reduce transmission but again not one measure alone is enough. Within our guidance itself it is also worth noting that the use of fabric masks; we recommend a three-layer mask and in our guidance materials we have recommendations on the specifications for filtration for example, what the type of fabric should be for the inner layer, the middle layer and the outer layer. Not all fabric masks are the same and so they need to be produced and made so that they provide the right type of protection and source control. Shortage is always a worry. WHO and partners have worked incredibly hard to increase capacity for medical masks, for respirators, for other personal protective equipment so that our front-line workers have access to this life-saving personal protective equipment. There's still a global shortage despite all of these efforts that are made so it is important that we do make sure that our front-line workers are protected with the equipment that they need so that is always a concern of ours. 00:48:39 The shortage issue has improved over time but it's still not completely fixed so I just wanted to add that because I think that's an important aspect to the question that you ask. Thanks for the question. FC Thank you. Just reminding journalists that we have with us three guests willing to take any of your questions. Now I would like to move to India and to call on a reporter from Observer Times, Ashvin. Are you with us, Ashvin? Can you unmute yourself, please? AS Hello. My question is, can there be many autoimmune, neurological and chronic health disorders that have a major impact on quality of life that the vaccine will cause? What reports [?] does WHO have on this? FC Ashvin, can you repeat your question, please? The sound was not very good. AS Yes. Can there be many autoimmune, neurological and chronic health disorders that have a major impact on the quality of life that the vaccine can cause? What reports does WHO have on this? 00:50:34 FC Dr Swaminathan. SS Yes, thank you for that question. I think there are two elements there. The first one is on the vaccines; who do we prioritise for these vaccines? It's really people who are at the highest risk of getting infection and the highest risk of dying and we know who those people are and we've seen; it's the healthcare workers who are at the front line who are exposed to get infected and it's also people who are older individuals who are at more risk of complications and death if they get the infection. But it's also younger people with underlying diseases. You mentioned chronic diseases. We know that people with underlying heart disease, hypertension, renal disease, dementia, diabetes are at higher risk again of having complications and of dying. They need to be prioritised for the vaccine roll-out and that's what countries are doing based on the WHO's advice to SAGE. I think your question was also about, will the vaccine cause some of these complications. The first thing we're saying is that vaccines should be given to people with underlying chronic diseases because they are at higher risk, much higher risk of death; we know that. 00:51:54 There may be unusual diseases - you mentioned, I think, autoimmune diseases - where there may be a need for an individual to consult their local physician so wherever there's a doubt it's always a good idea for the individual to consult with their local healthcare provider before taking the dose of a vaccine. We're reviewing the data from trials as they're coming out and as you know, these trials; many of them are still ongoing. We have seen interim results from a few trials and a few more are likely to come out and based on that we evaluate the safety profile, we evaluate the efficacy. When we look at safety the companies do present data on the different groups of patients they have and most companies are trying to include people with a broad age group range, from 18 up to 80-plus. They also try to include people with underlying chronic diseases and so we get some hints of the safety profile in all of these different subgroups. 00:53:03 But you know that the numbers are limited in clinical trials and so post deployment there will continue to be active monitoring, pharmacovigilance, safety monitoring across larger numbers of people and already we've crossed 55 million vaccinations, I think, globally and we are tracking safety and so far it's been really very encouraging. This is something that the data base will continue to evolve and if there are safety signals WHO and the regulatory agencies are tracking this and we will provide that information. Again, to conclude, it's always a risk and a benefit evaluation when you take a vaccine because a vaccine is taken by a healthy individual to protect them from a disease, in this case COVID-19. So in the vast majority of people the benefits will outweigh the risks but there may be individual instances where you need to consult with healthcare providers. FC Thank you, Dr Swaminathan. I would like now to call on David Pelling from Financial Times. David, can you hear me? DA I can. Thanks very much. Can you hear me okay? 00:54:14 FC Yes, very well. Go ahead, please. DA Great. Thank you. Hi. First, I think Seth said that the hope was to have enough vaccine to vaccinate 27% of the population - I don't know if that's the adult population but anyway the populations of poor and middle-income countries. My question is, what impact is that likely to have, all else being equal, on transmission? My second question is to do with vaccines again. Given that the AstraZeneca vaccine has been approved by UK authorities why does the WHO need to separately approve that vaccine, given you'd expect the UK to be pretty stringent? And just a follow-up on that; will you also be looking at the Sinopharm, Sinovac and the Russian vaccine and what are the prospects for those to be used by COVAX, which would potentially really increase the amount of vaccine that were available should, of course, it be safe and efficacious? FC Thank you, David. We have three questions. First of all I would like to ask Dr Berkley to take the first question. 00:55:39 SB Thank you, David, and Happy New Year to you. First of all I said - that is correct - that given our current projections, which we have now posted, we hope to get in the AMC countries to 27% with all the caveats that have to occur across the course of the year. What effect should that have on transmission? Of course we don't know yet whether these vaccines are just disease-mitigating vaccines or if they are also transmission-blocking vaccines. I think that data is beginning to trickle in and being looked at but there're not comprehensive studies on that. But the original reason that 20% was the number was because that would cover, on average, the healthcare workers plus the elderly plus those with comorbidities, those at highest risk and therefore would protect those health systems in those countries at a time when we knew that there was going to be a supply shortage and much more demand. That's where the original 20% came from; it's what we thought could be produced and how it might have an effect. With this higher number obviously that's good news, assuming that those doses are there and of course we will have to see if those countries will need more doses or not over time. 00:57:11 In terms of your question on why this vaccine is not... we can't just use the UK approval I'm sure Mariangela will want to say something on that but a vaccine that is made in the UK is different than a vaccine that's made in India, it's different than a vaccine made in Korea and so we have to make sure that those vaccines meet the standards and are comparable with the vaccines that have had their regulatory approvals. Lastly you asked about the Chinese and Russian vaccines and of course the answer is, we will consider any vaccines for inclusion in COVAX assuming they add value to the portfolio, assuming that there is transparent data on safety and efficacy and that we can come up with a reasonable price point and supply allocation that makes sense. Let me stop there and I think Mariangela's going to come in. MS Yes, let me complement and thank you for the question, David. First on Sinopharm, WHO is assessing several vaccines right now and Sinopharm and Sinovac are going to be inspected next week. They have both sent their full dossiers to WHO for the emergency use listing so they're being assessed right now. 00:58:45 Gamaliya; we had a meeting today. We have yet to receive more information, especially on clinical data, from Gamaliya. Seth has responded already on the AstraZeneca because you'll know that AstraZeneca has eight different production sites and for the sites that AstraZeneca will be providing to the COVAX facility we have the site in India which is the Serum Institute of India, which has already submitted a dossier to WHO last week and it's under assessment. We have another site in the Republic of Korea so we are working together with the Korean authorities to expedite the assessment of these two sites for the AstraZeneca vaccines, the eight AstraZeneca-derived vaccines. Two of them are providing to the facility. I hope that answers your question. Thank you. FC Thank you, Dr Simao. I would like now to call on Laurent Siero from ATS, Swiss news agency, for the next question. Laurent, can you hear me? LA Yes, I can. Can you hear me? 00:59:58 FC Yes, very well. Go ahead, please, Laurent. LA Yes, very good. Thank you for taking my question. Dr Tedros, this morning you met with the Swiss Health Minister, Alain Berset. I assume you raised the question of that new repository or biohub. What's new in that regard and when should we expect an operationalisation of the repository? Thank you. TAG Thank you so much. As you have rightly said, one of the issues we discussed with the Minister was the biohub and the progress so far is the number of countries interested in joining the biohub voluntarily is increasing and at the same time the preparation of the lab in Switzerland is also going very well. So we hope to have the lab in place as soon as possible and this will be very important. This is as part of the pandemic preparedness changes we're making, as you know, on sharing pathogens. Member states have been negotiating for many years - I remember even when I was Minister of Health; this was many years ago - but there was no breakthrough. 01:01:31 So the proposal from WHO was to start it as a volunteer programme so the willing join this volunteer programme and from that I think more and more countries can join. But we're really encouraged now by the co-operation and interest of many countries and I hope this biohub which is starting as a volunteer programme will get a consensus globally. So we have agreed, WHO and Switzerland, to continue to champion this, pioneer this together with the three countries who have agreed; that's South Africa, Italy and Thailand. These are the front-runners and we hope many others will join. There is a positive signal. Having said that, on some of the details maybe, Mike, you'd like to complement. MR No, I think you've covered it there extremely well. Maybe just to supplement - and Maria may wish to add - this is really a measure to enhance the ongoing work that's going on between labs around the world. We have the Global Influenza Surveillance and Response Network, the global polio lab networks. We've got a global network of labs on SARS coronavirus; 26, I think. Maria, you can speak to that. So countries are sharing material, labs are sharing material for all kinds of different purposes and we're very lucky to have that. Now we need to accelerate that because of the need to add genetic sequencing and genetic characterisation into that and the more we can find ways to create these hubs... 01:03:13 And you'll note that we call this a biohub. The idea is not to create a place where we just put stuff. We've got to be able to move material around so it can be studied properly and from that perspective we want to get across that dynamic. But we also have to within this work within the frameworks of the Nagoya protocol and other important issues around the sharing of benefits and the sharing of the fruits of the research that come and innovation that comes from having access to that material. WHO will maintain and through the process of having a biohub will retain the responsibility for those materials and act as the steward of those materials. We thank our colleagues in Switzerland for acting as the repository and providing us with the means. 01:04:07 We will start small on this and we will work this through as we go. This is a completely voluntary process. We will involve our member states increasingly in building the system and, as I said, it will not replace existing systems. Too many times in health or public health or in public life we tend to dismantle and try and rebuild. The world is more complex. We have to evolve the systems we have, use the systems we have, enhance the systems we have and build new where we need to and evolve the system. Maria, you may wish to speak about the wonderful labs we already have around the world. We're probably out of time so maybe we can leave that to another day. MK I'll just take the opportunity to thank them. I don't need to add anything on the biohub that Dr Tedros and Mike have just said but just to thank all of our lab networks that are around the world, our lab networks and our clinical networks, our IPC networks, our epi networks. These are built over decades and they're built through collaboration, they're built through trust, they're built through mutual goals that we all have of achieving better health for all. So the SARS-CoV2 lab network was built on the MERS coronavirus network which was built on the first SARS coronavirus network which is all built from our flu network and so we're leveraging systems, we're building, we're not starting from scratch. 01:05:30 So it's a good opportunity to thank all of the 26 collaborating labs that provide reference services for countries that didn't have capacity in the beginning, some of which don't have capacities for sequencing. So what we are doing as an organisation and working through our regional offices is trying to build capacities for better diagnostics for sequencing, for serology, for the sharing of information and the corresponding data that goes with those samples, the clinical data, the epi data. All of this helps us better understand transmission, it helps us better understand these viruses that emerge and spread and how we can develop countermeasures against those; the rapid diagnostics, the therapeutics, the vaccines. So it's a massive thank you to all of our partners worldwide. We don't thank you enough and we rely on the good work that you do, your willingness to collaborate and share information so thank you. 01:06:34 FC Thank you. We have gone for more than an hour since we started this press conference. I would like to thank you for your participation and hand over to Dr Tedros for final comments. Dr Tedros, you have the floor. TAG Thank you. Thank you so much to all those who have joined today and have a nice weekend. See you in our next presser next week. Thank you so much. MR If I could just say one thing because all of the staff here at WHO including Dr Tedros... Tomorrow's the anniversary of the passing of our colleague, Pete Salama. Dr Tedros raised this and held a moment of remembrance for Pete and all those we have lost in the front lines during the executive board this week. Tomorrow is the anniversary of his passing and tonight his wife, Annelise, and his boys are in our thoughts. We still miss him and we will all mark the day, tomorrow, when we lost a fantastic humanitarian and global health leader. Thank you. FC Thank you, Mike. Just to remind journalists, we will be sending the audio file and Dr Tedros' speech just after this press conference. The full transcript of this press conference will be posted on the WHO website. If you have any follow-up questions to WHO, Pfizer or GAVI please do reach out to us and we will make sure you have the answers you need. The press briefing is now closed. Have a nice weekend. 01:08:13

Media briefing on COVID-19 - 15/03/2021

00:00:24 CL Hello and good day wherever you are joining us today. It is Monday 15th March 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 first anniversary of the COVID-19 Solidarity Response Fund. Simultaneous translation is provided in the six official languages, Arabic, Chinese, French, English, Spanish and Russian, as well as in Portuguese and Hindi. We have two special guests today. First of all with us in the room here today is Anil Soni from the WHO Foundation, the Chief Executive Officer; welcome. And we have Elizabeth Cousens, Chief Executive Officer of the UN Foundation online. Hello to both of you. Now let me introduce to you the other participants. Present in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director of the WHO 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. We have Dr Soumya Swaminathan, Chief Scientist and Dr Bruce Aylward, Special Advisor to the Director-General and the Lead on the ACT Accelerator. Online we have Dr Kate O'Brien, Director for Immunisation, Vaccines and Biologicals, Dr Soce Fall, Assistant Director-General for Emergency Response, Dr Michel Yao, Director of Strategic Health Operations and last but not least, Dr Peter Ben Embarek, WHO Expert on Food Safety and Zoonosis and the International Lead of the WHO-convened global study of the origins of SARS-CoV-2. With this let me hand over to the Director-General for his opening remarks. Dr Tedros. 00:02:24 TAG Thank you. Vielen dank, Christian. Good morning, good afternoon and good evening. I would like to start by acknowledging that today marks ten years since the start of the crisis in Syria. WHO continues to work on the ground with our partners to deliver services and supplies, to protect public health and to support a network of more than 1,700 health facilities. The conflict in Syria has brought a once highly effective health system to its knees but tragically it's not an isolated example. Syria is one of many crises around the world from Myanmar to Yemen and Tigray in Ethiopia where millions of people have been denied access to essential health services and where health facilities have been destroyed and health workers have been attacked and intimidated. 00:03:31 This must stop. Now more than ever health workers, health supplies and health facilities must be supported, functioning and serving all people. Now more than ever parties to all conflicts must adhere to agreed international norms that protect healthcare. Since our last press conference on Friday several more countries have suspended the use of AstraZeneca vaccines as a precautionary measure after reports of blood clots in people who had received the vaccine from two batches produced in Europe. This does not necessarily mean these events are linked to vaccination but it's routine practice to investigate them and it shows that the surveillance system works and that effective controls are in place. WHO Advisory Committee on Vaccine Safety has been reviewing the available data, is in close contact with the European Medicines Agency and will meet tomorrow. But the greatest threat that most countries face now is lack of access to vaccines. Almost every day I receive calls from senior political leaders around the world asking when their country will receive their vaccines through COVAX. 00:05:14 Some of them are frustrated and I understand why. They see some of the world's richest countries buying enough vaccines to immunise their populations several times over while their own countries have nothing. We welcome the commitment by the Quad countries to deliver up to one billion doses of vaccine in the Asia Pacific region through COVAX. We continue to call for all countries to work in solidarity to ensure that vaccination begins in all countries within the first 100 days of this year. We have 26 days left. No country can simply vaccinate its way out of this pandemic alone. We're all in this together. Today marks the one-year anniversary of the launch of the COVID-19 Solidarity Response Fund, an unprecedented collaboration between WHO, the United Nations Foundation, the Swiss Philanthropy Foundation and many other partners to generate funds for the pandemic response including WHO's strategic preparedness and response plan. 00:06:42 Thanks to the generosity of individuals and corporations over the past year we have raised US$242 million from more than 662,000 donors, persons. This is the first time in its history that WHO has received donations from the general public. To every individual and organisation that contributed I say thank you. Your donations made a significant impact all over the world. With your support we shipped more than 250 million items of personal protective equipment, provided technical support to hundreds of labs, supplied more than 250 million COVID-19 tests, co-ordinated the deployment of more than 180 teams and missions, delivered oxygen and supported over 12,000 intensive care beds to prevent health systems from being overwhelmed, provided training through openwho.org which has more than five million registrations for courses that are delivered in more than 50 languages from Albanian to Zulu and much more. But as you know, the pandemic is not over. Three weeks ago we launched the Strategic Preparedness and Response Plan for 2021, which outlines how WHO will support countries in responding to the pandemic and the resources we need to do it. The plan calls for a total requirement of US$1.96, close to US$2 billion, and we thank all countries and organisations who have already committed funds. 00:08:50 We're now inviting everyone to support the 2021 Strategic Preparedness and Response Plan through the Solidarity Response Plan. The money collected will be used to suppress transmission, save lives, fight the infodemic and accelerate equitable access to vaccines, diagnostics and therapeutics. When we launched the Solidarity Response Fund one year ago the United Nations Foundation played a vital role in making it happen. Today it's my great honour to welcome Elizabeth Cousens, the President and Chief Executive Officer of the United Nations Foundation. Elizabeth, thank you so much for your support and partnership over the past year and for everything your team and yourself have done. You have the floor. EC Thank you so much, Dr Tedros. It is wonderful to join you, Anil and your colleagues as we mark a year since the launch of the COVID-19 Solidarity Response Fund and look to its future. When WHO called on the United Nations Foundation just over one year ago you asked us to help create a tool to mobilise global support with the same ferocity as the virus that was beginning to sweep the world. 00:10:15 You knew that the scale of support would need to exceed anything that any of us had ever done before and that it would require all of us, every country, every sector, every individual to play their part. You also knew that fast funds and flexible funds were needed most of all. Indeed every emergency, even ordinary ones, teach us that every single time. We were honoured to answer your call and working with WHO, the Swiss Philanthropy Foundation and fiduciary partners all over the world we created those novel flexible fund in less than a month to enable individual, corporate and organisation donors alike to give unrestricted support to the global pandemic response being led by the World Health Organization. $242 million has since been raised from more than 662,000 individuals, corporations and organisations from 190 countries, making the COVID-19 Solidarity Response Fund possibly the most diverse pooled fund in history. The hundreds of thousands of individual donors who answered the call did whatever they could, whether $3 or 300. Companies rallied to give millions. Private donors from Italy, India, Germany, Kenya, Japan, Brazil; virtually every country, many who didn't have much to give, found in the fund a way to do their part against this unprecedented global threat. 00:11:34 Online gamers ran livestream marathons generating hundreds of thousands of dollars. Celebrities, fitness gurus, artists, athletes, children, even the Minions joined this worldwide effort to support WHO and its partners in working to prevent, detect and respond to COVID-19. The fund was fast. In just six weeks we raised more than $200 million and to date the fund has disbursed more than 226, making it one of the top donors to WHO's COVID-19 response. Every gift large and small was also moved out the door quickly to fill critical gaps and the fund's agility quickly became one of its superpowers, essential to fighting this novel and rapidly unfolding pandemic. The fund's resources were used to repair the global supply chain for things like personal protective equipment, testing supplies and medical equipment for well over 100 countries. It helped infection prevention and control for migrants, refugees and other vulnerable people, helped train front-line personnel in multiple languages, seed early research into treatments and vaccines and as you noted, helped fight the world fight against the infodemic, the corrosive spread of bad science and misinformation so that people could get trusted, evidence-based information on which they and their communities needed to rely. 00:12:49 The fund has also revolved resources where possible to enable those gifts to have even greater impact but for us possibly the most powerful impact of the fund has been its demonstration of solidarity. The COVID-19 pandemic is a global threat that will only be overcome by global action but it isn't the last such threat we will face. All of the good the fund has done; that's come from people, those 662,000 people in 190 countries, those 100-plus companies and organisations, the thousands of professionals working through WHO as partners and on the front lines of public health around the world, the citizens who mask, distance and protect. That should all be an incredible source of hope and of confidence; confidence that we can do big, bold, transformative things when we act together, confidence that through global solidarity we'll not only conquer this virus but be able to shape a healthier, fairer and better future. 00:13:45 At a time of temptations to nationalism and polarisation in too many places the fund shows that collective action works and that we are stronger when we act together. The United Nations Foundation has been honoured to be in this fight with all of you as we work to bring the acute phase of this pandemic to an end and set our sights on recovery and we very much look forward to being your partner in the future. Thank you. TAG Thank you. Thank you so much, Elizabeth, and thank you once again to you and your team for your support. We look forward to our ongoing partnership. In May last year I announced the creation for WHO Foundation, a new, independent body to generate resources for WHO from sources we have not accessed before. The creation of the WHO Foundation was part of the WHO transformation underway. 00:14:44 Its goal is to raise US$1 billion for global health over the next three years. The WHO Foundation will play a leading role in running the Solidarity Response Fund in this next phase and it's my honour today to welcome Anil Soni, the first Chief Executive Officer of the WHO Foundation. Anil, welcome and you have the floor. AS Thank you, Dr Tedros. As Elizabeth made clear, the opportunity to act in solidarity one year ago gave people hope and this report on the impact of that generosity is intended to likewise give hope and inspire continued action. The arrival of the first generation of safe and effective COVID-19 vaccines has proved that there's a light at the end of the tunnel, that the world will defeat this pandemic. But it also coincides with a new set of challenges including the pace at which current variants are evolving. Strengthening regional surveillance tools and systems including the capacity of labs will be critical to scaling up the detection of variants and staying one step ahead of the virus. But the longer it takes to roll out vaccines across every country in the world and not just those that can afford them the more of a risk we face that these variants will continue to progress and the more they progress the more strained our health systems will become, resulting in supply shortages and diminished capacity of hospitals for example to provide critical supplies like medical oxygen. 00:16:18 In parallel there is much to be done to improve understanding and trust within communities on vaccines and to ensure we have the tools and systems to disseminate the latest health guidance and counter the misinformation that threatens to undermine vaccination efforts. All of that is to say, there's equal urgency today to act together to fight COVID-19 as there was one year ago and today we can better quantify the cost of inaction. With 120 million confirmed cases and 2.65 million deaths this disease has reached into all of our lives. No community has been spared and there is now a dramatic contrast, as Dr Tedros said earlier, between the confidence of some countries who look to life getting back to normal by the end of the year and the desperation of others who do not have access to the same life-saving tools. 00:17:10 As Dr Tedros says repeatedly, this pandemic will not be over anywhere until it is over everywhere. There is a moral imperative to act in solidarity. There's also a clear economic rationale. The International Chamber of Commerce concluded that even with high vaccine coverage in wealthy countries restricted coverage elsewhere could cost the economies of those same wealthy countries more than $2 trillion in 2021 alone. In other words, there is a compelling return on investment for companies to act to end the pandemic globally. With this moral and economic argument we are appealing now for the private sector to redouble its efforts and to give to the WHO through the Solidarity Response Fund to roll out vaccines, to conduct the necessary surveillance on variants and the pharmacovigilance on vaccines and therapies, to support countries in stopping the spread, to tackle the mental health impacts of COVID-19 and to continue to provide accurate scientific guidance to shape national responses. We appreciate that many companies, especially small businesses, are struggling to stay afloat but others have seen their profits and market capitalisation increase in the last year. If you are a CEO of a company with resources to share please give, please support the WHO's leadership to fight and end COVID-19, please act in solidarity with everyone in this world. 00:18:34 Maria, the WHO's Tactical Lead for COVID-19 is sitting by my side and she told me that her 11-year-old niece in North Carolina raised $1,300 for the Solidarity Response Fund. She gave what she could. We ask you to do the same. The WHO Foundation was created for this purpose, to mobilise more support for the life-saving work of the WHO. Today we are focused on explaining the impact of private contributions and appealing to companies to give, to power the urgent work of the WHO this year. We also want to give individuals, anyone anywhere, the power to pitch in and we will be sharing in the coming weeks new platforms to do so including a platform to help meet the immediate needs of countries for medical oxygen, where more than a million cylinders are needed each day in low and middle-income countries, and a campaign for vaccine equity building on the initial focus of the WHO this year on vaccinating healthcare workers. 00:19:30 Thank you, Dr Tedros, for the life-saving work of the WHO and back to you. TAG Thank you. Thank you so much, Anil. I look forward to our continued partnership in the weeks, months and years ahead and as the first CEO of WHO Foundation I wish you all the very best. I have already seen that the start is excellent. Thank you so much. Of course WHO's other work has continued all around the world even during this pandemic and I would like to acknowledge the many donors who continue to support our programme budget for 2020 and 2021. Earlier today for example I had the pleasure to accept a fully flexible contribution of US$10 million from the state of Qatar. Shukran jazeelan, Qatar. Flexible financing like this is critical for WHO to deliver on our mission to promote health, keep the world safe and serve the vulnerable. Christian, back to you. CL Thank you very much, Dr Tedros. With this I open the floor for questions. We already have a good list of queries but if you want to get into the queue please use the raise your hand icon. We'll start with Kai Kupferschmidt from Nature. Kai, please unmute yourself. 00:21:05 KA Thanks, Christian. It's still Science. I just wanted to ask about the signal from the AstraZeneca vaccine and the decision by countries to suspend their use. A lot of people have said this is purely precautionary. At the same time we know that that decision is going to cost lives because it slows down vaccinations. Can you just give an idea about what the balancing act is here and whether you have any idea about how serious this really is and whether it is the right decision at this point to incur these very real costs of stopping the vaccine? CL Thank you. Dr Simao, please. MS Hi, Kai. Thank you for the question. I think the first thing that you have to notice - and I think we mentioned this on Friday - is that we do have pharmacovigilance systems in place so we are able to detect... With any vaccine and old vaccines we need to follow up any adverse event that follows immunisation and this is not a new thing. 00:22:19 The health systems know how to do it and we have a very sensitive way of detecting early warning signs, so to speak. We're seeing this as a precautionary measure because we're still investigating. WHO is working very closely with the EMA. The EMA has an expert committee working with this and we're also working with the national regulatory authorities in Europe and in other regions in assessing not only the more recent news about potential thromboembolic events with the AstraZeneca vaccines but all adverse events from other vaccines as well. WHO's global advisory committee on vaccine safety is meeting tomorrow. It's an experts' group with high expertise on vaccine safety. They have been assessing the data that's available since last week when the first reports came and it will be meeting tomorrow to do a more thorough investigation. Meanwhile the EMA is also meeting tomorrow and on Thursday so most likely during this week we will have more news on the more in-depth assessment of the different cases that were reported so far. What we can say is that so far it doesn't look as if there are more cases than would be expected for the period in the general population because people get sick and people die all the time. 00:24:00 What we have seen so far from the preliminary data is that there is not an increasing number of cases of thromboembolic events. For example in Europe and the UK only more than 70 million doses of AstraZeneca vaccines were administered so far. So the recommendation at this point is that the risk/benefit of not vaccinating using AstraZeneca vaccines and other vaccines outweighs the risk of the COVID infection, which we know has a significant impact on people with severe disease, hospitalisation and death. Maybe Dr Soumya wants to complement. CL No, looks as if we are good and apologies; this was a question from Kai Kupferschmidt from Science. We will mice to the next one and that's Agnes Pedreiro from AFP. Agnes, please unmute yourself. AG Yes, hello, everybody. Good evening. I wanted to follow up on the AstraZeneca vaccine. I wanted to ask you, after on Friday you said that you recommend to continue to vaccinate with the AstraZeneca vaccine, how much are you concerned that the European countries haven't followed your advice? 00:25:30 For tomorrow, are the experts going to look only at the batches of the vaccine produced in Europe or also the ones produced in India and South Korea? Thank you. CL That's for Dr Simao again, please. MS Thank you, Agnes. Let's just make it clear; although we are in touch with the national regulatory authorities from other regions we have yet to see similar reports of thromboembolic events as the AstraZeneca made in Europe. So far we only have news about specific batches in Europe. Are we concerned about the suspension? We understand these are precautionary measures. Some countries have suspended the use, some countries have suspended some batches but this is very clear and I'd like to say this to countries from other regions that are not Europe; the vaccines so far are from European manufacturing, not the vaccines that are provided to the COVAX facility which are made in Korea - South Korea, Republic of Korea - and India. 00:26:51 So I think we will need to wait until WHO's expert committee has had a chance to meet and assess all the data that's available in tandem or in conjunction with the information that's also coming up from EMA and the advisory committee of EMA. CL Thank you very much, Dr Simao. With this we move to Jeremy Launch from RFE. Jeremy, please unmute yourself. JE Thank you so much. The question is in line with the previous questions, I'm afraid. I was just wondering if you're concerned at what is going on with the AstraZeneca vaccine. It might fuel further vaccine skepticism among the population. We see already that some people are refusing the AstraZeneca vaccines. Are you concerned that it might trigger some more refusals of this vaccine? CL Thank you, Jeremy. Dr Soumya Swaminathan, please. SS Thank you. Thank you for that question and this is something obviously that we are tracking and following literally on an hour-by-hour basis and we're working with the EMA, with our network, the Global Advisory Committee on Vaccine Safety, our expert group that has been following right from the beginning since the vaccine started all the adverse event reports that are coming in from different countries. 00:28:35 If you remember there was an initial scare about excess deaths amongst the elderly that was reported from Norway and then it was clarified that it was not really excess deaths, it was just the normal expected rate of deaths. So again when you talk about adverse events, these events are things which happen to people. People do get thromboembolic events, pulmonary embolisms and people die every day so the question really is the linkage with the vaccine. This is why we need to look at all of the data. The experts are looking at the data and so far we do not find an association between these events and the vaccine because the rates at which these events have occurred in the vaccinated group are in fact less than you would expect in the general population at the same time. Whenever a decision is made on using a vaccine the safety is of utmost importance and one looks at the benefits versus the risks. Nothing, no drug or vaccine could ever be 100% safe. You could have something that happens one in a million but then you need to look at what's the benefit of protecting people against a disease that's killing millions, against the potential risks. 00:30:06 This is being looked at very carefully and we will be learning about these vaccines. We have to accept the fact that these vaccines have been in use for a few months now even though they're so rapidly scaled up; we have 300 million people already who have received at least one dose. The DG said something on Friday which we need to remind ourselves about which is that at least 2.6 million people have died of COVID-19 disease and so far of the 300 million doses that have been given to people across the world, of course using different vaccines, there is no documented death that's been linked to a COVID vaccine. So I think that while we need to continue to be very closely monitoring this we do not want people to panic and we would for the time being recommend that countries continue vaccinating with AstraZeneca but we will have more updates tomorrow or at any time when there is a change in this recommendation. Thank you. 00:31:18 CL Thank you very much, Dr Swaminathan. With this we move to the next and that's Jamie Keaton from AP. Jamie, please unmute yourself. JA Hi, everyone. I actually have to tell you that Jeremy asked my question so thank you very much. CL Thank you very much for pulling your hand back, so to say. Then we move to Bayram Altug from Anadolu News. Bayram, please unmute yourself. BA Hi. Thank you, Tarik, for taking my question but my question was already taken as well. Thank you for your time. CL Can I ask you all to look at your hands and whoever has AstraZeneca questions please pull your hands down? That makes it easier for us. Then we'll try with Gunila Van Hal from Svenska Dagbladet. Gunila, please unmute yourself. GU Yes, thank you. I had a question on AstraZeneca but I have another one too and that is on the so-called COVID passports or digital green passes that the EU will talk about, discuss later this week. I wanted to know the WHO position on these destination passports; how can they be made so that they're not discriminatory? Thanks. 00:32:47 CL Mike Ryan, please. MR Okay, I'll begin. Soumya may wish to supplement. Yes, if we can separate here in our minds the concepts digital registration of vaccination, which WHO believes is a very positive thing within national health systems; in fact digitalisation of health information and health records in general is a potential way forward to better primary healthcare and better integration of health services. So we're working very, very closely through Soumya's leadership of the Digital Health Initiative with Bernardo, Mariana here and many, many partners on advancing that whole agenda. Obviously within that the development of e-certificates for COVID-19 vaccination represents a potentially very useful instrument for governments to use themselves for managing the registration of vaccination in country and that allows better monitoring of vaccination and batches and coverage and many other things. 00:33:47 To that end Soumya may explain where the objectives of that lie and setting the global standards for that but also being able to advance that whole idea of electronic health records. With regard to what a certification of vaccination can allow you to do, that is at national or international level and the use of a certification of vaccination which allows you to travel or allows you to carry out certain activities like attend a restaurant or go to school or attend university, we have to be exceptionally careful because right now we're dealing with a tremendously inequitous situation in the world where the likelihood of you being offered or getting a vaccine is very much to do with the country you live in, very much to do with the level of wealth, the level of influence that you or your government has on global markets. Therefore the emergency committee of WHO have made it clear in their recommendations to the Director-General that at the represent tie the requirement for certification of vaccination as a requirement for international travel is not justified as vaccination is not widely enough available and is inequitably distributed throughout the world. That is not to say that in a situation where vaccine is more widely available... WHO is working on plans to be able to provide a global registry of public keys which could be used as a way of smoothing information flow between jurisdictions regarding vaccination history, not as a way of collecting data on people but as a way of providing a process of trust between governments regarding key information regarding vaccination status. 00:35:35 But that must follow the appropriate policies. We need vaccination policies that don't create in themselves inequity and we need to be very, very careful that the process of certifying vaccination does not result in personal freedoms or human rights being impeded in any way that is not justified. Soumya mentioned before; the risk-benefit issue here also applies. There are potential benefits from having certification of vaccination but there are also potential downsides because we have to understand that at the centre of this there's personal choice, there is the issue that mandating anything in health requires a very, very strong justification for that mandate and then whether or not someone has the right to do certain things after vaccination again requires deep thought. 00:36:27 There are ethical and human rights issues at the centre of this as well so WHO is working very much now around the policies we're going to need in order to manage this. Each and every government may take a slightly different view on this depending on what proportion of their population is actually vaccinated but I think it does nothing more than actually highlight the deeply inequitous situation that we're in now with the distribution of vaccine. Soumya, you may want to add on the... CL Please go ahead. SS Thank you, Mike. I think you've addressed the larger issues of how these certificates are proposed to be used by countries and as long as we have shortage of supplies across the world and inequitable distribution, as Mike said, it would only increase the inequities between people if we started using it in ways that restrict certain activities by people who are not vaccinated. But let me say what WHO is going to do, which is towards building a digital health infrastructure in countries and particularly in the low or middle-income countries and this is a focus of our global strategy of digital health, to move towards more digital health systems. That is having proof of vaccination. We have children in countries; every child has a vaccination card that the mother keeps and it's a paper card in most countries. This can often get lost or destroyed or damaged and so having a digital certificate on a mobile phone would be an advantage to having a paper certificate. 00:38:06 It may take some countries time to move to that but we think that building the system using COVID as an example could actually help national immunisation programmes move into the digital era. So what we are doing is working with partners; we have 180 people working on this representing member states and other agencies who are working to develop the standards that would facilitate a digital certificate of vaccination that would be interoperable so that if you travel from country A to country B the certificate could still be read by the system there and it would still be valid. It would also help for an individual to have a record that they could keep with them. As I said, paper can always be lost. Finally it would provide an opportunity also to build a global system of sharing this kind of data using, as Mike described, a public database of trusted public keys so every country would develop their own. 00:39:19 They would put forward their agency that would be the agency that's been given that responsibility for the country and then WHO would authorise it and we would of course also look at which vaccines would go into this. It would be vaccines approved by the WHO and so on so it would bring a lot of rigour and standards into this process. So over the next few weeks and months we'll be working mainly with our member states to discuss how this could be implemented and we will provide technical support to those countries that need some capacity support in order to implement this. Of course there are many countries that are already advanced in planning this but the idea of having the global standards developed by WHO so that all countries will align on this... and we need to move towards this kind of interoperable systems. We'll start with COVID-19 immunisation, vaccination but it will extend to many other areas. Thank you. 00:40:21 CL Thank you very much. Dr Kate O'Brien wants to chime in too. Thank you. KOB Yes, I just wanted to add; one last point on this is that in the consideration of any requirement that might be considered about vaccination for travel either within a country or across borders one of the underlying principles would be that a vaccine would have a very substantial effect on infection status, not just disease but on infection status and transmission to other people. I think we've commented before that first of all our expectation that these vaccines are going to have the kind of magnitude of impact on transmission that we're seeing as the magnitude on disease is not very likely to be met. Secondly the amount of information that we have about what their impact is on transmission is still very early and very incomplete. So when we also consider what the intent would be of considering the vaccination as a requirement for travel across an international border there are also some issues around what the vaccines actually do and whether or not they could deliver on that intent. 00:41:39 Then finally we don't also have vaccines that have been evaluated for people under 18 years of age or 16 years of age at this point so when you consider the full nature of the potential benefit, the risks that have been laid out really well here of what it would actually imply, I think those are just some other considerations in what that benefit/risk analysis is. CL Thank you very much all for these answers. Now we move on to Ashwin Balshinger from the Observer Times in India. Ashwin, please unmute yourself. AH Thank you for consideration of my question. As per Dr Swaminathan's statement we are going to see the emergence of improved vaccines into 2022. Does this imply too a regular booster vaccination against the COVID-19 disease as virus mutations occur periodically? How is the regular booster vaccinations' financing, funding going to be to keep momentum of vaccination against COVID-19 disease? Thank you. CL Dr Swaminathan, please. SS Thank you for that question. I can start and maybe Kate might want to come in. We're already thinking ahead, we are planning for all these different possibilities and we've seen in the last few months the emergence of variants. 00:43:19 It was not entirely unexpected but some of the variants are of concern. As you know, WHO has a nomenclature now of how to define these variants of interest and then variants of concern are based on changes in transmission capacity, changes in the clinical features or changes in the way they respond to drugs or vaccines. So because of the observation that some of the vaccines seem to have a lower efficacy against particularly the B1351 variant that was described in South Africa, scientists and companies have already started thinking about the next version of the vaccine that might incorporate those mutations. Luckily some of these platforms that are being used now, the MRNA platform and the viral vector platforms allow very rapid changes in the vaccine composition. So we are working with a number of scientific expert groups around the world as well as with the regulatory agencies to both study the science as it is changing and evolving... 00:44:32 And it is important to note that we do not have all the information currently to make those decisions that you were just asking about; whether boosters will be needed and how often and whether the boosters will be new vaccines. Those are still questions that need to be answered. We need information around the duration of protection of existing vaccines. We still need to see whether the existing vaccines are able to prevent severe disease and death even amongst people infected with the variants and it is possible that that could be the case. There are many vaccines in clinical development still using a whole host of different platforms. Some of those vaccines may be more effective; the inactivated vaccines which use the whole virus for example, which have all the proteins of the virus potentially; are they more effective against the variants? These are questions that need to be answered but the COVAX facility and the COVAX partners are already thinking about these future scenarios and preparing for them. So yes, we are now in the process of developing a strategy from 21 going through 2022 to keep in mind the fact that first of all we would need to vaccinate large segments of the population across the world so we do need to plan for those additional doses that are going to be needed. 00:46:06 As you know, the budget for COVAX to date only accounts for doses up to the end of 2021 and we think it will have to keep going in 2022 plus looking at these new scenarios and planning for those. So this is a work in progress. Certainly we will let you know as things progress but as of now there are different scenarios, options that we need to consider as we plan for the future. But suffice it to say that WHO is aware of all these options; we are working with a number of different expert groups ranging from what Maria has described on the genomics, on tracking of these variants, looking at the prevalence in different countries. Also it's important that countries as they roll out vaccines try to collect data to see because it's important to document both the effectiveness and the safety of vaccines. We've spoken a lot about safety today but effectiveness is also important to document. I don't know if Kate wants to add anything. CL I think we have Dr Van Kerkhove or Kate. Kate, go on. KOB Hi, thanks. I wanted to add just a couple of things to that. I also want to emphasise how early the information is and I'll give you an example. People probably wonder what we mean when we say that. As we get more information the very first observations are often adjusted for new information that comes and the example I'll give now is with the Novovax vaccine, which was tested in part in South Africa at a time when the variant that was initially found there was circulating. There was also some information from that study that being infected previously with COVID did not confer protection against being infected with the variant. With more data coming in in fact that doesn't seem to be holding up; it looks as if if you were previously infected you do have protection to some large degree against the variant. So I want to emphasise that as Soumya was providing a reply about whether or not we need boosters, whether the vaccines need to be adjusted, whether we'll go to multi-strain vaccines, these are all decisions that will have to be grounded on more information as it comes in from a number of different places around the world over time, in a number of different age groups. 00:48:46 That's exactly what vaccines policies and vaccine research should do; it should adapt to the information as it comes in and we'll continue to optimise the vaccine programme and the policies about how we use vaccines that are in the portfolio, how we use the vaccines that are in our quiver of arrows to their greatest impact even while additional research continues to continue to optimise the products themselves. Then the second thing I just wanted to say is that we don't have any evidence to say that for any variant or any vaccine combined with the variant the vaccines do not work. It's really a question of at what magnitude they're working. There's really no product right now where we would say, this simply does not work at all against a variant. It's not the way the immune system works, it's not an all-or-none phenomenon and it's really much more about the magnitude of the effectiveness of these products and that does vary according to age and other factors. 00:49:59 The most important thing here is that as these vaccines are rolling out this is the time when transmission really needs to be driven down; the lower the transmission is the less likely it is that there will be emergence of variants. That's just a commonsense but a very important thing that we need to keep doing; it's not the time to take our foot off the pedal on any of the other interventions that are in place right now while we're getting as much vaccine out as possible and protecting people. CL Thank you. This was Dr Kate O'Brien, Director of Immunisation, Vaccines and Biologicals. We have Dr Van Kerkhove to add. MK Thanks. Just very briefly to cover a little bit on the system that we have in place to monitor these changes in the virus. Soumya's talked about it; you've heard me talk about it a lot. It's really important that everyone out there understands that there is a very robust system globally that is looking, that is tracking this virus, that is looking to not only find where there are cases so that we can take appropriate public action so that we prevent the spread of the virus. But we're also looking at any detailed changes in the sequence of the virus itself and this is done through genetic sequencing, epidemiologic surveillance in countries to look at trends in incidence going up, going down, if there's anything unusual happening, to make sure that there is robust sequencing that is happening around the world in many countries. 00:51:23 We know that many countries don't have sequencing capacities so we are working through our regional offices and the regional platforms that have been set up to increase genomic sequencing around the world, leveraging systems like the flu system that exists worldwide, that has labs in 150 countries; to leverage systems like HIV, TB, polio, to make sure that the countries that have labs that can sequence for other pathogens can also sequence for SARS-CoV-2 because we need eyes and ears on the changes in these viruses. Any of these changes need to be evaluated in a transparent, comprehensive and robust manner and what we are looking at now are variants of interest as well as variants of concern. There are three variants of concern that WHO is tracking with partners around the world; you've heard us speak about those. 00:52:12 As Kate has said, the vaccines still work against these virus variants but we're also tracking a number of variants of interest which are being identified in countries. There are a number of studies that are underway to look at transmissibility, to look at severity and we don't yet know if some of those variants of interest will become variants of concern. I mention this because it's important that there's a process in place to check and we are working with labs, we are working with our R&D blueprint for epidemics, our animal model working groups; we're working with CEPI; we're working with so many different groups around the world that are helping us do the studies in real time so that we can determine if any of these changes mean there may be a change in diagnostics or a change in therapeutics or a change in vaccines and so the proper decisions can be made based on data. So these systems are in place, they're being strengthened around the world and it depends on collaboration, it depends on the good work of scientists and public health professionals, lab technicians, people who do bioinformatics and phylogenetics, epidemiologists. 00:53:19 It's a multi-disciplinary approach to assess each of these variants to determine their importance so that is something that is ongoing and it is something that WHO's working hard to co-ordinate around the world to make sure that any change that we see in the virus, if it has a change in the way our countermeasures work including our countermeasures of public health and social measures; we will take decisions to adjust accordingly. So far of the variants of concern that are circulating around the world the public health and social measures work against reducing transmission; the infection prevention and control measures that are in place work against reducing transmission; vaccines work. So it's important that we take this do-it-all approach including vaccination. I do want to say that in the last week we have had an 11% increase in transmission across the world. Five of six WHO regions have seen an increase in transmission. It is not the time to let up. We have to continue to do everything that we can including all of the individual-level measures, the community-level measures, everything that we can to drive transmission down. 00:54:31 If we allow this virus to spread, if we give it an opportunity it will. Adding vaccines and vaccinations where they can be used is an important tool in addition to the public health and social measures so please continue to follow the local recommendations, please make sure you keep your distance, you wear your mask, you wash your hands, you practise respiratory etiquette, you work from home if you can. Do everything that you can to limit your exposure to this virus and if you get infected the virus stops with you. So there's a lot that we can continue to do and it's worth mentioning because we're seeing an increase in transmission so we cannot let down our guard. CL Thank you very much all. With this we move to Carmen Pelham from Politico. Carmen, please unmute yourself. CA Hi. Thank you so much for giving me the floor. I have two questions if I may because some of my colleagues had similar questions earlier on COVAX. One of the things was related to the healthcare workers. Are there enough healthcare workers in some of the countries where the vaccine is being rolled out to help with the vaccination drive? It seems in countries like the US that they had to bring back retired doctors and nurses to vaccinate so I was wondering what that looks like in some of the countries rolling out vaccines. 00:55:50 The second one is something that I remember Dr Bruce Aylward speaking to you about before which is countries like Canada and the UK getting supplies from the Serum Institute of India. Have you had any sign so far that that might decrease in the short term the supply of vaccines that COVAX is getting from the Institute? Thank you. CL Thank you. Let me give this to Dr Aylward. BA Thanks for the question. On the first part of it Kate may want to come in as she's closer to the delivery and the roll-out in specific countries with respect to some of the challenges that are being found there. But remember, as we are rolling out and prioritising first the healthcare workers that's a relatively small proportion to the population in most countries so there's been a lot of work in advance of the receipt of the vaccines to make sure that they've identified the healthcare workers necessary to be able to manage the roll-out and the additional personnel. 00:56:58 So you'll remember in some of the previous press conferences we've been talking about the readiness work that's been done in all countries and if we look at the 92 what we call AMC countries that are part of COVAX they have been working across the nine-point national vaccination plan and that includes of course making sure that they've got the healthcare workforce necessary to roll it out. To date we have not heard of that as a limiting factor in the ability of countries to take full advantage of the products that they're able to get through COVAX. What we're more concerned about - and I'm sure Kate may speak to this - is as we get into the later part of 2021 when we're dealing with much larger volumes of vaccines or a much larger portion of the population it will be a challenge in terms of the healthcare workforce needed to be able to deliver these products at scale. On the second issue that was raised, as we've discussed on previous press conferences there're a number of suppliers and sites that are particularly important to the COVAX facility. One of them of course is the Serum Institute of India and this facility is committed to supplying the needs - or part of the needs obviously of the Government of India and then preferentially the COVAX facility as well. 00:58:27 Due to the challenges in supply globally many, many entities have looked to all producers around the world and whether individual countries, whether companies, whether others have reached out to all suppliers and tried to look for excess vaccines and the Serum Institute of India has been no different. They've been approached by many countries for bilateral deals; both high-income and upper or lower-middle-income countries as well as other entities so we are aware of that. In terms of actual supplies, no, we don't know. These are contractual relationships between companies and countries so at this point what we wanted to flag and what we said previously - I think I might have been misquoted there - was that we are concerned that in the effort to try and ensure every country has got sufficient vaccines or the vaccines to meet their perceived need they're making demands on suppliers that would normally supply COVAX. 00:59:33 At this point we do know that COVAX and India are being prioritised by the Serum Institute and we're grateful for that and we hope that continues. CL Thank you. We have Dr O'Brien to come in. KOB Yes, just a little bit more on the healthcare workforce required to deliver vaccines. We're looking at this very carefully; countries are looking at this very carefully and as Dr Aylward indicated, the short term is really not the issue, the short term where doses are starting to come into countries; there's certainly capacity for the programme as an entity to absorb the scope that's needed to immunise healthcare workers and those at highest risk of severe disease and death. What is really at question here is what will happen as the volume of doses increases through 2021 and into 2022. It's also in question the efficiency with which programmes can deliver vaccines; how many people can a programme design their programme to move through the process in a day for instance? 01:00:44 We're seeing a very broad range around that efficiency that is actually being experienced by countries but what we also see is countries get really good at this. They figure out in their own local context how best to form a team that can move people through an immunisation centre with great efficiency and that changes over time and it changes as learning occurs in that particular construct. I also want to bring it back to what we were talking about before in the press conference, the role of electronic records. Even in high-income countries there're still a lot of paper records being used and that is more time-consuming and certainly less efficient for the programme and for people who are coming to be vaccinated. So all of the innovation that are out there to create efficiencies will help reduce the amount of health workforce that will be required to actually immunise in a programme. Then it also is going to depend on what the programme looks like; will we need to give booster doses, will there be more vaccines that are single-dose vaccines? 01:01:56 So a lot of these are in play but certainly over the course of the rest of this year and into 2022 the requirements for additional workforce - not all of whom need to be licensed healthcare workers; a lot of this is information staff flowing people through clinics and things like that - will be needed. CL Thank you very much, Dr Kate O'Brien, for this. With this we're coming to the end of our press briefing. Thank you all very much. Before I hand over to the Director-General and to our special guests for their last words, let me remind everyone we will send out the audio files of the DG's remarks right after this briefing and tomorrow morning we'll have the full transcript on our website. Let me ask Elizabeth Cousens from the UN Foundation for any final remarks, please. EC Thank you so much. Two quick closing thoughts; first for anyone who is interested in more details about the COVID Solidarity Response Fund there is a lot of detail online about how the funds were allocated and the impact that they had. Second just to echo what so many have said already, there has been so much progress over the last year but we're obviously not done and we won't be done anywhere until we are done everywhere. So to echo Kate and others, this is not the time to take our foot off the pedal. 01:03:20 Our experience over the last year shows what is possible; it shows how much solidarity is out there to overcome such an unprecedented challenge so follow the science, build on the solidarity and we will be able to see this essential work through in these critical months ahead. Thank you very much. CL Thank you very much, Elizabeth Cousens. Now to Anil Soni from the WHO Foundation. AS I certainly echo what Elizabeth just said. Sitting through this press conference it's clear that we have a lot of challenges to tackle together globally and I'm also incredibly inspired by the work of my colleagues here at the WHO so it reinforces what Elizabeth and I are trying to do with the COVID-19 Solidarity Response Fund which is to reach out to everyone in the world and ask that you contribute to this important work. Thank you. CL Thank you both. Now for the final comments first of all to Dr Ryan before we come to the Director-General. 01:04:15 MR I just want to express a note of personal thanks from the staff of WHO and all of the agencies who benefited from these funds. This time last year was a very, very difficult time; funding was very sparse; everyone was reacting in different ways. The creation of the fund and the fact that companies and institutions and individuals, people out there just reached into their pocketbooks and put money into this response, provided a vital lifeline for many organisations. It drove the first responses of WFP in setting up the air transport system. It supported UNICEF in putting their first support into supporting children around the world; it supported UNHCR and UNRWA and protecting refugees, not just WHO and it made a huge difference to the work that we were doing on things like you said, Anil; like oxygen; on specific things that we could do to save lives at country level. So these funds mattered, your funds mattered and we hope we put them to the best possible use and we will ensure that we continue to do so in collaboration with the UN Foundation and thanks to our colleagues there. We hope that with the advent of the WHO Foundation we will go from strength to strength. 01:05:33 But your funding mattered, it made a difference and we'd like to thank you and thank the Director-General because, Tedros, I can't tell you the number of times in the last year having been around here in various forms for many, many years and back and forth, I've seen many times in this organisation where innovative ideas in the middle of a crisis aren't taken on board; it's too complicated, we don't have time, it won't work. The number of things we have done in this organisation; created with partners the UN supply chain system which has delivered over a billion items, with many agencies working together; the ACT Accelerator; COVAX; the Solidarity Response Fund; none of this would have happened without leadership that was open to innovation, driving change, willing to look at that crazy idea and actually allow people to make it happen. I think it's another reflection of the style, the type of leadership we've all experienced in the last year which seeks to reach out, create and leverage partnership around the world, to make WHO a central actor in supporting and facilitating the work of others, not doing everything itself and this has been part of WHO's transformation. 01:06:50 So it's also an opportunity - because in honesty and in directness sometimes big organisations aren't innovative at their core, they don't like new ideas and in a sense they kill new ideas. The organisation I'm working in now generates a demand for these ideas and wants to innovate. It's a fundamental shift in the way this organisation has operated and we wouldn't have the Solidarity Response Fund without that style of management so thank you, DG, and thank you to all who made it work. CL That leads me to give the final words to Dr Tedros. TAG Thank you. My life is easier now. I endorse what Elizabeth said, Anil and my general Mike. I think it has all been said but it all comes to our staff, who are bringing new ideas, as Mike said, crazy ideas every single day and the changes we have introduced in the last three years; it's amazing. Looking back I ever get surprised so probably the message is to our colleagues, please continue bringing new ideas, crazy ideas to change our organisation so we can serve humanity better and save lives and of course the immediate thing is ending this pandemic. Thank you so much again to all who have joined today and see you on Friday. Thank you, Christian. 01:08:36

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.

I Seminário Nacional do Conass e Conasems - 09/12/2020

As inscrições para o I Seminário Conass e Conasems encerram amanhã (terça-feira, 08), às 18h. O impacto da pandemia de Covid-19 nos serviços de saúde e a resposta do SUS serão os principais temas abordados no I Seminário Nacional do Conass e Conasems. O evento, que será realizado de forma virtual, ocorrerá entre os dias 9 e 11 de dezembro, sempre entre 14h30 e 18h. As experiências bem-sucedidas para garantir o atendimento à população e perspectivas de desenvolvimento de imunizantes também serão assuntos debatidos durante o evento, que vai contar com a participação de representantes de institutos de pesquisa, secretarias de saúde municipais e estaduais, pesquisadores e profissionais de saúde. O primeiro dia do encontro (09/12) será dedicado às discussões sobre aspectos epidemiológicos da Covid-19 e os esforços para o desenvolvimento de uma vacina segura e eficaz. No segundo dia (10/12), o tema será o impacto do Guia Orientador para Enfrentamento da Pandemia nas Redes de Atenção à Saúde, documento fruto de parceria entre Conass e Conasems que reúne portarias, decretos e normas editadas pelo Ministério da Saúde para nortear o atendimento, a sistematização de procedimentos essenciais de pessoas com suspeita ou confirmação de Covid-19. Já no último dia do evento (11/12), será dedicado às discussões sobre a Planificação de Atenção à Saúde no País: como a iniciativa capitaneada pelo Conass, tendo o Einstein como parceiro, se adaptaram aos tempos de Covid-19 e, sobretudo, como a estratégia de planificação auxiliou no enfrentamento da pandemia. O evento é voltado, principalmente, para profissionais de saúde e gestores do SUS. As inscrições podem ser feitas no endereço: https://formulario.conasems.org.br/1s.... Após a inscrição será enviado ao e-mail cadastrado um link da plataforma Zoom, para acesso às transmissões. Programação 09/12 14h30 às 17h 14h30 – Abertura – Conasems, Ministério da Saúde, Einstein e OPAS 15h – Conferência Magna O lado oculto de uma Pandemia: A terceira onda da COVID-19 ou o paciente invisível Prof. Eugênio Vilaça Mendes 1º Painel – O desafio do Brasil no enfrentamento da pandemia do novo Coronavírus Mediação do painel – Carlos Eduardo de Oliveira Lula (Presidente do Conass) 15h50 – Cenário epidemiológico do novo coronavírus na atualidade: Perfil no Brasil e no mundo Arnaldo Medeiros – Ministério da Saúde/ SVS 16h10 – Perspectivas atuais das vacinas contra o novo coronavírus para a população brasileira Dimas Covas – Instituto Butantã 16h25 – A vacina desenvolvida em parceria com a biofarmacêutica AstraZeneca Universidade de Oxford Nizia Trindade Lima – Fundação Osvaldo Cruz 17h20 – Encerramento e Informes Fernando Cupertino – Conass

Ministério da Saúde apresenta balanço de ações contra a COVID-19

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