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1.
Front Immunol ; 12: 667889, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34512622

RESUMO

Type 1 diabetes (T1D) is the most common paediatric endocrine disease, and its frequency has been found to increase worldwide. Similar to all conditions associated with poorly regulated glucose metabolism, T1D carries an increased risk of infection. Consequently, careful compliance by T1D children with schedules officially approved for child immunization is strongly recommended. However, because patients with T1D show persistent and profound limitations in immune function, vaccines may evoke a less efficient immune response, with corresponding lower protection. Moreover, T1D is an autoimmune condition that develops in genetically susceptible individuals and some data regarding T1D triggering factors appear to indicate that infections, mainly those due to viruses, play a major role. Accordingly, the use of viral live attenuated vaccines is being debated. In this narrative review, we discussed the most effective and safe use of vaccines in patients at risk of or with overt T1D. Literature analysis showed that several problems related to the use of vaccines in children with T1D have not been completely resolved. There are few studies regarding the immunogenicity and efficacy of vaccines in T1D children, and the need for different immunization schedules has not been precisely established. Fortunately, the previous presumed relationship between vaccine administration and T1D appears to have been debunked, though some doubts regarding rotavirus vaccines remain. Further studies are needed to completely resolve the problems related to vaccine administration in T1D patients. In the meantime, the use of vaccines remains extensively recommended in children with this disease.


Assuntos
Diabetes Mellitus Tipo 1/imunologia , Vacinação , Vacinas Virais/administração & dosagem , Viroses/prevenção & controle , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Imunogenicidade da Vacina , Medição de Risco , Fatores de Risco , Vacinação/efeitos adversos , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/efeitos adversos , Vacinas Virais/efeitos adversos , Viroses/epidemiologia , Viroses/imunologia , Viroses/virologia
2.
Schweiz Arch Tierheilkd ; 163(9): 545-552, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34465558

RESUMO

INTRODUCTION: The aim of the vigilance system in Switzerland is the evaluation and classification of reported suspected adverse reactions of immunological veterinary medicines (IVMP), including suspected lack of expected efficacy. The Institute of Virology and Immunology (IVI) is the competent authority for marketing authorizations of immunological veterinary medicinal products in Switzerland and responsible for the vaccinovigilance system. In 2020, 130 adverse reaction reports were received (5% less compared to 2019). The reports mainly concerned dogs (41%) and cats (25%) followed by cattle (18%) and horses (7%). Many of the reports in dogs involved the application of combined vaccines against canine distemper, hepatitis, parvovirosis and parainfluenza in combination with canine leptospira components, in cats against cat flu and feline panleukopenia in combination with feline leukaemia virus infection. Causality assessments were done according to the international ABON system. In 27% of the reported cases, the causality assessments between the vaccination and the reaction described were evaluated as being probable (ABON A), in 44% as possible (ABON B).


Assuntos
Vacinas , Drogas Veterinárias , Vacinas Virais , Animais , Bovinos , Cães , Cavalos , Suíça , Vacinação/efeitos adversos , Vacinação/veterinária , Vacinas/efeitos adversos , Vacinas Combinadas , Drogas Veterinárias/efeitos adversos , Vacinas Virais/efeitos adversos
3.
Avian Dis ; 65(1): 18-25, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34339117

RESUMO

Severity of the tracheal histologic inflammatory response induced in broilers by ocular inoculation of two infectious bronchitis (IBV) and three Newcastle disease virus (NDV) commercial vaccines were evaluated. The vaccine was delivered by eye drop with a coarse spray to day-old chicks. The vaccines were given individually or in various combinations and were evaluated relative to nonvaccinated controls. Evaluations were performed on postvaccination (PV) days 7 and 14. Histologic endpoints included semiquantitative severity scoring of inflammatory components and quantitative morphometric determinations of inflammatory cell concentration, mucosal thickness, and percentage of ciliated mucosal surface. Strong positive correlations were observed between routine severity scoring and morphometric inflammatory parameters, whereas a negative correlation was present between inflammation severity and the percentage of mucosal ciliation. Variable, sometimes extensive, and often statistically significant differences in inflammatory responses were observed between the various vaccines. One IBV Massachusetts strain vaccine (IBV-A) produced the greatest overall inflammatory response when given alone or in combination with the NDV vaccines. Enhancement of tracheitis was seen on PV day 14 by covaccination of IBV-A with the NDV vaccines, but not by covaccination of another IBV Massachusetts strain vaccine (IBV-B) with NDV. Reduction in cilia percentage was observed for all vaccine groups relative to controls on PV day 7. However, although reactive cilia regeneration occurred on PV day 14 for most vaccine groups, a cilia regenerative response was not apparent for individual or NDV combination vaccination for IBV-A. The study also demonstrates that substantial microscopic trachea pathology may be present in vaccinated birds not exhibiting apparent clinical respiratory signs.


Assuntos
Galinhas , Infecções por Coronavirus/veterinária , Vírus da Bronquite Infecciosa/imunologia , Doença de Newcastle/prevenção & controle , Vírus da Doença de Newcastle/imunologia , Doenças das Aves Domésticas/prevenção & controle , Vacinação/veterinária , Vacinas Virais/efeitos adversos , Animais , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Doença de Newcastle/virologia , Doenças das Aves Domésticas/virologia , Traqueia/patologia , Traqueia/virologia , Vacinação/efeitos adversos , Vacinas Combinadas/efeitos adversos
4.
Nat Commun ; 12(1): 4636, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330906

RESUMO

Chikungunya virus (CHIKV) is a reemerging mosquito-borne virus that causes swift outbreaks. Major concerns are the persistent and disabling polyarthralgia in infected individuals. Here we present the results from a first-in-human trial of the candidate simian adenovirus vectored vaccine ChAdOx1 Chik, expressing the CHIKV full-length structural polyprotein (Capsid, E3, E2, 6k and E1). 24 adult healthy volunteers aged 18-50 years, were recruited in a dose escalation, open-label, nonrandomized and uncontrolled phase 1 trial (registry NCT03590392). Participants received a single intramuscular injection of ChAdOx1 Chik at one of the three preestablished dosages and were followed-up for 6 months. The primary objective was to assess safety and tolerability of ChAdOx1 Chik. The secondary objective was to assess the humoral and cellular immunogenicity. ChAdOx1 Chik was safe at all doses tested with no serious adverse reactions reported. The vast majority of solicited adverse events were mild or moderate, and self-limiting in nature. A single dose induced IgG and T-cell responses against the CHIKV structural antigens. Broadly neutralizing antibodies against the four CHIKV lineages were found in all participants and as early as 2 weeks after vaccination. In summary, ChAdOx1 Chik showed excellent safety, tolerability and 100% PRNT50 seroconversion after a single dose.


Assuntos
Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Febre de Chikungunya/imunologia , Vírus Chikungunya/imunologia , Vacinas Virais/imunologia , Adolescente , Adulto , Febre de Chikungunya/prevenção & controle , Febre de Chikungunya/virologia , Vírus Chikungunya/classificação , Vírus Chikungunya/fisiologia , Citocinas/imunologia , Citocinas/metabolismo , Ensaio de Imunoadsorção Enzimática , Fadiga/induzido quimicamente , Feminino , Cefaleia/induzido quimicamente , Humanos , Imunoglobulina G/imunologia , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Linfócitos T/imunologia , Linfócitos T/metabolismo , Vacinação/métodos , Vacinas Virais/administração & dosagem , Vacinas Virais/efeitos adversos , Adulto Jovem
5.
J Immunother Cancer ; 9(6)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117117

RESUMO

SARS-CoV-2 infection and the resulting COVID-19 have afflicted millions of people in an ongoing worldwide pandemic. Safe and effective vaccination is needed urgently to protect not only the general population but also vulnerable subjects such as patients with cancer. Currently approved mRNA-based SARS-CoV-2 vaccines seem suitable for patients with cancer based on their mode of action, efficacy, and favorable safety profile reported in the general population. Here, we provide an overview of mRNA-based vaccines including their safety and efficacy. Extrapolating from insights gained from a different preventable viral infection, we review existing data on immunity against influenza A and B vaccines in patients with cancer. Finally, we discuss COVID-19 vaccination in light of the challenges specific to patients with cancer, such as factors that may hinder protective SARS-CoV-2 immune responses in the context of compromised immunity and the use of immune-suppressive or immune-modulating drugs.


Assuntos
Vacinas contra COVID-19 , Neoplasias/terapia , RNA Mensageiro , SARS-CoV-2/imunologia , Vacinas Virais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/genética , Vacinas contra COVID-19/uso terapêutico , Estabilidade de Medicamentos , Humanos , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Neoplasias/epidemiologia , Neoplasias/imunologia , Pandemias , Estabilidade de RNA/fisiologia , RNA Mensageiro/administração & dosagem , RNA Mensageiro/efeitos adversos , RNA Mensageiro/química , RNA Mensageiro/genética , SARS-CoV-2/genética , Vacinação/métodos , Vacinas Virais/efeitos adversos , Vacinas Virais/química , Vacinas Virais/genética
7.
Viruses ; 13(5)2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-34067226

RESUMO

The bluetongue virus (BTV) is transmitted by Culicoides biting midges and causes bluetongue (BT), an OIE-notifiable disease of ruminants. At least 29 BTV serotypes are described as determined by the outer shell proteins VP2 and VP5. Vaccination is the most effective control measure. Inactivated and live-attenuated vaccines (LAVs) are currently available. These vaccines have their specific pros and cons, and both are not DIVA vaccines. The BT Disabled Infectious Single Animal (DISA) vaccine platform is based on LAV without nonessential NS3/NS3a expression and is applicable for many serotypes by the exchange of outer shell proteins. The DISA vaccine is effective and completely safe. Further, transmission of the DISA vaccine by midges is blocked (DISA principle). Finally, the DISA vaccine enables DIVA because of a lack of antibodies against the immunogenic NS3/NS3a protein (DIVA principle). The deletion of 72 amino acids (72aa) in NS3/NS3a is sufficient to block virus propagation in midges. Here, we show that a prototype DISA vaccine based on LAV with the 72aa deletion enables DIVA, is completely safe and induces a long-lasting serotype-specific protection in cattle. In conclusion, the in-frame deletion of 72-aa codons in the BT DISA/DIVA vaccine platform is sufficient to fulfil all the criteria for modern veterinary vaccines.


Assuntos
Vírus Bluetongue/genética , Vírus Bluetongue/imunologia , Doenças dos Bovinos/prevenção & controle , Vacinas Atenuadas/imunologia , Proteínas não Estruturais Virais/imunologia , Vacinas Virais/imunologia , Animais , Anticorpos Antivirais/imunologia , Especificidade de Anticorpos , Bluetongue/prevenção & controle , Bluetongue/virologia , Bovinos , Genoma Viral , Imunização , Sorogrupo , Vacinas Virais/administração & dosagem , Vacinas Virais/efeitos adversos
8.
J Vet Diagn Invest ; 33(4): 777-781, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34041966

RESUMO

Rift Valley fever (RVF) is a zoonotic, viral, mosquito-borne disease that causes considerable morbidity and mortality in humans and livestock in Africa and the Arabian Peninsula. In June 2018, 4 alpaca inoculated subcutaneously with live attenuated RVF virus (RVFV) Smithburn strain exhibited pyrexia, aberrant vocalization, anorexia, neurologic signs, and respiratory distress. One animal died the evening of inoculation, and 2 at ~20 d post-inoculation. Concern regarding potential vaccine strain reversion to wild-type RVFV or vaccine-induced disease prompted autopsy of the latter two. Macroscopically, both alpacas had severe pulmonary edema and congestion, myocardial hemorrhages, and cyanotic mucous membranes. Histologically, they had cerebral nonsuppurative encephalomyelitis with perivascular cuffing, multifocal neuronal necrosis, gliosis, and meningitis. Lesions were more severe in the 4-mo-old cria. RVFV antigen and RNA were present in neuronal cytoplasm, by immunohistochemistry and in situ hybridization (ISH) respectively, and cerebrum was also RVFV positive by RT-rtPCR. The virus clustered in lineage K (100% sequence identity), with close association to Smithburn sequences published previously (identity: 99.1-100%). There was neither evidence of an aberrant immune-mediated reaction nor reassortment with wild-type virus. The evidence points to a pure infection with Smithburn vaccine strain as the cause of the animals' disease.


Assuntos
Camelídeos Americanos , Meningoencefalite/veterinária , Vírus da Febre do Vale do Rift/imunologia , Vacinação/veterinária , Vacinas Atenuadas/administração & dosagem , Vacinas Virais/efeitos adversos , Animais , Feminino , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/virologia , África do Sul , Vacinação/efeitos adversos
9.
Virus Genes ; 57(3): 266-275, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33950332

RESUMO

An outbreak of canine distemper in 2017 in mink breeding farms (Shandong province, China) caused severe pneumonia, hardened footpads, and death in more than 5000 vaccinated animals. Sequencing of the hemagglutinin and fusion protein genes from the WH2 canine distemper virus (CDV) strain we isolated from the infected minks were clustered into the recently isolated CDV Asia-1 genotype group. The WH2 strain was distinct from the current vaccine strains, containing a novel potential N-glycosylation site in its hemagglutinin protein. It also contained amino acid mutations in the fusion protein gene (I87N, T110P and L386I), and the T110P mutation results in N-glycosylation site silencing. WH2 was highly virulent in both unvaccinated and vaccinated animals in our pathogenesis experiments. Immunohistochemistry results revealed positive staining of different organs in unvaccinated and vaccinated animals. The serum in vitro neutralizing antibody titers for the vaccinated mink group and a dog were higher for the WH2 strain than those of the HNly150520B strain (isolated from a dog). These findings indicate that the current commercial vaccines provide incomplete protection against WH2 challenge infections. Thus, a new vaccine strain is urgently needed to protect against variant CDV strains.


Assuntos
Vírus da Cinomose Canina/isolamento & purificação , Cinomose/virologia , Vison/virologia , Vacinas Virais/efeitos adversos , Animais , Anticorpos Neutralizantes/efeitos adversos , Anticorpos Neutralizantes/farmacologia , Cinomose/genética , Vírus da Cinomose Canina/patogenicidade , Cães , Genótipo , Vison/genética , Filogenia , Vacinação/efeitos adversos , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/farmacologia
11.
Multimedia | Recursos Multimídia | ID: multimedia-8826

RESUMO

If you have the choice of more than one vaccine and are wondering which one to take and how to assess the risk of side effects, this episode of Science in 5 with WHO’s Dr Katherine O’Brien is for you.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias/prevenção & controle , Vacinas Virais/efeitos adversos , Programas de Imunização/organização & administração , Comunicação em Saúde
12.
Multimedia | Recursos Multimídia | ID: multimedia-8827

RESUMO

Entender cómo piensa, se posiciona y actúa la gente sobre la vacunación es fundamental para informar el desarrollo de estrategias para la aceptación y el uso de las vacunas. La generación y el uso de datos sobre los factores sociales y de comportamiento implicados requiere un conjunto de herramientas -encuestas, guías de entrevistas, herramientas y marcos relacionados- para apoyar la recopilación y el uso de datos de calidad sobre los factores y las barreras para la aceptación de la vacunación contra el COVID-19. Los programas de inmunización se enfrentan a una serie de retos en el contexto actual de la vacunación contra la COVID-19, incluyendo la preocupación por la seguridad de la vacuna, los retos relacionados con la politización, la equidad y la aplicación de la vacuna, así como la desinformación. La situación es especialmente crítica en lo que respecta a la seguridad de las vacunas, ya que muchos países de América Latina y el Caribe informan de la preocupación del público por la seguridad y la eficacia de las vacunas durante las fases iniciales de su implantación. La escucha social y la recopilación de datos sociales y de comportamiento relacionados con estas preocupaciones reforzarán el diseño, la aplicación y la evaluación por parte de los países de estrategias específicas para generar y mantener la demanda de vacunas, y contribuirán así a aumentar la aceptación de la vacunación contra la COVID-19.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias/prevenção & controle , Vacinas Virais/provisão & distribuição , Programas de Imunização/organização & administração , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Equidade em Saúde , Vacinas Virais/efeitos adversos , Comunicação em Saúde , Comunicação , Sistemas de Saúde/organização & administração , Participação Social , Potência de Vacina , Grupos de Risco , Quarentena , Isolamento Social
18.
Multimedia | Recursos Multimídia | ID: multimedia-8755

RESUMO

00:01:55 CL Hello and good day to wherever you are listening to us today. It is Monday 12th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. Simultaneous interpretation is provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian as well as in Portuguese and Hindi. Now let me introduce the participants in the room; Dr Tedros Adhanom Ghebreyesus, WHO Director-General; Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to the Director-General and the Lead on the ACT Accelerator and Dr Kate O'Brien, Director for Immunisation, Vaccines and Biologicals. We're also joined remotely by Dr Mike Ryan, Executive Director for the Health Emergencies Programme and by Dr Soumya Swaminathan, the Chief Scientist. Let me hand over to the Director-General for the opening remarks. The floor is yours. TAG Thank you. Thank you, Christian. Good morning, good afternoon and good evening. In January and February the world saw six consecutive weeks of declining cases. We have now seen seven consecutive weeks of increasing cases and four weeks of increasing deaths. 00:03:22 Last week was the fourth-highest number of cases in a single week so far. Several countries in Asia and the Middle East have seen large increases in case. This is despite the fact that more than 780 million doses of vaccine have now been administered globally. Make no mistake; vaccines are a vital and powerful tool but they're not the only tool. We say this day after day, week after week and we will keep saying it; physical distancing works, masks work, hand hygiene works, ventilation works, surveillance, testing, contact tracing, isolation, supported quarantine and compassionate care; they all work to stop infections and save lives. But confusion, complacency and inconsistency in public health measures and their application are driving transmission and costing lives. It takes a consistent, co-ordinated and comprehensive approach. So many countries around the world have shown that this virus can be stopped and contained with proven public health measures and strong systems that respond rapidly and consistently. 00:05:04 As a result many of those countries have gained control over COVID-19 and their people are now able to enjoy sporting events, concerts, restaurants and seeing their family and friends safely. WHO does not want endless lock-downs. The countries that have done best have taken a tailored, measured, agile and evidence-based combination of measures. We too want to see societies and economies reopening and travel and trade resuming but right now intensive care units in many countries are overflowing and people are dying and it is totally avoidable. In some countries despite continued transmission restaurants and nightclubs are full, markets are open and crowded with few people taking precautions. Some people appear to be taking the approach that if they are relatively young it doesn't matter if they get COVID-19. This disease is not flu. Young, healthy people have died and we still don't fully understand the long-term consequences of infection for those who survive. Many people who have suffered even mild disease report long-term symptoms including fatigue, weakness, brain fog, dizziness, tremors, insomnia, depression, anxiety, joint pain, chest tightness and more, which are symptoms of long COVID. 00:07:15 This pandemic is a long way from over but we have many reasons for optimism. The decline in cases and deaths during the first two months of the year shows that this virus and its variants can be stopped. With a concerted effort to apply public health measures along side equitable vaccination we could bring this pandemic under control in a matter of months. Whether we do or not comes down to the decision and the actions that governments and individuals make every day. The choice is ours. Christian, back to you. CL Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask questions you need to raise your hand using the raise your hand icon and please do not forget to unmute yourself. We have a long list already so let's see how far we get. We'll start with Agnes Pedrero from AFP. Agnes, please unmute yourself. 00:08:38 AG Hi, good evening, everybody. Thank you. Dr Tedros has participated in a summit on manufacturing vaccine in Africa today while there is another high-level meeting with WHO and WTO and manufacturers of vaccines this week. We wanted to know if there is any progress on that front and if you can share some details with us about that and if we should expect a boost, an increase in production in the near future of the vaccines that have been already authorised. Thank you. CL Thank you very much, Agnes. Let me start with Dr Aylward, please. BA Thank you very much, Agnes. Yes, the meeting today was particularly important and it was a summit called by a number of heads of state of Africa and the African Union to discuss steps that could be taken concretely and rapidly to establish production capacity on the continent and then to use that obviously to expand in the near term and longer term the production capacity for Africa in particular but even to serve beyond that potentially. In that meeting I think what we saw was extraordinary seriousness and commitments from the very heads of state as well as the expert agencies in Africa such as the Africa CDC to move very, very quickly on this agenda. 00:10:20 As everyone knows, it takes time to build those capacities, to get the regulatory capacities in place but when you have that kind of political will to put the necessary resources behind it and support behind it I anticipate that this is going to move much more quickly than people will have anticipated. But the meeting is still going on and will be for some time so I think we have to wait to see where the final decisions and next steps land. CL Thank you very much. SS Christian, maybe I could add. CL Sure, Soumya. This is Soumya Swaminathan, our Chief Advisor. Please add. SS Thank you. Just to add to what Dr Aylward said, the WHO along with the partners in COVAX - that's CEPI, GAVI, UNICEF but also others like the Bill and Melinda Gates Foundation and the World Bank - have now been working on a proposal to really expand manufacturing capacity for vaccines and eventually other health products, drugs as well, in areas of the world where there is little or no capacity just now. 00:11:33 Because what we've seen in this pandemic is that there is a massive imbalance in the global supply chains, especially in manufacturing capacity in some parts of the world and not in others. The African Union, as we've just heard, is very keen to invest in building that infrastructure and capacity. This is something that will take some time because we'll have to build not only physical infrastructure - that's the easier part - but it's the trained human resources that you need that have the expertise because a vaccine development is a fairly complex endeavour and so there would be a process of having to train those staff. And then very importantly there will need to be technology transfer from institutes, academics and companies that have technologies for vaccine development, tried and tested technologies now. As we know, the MRNA, the viral vector vaccines; these are now tried and tested and can be very easily also changed to accommodate a new pathogen, either a new variant or a completely new pathogen. So the goal is over the next few weeks and months that we will launch a programme to try to do this in partnership with the African Union but also in other regions of the world where there is interest. Thank you. 00:13:01 CL Thank you very much, Dr Swaminathan. We come now to the next question and that's Donato Mancini from the Financial Times. Donato, please unmute yourself. DO Thanks for taking my question. Do you have any more comment on the planned mixing and matching of vaccines, most recently in China but also in France and Germany? I know you said there was not enough data to support the use but I'm wondering if you have any more colour on that. The other question that I have for you is, what is the current status of the four Chinese-made shots in terms of WHO appraisal? Are you looking at them, will you be looking at them? Thank you so much. CL Thank you very much, Donato. Dr Aylward, please. 00:13:55 BA Thank you very much, Donato. I'll take the second part of the question and then I think Kate will speak to the first part of it. In terms of the Chinese products, as we talked about last week, WHO has since the beginning, since late last year actually, 2020 we've gone out with a call for expressions of interest for any company that is engaged in advance-stage trials and production of COVID-19 vaccines to work with the WHO on the early and ongoing what we call a rolling review of those products, similar to what the European Medicines Agency is doing, so that we might as rapidly as possible be able to ensure that they meet WHO's emergency listing requirements and that they could be then recommended by WHO for use. At this point two of the Chinese vaccines are in advanced stages of assessment in that process, the Sinopharm and Sinovac products. As you know, we had teams in China for nearly a month through January and the beginning of February to assess the facilities, the manufacturing practices, etc. With that part done there're a number of additional stages and steps which are happening now with the expectation that at least one of these products will be looked at by the technical advisory group that advises on the emergency use listing for products for WHO as early as late this month and then a second product hopefully very soon after. Then with respect to the mix and match perhaps Kate would like to speak to that. 00:15:37 Yes, on this question of what we refer to as mix and match where a second dose would be of a product different than the first dose, there are no data at this point on any mix and match regimens although certainly there probably are individuals around the world who have had a different product for their second dose than the product that they had for their first dose. We really welcome studies that would look at mix and match regimens because clearly from a supply perspective and also from a programmatic perspective where many countries have more than one and some countries up to three, four, five products in a country it would be very valuable to have these kinds of data to inform how best to use the vaccines. So we really encourage studies to look at mixing and matching vaccines but that really does have to be done in a way that provides evidence that can be acted upon both by the regulators and by the policy advisors and policymakers. 00:16:40 We are aware of a clinical trial in the UK looking at a mix and match regimen with the AstraZeneca and the Pfizer products and again we look forward to additional studies looking at combinations of different products in a single regimen and in an individual. Thank you. SS I'd like to add very quickly, Christian, to what's been said and that is about the standardisation of the assays. As you just heard, there's a study going on in the UK that's looking at mix and match of AstraZeneca with one of the MRNA vaccines; I think they're using both Pfizer and Moderna. The endpoint there is going to be immunogeneicity so it's not a clinical efficacy trial but it's basically going to look at comparable immunogeneicity. As you know, we still don't have a definite correlate of protection to use for vaccine trials or for that matter to test people to see if they have antibodies that will protect them from infection or disease. So we really need to define that cut-off and that can be done essentially if the different studies around the world try to use the same standard because otherwise you cannot compare the results of the antibody assays, both neutralisation antibody assays and binding antibody assays. 00:18:05 So what WHO has done is we of course have this expert committee on biological standards that sets the standards for many, many tests and it does so every year. They work very rapidly to establish the standards both for neutralising and binding antibody assays. We've worked with the National Institute of Biological Standards in the UK, NIBS, where now the WHO international standard is available for any group, a vaccine developer, a company or an academic lab that's doing these assays to use. We encourage everyone to use the WHO international standard and to report their assay results in international units that have been defined. That will then enable us to compare the different studies and ultimately hopefully define the correlate of protection, which would really help in the kind of studies we're talking about, the mix and match studies but also to test the new vaccines which are being developed for variants as well as other potential new vaccines that are coming down the pipeline. So I wanted to alert everyone to the fact that we do have the WHO international standards and we encourage everyone to use those. Thank you. 00:19:23 CL Thank you very much. This was Dr Soumya Swaminathan, Chief Scientist for WHO. We'll continue with 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. With doses of AstraZeneca vaccine drying up across the world can you give us an update on the COVAX vaccine roll-out across Africa? How many doses have been sent to Africa now? How will this vaccine freeze affect roll-out in Africa? How does it affect those who have received only their first doses? Thank you. CL Thank you very much, Simon. I'll hand to Dr Bruce Aylward. BA Hi, Simon. Thank you very much for the question. As I think most people are aware, one of the priorities of the COVAX facility has been to ensure that all countries can get access to vaccine in an equitable manner. At this point, as again most of you are aware, the COVAX, facility has as of today distributed just over 38.7 million doses and we expect to get past 40 million doses later this week. 00:20:46 33 countries of the African Union have received doses so far from COVAX; another five or six - so we should go over 40 countries on the African continent that will have received doses by the end of this week and nearly half of the doses from COVAX will have gone to countries on the African continent. As of today, Simon, that stands at almost exactly 17 million doses and it'll go to about 18, nearly 19 million doses by the end of this week. In terms of the bigger question you raise about the overall vaccine supply this continues to be a real challenge. As most of the journalists on the call are aware the demands of the escalating outbreak and pandemic in India have made tremendous demands on the supply out of India, the SII producer in particular which is one of the main producers that supplies the COVAX facility. We do know that India's working hard to ensure that as it meets the needs of its own citizens it can also ensure that SII doses can continue to flow through COVAX as well. So there's certainly the commitment on that side to ensure that that happens. 00:22:02 At the same time we have supplies from AstraZeneca directly through the COVAX facility and over the last two weeks we've seen a real scale-up in the speed and roll-out of those products. Now if we look at the country supply from the AstraZeneca side that now is getting up in the double digits as well. So, Simon, one of the things we'll be looking at is how best then to distribute the doses that are coming out of SII, out of AG, etc, to make sure that all countries and especially and including the countries on the African continent can be covered as well. But the reality is the whole vaccine supply situation remains precarious and the challenge still because of such competing demands for these doses remains a very difficult one to manage. The good news is, as we spoke about previously, that the interval between the AstraZeneca doses can be extended out to 12 weeks and probably if necessary a bit longer so we do have a bit of time, to the second question that you asked about ensuring people get their second doses. But obviously we'd like to make sure that that interval doesn't go longer than that so we're doing everything possible to ensure the supply of doses of AstraZeneca product in particular - because that's what's gone out already through COVAX - continues. 00:23:33 CL Thank you. Dr Kate O'Brien, please. KOB Let me add a couple of things to what Bruce shared in terms of the doses going to different parts of the world. We've provided guidance to countries about using the supply that has been provided to immunise as many people as possible with the expectation that additional supply will be coming in order to provide the second dose. But it really provides an emphasis that I think many people in these press conferences - Maria especially - have just emphasised over and over; that as vaccines are being deployed this is exactly the time when we need to double down on the non-pharmaceutical interventions; on masking and reducing transmission. Because we give the vaccines their best chance of providing protection across the whole of the community when in addition to scaling up immunity through vaccination we reduce transmission, which also reduces the likelihood of having emergence of variants that could escape from vaccine-induced immunity. 00:24:54 This is just again a reinforcement that we have so much hope and desire to get on with more regular life as people become vaccinated but it's actually the opposite; it's the very time when we should be as diligent as ever and ensure that we're not releasing too early those non-pharmaceutical interventions; hand washing, masking, not gathering in large crowds. So I just really want to emphasise that again and in particular around this issue of supply of second doses and the interval between giving a first dose and then getting that second dose. CL Thank you. Dr Maria Van Kerkhove, please. MK Thanks, Kate. I wanted to come in on that as well. I think we really need to emphasise and we need your help; those of you who are writing articles following our press conference today, we need headlines around these public health and social measures, we need headlines around the tools that we have right now that can prevent infections and save lives. We are in a critical point of the pandemic right now. The trajectory of this pandemic is growing. For the seventh week in a row we've had more than 4.4 million new cases reported in the last week. 00:26:12 If you compare that to a year ago we had about 500,000 cases being reported per week. Last week we had 4.4 million cases. If you look on our website and you actually look at the epi curve and the trajectory of the pandemic right now it is growing exponentially. This is not the situation we want to be in 16 months into a pandemic, where we have proven control measures. It is time right now when everyone has to take stock and have a reality check about what we need to be doing. The Director-General's speech today outlined what we need to be doing. You hear us every day saying what we need to be doing. Vaccines and vaccinations are coming online but they're not here yet in every part of the world where they need to be. There are a lot of concrete steps that are being made to increase vaccine capacities, vaccine production and rolling vaccines out. But right now there are tools that we have; we have to be using them right now. Take a look at your social media feed, take a look at what people are doing and how you are mixing, make sure that you are doing the right steps that you can to keep yourself safe, keep your loved ones safe. 00:27:20 We need governments to support individuals so that the control measures that are in place are applied consistently, are applied in a coherent manner across state lines, province lines, canton lines, whatever that subnational level is because it's confusing. The messages and the application of these interventions is not being applied consistently. About a year ago we outlined guidance about adjusting public health and social measures and the six things that we mentioned to have in place were about having a system in place to know where your virus is. Do you have good surveillance in place to know where the virus is circulating, do you have health system capacities in place to detect cases quickly, to carry out contact tracing, to provide supported quarantine, to get individuals into a clinical care pathway so that they can receive the care that they need? Do you have the outbreak risk minimised in specific settings like long-term living facilities or settings where we know that the virus transmission can be amplified, indoor settings for example? 00:28:22 Do we have preventative measures in place in workplaces, in schools, all of the measures that are outlined for physical distancing, disinfection, good ventilation, good communication for staff, for people who are visiting these essential locations? Have you managed the risk of importation as travel is opening up and do we have communities fully engaged? All of those six measures that are outlined still need to be applied as we look at adjusting our measures. If you look at your trajectory within your borders, reassess the situation and see what can be done. We all need to be playing our part at an individual level but we need governments to support us in being able to do so. There was a 9% increase in transmission last week - seventh consecutive week where we see an increase in transmission - and a 5% increase in deaths. This is not the direction we need to be going and we really need to be serious about this. It is vaccines but it's not vaccines only; it's vaccines and; what can you be doing every day, what can you be doing to keep yourself safe and your loved ones safe? 00:29:29 CL Thank you all so much for these clarifications. Now we'll move to Priti Putnak from, I guess, the New Humanitarian. Priti, please unmute yourself. Priti Putnak, do you hear us? Please unmute yourself. PR This is Priti from Geneva Health Files. Last week it was mentioned that a vaccine manufacturing taskforce was set up under COVAX. Can you tell us a little more about this and if this taskforce will only look at bilateral technology transfer to boost production of vaccines and if yes will this undermine the COVID-19 technology access pool that seeks to encourage non-exclusive licensing agreements? Thank you. CL Thank you very much, Priti. I'm virtually looking at Dr Soumya Swaminathan; please. SS Thank you for that question, Priti. It's really important and I think just to build on what was discussed a little bit earlier in response to another question, we will come up with more details on the vaccine manufacturing taskforce in the next few days but what we're doing right now is working with the key partners, particularly with CEPI, also with GAVI and UNICEF to outline what the key actions are going to be. 00:31:06 The goal of course is to increase vaccine supplies so that we can scale up the vaccination programmes globally and do it as quickly as possible. For that we need some actions which are very immediate and short-term and that will result in immediate removal of any obstacles. That is things like looking at the raw materials and ingredients and the tubings and the plastic which are getting into short supply now because there are limited suppliers of these products and the demand is clearly outstripping the supply. There are also export restrictions that have been put in place by some countries on some of these products, which is creating a problem for some manufacturers. So the first step is really to identify what those critical needs are, where there is a global shortage and try to address them, find either new manufacturers for those products... but also work with governments to make sure that there are no export restrictions on these products. That's where the WTO and the trade rules would come in. 00:32:17 The second would be really to look at expanding the manufacturing of currently available and approved vaccines. We've seen a number of manufacturers have gone out and made their own arrangements; AstraZeneca for example has partnered with over eight companies around the world. But not all have done that and so we want to try to encourage companies to do more of this type of voluntary licensing of their technologies and this is where the CTAP comes in so there is a link very much with the COVID technology access pool, who will work closely with the medicines patent pool. They have the knowledge and experience through doing these kind of licensing agreements which are fair, which are transparent. Most important, we must ensure that the additional doses will go through COVAX to the countries that need them so there has to be an equitable distribution of the additional doses that are produced. That's why working with an intermediary like the medicines patent pool and CTAP is going to be very important. 00:33:35 The third stream of work in this taskforce is really going to be expanding the basic manufacturing capacity of parts of the world - the African continent for example - that currently have very, very limited capacity. That will involve a number of different activities. It's going to require investment, it's going to require a business plan for sustainability and it's going to need of course technology transfer, a lot of training and so on. So that will probably take six to 12 months to get into place gut some of the other actions that we can take now could make a different in the next two to three months. So it's going to be an integrated approach with immediate, short-term and medium-term as well as long-term goals and objectives but all with the goal of increasing vaccine supplies for COVID but also for other diseases. Africa has a huge need for vaccines that are still quite common on the continent; yellow fever, lassa fever and others; Ebola. So there is a huge potential for manufacturing vaccines on the continent for other diseases and ultimately being self-sufficient. 00:34:52 That really is the goal and I think you'll be hearing more about it in the coming weeks. Thank you. CL Thank you very much, Dr Swaminathan. With this we move to Ankit Kumar from India Today. Ankit, please unmute yourself. AN Thank you. I wanted to ask about remdesivir. Where does the WHO stand on the use of remdesivir.? Is there any clinical trial to show that it's useful as far as COVID is concerned? Because in India there is a huge queue of patients to get remdesivir. who cannot get it. Could you please comment on this? Thank you. CL Thank you very much, Ankit. Please, Dr Swaminathan. SS Yes, I can start and I don't know if Janet Diaz is on the call but essentially the guideline development group of WHO did put out guidance. As you know, we have these living guidelines now where every time there is enough evidence on a particular drug we update the guideline. This was done for remdesivir. several months ago based on the available evidence. There were about five trials that were available at that time, of which the Solidarity trial was the largest multi-country trial in more than 30 countries which essentially showed that remdesivir. given to hospitalised patients did not reduce mortality, it did not reduce the duration of hospitalisation and it did not affect the progression of disease from being, say, off oxygen to patients progressing onto oxygen or the need for mechanical ventilation. Those were the endpoints that were looked at. 00:36:48 There are smaller studies that have shown in some subgroups of patients perhaps some marginal benefit, like patients who need low-flow oxygen. The NIH trial showed that perhaps there was a marginal mortality benefit but it was in a very small sub-group of patients. The Solidarity trial, as you know, has been going on now for almost a year and the final data on remdesivir. is now being analysed. This is going to be looking at more than 4,500 patients in remdesivir. compared to the same number in placebo so this is really a huge number. 00:37:25 The data analysis is currently ongoing and we should be updating those results in the next few weeks but I refer you to the guidelines that were put out by WHO that clearly summarise all the evidence on remdesivir. Basically the recommendation was that there wasn't enough strong evidence of its benefit in hospitalised patients but obviously we're looking at any emerging data that is coming out, which will be then used to update those guidelines. Thanks, Christian. CL Thank you very much. We don't have Dr Diaz online but Dr Van Kerkhove could add. MK Yes, only very briefly to add about the guidelines that Soumya mentioned. We do have living guidelines published on remdesivir.; they were published in November. We currently have made a conditional recommendation against the use of remdesivir. in hospitalised COVID-19 patients regardless of their disease severity because of a lack of evidence showing that it improved survival and other outcomes in these patients. But as Soumya has said and as we have said for other therapeutics. We are constantly looking at the clinical trials that are underway and these are living guidelines so these will be updated as more data from those clinical trials becomes available. 00:38:45 CL Thank you very much. For the next question in line we come to Gabriela Sotomayor from Progreso. Gabriela, please unmute yourself. GA Hola. Thank you for taking my question, Christian. On question and one quick clarification. The Head of the Chinese Centre for Disease Control and Prevention said that their vaccines don't have very high rates of protection. So my question is, many countries in Latin America are using the Chinese vaccines so what is your assessment on this situation? And a very quick clarification if I may after my question last week because I think your message has not been understood. Doctors who are in the first line with COVID patients have the priority to be vaccinated regardless whether they work in the private sector or the public sector. Because in Mexico those who work in private hospitals with COVID patients have been relegated, they have not been taken into account so just a quick clarification on that. Thank you so much. 00:39:59 CL Dr Kate O'Brien, please. KOB Thank you for the question. As you know, there are quite a number of vaccines that are being used around the world now in different programmes and all of those vaccines are under emergency use licensure with an evolving evidence base around their efficacy, their performance and of course those are from randomised-control trials. Then we're also looking at evidence from the routine use of vaccines and there is a range in the randomised-control trials of the efficacy of the vaccines but what's really important to recognise is that the vaccines have all met the benchmark of what WHO established as the minimum criteria for vaccines that would be effective for use to control the pandemic. The second thing to recognise is that when you compare the results of one vaccine against another in spite of some standardised case definitions that doesn't necessarily mean that the case definitions were used in a standardised way from one trial to the next so it is quite difficult to compare the specific quantitative results from one product to the next. 00:41:26 Thirdly the results for just about every one of the vaccines have shown that there's much higher efficacy the more severe end of the spectrum of disease that is looked at. So each of the vaccines has had very high efficacy against hospitalisation, severe disease and then as you go down into more mild disease and frankly as we go down just to asymptomatic infection for most of the vaccines the efficacy value goes down. So what I think is most critical here is that we are in a phase of constraint of supply of vaccines around the world. We're learning about the best use of each of the vaccines as we go forward. In particular I think you're referring to some recent results that have come out in the past four or five days and over the weekend on the Sinovac product and some trial results both in routine use and from clinical trials. Again a range of values have been reported for that product going from mild and moderate disease to more severe disease with again that gradient of efficacy as you go to more and more severe disease. 00:42:54 In this phase where we're really focusing on reducing hospitalisation and deaths and serious disease it really is the performance against the serious end of the spectrum of disease that is most critical. So I think those are some of the main points around caution about comparing across products; the fact that we're really looking at products that meet those benchmarks that WHO set for the performance of the vaccines that would be useful in public health programmes and ongoing learning about how best to use the products that are at hand with prioritisation of the products for healthcare workers and those at highest risk of serious disease, which is really the target for protecting healthcare systems and reducing to the maximum degree possible serious disease and death. CL Thank you very much for these clarifications. We'll come to the last question, as I see it, from a guest we haven't had online here with us so far and that's Konstantinos Davanis from Greek public TV, ERT. Konstantinos, please unmute yourself. KO Thank you, Christian. Greece, like other European countries, has rightly started conducing self-diagnostic tests in schools and society so that the coronavirus transmission chains can be broken in a very difficult situation with increasing numbers of cases. 00:44:39 My question; how useful are the self-tests in the strategies to reduce cases? One question that has arisen in many countries is the management of test waste that has been done so far in test centres. Are there guidelines from the WHO on the management of this waste, are the tests dangerous if they are positive and someone comes in contact with them? Thank you very much. CL Thank you very much, Konstantinos. I'll ask Dr Van Kerkhove, please. MK Thank you. Bruce was just mentioning also we didn't answer the second part of the last question, which was about health workers. Just to emphasise that our recommendation for health workers is for all health workers regardless where they are working to receive the vaccination and make sure that we reach all health workers in all countries before we reach all of the populations in some countries. Thanks for just giving me a chance to clarify that; that was for Gabriela. 00:45:45 With regard to self-testing I think your point about waste is an important one but let me highlight something before that. I think what is really interesting in this pandemic is that we've had really interesting innovation as it relates to testing and this is a very exciting time in terms of the advancement in our ability to detect the virus, to detect the SARS-CoV-2 virus. So there's a lot of really exciting innovation that is out there on testing that's easier to use, that could be done by an untrained individual, by you or I at home, outside of a healthcare facility. But what we have to do is make sure that these self-tests are accurate, that they're reliable, that they're quality-assured, that they're easy to use and that they perform well. There're a lot of tests on the market and not all of them perform well. Many of them are under evaluation in individual countries. We will be assessing those as well into the future because testing needs to be strategic in countries. The use of tests as part of controlling COVID needs to be linked to public health action. Testing for testing's sake really isn't useful. What we need is to know who has the virus so that they can receive clinical care and appropriate care so they can be isolated and so that contact tracing can be carried out and so it's really important that it's reliable. 00:47:09 Given that we have some self-tests that are coming on the market we need to make sure that they're assessed but this is really important. In terms of waste, the viral load that's used as part of the tests are considered to be quite low. It's important to follow the manufacturers' recommendations in terms of disposal of this. As a precaution we recommend putting it in a sealed bag before you dispose of it but it is possible that a combination of testing can be used. I think you heard the Director-General talk a lot about testing and how important that is but I do want to emphasise that testing needs to be strategic and we need to use all of the tools at hand but these tools need to be reliable, they need to be accurate and they need to be linked to public health action. CL Thank you very much for these clarifications; also the add-on for the question before. With this we're coming to the end of our question-and-answer session. Thank you all for your participation online and in the room. We will be sending the audio files and Dr Tedros' remarks right after the press conference. The full transcript will be posted on the WHO website tomorrow morning. For any follow-up questions please contact mediaenquiries@ who.int. Now over to Dr Tedros for closing remarks. TAG Thank you. Thank you, Christian. In closing I'd like to say a few things. The COVID-19 pandemic. has shown that global manufacturing capacity is not sufficient to deliver vaccines and other essential health products quickly and equitably to where they're needed most. Earlier today I joined several leaders from Africa for a discussion about how to increase local vaccine production. It was very encouraging to hear the Presidents of Rwanda, South Africa and also Senegal speak about the concrete steps they have so far taken to start local production. As you know, early in the pandemic African countries came together to agree on a co-ordinated continental approach to the pandemic and now they're coming together for a co-ordinated approach to scaling up manufacturing. 00:49:34 Investing in sustainable and secure domestic manufacturing capacity and national regulatory authorities is critical for providing essential immunisation programmes and for building strong, resilient health systems against the inevitable health emergencies of the future. To address this challenge WHO and our partners have established a COVAX manufacturing taskforce, as has been explained by Soumya, to increase supply in the short term but also to build a platform for sustainable vaccine manufacturing to support regional health security in the long term. What should be done today should be done today. WHO is also ready to provide immediate technical support to assist countries in assessing the feasibility of local production and in accessing technology and know-how. I also want to express my solidarity with the people on the Caribbean island of St Vincent, who have been evacuating their homes due to volcanic activity over the weekend. According to experts there are likely to be further eruptions and WHO stands ready to support the Government and people of St Vincent in any way we can. Finally I would like to wish all Muslims Ramadan Mubarak, Ramadan Karim. Thank you. 00:51:08


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias/prevenção & controle , Vacinas Virais/provisão & distribuição , Programas de Imunização/organização & administração , América/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , , Monitoramento Epidemiológico , Quarentena/organização & administração , Isolamento Social , Consórcios de Saúde , Betacoronavirus/genética , Infecções por Coronavirus/genética , Pneumonia Viral/genética , Mutação/genética , DNA Viral/genética , Vacinas Virais/imunologia , Potência de Vacina , Vacinas Virais/efeitos adversos
19.
Multimedia | Recursos Multimídia | ID: multimedia-8604

RESUMO

No momento em que o mundo introduz as vacinas contra a COVID-19, há muitas pessoas que se interrogam sobre o que devem esperar – em particular, essas vacinas são seguras? A resposta é "sim", mas há aqui um pouco mais de informação que poderá ser considerada útil.


Assuntos
Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Betacoronavirus/imunologia , Pandemias/prevenção & controle , Vacinas Virais/imunologia , Vacinas Virais/efeitos adversos , Programas de Imunização/organização & administração
20.
Multimedia | Recursos Multimídia | ID: multimedia-8586

RESUMO

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


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/prevenção & controle , América/epidemiologia , Monitoramento Epidemiológico , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Vacinas Virais/provisão & distribuição , Recursos Financeiros em Saúde/economia , Grupos de Risco , Vacinas Virais/efeitos adversos , Infecções por Coronavirus/genética , Pneumonia Viral/genética , Mutação/genética , DNA Viral/genética , Isolamento Social , Quarentena , Sistemas de Saúde , Potência de Vacina
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