Lessons from the COVID-19 pandemic and recent developments on the communication of clinical trials, publishing practices, and research integrity: in conversation with Dr. David Moher.

BACKGROUND: The torrent of research during the coronavirus (COVID-19) pandemic has exposed the persistent challenges with reporting trials, open science practices, and scholarship in academia. These real-world examples provide unique learning opportunities for research methodologists and clinical epidemiologists-in-training. Dr. David Moher, a recognized expert on the science of research reporting and one of the founders of the Consolidated Standards of Reporting Trials (CONSORT) statement, was a guest speaker for the 2021 Hooker Distinguished Visiting Professor Lecture series at McMaster University and shared his insights about these issues. MAIN TEXT: This paper covers a discussion on the influence of reporting guidelines on trials and issues with the use of CONSORT as a measure of quality. Dr. Moher also addresses how the overwhelming body of COVID-19 research reflects the "publish or perish" paradigm in academia and why improvement in the reporting of trials requires policy initiatives from research institutions and funding agencies. We also discuss the rise of publication bias and other questionable reporting practices. To combat this, Dr. Moher believes open science and training initiatives led by institutions can foster research integrity, including the trustworthiness of researchers, institutions, and journals, as well as counter threats posed by predatory journals. He highlights how metrics like journal impact factor and quantity of publications also harm research integrity. Dr. Moher also discussed the importance of meta-science, the study of how research is carried out, which can help to evaluate audit and feedback systems and their effect on open science practices. CONCLUSION: Dr. Moher advocates for policy to further improve the reporting of trials and health research. The COVID-19 pandemic has exposed how a lack of open science practices and flawed systems incentivizing researchers to publish can harm research integrity. There is a need for a culture shift in assessing careers and "productivity" in academia, and this requires collaborative top-down and bottom-up approaches.

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

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

Narrative ethics, authentic integrity, and an intrapersonal medical encounter in David Foster Wallace's "luckily the account representative knew CPR".

In Wallace's short story "Luckily the Account Representative Knew CPR," a vice president (VP) suffers cardiac arrest. As an account representative (AR) administers CPR, he discovers his own impersonality mirrored back to him by the VP-a disturbing vision of himself that the AR wishes to escape. Because modern moral theories would have the AR respond impersonally to the VP, those theories would only exacerbate his existential predicament. In contrast, by regarding the AR's act as one that he, in particular, should perform, narrative ethics can discern a resolution for his predicament: because the AR still values his diminished capacities for care and spontaneity, this situation offers him an opportunity to revive those former traits. Doing so would give him greater authentic integrity, or narrative continuity with the most important aspects of his past. Authentic integrity can serve narrative ethics as a helpful starting point for understanding how the life stories of patients, clinicians, and others might appropriately unfold.

The father of ethology and the foster mother of ducks: Konrad Lorenz as expert on motherhood.

Konrad Lorenz's popularity in the United States has to be understood in the context of social concern about the mother-infant dyad after World War II. Child analysts David Levy, René Spitz, Margarethe Ribble, Therese Benedek, and John Bowlby argued that many psychopathologies were caused by a disruption in the mother-infant bond. Lorenz extended his work on imprinting to humans and argued that maternal care was also instinctual. The conjunction of psychoanalysis and ethology helped shore up the view that the mother-child dyad rests on an instinctual basis and is the cradle of personality formation. Amidst the Cold War emphasis on rebuilding an emotionally sound society, these views received widespread attention. Thus Lorenz built on the social relevance of psychoanalysis, while analysts gained legitimacy by drawing on the scientific authority of biology. Lorenz's work was central in a rising discourse that blamed the mother for emotional degeneration and helped him recast his eugenic fears in a socially acceptable way.

Clinical Results of 90 Eyes of Keratoplasty

Needless to say, the essence of keratoplasty is the maintenance of the vitality and clarity of the graft. About 60 years ago, Dr. Elschnig performed the first successful and well-documented partial iso- and allografts of human cornea with von Hippel's original trephine. In Korea, the first successful corneal graft was performed 40 years ago by Drs. Hayano and Sadake, Japanese ophthalmologists in Seoul. They used an 8mm trephine and fixed the graft by the overlapping method in which a square thin rubber piece was fixed to the subconjunctival tissues by direct suture at its four corners. After the World War II, the keratoplasty was not very popular in Korea untill about 1960, for various reasons, including the Korean war, lack of available donor corneas and above all well-trained corneal surgeons. Only scattered cases of keratoplasty were reported by a few Korean ophthalmologists with some successful results. The recent advances in keratoplasty in Korea has been greatly stimulated by the lectures and practice courses on keratoplasty which were conducted by Drs. David Paton and Miguel Martinez, expert corneal surgeons of Johns Hopkins Hospital, U.S.A., and by the donation to the EyeBank of St. Mary's Hospital of a set of instrument and basic equipment from Dr. J. H. King, Jr. in Washington, D.C. in 1967. Although a few eye banks were launched in Korea in the sixties, their activities have been. greatly restricted on account of the peculiar custom of the Korean people's reluctance to donate their eyes after death. In Korea, 231 cases of keratoplasty have been performed until 1975, which means that only about twenty patients per year undergo corneal grafts althogh many more registered patients are waiting for operation. CORNEAL BLINDNESS AND ITS STATISTICS ON HOSPITAL EYE PATIENTS. The population of South Korea is about thirty-five millions, among whom the number of the blind is estimated to amount to 100,000 equivalent to 0.3% of the total population. According to a survey of blindness (the definition of blindness applies to corrected visual acuity under 20/200) on 94,799 hospital patients selected at ramdom in seventeen hospitals in Korea (Koo and Chai, 1974). the estimated number of blind patients was 1,763 (1.9%) in binocular and 4,585 (4.8%) in monocular blindness, the proportional percentages of the causes being in the descending order of senile cataract (36.10% in binocular and 25.5% in monocular), retinal diseases (13.18%,10.70%), corneal diseases (8.16%, 17.88%), and others such as glaucoma (7.78%, 6.13%), myopia (8.16%, 6.17%) and optic nerve diseases (9.33%, 4.03%) etc. (Table 7) The main causes of corneal blindness were infectious diseases such as herpes simplex keratitis and bacterial ulcers (0.65% in binocular, 6.06% in monocular), of corneal opacities from injuries and burns (2.07%, 5.83%) and general diseases (1.56%, 2.72%). The most prevalent area was Kangwon-do Province, where binocular corneal blindness was 16.05% and monocular blindness 28.73% of the whole blind patients. Comparing this data with that of other advanced countries, the corneal blindness in Korea occupies the same position as in the case of Sweden, representing the third largest causes of blindness among all the causes of blindness. However, the combined percentage of monocular and binocular blind patients was 6.7% (6,348 patient among the total of 94,799) in the survey of 1971-72. Although the present demand for keratoplasty increases day by day, the supply of donor corneas is still in great shortage. THE EYE BANK AND SUPPLY OF CORNEAS. In answer to the large demand of donor corneas, an eye bank was first opened at the Department of Ophthalmology, Seoul National University Hospital in 1962. But the supply of corneas by the eye bank was scanty due to the lack of donors and traditional Korean customs. A few years later, two more eye banks were launched. Thereafter, the Central Eye Bank attached to the Department of Ophthalmology, St. Mary,s Hospital, Catholic Medical College, Seoul, was inaugurated on April 19, 1967 with the help and contribution from Dr. J.H.King, Jr. Director of Interilational Eye Foundation, Washington, D.C. At the request of Dr. B.S.Koo, former professor of ophthalmology, Catholic Medical College, Dr. King sent in November, 1965, two corneal surgeons, Drs. David Paton and Miguel Martinez of Baltimore, to Korea for the instruction of keratoplasty and opening of the Central Eye Bank of St. Mary's Hospital which was designed to supply corneas to all hospitals of korea. This served as a big stimulus for Korean ophthalmologists. Table 2 shows data regarding donor eyes supplied by the Central Eye Bank from 1967 to 1975. The Central Eye Bank has enucleated 182 eyes from donors and supplied 90 corneas for keratoplasty at St. Mary's Hospital. It also supplied corneas to many eye surgeons of other hospitals or corneal graft operations. Pamphlets for enlightenment and publicity were distributed among hospitals, clinics, and varlous other organizations, and in response to the publicity activities, so far 300 noted persons desiring to give their eyes have been registered with this eye bank. Although a considerable number of willed persons registered as would-be donors, practically almost all the donor eyes in the past were obtained from such cadavers as hae no relatives and families and died of chronic or senile diseases in hospitals. Because of such limited supply of donor corneas, and of the socioeconomic problems of poor patients in my country where no medical insurance system has been established yet, the activities of the eye banks in Korea are very inactive although the Enucleation Act for research was put into practice in 1973 by the Ministry of Health and Wellfare of Korea. RETROSPECTIVE CUNICAL REVIEW. In Korea, 231 cases of keratoplasty have been performed by different surgeons and different techniques from 1935 to the present time. Among them, the most common grafting method was penetrating keratoplasty which was performed on 208 patients. The rates of clear grafts greatly differ depending upon surgeons and the time of operations, ranging from 60% to over 90%. Fig. 1 shows the total numbers of cases of penetrating and lamellar keratoplasty which were performed during the past 40 years in Korea. 90% (208 eyes) of them were performed by penetrating keratoplasty. As memiomed above in the introduction, the first penetrating keratoplasty using a square thin rubber for overlapping fixation was performed separately in Korea by Drs. Hayano and Sadake in Seoul between 1935-40. But the postoperative results for these patients are not known. During about 10 years following the Second World War, Dr. S.M.Hong, former professor of ophthalmology, Chun Nam University and his assistants performed 5-7mm small penetrating grafts with good results in two cases out of four. They used a conservative fixation method such as thick sutures for fixatian of an overlapped rubber piece to the bulbar subconjunctival tissues. Practically, keratoplasty has become popular since 1963. During this revival stage of keratoplasty, Dr. Ko, C.J., former chief of ophthalmology, Seoul Red Cross Hospital, made operations by himself for sixty eyes of all penetrating grafts with a success rate of about 70%. Inconsideration of the various disadventages mentioned above, it can be said to be exceptional that a surgoon should have performed sixty grafts singlehandedly. Four fresh donor corneas were sent to Yun Sei University Hospital via air mail from an International Eye Bank of Sliranka. Only two cases out of four eyes maintained a clear graft after penetrating keratoplasty. Direct suture technique with 6-0 silk around the margin of a corneal button was popularized since 1957. But ten years later, 8-0 virgin silk (or chromic gut) for direct or continuous sutures was then introduced in keratoplasty. Since this time an operating microscope with fine micro-surgical instruments and sutures has been used as an essential surgical instrument in our operating rooms. Continuous suturing technique with 10-0 monofilament nylon under the operating microscope is now a common practice and has increases the success rate greatly since 1971. With the opening of the Central Eye Bank of St. Mary's Hospital in 1967, our activities in keratoplasty have been greatly accelerated and we have been given more opportunities to collect patients indicated for keratoplasty. Anyhow, during the period of 1967-1975, we performed keratoplasty in 90 recipient eyes which correspond to two thirds of the total 135 grafts in this period. Table 1 shows incidence of causative diseases of corneal opacity and corneal conditions at the time of keratoplasty seen in 90 eyes (87 patients; one patient received two grafts on both eyes, and two patients received regrafts because of an opaque graft). The successful results of our early cases showed 71% (19 of 27 grafted eyes); however, due to the improvement of surgical techniques, careful selection of donor-recipients, and the use of fine microsurgical instruments, sutures and needles under the operating microscope since 1970, the results are getting better; 55 eyes, which amounted to 87.3% of 63 eyes grafted successfully, maintained their clarity. Fourteen eyes of clear grafts that did not improve vision had reasons such as amblyopic eye (cosmetic graft, 7 eyes), therapeutic pterygium(2), progressive cataract (1) and cloudy host tissues under lamellar graft(4). Most cases of opaque grafts resulted from irreversible graft rejection which was seen in eleven eyes. Another four eyes showing graft rejection were controlled by topical (0.5% hydrocortisone drop per hour) and systemic use (60mg. of prednisone per day in adult) of corticosteroids and three eyes by systemic use of Azathioprine (100-200mg per day in adult). Another complications were as follows; bullous keratopathy(5 eyes), wound gapping with or without iris incarceration (5), anterior or posterior synechia(5), neovascularization(3), complicated cataract(1), complicated glaucoma (1) and retrocorneal membrane (1). Almost all donor corneas which were used for keratoplasty in Korea were supplied as the condition of a fresh or a 40 degrees C wet chamber stored fresh cornea. Only a few glycerine preserved corneas were used for lamellar grafting with good results. Recently, I have experienced one successful case of 7mm partial penetrating keratoplasty by using of full 5 days wet-chamber stored cornea. obtained from 24 year old young donor. This 5 days stored cornea was, anyhow, grafted to a man (29 year old) whose right eye had been blind from leucoma cornea adherens since childhood because of measles. The graft retained crystal clear after operation, postoperative vision being 20/100 without a contact lens. SUMMERY. In Korea, the first successful keratoplasty was performed 40 years ago by two Japanese ophthalmologists in Seoul. The combined percentage of monocular and binocular blind patients was 6.7% in a survey of hospital patients of year 1971-72. Among them, the combined percentage of monocular and binocular corneal blind patients was 26.58%. The recent progress of keratoplasty in Korea has been greatly stimulated by the intensive lectures, experiments and technical practice on keratoplasty which were conducted by the intensive lectures, experiments and technical practice on keratoplasty which were conducted by Drs. D. Paton and M. Martinez of Johns Hospkins Hospital in 1967. At the same time, through these two doctors, Dr. J.H. King, Jr. of Internationsl Eye Foundation, Washington, D.C. donated many medical instruments and a great deal of materials, including eye preservation containers, preserved corneas, atc. The Central Eye Bank of Catholic Medical College has enucleated 182 eyes from donors and supplied 124 fresh corneas for keratoplasty during the last 7 years. 231 cases of keratoplasty have been performed by different surgeons and different techniques from 1935 to 1975. The most common grafting method has been penetrating keratoplasty(90%). Continuous suturing technique with 10-0 monofilsment nylon under the operating microscope is now a common procedure and has increased the success rate greatly. In our hospital, we performed keratoplasty in 90 recipient eyes during the improvement of surgical techniques, careful selection of donor-recipients, and the use of fine microsurgical instruments, sutures and needles under the operating microscope since 1971, the results are getting better; 55 eyes, which amounted to 87.3% of 63 eyes grafted successfully, maintained their clarity.