Media briefing on COVID-19 - 07/12/2020

ABSTRACT

000025 FC Hello, all. I am Fadela Chaib speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 7th December. Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, and Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products. Joining us remotely are Dr Soumya Swaminathan, our Chief Scientist, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals, Steve Solomon, Principal Legal Officer. Welcome, all. As usual we have simultaneous interpretation in the six official UN languages plus Portuguese and Hindi. Now without further delay I would like to hand over to Dr Tedros for his opening remarks. Dr Tedros, the floor is yours. TAG Shukran, Fadela. Good morning, good afternoon and good evening. Last week I spoke about the importance of testing, which is vital for knowing where the virus is but it's also important to know where the virus has been and how many people might have been infected without showing symptoms or being diagnosed by testing. 000202 To do that seroprevalence studies are important, which look for antibodies in the blood of individuals to evaluate the extent of infection in different populations. Hundreds of seroprevalence studies have been done around the world, which vary in quality, methods and the type of tests used. Some follow people or populations over time to show how an antibody response in the individual or seroprevalence in populations changes over time. Despite their limitations their results are fairly consistent. They tell us that most of the world's population remains susceptible to infection with the COVID-19 virus. We're still learning how strong immune responses are in different populations and for how long this immune response lasts. In January WHO launched the Unity studies, a global effort to standardise seroprevalence studies and the use of serological tests. 000310 So far more than 60 countries including more than 40 low and middle-income countries are conducting one or more of these studies using WHO's protocols. We're providing technical, financial and operational support and building research capacities for these studies. We continue to work with our global networks to better understand the proportion of the world's population that has been exposed to this virus and how long immunity lasts in people who have been infected. Seroprevalence studies can help us to understand how long immunity from natural infection lasts, which could also help us to understand how long immunity from vaccination might last. As countries plan to roll out vaccines in the coming weeks and months we urge them to prioritise vaccinating those most in need based on the values framework and population prioritisation roadmap issued by WHO's strategic advisory group of experts on immunisation. This document provides recommendations on who should be considered for vaccination first and lays out the values that inform those recommendations. These are not easy decisions. Vaccinating health workers who are at high risk of infection will help to protect them and the health system. 000445 People at highest risk of severe disease or death as a result of age are also a high-priority group because protecting them will reduce severe disease and death and protect the burden of health systems. As supply increases the next groups would include those who have higher risk of severe disease because of their underlying conditions and marginalised groups at higher risk. In the initial stages of roll-out with only a small proportion of a country's population immunised it's vital that governments, communities and individuals continue using proven public health tools. Shortly after my election as Director-General in 2017 we analysed WHO's funding situation and showed that the organisation was too reliant on a handful of major donors. In May of 2018 we announced our plans to establish a foundation to reduce that reliance by generating funding from new sources. In May of this year I announced the creation of the WHO Foundation, a new independent body to generate resources for the work of WHO from source we have not accessed before. 000614 Today the WHO Foundation announced the appointment of Anil Soni as its first Chief Executive Officer from the beginning of next year. Anil is an experienced global health expert with experience in the public, private and non-profit sectors. His previous role was at Viatris, a pharmaceutical company, where he was head of global infectious diseases. He has also held senior leadership roles at the Clinton Health Access Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Anil will play a vital role at a vital time in supporting the WHO Foundation to achieve its goal of raising $1 billion for global health over the next three years. The Foundation will also become a key partner of the COVID-19 Solidarity Response Fund, which has so far raised US$238 million from more than 650,000 individuals, companies and philanthropies. I would like to thank the United Nations Foundation and the Swiss Philanthropy Foundation for their partnership in the success of the Solidarity Response Fund so far and I would like to congratulate Anil Soni and we look forward to this exciting new era and to implement the strategic solution that can bring better resources to WHO. I thank you. 000755 FC Thank you, Dr Tedros. I will now open the floor to questions from journalists. I remind you that you will need to use the raise your hand function in order to get in the queue and please unmute yourself. I would like now to invite Carmen from Politico to ask the first question. Carmen, can you hear me? CA Yes, I can, Fadela. Thank you so much for giving me the question. I have a question about the WHO Foundation and I was wondering, does the WHO framework for engagement with non-state actors apply to the WHO Foundation and where is the money coming from for the initial set-up of the foundation, who has financed it so far so it can get on track? Thank you. FC Thank you, Carmen. I think we can also... Dr Tedros would like to say something. TAG Yes, thank you. Thank you so much. I think, as I said in my speech, maybe I can go back to how it all started. We did a diagnosis of the problems WHO has been facing, especially in 2017 and 2018, as part of our transformation. 000939 We have concluded that from some of the problems many of the problems, especially the financing part, could challenge WHO's sustainability in terms of funding. As you know from the volunteers, most of the money, 80% comes as volunteer financing and it comes from few donors. During that analysis what we thought was, if any of these donors withdrew its funding WHO could get into shock which it cannot absorb. So the strategic solution we proposed at that time was for WHO to broaden its base of donors but at the same time find new areas of resources and that's why we developed the first ever investment case, the first resource mobilisation framework and also the first partners' forum, which was held in Sweden last year, and also we decided to have the establishment of the WHO Foundation. WHO Foundation was one of the solutions so based on the first three I think there are strategic areas that have been already covered and this will focus - the WHO focuses new areas of resources. So the money will come from areas where WHO cannot mobilise directly and where, like the principles we have in FENSA, there could be a conflict of interest. 001142 So the WHO Foundation can mobilise resources without really direct involvement of WHO so the relationship between WHO and what the WHO Foundation makes is not direct. So one thing I would like to assure you is that we have done all the assessments and based on FENSA the foundation's establishment is clear so it's based on FENSA that the foundation itself was established. But I just wanted to use this opportunity to tell you that WHO Foundation is one of the strategic solutions among others. Thank you. FC Thank you, Dr Tedros. I would like now to invite Bianca Rothier from Globo to ask the next question. Bianca, can you hear me? BI Hi, Fadela. Yes, can you hear me? FC Yes, very well. Go ahead, please. 001245 BI Thanks. My questions' to Globo. I'm a correspondent here in Switzerland for Globo. It's about schools because contrary to what we have seen in most European countries during the second wave some cities in Brazil - Hijadel [?] for example - are closing schools again while shipping centres can still be open 24 hours a day. What are the WHO recommendations for schools in countries facing a level of spread like Brazil is facing now again and what have the most recent studies shown, what is the role of children in transmission; how about the teachers and other staff, parents when they are going to pick them up? How important is this risk? Thanks a lot. FC Thank you, Bianca. Dr Van Kerkhove will take this question. MK Thanks, Bianca, for this question. WHO advises taking a risk-based approach as it relates to schools and considerations for schools and education systems, whether they remain open or closed. I think universally everyone understands the critical importance of schools and education for children and young adults, especially the youngest kids. 001411 So in our guidance which we've jointly issued with UNICEF - we're grateful for our partners at UNICEF and our global network, our strategic advisory group that helps advise us on educational settings - is to take this risk-based approach and first and foremost schools operate in communities and if the virus is circulating in the communities and there's intense transmission in the communities it's possible that the virus will enter into the school because individuals who work at the school, who attend the school live in those communities where the virus is circulating. So the first thing that needs to be done is to focus on reducing transmission in the communities and there are a number of steps that you've heard us outline over time. But on the schools themselves we also outlined guidance on what type of plans schools need to have in place in terms of the policies and plans for identifying cases, if they were to have a case how they would carry out contact tracing, having certain environmental cleaning within the school, make sure there's disinfection that's happening, certain physical barriers and distancing of desks for example to ensure that children remain apart. 001518 Age-appropriate use of marks, making sure that there's good ventilation and ensuring that there's good natural ventilation and fresh air coming into the schools and making sure that part of those plans include communication; good communication with not only the students themselves who want to know what's happening and who are very, very smart but also the parents of those schools and what role they can play in this. So we've outlined an approach to help schools in taking the decisions of when t open and when to close, if they need to move to a distance-based learning application or virtual-type schooling. So we've helped countries and decision-makers with taking those decisions at the most local level possible because the virus doesn't spread uniformly, there're different levels of intensity. So that is something that's been issued and that's what countries are following. There's a lot of research now that's happening and looking at children and COVID-19 and the infection among children and we do see some age differences in terms of the amount of infection identified in kids as measured by seroprevalence, as the Director-General was talking about earlier in his speech. There seem to be lower levels of seroprevalence in the youngest age groups as compared to older children and teenagers and we do also see differences in the rates of transmission amongst the youngest children, which seems to be lower compared to older children and teenagers who can spread more than the youngest kids. 001650 But we still have quite a lot to learn. Still we do see overall that children when they are infected tend to have more mild disease and asymptomatic infection and that is something that has held true through the more and more research that is being published but it isn't universal so we do have some children who have developed severe disease and we have had some children die. So it is really important that we take a risk-based approach, we look at schools as part of communities because it's not only the children, it's the people who work there. But there are many places all over the world who have open schools and who have prioritised keeping schools open while keeping transmission low. FC Thank you very much. I would like now to invite Emma Farge from Reuters to ask the next question. Emma, can you hear me? 001742 EM Yes, I can. Thank you for taking my question. It's regarding the Biden health team which is coming together now. I'm wondering if the WHO has had any discussions with the incoming administration and whether specifically you can update us on those discussions; did they lead to anything significant on funding or even a possible late inclusion of the US into the COVAX scheme? Thanks. FC Thank you, Emma. TAG As you know, they're in transition and the team is not formed in full so there cannot be formal or organised discussions when they're doing their transition. So we will let you know when we have contacts, when we have formal engagements but so far we haven't done any discussion with the group as a group. As you know, some of them were just announced a few hours ago. Thank you. FC Thank you, Dr Tedros. I'd like now to invite Bloomberg to ask the next question; Corinne Gretlet. Corinne, can you hear me? Corinne? I can't hear you, Corinne. Okay. If not I will go to the next journalist, Gunila Van Hal, Swedish journalist. Gunila, can you hear me? 001943 GU Yes, I can hear you. Can you hear me? FC Yes, very well. Go ahead, please, Gunila. GU Thanks for taking my question. It concerns vaccine hesitancy now, when we have the vaccines here or very close. How worried are you, how concerned are you about this and the fact that maybe too few people will vaccinate themselves to have a real impact on stopping the virus? If I may ask a question concerning that connected to Sweden where we have experience through the swine flu and the vaccinations that led to the life-long disease of narcolepsy for hundreds of young people, how to address vaccine hesitancy that actually comes from a negative experience of mass vaccinations and also from a vaccine that was developed extremely fast and keeping in mind that the pharmaceuticals do not know anything about the long-term side-effects. Thanks. FC Thank you, Gunila. I'd like to invite Dr Kate O'Brien to take this question. Kate. 002051 KOB Thank you. This is an extremely important issue and I'm really glad you raised it. The vaccines that are demonstrating efficacy and are reaching authorisation for use in countries - and we expect that we will see more of these - are not going to be useful unless people actually become vaccinated. The vaccine that sits on the shelf in a refrigerator or a freezer is going to confer no benefit to people. The issue of vaccine hesitancy and certainly the questions about the vaccine are really legitimate questions and we do want people to be informed about the science, we want people to be fully informed about the evidence that regulators and policy recommending bodies are reviewing in order to make the recommendations and the decisions that are being made. I think one of the things that really helps communities and people, individuals who have to make decisions about being vaccinated is the trust that they have in where the information is coming from. Information really does need to come from the most local level possible; from trusted providers, from people's physicians or the nurse that they go to or the voice of public health people in the community. 002226 So sharing the information and the transparency that we have through the regulatory process and through the policy recommending process is really important so that there's accuracy in what people understand about the vaccines. Each individual will make a decision for themselves about the value that they place on the vaccine and especially in this time where so many people, millions of people have suffered and the deaths that have occurred. I think this assessment that people will make about their understanding of the benefits of the vaccine is going to be a critical mixed phase in the pathway towards having these vaccines be critical tools in the toolbox of the interventions that we have. As Mike and Maria have emphasised so often, having vaccines is not going to be a switch, it's not going to be just going from not having vaccines to having them. We're going to have to continue with the public health interventions for some time yet because of vaccine supply and because of the ramp-up of people getting vaccinated. 002342 What I really want to emphasise here is that there's a very robust, a very strong safety monitoring system that is in place and that system is in place in countries that will be starting vaccines, in all countries around the world. As WHO - and perhaps Mariangela can speak to this a little bit more - that safety system is switched on fully for full co-ordination across all of the different groups - the regulators, the manufacturers, WHO - to be looking at the data in real time. But if there are any signals of concerns around the vaccine we have the ability to look at that, to investigate it and to really understand if there's any issue. But in the clinical trials - which have been very large in nature - the safety evidence is the critical piece of evidence that is being assessed by regulators looking very carefully at the safety profile. As you've seen in the trials that have been reported - in the press releases at least - there are tends of thousands of people who have been enrolled in the trials and each of them is randomised so approximately half of them have received the vaccine. 002509 So I think we have standards around safety, we have large clinical trials that have been done, we have a system in place to monitor for rare or unusual potential outcomes from the vaccine and assess whether they were related to the vaccine or not. I think where people really need to spend their time and their energy is on really being sure that the information that they're receiving is information that is based on the science. I wonder if Mariangela wants to say anything more about the safety part or anybody else to come in here. Thank you. FC Thank you, Dr O'Brien. I think that was a very comprehensive answer. I hope that Gunila was happy. I would like now to invite NPR, Jason Bobian from NPR, to ask the next question. Jason, can you hear me? JA Yes, I can, thank you. The CDC updated what they're calling a close contact and they're now adding anyone who had direct physical contact of a person; before it was anyone who's been within six feet of someone for 15 minutes, masked or unmasked. 002635 I think there's still a little bit of confusion. What is your view of whether or not... They mentioned hugging, that if someone had hugged a person that person would then be considered a close contact and should quarantine. What would be your take on a short interaction like that, just a hug, would that be considered close contact? MK Thanks for the question. It's a good one because there are lots of different definitions out there for contacts. The reason we have the definition of contacts is because of the way the virus spreads. It's a respiratory pathogen and so the virus can be released from your mouth and your nose when you talk or cough or sing but it can also be passed if people have direct contact with one another. What we learn about through these studies is to really get much more detail around what that contact entails. What we know is that most transmission is happening among people who tend to spend a lot of time together. They happen in households, they happen in workplaces and so you have more than just a passing or a brief exchange between individuals. 002750 So when you have a household contact you may hug that person, you may spend long periods of time in the same room together, you may sleep in the same bedroom together, you may share meals together. So when transmission happens in those households it's very difficult to disentangle how transmission actually occurred and the instant of transmission. But we know that long periods of time together, the intensity of that type of interaction, meaning the closeness of it, the direct contact, the direct nature of that contact and the type of setting in which that type of transmission takes place; if it happens in a closed setting with poor ventilation for example that is a situation where transmission can be facilitated more readily. So we define a contact; we use a time frame, we do give a 15-minute window in terms of that amount of time spent with someone. But countries and institutions and agencies need to take decisions about how they define contacts based on the experience that they're seeing in their countries, based on the studies that are being conducted, the details of those outbreak investigations. 002854 This is why these outbreak investigations are so critical for us; because you get to that level of detail that really disentangles how transmission is happening because there are different ways in which transmission can take place. So it is important the time element, the type of contact; if you're hugging for someone, if you're kissing someone, if you're caring for someone, especially if they're sick. Those are really important to define contacts. Also, having said that, we try to outline what would be considered a higher-risk contact versus a lower-risk contact and that relates to the amount of exposure, the duration and the time of exposure because when you're carrying out contact tracing sometimes those numbers of contacts become very high and you do prioritise who you follow up so we recommend following up the highest-risk contacts, those who have the most exposure to someone who is a case. MR Thank you, Maria. I think Maria's spot-on with that. Also just for ordinary people out there, it's like looking at your skin in the sun. Some people can develop a cancerous growth. Nobody knows which specific event caused that. What we do know is if you spend longer in the sun there's more of a chance that you will but it's very difficult to associate a specific day or time at which that sun might cause that cell to change but we do know it's bad to be out in the sun with unprotected skin. 003025 It doesn't mean that sunlight is bad; it means that overexposure to sunlight can lead to that outcome. In the same way we don't know what specific event causes the transfer of the virus to humans. It could be a hug but it's much more likely to occur in a situation where you're in the same space as somebody else for a long time because there are more opportunities during that period for the virus to jump. I think it's difficult right now for the likes of CDC in Atlanta; the US is accounting for a third of all world cases at the moment over the last number of weeks. The epidemic in the US is punishing, it's widespread. It's quite frankly shocking to see one to two persons a minute die in the US, a country with a wonderful, strong health system and amazing technological capacities. So I believe that the CDC are doing their job; they're trying to identify each and every possible significant contact, they're really reaching out to try and get people to stay the course and to use the hope of vaccines but just to remember, there are a number of months to go in which everyone is going to have to unfortunately avoid those hugs. 003141 Maybe because we're here talking today about hugs and about how much we would like those hugs over the holiday period and just how getting that close to people in a situation with intense community transmission can be so tragically dangerous; that's, I think, the awful, brutal dilemma that we all face. It's a horrible thing to think that we would be here as the World Health Organization saying to people, don't hug each other. It's terrible but that is the brutal reality in places like the United States right now and I commend the CDC for doing everything they can. Definitions are definitions. At one level they're arbitrary; who is a contact, who is not. What CDC are trying to do is pick out as many of the significant contacts as they can so that people can protect themselves, get the diagnosis they need, get into treatment early. They're trying to make sure that people are detected and get access to care, they're trying to break the chains of transmission and I commend them as a strong federal agency and as an agency that sends light to the world through its science for doing what they're doing. 003254 FC Thank you. I would like to call again Corinne Gretler from Bloomberg news, our second attempt. Corinne, can you hear me? CO Yes, I can. Can you hear me? FC Corinne? CO Hello, can you hear me? FC Yes, very well. Go ahead, please. CO I may have missed this in previous briefings but I was wondering whether the WHO is advising member states to make the vaccine mandatory. What's your general stance on that and if not countries would it maybe make sense for companies to make it mandatory for employees? FC Thank you, Corinne. Dr Simao. MS Let me start and colleagues can complement. Actually there are very few cases where vaccines are mandatory in countries because countries have different regulations and they usually refer to vaccination in children. 003400 We don't have that experience with adults so far but we do believe that it's much better to work on information campaigns, on making the vaccine accessible to those priority groups who need to be vaccinated first as we don't have enough vaccine next year to vaccinate the entire population. So it will be up to countries to decide but the position is that the way it works better is to make sure that people who are in the priority populations should be vaccinated first, that they have the right information and that they can make an informed choice regarding getting the vaccine. FC Thank you, Dr Simao. I think Dr O'Brien would like also to comment. Dr O'Brien. KOB Yes, I also just wanted to add to what Mariangela has just said is that there is only one vaccine, the yellow fever vaccine, that has any requirement regarding international travel and obviously international travel is not a mandate to be vaccinated, it's an underpinning of that travel requirement. 003520 Just on the issue of mandatory vaccination I fully agree with what Mariangela has had to say; there are some examples of countries for the purpose of paediatric vaccinations that have had success in ensuring that children have high coverage with vaccination in a setting where there are school-related requirements for attendance. But we do think that it is a much better position to actually encourage and facilitate the vaccination without those kinds of requirements. Really one of the limitations for vaccination is availability of vaccines and that doesn't just mean in a country itself but in a time and a place that is convenient for people to go and get vaccinated and with facilities that are of high quality, that provide a positive environment for people to come and be vaccinated. So there are many ways in which we can facilitate people coming to get the vaccines that they want to get and that they know are for their health and their safety. I think the other thing to say is that there may be some countries or some situations in countries where there are professional circumstances where it would be required to be vaccinated or where it would be highly recommended to be vaccinated. 003655 One can imagine certain professional jobs in hospitals - respiratory technicians, intensive care unit physicians and nurses - where for the safety of the staff and the patients there would be a very strong recommendation to be vaccinated. So I don't think we envision any countries creating a mandate for vaccination but there certainly are situations where that strong recommendation - or perhaps on the part of an employer - would decide that that would be a requirement. FC Dr Ryan. MR Yes, I agree with very much of what Kate said. I think the issue and the discussion we need to have amongst ourselves, with ourselves is the issue of what is personal responsibility versus what is a requirement of law and what are you as an individual willing to do to protect yourself and those people around you. If I lived on a desert island would I necessarily want to have COVID vaccine? I don't know. But if I was going to visit my 80-year-old mother - she's not in the nursing home but if she was - if vaccine was available would I be responsible in going in there, visiting lots of older people without being vaccinated if a vaccine was available to me? 003827 So I think we all have to ask ourselves those questions and when you ask yourself those questions you tend to come up with the right answers and then you avoid questions about law and mandatory nature of vaccines. I think the other thing that Maria reflected to me earlier was, the reality is most people want these vaccines. This is a massive potential breakthrough for global health. People are demanding these vaccines, people want these vaccines. They want these vaccines to be rolled out carefully and safely and Mariangela, Soumya, Kate and some of the others - Ana Maria - are working so hard here and around the world to ensure that process and give people the necessary reassurances. But the reality is the vaccine story is a good news story. It is the victory of human endeavour potentially over a microbial adversary, as the DG has called it many, many times and there's hope with that. Yes, we have to continue to bring people along on that journey but I don't think we should necessarily focus on the negative aspects here. 003929 We need to convince people and we need to persuade and we need to dialogue on this issue. I'm not a great believer... I agree with Kate; there are specific circumstances in which governments may have to require a specific mandate for vaccination but I think all of us who work in public health would rather avoid that as a means of getting people vaccinated. I think we are much better served to present people with the data, to present people with the benefits and let people make up their own minds, obviously within reason because there are certain circumstances, as I've alluded to, where I would believe that the only responsible thing would be to be vaccinated, in future when the vaccine is fully available. FC Thank you. Kate, do you have something to add? KOB Yes, I just wanted to add on the comment that I made that there are some countries, a limited number of countries that do have requirements for school attendance for children to verify the vaccination status. 004035 I'd like to also just comment that mandates have another side to them which is that they're also examples where when countries thought that this would be a means to improve the coverage of vaccination in the country it just went in the opposite direction. So just really reinforcing what I said before and what Mike said, that this is not a tool that has strong evidence behind it that it results in higher coverage. In each circumstance where it has been tried the evidence is that it actually goes in both directions. So especially in the circumstance that we're in - and as Mike has said and Maria has said - the substantial majority of people - and people are really eager to have these vaccines available and to move along with vaccination and access to vaccines so I don't think that mandates are the direction to go in here, especially for these vaccines. Thank you. FC Thank you all. I would like now to invite Kumar Bian, Indian media, to ask the next question. Kumar, can you hear me? KU Yes. Can you hear me? 004200 FC Very well. Go ahead, please. KU From the beginning the WHO has been saying - the DG in particular - that the vaccine is very unpredictable, it behaves differently with different people. In this context I would like to ask whether the WHO is looking at different vaccines for different ages groups and geographies because elders have different symptoms, children have different symptoms. I myself have come out of COVID very recently. My age group will have different symptoms. What's your take on it, WHO? FC Thank you, Kumar. Dr O'Brien, can you take this question, please? KOB Sure. We have been emphasising that in the evaluation of the vaccines it is important that the trials are of large enough size and are of diverse enough populations that we can get some answers to questions about whether or not there is a difference in the efficacy of the vaccines according to different subgroups. Age is one particular attribute; that there is a high interest in knowing whether or not the vaccines perform in the same across different age groups. I want to emphasise that the data that has been made public at this point is from press releases. We're very eager to see the details of the data from these clinical trials. 004337 Some of the clinical trials are large enough and enrolled in a a way that they are able to look at the efficacy of the vaccines according to some of the different age strata of interest, in particular older adults. But none of the trials enrolled people who were over 80 years of age so we don't have information among the very oldest in our communities. What is available from some of the press releases are statements in the press release that the efficacy in older age groups was very similar if not the same as among the groups in the younger age groups. So what we really need to wait for is to see the data go through the regulatory process and through the public processes where the data is provided. There are scientific reasons to ask a question about whether or not there could be differences of performance of vaccines in different age groups or underlying medical conditions. 004445 There are a number of areas in which one might expect that there could be differences in the performance of the vaccine and as vaccines become used in communities there will be ongoing evaluations of those vaccines as people become vaccinated to identify whether one or more of the vaccines has better performance or less good performance in some subgroups of people. It's also the reason why we need to continue the research on vaccines, that the story isn't over with the first vaccines coming to authorisation and there are a large number of vaccines in the pipeline and it really is important that as we focus on ramping up both the manufacturing and the delivery as vaccines come through and are assessed for authorisation from a regulatory perspective that we don't stop with the research. Because for most vaccines there has been ongoing development of them and the ones that we started with at the beginning were improved upon over time. So as much as we want the vaccines that are coming through now I do want to emphasise the importance of the ongoing research. Thank you. FC Thank you, Dr O'Brien. I would like to invite Ana Maria Henao Restrepo, Dr Ana Maria, to respond also to this question. 004619 AMR Yes, I just want to echo some of the points that Kate has highlighted. We have been discussing with chemical trialists and vaccine experts and, as Kate says, we are very pleased to have the third term information on the efficacy of these three vaccines but all the experts agreed that we require to have additional evidence. Placebo-controlled trials are the gold standard of obtaining information on the efficacy, the safety, the duration of the protection and the occurrence of serious adverse events. This is why we are communicating to all the researchers around the world who are doing the trials to continue the trials as per the protocols. Second, as he was saying, randomised evidence is the best opportunity we have to evaluate the additional vaccines and to know if these additional vaccines in the pipeline - we have almost 150 candidate vaccines all with different attributes. Some require one dose, some have different routes of administration, some are more suitable for certain contexts. 004728 We want to test all of them because maybe there will be the solution for countries or for certain locations. Thirdly we of course understand that at some point we are going to move into observational data. The randomised placebo-controlled trials will not be possible any longer but we have to enter into this phase understanding that this kind of a study doesn't have the same attributes as the mass clinical trials, that even if they are very well conducted they are subject to bias and interpretation is going to be more complex. So we need to look at that; having close marketing surveillance, having case controlling studies, having cohort studies is a good idea but we need to deliver data. We are in the process of organising consultations to deliberate on what are the best contexts and the best approaches to conduct such studies so that we don't get the wrong answers. FC Thank you. I would like just to give you the title of Dr Ana Maria Henao Restrepo. She's Co-Lead, Research and Development Blueprint at WHO. Thank you so much for your answer. I would like now to invite the next journalist, NSK Shoko [?]. NSK, can you ask your question, please? 004854 SH Hello, Fadela, can you hear me? Hello? FC Yes, I can hear you. Go ahead, please. SH Okay, thank you for taking my question. Tomorrow marks a year since the first patient was detected in Wuhan in China. Can you please give us an update on when WHO is planning to send the international experts to China? Does it take place by the end of this year or rather the beginning of next year or even later? Thank you. TAG Yes, thank you so much. We're planning and we're hoping to be to the ground as soon as possible. Thank you. FC Thank you. I would like now to invite Maya Klans from the UN Brief to ask the next question. Maya, can you hear me? MA Thank you very much, Fadela, for taking our question. My question is regarding the foundation. I know you have spoken already about it but I would like to know what's in the pipeline for the coming year, for its very first year. 005017 FC Thank you so much. The board is established now and we have our CEO, as I have announced today, and we have already started and the foundation have already started taking the next steps, meaning raising the funding as operational cost for the foundation. While raising that funding of course it will trigger the ambitious three-year plan the foundation has. So while the immediate funding will be the US$40 million for the operation of the foundation then the plan is to mobilise US$1 billion in the next three years. Thank you. MR If I could just add - and this is more aspirational in terms of the foundation because I've had the great pleasure of working on behalf of Dr Tedros on the Solidarity Fund for COVID-19 which is the precursor in a way of some of the hopes that we have for the foundation. It's been very, very empowering this year to see how funding coming from sources other than traditional has funded so many amazing efforts in terms of the Solidarity Fund. It's invested in youth organisations for COVID-19 messaging, it's invested in oxygen solutions, in emergency medical team training and subregional centres in Ethiopia. 005205 It's evolved funding our partners outside WHO more than our partners inside including UNICEF, the World Food Programme, UNROA, the UNHCR and others who are doing health-related activities in the field. So it is our hope, Dr Tedros, that the foundation will be, as you have laid out, a way in which WHO can leverage increased investment in health. I think Tedros always says that; that this isn't about necessarily just increased investment in WHO. It's about leveraging more funding into the global cycle for health and driving partnership and innovation throughout the world. I think we've started well with the Solidarity Fund and we hope that the foundation will have that same impact and I'm sure it will. TAG Thank you, Mike. You have reminded me of one thing. When we propose these strategic solutions for WHO it's not just to raise funding only. It could improve the amount of funding, it could improve the quality of funding; that's one. 005315 But at the same broadening our base and moving into additional resources which doesn't have any strings attached means improving also WHO's independence. So it's not about funding only; it's also an independence issue. With long-term multi-tier [?], broad-based funding comes independence also so it's not just finance, it's also ensuring and securing the independence of the organisation and that's why I say this is a strategic solution that addresses some of the systemic problems that we have. Thank you. FC Thank you, Dr Tedros. I would like now to invite Kostas from ERT Greece to ask the next question. Kostas, can you hear me? KO Can you hear me? FC Very well. KO Thank you for taking my question. I would like to ask you about the origin of the coronavirus. Do you agree with the scientific opinion of several virologists in the last days who claim that the virus did come from China but mutated in Italy and then became more contagious and deadly than the original virus in Wuhan? Thank you. 005451 FC Thank you, Kostas. Dr Ryan. MR We can pass to Maria for more specific comment but there are many, many hypotheses as to the origins, the evolution and the spread of COVID-19. They all make for great stories but at the moment there is no proof that any of the hypotheses for generation or for transmission are so. But it is important that we continue to create those hypotheses and then test those against the data that we know. That's part of the reason why Dr Tedros has pushed so hard to work with our Chinese colleagues on understanding the origins of the human disease in Wuhan. But we also have other data that we're looking at very closely for early transmission potentially in Europe and also we've seen the human-to-mink-to-human transmission. So what we see here is a very dynamic interface between animals and humans. We see evolution of the virus within human populations and potentially even faster evolution within small animal populations that are densely packed together. 005601 So it is difficult to come up with a single hypothesis that explains transmission and there is no question that there was very explosive transmission in Wuhan in the early part of the epidemic and clearly in northern Italy a similar explosion of transmission at that time and Italy suffered greatly for that and then we saw the subsequent transmission in other countries. So it is an interesting observation around those effectively two epicentres and how they were related but there are no answers to those questions but we're really interested and we're working with both colleagues in Italy and other countries in Europe - and Denmark. We're working with our colleagues in China and we would hope to build up a much more definite picture on that so please keep sending us your hypotheses but every hypothesis needs to be tested against the data that we actually have. Maria. MK Thanks. Just to support what Mike has said, the studies that need to take place in Wuhan looking at the first cases that were detected are really, really critical in terms of those epidemiologic investigations and really understanding the time that the virus was detected. 005711 Those need to take place and those are taking place and that's the main mission of the China international team and that's ongoing, as the Director-General has said and as Mike has said. But we are a scientific organisation, we are an evidence-based organisation, we follow the science, we follow all of the research that is ongoing globally and there are research groups that are looking at past serologic samples, sera from 2019 and for all of those examples we will follow up and we're following up a recent publication from Italy and those samples are being tested by a partner lab. All of the sequencing that has been made available and again it's incredible that more than 200,000 full genome sequences have been shared globally and these have been shared on publicly available platforms like GISAID. It's really incredible; we need more sequences to be shared so thank you to colleagues for doing that. 005809 Looking at the most common ancestor, any evidence that points to a late November/early December most common ancestor. We're looking also at some countries that are looking at stored waste water samples and following up any indication of RNA testing and making sure that it's a real finding or it might be contamination. We're looking at countries that are going back into their labs and looking at stored clinical samples from 2019 and so all of these avenues are followed up but again - and the Director-General has made very clear and so has Mike and so have I - these studies will begin in Wuhan and it's really, really critical from the public health point of view to understand the events that took place because of the public health importance. What is really critical is that we understand the intermediate host or hosts because that is the important animal or animals that the virus can pass between and we want to make sure that that doesn't continue to happen or doesn't happen again. FC Thank you so much. I would like to invite Peter Kidi from Anadolu news agency to ask the last question. Peter, you have the floor. 005928 PE Thank you for taking my question. Can you hear me? FC Yes, go ahead, please. PE Thank you. With all the growing optimism from vaccine development there's also quite a lot of talk about the thorny issue of intellectual property rights and sharing of knowledge and data. I know that South Africa and India have proposed to the WTO that they should choose whether to grant or enforce patents and other intellectual property related to COVID-19 and to share data. The industry says with all the innovation it's pushed forward such fast development of data. Can you say what the WHO has to say about this? Thank you. FC Thank you, Peter. Dr Simao. MS Thank you for the question; it has been coming up quite frequently lately because these discussions are ongoing in the Trips Council, which is managed by WTO, as you know well. WHO of course welcomes all measures that countries can make in order to address any barriers to access to safe and effective products. That's the spirit behind this process that's happening at the WHO. 010059 On the other hand WHO's Director-General together with the President of Costa Rica has launched at the end of May the COVID Access Technology Pool which is aiming at increased sharing of knowledge and scientific information but also increased pooling of patents, pooling of licences through the medicines patent pool. We believe very much that for next year as we are facing a situation where we will have scarce products, scarce manufacturing capacity in countries and that short-term we need to deal with the affordable access, equitable access to these products that prove to be safe and effective. In the mid and long term we need to increase capacity for, for example, local production or technology transfer and that's where the CTAP, which is this platform, can play a very important role through a voluntary mechanism where manufacturers and researchers, academics and institutions in general can deposit and make available the pertinent licensing or scientific knowledge that can help us face the pandemic at the end of 2021, into 2022 and 23. 010233 I'm saying this particularly because we have situations where we may have for example biotherapeutics that could be useful to fight COVID but they are also being developed for other disease but for which - for example monoclonal antibodies - there is a very, very limited manufacturing capacity concentrated in some multinational companies at the moment. We need to increase the willingness to do technology transfer and also to do the pooling of licensing so that we do not only address the COVID needs but we also address other conditions like oncological products and HIV products for example. Thank you. MR Thank you, Mariangela. I fully agree with your points but just from the perspective as we enter many holiday seasons - Mariangela's right - the technology transfer can take time and it can be done over many products but what we need now globally is not to enter the land of empty promises in terms of supporting the ACT Accelerator. 010351 The structure is there, the partnership is there, the means to do this, allocation fairly and equitably is there. We've never had that in place previously but what's not in place is the financing to make that happen in 2021. I'm not directly and daily involved with the ACT so I'm speaking as an advocate for my colleagues who've given every ounce of their energy across multiple organisations on this project over months. Quite frankly right now there's too much of a gap between the rhetoric and the reality of what the Director-General and other leaders have at their disposal in order to make the ACT Accelerator deliver on a fair and equitable result for people around the world. Equity and fairness is still an aspiration, it's a dream, there's a plan. We have the architectural drawings for this moon shot but I think the DG will agree, we still don't have the financing to make that happen. So I do think as we approach the time of giving it's really important that countries that speak to the idea of fairness and equity, countries that want that to the a reality and have the financial power, the donors that have the power, be they philanthropic or be they government or other or private sector, that we actually make that happen. 010519 Anyway, that for me is going to be the essence of creating equity. It's not just about the technology, it's about financing the ACT Accelerator, particularly the COVAX facility, in order to make this happen. FC Thank you so much. We have gone over one hour since we started this press conference. I would like to invite Dr Tedros for any final comments. Over to you, DG. TAG Thank you so much, Fadela, and thank you all for joining us. See you in our upcoming presser. Thank you. Have a nice week. FC Thank you, DG. I would like to remind journalists that we will be sending the DG's opening remarks and the audio file after this press conference. The full transcript will be available tomorrow on the WHO website and as usual don't hesitate to contact the media team for any follow-up questions. Thank you and see you on Friday. 010622