World Health Organization Coronavirus Press Conference Transcript May 22: South America Becoming Epicenter

Tariq: (00:10) Hello to everyone from WHO headquarters here in Geneva and welcome to the regular press conference on COVID-19. You can watch us on our social media platforms, on WHO website, and also you're welcome to [crosstalk 00:00:25] us through Zoom. Just to remind you that questions can be asked, as well as you can listen if you are listening on the website or on Zoom in six UN languages, plus Portuguese, plus Hindi. And you can also ask your question in any of those languages later. We are thanking our interpreters who are here with us to facilitate that. Today, with us we have Dr. Tedros, WHO general, Dr. Maria Van Kerkhove, Dr. Mike Ryan, and we also have Dr. Kate O'Brian, who is the WTO director for immunization, vaccines, and biologicals. I will give the floor now to Dr. Tedros for his opening remarks. Dr. Tedros: (01:18) Thank you. Thank you Tariq. Good morning, good afternoon, and good evening. This week was a very productive week with all members states agreeing a landmark resolution on COVID-19. And today, we held our executive board. In particular, I want to congratulate Dr. Harsh Vardhan, the India's Minister of Health for his appointment as chair of the executive board. Dr. Tedros: (01:49) The world passes 5 million recorded cases of COVID-19. We recognize the importance of building national unity and global solidarity to learn from each other and suppress the virus everywhere. A key part of this week's landmark resolution was that as well as fighting COVID-19, governments need to also ensure that essential health services are maintained. When health systems are overwhelmed, deaths from outbreaks and from preventable and treatable conditions increase dramatically. Maintaining people's trust in the ability of health systems to provide essential services and safety is crucial to ensure people continue to seek care when needed and follow all public health advice. Dr. Tedros: (02:44) WHO has previously released guidance for maintaining the services during an outbreak. In this context, I would like to thank Novo Nordisk for its donation of insulin and glucagon, which will help to support treatment for people with diabetes in 50 low and middle income countries. This is the first donation in WHO's history of a medicine for a noncommunicable disease and comes at a critical point. People with diabetes are vulnerable to developing severe disease from COVID-19 and struggle with the day to day problems of disrupted access to medication, equipment, and health care. Initiatives to secure the supply of essential diabetes medicines are very welcome and reinforce the multiple ways that the private sector can get involved in fostering global solidarity. Dr. Tedros: (03:51) One of the most essential services that has been disrupted is routine childhood immunization. Today, WHO is publishing new guidance on implementing mass vaccination campaigns in the context of COVID 19. WHO, UNICEF, and Gavi, The Vaccine Alliance, and other partners are working to ensure that the pandemic does not reverse decades of progress against vaccine preventable childhood diseases. Dr. Tedros: (04:27) Today, I'm pleased to be joined by UNICEF executive director Henrietta Fore and Seth Berkeley, CEO of Gavi. Since the turn of the century, child mortality has been helped in large part because of the power of safe and effective vaccination. However, we're here today to collectively reinforce the warning that COVID-19 threatens to undermine lifesaving immunization services around the world. These risks putting tens of millions of children in rich and poor countries at risk of killer diseases, like diphtheria, measles, and pneumonia. As the world comes together to develop a safe and effective vaccine for COVID-19, we must not forget that dozens of lifesaving vaccines that already exist and must continue to reach children everywhere. Initial analysis suggests the provision of routine immunization services is substantially hindered in at least 68 countries and is likely to affect approximately 80 million children under the age of one living in these countries. Dr. Tedros: (05:49) Any suspension of childhood vaccination services is a major threat to life. WHO is working with governments around the world to ensure supply chains remain open and lifesaving health services are reaching all communities. The epidemic of misinformation has also harmed vaccination in recent years, and we call on everyone to do more to prevent rumors and pseudoscience from undermining public health efforts that save millions of lives. In June, the UK government will host a global vaccine summit, and we asked the world leaders to commit to fully funding Gavi for its lifesaving work. WHO and UNICEF have been working closely from the start of this outbreak to ensure essential supplies are reaching health workers, patients, and children across the world. I would like to turn to my sister Henrietta Fore to say a few words. Henrietta, you have the floor. Henrietta Fore: (07:02) Thank you very much, Tedros. It has been five months since COVID started upending the lives of billions of people around the world. And we know for sure that its impact on children will last long and cut deep. We fear the COVID-19 is a health crisis that is quickly turning into a child rights crisis. Three out of four children worldwide, or 1.8 billion children live in countries with stay at home policies. School are closed in 153 countries leaving 1.2 billion students or 70% of learners out of school. Last week, using data from Johns Hopkins University, we at UNICEF said that an additional 6,000 children could die every day from preventable causes over the next six months, as the endemic continues to weaken health systems and disrupt routine services. And today UNICEF, the WHO, and Gavi are sounding the alarm about the impact that these disruptions are having on vital immunization services around the world. Henrietta Fore: (08:25) And the figures are staggering. At least 80 million children, as Tedros has said, under the age of one are at risk because routine immunization services for young children have been substantially disrupted in 68 countries. Vaccination campaigns which seek to vaccinate large parts of population in a short period of time have also been badly hit, especially for measles and polio. Measles campaigns have been suspended in 27 countries and polio vaccination campaigns put on hold in 38 countries. The consequences for children can be deadly. There are many valid reasons why immunization efforts have been impacted. Countries justifiably have had to suspend campaigns due to the need to maintain physical distancing. Health centers have been overwhelmed with response efforts. Health workers have been redeployed to treat COVID-19 patients. And parents have been reluctant or unable to go to vaccination sites for fear of exposure to COVID or due to movement restrictions. Henrietta Fore: (09:49) And there have been serious disruptions that Tedros has mentioned in supply chains and transport services. UNICEF has had a substantial delay in planned vaccine deliveries due to lockdown measures and resulting in the decline in commercial flights and limited availability of charters. However, we cannot let our fight against one disease come at the expense of long term progress in our fight against other diseases. We cannot exchange one deadly outbreak for another. We cannot afford to lose decades of health gains that everyone has worked so hard to achieve. We need joint concerted efforts to put vaccinations back on track, and there are many ways we can do this. Henrietta Fore: (10:43) So first, countries need to intensify their efforts to track unvaccinated children, so that the most vulnerable populations are vaccinated as soon as it becomes possible to do so. Second, we need to address the gaps in vaccine delivery. UNICEF is working with offices around the world, freight forwarders, partner organizations to prioritize shipments and arrange charter operations as required, but we need them for the emergency and critical supplies. And thus we've appealed to governments, private sector, airline industry, and others to free up great space at an affordable cost for humanitarian supply and lifesaving vaccines. And may I give a special thanks to Gavi who made the US $40 million available to UNICEF to secure vital supplies, including vaccines and personal protective equipment on the half of 58 low and lower middle income countries as respond to the COVID-19 pandemic. Henrietta Fore: (11:57) We need to look for innovative solutions to keep vaccines going. In some countries, this is already underway. In Uganda, for example, they are ensuring that immunization services continue along with other essential health services, even funding transportation to ensure outreach activities. The Lao people's Democratic Republic is conducting routine immunization in fixed sites with fiscal distancing measures in place. Henrietta Fore: (12:29) And in other countries, vaccinations are being delivered in pharmacies, in cars, in supermarkets while incorporating physical distancing in their delivery. And forth, vaccines need to be affordable and accessible to those who need them the most. Lastly, we need to make sure that we have the resources to do all of this. And this is a significant undertaking that requires generosity and commitment. We know only too will that when it comes to these diseases, no child is safe until every child is safe. Ahead of the Gavi replenishment conference in June, we also call for the additional funding. It could not be timelier. So with that, shall I hand it over to Seth? Dr. Tedros: (13:31) Yes. Thank you. Thank you, Henrietta. And I want to turn to Seth please. Seth, you have the floor. Seth Berkeley: (13:44) Thank you, Dr. Tedros for inviting me to be here today and for your strong support for immunization always. And thank you Henrietta for that opening statement for your strong support and all the work that UNICEF is doing for this. Seth Berkeley: (14:01) This is really alarming data that we're announcing today, putting numbers on the fact that we've been grappling with for months now, that the scale of the impact of COVID-19 is having on global immunization programs is something we haven't seen really in a lifetime. It's interesting because recent modeling from the London School of Hygiene and Tropical Medicine show that if you were to try to avoid getting COVID by stopping routine immunization, for every COVID death prevented, you would have more than a hundred deaths from vaccine preventable diseases, which reminds us how important immunization is. Seth Berkeley: (14:47) Over the past two decades, we've seen incredible progress ensuring every child everywhere has access to vaccines. Basic vaccine coverage in the world's poorest countries has risen from 59% in 2000 to 81% today, helping to reduce vaccine preventable diseases by 70% during that time period. And as the Henrietta has already said, contributing to halving of child mortality in these countries. Seth Berkeley: (15:18) New vaccines that protect against deadly diseases, such as pneumonia, diarrhea, and cervical cancer have been rolled out worldwide in record time, while global stockpiles against diseases like cholera, yellow fever, meningitis, and now Ebola keep us all safe from outbreaks. More children and more countries are now protected against more vaccine preventable diseases than at any point in history. Now this pandemic is threatening to unravel this progress, risking the resurgence of other diseases we thought we had under control and putting the lives of millions of children and their families in danger. Not only that, if we neglect the supply chains and immunization infrastructure that keeps these programs running, we also risk harming our ability to roll out the COVID-19 vaccines that represent our best chance of defeating this pandemic when they are ready. So this is the problem we're facing. The solution, however, is absolutely clear. Countries must take every step necessary to keep this routine system going and continue to vaccinate. And we're seeing incredible examples of ingenuity, persistence, and hard work to ensure that this continues. You've already heard some examples from Henrietta. Let me just add a few more. Not only is Lao continuing their outbreaks, but they had a scheduled rollout for HPV vaccine, which was introduced to the country's vaccine program in March. And that's reached more than 70% of the population despite- Seth: (17:03) More than 70% of the population, despite the national lockdown there. In Cote d'Ivoire a mobile app that was set up for vaccination is helping to drive that demand and be able to track it. In Afghanistan we're seeing religious leaders helping to spread the message. So supporting all of this work is not only Gavi, but our Vaccine Alliance partners the two most important two are here with us today, WHO and UNICEF. We are continuing to help fund the vaccines, the cold and supply chains and the wider health systems needed for routine immunization and keeping primary health care going. Gavi has made up to $200 million available to immediately fund PPE diagnostics and other measures that countries needed to tackle the COVID pandemic, working alongside with our other partners such as the global fund. And we stand ready to support the mass vaccine catch-up campaigns that are going to be needed to protect the children missing out on vaccines right now. However, for us and our partners, to continue to perform this vital work to maintain immunization programs, to prevent the resurgence of deadly diseases and to ensure health systems are ready to roll out a COVID-19 vaccine it is vital that the Alliance receives the resources we need to continue our work over the next five years. That is why the global vaccine summit hosted by the UK in two weeks time is a pivotal moment. We're asking for at least $7.4 billion for the next five year period, 2021 to 2025. Seth: (18:51) That's enough to vaccinate 300 million additional children preventing at least another 7 million deaths. We've already received substantial pledges from the UK, the US, Norway, Germany, Canada, Italy, Japan, Saudi Arabia, Spain and numerous others. For this we're profoundly grateful. But in two weeks time, we need the rest of the world to come together to meet our target so that children and their families and countries, no matter where they're born can continue to live healthy successful lives free from these terrible preventable diseases. So with that, Dr. Tedros let me turn it back over to you. Dr. Tedros: (19:36) Thank you. Thank you Seth and again Henrietta for joining us today. And I now want to open the floor for questions from journalists around the world so back to Tarik. Tarik, you have the floor. Tarik: (19:59) Thank you, Dr. Tedros, and thanks to our guests from Gavi and UNICEF who I understand will stay with us to take any questions. Before we start with questions just to remind you that you can ask questions in six UN languages plus Portuguese. For Hindi language we don't have a possibility to translate questions, but we have a simultaneous interpretation if you click on the settings on your zoom. So if we are okay from technical side, we will open the floor. And first question is coming from POLITICO and we have Ashleigh Furlong online. Ashleigh do you hear us? Ashleigh Furlong: (20:37) Yes. Hi, thanks for taking my question. My question's for Seth and Henrietta. The resolution coming out of the World Health assembly earlier this week says that member States recognize immunization as a global public good. Obviously this is quite an academic term and there are debates around exactly what that means. I would like to know from you what you see it to mean, and whether you think it has any concrete implications. Tarik: (21:07) So who would like to start? Maybe Henrietta. Henrietta: (21:19) Thank you very much. So one of the things that we are trying to say to countries is that be prepared, be innovative, think of vaccines as an investment, that it is smart, that it is strategic, but that it is also an obligation for children. So what we worry about most are the countries that are very poor and we worry most about the poorest households in every country. And we worry about girls. So as you think about where we need vaccines and how broad it should be, this is our focus and intent and need as a world. Seth over to you. Seth: (22:16) So sorry for the delay it's just we were muted. So thank you for that question. And I think the important point here is to think about the fact that immunization is not only about protecting the individual, but it's also about creating herd immunity and protecting the rest of society. And that's a critical point because even if your child or your family cannot be immunized because they're having an immunosuppressive disease, or because the vaccine doesn't take what protects them is the fact that other people around them are protected. That's why immunization has the characteristics of a global public good. And why in the discussion now as developing COVID-19 vaccines, one of the critical issues there is to think about the role it will play in ending the pandemic. Seth: (23:10) So that's not just the individual protection, but the ability to get rid of infection in surrounding communities to get rid of reservoirs of infection, et cetera. So to me that's why we should be thinking about vaccinations as a global public good and not just an individual protection device. And it is a nuance, but it's an important point as we discussed what effects these products can have on the world, over. Dr. Kate O'Brien: (23:42) Seth and Henrietta have made some really important points and I want to just add a couple to those. I think the other thing to recognize around global public health goods as vaccines are, is that the outbreak pathogens don't recognize borders. And although one country may be able to vaccinate a high proportion of individuals. And in fact, even induce herd immunity in the country, transmission of pathogens cross borders, and mean that we're all at risk when any country is at risk. And as we say especially for measles, which is one of the most transmissible pathogens, is that measles anywhere is measles everywhere. And when we have measles anywhere it means every country must continue to immunize and immunize at the rate that it does protect every individual in the community. And so we can't protect from pathogens from germs crossing our borders and that's why these vaccines have to be recognized as protecting the whole of the world and the contributions from every country to do that. Tarik: (24:47) Thank you very much for these answers. Now we will go to next question that comes from Jamil [inaudible 00:24:56] from the press Corps here in Geneva who is covering for Brazilian media. Jamil can you hear us? Jamil? Jamil are you with us? Can you hear us? Okay, so maybe we'll come back to Jamil if we can go now to Gunilla [inaudible 00:25:31] from Swedish press. Gunilla can you hear us? Gunilla: (25:40) Yes, can you hear me? Tarik: (25:41) Yes, please go ahead. Gunilla: (25:42) Thank you for taking my question. I wonder in places like Pakistan where you have polio and DRC we have problem with measles. There is a lot of discussion now, when could we restart the suspended vaccination campaigns? So my question to you is that what needs to be in place in order to restart these vaccination campaigns? How to assure that health workers have enough protective equipment and so forth. Thank you. Tarik: (26:11) Thank you Gunilla. Kate would you like maybe to state and then we'll go to guests? Dr. Kate O'Brien: (26:16) Sure I'd be happy to address that. We're releasing guidance on how countries can assess and can plan for resuming the campaigns that were paused as a result of the onset of COVID and the opportunity that countries needed to figure out how campaigns could be done in a safe and effective manner. So the guidance is being released and it really calls on countries and provides recommendations and advice on the various attributes to consider. Certainly the availability of the necessary protective equipment for healthcare workers to protect healthcare workers, but also to assure families and communities that they will also be safe in seeking those services. Dr. Kate O'Brien: (27:03) One of the big issues we've found is that people are reluctant to come for immunization services out of concern for themselves and out of concern of course for the healthcare workers. So part of the planning that countries are now able to do is have greater clarity on what protective equipment is needed for immunization services. Which is different than what is needed when actually treating patients who have COVID. In addition, we've heard and seen that there are innovations around how campaigns can be conducted. With physical distancing campaigns can be conducted and they can be conducted in a safe way. And so countries are able to assess the degree to which there is risk for the vaccine preventable diseases and weigh that against their readiness and their ability to secure the healthcare workers to conduct the campaigns and to assure that there are the protective equipment for for those healthcare workers. Tarik: (28:03) Thank you Dr. O'Brien, maybe Henrietta or Seth would like to add something. Henrietta: (28:23) So, may I just add that to Kate's very good points there are some countries that have large populations of unimmunized children. So Nigeria, Ethiopia, Democratic Republic of Congo, Chad, Philippines, Ukraine are some of them. So those would be countries that would want to really think about planning for how they can restart their campaigns. Seth: (28:53) And if I can just add to both of the excellent comments, there also is an important role here in technology and innovation. And so for example, in Pakistan one of the things we've been working as an Alliance is to have better tracking for example in urban slums. To be able to figure out how those campaigns are going on when the hours are and to use that as a way to track people who are vaccinated. So if you have tools like that available, then you can stagger the times of immunizations, you can also bring people back in at different time points and avoid some of the gathering. So I think this is some of the innovation that's going on. Seth: (29:37) And what's exciting about it and I think this is potentially the silver lining over the longterm is that we might see better organized situations, better campaigns going on that are not only directed at any one pathogen, but coming together with multiple pathogens and done in a way that is more convenient for particularly women who obviously are major caregivers in terms of being able to do that at a time that's appropriate. And so these are things that can be done over time. And hopefully as we get back to normalcy, we'll be able to not just go back to where we were, but perhaps go back even better as a set of tools to do this, over. Tarik: (30:24) Many thanks for these answers. We will try to go back to Jamil, who I understand is now available to move with his question. Jamil. Jamil: (30:36) Thank you. Can you hear me? Tarik: (30:38) Yes. Jamil: (30:39) Yes, fantastic. Thank you Tarik. Dr. Tedros a question on Brazil, with over a thousand deaths in the last two days, what do you make of the situation in Brazil and whether you're negotiating any kind of assistance directly from WHO to do so? Thank you. Dr. Michael Ryan: (31:07) Which country [inaudible 00:31:07]? Oh Brazil, sorry I missed the country. Sorry. I heard the question, so many countries. Yeah the situation in Brazil right now, we have I think approaching 300,000 cases, I think just over 290,000 cases of confirmed disease in Brazil with nearly 19,000 deaths. The majority of the cases are from the Sao Paulo region, but also Rio de Janeiro, Yara, Amazonas and Pernambuco are affected. But in terms of attack rates, the highest attack rates are actually in Amazonas, about 490 persons infected per hundred thousand population, which is quite a high attack rate. In terms of the response our colleagues [inaudible 00:31:59] are providing direct assistance to the government to many of the States that are badly affected including Amazonas. In a sense South America has become a new epicenter for the disease. Dr. Michael Ryan: (32:19) We've seen many South American countries with increasing numbers of cases. And clearly there's a concern across many of those countries, but certainly the most effected is Brazil at this point. We also know that the government of Brazil has approved the use of hydroxychloroquine for broader use. But we do point to the fact that our current clinical and systematic reviews carried out by pan American health organization on the current clinical evidence does not support the widespread use of hydroxychloroquine for the treatments of COVID-19. Not until the trials are completed and we have clear results. Dr. Maria Van Kerkhove: (33:10) I also like to point out something that Mike touched upon is the disproportionate risks that we see a vulnerable populations for COVID-19. We're seeing this across a large number of countries. All countries have vulnerable populations and we are seeing a greater impact in terms of disease severity, poor outcomes in groups that are vulnerable. And a lot of this has to do with underlying conditions in these groups, access to care. It highlights the inequalities that we see in vulnerable groups. And I want to highlight that there are vulnerable groups in every country. And so we need to work even harder to ensure that all people have access to healthcare, that all people have access to testing, to information. And so that we could prevent as many severe infections and deaths as possible. Dr. Van Kerkhove: (34:02) ... any severe infections and deaths as possible. Dr. Tedros: (34:06) Many thanks. Next question is from Today News Africa and Simon Ateba. Simon, can you hear us? Simon Ateba: (34:17) Yes, I can hear you. Can you hear me? Dr. Tedros: (34:19) Yes. Simon Ateba: (34:19) So my name is Simon Ateba from Today News Africa in Washington DC, and my question goes to Dr. Tedros. Earlier today, you highlighted certain aspects that WHO is using to fight COVID-19. And one of them was information, the fight against fake news. And you said we have worked with multiple partners, including Facebook, Google, Instagram, LinkedIn, and all the rest. So my question is, are you concerned that these companies, these tech companies, are using the fight against fake news to increase in a way communication racism by deciding that the only people who have the right information are Western and American newspapers? Are you concerned that, when we are done with COVID-19, we may end up with a situation where we have only one sources of information on diseases around the world? Thank you. Dr. Tedros: (35:32) Yeah. Thank you. First of all, as I said earlier today, I would like to, again, use this opportunity to thank all these tech industries for their support. And the way they are fighting the informatics is by routing any questions that come to reliable sources. One is WHO, as you know, and others are local health authorities, reliable local health authorities. Dr. Tedros: (36:05) And when also we report if there is any information which is not science based, and they have already cooperated in removing any information which is not science based. So this is the way they're operating. And we believe that channeling people to WHO website or reliable local health authorities is actually the right thing to do so that people can get the right information. Dr. Tedros: (36:42) As you know, in addition to that, we have started a WhatsApp application. And in just few weeks, as soon as we started, millions have joined, and we're managing to give them direct information, which can help them to understand what COVID means and how they can protect themselves and also protect others. So that's how they're helping us. Dr. Tedros: (37:11) But not only that, they have also provided resources in terms of funding to the Solidarity Trust Fund. And these tech industries, by the way, are not just from the West only, but we have also from Asia. And they're cooperating, and I think this cooperation should actually be the foundation for even a stronger cooperation in the future. But I would like to use this opportunity to appreciate their support. It's a great, great support. Thank you. Dr. Michael Ryan: (37:50) And if I could maybe just expand slightly, because the DG referred very much there to the tech companies who have been working very closely with us. But there is actually also a much broader movement that's been working with us in order to counter misinformation. Dr. Michael Ryan: (38:06) We've been working through the EPI-WIN network, which is a network for information on epidemics that involves thousands of individuals, communities, health and trade organizations, employers organizations, trade unions, food and agricultural organizations, faith-based organizations, youth organizations all over the world. And we've been engaged directly with them in promoting health, tracking the infodemics, picking up from them the questions they're getting from their communities, and directly addressing and engaging on the difficult questions and sometimes the complex questions that different communities are asking, because we have to recognize that each community, be it geographic, be it ethnic, be it based on interests, be it age, have different concerns at different times and ask questions and need information presented to them in different ways. Dr. Michael Ryan: (38:54) And we've really worked hard at WHO to move away from the static guidelines approach and producing one-size- fits- all for information and becoming much more dynamic in our direct engagement with people's concerns. Dr. Michael Ryan: (39:05) And this is the great credit of the many partners who work with us. And many of our internal staff who science isn't just about lab science. Science isn't just about equations and algorithms. Social science is about understanding social dynamics, understanding messaging, understanding human communication, and that form of science is proving just as important in the fight against this pandemic as is the core vaccine science that Kate and other people lead. And balancing our ability to communicate effectively is equally the vaccine against bad information is good information. Dr. Michael Ryan: (39:43) And in that, I think for the first time ever this organization has produced over 130 risk communication products that are not in the form of guidelines. They're in the form of videos and animations, myth buster articles, and infographics, living frequently asked questions that are updated on a minute to minute basis. So as soon as we detect particular questions being asked by the global citizens, we see those questions coming on the internet, we immediately develop answers to those questions. So rather than waiting three weeks for bad information to spread, we try to engage much more directly to amplify good messages. Dr. Michael Ryan: (40:22) And we've had, I think, at this stage over 60 global webinars with thousands and thousands of participants, where we sit and we answer questions to different communities all over the world. So it's not just using tech. We're engaging also directly using technology with many communities around the world directly. Dr. Van Kerkhove: (40:40) I'd just like to add just short to ... I was going to say what Mike was saying. I had my notes in front of me. It's perfect. No, no. It's perfect. Also, to add that not only are we talking to the tech industries and the companies, we're talking to you. We sit here three times a week. We're talking directly to you, answering your questions directly. We're doing Facebook Lives and Q&As and TikTok, and I'm not going to name all the right companies. Dr. Van Kerkhove: (41:08) But the point is that we're not only talking out. We're listening. Getting the answers, getting these myths, looking at what people are concerned about, and hearing directly from individuals helps us to tailor the approach back. And we will continue to do that. We will continue to sit here and answer your questions. We will do this at the headquarter level, at our regional office level, at the country office level to ensure that you have the right information. Dr. Van Kerkhove: (41:34) And to say that science isn't static, this situation isn't static. It doesn't stand still. We are constantly learning. We are constantly updating our information and our advice, and that's a good thing. That's a positive thing, because if we stayed still, we wouldn't be able to pull together this growing knowledge that all of you are contributing to helping to fight this global pandemic. Dr. Tedros: (41:59) Many thanks. Our next question is from Michael Besutkiv [phonetic 00:42:03], who is a contributor to CNN. Michael, can you just unmute yourself? Yes, please. Michael: (42:09) Yep. Thank you for taking my question. This is a topic very dear to my heart, immunization, having worked on many campaigns around the world. A question for Madam Executive Director and perhaps Dr. Kate, a big criticism of immunization has been that it's been very siloed. For example, a lot of resources and infrastructure going into polio and that resources aren't shared. Do you think, given the dire situation you've outlined, that it's time for a total rethink of immunization, that the more synchronized campaigns, more shared resources, that sort of thing? Thank you. Dr. Tedros: (42:45) Thank you. Dr. Ryan or maybe Henrietta, whoever wants to start. Maybe Kate, please. Dr. Kate O'Brien: (42:52) So thanks for that great question. I think the COVID pandemic is bringing to the surface something that, in fact, we've been focusing on for quite some time, is that the immunization program is the public health program that has the widest reach and the deepest impact really of any public health program that we have anywhere around the world. Every country has an immunization program, and it serves all children as well as adolescents and adults in communities. Dr. Kate O'Brien: (43:27) And because of this, this is the way that we can also layer on other interventions and we can link up with other interventions. And in fact, vaccination campaigns are now integrated across not just vaccines, different vaccines being given in campaign mode, but with non-vaccine interventions, deworming, vitamin A. And we're looking for more and more ways that the immunization program can integrate more deeply and can actually be some of the leading edge of growing even further primary health care services. I think we're all in the field of immunization seeing that there is no going back. There is no pre-COVID world that we're going back to. And we're looking for every opportunity and every innovation for how the immunization program can actually take a leap forward through the pandemic and into an even better program that serves more people, and especially is serving those children who are completely left out of immunization services, the so-called zero dose children, so that we're actually getting the degree of impact that all countries around the world have signed up to. Dr. Tedros: (44:39) Thank you. Maybe our guest would like to add something. Henrietta? Please unmute. Henrietta: (44:50) There. Dr. Tedros: (44:50) Now it's okay. Henrietta: (44:51) Oh, good. Thank you very much. Yes. So to add to Kate's comments, Michael, you're onto just the right issue, which is how do we use these resources in the field? The polio workers have been trained really well. So part of our puzzle will be how to make sure that we are giving good training to all of our healthcare workers on each one of these diseases and how we approach each one a bit differently in terms of vaccinations and community surveillance and basic hygiene. Henrietta: (45:31) The other one is one that Tedros and Seth and I have all talked about it, but I think has a real chance now. The idea of hygiene has changed in all of our minds in developed countries and developing countries, how often we wash our hands, how we use soap. This is not available everywhere in the world. So if we can focus on getting good systems, wash systems for water and soap around the developing world, it will have a lasting impact and it will change both what healthcare workers can do, but also how communities can keep themselves safe. Thank you. Dr. Tedros: (46:14) Maybe Seth would like to add something to this. Maybe we will move on, and if Dr. Berkley wants to add something later, we will come back. We can't hear you. Do you want to add something to this question? Dr. Seth Berkley: (46:38) Yes. Sorry. I was on mute. I just want to add something to what both of my colleagues have said, and I want to go back to what Kate said about the zero dose child. And that's a really important concept. We know that, with routine immunization, we reach about 90% of children in the world with at least one dose. That last 10% are particularly important, because if they're not receiving immunization, they're not receiving anything. And if we want to get to the goal of universal health coverage and to extend the primary healthcare system, those are the critical frontiers. Dr. Seth Berkley: (47:16) And if we look at that group, two-thirds of them are living below the poverty line. So this is pro poor, it's pro women. And the reason I wanted to bring that up is it's a mindset shift, because let's just say you're looking at bed nets for malaria, which is about 45 to 50% of the world that needs them is covered. Let's say you want to add 10 additional percent. You can go to the easy ones and add 10%, which will save lives. But if you go to the place where the zero dose children are and we join together, those children are more likely to not just get malaria, but if they get it, they're more likely to die because there's no treatment. Dr. Seth Berkley: (47:55) So if we can bring to these situations a collection of interventions, and most importantly, plug them into a primary health care system, we then get to our universality. And that's going to be critical also for global health security, because it's those health workers, that system, that is going to be there if outbreaks start in those settings. Dr. Seth Berkley: (48:19) So this really is part of a mindset shift that has to happen. Over. Dr. Tedros: (48:25) Thanks for these answers. Now we will try to get to a journalist from Uganda. We have Pamela Mawanda online. Pamela, can you hear us? Pamela Mawanda: (48:37) Yes, I can hear you. Thank you, Tedros. My question is, when we look at the number of COVID-19 cases in Africa, they seem to be on the rise and so are the deaths, but some countries like Uganda seem not to have any deaths. While the number of cases are rising, no deaths are being reported. And I'm wondering might you have a reason for this? Is it because the country has a better health system, or is due to its experience handling disease outbreaks? Thank you. Dr. Michael Ryan: (49:14) I think you are right. The situation in African countries is actually quite varied. I think in the last week, about nine countries have experienced an increase of 50% or more in cases. And actually, in the last week, four countries have had over a hundred percent increase in cases. Other countries have seen the falling number of cases or are stable. So no more than in other parts of the world, we see a different pattern. Dr. Michael Ryan: (49:38) What we haven't seen so far is very high number of deaths in any country, and that's to be, number one, really welcomed. And it's a credit to the systems in countries that they are picking up cases and are able to treat. Africa also benefits, as in much of the developing world. The median age, I think, in the African continent, 50% of the population are 18 or younger, and only 15% of the population are actually over the age of 18. Dr. Michael Ryan: (50:07) And therefore, the age profile of the population, and if you look at the profile of high morbidity and mortality around the world, that profile has been very much in the older population. So the fact that there are a very low number of deaths may reflect that, but it doesn't in any way reduce the chance that the disease will spread. And within Africa, there are many, many highly vulnerable groups, particularly in refugee camps and others. And we need to see the impact of this disease in more vulnerable people. And we don't know what the impact of this will be in undernourished children with chronic malnutrition. We don't know what the impact this will be in overcrowded refugee camps. So there's a lot still to be learned. Dr. Michael Ryan: (50:50) And we've had surprises. And remember, in other countries we've had, in some senses, the surprise of the impact in long-term care facilities. We've seen the impact in dormitories in places like Singapore. This virus can surprise- Dr. Michael Ryan: (51:03) In places like Singapore, this virus can surprise, so we need to be careful not to make assumptions around that. But again, countries in Africa need to be commended for the rapid way in which they developed testing capacity, trained laboratory technicians, they've utilized their existing surveillance systems, including polio surveillance and surveillance system designed to pick up childhood illnesses. And they've adapted those to pick up early warning syndromic systems to pick up suspect COVID 19. And we've been working as many other agencies have, with increasing capacity to treat cases. Dr. Michael Ryan: (51:39) There are significant gaps in capacity in African countries for intensive care, for the ability to deliver medical oxygen, ventilation and others and we're working with the EMTs network, we're working within the supply chain's network, task force, which Dr. Ted Ross initiated a number of weeks ago with WFP and with the Secretary General's office to increase supplies of vital medical supplies on the African continent. So yes, on the one hand good news, the disease hasn't taken off in a very fast trajectory. But a concern, some countries are accelerating in the number of cases, and yes, there are still many vulnerable people on the African continent. We will do everything in our power to support countries to reduce mortality in the coming months. Maria? Dr. Maria Van Kerkhove: (52:30) Yes. A short comment to add is that there are likely a combination of factors of why we would see a difference in mortality as Mike has outlined. The proportion of those with underlying conditions, the age profile, but just a caveat, the deaths and the outcome tend to lag a few weeks in terms of what we know about the case numbers. So, as we're seeing cases, there's usually about at least a two week delay to when we start to see mortality, we start to see deaths. So on the one hand, we could be seeing that people are being identified earlier, you have a testing capacities in place. The proportion of people that may develop severe disease could be lower because you have a younger age profile, you have fewer people with chronic conditions like diabetes or obesity, or chronic heart disease. Dr. Maria Van Kerkhove: (53:21) But, it doesn't mean that we won't see that later. So we still must do everything that we can in every country, even countries that have been successful at suppressing transmission, that have seen a decline in cases, every country right now still needs to be completely ready and vigilant to identify cases, to test those cases, to care for those cases in medical facilities or in facilities depending on their symptoms. To trace and find contacts, quarantine, those contacts, keep your public engaged, keep informing them about what they need to do. Ensure that hand hygiene is in place and ensure that we have the facilities so people that can practice hand hygiene or use an alcohol rub, practice respiratory etiquette. This entire comprehensive package has to be utilized by all countries continuously. So, just a warning that we are seeing successes. We are seeing countries that haven't yet taken off and that's wonderful. And we hope that that still remains, but we must remain vigilant. Speaker 3: (54:28) Many thanks. We have time for one, maximum two questions. So we will go to Ankit Kumar from India today. Ankit, can you hear us? Do we have Ankit Kumar online? You need to unmute yourself maybe. Ankit: (54:54) Yeah. Speaker 3: (54:56) Now we can hear you. Ankit: (54:57) Thank you for taking my question. My question is, on those study public... Yes. Can you hear me? Speaker 3: (55:03) Yes. Ankit: (55:03) Can you hear me? Speaker 3: (55:04) Yes. Yes. We can hear you. Ankit: (55:06) Sure. Based on the district analysis, there were no visible benefits of either HCQ or chloroquine in hospital outcomes of COVID-19. While the study is based on retrospective [inaudible 00:55:19] analysis and is not on a prospective randomized trial, so it has a slight potential bias, but given where we stand today, what is your advice to the countries who are still using HCQs, not only as a therapeutic, but also as a preventative measure for those at risk. Thank you. Dr. Michael Ryan: (55:41) I think we've stated that before, at the present time, there is no evidence from randomized control trials for the effectiveness of hydroxychloroquine or chloroquine in the treatment or prophylaxis against COVID-19. However, given some of the early data available on its use, the drug has been introduced to a number of randomized control trials, including the WHO Solidarity Trials, in order to prospectively see what value the drug has. We know that a number of federal agencies around the world, a number of regulatory agencies have issued warnings indicating that the use of the drug should be reserved even when it is used outside of clinical trials for use in clinical settings under close clinical supervision, because of the likely side effects, particularly in patients with severe COVID-19 where people have noticed the emergence of cardiac complications, including cardiac arrhythmias. So therefore, it would appear the use of chloroquine or hydroxychloroquine in the case of COVID, reserve it for randomized trials, where it is approved for emergency use in clinical settings under close clinical supervision because of its potential side effects. Speaker 3: (57:03) Thank you very much, Dr. Ryan. With this said, we will conclude this press briefing. We again apologize to journalists who did not have an opportunity to ask questions this time, but we will see you again next week. We will send the audio file soon after. We will also have a transcript. So from my side, I wish also to thanks to our guests from UNICEF and Gabby. Dr. Michael Ryan: (57:26) Sorry, I just wanted to make one point. We just wanted to express our sympathies for the people of Pakistan after the very devastating air crash today. I know an aircraft arriving in Karachi crashed on on approach from Lahore. I have taken that airplane personally many times myself, so our condolences to the people of Pakistan and to all our colleagues there. Tazeest. Speaker 3: (57:51) Yeah. Thank you. Thank you, Tarik, Thank you, Mike. I join Mike in expressing our condolences to the government and to the families of those who have lost their lives. And I would like to also thank Henrietta and Seth for joining us today and for your wonderful and very inspiring messages as always too, both of you. And also our own Kate for joining us today. So thank you so much and see you next week and have a nice weekend.