World Health Organization Media Briefing on Global Health Issues 7/05/23 Transcript

Hello everyone. Today’s Wednesday, July 5th. My name is Tarik and I welcome you to regular WHO Press Conference on global health issues. As always, we will start by introducing our speakers here in the room. With us is our Director General, Dr. Tedros. Also Dr. Mike Ryan, Executive Director of our Health Emergencies Program. Dr. Kate O’Brien is Director for Immunization, Vaccines, and Biologicals. We also have Dr. Francesco Branca, our Director for Nutrition and Food Safety. Also in the room, Dr. Sylvie Briand, who is the Director, Epidemic and Pandemic Preparedness and Prevention. Dr. Abdirahman Hamud, who is a Director Ad Interim Alert and Response Coordination. And we also have Dr. Olivier Le Palain, who is Incident Manager for Sudan Crisis. We also have a number of our colleagues online who will be able to answer any particular questions in their area of work, and we will introduce them at some point. With this, I’ll give the floor to Dr. Tedros for his opening remarks. Dr. Tedros.

Thank you. Thank you, Tarik. Good morning, good afternoon, and good evening. First, malaria. I’m pleased that together with Gavi and UNICEF, WHO will shortly announce the allocation of 18 million dose of RTSS malaria vaccine to 12 countries in Africa. With the climate crisis changing weather patterns, mosquitoes that carry these diseases are increasing in density and spreading further afield. Malaria remains one of Africa’s deadliest diseases, killing nearly half a million children under the age of five every year, and accounting for approximately 96% of global malaria death in 2021. The first vaccine against malaria, the RTSS vaccine has now been delivered to more than 1.6 million children in Ghana, Kenya, and Malawi. It has been shown to be safe and effective, resulting in a substantial reduction in severe malaria and a fall in child [inaudible 00:03:09].

(03:10)
Other positives worth noting, at least 28 African countries have expressed interest in receiving the RTSS vaccine. And the second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.

(03:32)
The climate crisis is now one of the major factors determining human health outcomes. El Nino, which has now been announced by the World Meteorological Organization, together with global warming, is already driving record temperatures. On Monday, the world recorded its highest day on record, its hottest day on record. Over the coming months, we expect a range of extreme weather events, including droughts, floods, hurricanes, and heat waves, all of which harm human health. Prolonged drought in the Greater Horn of Africa has already driven a wave of both hunger migration and [inaudible 00:04:22], and is putting a major strain on health services.

(04:26)
This year, nearly 60 million people are food insecure across the Greater Horn of Africa, which includes seven countries, Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda. In Somalia, South Sudan and parts of Kenya, WHO teams are seeing the highest levels of severely malnourished children arriving in health facilities since the crisis begun three years ago. Over 10 million children under five years are facing acute malnutrition in 2023.

(05:03)
While drought has given way to heavy rain and flooding, the situation remains extremely difficult and hunger levels are expected to remain high. WHO is working with local partners to provide critical health and nutrition services to marginalized communities and training to health workers. There is a 97% cure rate when treating severely acutely malnourished children, but it takes well-trained health workers to deliver skilled care. The sooner WHO and partners are able to treat children in need, the better chance of regaining their strengths and health. WHO and health partners need sustainable and coherent funding to mitigate the severe health outcomes which are happening today.

(06:09)
Conflict in Sudan is further exacerbating an already challenging health and hunger situation. The health needs of the population are high. Access to healthcare remains very difficult, and the conditions created by the conflict in Sudan increase the risk for epidemics to spread and kill. The conflict has dramatically increased the number of people at highest risk of hunger, from 11.7 million to 19.1 million people. WHO has verified 50 incidents through WHO surveillance system for attacks on healthcare since the beginning of the conflict, which started in April. This includes 32 incidents affecting health facilities and 10 deaths and 21 injuries reported among health workers and patients.

(07:15)
I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country. The ongoing violence including attacks on healthcare workers, facilities, transportation, and supplies are preventing survivors of gender-based violence from accessing essential health services at a time when they need them most. Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth. Health workers and facilities must be protected. Corridors for humanitarian and health supplies to be delivered need to be safeguarded. We urge all parties to the conflict in Sudan to cease hostilities now before the health and hunger crisis gets even worse.

(08:21)
Over the last few days, I have also been deeply concerned about the situation in the occupied Palestinian territory, where renewed violence has led to 12 deaths, including five children, hundreds of injuries, and thousands of people displaced. Roads have been destroyed, which has made it difficult to reach those people injured. Across the occupied Palestinian territory, WHO has been using contingency funds for emergencies to train medical staff for mass casualty events and prepositioning supplies to help

… Health systems and health workers. WHO pledges to continue working with our partners to get medical supplies to those in need. WHO also calls for deescalation of tension and for talks to maintain peace in the long term so that health systems can recover. Now to food guidelines for children. Based on reviews of recent evidence, WHO has released a new guideline on policies to protect children from the marketing of foods and non-alcoholic beverages that are high in saturated fatty acids, trans fats, sugar and salt.

(09:50)
Marketing of unhealthy food remains a threat to public health and continues to negatively affect children’s food choices and is linked to growing rates of obesity in children and adults worldwide. Considering this evidence, WHO now recommends that government should establish strong and comprehensive regulations as part of a comprehensive policy approach to create enabling and supportive food environments. Finally, tomorrow, WHO UNICEF are releasing a new report with new data on the impact of water sanitation and hygiene on gender inequalities. Too many people, especially women, girls, and the elderly, face the reality to have to go outside the home just to use a toilet and walk miles to get clean water.

(10:48)
This puts them at risk of being harassed or injured. I invite you to tune into WHO and UNICEF social media channels tomorrow to learn more. And Tarik back to you.

Thank you Dr Tedros for these opening remarks. Before we open the floor to questions, just to remind journalist that you should raise your hand and then unmute yourself once you are called to ask a question. I’m promise that I will introduce few colleagues who are online, also available to answer questions. With us is Dr. Tereza Zakaria, Officer in charge for humanitarian interventions, Dr. Rosamund Lewis, who is MPox Technical Lead. We also have Dr. [foreign language 00:11:38], who is Incident Manager for Ethiopia Crisis. This is also Mr. Derek Walton WHO Legal Counsel, and we also have Dr. Bruce Gordon, who is the Unit Head for water sanitation and hygiene. We also hope that Dr. Rogerio Gaspar, who is director for Regulation prequalification, will join us. So let’s start with the first question. We have Alexander Tint from CBS. Alexander, could you please unmute yourself?

Hi, thanks for taking my question. First on influenza, the US CDC recently published an updated risk assessment of H-5-N-1 virus that was in that Spanish mink from last year. Does what we know now about that virus that was seen in the mink change, anything about pandemic vaccine preparations? And then separately on malaria, can you clarify how eradication certification is affected by the detection of new locally acquired cases? And I’m thinking, of course, in this example of the recent cases in the United States. Thank you.

Thank you, Alexander. So maybe we start with the first question, Dr. Briand.

Thanks a lot for this question. So indeed, we are monitoring very carefully H-5-N-1 viruses, not only in birds, but also in other mammals. And for example, more recently in cats because some outbreak have been reported in Europe in cats as well. So this monitoring is done globally with our partner agencies, FAO and OA as well. And we have networks of laboratory at the human animal interface who are sharing information on the virus and monitoring the evolution of this virus across the different species. What it means? It means that we are collecting those viruses, doing genomic sequencing on some of them, and also comparing the results of the analysis of the virus with the epidemiological information. Because what is very important with those H-5-N-1 infection is to see how much it affects a different animal population as well. So we are monitoring this.

(14:11)
We have done an assessment of this virus in the last vaccine composition meeting, and we have secure seed viruses in different WHO collaborating centers. And those viruses would be used if we need to develop H-5-N-1 vaccine. And we will review these viruses at the next vaccine composition in September, and we see if there is a need to update those seed viruses in the coming months. But for the time being, the evolutions we have seen is not so different than what we have seen previously and it doesn’t deserve yet to change the virus that we have put in the library of virus for potential vaccine production, but we are concerned about the situation and monitoring it very carefully. Thank you.

Thank you very, thank you very much, Dr. Briand. Alexander, if I’m not wrong, your second question was on malaria. I’m not sure we have any experts on malaria. Maybe Dr. [inaudible 00:15:30].

Well, I’m definitely not a malaria expert, but I can speak to the general issue of mosquitoes and the fact that the, and Ted Russell referred to it directly in a speech, that it’s not just the wetter or dryer sometimes condition. If you change the climatic conditions, you create an ecologic opportunity or you create a new ecologic niche for any organism to thrive. Sometimes that’s bad for the organism. Sometimes that’s good. With climate change and particularly with increased or decreased rain or precipitation increased or decreased humid humidity, different vectors can either thrive or struggle. We see that with vectors like arthropods, essentially mosquitoes. But we also see other vectors like rodents that can either thrive in a certain situation, that can come closer to human populations. And we see that. We see many, many outbreaks in which the relationship between the human being and the vector transmitting the disease changes.

(16:40)
Very rarely do the viruses themselves change. What changes is the density or the presence or the proximity of the vector. And what is happening right now is, for example, dengue a disease transmitted by mosquitoes is moving further south in the Americas, causing more disease and a more extended range. We’re seeing cases of malaria being reported in the southern United States. Again, we’re seeing the range of the virus extending or the vector extending. That can be a problem because if you, for example, live in Africa, there’s an assumption in the world that all parts of Africa are affected by malaria. There are many parts of Africa at high altitude that have very little malaria, and there’s very little immunologic memory in the population.

(17:26)
If the conditions and the climate conditions change and the viruses can move further and distribute themselves more widely, then you end up with very susceptible people being exposed to that disease, and therefore incidence increases, mortality increases. So we are also seeing increasing density as humidity changes or breeding sites increase, with dengue, we see this peri-urban transmission of dengue, which can be extremely intense, and it’s driven by the fact that there are so many human beings

… packed into such a small area, and then you get a massive explosion of vectors because there’s a lot of standing water. And then you have the perfect situation for an explosive outbreak. So it’s not just the climate per se, it’s the climate interacting with the density of the population, with poverty, with the lack of services. And therefore, climate is one of the drivers. It’s creating more and more opportunities for these vectors to thrive and act as conduits of the disease. And we’re not doing enough to protect our communities from that. We’re not giving our communities the necessary tools, the necessary capacities to deal with vector breeding sites, safe water that you referred to it again, basic sanitation. These are interventions that will mitigate the major impacts of these diseases in these settings. But we’re not making those investments. And we need to adapt our health systems and we need to adapt our community services to be able to deal with the broader extension of these vector-borne diseases. And we need to invest in that now, not in 10 years time.

(19:05)
The climate crisis is here and the health crisis associated with the climate crisis is here, it’s now. And we need to start investing in the measures that protect our communities from these diseases. These diseases will just continue to exploit the opportunities provided. We’ve seen that again and again and again. The vectors are the conduits of that disease, and we need to deal with them by reducing the presence of the vector, but also reducing the impact that that vector has by reducing the susceptibility of the population.

(19:35)
A simple thing like yellow fever vaccination can protect you for life. A single injection can protect you for life from yellow fever. Yellow fever killed hundreds of thousands of people right the way through the last century and the century before. For many people, it was known as yellow jacket. It was a disease that was absolutely feared and a disease that actually affected the southern part of the United States for many, many years. So vector-borne diseases have affected southern parts of the United States historically, and they certainly could return unless we double our efforts both to control those vectors, but also to reduce the vulnerability of our populations to the diseases that they cause. Thank you.

Thank you, Dr. Ryan. Maybe Dr. O’Brien would like to add something in light of the news on the malaria vaccine that Dr. Tedros mentioned.

Yes. Thanks so much. Mike’s comments are really prescient, and not just prescient, but in the here and now. I think it’s really important to remember nearly every minute a child dies of malaria. And the introduction of malaria vaccine as another tool, an additional tool in the toolbox to fight against the severe disease, the deaths that occur, is a really essential step forward. This malaria vaccine that is now, as we’ve just announced, 18 million doses going out to 12 countries, is a step absolutely in the right direction, and it’s the preview of many more millions of doses that will go out in the future.

(21:11)
I think what’s critical is that malaria vaccine is a real breakthrough in child health and child survival. It’s the first vaccine for a parasite. And this is the thing that kills children in Africa and is the vaccine that is in such high demand with many countries applying for this vaccine. So this is a very positive news story that the allocations are being made. The supply that we have is going out. We already have over 4.5 million doses that have been deployed in three countries, immunizing about 1.5 million children. And with the further deployment, many more millions of children will be vaccinated.

(21:50)
But as Dr. Tedros said, the supply is insufficient for all of the need. And so, we’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes. And if that review of that evidence leads to recommendations, we would expect a significant increase in the supply, in the quite short-term. So these are the things that are going to make the difference. And as the changes of climate change are impacting the distribution of malaria, deploying vaccine in routine immunizations in those areas of highest need first, is really the thing that needs to happen and is going to happen now. Thank you.

Thank you, Dr. O’Brien. Just to remind journalists, those who have their hands raised, to name the media they’re reporting for either in their name or through chat so we know who you are. So let’s go to next question, Erika Edwards from NBC. Erica? Can you please press-

Hello. Can you hear me now?

Yes. Now it’s okay. Now we can hear you.

Thank you so much. My name is Erika Edwards. I’m from NBC News. Might you have an update to reports of severe neonatal sepsis related to echovirus 11 or perhaps other enteroviruses? Thank you.

I don’t think we have an immediate update. We’ve been updating our disease outbreak news, but I don’t think we have an update in the last number of days. So if you give us the opportunity, we’ll come back to you after the press conference with an update on the detail. But again, there have been a number of different enteroviruses that cause seasonal disease around the world, some of them causing encephalitis, some causing cardiac disease. And these are, as I said, I won’t call it as normal, but there is a yearly spread of these viruses around the world in a very tiny percentage of children. We see these unusual clinical syndromes associated with them.

(24:07)
In fact, when you look at something like polio, polio is an enterovirus. And only a small fraction of children who actually get polio will become paralyzed, but it has been one of the most virulent enteroviruses that we have seen in history. But most of the other enteroviruses cause a very mild disease in the children that they infect. But in a small proportion, we see a much more significant and catastrophic disease in the child, particularly those that get neurologic or cardiac symptoms. So we will come back to you with an update on the numbers. I’m looking at Abdi to get the journalist’s address or we’ll put it on the web. I just can’t recall when our last update was on the web.

Thank you, Dr. Ryan. So Erika, please stay in touch with us, and as soon as we have something we’ll make sure that you receive the information. Again, just for journalists, please identify yourself; otherwise, we can’t really take you. And while we wait to get those with the raised hand identified, maybe there’s just an opportunity to answer many questions that we have got on aspartame issue, as it was a hot topic in the media. So maybe Dr. Francesco Branca can tell us when the IARC and JECFA reports will be published.

Thank you, and good afternoon. So as indicated, the assessment of aspartame has been, in the first place, a hazard identification process. That was done by the IARC Committee. This hazard identification has been closed. This hazard identification is now followed by a full risk assessment process done by the Joint Expert Committee on Food Additives. The committee will complete its assessment by the end of this week. The two assessments will be then put together in a final release that will be completed and disseminated next week. So a full risk assessment will be available next week. Thank you.

Thank you very much. And just to add that we may have a embargoed press conference on that topic prior to the release on the 14th. I’m just checking if we have more questions. Otherwise, we have received in an email questions about the situation in El Geneina, and what is WHO doing regarding injured people and access to healthcare? So I don’t know if we have something on that. Yes. Dr. Le Polain.

[inaudible 00:27:00]

Okay. Thanks so much. The question is about the situation in El Geneina in West Darfur. We are very concerned about the situation in Darfur, which by all accounts is very dire. We also have very limited information in Darfur, given the security situation at the moment. So providing health support to the population affected by the conflict there is particularly difficult. We know that a conflict is intensifying, some of which along ethnic lines. And the visible side of the conflict is the hundreds of thousands of people who fled from Darfur into Chad on the other side of the border.

(27:41)
We have, as of this week, more than 200,000 people who fled into Chad, settled mostly in refugee and existing refugee camps on the Chad border. And the number of people arriving is still increasing by today. We’re providing health services and strengthening our response on the Chad side, working with partners in the Ministry of Health in Chad. And we’re also exploring options to provide health directly or through partners in Darfur, again, with very limited visibility on what’s happening, but by all accounts, a situation which is rapidly deteriorating and people dying from common illnesses by lack of medical care, lack of available supplies, and also directly by the impact of the conflict.

Thank you, Dr. Palang, for this update on the situation in El Geneina in West Darfur and Darfur in general. So again, I don’t see any hands raised. And maybe we can have a update on the… Because we got another question over email about the occupied Palestinian Territories in Geneina camp and what is being done.

Yeah. I thought that was maybe the… We’ve got El Geneina and Genin, so it was easy to pick up on both. No, I think it’s important. I mean, the DG spoke, and I won’t repeat the DG’s words, but we’ve been as an organization, operational in the occupied Palestinian Territories for decades now, working very, very closely. We also obviously work very closely with Israel and we work on both sides of that conflict to try and ensure that adequate health services are provided.

(29:40)
In this particular case, there’ve been a number of different incidents over the last number of years, and we’ve focused our efforts on improving the capacity of the Palestinian health authorities to manage mass casualty events, to improve their capacity in terms of surgical and trauma interventions, to improve the capacities of paramedics to act within the golden hour, get people from a position of danger into a properly managed health facility with the right equipment and the right doctors, the right nurses. So a lot of investment has been made using contingency funds over the last number of years to do that. And we believe that does make a great difference.

(30:24)
Dr. Rick Peppercorn and his team in OPT do a fantastic job also working with other agencies and including the [inaudible 00:30:33], the agency responsible for Palestinian refugees. So we will continue to do that. Our job is to support health systems and support health services in country, regardless of the conflict. But Ted Ross has said this again and again and again when it comes to provision of health services in these situations as a conflict and act of fighting reduce access and act tax on healthcare further reduce that access.

(30:57)
So I think the plea from WHO is that in all of these situations, regardless of where they are in the world, we have to maintain safety and security of healthcare facilities, the safety and security of paramedics and other frontline health workers out providing direct assistance. And we have to continue to invest in the ability of those local health systems to provide immediate care and assistance. We will continue to do that. And we thank the donors and partners who continue to fund the contingency fund for emergencies. It makes a huge, huge difference in situations like this.

Thank you, Mr. Ryan. So I think it’s important that we got updates on both those situations in Darfur and in occupied Palestinian Territories. I understand that we don’t really have any journalists that we know who are raising hands. So then we will conclude today’s press briefing. And I’ll give the floor to Dr. Tedros for final remarks.

Yeah. No, thank you. Maybe if there is one thing I would like to stress today is about Sudan, especially the situation in Darfur is very grave and serious atrocities are being committed against civilians. And we call on the international community to give attention. From WHO side, we will do everything to help, of course. And with that, we would like to thank all the members of the press who joined today and see you next time.