World Health Organization (WHO) Coronavirus Press Briefing Transcript August 13

Margaret Harris: (00:26) Hello everybody. This is Margaret Harris in Geneva on this Thursday, August 13, welcoming you to today's World Health Organization press briefing on COVID-19. We have with us, as always the WHO director general, Dr. Tedros, along with Dr. Mike Ryan, executive director of our emergencies program, Dr. Maria Van Kerkhove, technical lead for COVID-19 and a big panel of experts today. Please ask a good broad range of questions. Our experts include Dr. Bruce Elwood, Dr. [inaudible 00:01:01], Dr. Sumia Swaminathan, who's joining us remotely and quite a few others. As usual, we're translating this simultaneously in the six official UN languages plus Portuguese and Hindi. Remember that under the Zoom system, you need to go to the Korean button to use Arabic. But now without further delay, I'll hand over to Dr. Tedros. Dr. Tedros, you have the floor. Dr. Tedros: (01:27) Thank you. Thank you, Margaret. Good morning. Good afternoon. And good evening. We're half a year from the WHO, from WHO sounding its highest alarm by declaring the COVID-19 outbreak, a public health emergency of international concern. At the time, on 30 January, there were just a hundred cases outside of China and no deaths. Since then, there has been an exponential rise in cases and every country in the world has been impacted. And with major disruptions to essential health services, the ripple effects of this pandemic are having a major impact politically, economically, and in how people live their day to day lives. Everyone is asking, "So how do we go back to normal?" And today, I want to talk about not how we're going to go back, but how we are going to go forward and that to move forward, the best bet is to do it together. Dr. Tedros: (02:38) In early January, at the beginning of the outbreak, WHO activated our global technical networks to gather all available information about this virus. Within the first two weeks of January, the viral genome of COVID-19 was mapped in China, shared globally and the first PCR test protocol was shared on the WHO website. This enabled the first diagnostics to be developed, boxing research to start and soon after millions of tests, PPE and supplies were shipped around the world. In February, we held the WHO's research and development blueprint meeting, where scientists and researchers from across the world came together to identify research priorities. A roadmap was created for the development and fair distribution of diagnostic therapeutics and vaccines. Also, in February and March, numerous countries showed that it's never too late to suppress COVID-19 using a comprehensive approach. This includes active case finding and isolation, contact tracing and quarantine, adequate testing, and appropriate clinical care. Dr. Tedros: (04:02) With these tools, it was clearly possible to break the chains of transmission by a combination of traditional public health techniques. The pandemic evolved, countries clearly needed to come together in an unprecedented way to develop new vaccines, diagnostics and therapeutics, and to set the stage for ensuring that they reach all people everywhere. In April, WHO convened world leaders and launched the access to COVID-19 Tools Act-Accelerator. In just three months, the accelerator has already shown results. As of today, nine vaccine candidates are already in the COVAX portfolio and going through phase two or three trials. And this portfolio already the broadest in the world is constantly expanding. And through the COVAX global vaccines facility, countries that represent nearly 70% of the global population, have signed up or expressed an interest to be part of the new initiative. On therapeutics, the first proven therapy for severe COVID-19, dexamethasone was announced in June with support from the therapeutic accelerator arm and is currently in scale up. On diagnostics, more than 50 tests are currently in evaluation and new evidence has been generated around rapid antigen detection tests that could be game changing. Dr. Tedros: (05:42) The ACT-Accelerator is the only global framework for ensuring the fair and equitable allocation of COVID-19 tools, but it must be financed to be successful. IMF estimates the pandemic costs the global economy 375 billion US dollars a month and predicts a cumulative loss to the global economy over two years of over 12 trillion US dollars. The world has already spent trillions dealing with the short term consequences of the pandemic. G20 countries alone have mobilized more than 10 trillion US dollars in fiscal stimulus to treat and mitigate the consequences of the pandemic. That's already more than three and a half times as much as the world has spent in the entire response to a global financial crisis. It's easy to think of the ACT-Accelerator and the research and development effort, but in reality, it's the best economic stimulus the world can invest. Dr. Tedros: (06:51) Funding the ACT-Accelerator will cost a tiny fraction in comparison to the alternative where economies retract further and require continued fiscal stimulus packages. Before spending another 10 trillion US dollars on the consequences of the next wave, we estimate that the world will need to spend at least 100 billion US dollars on new tools, especially any new vaccines that are developed. The first and most immediate need is set to 1.3 billion US dollars for the ACT-Accelerator. The ACT-Accelerator is the only up and running global initiative that brings together all the global research and development, manufacturing, regulatory, purchasing and procurement needed for all the tools required to end the pandemic. Picking individual winners is unexpensive risky gamble. The ACT-Accelerator enables governments to spread the risk and share the reward. In particular, the development of vaccines is long, complex, risky and expensive. The vast majority of vaccines in early development fail. The world needs multiple vaccine candidates of different types to maximize the chances of finding a winning solution. Dr. Tedros: (08:22) When a successful new vaccine is found, there will be greater demand than there is supply. Excess demand and competition for supply is already creating vaccine nationalism and risk of price gouging. This is the kind of market failure that only global solidarity, public sector investment and engagement con solve, but the ACT-Accelerator funding gap can't be covered by traditional development assistance alone. The best solution for everyone is a blend of development assistance and additional financing from stimulus packages to fund this effort. And this blend of financing is the best solution right now because it's the fastest way to end the pandemic and ensure a swift global recovery. We live in a globalized economy and countries are dependent on each other for goods and services, transportation, and supply. If we don't get rid of the virus everywhere, we can't rebuild economies anywhere. Dr. Tedros: (09:38) And the real beauty of the ACT-Accelerator and its work is that stimulus investments and globally coordinated rollout of new vaccines, tests and therapeutics would have a major multiplier effect on our economies. The sooner we stop the pandemic, the sooner we can ensure internationally interlinked sectors like travel, threat and tourism can truly recover. There is hope. If we all deploy the tools currently at our disposal today and if we collectively invest in new tools through the ACT-Accelerator, we have a route out of this pandemic. Together, together, together with solidarity. Dr. Tedros: (10:34) Over the past two years, working with the government of the Democratic Republic of the Congo, communities, health workers, and local and international partners, we collectively defeated one of the most difficult Ebola outbreaks the world has ever faced. However, at the time of COVID-19, the outbreak in Equateur province is a worrying development. So far, there have been 86 Ebola cases across the province. The country, government and partners face significant logistical challenges in being able to rapidly investigate and establish response capacities in extremely remote and difficult areas to access. The geographic spread of the outbreak is vast, with cases in some areas separated by more than 250 kilometers, and many areas are only accessible by helicopter or boat. Right now, WHO has approximately 100 staff on the ground working with the Ministry of Health, UN agencies, NGOs and communities. Dr. Tedros: (11:47) We immediately released 2.5 million US dollars from the contingency fund for emergencies and our regional emergency response fund to support the immediate response. To bring the outbreak under control and end it, WHO and partners require additional funding. We're currently working with surrounding provinces and neighboring countries to enhance preparedness as we did with the previous Ebola outbreak in Eastern BRC. As we know from past experience, this is not just a matter for a country's health security, it is a matter of global health security. Whether it's COVID-19, Ebola or other high impact epidemics, we must be prepared. We need to be on high alert and we need to respond quickly. And our best chance to be successful is always do it together. I thank you. Margaret Harris: (12:47) Thank you very much, Dr. Tedros. I'll now open the floor to questions from journalists, but before that, I'd like to remind you that if you want to ask a question, you must use the raise your hand icon, even if you've submitted the question beforehand. And I'll also apologize to you now to those who miss out. We've got a lot of people online, so please restrict your questions to one question. I know it's a really complex subject, but please try to just ask the one question. We've got a lot of very strong science and health journalists on the line and we'll start with Helen Branswell from Stat News. Helen, could you unmute yourself and ask your question? Helen Branswell: (13:27) Hi. Hi all. Thank you very much for taking my question. I've asked it before and I'm going to ask it again. One of these times the answer might be different. Is there any evidence yet of confirmed re-infection of cases of people who had earlier had infection and have had a second subsequent infection? Thank you. Dr. Maria Van Kerkhove: (13:52) Hi, Helen. Thanks for the question. It's a timely one. I think this is on the minds of, of many individuals. There are some examples of countries that have suggested that an individual may have been reinfected. It's not still not confirmed. What we need to be able to do is to look at a few things. One is the testing that's been done in an individual and how long that individual tests positive, because some people can have PCR positivity for many weeks, not just days, but many weeks. And it doesn't necessarily mean that they are infectious for that long. In fact, we know that they are not infectious for that long. There are some examples of individuals that have tested PCR positive, and then after several days, several weeks, after testing negative have tested positive again. We've had some examples in Korea and that was not an example of reinfection. Dr. Maria Van Kerkhove: (14:50) What we are trying to do in the instances where there may be an individual that tests positive again, we need to look at a few things. One is how the tests were collected, what samples were collected, the tests that were used to see if there are any issues of false positivity or false negativity and what we ideally would like is to look at sequencing. If the virus can be isolated, if sequencing can be done, so we can look and see if somebody has been reinfected. The third thing that we're looking at is the immune response that an individual has after infection. Dr. Maria Van Kerkhove: (15:22) You've heard us talk about this quite a lot. There's a lot that we're still learning. We expect that individuals who are infected with the SARS-COV-2 virus develop an immune response. We don't know for how long that immune response lasts. We don't know how strong it is or for how long it lasts. And that is something that is currently actively under development. And of course, somebody will have protection for reinfection while they have those antibodies. It's a long winded answer to say, we don't know yet, but we are actively following up any examples where this may be suggested. Margaret Harris: (15:58) Thanks very much, Dr. Van Kerkhove. The next question comes from Antonio Bruto from the... Margaret Harris: (16:03) The next question comes from Antonio Brutto from the Spanish newswire EFE. Antonio, could you unmute yourself and ask your question? Antonio Brutto: (16:08) [foreign language 00:16:17]. Interpreter: (16:14) Good afternoon. I wanted to ask about the Russian vaccine. The World Health Organization in recent days has reacted with a little caution to the announcement from President Putin. And I want to know if in recent days you've managed to have more information on the vaccine, and if you think it will be reliable, and if it can be extended to other countries? And if it's amongst the nine vaccines that Dr. Tadros mentioned in his opening statement? Thank you. Margaret Harris: (17:05) The question was about the Russian vaccine. Bruce Aylward: (17:10) Thank you very much. This is Bruce Aylward, who's heading up the hub for the ACT-Accelerator. As everyone on the call is aware, we have now dozens and dozens, well over 170 vaccine candidates that are under evaluation around the world at different stages. 26 of those have been in clinical trial, one of which people on this call will be aware, was the Russian vaccine. It was not one of the vaccines that are in the COVAX portfolio. I think there was a specific question about the nine that are in the portfolio. It does not include that vaccine or those vaccines. Bruce Aylward: (17:53) In terms, I think there was a specific question about whether or not we would see the WHO expanded use of that. We don't have sufficient information at this point to make a judgment on that. We're currently in conversation with Russia to get additional information, understand the status of that product, the trials that have been undertaken, and then what the next steps might be. Margaret Harris: (18:28) Dr. Swaninathan on the line. Do you want to add anything? Dr. Swaninathan: (18:35) No. Margaret Harris: (18:38) Dr.? No. Dr. Swaninathan: (18:38) I think that's fine, Margaret. That's fine. I don't want to add anything. Margaret Harris: (18:42) Thank you so much. The next question goes to Kai Kupferschmidt from Science. Kai, could you unmute yourself, and go ahead. Kai Kupferschmidt: (18:57) Yes. Thanks for taking my question. Very, very big picture question. I'm curious, following the WHO numbers on COVID-19, you can kind of see that globally, the numbers are leveling off. Now, I'm aware that as a pandemic, this is a lot of different outbreaks, all going on at the same time, each with its own dynamic. I'm just curious whether you can speak a little bit to the global picture at the moment. How do you see it? Do you expect the numbers globally to stay at this spot or even go down? What's the dynamic if you take the very big picture view at the moment? Thanks. Michael Ryan: (19:38) I think I can start, but Maria, Bruce and others may wish to weigh-in. I think, Kai, yes. I mean, you are right, the numbers vary from week to week, from month to month, and from geography to geography. But I think what we have to keep in mind is a very small proportion of the world's population have actually been exposed to this virus and have developed an infection, and have developed an immunologic memory to the virus. So this virus has a long way to burn if we allow it. Michael Ryan: (20:08) It may move in certain populations more efficiently, depending on behavior. It may move in certain populations, depending on whether people are spending more time inside or outside. It may return in colder periods. It may do many things. But the one thing I think we have to remember is most people, the vast majority of people, remain susceptible to this infection. Michael Ryan: (20:33) Countries I think in terms of the overall global picture, there are still a number of countries that are very much dealing with extensive uncontrolled community transmission, with all of the consequences that go with that, with pressure on the health system, preventable deaths, and all of the socioeconomic damage that goes with that, having to take a very, very strong measures to try and control the disease. Michael Ryan: (20:58) There's a number of other countries at the other end of the spectrum who have previously brought the disease under control, but are now experiencing spikes in the numbers of cases, mainly related to clusters of infection around particular events, around particular contexts, around crowds, around gatherings and other things. And they're struggling obviously to bring those clusters under control, in order to prevent community transmission reigniting. I think that's probably the key issue here. Once you get community transmission under control and you get back to clusters or sporadic cases, you have to try and keep it there, because if you take pressure off this virus, it will slip back towards community transmission. Michael Ryan: (21:41) Once community transmission takes off, establishes itself, and becomes intense, then you have all the consequences of the health system under pressure, death rates rising, hospitalizations rising. The key objective for us all is to try and suppress infection to a point where we have control at community level, and then risk manage our way through this. And we have to make some difficult trade offs; opening schools versus crowded gathering places. We need to make choices. And some of those choices are not easy. They are hard. I think that's going to be the struggle over the coming months, making good choices, governments making good choices, communities making good choices, and individuals making good choices. And that requires good information. That requires good data. That requires knowledge and being able to act. Michael Ryan: (22:31) The DG said it in the speech. He said, we have the tools. We have a number of tools that we know that work. We need to continue to apply them. We need to, as he has alluded to, and Bruce as well, we need to accelerate the development of vaccines and we need to be able to pay for a massive expansion in our capacity to deliver vaccines to everyone that needs them. Michael Ryan: (22:53) But I would characterize the global situation now, yes, we've seen a plateauing of numbers, Chi, and I know you track that every day. But this is like the cascades of a waterfall. You can go down one level and you think you're in calm water and you go over the next level, and you're in a waterfall again. So I do think we need to be very, very careful. Calm waters do not mean the storm is over. We may just be in the eye of the storm and we don't know it, so I think absolute vigilance now. Michael Ryan: (23:23) Those countries that have made progress, please retain that progress. You will lose that progress if you relent, if you become complacent. Those countries that are in community transmission, the DG keeps saying, there is always time to turn it around. Some of the countries now that have the best numbers are countries that had terrible outbreaks only a few months ago. Look at Italy. Look at what Italy has achieved in terms of its ability to control this disease. It is never too late to put this virus under pressure. So those countries that are have made progress, give us hope. But those countries who have made progress need to remain vigilant. Dr. Maria Van Kerkhove: (24:02) If I could just add, we've said it many times, but the trajectory of this pandemic in every country is in our hands. It remains in our hands. I think that we need to say that as much as we possibly can, because there is hope of countries that have been in terrible situations, as Mike has just said, that have turned it around. The trajectory is in our hands and it depends on the actions of countries. It depends on the actions of governments, of communities, of individuals. Dr. Maria Van Kerkhove: (24:28) There are many situations where we have choices where we can reduce our risk of exposure, and it is really, really critical that as societies open up, that we minimize the infections, the number of people that get infected, even among people who are at a lower risk of developing severe disease, because they may also pass the virus to somebody else, who may be of a vulnerable category who could develop a severe disease, need hospitalization and die. I that's really, really important. Dr. Maria Van Kerkhove: (24:56) I think what we're learning seven months in, is that the actions that need to be taken at the different levels to suppress transmission, to reduce mortality now, with the tools we have now, are fairly clear. It's the implementation that is incredibly difficult, and the consistency, and the vigilance, and the focus to do this, having clear plans, but localized adapted implementation is really, really difficult. Dr. Maria Van Kerkhove: (25:22) To have this done at the scale that's necessary depending on the intensity, and what we're seeing for countries that are opening up that are seeing these clusters, really quick action to stamp out and put out those individual fires where those outbreaks are happening is proving successful. As an individual, avoid the crowded places, wear a mask where appropriate, listened to your governments. If you're asked to stay home, please do so because there are many frontline workers, essential workers who are out there who are doing incredibly hard work that are keeping people alive. Everybody has a role to play, and we will say this over and over and over again, that we have control, we have power that we can play a role in this and really do everything we can to prevent ourselves getting infected, and preventing ourselves from passing it to someone else. Margaret Harris: (26:11) Thank you very much Drs. Ryan and Dr. Van Kerkhove. I'd also remind, as I said, we've got a wealth of expertise in this room and on the line. I mentioned Dr. Soumya Swaminathan. We also have Dr. Dr. Hanan Balkhy, who can talk about the therapeutics' arm of at the ACT-Accelerator, among may other topics. We also have Dr. Edward Kelly, who can talk about the health systems arm of the ACT-Accelerator. So you've got a great opportunity here today. The next question goes to Simon Ateba from Today News, Africa. Simon, please unmute yourself and go ahead. Simon Ateba: (26:47) Thank you for taking my question. This is Simon Ateba from Today News, Africa in Washington, DC. It's been six months since the first confirmed case of COVID-19 was recorded in Africa. Between then and now more than a million cases have been recorded and over 24,000 people have died. However, these cases are mainly concentrated within five countries in Africa, South Africa, Egypt, Nigeria, Ghana, and Algeria. I was wondering, do we know exactly why some countries are affected more than others? And what are other countries doing right that these five countries are not doing? Thank you. Michael Ryan: (27:34) Thanks Simon. I think there's a number of factors at play here. I think if I remember correctly, you said South Africa, Nigeria, Ghana, Egypt. What was the other one? Ghana. And if you look at those, those are very high populous. So I think Egypt and Nigeria and South Africa, probably the most populous countries in Africa. Michael Ryan: (27:56) So yes, we would expect the most cases to be in those countries because that's where we have the most people. Some other factors, South Africa would have imported disease much earlier than other countries, quite early in the course of this pandemic. The pandemic has had longer to generate it's epidemic curve in that situation, equally Nigeria as well. So some of these countries are highly connected. If you look at these countries, they're very connected through direct airline routes and others to Europe, and they may have important disease earlier. They also have a lot of family and other links with other countries. There may be elements of how the disease and when it was introduced into those countries. Michael Ryan: (28:40) Also, I would argue that paradoxically, these five countries actually have relatively strong public health systems. They have good surveillance systems, they have good national labs, and they may actually be detecting more cases than some other countries. The absence of evidence is not evidence of absence. And in this case, I think countries with stronger public health laboratory systems tend to find cases more quickly. Michael Ryan: (29:11) Equally, though, on the other side, there are risk factors associated with these countries, and that is large dense urban populations in Nigeria, in South Africa, in Egypt. Therefore, on the other side of it, there are pockets of poverty and large pockets of urban poverty in which this disease can spread much more easily. So I'd say there are factors in two directions, Simon. These countries are more at risk. These countries have larger populations. These countries have strong surveillance capacity to detect, but also there are real reasons why these countries are at higher risk given their population distribution and their dense peri-urban and urban populations. Maria, you'd like to add? Dr. Maria Van Kerkhove: (29:57) Yeah. Just to briefly add, to say, in addition to what Mike has said. I think one of the things we need to accept that in all countries, there are unrecognized cases that are not being picked up by current surveillance strategies, that are not being picked up by current testing strategies. And while Africa has done an incredible job of building and increasing and expanding testing capacity to be able to detect COVID-19 cases, it isn't evenly distributed throughout the entire continent. I think there may be unrecognized cases that way. Dr. Maria Van Kerkhove: (30:28) There's also demographic differences where you have younger populations, median age of a population is younger than some countries perhaps in Europe, in North America. And you have different prevalences of underlying conditions, which put people who are infected with the SARS Co-V virus at a higher risk of developing severe disease, therefore, possibly being detected by the health system. I think there's a number of factors there. I think in the beginning of this pandemic, we were asked this question a lot, of why aren't we seeing so many cases in this country or that country? It's a combination of factors. Dr. Maria Van Kerkhove: (31:03) I think one of the things that I find quite interesting are the results from the early serial epidemiologic studies. There's a variety of them, a large number of them that are happening across the globe, more than 100 at present. Some of the early results in Africa are suggesting that there are people who have detected antibodies, meaning that they have been infected, but they were unrecognized. They weren't picked up by the current system. And so I think we also need to look at that data as well, and perhaps they didn't develop a severe disease or they didn't develop a disease and therefore weren't picked up. Dr. Maria Van Kerkhove: (31:37) As Mike has said, it's a number of factors that are largely contributing to why we see differences in testing and differences in detection across countries. Michael Ryan: (31:47) Thank you very much, Dr. Ryan and Dr. Van Kerkhove. The next question is from Bianca Rothier from Il Globo Brazil. Bianca, can you unmute yourself and ask your question? Bianca Rothier: (32:01) Thanks lot, Margaret for taking... Bianca Rothier: (32:03) Thanks a lot Margaret for taking my question here. Bianca, I'm correspondent in Switzerland for Global News, the largest TV network in Brazil. My question is about China that announced today that chicken wings imported from Brazil tested positive for COVID-19. So what should be done in a situation like this? Can we get infected by the virus from food, including frozen food? What are the risks? What are the recommendations for consumers? The people that work in transportation of food and also in production and packaging. And of course to companies and governments as well. Thanks a lot. Dr. Maria Van Kerkhove: (32:48) So thanks for the question. I can start and maybe Mike, you would like to supplement. So yes. We are aware of the reports of these tests. What we understand is that China is testing on packaging. They're looking for the virus on packaging and they've tested a few hundred thousand samples of looking on packaging and have found very, very few, less than 10 positive in doing that. We have issued guidance with FAO on food handlers and working with food, working with frozen foods, working with live foods, to keep people safe in their working environment. We know that the virus can remain on surfaces for some time, but the virus can be inactivated on your hands if you wash your hands or use an alcohol-based rub and if the virus is actually in food and we have no examples of where this virus has been transmitted as a foodborne, where someone has consumed a food product, the viruses can be killed, like the other viruses as well can be killed if the meat is cooked. So we have issued guidance on how to ensure that people who are handling these products can work safely. Michael Ryan: (34:00) And may I just add, because I think people are already scared enough and fearful enough in the COVID pandemic. It's important that we track findings like this. And it's important that we don't discount scientific evidence where we find it. But it's also important that people can go about their daily lives without fear. People should not fear food or food packaging or the processing or delivery of food. Food is very important and I would hate to think that we would create an impression that there's a problem with our food, or there's a problem with our food chains. They're under enough pressure as it is already. We will continue to track findings like this but as Maria has said, there is no evidence that food or the food chain is participating in transmission of this virus and people should feel comfortable and feel safe. Michael Ryan: (34:53) There are many other reasons why we need to protect and we need to cook our food properly, and there are many other contaminants of food that occurs, but I think we should not be placing COVID as a risk in this area. I think it's important that we don't conflate observations like this into a major concern around food. Our food from a COVID perspective is safe, but there are many other reasons that we need to keep our food chain safe. And many, many people work very, very hard across the world to ensure that our food is safe and of the highest quality. Margaret Harris: (35:30) And Dr. Van Kerkhove. The next question goes to Michael from CNN. Michael, can you unmute yourself and ask your question? Michael: (35:40) Good afternoon from Ottawa. This is Michael [inaudible 00:03:42], I'm a contributor to CNN Opinion. There's been a lot of talk, and thank you for taking my question. There's been a lot of talk about the expected demand for the new vaccine, but as you know, anti-vaxxers have taken to social media in a big way. In fact, I'd say there's almost a virus of disinformation out there about the future of vaccine and according to a CNN poll in May, and this is quite shocking about one third of Americans said they would not get vaccinated against Coronavirus even if it were widely available and low cost. And then just quickly, I interviewed just now the Head of Rotary International, John Hewko, and he said one of the end games of COVID crisis will be vaccinations and that there will be resistance. However, there's a lot to learn from polio in terms of how to overcome the resistance. So my question is, what needs to be done? Have governments underestimated the degree of resistance? And is it too late to counter that effectively? Thank you. Dr. Mariangela: (36:48) Thank you for the question because it's absolutely important that there's work on both sides on the vaccine acceptance and also on the vaccine hesitancy and WHO takes this extremely serious. Because as you mentioned, there are already problems with routine vaccination. And we've seen that the problems are related either to mistrust on the institutions or on scientific information, but also because of the very rapid access to incorrect information that happens through social media and so on. So WHO has been working in the past years and it's intensified its work with the social media platforms to ensure that there is early detection of incorrect information and there are also people looking for information that they have access to the right sites that provide solid and scientific-based information on vaccines. But this is absolutely a work stream that WHO has taken very seriously thinking that we will need to have a rapid uptake in many countries as vaccines become available. Thank you. Dr. Maria Van Kerkhove: (37:57) If I could just add. Some of the things we're doing right now about this issue in addition to what Mariangela just said is that, we're engaging with a lot of different groups right now to discuss vaccine understanding, what a vaccine is, what a vaccine does, what it's meant to do, what it can't do. How these are being developed to be a safe and effective vaccine, even though it's a rapid development, that steps are not being skipped in terms of safety and in terms of efficacy, and also to understand acceptance and demand. And so we're working with different groups to work on communication packages, listening and so this could be worked on now as the vaccine itself is being developed. But what we understand from most countries that are communicating with us, most groups that are working with us, civil society, individuals, that most people want access to a safe and effective vaccine. So there's a lot of different avenues that we are pursuing, but really trying to increase vaccine understanding, acceptance, and demand is something that we take very, very seriously and we're listening and we're learning and we're developing those communication packages. Michael Ryan: (39:00) And maybe also, speaking to the cost of doing all of this. We need to invest in now, in a dialogue with people, with communities, in creating the conditions in which this vaccine, these vaccines we hope can be introduced in the most successful way. There are reasons for vaccine hesitancy. There are reasons for lack of acceptance of vaccines, and they range from specific fears about the vaccine to distrust of government. There are many different reasons. And Bruce has vast years of experience in polio, overcoming issues and misunderstandings and misinformation. Spent many years at it myself. If you think about Congo, Eastern Congo in the last year and a half, we were using an investigational use vaccine, brand new vaccine in a population, in the middle of a highly conflictual situation with a very disrupted society. Michael Ryan: (39:55) And through the work that we, UNICEF, the government, and others did with communities, we had 97% acceptance of vaccine amongst eligible people for that vaccine. That's incredible. That's a great testament to the people of Congo, to their understanding, to their acceptance. But it's also a two way street. There must be a dialogue. People need to be allowed to have a conversation about vaccines and have a proper conversation. And it's not a one way street. It's not about shoving things down people's throats. It's about having a proper discussion, good information, a good discussion on this, and people will make up their own minds. And I think science and government have a job to do. And that is to make the case. I think communities and people have a job to do, which is to listen to that case. And hopefully the result of that will be a widely accepted, successful vaccine that could bring this pandemic to an end. Bruce. Bruce Aylward: (40:51) Hi, thanks Mike. And Michael, thank you for the point. I don't want to belabor it because others have covered the big points. But first, no one's underestimating this. And one of the ways and things that we're doing to address it also is to make sure that we're putting together an integrated package of tools. And that's what the ACT-Accelerator is all about. We all want a silver bullet but we want to make sure we have multiple ones. We need better, faster diagnostics, we need therapeutics, we need the vaccines. Not everyone may use a vaccine. It may not work in every one so we need the other tools and as Mike has been emphasizing, we need those tools now, especially the diagnostics to be able to get the massive step change in terms of the coverage of folks who, number one, know their status, whether or not they have the disease. And number two, whether or not they're still shedding and they're isolated properly. Bruce Aylward: (41:42) So that's the reason. And again, one more of the arguments as we do all these pieces, to work now, to be prepared for optimum uptake, that we also have the other tools. Maria made the point, but it's another thing to emphasize. One of the key things we're trying to do with the accelerator is to move in parallel, things that we would normally do in sequence. Normally we do the research and development, then we do the manufacturing and then the prequalification, then we work on the delivery issues. But in this, again Maria, I think you referred to it, we're trying to do all of those almost in parallel. That's why we need the money up front, that's how we're going to be successful. If we do all the work on the RnD, we don't have the resources to do this community preparedness work exactly as you're speaking to, we won't be as successful as we want to be, we won't get the coverage that we need, and we won't stop this as quickly as we could with the new tools that are coming online. Margaret Harris: (42:41) Thank you very much Dr. Aylward, Dr. Simao, Dr. Van Kerkhove, and Dr. Ryan for all those fantastic answers. The next question goes to [inaudible 00:42:50] please unmute yourself and go ahead. Speaker 1: (42:51) Okay. Thank you for accepting my question. My question is still about the vaccine. So WHO has always been promoting the equal distribution of vaccines. So now I want to ask, how many countries now have publicly declared that if they have an effective vaccine against COVID-19 being developed and they will treat it as a public good for the world? And what are the positions of the major countries that now have most developments in the vaccine research? Thank you. Margaret Harris: (43:34) I think this is a question for Dr. Mariangela again. Dr. Mariangela: (43:38) Thank you for the question. That's a very hot discussion at the moment because we're talking about a vaccine, a safe and effective vaccine being a public health good. And we are talking about ensuring that there is equitable access to the technologies that are developed and that they reach all countries that they benefit, populations in all countries, not only a high income country. We're going through a moment where we see that some countries are doing bilateral agreements with companies, but at the same time, we have a global movement. We are working together with international organizations, WHO, with The Vaccine Alliance, Gavi, and we're working together, discussing with the member states, the organization of a global facility and this global facility will be a pull mechanism to procure, invest in vaccine candidates and ensure that countries who are participating, it's open to all countries, will have access to the vaccines once they prove to be safe and effective. Dr. Mariangela: (44:51) So far, we have 167 countries already engaged in this process. So I think it's very reassuring that we have such a global commitment towards ensuring that once that technology is available, that there would be a commitment to ensure that equitable access on a timely fashion, that all countries are reached by the vaccines. Margaret Harris: (45:21) Thank you. Thank you very much, Dr. Mariangela Simao. We'll now move to the next question. We've only got time for a couple more questions because we've got a hard stop at 6:30. The next question goes to John Miller from Reuters. John Miller: (45:39) Hi, thanks very much. YAs we look around the world, we see a lot of unilateral deals between companies and countries for vaccines. And we heard earlier this week Dr. Tedros talking about only being about 10% of the way towards the ACT-Accelerator goal, including the COVAX component of that. And I'm wondering, do you have concern that these unilateral deals, whether it's between Switzerland [inaudible 00:46:05] or the US or Europe, that they are competing with efforts on a multilateral level to address this problem and perhaps in a more comprehensive way. Thanks. Bruce Aylward: (46:18) Thanks so much for the question. And it relates a little bit to the question that we just heard. It's an interesting situation we're in, when we first started talking about vaccines, of course against this disease, everybody was quick to say, it's so important that we have enough of these products and we equitably distribute these products. But then of course, we've seen a lot of, as you just mentioned, of countries now moving forward on bilateral, we call them, or multilateral deals to try and secure access for their populations. And the motivations behind that at a certain level, of course, they can be understood. Bruce Aylward: (47:02) What's interesting now and it's a little bit the point that Mariangela just spoke to is, over the last couple of months, there's been an increasing recognition among countries that it is not enough to vaccinate their own populations, and they're also recognizing that they don't need to vaccinate their whole populations immediately to get the biggest bang potentially from these vaccines. And what we're seeing more and more is that even, in fact, it was just over the last few days, even weeks, we're seeing countries that have set bilateral and multilateral deals coming to us and saying, "Look, how do we work with you to make sure that we're part of a solution that ensures that this rolls out simultaneously to the world?" Like the Director General said, there's self-interest in this as well as the moral case for it because there's a recognition, we cannot get the global economy moving again, we cannot get travel, trade- Bruce Aylward: (48:03) I mean, he's moving again. We cannot get travel, trade, transportation. The world is just too interlinked and what we've got to do is get pressure off the health systems because that's been what the real drag on the economies have been in the course of doing that will save lives. And we can do that again a little like Mary Angela mentioned by vaccinating a proportion of the global population together, much more effectively than if we were to try and do pockets of it completely one at a time. And it's been encouraging and just striking how many countries that are doing deals. And on the other hand, remember, as countries are making deals and the rest are sending very loud messages that they want these vaccines, and then manufacturers have a whole new confidence that they need to expand their capacities. They need to produce more of these products, produce more of it at risk. Bruce Aylward: (48:56) So the key thing at this point is how do we harness all of those investments into a global solution? And that's what the director general was speaking about. It's the time now that we have heard evidence that the best solution is to roll this out simultaneously. Globally, every economy is interlinked today. It just will not work otherwise and as we move toward that, now it's the trying to work out, okay the nuts and bolts. If you've bought a lot of vaccine over there, how do we work with you to make sure that that can be part of a global solution? And that's really where we are. And remember, we have some time to sort this out. We hear a lot of panic about buying and deals, et cetera, but we have a couple of months to work together as a global community to find the solution to this so we roll these out in the way that's going to be most effective. Bruce Aylward: (49:50) So a global solution where we're all pooling our risks pooling, our procurement would be the ideal. If we do separate deals, then it is how do we coordinate these so that we don't prejudice any part of the world in a way that's ultimately going to be detrimental to everyone, even those who work to try and vaccinate their own populations completely first. So yeah, perhaps I'll leave it at that. But Mariãngela, you've been a big piece of this work, have you not? Dr. Mariangela: (50:24) I think that the fact that if you are betting in one or two candidates, we have around 200 vaccine candidates at the moment. So what's your best bet. Now we don't have any, any, any of the vaccine candidates has finished the clinical trials yet. So we don't know which one will be the front runner, which one will actually prove to be safe and effective. So we are encouraging countries to join a global facility because we will have access to more candidates and you have a better chance to actually have concrete access be able to procure one of the successful candidates. I think this is the main issue. Bruce Aylward: (51:12) I'm sorry, I'm just going to come back on it for one second because again, the director general in his comments, he mentioned some numbers that are so staggering, right? $10 trillion in global stimulus financing, a fiscal stimulus, financing to deal with the consequences of this disease, not even the causes. And the kind of numbers that we're talking about to try and roll out a global solution are a fraction of that. So again, coming to the points that we were discussing earlier, countries are recognizing that. They're recognizing that if we don't get a global solution, there's got to be waves of global set of fiscal stimulus financing needed to try and get out of this crisis, similar to what happened with the global financial crisis and that's the situation that nobody wants to be in. Bruce Aylward: (52:04) So I think all of these factors are coming together. I'm sorry. I can't remember the name of who has asked the question, I apologize, but it's a fantastic question. We have an opportunity. We have a window. And so now it's aligning all of these deals so that they roll out with the right timing. It's not who bought the vaccine almost. It's how they use that vaccine in a globally coordinated manner for a global solution to a global crisis. Margaret Harris: (52:31) Thank you so much, Dr. Aylward and Dr. Simão for those fantastic answers. We're really running out of time. So last question, we go to North Africa to Morocco, and the question is from Ul-Hassan Abdallah from Moroccan News. Ul-Hassan, please unmute yourself and ask your question. Ul-Hassan Abdallah: (53:00) Thank you for giving me the floor. I'd like to ask her about the number of cases in Morocco, where more than 1,400 cases are registered every day or even more. Since the implementation of policies in the country, how can you explain these numbers in Morocco? Thank you. Margaret Harris: (53:24) Thank you. Shukran. I think this question will be for Dr. Ryan. Yes. So your question was about the number of cases and what the country should be doing about it. Michael Ryan: (53:47) Yeah. I'm just trying to get the exact numbers. Sorry. Forgive me for Morocco. Maybe Maria, you can start Dr. Mariangela: (53:55) According to our data as of Dr Maria Van Kerkhove: (53:58) Yesterday 35, 195 cases, new cases in the last week, almost 8,000 cases in the last week, Dr. Tedros: (54:10) Maybe to, and the number of deaths I think is 556. And I think if you see the situation, it's not the number of cases, but that trend is on the increase, both in the number of cases and deaths. So I think Morocco should do more, especially to reverse the increasing trend that we're seeing now. Compared to many countries, actually, if you see the number of deaths, it's low, but with the increasing trend, it may, if it continues to increase, it may get serious. So our advice is with the increasing trend to be more aggressive in the interventions that they take tailored to of course, the Covid situation at the sub national levels and below, and tailored action can be taken in areas where there is more contribution of cases, because we don't think that the situation is very even throughout the country. Dr. Tedros: (55:34) So they can focus where the concentration of cases is and where especially the new cases are coming from. But the last August, that week of August 3 is the highest since the outbreak actually started in terms of number of cases, which is almost close to 7,000 in a week, which is the highest number of cases reported. Michael Ryan: (56:04) If I can supplement as well. The numbers for example, across the Eastern Mediterranean, North Africa and Middle East. Numbers in places like Saudi Arabia, Pakistan and others are falling in the Gulf countries. We certainly seen rapid increases in Morocco, in Lebanon, unfortunately, and that's a big concern in the aftermath of the explosion there, the rising number of cases in Lebanon and the stress that the health system was under. But similarly in Syria and Iraq, and of note in the last 24 hours, Iraq has the most cases, new cases reported from the Eastern Mediterranean region. Michael Ryan: (56:46) I believe that's the first time where Iraq has had the top number of cases for that region. So I think we're seeing a very dynamic situation in the region. Morocco's also had some previous issues of clusters of infections in prisons and other places and again it shows the difficulty when you get close to as established in certain areas in certain groups, you may end up with those clusters extending into full blown community transmission. So Morocco is not alone in North Africa or in the Eastern Mediterranean with an increasing trend of cases. And as the DG says, every country now needs to double down examine what it's doing, where it's doing it at national and sub national level and effectively use the tools that we do have and Morocco has. If you go back over the last number of months, actually Morocco had a very low level of disease right through the early parts of this pandemic. Michael Ryan: (57:40) So there's no question that Morocco has the capacity to do that. Every country has had to contend with flare ups. Every country has had to contend with this disease bouncing back. Question is not, does the disease bounce back? The disease bounces back. It happens. It's a virus. It exploits, weaknesses and gaps in our system. The real test is how do we react? How do we respond as a government, as a community, as a society and as individuals to that reality. And I think that's what we would ask each country to do. Don't lose hope when the disease bounces back, don't blame others. Take action. Everyone takes action together in response to a jump in disease, then the disease will go away. It will be pushed away. I think in too many countries, we tend to look for scapegoats. Michael Ryan: (58:23) We tend to look for whose fault is it that the diseases back, who made a mistake? In an emergency response, there's no time for that. It's a time for action. When the emergency is over, you sit down and then you say, okay, who did what, who was slow, who was fast? And during an emergency, we need everyone to act together and act quickly. And I think Morocco has demonstrated right away through this pandemic it's capacity to keep disease at a low level. Morocco needs to get back there again with many other countries who were in a very similar situation. Bruce Aylward: (58:59) Thanks. Just to Mike's point, this really comes back to what Kye asked earlier about this leveling of virus that we're seeing globally. I mean, what we're actually seeing and as Mike talks about all the time is two factors. The first is the scale of the susceptibility in the world. The vast majority of the population in the world is susceptible to this disease. The second thing that we're seeing is the stringency of the application of control measures is dropping. People are coming closer together. As Marie has been talking about masks aren't being used always as the way that they should, et cetera. And so any leveling of the disease that we're looking at is just lulling you into a sense of false security because this disease like Mike's been emphasizing has lots of space to still cause trouble. When it does level, we have to take advantage of that opportunity to really get the testing in place, get the isolation capacity in place, get the contact tracing and quarantine working because the vaccines are not going to be here tomorrow, but the virus is here today, which means we've got to use the tools we have today, or we're going to see these flares just like our caller from Morocco emphasized. But there's so much that can be done long before we have a vaccine. Margaret Harris: (01:00:25) Thank you so much. And on that important note of hope and action, I will close the press conference. Remember we will post the audio files and we will send, also post a copy of the director general speech. Now I'll hand over to the DG Dr. Tedros for final words. Dr. Tedros: (01:00:44) Yeah. Thank you so much. So thank you to those who have joined today and see you on Monday on our upcoming or next presser. Thank you.