World Health Organization (WHO) Coronavirus Press Briefing Transcript December 11

Fadela Chaib: (03:04) Hello, everybody. I am Fadela Chaib, speaking to you from WHO Headquarters in Geneva and welcoming you to our Global COVID-19 Press Conference today, Friday, 11th December. Present in the room is the WHO Director General, Dr. Tedros, Dr. Mike Ryan, Executive Director, Health Emergencies, Dr. Maria Van Kerkhove, Technical Lead for COVID-19. Dr. Ed Kelly, Director, Integrated Health Services, Dr. Bruce Aylward, Special Advisor to the DG and who leads on ACT Accelerator. Joining us remotely are doctor Sumia Swaminathan, our chief scientist, Dr. Kate O'Brien director, immunization, vaccines and biologicals, and Mr. Joe Cudson, who leads the WHO health financing team at WHO. Welcome all. Simultaneous interpretation is provided in the six official UN languages plus Portuguese and Hindi. Now, without further delay, I would like to hand over to Dr. Tedros for his opening remarks. Dr. Tedros, the floor is yours. Dr. Tedros: (04:25) Thank you. Thank you so much Fadela. Good morning, good afternoon, and good evening. This week, vaccines against COVID-19 have started to be rolled out in the United Kingdom, and we expect more countries to follow. To have safe and effective vaccines against a virus that was completely unknown to us only a year ago is an astounding scientific achievement. But an ever greater achievement would be to ensure all countries enjoy the benefits of science equitably. WHO and our partners are focusing on three priorities. First, we face an immediate funding gap of 4.3 billion US dollars to procure vaccines for the most needy countries. I urge donors to fill this gap quickly so that vaccines can be secured, lives can be saved and a truly global economic recovery is accelerated. Second, we have worked hard to secure political commitment from world leaders for equitable access to vaccines, but we would like to see that commitment being translated into action. Dr. Tedros: (05:49) And third, we're preparing countries to deliver vaccines by assessing gaps in infrastructure. Already almost 1 billion [inaudible 00:06:01] of three vaccine candidates have been secured as part of the COVAX facility. And 189 countries are now participating. Our COVAX partner, Gavi is in discussions with several other manufacturers and further deals will be announced in the near future. Simultaneously, WHO is working with Gavi and UNICEF to evaluate the first set of requests received from countries who are eligible for assistance through the COVAX facility. Addressing the financing gap is an urgent priority. Dr. Tedros: (06:40) On Monday, WHO and the European Commission are reconvening the facilitation council for the ACT accelerator without co-chairs Norway and South Africa. The council will scrutinize our strategic priorities and the draft financing framework to close the ACT accelerator financing gap for 2021. This is crucial to ensuring all people everywhere are protected. We have all seen images of people being vaccinated against COVID-19. Dr. Tedros: (07:19) We want to see the same images all over the world, and that will be a true sign of solidarity. Yesterday was Human Rights Day and tomorrow is Universal Health Coverage Day. These two days coming so close together at the end of this very difficult year are a reminder that as we rebuild from this crisis, we must do so on the foundation of human rights, including the rights to health. 2020 has reminded us that health is the most precious commodity on earth. In the face of the pandemic, many countries have offered free testing and treatment for COVID-19 and promised free vaccination for their populations. Dr. Tedros: (08:18) They have recognized that the ability to pay should not be the difference between sickness and health, between life and death. This year Universal Health Coverage Day takes on even more importance than usual. Apart from the death and disease caused by the virus itself, millions of people have suffered and died as a result of disruption to essential health services. Dr. Tedros: (08:48) This week, WHO is launching two initiatives to support and rapidly accelerate countries' journey toward this universal health coverage. The first is a global program to strengthen primary health care, better at keeping countries to prevent and respond to emergencies of all kinds, from the personal crisis of a heart attack, to an outbreak of a new and deadly virus. The second is a new UHC compendium, designed to help countries develop the packages of services they need to meet their people's health needs. Dr. Tedros: (09:29) WHO is also launching a new report that provides the first analysis of how global health spending has changed during 2020 in response to the COVID-19 pandemic. Many governments have responded to the pandemic with exceptional budget allocations for their health systems and even larger allocations for economic stabilization and social products. At the same time, COVID-19 has triggered a deep global economic crisis that could have a long lasting impact on health financing. Dr. Tedros: (10:08) Public revenues are declining, forcing many countries to take on additional debt, which will impact lower income countries whose economies were vulnerable before COVID-19 struck. The report warden is that high debt servicing could make it more difficult to maintain public spending on health. But this is precisely the moment for investing in health. The pandemic has demonstrated that held is not a luxury, it is the foundation of social, economic and political stability. Indeed, today's report highlights that COVID-19 crisis provides an opportunity for a reset in countries with weak health financing systems. It makes six key recommendations for a new health financing compact. To draw more attention to inverse our health coverage, we have also made it one of the main categories in the second WHO Health For All Film Festival. We're inviting all filmmakers, whether professional or amateur, to submit short films, focusing on access to quality care for any health need by the 30th of January, 2021. Dr. Tedros: (11:33) Several hundred films have already been submitted, and the two other categories for the festival are health emergencies, in which we invite short films about COVID and other humanitarian crisis. And better health and wellbeing in which we invite films about climate change, pollution, sanitation, nutrition, gender issues, and more. We know that although children are less at risk of severe disease and deaths from COVID-19 than older adults, millions of children have suffered from the pandemic in other ways, including disruption to their education. Dr. Tedros: (12:21) According to data collected by UNESCO, classrooms for nearly one in five school children globally, or 320 million, were closed as of the first December, an increase of nearly 90 million in just one month. In some places, children have been out of school for nine months or a more. Prolonged school closures are being presenting an unprecedented challenge to children's education, health, and wellbeing. Today WHO has released a new checklist to support schools in reopening and in preparing for resurgences of COVID-19 and similar public health crisis. It lists 38 essential actions, a new checklist to support schools in reopening and in preparing for resurgence of COVID-19 and similar public health crisis. It's lists are essential actions to be considered by different stakeholders as they work together to agree the school reopening plans. Dr. Tedros: (13:33) More than 66 million cases of COVID-19. And 1.5 million deaths have now been reported to WHO. In the past six weeks, the number of weekly deaths has increased by around 60%. Most cases and deaths are in Europe and the Americas. The festive season is a time to relax and to celebrate, but we must not relax our guard. Celebration can very quickly turn to sadness, if we fail to take the right precautions. As you prepare to celebrate over the coming weeks, please, please consider your plans carefully. If you live in an area with high transmission, please take every precaution to keep yourselves and others safe. That could be the best gift you could give the gift of health, life, laugh, joy, and hope. I repeat, the gift this season, the best gift this season you could give is the gift of health, life, laugh, joy, and hope. I thank you. Happy holidays. Fadela Chaib: (15:11) Thank you, Dr. Tedros. I will now open the floor to questions from members of the media. I remind you that you need to raise your hand, use the, raise your hand icon in order to get in the queue to ask your question. I think we will start with Laurent Hiro, from RTS Swiss News Agency. Laurent, can you hear me? Laurent: (15:40) Yes. Thank you, Fadela. Can you hear me? Fadela Chaib: (15:43) Very well. Go ahead, please, Laurent. Laurent: (15:45) Yeah. Very good. We have observed in the recent weeks, a trend downwards in countries like Switzerland and some of its neighboring countries. But then more recently, since one week, there is a kind of plateau at a high level number of cases, despite strong measures that have been taken by the different governments. So how do you explain that? Thank you. Fadela Chaib: (16:16) Thank you, Laurent. I would like to invite Dr. Van Kerkhove to take this question. Dr. Van Kerkhove: (16:20) So thank you for the question. And indeed across many countries in Europe, we have started to see a decline in cases. And I think that's a result because of the measures that have been put in place and individuals who are adhering to those measures. But as you said, it's starting to plateau in some locations. And what this means is that we need to stay the course. We need to follow through, we need to continue to practice the physical distancing, staying home if being asked, teleworking. Following all the measures that are put in place to keep ourselves safe. Whether these are individual level measures, such as physical distancing, the wearing of masks, cleaning your hands, practicing good respiratory etiquette. Whether you are asked to stay at home, continue to stay at home, but we have to follow through. Dr. Van Kerkhove: (17:06) I think one of the lessons we can learn, especially across Europe is over the summer, Europe showed us that they brought transmission under control. In many countries, cases were down to single digits and that can, and that will be done again. But we really must be vigilant and we really must stay the course. Given the holidays that are coming up as the director general just said, it is a time when many people want to come together, but we really need to make very careful decisions about how we celebrate this year. Dr. Van Kerkhove: (17:35) We will celebrate, but maybe it means we celebrate with just our household. And maybe we do another type of Zoom celebration as we will do with my family this year. But we do need to stay strong and we do need to make that we keep ourselves separated from others for the time being, while we have the good news of vaccines coming online. But again, just to repeat, we need to stay the course. It's very easy for us to go up quickly in case incidents. It takes quite some time to actually come down the other side of the mountain that you've heard Mike say in the spring. So we have to follow through, but we will do it. Europe will do this again. And they will show us how to bring it under control. Dr. Ryan: (18:20) I think Maria, you're absolutely spot on. I'll just repeat two of your words. Follow through. Make sure this time we follow through on the measures. We continue to build public health surveillance. We continue to work with communities to maintain those measures around physical distance, personal hygiene, avoiding crowds. And then we add vaccines gradually in the coming year, we can avoid the lockdowns. So, this is about us all following through on our commitments, both as individuals, as communities and as governments in the coming months. Fadela Chaib: (18:59) Thank you. I would like now to call on Jason Bobbia from- Fadela Chaib: (19:03) I would like now to call on Jason Bobbia from NPR to ask the next question. Jason, are you with us? Jason: (19:08) Yes, thank you very much. As you mentioned, Dr. [Tedros 00:00:12], that the UK has now started vaccinating and the US appears to be on the verge of authorizing the Pfizer vaccine. And you talked about the need for equitable distribution, but obviously that distribution can't start in many places until the WHO authorizes the vaccine. Can you give us an update on when we can expect the WHO to authorize a vaccine that can start being distributed through COVAX? Fadela Chaib: (19:35) Thank you, Jason. We have with us remotely, Dr. O'Brien and Dr. Soumya Swaminathan. Kate, do you want to start? Or Dr. Swaminathan. Speaker 1: (19:53) I don't think it is connected. Fadela Chaib: (19:56) Okay, Dr. Swaminathan, you have the floor. Dr. Swaminathan: (20:00) Thank you Fadela, I guess I can start. So the WHO has put out a criteria for emergency use licensing, and we are open to receiving submissions from all manufacturers who are interested, in fact, we have received several and it's a rolling submission. So as more data is accumulated from the different phases of trials, it's provided to WHO so that we're up to date, and we can stay as updated as possible, and we are now going to be looking at the Pfizer dossier followed by a couple of others as they come in, and we expect that... We work very closely with the European Medicine Agency along with some of the other national regulatory agencies, and so we expect that in the next couple of weeks that our committees will be reviewing the Pfizer BioNtech dossier and coming out with an opinion. Thank you. Fadela Chaib: (21:07) Thank you. I think Dr. Ayiward would like to add something. Dr. Bruce Ayiward: (21:10) Yeah, thanks so much. And Jason, thanks for the question. Super important. When we established the COVAX facility to make sure that there would be absolutely no barriers to the most rapid access to vaccines possible for all countries in the world, we're actually using a slightly different process and we are indeed looking at these products through the WHO emergency use listing procedure, and at the same time, we have an exceptional procedure in place where some products that are approved by what we call a stringent regulatory authority can also be considered by the COVAX facility. So there will be no barrier to the speed with which these products could potentially be used globally. Fadela Chaib: (21:57) Thank you. I would now to call on Isabel [Sako 00:22:02] from FA, the Spanish News Agency. Isabel, you have the floor. Isabel: (22:13) Good afternoon. Yes, I had this more or less the same question as the previous one. I would like maybe to do ask again Dr. Soumya can identify the vaccines, the candidates that the WHO is reviewing, and if for the general public, if she can explain the importance of these review by WHO, we all know that there are many other regulatory and national agencies that are doing the same procedure. Thank you. Fadela Chaib: (22:56) Thank you, Isabel. Dr. Swaminathan. Dr. Swaminathan: (23:01) Yes. Thank you for that question. Indeed it's a bit confusing because as you rightly pointed out, national regulatory authorities do have the mandate and the jurisdiction to make these assessments and decisions for use within their own countries. So every national regulatory authority has the authority and the mandate to do that, but that's limited to their own countries. Now, several countries rely on WHO's pre-qualification service for vaccines and for drugs, and that's a service that the WHO provides also for global procurement agencies like UNICEF and GAVI, because it's a stamp of quality, safety, efficacy, and manufacturing quality. Dr. Swaminathan: (23:50) In the case of the emergency use license, of course we base this assessment on limited amounts of data, and that's clearly laid out in the criteria. So what should be the minimum efficacy? What's the minimum safety required data that's needed as well as of course, all the manufacturing details around the quality of the product. Dr. Swaminathan: (24:14) So as I mentioned, we had opened the expressions of interest several weeks ago. I think it was about four to six weeks ago, and we have been receiving both inquiries as well as submissions of dossiers from several companies. At least 10 companies have either expressed an interest or submitted initial dossiers. Now, the data will only be considered for an emergency use license when there is some phase three clinical trial results available and so there are only a couple of companies now that have those phase three results and those are interim results, and so we've started with the Pfizer dossier. We expect also to have the Moderna followed by the AstraZeneca dossiers examined in the next few weeks, and we will be coming out with the decision whether it is receiving an emergency use license or not. Dr. Swaminathan: (25:16) The other thing that we are doing is of course working with the regulatory agencies, the International Coalition for Medical Regulatory Agencies, the ICMRA, which we have a letter agreement now on how we would work together so that we can speed up things further. We have regulators from several countries actually who have stepped up and volunteered to help the assessments the WHO will be performing. So these will be joint assessments done with the national regulatory agencies, and we have asked countries also to prepare for licensing of vaccines by either accepting the WHO, EUL or PQ procedures, or by accepting one of the stringent regulatory authorities as Bruce was just mentioning so that they are in a position to receive vaccine doses from the COVAX facility. They have to accept either of these, what we don't want is for every country to start an assessment process for every vaccine, because that's just going to take far too long. And so therefore it is important to rely on a few regulatory agencies globally plus the WHO process. Thank you. Fadela Chaib: (26:27) Thank you, Dr. Swaminathan, Dr. Edward Kelley would like to add something. Dr. Edward T. Kelly: (26:31) Yep. Thanks Fadela, And just to compliment of the points made by Soumya on this. One of the pieces of work certainly is getting the vaccine through the regulatory process and getting it reviewed here at WHO. But as we've always said, it's not vaccines, but vaccinations and vaccination programs that will end up protecting people, and there's tons of work going on right now. In fact, the entire act accelerator in many ways as the person doing a lot of the work on the health systems connector has pivoted to support the assessment in countries. We were targeting 100 countries, we have now got 105 assessments already in, and the picture of what is going on and how countries are preparing, not just on regulatory work, which does need some more work on, but also on safety monitoring systems. We've got over 65% of countries that already got safety monitoring systems in place. So all of that work will be as important as the work that Soumya just mentioned. Fadela Chaib: (27:31) Thank you. I would like now to invite Jeremy [inaudible 00:27:35] from Radio France International RFI to ask the next question. Jeremy, do you hear me? Dr. Tedros: (27:43) Yes, I can hear you Fadela. Thank you so much. A question about testing. A lot of people are thinking about getting tested ahead of Christmas. In France, the health minister advised against it saying that it might provide a false feeling of safety. I would like to know what is WHO? Do you have any comments on that? Do you advise against or for testing before Christmas? Thank you. Dr. Ryan: (28:18) We certainly advise that all patients who are suspected of having COVID-19 are tested and that we expand testing, particularly the use of rapid diagnostic tests in specific circumstances. Maria can go into details about how we see the strategic expansion of testing. But we need more testing, not less. I think the minister may have been relating to the specific issue of individual risk. Finding as many infected people in the community is very important, but when you get a test and you test positive or negative on a certain day, it doesn't mean you will test negative the next day or the next day. Dr. Ryan: (28:58) So doing more testing to find the infected people, yes, good. Relying on a single test to guide your behavior in the coming days or who you can meet, or what you can do is problematic because knowing your status today does not guarantee your status tomorrow. So we must sustain the behaviors of physical distancing, wearing masks, avoiding crowded spaces, ensuring we're using appropriate ventilation, and doing all those things to minimize risk in those environments. That does not mean that targeted strategic testing is not a good idea, we want to see an expansion of testing, but we want to see it done for public health purposes. Dr. Ryan: (29:34) Individuals who have the resources to have their themselves tested, there is nothing wrong with getting a test. It's really how you interpret that result and how that affects your behavior, and how it should or shouldn't affect your behavior. Maria. Dr. Van Kerkhove: (29:51) Yeah, thanks. Just to supplement what Mike has said. We encourage, we advise, we recommend strategic testing. We have since the beginning. And anyone who meets a suspected case definition should be tested. We've worked very hard through our regional offices and our country offices to build testing capacity. This has been a PCR based testing capacity, and now all countries are able to test for COVID-19, test for SARS-CoV-2 infection, the virus that causes COVID-19. And that is really quite and incredible feat. Dr. Van Kerkhove: (30:20) We now have antigen based rapid diagnostic tests that are coming online. These are cheaper, quicker, easier to use, and we recommend these to be used in areas where there's a lot of virus circulating, where there are outbreaks that are happening, in areas, potentially screening individuals like health workers who are at a higher risk of exposure because they have direct contact with known patients, and those are really helpful to alleviate some of the pressure on the PCR based system. Dr. Van Kerkhove: (30:48) But testing for testing's sake must be linked to public health action. It must be linked to isolation of cases, clinical care of cases, contact tracing, supported quarantine of those contacts, and as Mike has said, a test result gives you the results of that sample that was collected at the time of testing. You could become infected between the time that you took that test and the time you get that result back, which is why it's really important that you not only get tested with a high quality either a PCR test or an antigen based test, but that you get that result back quickly. Dr. Van Kerkhove: (31:25) And you follow through with the public health actions that are there. So in some countries, testing will be expanded, and this is good, and we have seen a global expansion of testing, but again, it needs to be fit for purpose. It needs to be linked to cluster investigations and case finding, and making sure that you're working towards your goal of reducing transmission, and you're breaking chains of transmission. Dr. Van Kerkhove: (31:48) So there are good products that are coming online. These rapid antigen based tests are a game changer in many ways, because they could be used in lots of different settings and take the pressure off of the PCR systems. But again, we still, all of us need to adhere to all of the measures that keep ourselves safe and keep our loved ones safe. So keep up that physical distancing, keep following all of the measures that are put in place in the local area where you live, which is based on the transmission that's happening around you. Fadela Chaib: (32:17) Thank you. Moving now to Cancun in Mexico. I would like to invite Polina Alcazar from [Kadina 00:32:27] news to ask the next question. Paulina, do you hear me? Speaker 2: (32:32) Yes, Fadela, can you hear me? Thank you. Good day to everyone from Cancun. What considerations should be taken in account with a high number of reinfections or is it considered as a long COVID or a persistent COVID when someone is positive again at a test several months later. What do we consider it as? Dr. Van Kerkhove: (33:03) So thanks for the question. There's two aspects to the question that you've asked. One is about reinfection, and then I think the other one is about long COVID. So these are two separate things, and let me just break them down very briefly. So we do know that there are some individuals who can be reinfected with this virus, and this is being detected in a number of countries that have good lab systems that have been able to do a sequence of the first infection, and a sequence of the subsequent infection, the second infection, and they can tell that there's a difference in that virus, slight difference because the virus changes and that is an indeed a subsequent infection. Dr. Van Kerkhove: (33:40) This is now starting to be picked up in a number of countries, and we have more than 69 million cases that have been reported globally. But the number of reinfections is a lot smaller than that. We're working with countries to help them better define what a re-infection is and to help them look to see how often this is happening. So it doesn't seem to be happening very often, but we can't quantify that at the current moment. Dr. Van Kerkhove: (34:06) The question around long COVID is that there are individuals who have been infected with the SARS CoV-2 two, they have an acute disease where they're very unwell or they're mildly unwell, and then they seem to slightly recover, but they're having longer-term effects. We are learning more and more about what long COVID is. In terms of the effect on the body, it seems to affect many different organ systems. It's not just a respiratory illness of two weeks, it seems to persist for months. We're working with many different patient groups. We're working with many different researchers to really better understand what is happening. Dr. Van Kerkhove: (34:47) We have met, and the director general has met with patient groups and the patient groups have said to us what they need is recognition that this is real, and this is real. And there is now an ICD code for post COVID syndrome, it's called. We're working with them because we need better research to understand the extent of this in different populations to understand what disease looks like in terms of the longterm effects and the different effects on the organ systems and also rehab. Dr. Van Kerkhove: (35:16) So we're working with clinicians to better design and work on rehabilitation for individuals who are suffering from this to ensure that we give them the best care possible. So we have a lot to learn in this area. There was a forum that was organized this week by ISAK and partners, which WHO participated in, and we have seminars and working groups that have been established specifically to look at this so that we can provide adequate care. Dr. Ryan: (35:45) I wonder if we could just emphasize what Marie has been saying. It is best that we all try to avoid this infection. It's better not to have to be concerned about your health going forward. Also to reassure people, yes, the vast majority of people do have an infection that doesn't result in the ongoing specific effects, but there's a significant minority of people who are suffering very, very long into a post COVID period, and our hearts go out to them as they approach this Christmas period because... And sometimes in life, mortality and death is recognized and we all sympathize. It's very hard when you're carrying the aftereffects of an illness, it can be a very lonely experience and people don't want to attract attention to themselves because people may think I'm infected and I'm still coughing. Dr. Ryan: (36:36) So people are going through a lot of psychological trauma as well as having those lingering effects. So I think we should all be very kind to each other and particularly kind to those who've had to fight through very difficult infections and have the continued concern of the long-term impacts on their family. And to our journalists I would say, given the weather here today in Geneva, we would love to be with you in Cancun. Fadela Chaib: (37:00) True. So let's go to Georgia. I think it's cold in Georgia. I would like to invite a journalist from a Georgian television, Imedi, [Katie Wancardova 00:00:37:14] to ask the next question. Kate Wan, are you with us? Speaker 3: (37:21) Good evening. Can you hear me? Fadela Chaib: (37:23) Very well. Go ahead, please. Speaker 3: (37:25) Thank you very much for this opportunity, Mr. Director General. When you were talking about vaccine, you said recently that a beam appeared at the end of the tunnel. How bright is it really today, can you tell us? As I represent Georgia, I want to ask you about Georgia. Thousands of people are infected in my country every day, and what would you say to the population of Georgia? They are watching your statements carefully every week. And also I have a- Speaker 3: (38:03) ... week. And also I have a question about information campaign, how should information campaign about vaccination should be conducted so that the people have confidence in the vaccine. We all know that a vaccine will be effective in the case when people have confidence and trust in it. Thank you very much. Fadela Chaib: (38:28) Thank you. These are three questions. So maybe Dr. Aylward would like to start. Dr. Bruce Ayiward: (38:38) Sure. And some of you may wish to come in on the issue around the confidence and everything that's being done to build that. But in terms of the comment the director general made last week about the light at the end of the tunnel, I think was the phrase, and how bright is that. Well, that light is getting brighter. In fact, if you look week by week at the number of companies that are announcing positive results in terms of the efficacy of vaccines, that number is increasing. And what's important is it's increasing not just in terms of the number of products, but also the different technology platforms that they are being built on. As we see now, there are three different sort of technology platforms as we'd call them that have reported very positive efficacy, safety and safety data. Now we haven't seen and scrutinized all of the data behind that as we've emphasized multiple times. Dr. Bruce Ayiward: (39:31) Some of this is still in press reports, but it's positive, which means that beam is looking brighter to the point that you asked. But at the same time, there's other considerations, and Mike emphasizes this repeatedly, and Maria, I think it's so important and that is that there are real challenges with volumes. These are still very, very scarce products. And just as some companies are announcing successes, there are others, and we've had two over the last few days that have said they've had challenges with their products, either in terms of the volumes they can produce or in terms of some of the trial results. And so this reminds us that while the beam, as you said, or light at the end of the tunnel is getting bright over time, it's still a long tunnel to get out of the battle against COVID and we still have a long winter in front of us. Dr. Bruce Ayiward: (40:20) And I think to the point that Mike emphasizes again and again, we have to do everything and we need to continue doing everything for the foreseeable future, because with that light at the end of the tunnel, we should have a new energy now to do the case finding right, do the contact tracing right, do the isolation right. So what this really should give us is the hope and the stamina to be managing this disease and implementing those measures that much more strongly in the near term. Perhaps, Soumya, you'd like to comment to the broad agenda of work on confidence building. Fadela Chaib: (40:53) Thank you. Dr. Ryan. Dr. Ryan: (40:57) Specific reference to Georgia itself, Georgia has had a tough time over the last number of weeks. It's had a very steep rise in cases and has reached a pretty high cases per million population overall. Although that's stabilized in the last week, there's been a 9% increase in cases in the last week and I think an 8% increase in deaths. Certainly in the first wave earlier in the year, Georgia managed to avoid a good deal of the impact of the first elements of this pandemic, but has been hit quite hard this time around. I think the positive answers or news are that the case fatality rate has been relatively low and again, credit to frontline doctors and nurses who continue to maintain frontline services. But I think the story here too for Georgia, it's something that every country needs to look at. Past success or past avoidance of a given scenario does not mean that that scenario can be avoided the next time round. You may have dodged a bullet in the last time, you may get hit hard this time. And therefore it's really important that you understand, in a given setting, you see in situations like, for example, at the moment in Korea and in Japan, they've been dealing with bouncing cases in the last couple of weeks. Korea has been an extremely high performer in the area of disease control, but it's going to have to turn and fight that disease again. And each and every time there may be different risk groups, it may be a different part of the country, it may be a different age group. Each time you fight this battle, there are slightly different tactics required, and that's why you need to be agile, you need to look at what's happening in your country, you need to not make assumptions about what's going to happen or things are going to go away or it's going to disappear or whatever all the other euphemisms are for this. Dr. Ryan: (42:48) You got to fight what you see. Knowledge and data drives that, understanding what's happening and then giving people the right information, intervening aggressively in the right places, adapting your control measures to the situation you see on the ground, expanding your testing and improving your capacity to understand clusters and amplification events, and then supporting people and avoiding crowded settings and doing all of the other things we need to do. The DG keeps saying it again and again, do it all, but I would also say do it smart. And when you have limited resources, do it smart as well and use those resources and drive your public health interventions with the intelligence that comes from using science and using data, data-driven, science-driven approach. And again, Georgia is turning that corner. It is not an easy time. Dr. Ryan: (43:36) And we've seen in Europe that as the disease has come under control in many of the Western European countries, many central European and countries in the Caucasus and even in central Asia have continued to have a difficult time. And then that shows how this disease is in a different... We're not in an epidemiologically stable situation. The virus is still working its way through the human population. The vast majority of people remain susceptible. So it has not settled down into a pattern that you can predict and say, oh, this is what's going to happen next week and the week after. That is not the case. And there are potentially unique aspects of every country's culture and behavior and setup that can drive transmission one way or the other. Maria? Dr. Van Kerkhove: (44:19) I'm sorry. I just want to say, we're moving around from your question a little bit, but I just want to highlight some of the things Mike has just said there. It is about being in a state of readiness. We know so much more now. We're using data to drive our actions, and if a country is having an increase in cases like we're seeing in Georgia, you still have experience. There's a lot of experience and knowledge that is being used to help tailor the approach to what needs to be done, where it needs to be done, and for the amount of time that it needs to be done. And that's done at a political level, it's done at a community level, it's done at an individual level. And with the example of Korea, and we could choose a number of countries that have seen resurgence, it's about that state of readiness. So if you use the system that you have in place, the world is not in the same place we were in a year ago. Dr. Van Kerkhove: (45:07) Many countries have built up this public health infrastructure, some at a faster rate than others, but we still need to continue to invest in people in a workforce that can do active case finding, that can carry out those tests and that strategic testing so that lab results get back quicker, so that we carry out the contact tracing and the cluster investigations. This virus likes people. It needs people to transmit between. It primarily is transmitting between people in close contact with one another. If you put a lot of people together, you're in an enclosed space, you add poor ventilation, you are providing an ample opportunity for this virus to spread. We can take actions that can prevent all of that from happening and I think that's what's really critical right now. As Bruce said, as the vaccines are coming online, there's a lot of hope that we have. Dr. Van Kerkhove: (45:56) But I think many people will also feel a little bit frustrated because we won't be able to get to that light at the end of the tunnel as fast as we want to. We have to remain vigilant. And your question was, what should we tell the people of Georgia? Hang in there. Do everything that you can to protect yourself and to protect your loved ones. You have individual level measures that you can have, you have knowledge about where this virus is, how it spreads, and you have the power to take decisions. And each of these decisions that you take can minimize your risk. We are telling everyone, know your risk and take steps to lower that risk. And we want people to feel empowered that there's a lot that you can do. And again, especially as we're seeing in this holiday season, please make the right decisions to keep yourself safe. Dr. Van Kerkhove: (46:42) While we are seeing in many countries across Europe, a decline in cases, as the director general has said, the amount of percent increase in deaths globally as the director general side has been 60% increase in the last six weeks, 60% increase in deaths in the last six weeks. That is not evenly distributed around the world where we've seen in Mro, a 10% increase, in Afro, a 50% increase, in Euro, almost a 100% increase in deaths over the last six weeks. CRO, 7.5%, PAHO, 54%, Wipro, 15%. So it isn't evenly distributed. This virus is still circulating. Most of the world remains at risk. We can take steps to protect ourselves. Please do everything you can to protect yourself and your loved ones. Fadela Chaib: (47:31) Thank you. Dr. Tedros. Dr. Tedros: (47:36) Thank you. This is a rare threat from Georgia, so thank you and greetings to Georgia, first of all. That question is very important. As Bruce said, the light at the end of the tunnel is getting brighter, I fully agree, and with more vaccines now in the pipeline. And at the same time, we have to also focus on some of the challenges we are facing to make the light really completely bright. There are three major areas where we're focused and the challenges we're facing are associated with those. Number one, funding. There is a need for immediate funding of up to 4 billion US dollars, that's one. And second, we have all followed what has been happening the last few months. Many world leaders, our political leaders have pledged to make vaccines global public good. That pledge has to be translated into action, so that's second. And we expect our leaders to really honor their pledge. Dr. Tedros: (49:04) We see some concerns, but I hope we will have the vaccines on the ground based on the pledge that have been made. Third is infrastructure. The whole supply chain, especially of developing countries, has to be strengthened, have to be prepared. The supply chain training of health workers and so on, we're doing that and that's the other area where we are focusing, because when we do these three things; the funding, the political commitment translates into action, and preparing the infrastructure, then the vaccines that are coming into the pipeline will lead into vaccination. And at the end of the day, the most important part of the whole process is when you see people vaccinated, when they have the inoculation, and when that is done fairly, and when that's done globally. When that's done, then the world can recover faster. Dr. Tedros: (50:10) And as we say it many times, sharing the vaccine and having the inoculation everywhere in all countries means faster recovery and it's in the interest of each and every country in the world. Lives and livelihoods will get back to the new normal, and we believe that's what the world wants now. Thank you. Fadela Chaib: (50:38) Thank you, Dr. Tedros. Dr. Swaminathan, you have the floor. Dr. Swaminathan: (50:45) Thank you, Fadela. So very quickly on the building confidence in vaccines, which was the third question, it's really important that governments and public health officials start communicating with citizens in their countries to explain to them the process of the deployment of the vaccines, because things are happening extremely fast and people are anxious for information. They have a lot of questions, and very often it's the genuine questions that people have that need to be answered. They may have some fears that need to be allayed, but a lot of times it's questions and doubts which really need to be addressed. And it's only a minority of people, I think, which are anti-vaccine. So the surveys that have been done show that the majority of the world's people actually want a vaccine. They're waiting for the vaccine, they can't get it soon enough. And at the same time, they may have questions. Dr. Swaminathan: (51:42) So this is the time actually to explain to people, who are the population groups who have been prioritized? Why have they been prioritized? When are the doses likely to come? The fact is that we are going to have limited doses in the first half of 2021, all over the world. Doses supplies are going to be limited. We need to prioritize those who are at the highest risk of getting the infection or dying from the infection. These are our frontline workers, our healthcare workers, and the very elderly who are the most susceptible. The rest of us have to be a little more patient. We have to continue with all the measures that we've talked about, and these are the things that governments need to communicate. So it's important to have a national vaccine deployment plan and a strategy. Dr. Swaminathan: (52:29) And one of the key elements of that is the communication to the public, and the more open and transparent we can be, the more likely it is that people will have the trust and the confidence and would not only want to take the vaccine, but would also be patient and wait for their turn. Thank you. Dr. Ryan: (52:50) Just very practically that because we've been working very, very closely. The immunization program with Kate and the emergencies program on our side have joined together really to work with UNICEF and the International Federation of Red Cross and Red Crescent Societies on a common service around risk communication and community engagement, and specifically in the area of vaccination. So if countries require more integrated assistance and services and support, there is the planning part, but then there's the implementation. So we take this deadly seriously. This is a science and this is a moment of translating our knowledge and communications into behavior and action and demand, and it doesn't happen by itself. And it requires a dedicated and committed investment in social engagement. Dr. Ryan: (53:37) So we stand ready as three organizations and others to support member states and people and non-governmental organizations in the field and doing that. And we are specifically investing in a strand of activity to support the implementation of the ACT-Accelerator and the preparation of countries for successful vaccination campaigns. And Kate O'Brien, Sylvie, Ryan, others are leading on that internally here at WHO and we have many excellent colleagues in UNICEF and Red Cross working with us on this portfolio. Fadela Chaib: (54:08) Thank you so much to all of you. I would like now to invite Sophie from SABC South Africa to ask the next question. Sophie, are you with us? Sophie M.: (54:18) Yes, I'm here. Sophie Mokoena from the South African Broadcasting Corporation. The topic of a vaccine on the continent at times can be very controversial, on the African continent, because there's a perception that the continent is being used for all the trials. Now there's a heated debate in South Africa currently, the chief justice of the constitutional court yesterday, a very religious person, when he was praying, he prayed that there shouldn't be a vaccine that is being manufactured based on demos. And therefore that has generated a heated debate and it has instilled fear in some people questioning, particularly after he also pointed out that why you give people vaccine when they are not necessarily infected. I just want to check from Dr. Ryan and perhaps Dr. Tedros, this will demand a serious discussion and perhaps senior leaders to deal with issue of perception. Sophie M.: (55:31) What is your advice to the African continent, particularly South Africa at a time when the numbers are currently going up? We are in the second wave of the infections. Fadela Chaib: (55:49) Thank you, Sophie. Dr. Ryan? Dr. Ryan: (55:55) Dr. Tedros, Dr. [Inaudible 00:55:56], assume you may wish to comment. But if we take a step back and look from the perspective of Africa, Africa has used vaccines as one of the single most effective public health and health interventions over the last 30 years on the continent. Africa has just recently eradicated wild poliovirus. It has put the wild poliovirus to death on the continent using vaccination. And the way in which African nations, even with weaker health systems have prioritized immunization of children, it has been the single biggest life saving intervention on the continent. And therefore, I think Africa is to be commended for the way in which immunization has been used, has been trusted by populations and has been instrumental in reducing mortality rates. When a new vaccine is introduced, there are always concerns there are always questions. Dr. Ryan: (56:50) And increasingly, there are people who will distribute disinformation and misinformation and anti-vaccination information. The dialogue is needed at community level in order to address those concerns- Dr. Ryan: (57:03) Dialogue is needed at community level in order to address those concerns, and we were just speaking about that, how we can deal with that, but certainly we'd need leaders and others to be very consistent in their messaging to people. We need people not to be raising fears, but we need people at the same time, not to be in a sense ignoring fears. You have to address people's fears with knowledge and with information and allow people to make up their own minds. I have great faith in people in Africa, in general. South Africa and other countries and again, in this, African countries have actually shown the way in this response. In community engagement, they've led the way in community led responses. African countries have, for example, the laboratories in South Africa, in Senegal have been reference centers for diagnostics and even the development of diagnostic tests within Africa. Dr. Ryan: (57:52) Africa CDC, and our African regional office have worked, and the African Union have taken a big leadership role. The DGM have wished to speak to that on the continent. Africa is doing well. An African should be proud of what's being achieved. The next move of bringing in vaccines. Again, South Africa, I believe has participated in vaccine trials and has been at the leading edge of science in other types of trials for other diseases over many years. It is really important though, that countries that do support vaccine trials and countries that do participate in advancing science and innovation, have fair and equitable access to the products that come from that process. That's another issue, the DG speaks to that process of equity, but in this, I think African nations and particularly South Africa are partners in science. They're partners in the innovation, but communities have genuine questions that need to be addressed. Bruce, may wish to speak, or Sumi or others, but again, I think we need to be very rational in how we approach this discussion. Vaccination, immunization are life- saving interventions. They have saved hundreds of millions of lives on this planet. We need to maintain our standards. We need to be sure that everything is safe and efficacious, but we also need to trust in vaccination as a potentially game-breaking and game-changing intervention in this pandemic, Bruce. Dr. Bruce Ayiward: (59:19) Yeah. Thanks Mike, and thanks Sophie. This is such important questions and hardly unique to South Africa, you highlighted a couple of times specifically in the context of South Africa, but in fact, it's not just a South Africa issue. Mike alluded to this a little bit, but in every country there are people who raised questions, but at the same time, there's no question that vaccines are one of the most powerful public health tools that we have and certainly no population, no people would want to be disadvantaged in terms of being able to access them. That's what the entire COVAX Facility, the ACT Accelerator is all about. At the same time, we've got to make sure that when there are questions raised, that they get listened to and that they get addressed. It's so important to create the forum for discussing these things, to listen to the concerns and then to use the science and the data available to be able to answer those. Dr. Bruce Ayiward: (01:00:16) One of the striking things Dr. Tedros talked about in his opening remarks was the speed with which science has created tools now in vaccines to tackle this, it appears to be able to tackle this disease, but at the same time, as striking has been the amount of transparency and the amount of scrutiny that's been given to these products. It's extraordinary. I think one of the great advantages here I'll come back to South Africa is that in South Africa, you have such experts in the area of vaccines and vaccination, really world leaders, in fact that whose counsel we take. I think the country is in a very, very strong position, like all countries to create those forums for the discussion to listen to the issues and to address them. This has got to be anchored in what is now decades and decades of experience with vaccines, the power of vaccines and the countless millions of lives have been saved as a result of them, and that will be saved from COVID-19 as a result of these vaccines as they're proven, and as they come eventually to market and to use. Again, as Dr. Tedros said in his last intervention, a vaccine only saves lives when it's actually in someone and not in a vial. The big key now is making sure these products get out, get scaled to people as rapidly as possible. Fadela Chaib: (01:01:36) Dr. Tedros, you have the floor. Dr. Tedros: (01:01:38) Yeah. Thank you. Thank you Sophie, for those questions. I fully agree with what my colleagues said that, especially with regard to some wrong perceptions of the vaccine, it's not just in Africa, but it's all over the world. Then when we come to the testing, especially the vaccines for COVID have been tested actually outside Africa more than in Africa. Having the testing, as long as the right protocols are followed, it's very important. That's what has been done. The testing, I don't think has been focused in Africa, actually, it's more outside, but the most important thing is whether it has followed the right protocols or not. It's whether it's done in Africa or other places, but it's done in many places. Then when vaccines are introduced, whether they get the emergency use leased, or final pre-qualifications, the safety is central in addition to efficacy. Dr. Tedros: (01:02:59) We follow that and other organizations, regulatory bodies also follow that. We will make sure that whatever vaccine is available, the two important criteria are met. The safety first, and then of course the efficacy. Then the issue you raised with religion. I remember when HIV reached its climax and some medicine started to appear, and some people were saying, "Either you follow your religion or you follow the medicine, the two can't go together," but religion and science can go together. I remember during that time, religious leaders themselves came out and told the public that taking the medicine and doing their religious practices, actually doesn't contradict and many accepted that and many took medicines and they saved their lives. Dr. Tedros: (01:04:16) For our religious leaders, it's very important to see from the right authorities, whether the right safety and efficacy measures based on the medicine is, or the vaccine is being provided or not. That's what they should focus. I actually would like to use this opportunity, it's the role of leaders, religious leaders, community leaders, political leaders, to be models and examples to convince their followers to do the right thing. I hope our religious leaders will do their best to fight the pandemics, to fight the virus, using the tools we have at hand, and when vaccines are provided, to also help their followers to benefit from the vaccines. I thank you. Thank you, Sophie. Fadela Chaib: (01:05:25) Dr. Ryan? Dr. Ryan: (01:05:26) Just [inaudible 01:05:27] mentioned something there, and I think it was important. I think there were a vaccine trials ongoing of different types in more than 50 countries around the world and only three are in Africa right now. The vast majority of trials are occurring in South America and they're in Central America, in North America, in Europe, in East Asia, in the Western Pacific and Southern Africa. Also, I think in Kenya as well. The vaccine testing is distributed in a world ... In fact, it's a wonderful example of the absolutely global collaboration. It's the most amazing thing to look at a world map and see the number of therapeutic trials, the number of vaccine trials that are going, and the way in which that data is being shared between the public and the private sector. The way that data has been shared between academics and WHO. I think it's an actual sign of tremendous strength in the global system that such collaboration exists, and Africa is part of that. Fadela Chaib: (01:06:19) Thank you so much. We will take a last question from China Daily. Chen from China Daily. You have the floor. Last question. Chen: (01:06:32) Hi, thank you very much for the opportunity. This year, 2020, looks quite bleak. I mean, obviously, y'all mentioned about the light at the end of the tunnel. Could you give us a picture of what the coming year 2021 will look like? How much miracle this vaccine will do? Are we still going to see get our lives back or see new waves after waves of cases, lockdowns after lockdowns and the travel restrictions still there? What's the picture in your mind? Thank you. Fadela Chaib: (01:07:13) Thank you, Mr. Chen. Dr. Ryan? Dr. Ryan: (01:07:19) Okay. I suppose it's one of those moments where you say to everyone, let me give this to you straight. The situation globally is still very epidemiologically unstable. The vast majority of the world's population remains susceptible to this infection. Some countries are on a very negative trajectory in terms of the incidence and death rates for this disease. Most countries, even at low levels are still at risk of a disease resurgence. It's clear though, on what we have learned, and the hope is that many countries have demonstrated that this disease can be suppressed and controlled, and that control can be maintained at low levels, but some countries face the current challenge of intense community transmission in the context of a seasonal period, when it's very difficult to separate people adequately. For those countries who were not in that situation and are achieving lower levels of transmission, avoiding intense community transmission must be an absolute objective in the coming weeks and months. Avoiding going back into situations that require lockdown, because if that can be avoided and when we have now the vaccine coming online, it can give great hope. Dr. Ryan: (01:08:39) Our strategies, we must continue with a comprehensive approach to controlling this disease. Control, containment, suppression, and mitigation together, while introducing vaccine in a stepwise way. Testing needs to continue to be expanded. We need more testing, but strategic testing that tells us where the virus is. We still need more and better therapeutics. We tend to forget a little bit, we're all jumping on the vaccine story, but actually dexamethasone and other drugs are saving lives. We need better and new therapeutics, and that's another big piece of ACT at the moment, but vaccines will make a huge difference. I'll let Bruce speak to how that will and can happen. Dr. Ryan: (01:09:23) There are massively valuable too, but vaccines by themselves will not equal zero COVID. They will have a major impact on morbidity and mortality who gets sick, how sick people get and whether they die as we vaccinate those high risk groups. The impact on transmission will not come until much higher proportion of the population of a country is vaccinated. As I said, as the DG says, we have to continue to do it all. We have to continue to do it smart, but vaccines represent a major, major light at the end of the tunnel, but we have much work to do to make that a reality. I'll hand over to Bruce or others who wish to comment. Then the DG may wish to wrap up on that. Dr. Bruce Ayiward: (01:10:06) Yeah. Thanks, Mike. I liked the way Mike started when he said, "I'll give it to you straight," because we'll go into the coming year with more hope, definitely. We're in a completely different position in terms of the knowledge of this disease, the knowledge of the enemy, and also the tools with which we'll fight the enemy, there's no question as well. We also know that there's going to be challenges to scale up those tools, to get them out, to get them applied and to see them make the difference we want. You use that metaphor as well. The light at the end of the tunnel, it's a long tunnel, to give it to you straight. It is a long tunnel, and when we look at the epidemic curves, remember now the world is used to looking at these curves and you remember, they don't go up like that and come straight down, do they? Dr. Bruce Ayiward: (01:10:52) They go up and then they peak and then they come down slowly and they come down over time. Some of the tools will help us drive those curves down faster, but it's not going to change, boom like that overnight, which means again, to the point Mike makes, Maria makes, and then Dr. Tedros make repeatedly with this should give us hope, and with that hope we should have a new energy, a new stamina to apply the measures that can make a difference. There is no reason for us to see the same epidemic next year, because we know how to beat this disease, but we've got to apply the knowledge that we know in a way that we haven't to the degree possible in 2020. When you look at the places that have, they've had a very different epidemic, that's what we should be looking at. Fadela Chaib: (01:11:39) Thank you. I think Dr. Kelley would like to add something. Dr. Kelley, you have the floor. Dr. Edward T. Kelly: (01:11:43) Yeah, just a quick thing to add to those two good comments. Next year, IMF and World Bank are predicting that 3% of the world economy will contract and that we will have millions, 30 million people who will be put into poverty. On the eve of Universal Health Coverage Day, next year, for WHO certainly, and for a lot of countries will be the year of trying harder. We'll have to continue on this push for the response, just like Mike was saying, just like Bruce was saying, but we will also have to be continuing to work and expand this idea of what is essential. Expanding access to healthcare, to ensure that people have access for COVID, but also to ensure that when this is all over, we were able to say that we were able to treat those people that needed essential services as well. That, I think will be something that'll be coming through in the next year. Fadela Chaib: (01:12:38) Thank you, Dr. Kelley. Dr. would like to add something, Dr. Van Kerkhove: (01:12:42) I'm sorry. I know we shouldn't all answer the same question, but it's a really great question, and I just want to talk at an individual level. We see countries right now that have brought COVID under control, that are opening up, that have stadiums full of people who are at sporting events. I've been getting a lot of questions lately at the end of the year, thinking at the year roundup of what is this going to look like? You've heard us say before that it is completely in our hands. We have the tools now to bring this virus under control. Vaccine is an additional and vaccination is an additional tool that we will have. I think everyone needs to start to think about the patience that we will need in 2021 to get us through this, to see us through the end of this, and what is our motivation to get there? Dr. Van Kerkhove: (01:13:27) I've seen a lot of really excellent interviews lately about people saying, "I didn't think about this for me. I wasn't worried about me getting infected, but I was worried about my most favorite person in the world. I was worried about the person that I love most in the world. I would do anything I could to keep them from getting infected." I think whatever it is that motivates you to protect yourself, but even more so to protect that person that you love most in the world, do that and do it now because that's what 2021 is going to look like. That is what is going to help us bring this under control and the vaccinations coming online, it's incredibly hopeful, but we need the patience to get us to that end point. It will take some time, so we don't have that exact end date. If you think of some of the countries that have actually brought it under control, they're almost there. They have to keep it up. They have to remain vigilant and keep it down so that doesn't resurge, because no one, you've heard Dr. Tedros say this so often, no one is safe until everyone is safe, but find your motivation that will help keep you and your loved ones safe because that is what 2021 means to me. Fadela Chaib: (01:14:40) Dr. Tedros, you have the floor for your final comments. Dr. Tedros: (01:14:45) Okay. Thank you. Thank you everyone for joining and see you next week in our next presser. Bon weekend. Have a nice weekend. Fadela Chaib: (01:14:57) Thank you, DG. Just reminding journalists that we will be sending the opening remarks of Dr. Tedros ...