World Health Organization (WHO) COVID-19 Press Briefing Transcript December 28

Tarek: (00:00) ... and that Dr. Tedros, will introduce individually a little bit later. Tarek: (00:04) For journalists online, we would like to remind you that we have a translation in six official languages, plus Portuguese and Hindi. We'd use the opportunity to thank our interpreters who are here with us, again today. Tarek: (00:21) Here in the room, besides Dr. Tedros, there is Dr. Maria Van Kerkhove, technical lead on COVID-19. We have Dr. Anna Maria [inaudible 00:00: 33], who works in the Department of Health Emergencies at WHO. And we have Dr. Bruce Aylward, who is a Special Advisor to the Director General. We have other WHO experts online that I will introduce before we start with the question and answers. With that, I'll give the floor to Dr. Tedros for his opening remarks. Dr. Tedros: (00:54) Thank you. Thank you, Tarek. Good morning, good afternoon, and good evening. This week marks the one year anniversary since WHO learned of cases of pneumonia with unknown cause, via bulletin issued by the health authorities in Wuhan and ProMED. We immediately set up an incident management structure to follow this development. This is a moment for all of us to reflect on the toll the pandemic has taken, the progress we have made, the lessons we have learned, and what we need to do in the year ahead to end this pandemic. Dr. Tedros: (01:32) For the past year, WHO and our partners have worked relentlessly to support all countries as they respond to the virus. Staff have worked around the clock to accelerate science, provide solutions on the ground, and build solidarity. Science is at the core of everything we do, and it has advanced at a blistering clip this year. Dr. Tedros: (02:06) If we rewind to the start of 2020, it was on 10 January that WHO published its first comprehensive package of guidance documents for countries, covering topics related to the management of an outbreak of a new disease. The next day, WHO received the full genetic sequences for the novel coronavirus from China. By 13 January, WHO published its first protocol for a diagnostic test by a WHO partner lab in Germany to detect the virus. By mid January, our international technical expert networks were engaged and meeting by teleconference to share firsthand knowledge with the new, novel coronavirus and similar respiratory viruses, such as MERS and SARS. And WHO convened this strategic technical advisory group for infectious hazards, and the global alert and response network. By the end of the month 30 January, I declared a public health emergency of international concern, WHO's highest level of alert, and a global health low. Dr. Tedros: (03:23) And by the start of February, WHO was shipping diagnostic tests around the world, so that countries could detect and respond effectively. On 4 February, WHO released the first global preparedness and response plan for COVID-19 based on the latest scientific evidence. At the same time, WHO is connecting scientists, vendors, and manufacturers from across the globe together to accelerate research on tests, therapeutics, and vaccines. Dr. Tedros: (03:55) In mid-February WHO's long standing research and development blueprint group brought hundreds of experts from more than 40 countries together to float out a COVID research roadmap. This was based on years of work on other infectious diseases, including SARS, MERS, and Ebola. The roadmap subsequently developed, covered all technical areas from the animal human interface to the development of vaccines, and was set up to ensure maximum coordination and collaboration as the world tested, trialed, and rolled out new health tools. This included the Solidarity Trial, an international clinical trial that generated robust data quickly, to determine the most effective treatments. And by March, WHO is planning the access to COVID-19 tools accelerator, which was launched with partners in April. The ACT-Accelerator is a historic collaboration to further hasten the development, production, and equitable access to vaccines, diagnostics, and therapeutics for COVID-19 as part of an overarching endgame strategy. And it has worked. Dr. Tedros: (05:21) Good news came in June as initial clinical trial results from the UK showed dexamethasone corticosteroid could be lifesaving for patients severely ill with COVID-19. By September, new antigen based rapid tests had been validated, and the diagnostic pillar of the ACT-Accelerator had secured millions of them for low and middle income countries. And then, the shot that rang out around the world was the release of positive vaccine news from multiple candidates, which are now being rolled out to vulnerable groups. New ground has been broken, not least with the extraordinary cooperation between the private and public sector in this pandemic. And in recent weeks, safe and effective vaccine rollout has started in a number of countries, which is an incredible scientific achievement. This is fantastic, but WHO will not rest until those in need everywhere, in all countries, have access to the new vaccines and are protected. Dr. Tedros: (06:32) Throughout the pandemic, we have released and updated technical guidance and trainings, based on the latest science and best practice from countries. We have then disseminated it through all our channels, including more than 130 press briefings like this one. And our regional and country offices have kept local populations up to date. We have worked with thousands of brilliant scientists from around the world to build global solidarity, engaging with our critics, and calling repeatedly for all stakeholders to quarantine any politicization of the pandemic and focus on what really matters, accelerating science to save lives and end this pandemic. Dr. Tedros: (07:26) We learn something new every single day, sometimes good, sometimes challenging, sometimes downright surprising, but all helpful. There will be setbacks and new challenges in the year ahead, for example, new variants of COVID-19, and helping people who are tired of the pandemic continue to combat it. At present we're working closely with scientists all over the world to better understand any and all changes to the virus, and how these changes affect its ability to spread, or make people sick, or any potential impact on available tests, treatments, and vaccines. Dr. Tedros: (08:15) Specifically, we're working with scientists in the UK and South Africa who are carrying out epidemiologic and lab studies, which will guide next steps. Science drives our actions. And I would like to thank both those countries for testing and tracking new variants, and underscore the importance of increasing genomic sequencing capacity worldwide. This means the prompt sharing of epidemiological, virological, and full genome sequence information with WHO and other countries and research teams, including to open source platforms, such as GISAID and others. Only if countries are looking and testing effectively, will you be able to pick up variants and adjust strategies to cope. We must ensure that countries are not punished for transparently sharing new scientific findings. Dr. Tedros: (09:18) I'm so humble to work with scientists, epidemiologists, and public health experts in WHO and around the world. And today, I'm joined by four of the best to look back and look forward. First, Professor Quarraisha Abdool Karim from the Centre of AIDS Programme of Research in South Africa. Professor, you have the floor. Professor Quarraisha Abdool Karim: (09:45) Thank you very much, Dr. Tedros. It's a real honor and privilege to be part of this first anniversary, on the one hand celebrating much achievements, but also to reflect on a year, and to think as we move forward. We've not been reminded more about interdependence as individuals, as countries, as governments, as scientists. And it is this interdependence and the unity of purpose that has enabled us to achieve so much. Professor Quarraisha Abdool Karim: (10:29) I'm going to spend the next few minutes focused on the WHO Solidarity Trial for therapeutics. And I think it marks and highlights a very, very important advance in a state of disaster. Amazingly, within literally two months of the announcement that we're dealing with a pandemic, to launch a trial that finally included over 30 countries, over 500 hospitals, and 12,000 hospitalized patients, all with the single purpose of how do we save lives, how do we reduce invasive ventilation processes, and how do we reduce hospital stays? Professor Quarraisha Abdool Karim: (11:18) I don't think any of us needs to be reminded of the devastation that faced us in terms of the lives that were being lost, even in the face of uncertainty. And while it's traditional to undertake small randomized control trials to produce compelling evidence, what was done through this scientific consortium, consortium with hospitals, and thousands of collaborators across the globe was to establish a very important platform that was able to simultaneously evaluate four drugs, hydroxychloroquine, lopinavir, remdesivir, and interferon derivatives. And to be able to do this within a six month period, enrolling the number of patients that we have and come up with an answer that's relevant, not just for one country or two countries, but for global accountability and use is truly unparalleled. Professor Quarraisha Abdool Karim: (12:25) And while the first four and repurposed antivirals showed very little benefit for those hospitalized patients in terms of survival, hospital stay, or in terms of assisted bleeding, what it did demonstrate was these four drugs, particularly lopinavir and hydroxychloroquine, was compelling evidence that they have no benefit. And that's as important as the finding of dexamethasone that was demonstrated in the recovery trial to show 30% benefit in hospitalized patients in terms of survival. Professor Quarraisha Abdool Karim: (13:11) Now, what we've also learned, and that may not have headline news, is a range of non-invasive techniques to enhance ventilation in hospitalization patients. We've also learned a whole lot about disease progression and the importance of the bioremic stage, the importance of the cytokine storm. But also, as much as we've learned from those who've recovered in terms of informing vaccine development, what we're also learning about is those who are the long-haul COVID patients, who continue to, while they're not infectious, have taught us so much more about this challenge. Professor Quarraisha Abdool Karim: (13:58) What is impressive, even though we have so much more to learn about new therapeutic interventions, and we will be evaluating monoclonal antibodies in the new year, hopefully more specific antiviral agents, is that we learn as much from the patients that are being cared for by first responders, at hospitals, at the cold phase, that despite our promotion of non-pharmaceutical interventions, we still have our hospitals quite inundated. In the second wave, we're seeing a number of cases. Professor Quarraisha Abdool Karim: (14:37) So, how do we move forward? I think the rapid diagnostics is going to help us in terms of rapid identification of individuals, reducing the time for diagnosis. The numbers will enable us, also, to look at how do we more rapidly identify context of those who are being infected, and so that will also fuel the public health response. We need more than the vaccines we already have, to offer the world a safer and better place, and to minimize and mitigate against deaths. So, the vaccines, new therapeutics, new diagnostic tools are all what we can look forward to. And the learnings from those who've got infected, those who've recovered, and from those who have not recovered, all teach us important lessons as we move forward. Thank you very much. Dr. Tedros: (15:35) Thank you. Thank you so much, Professor Abdool Karim for those reflections. And now to Dr. Dan Barouch from the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center in Boston, US. Dr. Barouch, the floor is yours. Dr. Dan Barouch: (16:03) Thank you very much, Dr. Tedros. As I look back and reflect on the past surreal year, I think it really falls into the category of much accomplished and much to do. The response of the global scientific community to this pandemic has been extraordinary and unprecedented, in terms of the speed and precision of understanding of the virus and investigating methods to combat it. But equally unprecedented is the extent of collaboration, and essentially the global scientific community redefining how we do science. And I think the importance of science and the value of science to this pandemic is unprecedented, whereas science forms the foundation of virtually all of the interventions that we're talking about today. Dr. Dan Barouch: (17:05) Early in February, I had the privilege of joining the WHO working group for animal models, and I've also participated in the other working groups on assays and other topics. These have been international collaborations of hundreds of scientists from all around the world, with open sharing of data and results, often data generated in the past few days before a given teleconference. Certainly from an animal model perspective, scientists from all around the world started sharing data in early February of this year, in the development of both small and large animal models. And I think I can confidently say that research in every single person's group has been accelerated by the openness of sharing of data. Dr. Dan Barouch: (17:55) I think a key scientific advance has been the coordinated testing of therapeutics and vaccines in both animal models and clinical trials. Also these models, the human and the animal models, being the underpinning of understanding of the pathogenesis of this virus. In many cases, the results from animal models accurately reflected results that were seen in clinical trials. And I think the coordinated testing, and in many cases simultaneous testing, of interventions in both an interventional animal model, as well as large scale clinical trials, has really led to the acceleration of vaccines and drugs. Dr. Dan Barouch: (18:42) The development of safe and effective vaccines offers some of the best hope to end this pandemic. But of course, the vaccines have to be more than safe and effective. They have to be available, they have to be affordable, they have to be deployable, and they actually have to be used globally. Dr. Dan Barouch: (18:58) I think that in terms of the pandemic, the immediate future remains extremely concerning with cases at the highest levels and deaths at the highest levels. But the midterm and the long-term future, I believe is bright, with the development of multiple, and probably even more coming up, safe and effective vaccines, therapeutics, public health interventions that often originate by collaborations amongst physicians, scientists, and other stakeholders. So, I believe in future years when historians look back on this pandemic, then the value and importance of science in helping to guide the solution and end to this pandemic will be clear. Thank you very much. Dr. Tedros: (19:51) Thank you. Thank you so much, Dr. Barouch, for sharing those thoughts. And now my friend, Professor David Heymann from the London School of Hygiene and Tropical Medicine, and Chair of the WHO STAG-IH. Professor, and my friend, David, you have the floor. Professor David Heymann: (20:09) Thanks very much, Dr. Tedros. This year, I've had the privilege of chairing the STAG-IH as you said, and this has been quite an experience for me. We've had a total of 55 to our Zoom meetings with Mike, Maria, and other leaders of the emergencies program. Despite their busy schedules, they've attended these meetings since January 10th, when the STAG-IH first discussed the report from China with the WHO secretary. At our meetings, we've heard from countries, from businesses, from researchers, and from many other groups around the world who have freely shared their information with us. And because of this, and because of the rapidity with which manuscripts have been peer reviewed and placed in front of [inaudible 00:21:02], WHO has rapidly gained and shared understanding about SARS coronavirus and its epidemiology, despite the political tensions that have occurred, and despite some of the criticisms that have been leveled at the secretariat, which has continued to work and use the evidence to provide evidence-based recommendations. Professor David Heymann: (21:23) As this difficult year ends, we know much. We know that early in sustained outbreak detection, with isolation and management of those with infection, and locally managed contact tracing and self isolation can decrease community spread. Early on, we learned that this SARS coronavirus 2 does not always transmit directly into communities as does influenza. It stops off in discrete outbreaks, and these outbreaks can be contained, even if they involve large numbers of persons. Outbreak investigation, when these discrete outbreaks are detected early, especially in new areas where previous outbreaks have not occurred, often permits identification of where transmission is occurring, permitted targeting shutdown of transmission, while avoiding general lockdowns. Asia has led the way in this and shown that it's not necessary to lock down entire communities, that you can lock down and target resources where transmission has been occurring, and prevent the rest of the economy to continue to move forward. Professor David Heymann: (22:37) We've also seen that strategic testing with clear objectives and rapid availability of results, permits timely isolation and management of persons with infection. Newly developed diagnostic tests when properly evaluated and used in testing strategies, add benefit to stress testing strategies where PCR is not available, or where results are delayed because of logistics. Empowering populations with clear and consistent communication has also been shown to be essential, so that people understand how to protect themselves and others while doing their own risk assessment. And this is especially important at times when families get together, and transmission in the community is high. Personal risk assessment is the fundamental base of this pandemic response. Professor David Heymann: (23:32) Close monitoring of health systems is essential requiring contingency plans for patient support in order to maintain and save lives, and sustained mitigation, such as prohibiting public gatherings and requiring mask wearing in closed spaces where physically distancing is not impossible is essential. We've also seen and just heard that research and development has been sustained, and the challenge is now to make sure that new mechanisms such as the ACT-Accelerator- Professor David Heymann: (24:03) Which is now to make sure that new mechanisms, such as the acting accelerator in the Kovacs facility, are supported in order to ensure equitable distribution of vaccines, therapeutics and diagnostic tests. Dr. Tedros, I'd just like to close by saying that the world has hoped for herd immunity, that somehow transmission would be decreased if enough persons were immune. This concept has been widely misunderstood and still cannot be predicted because of our lack of understanding of immunity and its duration. It appears at present that the destiny of SARS Coronavirus 2 is to become endemic, as have four other human coronaviruses, and that it will continue to mutate as it reproduces in human cells, especially in areas of more intense transmission, but its final [inaudible 00:24:54] is not yet known. Fortunately, we have tools to save lives, and these, in combination with good public health as outlined before, will permit us to learn to live with COVID-19. Thank you very much, Dr. Tedros. Dr. Tedros: (25:13) Thank you. Thank you so much, Professor Heymann. And now, Professor Marianna Koopmans, who is head of the Department of Viral Science at Erasmus in the Netherlands. Professor, you have the floor. Marianna Koopmans: (25:29) Thank you, Dr. Jay Dorson. Thank you very much for this invitation. I'm very honored to by that. So, if I look back on this year, it's a year, scientifically, with very mixed emotions, coming to realize just how challenging research during an evolving pandemic is, how humbling, but also how exciting it is. And to me, there's a critical phrase, no one is the expert when it comes to an emerging disease outbreak, and we all need to collaborate and build the ship while sailing. Marianna Koopmans: (26:11) So, for me, some of the exciting points that I would like to highlight are examples where this bridge between scientific fields has been built, starting with the initial discovery work by our colleagues in China, who, if you come to look at it, really did a stellar job in pinpointing the course of this outbreak in a very short period of time, combining virus discovery toolbox with classical clinical virology and immunology to provide very convincing proof of this etiology. Marianna Koopmans: (26:56) The second element has been mentioned already, but it's just unprecedented, the entry of pathogen genomics in our everyday life. Super exciting. It had already become a standard, I would say, in outbreak investigations, in for instance, Ebola and Zika, but now the rollout across the globe with great contributions in Africa and South America, really across the world, has been exciting. Also challenging because what you see is the bridge needs to be built between the people pathogen genomics, understanding data analytics, but bridging that with the basic virology that wants to and needs to look at what all the mutations mean and how we need to work with that to anticipate the future of the pandemic. Marianna Koopmans: (28:01) Then, an exciting development, I think, is just how important diagnostics have been. I've been laughed at because I say the word diagnostics at every meeting. And I think what we've seen is just how critical lab [inaudible 00:28:20] is beyond assay development, because we really need critical thinking and collaborations to understand what these assays do. How do you know if someone is infectious? How do you measure that? Which tests or combinations do you use to really support the public health actions? All of those. Marianna Koopmans: (28:44) And we've seen new collaborations between clinical labs, public health labs, screening laboratories, epidemiology, and what have you. Then breakthroughs from pathogenesis work, with animal studies, but also clinical studies and the deeper laboratory work behind that, that has shown that this disease has two key pathogenic mechanisms. The one that we already understood, the exaggerated immune response, but the second one, the coagulopathies, which really led to the realization that we need additional treatments. Marianna Koopmans: (29:29) And then, finally, I think totally amazing, the many years of basic research in virology, oncology, immunology, biotechnology that brought us a totally novel way of vaccination, the MRNA vaccines. They seem to live up to the promise and we are where we are because of that foundation. Marianna Koopmans: (29:57) So, all of that, I think, is so humbling because there's never enough and this pandemic keeps evolving. It's far from over. So my key areas of attention for the near future are that we really should prepare for how this virus evolves. There are the development of pockets with people with increased immunity, whether through outbreaks vaccination programs. There's the risk of passage through animals that we have seen, that may put pressure on the virus. And we should not worry about that, but prepare for understanding, assessing what those variants and changes mean, and how we need to respond to them. Marianna Koopmans: (30:56) Finally, I think it's critical that we hopefully, by the end of this year, can quiet down a bit, but then start thinking about the future. What else is out there? What can we learn from this whole pandemic in building a preparedness for the next disease [inaudible 00:31:21] particularly what else is out there. Can we developed better prediction and early warning tools, so that the response tools that are in place, that have worked fantastically maybe will become less necessary. And with that, I think that's my take on the next year. Dr. Tedros: (31:48) Thank you. Thank you so much, Professor Koopmans, for such a wonderful wrap up. I would like to thank, again, Professor Abdul Kareem, Professor Baruch, Professor Heymann, and Professor Koopmans. Thank you so much for your amazing presentations. Dr. Tedros: (32:05) And amazing to think of what has been achieved in the last year and to consider what we can achieve in the year ahead. As the year closes and people around the world raise a toast to mark both the passing of the year and the dawn of a new one, let me raise a toast to science. May we share its results, especially the vaccines, fairly and equitably, in the year ahead, and together end this pandemic. Happy new year. And I thank you. Dr. Tedros: (32:42) Before I hand over for questions, I also want to thank the act accelerator partners, golden partners, the emergency medical team movement, member States, collaborating centers, advisory groups and expert networks for working with us. WHO is lucky to have you and work with you. None of us can end the pandemic by ourselves, but together, we will end this pandemic. And thanks to each and every journalist tuning in to our briefings and relaying signs to people around the world. With that, thank you again. And Terry, you have the floor. Tarek: (33:26) Thank you very much, sir. [inaudible 00:33:28] many thanks to our honorable guests. I hope our guests will stay with us. And if you would wish at any moment to complete some answer, just unmute yourself for us. That will be the sign that you would like to complete the answer or take the floor. Tarek: (33:48) As Dr. Tedros said, maybe on behalf of Department of Communications, I would like also to thank all journalists who were following us throughout this year, and to wish happy new year to everyone. Besides our experts in a room, and our special guests that we just heard from, we also have on the line, Dr. Mike Cryan, who is our Executive Director of Health Emergencies. We have Dr. Maria Angela Chenault, who is Assistant Director General for Access to Medicine. We have Dr. [inaudible 00:34:23] WHO Chief Scientist. And we also have Frank Corning's, who is our lab expert, who may intervene at some point and answer some questions if needed. With that, we will start with questions, and I'm very much happy to hear from Helen Groundswell from Stats. Helen, you could mute yourself. Hi. Hi, Helen. Helen Groundswell: (34:47) Hi, thanks very much, Terrick and hello to you all. I was hoping we could get a bit of an update on the variants from the UK and South Africa. Any kind of information about what functional changes are being seen as a consequence of these new viruses. And also, if I could tag onto that, is there any thought that mutations could actually completely erode the efficacy of the current vaccines? Is that possible, given that they target the spike? Is it more likely that they might just lessen the effect of the vaccine? Thank you. Dr Maria Van Kerkhove: (35:35) Hi, Helen. Thanks very much for the question. I'm going to begin, and then others will definitely contribute to this because this is two big questions that you've just asked us. As the director general has just said, we continue to work with scientists all over the world that are tracking mutations and changes in the virus. And as you know, changes are normal, changes are expected, and the more this virus circulates, the more opportunities it has to change. Dr Maria Van Kerkhove: (36:02) Most of the mutations that are identified, have little effect on the virus itself, in terms of its behavior, in terms of its transmission and severity that it causes. But each of these mutations that are identified need to be evaluated properly through our global lab network that was established in January. We have a specific working group around virus evolution that is tracking these mutations. It's a group of scientists and geneticists, phylogenetics, people with specialties in different types of laboratory studies, links with FAO and OIE and broader links to different technical expert groups on animal models, on vaccines, on diagnostics, so that we make sure that there is an appropriate process to evaluate each of these mutations. Dr Maria Van Kerkhove: (36:51) So, this virus evolution working group meets regularly and discusses the variants, the mutations that are identified as they are identified. And importantly, looking at which ones are important and why. And I mentioned this because, as the virus changes, not all of these mutations are important, so it's important that we look at why certain ones are. Dr Maria Van Kerkhove: (37:11) With regards to the UK and in South Africa, these are two separate virus variants that have emerged at the same time. They're different. They both have the 501Y mutation, which is a mutation in the spike protein, but they're different viruses. They're different variants. We're working with both countries. We have daily calls with our colleagues in the UK, and they are continuing to do studies looking at the epidemiology, looking at transmission characteristics, looking at the severity. We had a call with them today and they're releasing a report, it's likely online already, of a case control study that they looked at in terms of severity, where they found no significant differences in hospital admissions and case fatality at 28 days. And the occurrence of reinfections among those who were infected with this variant and those who were infected with other wild type viruses. So that is something that we've learned of recently. Dr Maria Van Kerkhove: (38:10) They will continue to do the laboratory studies, which, again, are happening as we speak. There are labs that have been working over the holiday period to study the neutralization, the antibody response based on this variant, and those studies haven't yet been completed. Separately, in South Africa, again, we're very grateful for the work that's ongoing in South Africa. They are growing the virus, and this is part of the process to be able to have virus to conduct studies. They're in the process of growing the virus, and they will be doing neutralization studies as well. They're also looking at the epidemiology of this variant in South Africa to determine if there are any changes in transmissibility of that variant as well. Dr Maria Van Kerkhove: (38:53) But again, I just want to point out that, as we go on with this pandemic, more variants, more mutations will be identified. We have people, we have groups who are linked together. There's a process in place to make sure that the appropriate laboratory studies are being done. And it's important to note that these laboratory studies take time. We expect to have results of further lab studies in both the UK and in South Africa in the coming days and the coming weeks. Dr Maria Van Kerkhove: (39:22) And we're very grateful for those studies to be done. Dr. Frank Connings is online, who's the lead for our virus evolution working group, who can give some more specifics on the virus studies that are going to be done. So, with that, I could pass to Frank, and then Dr. Anna Maria is here, who can also mention specific work looking at vaccines. So, Frank, can I hand to you please? Frank Connings: (39:48) Yeah. Thank you very much, Helen, for that question. And it's a really important one, but we know that we can learn a lot by sequencing the virus, like for example, geographic spread and the detection of these variants. But in addition to sequencing, as you already hinted at, it's important to obtain these live variant viruses from clinical specimens. We call it virus isolation. Frank Connings: (40:15) And once we have these virus isolates, at the laboratory, this will allow us to really better investigate how the variant interacts with human lung cells, for example, how it binds to it, how it enters the cells and how it replicates or make more copies of itself. As Maria mentioned, it's also important, once we have the live virus, or these isolates, that we can study how the antibodies interact with this variant, and learn about the impact of these changes, for example, on vaccine efficacy. Frank Connings: (40:51) So, it takes time. You need to isolate the virus, you need to grow it in sufficient quantities. You need to run the experiments. You need to analyze and interpret it. So, it takes some time, a couple of weeks, most of the time. This is happening in UK and South Africa. This is ongoing, in close collaboration with scientists from all over the world, and we'll keep you updated as new information becomes available. And my colleague, Ana Maria, will be able to answer your question related to changes and vaccine efficacy. Dr. Ana Maria Henao Restrepo: (41:28) Thank you very much, Frank. So just to add to Maria and Frank, WHO has activated the groups of experts that is helping us to look into this. So, the Professor Dan Baroosh, who is on the call, is part of our animal models group. We have teleconferences to discuss what kind of a status could be helpful. I'm on animal models to evaluate the potential effects that this variance will have impacts in vaccine efficacy. And as Maria says, we need to understand that we will have events like this in the future, but it doesn't mean automatically, that we have to reconsider the efficacy of vaccines. We have to develop an approach that will help us again and again, to evaluate. Dr. Ana Maria Henao Restrepo: (42:13) In addition, we have discussions with other experts, clinical trials and methodologist group, and we have looked into the possibilities of adding additional questions and explorations to the vaccine trials already ongoing, and also how to prepare observational studies that could be considered during the rollout. And in fact, we know that some of our members states are indeed preparing for such observational studies to be able to document, if they occur, any variations of efficacy over time and among the different strengths. Dr. Ana Maria Henao Restrepo: (42:43) Finally, we are also looking into the laboratory and the assays, and as Maria says, we are planning to have a broader consultation with all the experts on the difference of groups early in the year with the aim, again, not to address only the questions this time, but to create the approaches that will allow us, globally, to address emergence of new variants in the future. Tarek: (43:13) Many thanks, Dr. Restrepo, as well as Frank and Maria. I think that Marianne Koopmans would like to add something. Marianna? Marianna Koopmans: (43:28) Yeah, just a few points in this. I think this is a critical area where we have to learn how to get up to speed with our laboratory evaluation of mutations and variants for the sequencing, because we will see many more examples of this. And we have seen several examples. Just in the past months, we have discussed variants arising, following passage through mink in Denmark and in the Netherlands, that also had mutations of some concern, but not to the degree that we're currently discussing. Marianna Koopmans: (44:11) So, that package of combined genomic data analytics and pharmacological data analytics is going to be part of our critical toolbox that we need to be developing. There is some information that was published by the public health England group on the new variant that showed that, on average, and you have to look at that with caution, but on average it appears like people infected with the new variant UK have a somewhat higher viral load, which could be one little piece of the explanation why this is variant would lead to more transmission. Tarek: (44:54) Thank you very much, Professor Koopmans. Let's go to the next question. We have Kais [inaudible 00:45:03] with us, Kais. Professor David Heymann: (45:05) Thanks. Thanks a lot Tarik, and thanks to all of you. I wanted to follow on, as so often, from what Helen said, one of the things that I would argue that we've learned in the last year, or where the consensus has shifted scientifically a little bit, is the question of travel restrictions and how useful they are, whether they should be used or not. Professor David Heymann: (45:26) Now, obviously, with the new variants, they have been deployed again, even though there's a lot of uncertainty about these variants. And I'd just like to understand how the WHO is thinking about these travel restrictions, whether you have a clear position on it, and whether that position is different, essentially from what the position would have been a year ago when all of this started. Professor David Heymann: (45:51) And if I may, just because this is related, David Heymann said earlier, we've learned that we don't need, if we shut down the right sectors of society early on and stop the outbreaks. I'm just curious how David and this is asking what Marianne was already asking him, curious how David thinks about the situation in the UK and what should be done there, given what he said earlier. Dr. Ana Maria Henao Restrepo: (46:19) Thank you very much, Kais. So let's hear from Professor David Heymann. Professor David Heymann: (46:29) Thanks very much, Kais. It's a big question as to whether or not travel should be restricted in this situation. But I think what we must do is look at the natural history of virus in general, and they mutate. The RNA viruses tend to mutate, and they continue to mutate, especially in areas where there's intense transmission. So, rather than spending a lot of time blocking borders, it might be more important to try to decrease transmission using basic epidemiological tools and shut down where transmission is known to be occurring. Professor David Heymann: (47:03) I know that in South Africa, they feel that transmission may have been occurring of this new variant at the end of school, when there were many school parties. I think in various parts of UK, it's understood that it may have been transmitting when young people got together and increase the intensity of transmission. Professor David Heymann: (47:23) So, I'm not going to talk about border closing. That's a country's decision. And as we've seen countries prefer to do their own risk assessment using the information that's widely available, rather than listening to what the WHO has recommended for travel in the past. So, countries will have to sort this out with WHO, with the International Health Regulations, a treaty to which they all adhere, as time goes forward. And there is a group that's studying whether or not the IHR need to be in any way reinterpreted or modified. But what's clear is that the Director General has given a high alert. Professor David Heymann: (48:03) .. what's clear is, is that the director general has given a high alert that this is an important virus. Countries should be paying attention. And what we need to understand, just like the number of cases reported from WHO, is that countries can only report what they're testing, and in the UK, as we all know, there's a great amount of genomic testing, some of the most per capita genomic testing in the world, genomic sequencing, and therefore, they're able to detect these changes very rapidly. Other countries are now detecting them and of course, the blame will shift, where did it come from, where is it going? But that's not important, what's important today is that we're all in this together and we need to work on it together. I hope that's answered some of your questions, [Ky 00:00:45]. Tarek: (48:49) Thanks, Professor Heymann. Maria? Dr Maria Van Kerkhove: (48:51) Yeah, thanks. I'm not sure if Mike wants to comment as well, but just to say from the WHO perspective in terms of our guidance on travel restrictions, what we recommend are for countries, that these are national decisions, to take a risk-based approach to this because it so much depends on how this virus is spreading, where this virus is spreading, and the risks that are associated with your everyday actions, which include travel. And so we've outlined the considerations that countries need to take into account when taking these decisions. It's not a simple yes or no answer. It's not a simple all travel, no travel. There are considerations that are in place, not only to manage the travel itself, whether this is on a train or a plane, but the entire process from when you leave your house to when you arrive at your destination. Dr Maria Van Kerkhove: (49:36) There's no zero risk right now because this virus is spreading and we know we're all at risk at the moment. But as David has just said and as the director general and Mike and I have been saying for quite some time now, it's about the tools that we have to reduce transmission. These variants, if we didn't have a wake-up call before, we have an even further wake-up call about these mutations. You've heard everyone here say that these mutations will continue to happen and we need even more resolve. I know everyone is tired. I know that we're all kind of fed up with this and we want this to be over, but this should push us even further, to have even more resolve to end this pandemic. Vaccines and vaccinations are coming on line. This is another incredibly powerful tool. We cannot lose this battle now. Dr Maria Van Kerkhove: (50:27) We are all in this together, as David has just said, as you've heard us say over and over again, and we need to put in the work to reduce transmission everywhere we can. With these variants, what I didn't say in my previous answer is that in the variants that we have seen in South Africa and we have seen in the UK, as well as the Cluster 5 variant that was identified in Denmark, and other variants that have been detected over time, the D614 gene mutation that was first identified at the end of January and early February and replaced the circulating viruses by June, all of these viruses, these SARS-CoV-2 viruses can be controlled with the measures that we have in place, with adherence to the measures that we have, with the tools that we have in our toolbox, and vaccines are another powerful tool that will help us end this. Dr Maria Van Kerkhove: (51:13) We really need to focus on adhering to the measures that are put in place around us and sticking to it, hanging in there as much as we can. And for those of us who are able to work from home and stay at home, we reduce the opportunity for the virus to spread, which reduces burden on health systems and this breaks chains of transmission. So it's important that all of us play our part, all of us do what we can to reduce the spread because all of this gets us one step closer to ending the pandemic. Tarek: (51:46) Dr. Ryan, would you like to add something? Dr. Mike Ryan: (51:49) Yes, sir. Can you hear me? Tarek: (51:51) Very well, please. Dr. Mike Ryan: (51:53) Great. No, thanks, and following on from what David said and what also Maria has said, the reality is that countries like the UK and South Africa have been doing systematic surveillance and systematic genetic sequencing. And it's really important that we keep that open approach to connecting and sharing information and that countries are not unnecessarily punished for openness and transparency and for pursuing science. And the DG has said that pursuit of science is key to getting the solutions that we need. We have to balance those risks. As Maria has said, we've had the D614 gene and we've had the strains associated with the mink in Denmark. Dr. Mike Ryan: (52:34) Some countries have put in precautionary measures and so they can understand the variants better. WHO was always clear in saying if any restrictions on travel must be evidence-based, they must be time limited, they must be focused. And from that perspective, WHO is clear. We need to try and contain any virus, whatever the variant is in situ, and shutting down countries with absolute measures is neither feasible in the world we live in, nor is it necessarily the most effective public health action to take. It's really important that countries, transparent and open countries like South Africa and the UK, who pursue science on behalf of us all are not unduly or unnecessarily punished for their openness and their pursuit of science. Tarek: (53:26) Thank you very much, Dr. Ryan and Dr. Van Kerkhove and Professor Heymann for this. We will now go to Natasha Loder from the Economist. Natasha. Natasha Loder: (53:39) Hello. Yeah. I'm hearing that ... thanks for doing this everyone as well ... I'm hearing the Astra vaccine is going to get approval soon in the UK and I wondered if this approval is going to advance the international access of this vaccine. And then just one other quick question for Dr. Koopmans about her trip back to China. I wondered if she could give some thoughts on whether an intermediate species, whether she feels an intermediate species is likely to be involved in the origins of this outbreak or whether it was more likely directly between bats to humans. Thank you very much. Tarek: (54:22) Thank you very much Natasha. We have two questions there, but as you don't join us very often, we will try to answer both. So maybe on the first question on vaccines, Dr. Simao, if Assistant Director-General is online, maybe can take the first question on the vaccines. Dr. Simao? Frank Connings: (54:45) Thank you very much and thank you Natasha. But it's a very good question because we are hearing about the NHRE, which is a UK regulator approving the first site of the AstraZeneca. Actually the AstraZeneca [inaudible 00:54:59] vaccine, it has eight different nodes. It's being manufactured and trialed in different countries, so we're expecting that they also have submitted a core package of documents, of dossiers, to WHO. We're expecting that each of these nodes will have to test separately. And we know that [DMA 00:55:22] is receiving dossiers as well, and WHO is expected to assess some of the nodes by early February. And WHO has already received the core package, is expecting to have the assessment also done by February. Frank Connings: (55:40) So this is the state we are right now. We are hopeful with the data we have seen so far, but we still need to see the complete dossiers before issuing any emergency use listing. It's promising if it's approved by the UK regulatory agency also because this is a vaccine that has the potential of a large scale lab of manufacturing. So this is good news for everyone, if it comes true. Thank you, I'll stop here. Tarek: (56:12) Thank you very much, Dr. Simao on this. And then let's try to answer the second question that was asked specifically, and for Professor Koopmans to answer. Professor, please. Marianna Koopmans: (56:28) Yes. Thank you. So I really think it's too early to be anything more than speculative about this. So what we have seen is that the virus identified in Wuhan has a close relative in bats in the region, but there's clearly a lot of distance between those. And it's very well possible that there has been an intermediary path either through low level circulation among people or through another species. And we are starting to see an expanding range of animals that are susceptible to this virus. We have seen that in mink, in other fur animals. We've seen that experimentally, we've seen it in dogs and cats. So at this stage, what I think we need is a very open mind when move is trying to step back into the events that led eventually to this pandemic. I hope that answers to some of your question. Natasha Loder: (57:44) Thank you. Tarek: (57:44) Thank you very much, Professor Koopmans. Let's try to take a couple of more questions, although we already nearing the hour marker. Let's go to Sydney Morning Herald and we have Latika Bourke with us. Latika? Professor Quarraisha Abdool Karim: (58:05) Thank you so much. Thank you for being with us today and for taking these questions. I'm particularly interested in your views on how you think the vaccine will work in the context of elimination because countries in my home patch, of course in the Asia Pacific, have done very well and kept community transmission rates very low to the point where some have eliminated. But what does that mean in the long-term where people are vaccinated overseas, does that ensure that they are not a risk traveling to countries that have almost zero community transmission, or do you think that people who have been vaccinated will still need to quarantine if they're going to countries that have low transmission? Tarek: (58:47) That's a excellent question, Latika, thank you for that. I'll ask her Dr. Swaminathan if she can answer this question. Dr. Swaminathan. Dr. Swaminathan: (59:01) Thank you. And others might want to add, but I think that's a really important question. And I think, Latika, what we're learning now, and we continue to wait for more results from the vaccine trials, is to really understand if these vaccines, apart from preventing symptomatic disease and severe disease and deaths, whether they're also going to reduce infections or preventing people from getting infected with the virus, prevent them from passing it on or transmitting it to other people. Dr. Swaminathan: (59:32) At the moment I don't believe we have the evidence on any of the vaccines to be confident that it's going to prevent people from actually getting the infection and therefore being able to pass it on. So I think until we know more, we need to assume that people who have been vaccinated also need to take the same precautions until there's a certain level of herd immunity of course that's been built in the population. So again, this is a dynamic and evolving field, and I think our understanding and our recommendations will change as we get more follow-up data from these trials. Thanks. Others might want to add. Tarek: (01:00:15) Thank you very much, Dr. Swaminathan. And Dr Ryan? Dr. Mike Ryan: (01:00:18) No, I agree with Soumya's points there, and I think it's important that we also reflect on the main objective of the vaccine and the first rollout will be to prevent severe illness, prevent deaths, to protect frontline health workers, and to protect the most vulnerable people in our society. And we would hope that that protection is offered to health workers and vulnerable people all around the world. So the first and primary objective is to decrease the impact that this disease is having on people's lives, and therefore that will be a major step forward in bringing the world back to some kind of normal. Dr. Mike Ryan: (01:00:58) The second phase is then looking at how will this vaccine effect transmission, and Soumya's right, we just don't know enough yet about length of protection and other things to be absolutely able to predict that, but I think we should be able to get good control of the virus. A decision then to move towards elimination or eradication of the virus requires a much higher degree of efficiency and effectiveness in a vaccination program and all of the other control measures. And we still don't know, based on virus evolution, based on so many other things. The likely scenario is the virus will become, as David Heymann said previously, another endemic virus, a virus that will remain somewhat of a threat, but a very low level threat in the context of an effective global vaccination program. It remains to be seen how well the vaccines are taken up, how close we get to a coverage level that might allow us the opportunity to go for elimination or eradication. Dr. Mike Ryan: (01:01:57) We've seen this with polio, we've seen this with measles. To Bruce and others online, Anna Maria and others, who have a lot of experience with measles and polio, may be able to speak about this. The existence of a vaccine, even at high efficacy is no guarantee of eliminating or eradicating an infectious disease. That is a very high bar for us to be able to get over. First and foremost, we have to focus on saving lives, getting good control on this epidemic so our societies can return to normal. And then we will deal with the moonshot of potentially being able to bring eliminate or eradicate this virus. But at this point, based on the tools we have and the knowledge we have, that's impossible to say at this moment. Tarek: (01:02:41) Thank you very much Dr. Swaminathan and Dr. Ryan. Let's try to take one more question and that will be from Israeli Public Radio [Con 00:14:54], and we have Aaron with us. Can you please unmute yourself? Aaron: (01:03:01) Sure. Can you hear me now? Tarek: (01:03:02) Yes, please. Aaron: (01:03:04) Perfect. I would like to ask the director general for the last press conference of the 2020, I would like to ask should a similar pandemic happen again, are we more prepared than we were last year to deal with it? And on a more personal and professional note, how was your year in combating COVID? What are you taking from this year. Both questions are for the director general, and I would love to hear others comment on that. Tarek: (01:03:35) Thank you. Aaron, with this question, you're opening a big door, but ... Speaker 1: (01:03:42) [inaudible 01:03:45]. Dr Maria Van Kerkhove: (01:03:47) I get the nod from the DG, so I will start and I know others will want to come in. I mean, we all know it's been an incredibly challenging year. I think one of the things we've seen in countries at the start of this pandemic is countries that have had experience with similar pathogens have had this muscle memory. Those that have dealt with SARS coronavirus in 2003, those that have dealt with MERS coronavirus, those that have dealt with Ebola, and yellow fever, and measles, and polio, and so many other infectious pathogens, have a muscle memory and have had a trauma almost in dealing with these types of outbreaks, where they have used that experience to build a public health infrastructure, which have used this to build community health workforce, which has used to have trained health professionals at local levels and building hospital facilities and clinics to be able to treat patients, and may not be the most high-income countries across the world, but using the resources, the people, the communities to the best of their abilities. Dr Maria Van Kerkhove: (01:05:01) And in doing so and having that trauma of previous outbreaks knew immediately when they heard our warnings early on in our first disease outbreak news on the 5th of January and the press conferences that we had after that, the declaration of the public health emergency of international concern released outlined by the director general on the 30th of January, used that as a call to say this is something big and using the muscle memory of those past outbreaks to get their systems, kick those systems in gear. And in doing so act aggressively, act comprehensively, using an all of government, all of society approach and really tackling this. Dr Maria Van Kerkhove: (01:05:39) And I think that your question was about are we better prepared for the next one? I'm hopeful that during this traumatic year that we've all had that the muscle memory that we have from this horrific event this year will propel us and all of us to build societies that are prepared for the next one. Using this to have trained protected workforce, to have community workers who can carry out contact tracing and cluster investigations, to have laboratory technicians who are trained on different types of platforms using standard and robust technologies and innovative technologies that are coming online, making sure that we have communities that are engaged and informed and able to carry out the actions that will keep themselves safe. And again, using the solidarity that we've had across science. So I, for one, am very hopeful that countries will use this as an opportunity to build back better, and that has to go beyond words. But countries right now, many countries are seeing resurgence and we're seeing some countries learn from each peak that they've had to do more and to do better the next time as well. And I think that's a constant learning process. All of us can be better prepared no matter what. And as you've heard, many of our speakers say today, no one organization, no one expert, no one expertise can handle this alone. We have to come together and do that. So I think that we are learning, we will continue to learn, and I am hopeful that we will be better prepared for the next one. But we can't go from this pattern of urgency to neglect. And again, you've heard the director general say this many times, we need to really use this as an opportunity to make sure that we have the systems in place to be better prepared for the next one. Tarek: (01:07:31) Thank you very much, Dr. Van Kerkhove. This will be the last question. So I'll give the floor first to Dr. Ryan, and then also we'll ask our guests. If they want to add something, just unmute yourself. And then obviously the last word will be with the director general. Dr. Ryan. Dr. Mike Ryan: (01:07:51) I agree with what Maria has said, we are and have always been a learning organization. And I think we've learned over the years that no one institution has all the capacity when it comes to dealing with these kinds of threats. What WHO does and has done under the leadership of Dr. Tedros is pull the world together around science solutions and has leveraged all of that capacity around the world. Dr. Mike Ryan: (01:08:17) So therefore I do think we're in a much better place. We're in a better place on behavioral science, clinical science, vaccine science, diagnostic science, so many other areas in terms of that. But we're also in a better place on things like supply chains and collective production of guidance and rapid dissemination of training and using the digital world in order to amplify what we do. We've got better at innovation. We got better at applying that innovation. We're still not there yet on equity, and I'm sure the director general will speak to that. That's the final part of this that requires equitable distribution of all this knowledge and all this learning and all of these tools. But we are in that sense, a learning organization that so many people have contributed to. Dr. Mike Ryan: (01:09:03) And I will say one thing, and that may come as a shock to people, this pandemic has been very severe. It's spread around the world extremely quickly and has affected every corner of this planet. But this is not necessarily the big one. This virus is very transmissible, and it kills people, and it has deprived so many people of loved ones. But it's current case fatality is reasonably low in comparison to other emerging diseases. This is a wake-up call. We are learning now how to do things better, how to do science better, how to do logistics better, how to do training better, how to do governance better, how to communicate better. We've developed a whole new science of infodemiology and advanced behavioral science in this way. Dr. Mike Ryan: (01:09:51) So I think from our perspective, the planet is fragile. We live in an increasingly complex global society. These threats will continue. If there's one thing we need to take from this pandemic with all of the tragedy and loss, is that we need to get our act together. We need to get ready for something that may even be more severe in future. In this, we must honor those we've lost by getting better at what we do every day. Tarek: (01:10:20) Thank you very much Dr. Ryan. The planet is fragile. Let's hear from Professor Koopmans. Professor? Marianna Koopmans: (01:10:30) Yes. I think I second that statement by Dr. Mike Ryan, but particularly also that I think it's critical that we do a good look back once we have the time for that, to see what contributed to the successes and where could we have done better? I think we have seen how the foresight of some years ago to develop a focused program prioritizing pathogens, saying, "These are out there. We need to make sure we have something on the shelf for that." And deciding that we needed new vaccine platforms that really can bring vaccines to the clinic, to patients really at warp speed, that has paid off. I think the same can be said for the development of clinical networks, clinical trial networks, that has paid off. So they were there, they were prepared, the paperwork was in order, people were trained, that helps. And I think we can do a thorough review to see what else would be proper preparedness. Tarek: (01:11:51) Thank you very much Professor Koopmans. Maybe Professor Heymann or Dr. [Abuekerry 01:12:02] would like to add something- Tarek: (01:12:03) [inaudible 01:12:02] would like to add something. Professor Heymann? Professor David Heymann: (01:12:08) Thanks very much. I'll just add a few words. I think we've heard great optimism today from all the research in the way the world is pulled together to deal with this pandemic. And we're continuing to do that moving forward. We've also heard reality. And that reality, as Mike has just said, is that that virus will likely remain with us, endemic in the future. And no matter what we've done to date, it will continue to spread despite vaccines, despite therapeutics, despite diagnostic tests. We have to learn to live with this and use the tools that we can in the best way possible. And it reminds me of the end of smallpox in 1980. In 1980, smallpox was eradicated using a vaccine, which was imperfect. That vaccine actually killed one per million persons vaccinated. It was not a safe vaccine. But the risk assessment said, "Let's get rid of smallpox." Professor David Heymann: (01:13:07) It was eradicated, 1980 certified. 1984, a military recruit in the US was vaccinated with the smallpox vaccine. He actually was HIV infected and not known to be infected. This was an AIDS defining event. And six months later, he died from AIDS. We used the tool that we had to the best advantage we could before 1980, not knowing that that window of opportunity would close to eradicate smallpox. So we can't wait. We have to continue to move ahead with the tools we have, doing the best we can, understanding that this disease will likely either become endemic in humans, in some animal, or in both. So let's move ahead together with WHO leading us as they've done through many outbreaks in the past. Tarek: (01:14:00) Thank you very much, Professor Heymann. Let's all move together. And before I give the floor to Dr. Tedros. Croatia, Abdul Karim, would you like to have some final words? Professor Quarraisha Abdool Karim: (01:14:14) Thank you very much. Yeah. I think that we are reminded that there's no room for complacency. We have accomplished a lot, but even in addressing the SARS-CoV-2 epidemic, there is so much more that remains to be done before we can call it a day and success. It's also useful time to reflect that we still continue to deal with the challenges of other pandemics that continue to face us, including HIV, TB, and malaria, as examples. That at the end of the day, the science and the scientific advances that we make is just the first step. That it is up to us as individuals at the end on how we use that science and that what we do for ourselves and for others at the end of the day will define, do we reach eradication or not? Professor Quarraisha Abdool Karim: (01:15:14) So the world is becoming even more complex as we dealing with multiple pandemics, with the likelihood of new and emerging pandemics, while we still struggling to come to terms with these. So I just wanted to say that ultimately, we can't be complacent even when we have a vaccine, even when we have a cure, because it takes more than that. That's just the first step towards ending pandemics and eradicating new challenges that face us. Thank you. Tarek: (01:15:51) Thank you very much. And indeed, we shouldn't be complacent. Dr. Aylward would like to add something before we give a final word to Dr. Tedros. Dr. Aylward: (01:16:00) Thank you very much, Tarik. To the question, we are definitely better prepared. There's incredible awareness about pandemics now. There's incredible knowledge that's been built. The tools people have just spoken about, the networks and skills are at a whole different level than previously. But this virus is telling us we are not prepared. We're still not prepared. As Mike said, and others, we're now into second and third waves of this virus, and we're still not prepared to deal with and manage those. So while we are better prepared, the real question is, are we prepared and are we prepared for the next one? Dr. Aylward: (01:16:38) We're not fully prepared for this one, let alone the next one. The other thing is we're prepared for flu better than we were in the past. We're now better prepared for Corona viruses, but are we better prepared for the next pandemic? We don't know what the next pandemic is. We don't know what that next virus is, and it would be folly to say that we're fully prepared. There's still a lot. And if anything, at the end of 2020, we should be humbled by the fact that we will always be preparing for these viruses. Tarek: (01:17:10) Thank you very much, Dr. Aylward. This will bring us to final word from Dr. Tedros from my side. I wish you a Happy New Year, Dr. Tedros. Dr. Tedros: (01:17:19) Thank you. Thank you very much, Tarik. And thank you to all colleagues for your contribution, especially to this very, very important question. My role, I think will be less because many of the things have been said by my colleagues, but it's very important. And I would like to reflect on this. Are we better prepared? I think in terms of awareness, I think we're now getting it. I think the world is now understanding the centrality of health the hard way. I mean, this is not news. People say health is well. And when health deteriorates, even at individual level, at personal, one person, then the rest also goes havoc with that. When you're not healthy, the only thing you ask for is to get your health back. Dr. Tedros: (01:18:38) It's when you're healthy, you can aspire about anything else. But not only at individual level, but even at community level, national and global. We have seen the centrality of health during this pandemic, when the whole world got ill, and when we all became hostage of this virus, we have seen the centrality of it. It affected the economy, it affected our social fabric, it affected our politics, it affected everything. So I think the centrality of health now is very clear. And going forward, investing in health, will be a priority for all countries. And all countries in their vision when they founded WHO saved health for all more than 70 years. And I hope it's time now to be really serious and make sure that all roads lead to universal health coverage and that all countries are serious about health for all. Dr. Tedros: (01:20:12) So in terms of awareness and the centrality of health, I think there is progress. But to build capacity to strings in preparedness, to build our health systems, we will need time. We are now fighting with what we have, but to say the world is better prepared, the preparedness should be significant and it takes time. Then the other aspect of preparedness is I think this virus has exposed our societies. Exposed us. Expose the problems that we have. The level of inequity, the level of poverty, the level of exclusion. Health alone will not be a solution. We have to address the root cause of the problem to the inequity in our society. All the exclusions, racism, all the roots behind the problem. And that means implementing the sustainable development goals in its fullest. Caring about our world, the planet, including climate change and the rest. So implementing the sustainable development goals, and achieving the goals we have set ourselves by 2030. And even more ambition will be necessary. Then there was a very personal question about what I think about 2020. 2020 for all of us has been a very difficult year, a very tragic one. Dr. Tedros: (01:22:16) And for me personally, it's not just COVID alone. COVID has been tragic and is still tragic for all of us. But personally, in addition to COVID, 2020 has been very difficult for me because my country is in trouble. My country, Ethiopia, is in trouble. And the war, the devastating war that's happening, is actually in my home country, in my home region, Tigray, Northern part of Ethiopia. And I have many relatives there, including my younger brother, and I don't know where they are. I haven't communicated with them because communication is not there. As if COVID is not enough, I have that personal pain also. I worry about my country. Of course, my younger brother, or relatives, are part of the society. I worry about the whole country. I cannot worry about my younger brother or relatives alone, because the situation is worsening. Dr. Tedros: (01:23:41) So carrying all this could be tough, and has been tough. Then I see also hope because in difficult situations like this, we can also find ways to build a better world and hope to improve situations. And as we all say, build back even better. During this time, by the way, two months ago exact, I became a grandparent, a grandfather. Although I worry considering the two difficult situations that are happening about my granddaughter, but at the same time, looking at her, I see also hope. And that's why in my speech, I said, if the world works together, there is a solution. Dr. Tedros: (01:25:15) There is a solution globally, and there is a solution for any country. So I'm hopeful. And whatever the situation is, I believe it can change. And I call on global community to choose peace, to choose solidarity, to choose caring for one another, caring for each other. And to choose without caring for one another, or each other, that our world could be in trouble. And we have seen that. So that's what I hope for. And this is the last session we have, the last presser of this year, and I hope the problems and difficulties of 2020 will be behind us. And we will have a better 2021. Even with the tragic events, I have said, I am hopeful and we can do it together. I have faith in each other. I have faith in us. I have faith in the world and I hope we will change for the better. I thank you. (silence)