World Health Organization (WHO) Coronavirus Press Conference Transcript July 17

Dr Michael Ryan: (00:00) The health security of the world is threatened by the fact that there are not strong surveillance and response systems in place in these fragile settings. That's a threat to the people in those areas, and that's a threat to the world. So the cost of doing nothing and the cost of non-intervention is not just in the areas; it is a global consequence of inaction. And we really need to look at that. Dr Michael Ryan: (00:20) Secondly, when we look at our collective goals in terms of reaching the sustainable development goals and bringing better health and social justice to the world, the fact is that the highest rates of maternal and child mortality are occurring in these same countries. We will not reach our goals on childhood mortality, on maternal mortality. We will not reach our goals on immunization for the world unless we learn to do better in supporting these countries in conflict, in deep fragility. Dr Michael Ryan: (00:53) So therefore there is a massive cost of inaction, both on COVID, but on so many other things in these countries. So we stand with Mac and the interagency standing committee and our UN partners in really highlighting that the longterm issues arising in conflict are not only impacting the people in those areas, but have a major implication for the rest of the planet. And it is in our enlightened self interest to address this. This is not just the right thing to do; it is the smart thing to do. Margaret: (01:27) Thank you very much, Mr. Lowcock and Dr. Ryan. We know have [Biram 00:01:32] from Anadolu, the Turkish agency. Biram, please unmute yourself and go ahead. Speaker 1: (01:37) Thank you so much for taking my question. We keep on hearing different reports about whether or not people can be reinfected with COVID-19 after getting the virus and then being cured. What is the WHO's current assessment of this? Thank you so much. Maria Van Kerkhove: (02:02) Thank you for the question. Yes, this is an important question that we've been asked quite a lot lately in terms of if someone can be reinfected with COVID-19. This is an area of active research by scientists all over the world, clinicians all over the world. What we understand from people who are infected with the SARS-CoV-2 virus, the virus that causes COVID-19, is that they will develop an immune response. They will develop neutralizing antibodies, and an immune response that will provide some protection against reinfection. What we don't know right now is how strong that protection is and for how long that protection will last. And we need answers to those questions to be able to determine if someone can be reinfected after that immunity wears off. So this is an area of active research for the specific SARS-CoV-2 virus. Maria Van Kerkhove: (02:55) We do have some answers for other coronaviruses, the MERS coronavirus, and the SARS-CoV-1 coronavirus, which emerged in 2003, indicating that people have an immunity that lasts over 12 months or so, and maybe even longer. And we have some results from the human coronaviruses, the common cold coronaviruses that circulate the globe regularly. And your protection lasts a lot shorter than that. So we don't have a complete answer, but it is an area of active research. And I should say, an active collaborative research all over the world. Margaret: (03:31) Thank you very much Dr. Van Kerkhove Kickoff and Dr. Ryan. Margaret: (03:38) Now we have a question from Bianca, from Globo in Brazil. Bianca, please go ahead. Unmute yourself and please go ahead. Bianca: (03:48) Hi, Margaret, can you hear me? Margaret: (03:51) Very well, Bianca, please go ahead. Bianca: (03:54) Many thanks for your attention, for taking my question. So [inaudible 00:04:00] from global news and global TV, Brazil. I know that Brazil is between the 63 countries that Mark Lowcock mentioned where people need the humanitarian assistance. So I would like to hear from Mark, how concerned are you, Mark, with the situation there in Brazil? And from Dr. Tedros or Dr. Ryan, if they can give us an updated general view of the challenge Brazil is facing now with more than 2 million cases. Thanks a lot. Margaret: (04:39) Okay. This one's for Mr. Lowcock. So we'll go to Mr. Lowcock first and then we've got some things to say in the room, too. Mark Lowcock: (04:47) Well, thank you very much. Mark Lowcock: (04:53) The main activity of the humanitarian agencies, which I coordinate in Brazil, relates to support for Brazil in the way they are helping people who've left Venezuela. And Brazil, like Colombia, Peru, Ecuador, a range of other countries, is taken a large burden of supporting, helping support millions of Venezuelans, who, for reasons everyone's familiar with, have in recent years, left their country. Mark Lowcock: (05:28) Now, it's probably important for me also to say that we recognize that Brazil itself has a very substantial problem. And I know that Tedros and Mike will talk about WHO's perspective on there and the support and so on, but what the humanitarian agencies do is focus their effort on the very poorest countries. So Brazil country, obviously, which has developed a lot over recent decades has typically not needed assistance from humanitarian agencies in the way say, some African countries or some countries caught up in conflict have done. So we do not, at the moment, and we hope we never need to have a strong engagement of the humanitarian agencies in dealing with a crisis in Brazil because Brazil has built up a lot of capability of its own through the process of development. Mark Lowcock: (06:25) So I think that's probably what I can say on this topic, but I know that Tedros and Mike will have other things to add. Dr Michael Ryan: (06:31) Yeah, I can make some general points. Again, the number of daily cases has stabilized between 40 and about 45,000. So we're not seeing the daily increases that we've seen through the month of April and May. We saw very high rate of increase and coming then into mid-June and into July; you see that plateau occurring. But what's not happening yet is that that disease has not turned and is not heading down the mountain. So from that perspective, the numbers have stabilized, but what they haven't done is started to fall in a systematic day-by-day way. Dr Michael Ryan: (07:25) So Brazil is still very much in the middle of this fight. The last 24 hours, I think over 45,000 cases with 1,322 deaths. Overall, about 11% of cases, more than one in 10 cases in Brazil is a healthcare worker, which is in itself a tragedy. And Dr. Tedros referred to that similar situation in Spain. So our health workers are paying the heaviest price. The reproductive number, overall in April and May, the reproductive number was. Dr Michael Ryan: (08:03) In April and May, the reproductive number was quite high. It was over 1.5 and in many cases, over two. In other words, each case was generating two or more other cases. That, in general, across all of the regions, has stabilized now and is somewhere between 0.5 and 1.5 across the different states. So, the virus is not in a sense doubling itself in the community as quickly as it was before. The rise in Brazil is no longer exponential, it has plateaued, but the cases and deaths continue to occur and there is absolutely no guarantee that that will go down by itself. Dr Michael Ryan: (08:36) We've seen this in other countries. There is a plateau. There is an opportunity here now for Brazil to push the disease down, to suppress the transmission of the virus, to take control. Up to now, in many countries including Brazil, the virus has been in charge, the virus sets the rules. We need to set the rules for the virus and there is an opportunity, once those numbers have stabilized, to drive transmission downwards. I think that opportunity exists now for Brazil to do that, but it is going to take a very sustained, concerted action in order for that to occur, and we wish the authorities in Brazil, we wish the frontline health workers every success in doing this and WHO [inaudible 00:09:14], will be with them every step of the way in doing that. Margaret: (09:22) Thank you very much. The next question comes from [Dina Abi Saab 00:01:27] who writes for a number of outlets in the Gulf States. Dina, please go ahead with your question. Margaret: (09:42) Dina, can you unmute yourself please, and ask your question? We can't hear you. Margaret: (09:55) Okay. Dina, we'll come back to you and we'll go to our next person. The next reporter is Katrine from [France San Quatre 00:02:06]. Please go ahead, Katrine. Maria Van Kerkhove: (10:09) Yes. Thank you Margaret, for taking my question. In fact, this is a very precise questions regarding some research made, apparently, in Israel regarding medicine, a powder, that could block some of the infection, but through the nose. It is apparently a powder based on intranasal product. It's an intranasal product that could block the droplets to enter through the nose. So, do you think that it is an interesting research? Is it efficient. Is it a part of the treatments that you are looking into? Thank you. Dr Michael Ryan: (11:04) I think we'd need, I'm not personally aware of such a product in Israel, and we'd certainly need a lot more information before we could make any comment. But what have been developed in the past, and there are a number of the nasal pathway, and many of us use nasal products in the winter when people have colds or flus and we can inhale certain products to relieve symptoms. So, there's a difference here between symptom relief and treatment of a case or prevention of a case. There are lots of products out there that are intranasal that allow people to achieve relief when they have colds and flus. I'm sure many people are using them during the era of COVID. Dr Michael Ryan: (11:47) There are various other therapeutic products that can be delivered through the intranasal route, and I know some companies, for example, I know that the company Gilead is currently trying to develop an intranasal or an inhaled version of its drug. I know also on the vaccine development front, that there are vaccines currently being under development, that may also be delivered through the nasal route. So, there are potentially promising intra-nasal solutions, but in a sense, we have to decide if drugs or vaccines are best delivered by oral, by injection or by inhalation or by intra-nasal routes. But, certainly, I'm not aware of any particular powder or any particular medicine from Israel and we would need more information before making a specific comment on that. Maria, I don't know if you have any ... Margaret: (12:47) Thank you very much, Dr. Ryan. We now have Michael from CNN, Michael, please unmute yourself and go ahead. Michael: (12:57) Good morning from British Columbia. Can you hear me? Margaret: (13:01) Very well. Welcome to Geneva. Michael: (13:05) Thank you for taking my question. A question for Mark, if I can. Mark, I have to salute the work of [inaudible 00:13:12] and your colleagues. I've watched them at work up closely as a UN worker and as a journalist. You have some of the best in emergencies. My question is the following, and I think it overlaps with an earlier one a bit, but it seems to a lot of us tracking this, that conflicts are not only lasting longer, they are more lethal. I know today, for example, is the sixth anniversary of the downing of MH17 in Eastern Ukraine, and that conflict has lasted six years, killed more than 14,000, displaced millions. But why is that danger factor, that lethal factor much, much bigger these days than before? Thank you very much. Margaret: (14:02) Mr. Lowcock, please go ahead. Mark Lowcock: (14:04) Yes. Yeah. Thank you very much. So, you're right in terms of what's happened. I mean, you used the example of eastern Ukraine. The conflict in Syria is nearly 10 years old now, longer than the first and second world Wars combined. The Yemen conflict is more than five years old. The internal conflicts in and around the Lake Chad basin have been going on for many years. Why is this happening? Well, I think it's largely a commentary on the state of geopolitics, frankly, that the world was much better, more capable 10, 15 years ago in dealing with these kinds of problems, both preventing them, and then when they did occur, resolving them than it is in the current era. Mark Lowcock: (15:03) We see that particularly, also, in the Libya crisis where what we've got, as we have with some of the others I've referred to, is not just an issue inside the country. We have multiple external partners taking sides and engaging themselves, and this is the biggest driver of the huge increase we've seen in humanitarian suffering. Most humanitarian suffering these days arises not from earthquakes or typhoons or floods, natural events. It arises from human actions and the world needs to get better at resolving these problems. Mark Lowcock: (15:44) Now, of course, as I said earlier, there are underlying drivers, political, economic, environmental. And one of the things that we're also seeing is more conflict related problems which are driven in an underlying world, made worse in ... Mark Lowcock: (16:03) ... which are driven in an underlying way or made worse in an underlying way by resource pressures. And the only way out of this set of challenges is, firstly, to contain immediate problem. That's where humanitarian assistance comes in. And the world has a very good humanitarian system, which reaches more than a hundred million people a year, and certainly saves millions of lives a year, and prevents some conflict spreading even further, and the global public [inaudible 00:16:30] being exported even further. Mark Lowcock: (16:32) But, beyond that, what the world needs to get better at, again, is peacemaking and peace building and crucially development. It's evident that it's much less common these days than it used to be in previous human history for there to be conflicts affecting the better off countries. So, the path out of this little period were in, unhappily globally at the moment, is very fundamentally related to development and especially the achievement of the sustainable development goals. In the meantime, the humanitarian agencies need to be supported to relieve the suffering of those people who, through no fault of their own, are caught up in crises and avoid them spreading further. Thank you. Margaret: (17:14) Thank you very much, Mr. Lowcock. Do we have anyone in the room who wants to add? So, our next question comes from Peter from European News Agency. Peter, can you unmute yourself and go ahead. Peter: (17:36) Okay. Can you hear me now? Margaret: (17:40) Hear you very well, Peter. Please go ahead. Peter: (17:44) My question is addressed more in general because several studies have already indicated that antibodies become inactive. There are studies in Belgium and in Spain that have already indicated that the antibodies leave the bloodstream within a matter of months. So, that also, it would imply that the herd immunity and the T cell immunity is unlikely to work. That's a bit scary. So, why shouldn't we not address our narrative a bit more towards informing public that this pandemic is going to take us at least two to three years down the road? And what would the WHO could do in order to bridge this period from now until there is a vaccine, which is unlikely going to be there before 2023? Thank you. Maria Van Kerkhove: (18:42) So, thank you for the question. I'll start. And I'm sure others would like to add here. So, you have a number of questions in your question that you pose to us, in your statement here. There are a number of studies right now that are looking at the antibody response, whether this is a neutralizing antibody or whether it's a T cell response. That's not the same type of antibody response. The data that we have is very preliminary. Maria Van Kerkhove: (19:08) We mentioned the other day that there's three studies that are available. There are many studies in pre-print, which means they have not gone through peer reviewed publication. And there are hundreds, literally hundreds of other studies that are underway that are looking at the antibody response, whether it's neutralizing antibodies or T cell response, a cellular response among different individuals, people who have had mild infection, people who have had severe disease, people who have developed no disease at all, or these asymptomatic cases and what that actually means. Maria Van Kerkhove: (19:41) As you say, we do have some preliminary data that suggests that the neutralizing response may not last for a long period of time. But we do need to be careful about drawing too many conclusions from some preliminary information. What we really need is to do these longitudinal studies where we follow the same individuals over time and we actually measure the neutralizing antibody response and ideally a T cell response, which is actually a much more difficult study to conduct and can only be conducted in a few countries in the world right now. And we're supporting countries to be able to do these types of studies. Follow these individuals over time and collect samples over many, many months and actually look at what that protection looks like. Maria Van Kerkhove: (20:24) But, as you say, there are things that we need to do right now to be able to, first of all, prevent those infections. And we have outlined, since the beginning of this pandemic, a number of different ways in which people as individuals can prevent themselves from getting infected, prevent themselves from infecting others who may be of a more vulnerable population and develop severe disease, what governments can do to outline this, all of government, all of society, comprehensive approach. And these are steps. These are tools that we have right now. We must use these tools right now while there is this development, accelerated development of therapeutics and safe and effective vaccines, which will definitely take some time. Maria Van Kerkhove: (21:08) But what I want to just caution is to draw too many firm conclusions from preliminary results. I think we do need to prepare ourselves, as you say, with the information that we have and ensure that we have a comprehensive system in place to find cases, test cases, isolate cases, carry out contact tracing, ensure that contacts are quarantined, make sure that we have appropriate and adequate care facilities for individuals who need care for COVID and for other diseases so that we empower our communities, so that everyone knows what they can do to prevent themselves from getting infected, focusing on public health measures with the hand hygiene, the physical distancing, wearing a mask where appropriate. All of these measures need to be put in place now. Margaret: (21:54) Thank you very much, Dr. Van Kerkhove. So, we're coming up to the hour. We've got a lot of questions. And I apologize to all those who didn't get their question asked. But I think we'll have to make this the last question. And it goes to Musa from the Geneva Press Corps. Musa, please unmute yourself and go ahead. Speaker 2: (22:15) We as- Musa: (22:16) Yes. Can you hear me? Can you hear me? Very well. We can hear perfectly well. Yes. Thank you very much. So, my question concerns the developing countries, especially in Africa. The G20, if they haven't lived up to their pledges, so what is the situation in these countries, in the poor countries, in the developing countries, especially in Africa, when it comes to the economic, social, and health concerns? Thank you. Margaret: (22:49) I think that's a question for Mr. Lowcock. Mark Lowcock: (22:54) Well, thank you very much, indeed. So, let me start by saying a few things about the sets of problems and challenges that countries in the continent face as a result of the COVID pandemic. The first is economic. They're affected by the global economic contraction. And some of the measures around lockdown and so on have affected them as well. So, there are large numbers of people now in the continent for whom it's harder to make a living than it was before the crisis. Mark Lowcock: (23:25) Secondly, they're effected by what we observe as enormous pressures on the health system. Immunization rates, they're probably the best investment to save a life is to vaccinate a child against a killer disease. Immunization is under pressure, is not being sustained in lots of countries. Malaria prevention control is under pressure. It's harder to sustain basic services for pregnant women and for newborn children. HIV prevention treatment is getting harder to sustain as well. In addition, we're seeing a- Mark Lowcock: (24:02) In addition, we're seeing a plague of gender based violence, a global plague, actually. Not just in developing countries, but in other places. But women and girls in poorer countries are suffering from that as they are in other places. Now, what we want to see is support to African countries who don't have the same resource base as some other countries elsewhere around the world. We want to see more support for them as an act of human empathy and generosity, but also in the interest of the wealthier countries. And we have seen some generous funding for our humanitarian response plan for COVID-19. As I said earlier, we've raised $1.7 billion so far, but we need to raise a lot more. Mark Lowcock: (24:53) And the basic problem we have at the moment on the humanitarian side is needs are growing very dramatically. I think there'll be a need for $40 billion worth of assistance to protect 250 million people from humanitarian crisis this year. The needs are growing very dramatically. And although the funding is growing too, the funding is growing very slowly. So the gap between the need and the funding is growing. Mark Lowcock: (25:18) But we're also seeing another compounding problem, which is that more countries are coming under economic stress and are being dragged down into the category of that countries, which has humanitarian loads and people who can't survive without help. And that's where I really think the G20 needs to step up to resource the international financial institutions, the IMF and the World Bank and other institutions, better to help avoid a situation where more and more countries come into these acute levels of crisis. And the rules get changed on the basis of which the international financial institutions support those countries. So the money moves faster, more efficiently, but crucially, most of all, to the countries with the biggest problem. Thank you. Margaret: (26:09) Thank you very much, Mr. [inaudible 00:02:10]. Dr. Ryan's got something to add. Dr Michael Ryan: (26:13) Now just to support what Mark has said, and in the particular context of COVID-19, many countries are really taking a huge impact on the humanitarian front, on the development front, on the health systems front. And this is causing huge strand on overseas aid, ODA, and donors who would traditionally be supporting developmental health systems are strained by that because governments are also trying to take care of crisis at home. So equally, humanitarian donors in the same situation. Dr Michael Ryan: (26:43) And I think while trying to sustain overseas development assistance and aid and humanitarian intervention, I think we also need to accept that supporting countries for COVID-19 in humanitarian settings or in fragility or supporting humanitarian response in general in those settings is not just a humanitarian issue. It's not just an interrupted development issue. It is now globally about continued economic prosperity on this planet because unless and until COVID-19 is controlled everywhere, it is a risk everywhere. And it will continue to threaten the world economically. It will continue to threaten the world politically until we get rid of this virus or bring it under sustained control. Dr Michael Ryan: (27:36) Therefore, we cannot ignore the fact that over two billion people live in context of poverty, exclusion, fragility, and extreme vulnerability. It is not purely a development or humanitarian issue and neither is a purely an economic issue. It is an issue of global security. It is about global health security, but ultimately, if not managed and if these contexts are not stabilized and managed, they themselves will worsen conflict and will drive further instability. And I think it's time, and Mark has laid this out very, very clearly in the documents that he and his teams have produced, this is much more than a development and humanitarian issue and the world needs to wake up to that reality if we want to effectively deal with COVID-19 going forward. [inaudible 00:28:30] Margaret: (28:29) Thank you very much, Dr. Ryan. I will now close proceedings, but Dr. Tedros has something to say. I will first apologize for some of the problems with the sound and with this live streaming on social media, but we'll make sure that we will post it all on the web and we'll send you the links and we'll also provide the transcript. Now I'll hand over to Dr. Tedros to close proceedings. Dr. Tedros: (28:58) Thank you. Thank you, Margaret. At the beginning of today's briefing, I quote the remarks made yesterday by the Spanish nurse, Aroa Lopez. One of the other speakers at yesterday's memorial was Fernando Hernandez Calleja, who lost his brother to COVID-19. I want to finish by quoting him. This is what he said. "More than kindness, more than love, compassion is the emotion that most makes us human. Compassion allows us to understand the pain of others, their thwarted aspirations, their sadness. That's why I'm asking today for your compassion." Dr. Tedros: (29:53) I want to echo Fernando's call to whole world. More than anything, we are asking for your compassion. This pandemic can only be defeated when we unite and through compassion. Thank you and have a nice weekend. And thanks, Mark, also for joining us today. Thank you. And all those online for joining. Thank you so much. Have a nice weekend.