WHO press conference on coronavirus disease (COVID-19) - 12 November 2021
00:00:28
TJ Hello to everyone from WHO Headquarters in Geneva. My name is Tarik, welcoming you to COVID-19 press briefing. Here with us, in the room, we have WHO Director-General, Dr Tedros. Also, with us is Dr Mike Ryan, Executive Director of the WHO Health Emergencies programme, Dr Maria Van Kerkhove, who is Technical Lead on COVID-19, Dr Soumya Swaminathan, who is our Chief Scientist, Dr Mariângela Simão, Assistant Director-General for Access to Health Products. With us is also Mr Steve Solomon, who is the WHO Principal Legal Officer, and online we have Dr Janet Diaz, who is the Lead for Clinical Care and Therapeutics for COVID-19.
We, as always, have simultaneous interpretation into six UN languages and Portuguese and Hindi, and I would like to thank the interpreters who are here with us today. As always, we would ask journalist to be concise and ask only one question if possible so we can take as many that time allows. So, with this, I will give the floor to Dr Tedros for the opening remarks. Dr Tedros.
00:01:51
TAG Thank you. Thank you, Tarik. Good morning and good afternoon and good evening. Almost two million cases of COVID-19 were reported in Europe last week, the most in a single week in that region since the pandemic started. Almost 27,000 deaths were reported from Europe, more than half of all COVID-19 deaths globally last week.
COVID-19 is surging in countries with lower vaccination rates in Eastern Europe but also in countries with some of the world’s highest vaccination rates in Western Europe. It’s another reminder, as we have said again and again, that vaccines do not replace the need for other precautions. Vaccines reduce the risk of hospitalisation, severe diseases and death but they do not fully prevent transmission.
Some European countries are now reintroducing restrictions to curb transmission and take the pressure off their health systems. We continue to recommend the tailored and proportionate use of testing, masks, physical distancing, measures to prevent crowding, improve ventilation, and more, and get vaccinated when it’s your turn.
Every country must constantly assess its situation and adjust its approach accordingly. With the right mix of measures, it’s possible for countries to find the balance between keeping transmission down and keeping their societies and economies open.
No country can simply vaccinate its way out of the pandemic. It’s not vaccines or, it’s vaccines and. And, it’s not just about how many people are vaccinated, it’s about who is vaccinated.
It makes no sense to give boosters to healthy adults, or to vaccinate children, when health workers or older people and other high-risk groups around the world are still waiting for their first dose. The exception, as we have said, is immunocompromised individuals.
00:04:20
Countries with the highest vaccine coverage continue to stockpile more vaccines, while low-income countries continue to wait. Every day, there are six times more boosters administered globally than primary doses in low-income countries. This is a scandal that must stop now.
We have shown that COVAX works, if it has the vaccines. COVAX has now shipped almost 500 million vaccines to 144 countries and territories. All countries have started vaccinating except two, Eritrea and the Democratic People’s Republic of Korea.
The vast majority of countries are ready to get doses into arms but they need the doses. To reach WHO’s target of vaccinating 40% of the population of every country by the end of this year, we need an additional 550 million doses, about 10 days’ production.
Earlier this week, I participated in a meeting of foreign ministers convened by US Secretary of State Antony Blinken. I welcome the ministers’ commitment to achieving WHO’s vaccination targets, and to continue meeting to track progress, so that the targets are achieved, the 40% by the end of this year.
00:06:06
With a concerted effort by countries and manufacturers, we can get there. Vaccines alone will not end the pandemic but we cannot end the pandemic unless we solve the global vaccine crisis and COVID-19 is not the only vaccine crisis we face.
A new report by WHO and the US Centers for Disease Control and Prevention shows that more than 22 million infants missed their first dose of measles vaccine last year, three million more than in 2019, marking the largest increase in two decades. 24 measles vaccination campaigns in 23 countries were postponed because of the COVID-19 pandemic, leaving more than 93 million people at risk of one of the world’s most contagious pathogens.
The report shows that compared with 2019, reported measles cases decreased by more than 80 percent in 2020, but this decrease is cause for concern, not celebration.
Measures to prevent the spread of COVID-19 may have contributed to a reduction in transmission of measles but the decrease also reflects the fact that fewer specimens were sent for laboratory testing last year than any year in the past decade. The drop in vaccination, combined with weak monitoring, testing and reporting, create the ideal conditions for explosive outbreaks of measles.
WHO and our partners are continuing to work with countries to resume vaccination campaigns, make up the ground we have lost and drive progress towards measles elimination.
00:08:15
Finally, inequitable access to life-saving products is unfortunately not just a problem in COVID-19, it is a problem in many diseases, including diabetes. This Sunday is World Diabetes Day, and this year we are celebrating the 100th anniversary of insulin.
Insulin makes a deadly disease manageable for nine million people with type 1 diabetes. For more than 60 million people living with type 2 diabetes, insulin is essential in reducing the risk of kidney failure, blindness and limb amputation.
The scientists who first discovered insulin a century ago refused to profit from their discovery and sold the patent for just one dollar. Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps. One in every two people who need insulin for type 2 diabetes does not get it.
A new WHO report finds that high prices, low availability of human insulin, a market dominated by three companies, and weak health systems are the main barriers to universal access. WHO is working with countries and manufacturers to increase access to insulin for everyone who needs it. Tarik, back to you.
00:10:08
TJ Thank you, Dr Tedros. We will now open the floor to questions and we will start with Christophe Vogt, from Agence France-Presse. Christophe.
CV Hello. Can you hear me?
TJ Very well.
CV Thank you for taking my question. It’s about the two antiviral pills that have been showing promise recently against COVID-19, but as far as I understand they also have some limitations. The symptoms have to be detected early, which would mean testing, which would mean that low-income countries once again would have a hard time using those new drugs. So, I was just wondering if you could tell us about their efficacy but also the limitations. Thank you.
TJ Thank you, Christophe. We will ask Dr Diaz if she could take this question. Dr Diaz.
JD Thank you, Christophe, for the important question. I’ll just address the things that I can and then tell you what we’re doing in process to develop our clinical guidelines. Just to be clear that we, at this point, have not convened our Guideline Development Group panel, which is the expert panel that helps us write the guidelines.
At this moment we are processing the totality of the evidence, meaning taking the trail data, doing a meta-analysis and grading the data to present to the Guideline Development Group that then will help us draft and write our guidelines.
In preparation for that, we have been examining the data. We do know the trials are patients who are early in their symptom onset, so less than five days. That is true, so that means someone has to know themselves that maybe I have COVID and then get tested to get a confirmatory test.
00:12:00
Also, the studies were done in high-risk patients, meaning that those are patients with at least one risk factor for severe disease or hospitalisation, so I think that’s another important aspect.
We also know that the studies of molnupiravir, which is the trial data that we are looking at right now, did not give the drug to women who were pregnant, so that’s another consideration in that drug and the safety profile of that drug.
So, we are looking at the estimates of effect from the studies. I can’t tell you right now what that meta-analysis results are because we don’t have that yet but we hope in about three weeks that we’ll have a GDG meeting because we still need to carefully look at evidence to write the guideline.
In regards to other considerations, I think it’s also important we will be considering whether or not monotherapies, such as with one antiviral, may lead to resistance and what the risk would be, as we’ve seen with some of the monoclonal antibodies. With just using one monoclonal antibody, there may be a risk of developing resistance. So, that will be something we will also be looking at.
00:13:09
Then, as well, in preparation for any new drugs, as well as was done for the vaccines, good pharmacovigilance programmes and practices need to be in place. So, any place, low-middle-income countries, high-income countries, need to have a pathway to monitor the implementation of these drugs in the case that we do write the recommendation to ensure that when it goes out in a bigger population, that the safety profiles are closely monitored in addition to the virus itself and development or resistance or variance. Thank you. Over.
TJ Thank you, Dr Diaz. Dr Simão,
MS Thank you, Janet. Just on the issues regarding the availability at country level, we very much welcome, once the studies are concluded by WHO, we call these small molecules. They are pharmaceutical products. They are very welcome if they are proven to be safe and efficacious because of the capacity to produce in more places.
There is more manufacturing capacity in the globe for pharmaceutical products that are not biotherapeutics like the monoclonal antibodies. We already have a few monoclonal antibodies in WHO’s guidelines and they face, not only the problem of the difficult clinical management, but also the availability and the production is very concentrated in a few manufacturers.
With this type of antivirus, if they prove to be safe and efficacious, we do have already a voluntary licence to several generic producers which will increase the availability in the market, so this is potentially very good news.
TJ Dr Ryan.
MR Like Mariângela, I very much welcome these new data. One of the things we have been waiting for is effective small molecules. Relying on immunomodulators has been great, it has saved lives, but having drugs that are directly able to disrupt the virus replication is very, very welcome.
00:15:20
I think that we have to also remember that the primary prevention for COVID-19 is vaccination and avoiding getting infected in the first place but clearly having a second line approach of being able to treat those who do get infected is very attractive and being able to save lives in that manner is very effective.
This is one of these situations where the strategy will have to evolve and have many layers in our strategy. Our primary strategy is to prevent infection and prevent infection leading to severe disease and then, those infected, to be able to treat high-risk people.
As Janet said, rolling out any new molecule, at this stage these molecules have been tested in hundreds of people. To extend these therapies to potentially hundreds of millions of people is going to take a very careful process to assure safety, pharmacovigilance, surveillance and ensuring that the right patients, as Janet said, at least initially high-risk patients in clinical settings are going to be able to access these drugs.
That does bring in the issue of having appropriate diagnosis, both clinically and from a laboratory point of view and what it speaks to is having well-integrated detection and clinical management systems to care for and support patients with oxygen, with anti-inflammatories, with these drugs, and at different stages of the course of disease.
00:16:45
To have a drug potentially coming down the pipe that can treat high-risk patients earlier in the course of disease is good news but we wait to see the meta-analysis, we wait to go through the process. WHO will work with partners to ensure, under Mariângela’s leadership, that we have the safest and most efficacious products available. Then, obviously trying to get to the point where they can be produced at a price that people can afford.
I think it’s all going in the right direction but we just need to move step by step in a methodical way to ensure that critical care for COVID can improve using these molecules but we also have to focus on basic supportive care, oxygen and all of the other things that we know at this point can save lives.
TJ Next question, Carmen Paun, from Politico. Carmen.
CP Hi, Tarik. Thank you so much for giving me the floor. I just wanted to ask with there has been any update on the emergency use listing of Sputnik V. I know Dr Simão was talking about some, I think, bureaucracy issues a few good weeks ago and I was just wondering if there has been progress on that in the meantime. Thank you.
MS Thank you, Carmen. What we had, actually, were some legal requirements that had to be clarified and signed by the applicant, which is the Russian Direct Investment Fund, which were signed a couple of weeks ago. I think I mentioned this in a presser.
So, the process has restarted. We are in conversations with the applicant, with the Russian government, the different parts of the Russian government and we are expecting to have a meeting next week. We still have to receive the full dossier from Sputnik.
00:18:44
There are pending issues regarding inspections to Gamaleya, inspections to the manufacturers, and there is a lot of exchange of information that still needs to happen until the process is concluded but the process is moving again, which is very good news.
TJ Thank you, Dr Simão. Will now go to the portal, EURACTIV, and we have with us, sorry for my pronunciation, Giedre Peseckyte. Giedre.
GP Hi. Do you hear me?
TJ Yes, very well. Please, go ahead.
GP Thank you for taking my question. I have a question on the European Union’s role in COVAX initiative. I wonder what WHO’s view is. Is the EU doing enough as a global player and should it be doing more? And, if you know, is the EU willing to more, taking into ACT Accelerator’s new strategy that requires fundings of over $20 billion? So, I wonder again what WHO is thinking of EU’s input in COVAX, especially when countries in the region are already giving booster shots while a few percent of people are vaccinated in other parts of the world. Thank you.
00:20:00
TJ Thank you. The line wasn’t the best but I think that the question was on COVAX and where do we stand with that. So, maybe Dr Swaminathan may start. Also, there was mention about ACT Accelerator.
SS Thank you for that question about COVAX. As the DG said, COVAX is a mechanism that was really set up to address the equity issue in access, knowing from past experience that many countries and many people get left behind when there is a global need for a product. So, it was set up as an end-to-end mechanism to invest and we have a portfolio of 11 vaccines in the COVAX portfolio with advance purchase agreements signed with those companies.
The issue has been the supplies to COVAX have been slow. It has not been the first priority for companies to supply to COVAX and this is where we’ve been urging all countries that have already vaccinated over 40% of their populations with the primary course, to let manufacturers supplies to COVAX. We need the visibility and we need the supply chain to keep moving.
Countries are waiting for the supplies and I think we’ve been highlighting the fact that we have over 100 countries today that have not vaccinated 40% of their population. So, still a large number of countries, and we don’t think we can get to that target that we have set by the end of the year unless we increase the supplies through COVAX. 500 million doses, approximately, have moved. We hope to get another 500 million out but we are ready. COVAX is ready to ship doses.
00:21:56
The European Commission has been a strong supporter. As you know, they set up the ACT Accelerator along with WHO, co-founded it, have put in both financial resources as well as a promise of donations of doses that have started flowing. But, again, of all of the doses that have been promised as donations from countries around the world, almost 1.4 billion, less than 20% we’ve actually seen of those.
So, again, very grateful for the donations of doses but we need them to start flowing now, both from the countries of the European Union, as well as from other parts of the world that have promised us doses. We need more resources. The ACT Accelerator just came out with a refreshed budget for about $23 billion, not just for vaccines but also for the tests, for the treatments.
As you just heard, we now have treatments that can protect high-risk people from getting into hospital and dying, even if they get infected. This has to go hand in hand with testing, obviously, with diagnostics and for health systems support.
So, the European Commission has been a strong supporter of the ACT Accelerator and COVAX but this is the time really to prioritise first doses to people who haven’t had those primary doses and wait on the boosters at least till the end of this year, and let’s try and get to that target of 40% of every country’s population vaccinated so we can see deaths going down. That’s really the key here. Thanks. I don’t know if anyone else wants to comment.
00:23:32
MK I just want to come in and take an opportunity to talk about Europe, just given the situation, because I think it’s a balance of what’s happening. You said what’s the role of the European Union and whatnot, and all countries have a role to play in what’s happening right now at the global level, at regional level and countries.
One of the things we are seeing quite strongly in the data is how effective vaccines actually are in terms of reducing hospitalisations and reducing deaths but they have to reach the people who need them most. So, it’s not just about how much vaccine coverage there is, it is about who is being vaccinated, as the Director-General said again in his speech today.
One of our colleagues, a brilliant colleague of ours, today said it’s not even just about who is vaccinated, it is about who isn’t. What are the populations that are missing the critical need for vaccination? People with underlying conditions, people who are over the age of 60, our frontline workers, and in far too many countries those vaccines are not reaching those individuals.
We’re seeing across Europe, across the world, transmission is increasing. Transmission is driven by so many factors right now. The variants, increases in social mixing which began months ago.
The patterns that we are seeing across Europe, the patterns we’re seeing across the world are entirely predictable because when you lift public health and social measures, when you lift the rules around masking and distancing and improving ventilation, avoiding crowds in the context of variants, in the context of increasing social mixing, in the context limited vaccination, you’re going to see the virus thrive and that’s exactly what is happening right now.
00:25:13
In the Northern Hemisphere we are entering the winter months. People will spend more time indoors. What we are saying to all countries right now is look at your situation, critically assess the situation that you’re in right now and make adjustments.
Use the tools that you have, whatever tools you have right now, improving your surveillance, appropriate testing linked to public health action, getting that vaccine but also physical distancing, wearing of well-fitting masks, avoiding crowds. All of this will drive transmission down as we get vaccination coverage up because the deaths that are happening right now are just absolutely tragic because they can be prevented because we have tools.
So, we need to look at what is happening right now in every country around the world and make some course corrections using the tools and capacities at hand while, at the same time, fighting as hard as we can for vaccine equity to get those vaccines into the arms of the individuals around the worlds.
SS I just wanted to add one more point where I think the European Union and European Commission have been very active and that is really in supporting the local manufacturing and production of vaccines and, in particular, supporting the concept of the multilateral technology transfer hubs
00:26:38
The European Union has pledged $1.0 billion to support manufacturing in Africa and working closely with the African Union, with also supporting the new African Medicines Agency that has just been announced.
I think there are many things that are going to happen now and WHO is very happy and privileged with our partners to really support and enhance what is needed to set up manufacturing, not just for COVID vaccines but this is something that is going to be more sustainable, building local capacity so that countries in Africa and in other parts of the world can address their own health needs and produce products which are needed for their own health conditions of their population. So, that’s another area of activity that we’re working very closely with the European Commission on.
TJ Thank you. We will now go to EFE news agency, and we have Isabel Saco with us. Isabel.
IS Good afternoon. Thank you, Tarik. I would like to know that if, given the strong increase of cases in Europe, this can justify to establish capacity restrictions for indoor activities, for example for all public places, museums, fitnesses, cinemas and if you should also consider to avoid, again, crowds, for example in the stadiums, at sport events and so on. What do you think about this? Thank you.
MR I think the situation is almost unique to every country right now and the decisions governments make are very much dependent on what phase of the epidemic you’re in, if it’s winter or if it’s summer, what the background vaccination levels are and what level of compliance can be expected from the implementation of personal measures versus government mandated measures.
00:28:55
I think what is clear, and Maria spoke to this, that in many countries who have achieved 30-40-50% vaccination coverage, it is clear that that 30-40-50% does not include the people who are most vulnerable. In countries that have high vaccine coverage and where in particular within that vaccine coverage they’ve covered high-risk and vulnerable people, we are seeing an increase in disease incidence but we’re not seeing the health systems necessarily come under pressure because that’s not translating into very, very sick patients.
In other countries, with maybe lower levels of vaccination or countries who think they have a high level of vaccination but have significant pockets of vulnerable people unvaccinated, the same incidents of even lesser incidents of disease will lead to pressure on the health system.
All of that in terms of transmission is driven by social mixing, and that’s mixing in the home, mixing in any environment and the more dense that mixing is, the more intense that that mixing is. The more that mixing happens in a situation where people are not taking precautions or in poorly ventilated circumstances or spending a long time with large crowds indoor spaces, we’ve said it, we keep saying it, that is still a high-risk undertaking particularly in a situation where you have low vaccine coverage and where you have existing high incidence at community level.
00:30:22
So, each and every country, and Maria has just said it, needs to take step back, needs to look at the epidemiologic situation they’re facing, needs to do a deep dive on who exactly is vaccinated and, as Maria said, who exactly is not vaccinated. Who are the unvaccinated? Because if you have a significant number of individuals in your community who remain unvaccinated, who are at high-risk of disease and you have intense community transmission, your health system will begin to come under pressure.
There are a number of ways to try and avoid that scenario. Boosting vaccination, in terms of numbers of people who are vaccinated with two dose vaccines or dose of a single vaccine in high-risk areas. We’ve spoken before about the use of third doses or booster doses in people with immunocompromised and people with very, very high risk of disease. Then, looking at what measure at a societal level will help to reduce the intensity of that transmission and take the pressure off the system.
Some countries are facing a very difficult situation and they may need to put in place very stringent measures. Other countries may have opened up slightly too quickly and have completely taken away all measures, masks, no restrictions on gatherings, no restrictions on crowds. In a situation like that, where you have intense transmission with low vaccination, you’re going to be in trouble.
So, I think each country will have to look at what measures can be put in place to reduce the intensity of transmission and that is both an individual responsibility for all of us. Transmission should stop with you and knowing your status and if you are sick or unwell, stay away from work, stay away from school, stay away from contact with others. Get tested. Find out your status and ensure that if you are COVID positive, that you’re properly followed-up and there’s contract tracing done for you and anyone else you’ve been in contact with. All of the things we’ve spoken about before in terms of trying to stop chains of transmission.
00:32:29
I think, quite frankly, some countries are in such a difficult situation now that they are going to find it hard not to put in place restrictive measures, at least for a short period of time, to reduce the intensity of transmission. Other countries are maybe not too late. Other countries can maybe re-engage with communities around masks, around avoiding crowded spaces, around limiting their contact with others, work from home and many other initiatives and, very importantly, increasing vaccine coverage in high-risk populations. Maria, I don’t know if you have stuff to add.
MK I only want to comment on the timing. One of the things we keep saying is do an assessment, reassess the situation and take action. The earlier those actions can be implemented, potentially the less actions need to be taken. What we’re seeing is countries, they’re reaching a point where cases are increasing again, hospitalisation rates are increasing again, ICU capacity is increasing and these interventions that are coming back into place, the wearing of the masks, the physical distancing, the working from home, are coming into effect too late because you’re already in that exponential growth.
00:33:45
Remember, we have the Delta variant right now and Delta is 100% more transmissible than the ancestral strain. It’s the most transmissible virus we’ve seen so far. So, when say do regular assessments and assess where you are and take action, it’s about the timeliness, not only what you do, but the timing of when you implement those measures.
The idea is to avoid having to put all of the measures in all at once but to have that layered approach and have a tailored approach using what is needed in the most local level possible for the least amount of time needed, otherwise the transmission takes off too quickly, you have too many cases, the healthcare system gets overburdened and then you have to just slam down and do into these so-called lockdowns, and that’s what we need to avoid.
So, it’s not only about what is implemented, it’s about the timeliness of those interventions, how they are layered and how they are adjusted because it’s quite confusing for people out there to know what to do. The rules change all the time, the messages change all the time and we can understand that from an individual level measure.
What we commonly say is know what your risk is at an individual level and take measures to lower your risk every day because the situation is so different around the world and for leaders to have clear communication about what needs to be done and when so that people know how to keep themselves safe.
So, it’s combination of approach. Some people like the Swiss cheese approach as opposed to the comprehensive approach. We say whatever works for you, use it, but it’s about a combination of factors, a combination of interventions.
00:35:25
Then, lastly, on spending time indoors, this is an important part of your question. One of the things we’ve been working very hard on with governments, with industry, is to improve ventilation in the places where we live, the places we work, the places we study and that requires an investment.
Quite simply, you can open the windows, if it’s safe to do so where you are, but an investment in ventilation takes time and that is something we’ve been working on with countries to improve but those investments need to happen now.
MR Again, re-emphasising the point for all of you out there, if you’re in Europe right now where we’ve got that intense transmission and you’re in a high-risk or vulnerable group or an older person and you’re not vaccinated, your best bet is to get vaccinated.
There’s some excellent data coming out of European countries and particularly out of the United Kingdom and I think the recent estimate at the beginning of the month was that an unvaccinated person has a 32x greater risk of dying in this pandemic than a vaccinated person. That’s very good odds, if you just want to look at that in terms of something that enhances your chance of life.
00:36:44
So, make that decision if you can. Go out and get the vaccine because not only will that help the health system cope but it will protect you and your family. So, vaccination and getting vaccinated if you’re a high-risk or vulnerable person, older person, is absolutely critical at this point in any of the European countries.
TJ Thank you, Dr Ryan and Dr Van Kerkhove. We will now call on Simon Ateba, from Channel News Africa. Simon.
SA Thank you for taking my question. This is Simon Ateba, with Today News Africa in Washington. Ethiopia seems to be on the brink of a civil war right now or at least on a very dangerous path. Can you give us an update on your activities there? Do you even have access? Are you ready to provide healthcare to people as things continue to worsen there? Thank you.
TJ Thank you, Simon. This question will go to Dr Ryan.
RM I was just looking for my notes there. Thanks, Simon. The situation you outline is grave. The situation in Ethiopia in general but, in particular, in Tigray, continues to deteriorate. We’re in a situation now where not only Tigray but many other areas in Ethiopia are threatened by this situation.
We continue to have massive difficulties in accessing populations, in running operations, in maintaining security, and obviously in the current situation the UN is further interrupted by the recent detention of our staff members in Ethiopia and we hope for their very fast release.
So, we’ve got issues in terms of logistics, in medical access, in running our operations on the ground and this is not just us. World Food Program have similar obstacles in their operations. So, it’s exceptionally important that we have humanitarian access to all people in need in Ethiopia, to all people in need in Tigray.
00:39:09
That is not the case at the moment. That is frankly not the case and we are struggling to even maintain the most minimum of services right now on the ground. The risks are growing. People are dying. People are starving. People are dying because of lack of access to the very basics of medical care. The very basic human right to life is now being lost. It’s an unfolding tragedy and it’s unfolding before our very eyes and the world needs to wake up to what’s happening.
TJ Thank you, Dr Ryan and apologies to Simon. It’s Today News Africa. We will now ask John Zarocostas, from the Lancet, to join us and ask the question. John.
JZ Good afternoon. I’d like to briefly follow-up on my colleague’s question but I’ve got one for the Principal Legal Officer, who I understand is there. If you could bring us up to date on how the talks are going between the various parties on finding common ground for a pandemic treaty to see something happen at the end of the month, how those talks are going.
With reference to the crisis in Ethiopia, I was wondering if Mr Ryan could bring us up to speed if there are any contingency plans, in light that the situation could unravel even more than the dramatic language he just used.
00:40:57
TJ Thank you, John. We will start with Mr Steve Solomon.
ST Thanks very much for the question. There has been a formal member state process to prepare for the Special Session of the Health Assembly. The special session begins on November 29th and will last for three days. That formal process has concluded its work for the special session with a report that will go to the assembly.
At the moment, there is an informal process, also open-ended, which means all member states, all 194 countries can participate in this informal process to develop an outcome document of the special session, that is to say a decision or a resolution of the special session which will address itself to the question, the only question of the special session, and that is the consideration of the benefits of a convention, agreement or other international instrument for pandemic preparedness and response.
It’s a very active process that member states are engaged in. They have the full support of Secretariat and the Director-General in their work and there is good reason to believe that they will come to a successful conclusion.
MR John, could I just ask you to repeat the specific question on Ethiopia?
TJ John, are you still with us. Can you repeat the question on Ethiopia, please? You need to unmute, please.
JZ Dr Ryan, can you hear me now? Yes, I presume so. If I could follow up on my colleague’s question earlier. Given the dramatic situation on the ground as you described it and the high risk that it could unravel even more, are you putting in place contingency plans for a catastrophic situation of a full scale war, as some generals have warned in the last day?
00:43:13
MR We very much hope that that will not be the case because the consequences of such events would be catastrophic but we always have within our planning for any event, it doesn’t matter what it is, we have our current expected scenarios but we also have worse and worst-case scenarios.
So, we always plan for what we think will happen but we also plan for the unthinkable and yes, John, we are always aware in Yemen, in Syria, in Afghanistan, in Ethiopia and in other situations, that there are multiple future scenarios but there ways to avoid those scenarios.
We’ve had the means to avoid the suffering that’s happened already in Ethiopia. This hasn’t been a natural disaster. Tigray has been a man-made disaster. It has been driven by the blockage of aid to a whole people and that worse-case scenario for the people of Tigray has already unfolded. If this continues and if politicians continue to push this country to the edge, then the people can only suffer. That’s the reality of the situation on the ground.
We can only respond to the humanitarian consequences of the decisions of people who we have no control over and everyone needs to look now to the health, the wellbeing and the survival to all people in Ethiopia, to all Ethiopians, and to find a way to de-escalate and to find a peaceful path.
00:45:03
The Director-General, Dr Tedros, always talks about the best path is peace and we need health for peace but now, more than ever we need peace for health but, as I said, the reality is that the drivers of this disaster are man-made. These are human-made disasters and the continued blockage of aid and the continued restriction of our UN partners’ ability to operate, particularly in Tigray, is causing the loss of life and it is causing massive pain and suffering.
So, it is time for something to be done to change that but this has been the case. This didn’t happen yesterday. This has been going on and on and on and people have been speaking up and up and up but we haven’t seen action that would reduce the pain and suffering of the long-suffering people in the situation that they find themselves.
TAG Thank you. Mike has already covered most of it but I think the question is repeating, so I would be happy also to add a bit. Thanks to both who have asked this question. The situation in Ethiopia is really distressing and, of course, until recently the crisis was in Tigray but now the war has spread to Amhara and Afar regions, so the number of people who have been affected is more than seven million now but most of it is still in Tigray, five million people who need food aid.
This has been the case for more than a year now, no medicines. People are dying because of lack of supplies. We cannot send supplies and medicine to Tigray because it is under blockage and the blockage is systematic. So, no medicine. People are dying. No food. People are starving. No telecommunication. They’re isolated from the rest of the world. No fuel, no cash.
00:47:47
It’s under effective blockage so you can imagine the impact of that on the health of people, not only all the health problems that are deteriorating but also mental health. For more than a year now until full stress because of the blockage but even more, as you know, ethnic Tigrayans are being profiled and arrested en masse, in thousands. This is blatant and open. Imagine how that also affects the health of many millions.
From our side, because of the blockage, we are not supporting the people who need support because it is under full blockage, circled in almost all directions. So, there is no access and I don’t think we can give you that much figure on what kind of support we’re giving because it’s really too small and especially the last few months, no supplies, no medical supplies or medicine has entered the region because it was prevented from getting to the region. Medicine and supplies were prevented from getting into Tigray region. So, our activities are to the minimum or you can say it’s almost nothing. Thank you.
TJ Thank you, Dr Tedros, Dr Ryan and Mr Solomon. I think we will go to our last question for today. We have Zee News, from India, and Pooja Mehta, online. Pooja, can you hear us?
00:50:00
PM Thank you for taking my question. Good evening. My question is on booster dose. Is it needed at all or will it be a must for all. What is WHO’s take on it? More than 30 countries are already administering a booster, though evidence from breakthrough infection and secondary infection in India show that COVID is generally affecting one mildly post-vaccination. Thank you.
SS Thank for that question. I think this is a very hot topic and we see, as you mentioned, a lot of countries doing boosters. WHO is basically following the science and the data, so we have the scientific evidence based on which we will make the recommendations and, as you know, we will have the Strategic Advisory Group of Experts that makes the policy recommendations on vaccines. So, they’re tracking the studies around the world very closely and we really need more high quality data coming from more countries because the more representative the data that we can base our guidance on, the better.
Right now, there’s high quality studies coming only from a couple of countries and only on a couple of vaccines. So, I think there is a lot of scope for many countries, including India, to really start providing more data from the populations because of huge numbers of people who have been vaccinated. What we would like to see is data on breakthrough infections, mild, moderate, severe leading to hospitalisations and leading to death.
Now, what was mentioned earlier also by Dr Ryan and Dr Maria was the fact that the surges that we’re seeing in many countries today, including in Europe, are resulting in hospitalisation and deaths largely among the unvaccinated groups, especially if those unvaccinated people are older people, vulnerable, with comorbidities.
00:51:57
So, I think the bottom line is that vaccination with any of the approved vaccines is protecting, to a large extent, against becoming seriously ill. You can still get infected but the protection against severe disease is high, even with the Delta variant, which does cause you some reduction in protective efficacy, but it’s still extremely high.
So, what’s driving hospitalisation and deaths today globally is the unvaccinated across the world in countries which have lack of supplies but also in countries which have enough supplies. It’s that 30-40% of people who are still not vaccinated.
So, I think this is where countries need to focus on reaching those populations rather than on giving additional doses to those who have already received a primary course except, of course, we’ve said repeatedly that people who have underlying immune conditions which don’t allow them to mount a good immune response, they might need a third dose.
But, the majority of people today globally who are falling sick are those who have not had their primary course, so this is where I think countries need to look at their own populations and try to prioritise, get the second dose to people who have only one dose, reach all those vulnerable groups before we start doing boosters because we have limited supplies, and also share.
00:53:17
Countries which have excess supplies, which have already vaccinated their priority populations, let us share with those countries which have not. There’s a 25-fold difference today between countries, high and upper-middle-income countries in doses per 100 people compared to the low-income countries, so that inequity needs to be addressed.
Again, as Dr Ryan and others have said, vaccines are a very good tool that we have but we need to continue to use the other tools because this virus is still transmitting and circulating quite actively and aggressively globally, so we cannot let down on the other public health messages. So, it’s a combination. Thank you.
TJ Thank you, Dr Swaminathan. With this, we will conclude this press briefing. I understand Dr Ryan would like to add something.
MR Just on a personal note, I just want to note the passing of Dr Chris Bartlett, who died on 1st November in the United Kingdom, at the Royal Marsden Hospital. Chris Bartlett led public health in the Communicable Disease Surveillance Centre of the UK for over a decade in the United Kingdom and was one of the people… In fact, when you see the power of public health and public health measurement and surveillance in the United Kingdom today, Chris was one of the people who delivered on that and revolutionised public health and surveillance but, not only that, was instigator of the European Centre for Disease Control, the EPIET training programme and others.
00:54:59
I just wanted to extend on behalf of myself, the Director-General and the World Health Organization, our recognition of the career and life of Chris Bartlett and all the people that worked with him and to pass our condolences to his family. Sometimes, we should measure the heroes that pass who created the systems that we now rely on, as in the case of the United Kingdom, some superb public health systems that exist there for measuring health impact, and Chris was a major part of that. Thank you.
TJ Thank you, Dr Ryan, indeed. We will be sending the audio file from this press briefing shortly after and a transcript will be available tomorrow, as per usual. The last word is for Dr Tedros.
TAG Thank you. Thank you so much, Tarik, and thank you to all media colleagues who have joined today and see you next time.