WHO press conference on coronavirus disease (COVID-19) - 14 September 2021

00:00:45

MH         Hello, everybody. This is Margaret Harris in Geneva welcoming you today, Tuesday September 14^th, to this week's WHO global press briefing on COVID-19. Today's a very special event. We have assembled some of the best minds to discuss how to tackle the challenges posed by COVID-19 in Africa.

Joining our WHO Director-General, Dr Tedros Adhanom Ghebreyesus, today are Dr Seth Berkley, the Chief Executive Officer of GAVI, the vaccine alliance, Mr Strive Masiyiwa, the African Union Special Envoy for COVID-19, Dr John Nkengasong, Director of the African Centre for Disease Control, Professor Benedict Oramah, Professor and Chairman of of the Board of Directors, Afreximbank, and Dr Vera Songwe, the United Nations Under-Secretary-General and Executive Secretary of the Economic Commission for Africa. They're all assembled in the room for you today.

Online we have Dr Matshidiso Moeti, WHO Regional Director for Africa. We will also have a full team of experts available to answer your questions during the question-and-answer session, which will follow the interventions by our distinguished panel. As ever we have a team providing simultaneous translation in the six official UN language plus Portuguese and Hindi and I thank you all in advance.

00:02:14

Now it's time for less from me and much, much more from our distinguished panel so I'll hand you over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor.

TAG       Thank you. Thank you, Margaret. Good morning, good afternoon and good evening. As you know, WHO's global targets are to support every country to vaccinate at least 40% of its population by the end of this year and 70% of the world's population by the middle of next year.

So far just two countries in Africa have reached the 40% target, the lowest of any region. As I said last week, that's not because African countries don't have the capacity or experience to roll out vaccines. It's because they have been left behind by the rest of the world.

More than 5.7 million doses have been administered globally but only 2% of those have been administered in Africa. This leaves people at high risk of disease and death, exposed to a deadly virus against which many other people around the world enjoy protection.

00:03:25

This does not only hurt the people of Africa; it hurts all of us. The longer vaccine inequity persists the more the virus will keep circulating and changing, the longer the social and economic disruption will continue and the higher the chances that more variants will emerge that render vaccines less effective.

It was to avoid this situation that WHO, GAVI, CEPI and UNICEF established COVAX last year to accelerate the development and equitable distribution of vaccines. So far COVAX has shipped more than 260 million doses to 141 countries.

But, as you know, COVAX has also faced several challenges with manufacturers prioritising bilateral deals and many high-income countries tying up the global supply of vaccines. Last year the African Union established the African COVID-19 Vaccine Acquisition Task Team or AVAT as a complement to COVAX to purchase vaccines for the AU member states.

I would like to thank my friends and colleagues here today, Stride, John, Vera, Benedict for their leadership of AVAT and acknowledge the role of President Cyril Ramaphosa in initiative AVAT as Chair of the African Union.

Yesterday and today we had a very constructive meeting between partners from COVAX and AVAT to agree on a way forward. Vaccine inequity is a solvable problem. We call on manufacturers to prioritise COVAX and AVAT. We call on countries that have already achieved high coverage levels to swap their near-term vaccine deliveries with COVAX and AVAT, to fulfil their dose-sharing pledges immediately and to facilitate the sharing of technology, know-how and intellectual property to support regional vaccine manufacturing.

00:05:42

We call on all countries and manufacturers to share information on bilateral deals with COVAX and AVAT so we understand where vaccines are needed most and to share information on supply and delivery projections so countries can be ready to immediately roll out vaccines when they land.

And we call on all countries to recognise all vaccines with WHO emergency use listing. I may sound like a broken record. I don't care. I will continue to call for vaccine equity until we get it. But you don't just have to hear it from me. Today I'm honoured to be joined by several leading voices to talk about how COVAX and AVAT are working together to achieve our shared vaccination targets in Africa.

00:06:38

First I'm very pleased to welcome Mr Strive Masiyiwa, the African Union Special Envoy for COVID-19. Strive, thank you for joining us and for everything you're doing with AVAT to deliver vaccines to Africa's people as soon as possible. Thank you for your leadership and you have the floor.

ST          [Inaudible] over the last two days we have had two days of very intense discussions with our colleagues at WHO, GAVI, WTO, CEPI to really review some of our work together. Just to recap, the African Nations under the leadership of President Ramaphosa and the Executive Committee known as the Bureau of Presidents created AVAT because our target was 60% and the donors had kindly offered to provide up to 50% of our target through the initiative called COVAX.

So we were created and mandated to be a 50% partner of COVAX and we work closely together. We talk regularly, we exchange information but we felt that the time had come for us to meet even in these difficult times of travel, to meet and to really explore with our partners under the leadership of the Director-General and leadership it has been.

00:08:51

I'm joined by my colleagues. We will share remarks together around key issues but hopefully we will also be able to give clarifications around the deliveries.

Just to recap, our population is 1.3 billion people so our target of 60% of our population is just under 800 million. The African Union treats the Caribbean member states as the sixth region of the African diaspora and because the CARICOM member states appealed to the African Union to say, we are unable to buy vaccines by ourselves because we are treated as too small, could we work together with you?

So we treat our delivery target as vaccinating 800 million people for Africa and the Caribbean and so we created a pooled mechanism for aggregating our demand from the member states. We've so far, with all the difficulties that have been well articulated, managed to secure for the next 12 months 400 million single-shot doses from the American company, Johnson & Johnson and we continue to negotiate with other suppliers.

00:10:42

But as you will see, when we receive the 400 million that would go a significant way towards our stated target of 60% but there have been major difficulties in ensuring that supplies that are supposed to come through the COVAX facility come through.

So we've worked together to try and identify the challenges and we came also to offer whatever little help we can, to see how we can open up these deliveries, speed up these deliveries but it does require very much that there be a global effort because COVAX is only as strong as those who made commitments to support COVAX.

It's only as strong as those who made commitments to pledge to share their doses. It only works as well as the manufacturers recognising that they also have a responsibility in equitable distribution.

The production is limited, yes. That means we all must act responsibly when it comes to how vaccines are sold and bought. I will stop there for now. Mr Director-General, once again thank you for your time and attention to the African continent.

TAG       Thank you. Thank you, Strive, and thank you again for your leadership. It's now my great pleasure to welcome Dr John Nkengasong, the Director of the Africa Centres for Disease Control and Prevention. John, thank you for your leadership in fighting the COVID-19 pandemic in Africa without the tools that so many other countries have access to. You have the floor, John.

00:12:45

JN          Thank you, Director-General, Dr Tedros. Let me just pick up from where our AU Special Envoy, Mr Strive Masiyiwa, ended. He indicated that as a continent we have a target of immunising up to 60% of our population.

I think a good starting place for all of us would be to understand where we are. As we speak today as a continent of 1.3 billion people we have just under 3.5% of our eligible population that has been fully vaccinated. I will repeat that number; 3.5% of our population that has been fully immunised.

At the same time we have celebrated the remarkable success that was made by the scientific community, introducing several vaccines. At that time, at the start of this pandemic we always agreed that the way forward for all of us would be global solidarity and global co-operation and the power of partnership.

Today we are here to manifest that power of partnership, global co-operation and solidarity; that we will not be able to achieve 60% of our population fully immunised if we do not fully exploit and deploy the power of partnership, the power of co-operation and the power of solidarity.

00:14:16

We all have acknowledged now that vaccines are the only solution for us to get out of this pandemic collectively and that has to be done quickly. I've always stated that the quickest way to get out of this pandemic is to vaccinate quickly.

As a continent we believe and we adhere to the 70% target that Dr Tedros just mentioned and we will be working together with COVAX and other partners to make sure that the continent gets that 70% of its stated target.

Thank you, Dr Tedros, for the opportunity to continue to work with the WHO and work with GAVI and COVAX and other partners. Thank you.

TAG       Thank you. Thank you, John, and thank you for your continued partnership, including through the MRNA technology transfer hub that we have established together in South Africa. Next it's my pleasure to welcome Dr Vera Songwe, the United Nations Under-Secretary-General and the Executive Secretary of the Economic Commission for Africa. Vera, thank you so much for your leadership and thank you for joining us today. You have the floor.

00:15:33

VS          Thank you. Thank you very much, Director-General, Dr Tedros. It's a pleasure to be in one of our buildings with you again and with the team. My responsibility and role in AVAT is really to look at the economic perspective of the continent.

Before we had the COVID crisis of course Africa was seeking to create more jobs; 13 million more jobs we needed to get to prosperity and meet of course the SDG goals. The COVID-19 crisis has stopped all of that in its tracks and just to give you a sense of what that really means, every one month of lock-downs on the continent cost us $29 billion of production that was lost.

So for us when we say that COVID-19 is an economic issue and we need to respond to it to be able to recover and reset our economies it is real and I think for that we need financing and we need to see how we can bring together global financial structures to ensure that we can actually respond to this crisis and that is what, I think, Professor Oramah will be talking about.

00:16:43

But beyond that we also have the special drawing rights that have been released and Africa got $33.6 billion of special drawing rights and we thank the World Bank in particular and the IMF for providing financing up until now but we hope that we can get the international community to continue to on-lend special drawing rights so that we can create a vaccines facility to be able to respond to what is now seemingly going to be a continuous spend for the continent.

The continent has worked really hard to ensure that its macroeconomic balances were solid. Some countries were reaching debt distress levels. The COVID-19 virus is clearly going to throw them across the board so we need some funding for vaccines which is concessional and long-term if possible at best to make sure that countries can respond to COVID-19 but not compromise economic growth and prosperity.

So again I think we just want to thank you, Dr Tedros, for continuing the fight for vaccine equity but also to ensure that there is better transparency in the availability of vaccines because we know that scarcity means increased cost and we cannot afford today as a continent that kind of scarcity.

Then finally the African Continental Free Trade Area Agreement provides us with the recovery and the reset structure and framework for that. That means we need to manufacture vaccines on the continent and we hope that we can come together, working again with WHO, with COVAX, CEPI, UNICEF to ensure that pooled procurement mechanisms allow for Africa not just to produce but also to sell and not only to Africa but to the rest of the world the vaccines that it produces. Thank you.

00:18:25

TAG       Thank you. Thank you, Vera, and thank you once again for your leadership. I'm now pleased to introduce Professor Benedict Oramah, the President and Chairman of the Board of Directors of Afreximbank. Benedict, thank you for joining us today and thank you for your support for expanding access to vaccines in Africa and thank you for your leadership. You have the floor.

BO         Thank you very much, Director-General, Dr Tedros. It is a pleasure to be here and we thank you for the hospitality and the warm reception from you and your colleagues and also from Seth from the GAVI/COVAX facility.

00:19:16

I will continue from where my colleague stopped. The creation of the Africa Vaccine Acquisition Task Team was a direct manifestation of the continent's determination to take its destiny in its own hands, towards tackling the problem of the COVID-19 pandemic.

Africa did not want to once again be at the bottom of the queue with regard to vaccines because it was well-known to everybody that economic recovery meant bringing the virus under control, the pandemic under control and vaccines are seen as the only credible instrument to do that.

So the mandate given to the bank as a member of the AVAT was, as financial advisors, to help structure a financing mechanism and provide structures that will make it possible for the continent to produce vaccines on a whole-of-Africa approach.

Our leaders did not want our countries to be competing amongst ourselves. They also did not want countries to be in before manufacturers who are only interested in talking to countries that can provide cash before delivery.

So we were able as a team under the AVAT to structure instruments that we believe will now be legacies that will support the healthcare infrastructure for the continent.

00:21:24

We had to create a trust, the Africa Vaccine Acquisition Trust, as a vehicle for the pooled procurement that we wanted to make because the African Union itself could not borrow under this mechanism.

We had to do that because realising that the COVAX facility promised to provide 30% of the vaccines we needed we knew we had to find vaccines for the balance of the 30% to achieve the 60% target.

On top of the trust which we used we also created a continent-wide no-fault compensation scheme, which with the support of the WHO we've been able to put in place in record time so that everybody who receives vaccines under the AVAT facility will be protected. They can use the facility to deal with any complaints that they may have.

We've done this, making sure we use the same administrator as the COVAX no-fault compensation scheme to avoid confusion and this underpins the kind of collaboration we're building with COVAX going forward.

00:22:55

With the delta variant and with the revision in the vaccination coverage that WHO announced - that is 70% - we will now be going back to our leaders to also raise the coverage to 70%, as Dr Nkengasong mentioned. That will require another $300 million of financing to make sure we are able to cover the requirement.

It is important that we do this for the simple reason that countries want us to make sure that we do not fail and therefore put the economies in difficulties, make it difficult for us to recover quickly.

We thank you and thank Seth, COVAX for all the support and the work we've done together and we look forward to continuing to work with you as we deal with this and then transition to supporting the creation of manufacturing capacities on the continent. Thank you very much.

TAG       Yes, excellent team; I can see the division of labour and all that you have said is complementary to each other and also your own areas of contribution so very, very proud and thank you so much also, Benedict.

Next I'm pleased to welcome my friend, Dr Seth Berkley, the CEO of GAVI. Seth, thank you for your leadership and partnership and you have the floor.

00:24:42

SB         Thank you, Dr Tedros and esteemed colleagues, friends in the media. I appreciate the opportunity to be with all of you today. I am the last speaker so I want to leave as much time for questions... so I'll be brief but I want to make two sets of comments, first on COVAX and then on the importance of this meeting today.

On the COVAX side, I think we all know that the global response has not been good enough. The inequities that we've heard about over and over continue. COVAX was set up a year before at a time when we didn't even know if any of the vaccines would work to assure that all countries in the world could obtain access to a safe and efficacious vaccine.

With the backing of 190 countries we wasted no time in trying to raise money, over $10 billion at the latest count, to secure doses and to create the largest portfolio of products. We now have 19; this is the largest portfolio in the world.

00:25:43

Much has been reported about - and Tedros reviews - the challenges we face including things like the speed at which doses were snapped up early before there was money to buy for developing countries; export bans that limited our access to vaccines; the delays that were provided by certain manufacturers.

But I think it's important to look forward and today we're poised to embark on the busiest period of what is the largest and most complex vaccine roll-out in history. You already heard some numbers today; 270 million doses have been delivered through this mechanism. 70 million of these have come in the last month and we're seeing deliveries accelerate further.

In total this year we expect to have a total of 1.4 billion doses available for delivery. This is enough to protect 20% of the population in the 91 lower-income economies eligible for doses in the advanced market commitment.

By March this number will rise to 2.6 billion, which is enough to protect 37% of the populations in these countries. So I think we've demonstrated that COVAX can work at scale but it's really time for the world to get behind it.

00:27:04

That's why last week we called on governments to recommit with further action, join us in telling manufacturers to make the supply schedules transparent so we know where COVAX and its participants are being prioritised, for countries to give up their place in manufacturers' queues if they've already achieved high levels of coverage and don't need vaccine at that point, and to expand, accelerate and systematise dose donations so we can put excess doses to good use.

Let me move to this meeting which has been so important. It symbolises the spirit of partnership between COVAX, the African Union and AVAT. Africa needs more doses and together we will get them. The African CDC, under the leadership of John Nkengasong, had set a goal of 60% of the population; we've heard that that goal may change.

They've asked us to provide half of those 30%. We expect to meet that goal in February of 2022 and if the goal is increased to 70% we believe we can meet that goal by March of 2022. We look forward to working closely with the AU's regional mechanism, AVAT, to get the supply of the vaccines we need and to overcome the problems that stand in our way and to assure the most difficult challenge, which is to continue to build the systems to get these vaccines into people's arms.

00:28:31

We really also want to salute the leadership of AVAT and AU for creating such strong regional leadership in this area. This is critical to solve the issue now but it is also critical to prepare for the future and these are topics that we discussed on how we can all support that going forward.

So thank you very much, Dr Tedros; back to you.

TAG       Thank you. Thank you so much, Seth, and thanks again for everything you and your colleagues have done and continue to do to make sure everyone benefits from the power of vaccines.

Last but not least I'm delighted to welcome my colleague, Dr Tshidi Moeti, WHO's Regional Director for Africa. Tshidi, you have the floor.

TM         Thank you very much, Dr Tedros. It's a great pleasure to join you, join all of our partners and I very much appreciated our discussions earlier on, and to join our journalist colleagues for this press conference.

Much has already been said about the challenge in global vaccine supply so I will go to the question which is very often asked; do African countries have a capacity to absorb the vaccines when they get them?

My colleagues and I believe the answer is yes, although as Seth said, we are working very hard to make sure that that preparedness is up to speed. The continuous challenge is that global supplies are just not being shared in ways that would get all of us in the world out of this pandemic in time.

African countries are standing by to hugely ramp up their roll-outs, having learnt a lot from the delivery of the first vaccines that they received. Quite a few of them have done detailed analyses of what went went, what gaps were identified and are working very hard to fill them.

As WHO in the region we've worked with them to developed revised, detailed local plans to mobilise the delivery capacity needed. Intense work is going on to put the right storage capacity in place including cold-chain, to adapt delivery strategies to handle the multiple vaccines that countries are receiving, to use technology for registration and tracking systems, to mobilise and prepare non-vaccinators [?] most importantly to mobilise the people and address hesitancy and misinformation.

00:31:04

Hundreds of WHO staff are on the ground, backed up by our team in the regional office and headquarters and working within the COVAX partnership, ready to support countries to expand vaccination sites and to manage all the complexities of such a big operation.

What's more, I'd like to say that African countries have done this before, although perhaps not quite to this scale, successfully implementing huge vaccination campaigns against polio, yellow fever and cholera.

Of the doses already received three-quarters have already been administered and some countries are repeatedly now indicating they're hitting barriers simply of limited supplies.

So I'd like to join the appeal to pharmaceutical companies and to countries that have vaccinated their high-risk populations and also to the citizens of those countries to add their voice, to share vaccines with African countries urgently, to release reserve vaccine supplies for AVAT and COVAX to purchase so that we work together to protect the most at risk groups everywhere and we can end this pandemic together.

00:32:16

Again I'd like to say, I look forward very much to working with John, with Vera, with Strive and our partners at the African Union and within the COVAX mechanism to support our countries. Thank you.

TAG       Thank you. Thank you, Tshidi. Before we take questions, this Friday is World Patient Safety Day. Our theme this year is safe maternal and newborn care. Childbirth should be a time of celebration for families and communities but for too many it's a time of sorrow and grief.

Every day nearly 5,400 babies are stillborn and more than 800 women and 6,700 newborns die mainly around the time of childbirth. These deaths are mostly avoidable with safe and quality care delivered by skilled health professionals supported by a strong health system.

00:33:17

We call on all countries, health workers, communities and partners to act now for safe and respectful childbirth. Margaret, back to you.

MH         Thank you, Dr Tedros, and thank you to all our really distinguished speakers. I now open the floor to questions. As you know, we've got limited time and we've got an extraordinary panel here so please keep your questions short and please indicate who you would like to have answer that question.

We've got so many experts probably you'll get three answers to every question but please indicate who you would like to answer the question and indicate your outlet. Our first questioner is somebody who... The first person with his hand... is somebody who does ask very good questions. Simon Ateba, please unmute yourself and ask your question.

SI           Thank you for taking my question. This is Simon Ateba with Today News Africa in Washington DC. President Biden is set to announce additional steps to fight COVID-19 in the world including in Africa and as the WHO Africa noted last week, although new COVID-19 cases significantly dropped in Africa last week the delta variant is raging there. For instance it was detected in over 70% of samples in Botswana, Malawi and South Africa and in over 90% in Zimbabwe.

00:34:44

The story is no different elsewhere across the continent, where the delta variant is almost out of control, as it is here in the US.

The question is, with the limited number of vaccines in Africa right now are we losing the war against COVID-19 in Africa and should the measures that President Biden will announce here include not just scaling up vaccine donation to Africa but also lifting intellectual property rights, more technology transfer and money and tools to keep those vaccines at the required temperatures? Thank you.

MH         Thank you very much. You did not say who but I think it's for Dr John Nkengasong, who is the expert on this definitely.

JN          Thank you. I think it's very obvious, as I stated earlier, that we need global partnership, global co-operation and leadership to solve this problem. I think we need to act now, we need to act differently and we need to act urgently.

00:35:53

So at the African Union we will be participating at the conference that President Biden will organise. We don't know what the outcome will look like but you can be assured that we will contribute and will actually make our position known.

Our position is clear; we have limited access to vaccines, only 3.5% of our population has been fully immunised. We will need to get to 70% so any partnership and any announcement from President Biden that will enable us to get to 70% will be highly welcome.

[Inaudible]

BO         Thank you. Director-General, if I may with respect to this question just quickly clarify one issue, as AVAT and the African Union we want to buy vaccines. We're not asking for donations. You can donate to us if you so wish but our basis is not a donation. That means we want access to purchase.

We call on those countries that have put restrictions on exports of vaccines as finished products, exports of ingredients, drug substance; these restrictions are even more urgent for us today than intellectual property because the intellectual property doesn't deliver vaccine to us tomorrow.

00:37:38

But an export ban lifted in the United States, in Japan, in China, in South Korea, India; that will give us vaccines immediately so we urge you to put that into the mix. We always appreciate a donation but a donation is at the discretion of the donor. We want to buy at the same time. Thank you.

MH         Thank you very much for those answers. It looks as if we've had some excellent answers. We'll go on to the next journalist. The next person in the queue is Emma Farge from Reuters. Emma, please unmute yourself and ask your question.

EM         Hello, good afternoon. My question pertains to Indian supplies to COVAX so I suppose Dr Tedros or Dr Barclay or maybe Dr John if you have any negotiations with India right now. Dr Tedros, in a tweet the other day you mentioned that you were meeting with an Indian official and that you were counting on India's support to address vaccine inequity.

With COVAX set to fall short of its goal of two billion shots this year, tell me more about what you have agreed with India about supplies to COVAX going forward and does that agreement live up to your expectations? Thank you.

00:39:13

MH         I think this is a question for Dr Berkley.

SB         Thank you for the question. India has a very important role in the global vaccine manufacturing efforts. They have the largest vaccine manufacturing facilities in the world. It's one of the reasons we went to them early, to try to make sure that they would take technology transfers and scale up the production of their vaccines.

We've invested heavily in that over time and unfortunately after a period of time when we did receive doses, most of which actually went to Africa, there have been no doses since March of last year.

So we've been looking to try to find out when this will be relieved. We've heard that perhaps it may occur in this last quarter but we do not have a specific date for when there will be a releasing of those restrictions.

I would say it's even more important because not only were there a few vaccines at the beginning that were tech-transferred but now there is a larger number of them across a whole range of companies and that can make a difference in global supply.

00:40:35

MH         Thank you, Dr Berkley. I think Dr Aylward would like to add a little more.

BA          Yes. Thank you, Emma, for the question but just to reaffirm, the Director-General is in a constant dialogue with authorities in India on the restart of supply to COVAX and part of the discussions over this past day have just been the important relationship between India and Africa that goes back decades of course and the importance of ensuring that India is part of the solution for Africa.

So again as we look forward over the coming weeks and months, solving the problem of supply is going to require that engagement so be assured, the conversation is ongoing. We've been assured that supply will restart this year.

What we're hoping is we can get an assurance it will start even faster than later this year and in the coming weeks.

00:41:32

MH         Thank you very much for those answers. The next journalist in the queue is Sophie Mkwena from South African Broadcasting. Sophie, please unmute yourself and ask your question.

SO         Thank you so much. I just want to check with Dr John Nkengasong and Dr Tedros; yes, the vaccines. Now we see another challenge where countries are pushing for vaccine passports. What is your position and how can countries deal with this matter? Because countries are concerned and it might affect trade and investment in terms of movement of goods and services.

MH         Thank you, Sophie. Over to Dr Nkengasong to answer.

JN          Thank you, Sophie. You always ask tough questions but let me address it this way; I think our position as the Africa CDC and the African Union is known; that we do not encourage vaccine passports, I think, period.

The basis is simple; that we always want to ensure that people are vaccinated, that there is access to vaccines to everybody. Then we can begin to implement vaccine passports. We are very concerned that if countries start imposing vaccine passports it will further create inequities and worsen a very unprecedented and dedicated position that we find ourselves in.

00:43:08

So we are not encouraging vaccine passports across the continent and across the world.

TAG       Thank you, John. It's the same globally also; WHO has the same position. We don't want vaccine passports to be used as a precondition for travel because of lack of vaccine equity. It will be a tool to discriminate; it won't help so at this time it cannot be used as a passport, especially if it's going to be a condition for travel.

But for the future when vaccine coverage increases globally it can be considered and that's why we're helping countries who are working on vaccine passports so that we can have a uniform system when a vaccine passport is needed and when it's time to use it. Thank you and back to Margaret.

MH         Thank you, Dr Tedros and Dr Nkengasong. The next question goes to Christophe Vogt from AFP. Christophe, could you unmute yourself and go ahead.

00:44:36

Sorry. We're not ready. It's not Christophe. We will go to Carmen Powell from Politico. Carmen, please unmute yourself.

CA          Thank you so much for giving me the floor. I wanted to just clarify what Mr Masiyiwa said earlier about exports. As far as I know exports of vaccines from the US have been allowed for a few months but I just wanted to clarify with him that there are still restrictions because I thought they had lifted.

My question to him and to Mr Berkley and potentially to Mr Nkengasong if he wants to comment on this is about the summit that you were discussing earlier, that the US is organising next week. There is information out there in the media that the US will ask those participating to commit to vaccinating 70% of the world's population by next UN General Assembly so by next September.

But we also heard Dr Tedros say last week that he's sick and tired of promises and he wants to see action. So what kind of action do you want to see at the summit and will this commitment to 70% by next September make a difference or is it just going to come way too late? Thank you.

MH         Thank you, Carmen. That was quite a few questions. I think it was to Mr Masiyiwa first.

00:46:09

ST          Thank you so much. My principal job is to negotiate with suppliers and the suppliers have over the last eight, nine months made it clear that the biggest challenge that they face is export restrictions.

Export restrictions are being operated right across the board so if those export restrictions are there where are the vaccines? Because the production is happening but we're not seeing the vaccines and we're being told by the suppliers they're facing export restrictions.

So we urge you as the media to dig deeper into this issue around the movement of the various ingredients that drive production because without that we will not even be able to get manufacturing effectively set up.

So we need to get these restrictions removed. We had a very constructive discussion around this issue with WTO yesterday and they concur with us that there're a lot of restrictions in different countries and varying levels of restrictions from partial restrictions to total restrictions.

00:47:41

We mentioned earlier the problem in India. Most of those vaccines would come to us in Africa if the restrictions were lifted. We understood at the time why they were put in place because there was that massive surge in India and we were incredibly sympathetic.

But we do now urge our colleagues to show sympathy to us because we are the ones facing difficulty now. We need to see some of those vaccines begin to come through.

MH         Thank you. I think the rest of the question was to Dr Berkley.

SB         Yes, if I can but first of all let me add something to Strive's articulate response and that is that we also heard a press briefing, I believe, last week from the International Association of Pharmaceutical Manufacturers, who basically said there're enough doses for everybody.

I think the question we ask is, where are those doses if there are enough for everybody? You've heard from us over and over again - we had discussions here and you've heard from the other speakers that supply is an important problem so we need to square those two issues that are out there.

00:48:57

You asked specifically about the summit. Obviously we'll have to see what the summit brings. A goal of going to 70% itself is not the critical issue; it's unpacking that goal, as you've heard from my colleagues, and saying, what are the barriers to getting these goals, what's holding us back and what do we need to do?

If we can get political consensus on that from governments, from manufacturers to unbundle those problems and then move forward in a systematic way then we will have a constructive outcome of a summit going forward.

MH         Thank you. Dr Aylward, then I believe we have Dr Moeti. Sorry, Professor. You're right next to me!

BO         Okay. Thank you very much. I just wanted to comment on the goal of 70%. As you are aware, we as AVAT, as African Union through Afreximbank we've funded the current 400 million doses of Johnson & Johnson single-shot vaccines up to the amount of $2 billion.

00:50:12

I did mention when I was speaking that moving to 70% will require an additional $300 million immediately to be able to achieve that. However there are now discussions about booster doses.

Many countries, many economies, the rich economies are beginning to offer booster doses despite the fact that other developing countries, Africa has not even vaccinated up to 4% of its population.

What that means is Africa has to plan for boosters also. That will require on an annual basis an additional five to $600 million on the conservative side without adding in the logistic costs. If you add the logistics costs you'd be talking about $1 billion a year.

That is why we first of all have to thank the World Bank for supporting us with regard to the current deal we've done whereby they're helping some countries with grants who are able to then pay down on the facility Afreximbank has provided.

However going forward - because this will be a recurring thing if we go into boosters - we need the IMF to do the vaccine facility, to make it possible for countries to now access these vaccines through the structure we've put in place with the Afreximbank guaranteeing and providing the initial financing and then they refinance it in a way that makes it possible for their current accounts to be able to carry all of this while the World Bank continues to provide the additional structures that are required to effectively administer the vaccines. Thank you.

00:52:08

MH         Thank you very much. I think we had Dr Moeti who wanted to join as well, had some comments to make.

TM         Yes, thank you. Being a virtual participant is a bit of a disadvantage but thanks very much. I just wanted to add something to what Dr Tedros said with regard to the vaccine passports and impact on international travel.

Just to remind that according to the International Health Regulations, which is an agreement that member states have reached together, it is not to have a requirement for proof of vaccination for international travel except for a vaccine that is widely available.

I think, as we've discussed, these vaccines are anything but widely available. This is just a reminder that there's been a great deal of discussion about the International Health Regulations', if you like, mutual accountabilities of this club of member states who have reached an agreement as to how to manage the risk of international spread of disease.

00:53:17

Just to add that it seems that some of the protocols that have been put in place of testing, etc, seem to be sufficient to minimise the risk of transmission of the virus from international travel.

So I would just add that reminder; it's not only that we'd like people to be kind and not do this but they have agreed as member states to a principle of not applying passports for international travel unless the vaccine concerned is widely available globally. Thank you.

MH         This is a good question. Dr Aylward's also got something to say on this.

BA          We want to come back to the important point that you make, Carmen, about the action that the Director-General wants to see at this summit and first just to recognise and thank the United States for convening such a crucial summit at such a crucial period.

00:54:08

To be clear, that summit is not just about equity in vaccines; it's about equity in testing, equity in oxygen access, equity in access to PPE because we need all of that, as Maria, Mike and the others keep highlighting, if we're going to move out of this crisis.

But in terms of the action, to be clear, Carmen, the Director-General called for 10% coverage in all countries by the end of September to make sure healthcare workers were protected and the older populations.

At that time in Africa, John, I think we were about 0.9% coverage. That was five months ago. We are not on a trajectory to get to even 10%; the goal is 10%, the Director-General's, 40% by the end of this year and then to the 70%.

But we need to be solidly on the trajectory and that's what we need at this summit; it's what the Director-General is looking for and he welcomes the call of the United States on governments, manufacturers to come to the table and commit to helping get us on and ensure the world stays on that trajectory.

00:55:12

But what we need immediately; from manufacturers next week we need to know the supply by month to low... and low-income countries and then if it's not sufficient to get us on that trajectory we need to work with the high-contracting countries to explain how they will dose-swap deliveries to help get us on the trajectory and then donations if needed.

But, as Strive said, donations are not the answer. The answer is control of this supply. The world needs 2.4 billion additional doses to go into low... and low-income countries to get us to 40% by the end of this year. Those doses exist and next week is all about making sure there's a clear path to ensuring they go to where they're needed.

MH         Thank you very much for those excellent questions. I think we've only got time for one more question. We have Laura Lopez from TRT World, Turkey. Laura, can you please unmute yourself and ask your question.

LA          Hi. My question's for the Director-General. Many countries are providing boosters to those over 50, front-line healthcare workers and those with weak immune systems. Should these countries halt booster campaigns even to these populations in the name of equity given the recent results from the Lancet study? Thank you.

00:56:41

TAG       Thank you. I think the moratorium on the use of boosters which I asked should last up to the end of this year covers the immunocompromised specifically, not beyond that and we said it many times.

We had a meeting recently of 2,000 scientists coming from all over the world who discussed the same issue and there is nothing conclusive on the use of boosters for the time being so until we have conclusive evidence it's very important to halt it.

But at the same time, not only that; there are countries with less than 2% vaccination coverage, most of them in Africa, who are not even getting the first and second doses and starting with boosters, especially giving them to healthy populations, is really not right.

Mike is not with us today but you remember he said once, it's like giving a life jacket to someone who already has a life jacket and denying another one who doesn't have anything and letting that guy drown.

That's exactly it and WHO's position is to halt the use of boosters except for the immunocompromised until the end of this year. By then we will get more evidence; then we will see if there is additional guidance that we can give from WHO. Thank you. Margaret, back to you.

00:58:35

MH         Thanks. I think Dr O'Brien wanted to add a little on the extra primary dose for the immunocompromised.

KOB       Just to add one thing; the DG has really said it all but I think one of the important points for people to really understand that the DG is emphasising; this is not about withholding booster doses in the face of evidence that they're needed.

I think the Lancet paper made it very clear that the vaccines are holding up really well against the severe disease end of the spectrum, which is what they were intended for. So I just want us to be clear as we're messaging and communicating around this that this is not a question of asking people or countries to withhold vaccine doses in the face of a demonstrated need for those doses.

This is about needing evidence, a, that they're needed and secondly that there is a safe pathway towards their deployment, who exactly would need them, if they need them and when they would be needed.

00:59:38

So this, I think, underpins, as the DG has said, the reason for the position within WHO and the review of the evidence continues to take place and we'll continue to watch as that evidence accrues and make any adjustments as that evidence demands it but we're not there yet.

MH         Thank you, Dr O'Brien. I think we've run out of time for questions but Dr Tedros has more to add and I'd also like to ask if any of our panellists would like to make some final remarks.

TAG       Strive, anyone?

ST          Thank you very much, Director-General, for this opportunity. Let me just make my final remarks on two issues. You, working with your colleagues at the IMF and the World Bank and WTO, have created a task force and you invited us as a task force to make our contributions on some of the issues that we see going forward.

01:01:05

I want to just bring back two issues. One, we need to ensure that pandemic response financing is addressed. One lesson we learned from this is you can't run around looking for money in the midst of a crisis. The world needs to understand, we always knew that a crisis like this could emerge.

So we really urge those institutions such as the IMF and the World Bank to pick up the leadership on this issue and put in place a standby capacity, particularly for poor nations to have access to vaccines.

We know that had the money been available as early... The structure was there but the money did not come forward as it should have. It is one of the things that we as the African Union are now calling on, a permanent structure and it is something that we will be calling upon to be put in place at the summit that President Biden has called.

We strongly believe that the pledge architecture where countries gather together and make pledges which are then subject to, subject to, subject to... until it is next year and the crisis is done has had its day.

Let us now have a permanent structure. Vaccine sharing is good but we shouldn't have to be relying on vaccine sharing, particularly when we can come to the table, put structures in place and say, we also want to buy.

01:03:18

We want to buy from the same manufacturers but to be fair, those manufacturers know very well that they never gave us proper access. They gave access on a very different basis when they knew that supplies were restricted at the beginning.

There was no production; we all accept that; there wasn't sufficient production but they had a moral responsibility to ensure that others also had access and we find this very sad. It's very sad.

We could have addressed this very differently. We as Africa will now address this through setting up our own manufacturing capabilities. We therefore support particularly the calls for that intellectual property which was put in place as a public good by American taxpayers, European taxpayers; they financed some of this intellectual property and it should be for the common good.

So it's not wrong that we should say there should be waivers. It was for the common god so we ask for this IP to be made available and we will continue to stand behind that. It's not an unreasonable call because our neighbours in the United States as good neighbours supported these companies to produce some of these vaccines.

01:05:09

It was a great miracle to have these vaccines. Now let this miracle be available to all mankind. Thank you very much.

TAG       Maybe that would suffice or, Benedict, no? Seth? Okay. Tshidi, would you like to say a few points before we close?

TM         No, I can only echo Strive's last words. Thank you.

TAG       Okay. Thank you very much. I fully agree and I don't think we need to add to what Strive said. Maybe I would like to stress only the one issue, especially the IP waiver. We have been advocating for that as WHO.

This provision; if it cannot be used now during this unprecedented situation then when? This is a time when it can be used otherwise why did we even have in the first place a provision, TRIPS waiver?

Thank you so much for those very clear and strong words. Many of the things you have said, Strive, and many of our colleagues, are very important to take us forward and I hope the world listens.

I'd like to thank again my colleague, Tshidi, Strive, Vera, John, Benedict and Seth and all colleagues. Thank you so much and to the media also who have joined us today. Thank you and I look forward to seeing you in our upcoming presser. Thank you.

01:06:56