WHO press conference on coronavirus disease (COVID-19) - 25 August 2021
00:02:59
MH Hello, everybody. This is Margaret Harris in Geneva welcoming you today, August 25th, to this week's WHO global press briefing on COVID-19. We have with us today in the room our WHO Director, Dr Tedros Adhanom Ghebreyesus, and a very special guest, His Excellency Tharman Shanmugaratnam, Senior Minister and Coordinating Minister for Social Policies of the Republic of Singapore, who is also the Co-Chair of the G20 high-level independent panel on global financing for pandemic preparedness and response.
Alongside Dr Tedros is Dr Catharina Boehme, our Chef de Cabinet, and we also have with us as usual our WHO experts, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Ibrahima Soce Fall, our Assistant Director-General for Emergency Response, and Dr Bruce Aylward, who is the Lead for the ACT Accelerator.
Today we're having some technical difficulties. We do have people online but we are not certain that you'll be able to see them. You should be able to hear the audio. Online we also have Dr Mike Ryan, the Executive Director for the World Health Emergencies Programme, Dr Soumya Swaminathan, our Chief Scientist, and Dr Rogerio Gaspar, Director for Regulation and Pre-Qualification.
00:04:24
As usual our extraordinary interpreters will be providing simultaneous interoperation in the six official UN languages plus Hindi and Portuguese and I thank you all in advance for the extraordinary work you do. Now without further ado I will hand over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor.
TAG Thank you. Thank you so much, Margaret, and welcome. I think this is your first day after... Yes. Good morning, good afternoon and good evening. After increasing for nearly two months the global number of COVID-19 cases and deaths was stable last week but it's stable at a very high level, more than 4.5 million cases and 68,000 deaths.
However the situation is very different from region to region, country to country, province to province and town to town. Some regions and countries continue to see steep increases in cases and deaths while others are declining.
As long as this virus is circulating anywhere it's a threat everywhere. There are no short-cuts. WHO continues to recommend a comprehensive risk-based approach of proven public health and social measures in combination with equitable vaccination.
00:06:01
Even as we remain focused on ending the pandemic WHO is moving forward with plans to understand its origins. Last Friday we issued an open call to scientists around the world to apply to the new strategic advisory group for the origins of novel pathogens or SAGO.
SAGO will be composed of experts acting in their own capacity, not as representatives of member states and will play a vital role in studying the emergence of new pathogens including the next phase of studies into the origins of SARS-CoV-2.
We encourage all qualified professionals to apply. We need the best people to be part of this important new advisory group. I wish to emphasise that SAGO will not delay the progress of the studies into the origins of SARS-CoV-2.
The report of the international team, published in March, outlined a number of studies that can be taken forward without delay. We have encouraged all parties to pursue those studies. Even as we continue our work to understand how this pandemic started we're also moving ahead with plans to strengthen the world's defences against future epidemics and pandemics.
00:07:28
As you know, there have been several reports with many recommendations for how to do this including the report of the independent panel on pandemic preparedness and response, the review committee of the international health regulations, the independent oversight and advisory committee of the WHO health emergencies programme and others.
Most recently the G20 established a high-level independent panel on financing the global commons for pandemic preparedness and response. The panel published its report last month and it's now my great pleasure to welcome the Senior Minister of Singapore, His Excellency, Tharman Shanmugaratnam, the Co-Chair of the panel and who will present its recommendations.
I just had an excellent meeting with the Senior Minister discussing the report. Thank you so much, Your Excellency, for your leadership. Welcome and you have the floor.
00:08:34
TS Thank you, Dr Tedros, for having me at the WHO, inviting me to join you at this press conference. As Dr Tedros has mentioned, we've just had an excellent and, I'd say, very constructive discussion on the recommendations of the G20 high-level independent panel. Our recommendations are being actively considered as we speak and will be taken up in the next two months in a variety of fora but in particular at the G20 meetings leading to the G20 summit in October.
What is clear is that global health security is dangerously underfunded. We are consequently vulnerable to a prolonged COVID-19 pandemic with repeated waves affecting all countries and we're also vulnerable to future pandemics.
We can fix this. The resources that need to be mobilised are larger than what nations have collectively been willing to commit to in the past but they're very small investments compared to the costs of a prolonged COVID-19 pandemic and they're tiny investments compared to the costs of future pandemics that we can avoid.
The first and most urgent priority is to implement the action plan set out by the IMF, WHO and their other multilateral partners to vaccinate at least 60% of each country over the next year; that's the most urgent priority.
00:10:24
But we know too that COVID-19 is not a one-off disaster. The next pandemic could come at any time. It could come in ten years' time or it could come next year. The next pandemic could come at any time and it may be more devastating than COVID-19.
We therefore cannot lose any time in preparing for future pandemics. Fundamentally this requires a new way of thinking about international co-operation. We have to move away from thinking about funding of global health security in terms of foreign aid towards thinking about it as a strategic investment that all nations must make not only for the good of the global community but because it is in each nation's self-interests. It's not about aid to other countries; it's about a strategic investment that we must collectively make in all our own interests.
It's fundamentally about investment in global public goods that all nations benefit from, rich and poor. When I say global public goods I mean both global capacities and national capacities that are in fact global public goods.
00:11:47
The global capacities are well-known; early warning systems, strengthening the one health system, ensuring we have a scaled-up, globally distributed manufacturing capacity for vaccines and other medical countermeasures. Those have to be organised globally.
But there are also national capacities which are critical and we do need to support the low and low-middle-income countries to invest in national capacities to prevent and detect outbreaks at their source and to halt a pandemic once it gets going.
These national capacities benefit those individual countries that have the capacities but they also benefit the rest of the world and that's why they're global public goods that all of us have to contribute towards.
To invest in these global public goods on the scale required to prevent the next pandemic and prevent future pandemics we must strengthen multilateralism. First we must strengthen support for the WHO itself. There is no solution to pandemic security that does not involve a strengthened, empowered and financially secure WHO.
The WHO plays key roles in all the major gaps that the G20 high-level independent panel identified; first building up a global surveillance network. You're launching the Berlin hub soon but it's a very extensive global network that needs to be built up.
00:13:24
The WHO plays a key role in identifying gaps within countries in achieving the national core capacities set out in the International Health Regulations and the WHO plays a leading role within the coalition of health partners, which will have to develop a permanent, globally-distributed, end-to-end supply ecosystem for vaccines and medical countermeasures.
The WHO therefore requires stronger and more reliable funding and the G20 panel has proposed an enhanced and more predictable base of multilateral funding, not just bilateral funding but multilateral funding for the WHO through increased assessment-based contributions.
Second, we must repurpose the international financial institutions; the World Bank, the IMF, the other multilateral development banks - repurpose them so that they both bolster countries' preparedness in normal times as well as respond with speed and force when a pandemic is triggered.
00:14:38
The IMF, World Bank and the MDBs are unique international institutions with the ability to catalyse domestic investments by national governments as well as leverage private-sector investments. They have the ability to multiply resources and we've got a much better use of these international financial institutions.
We have to make financing of global public goods for resilience against climate change as well as pandemic security part of the core mandates of these international financial institutions and shareholders must support this by making timely replenishments of grants and the capital needed by the international financial institutions to ensure that the greater focus on global public goods does not come at the expense of poverty reduction and shared prosperity.
The first point I covered concerned the WHO; the second point concerned the international financial institutions but thirdly we must establish a new multilateral funding mechanism for global health security.
The current funding for global health is raised by individual global health organisations on a siloed basis. It is also largely dependent on discretionary bilateral aid. The result is a non-system; a non-system of complex, inefficient, unpredictable and greatly inadequate funding. We need a new global mechanism to overcome these silos, mobilise resources on the needed scale and predictability and Dr Tedros has been emphasising all along in our consultations the need for both scale and predictability of funding for global health security.
00:16:36
That's the only way we're going to be able to plug the gaps in global health security and to plug the gaps with agility. The G20 high-level panel has therefore proposed the establishment of a global health threats fund aimed at mobilising at least $10 billion a year from the international community.
That sounds like a large sum but $10 billion spread across a large number of countries on a fair and equitable basis means national contributions that are less than 1,000th of the annual budgets of almost all countries; in other words about 0.1%.
The fund will catalyse funding from other sources as well besides national contributions. It'll catalyse funding from private, philanthropic and bilateral sources. But this fund will not be a new institution because we shouldn't add to the complexity of the global health security landscape.
00:17:40
It will not be new institution with its own operations. It will instead fund existing institutions and networks and prioritise and re-prioritise based on the needs of the times. This way we add a strong multilateral layer on top of a siloed landscape without duplicating existing mechanisms.
Finally greater and sustained funding can only be achieved with better governance of financing for global health security. We have to again establish this without replicating existing governance mechanisms.
The existing governance of global health is at the WHO and at the World Health Assembly. However we lack a governance mechanism that brings finance and health together, that brings the finance and health decision-makers together. We do not have that global mechanism today and we need that mechanism to ensure proactive rather than reactive funding of global health security and to achieve alignment and coherence in the different sources of international financing and how they're deployed. That alignment and coherence is today lacking.
We need a new governance mechanism to achieve this and the G20 high-level independent panel believes that the most effective governance mechanism for the purpose will be an inclusive G20-plus board comprising health and finance ministers.
00:19:17
The WHO and key multilateral organisations will play a key role on this new board in an ex-officio capacity. The G20 panel has also proposed a permanent independent secretariat to support the board and to support the fund that has to be set up and this permanent secretariat should draw on the resources of the WHO and other key multilateral organisations.
We cannot prevent recurring pandemics through incremental reforms to individual organisations but neither can we wait for a grand reconstruction of the global architecture, which in any event is unlikely to come. We must instead strengthen multilateralism, strengthen the WHO and evolve and repurpose the international financial institutions, establish a new, effective multilateral mechanism to overcome today's siloed financing and to mobilise the much larger and sustained funding that is required.
00:20:25
The collective investments required as part of this deal are affordable. They will help us avoid blundering into pandemics again and again. We have to proceed with urgency. It will be economically and politically myopic and morally indefensible to defer the collective actions and investments that are in both the global interests and the national self-interests everywhere.
TAG Thank you. Thank you so much, Your Excellency. Thank you to you and also thank you so much to all of the members of the panel for their work. This report has much in common with the other reports and recommendations that have been published in recent months.
They all recognise the need for better global governance of pandemic preparedness and response. They all recognise the need for better systems and tools to prevent, prepare for, detect and respond rapidly to epidemics and pandemics.
They all recognise the need for better financing for global preparedness and response including for global goods such as vaccines and they also recognise the need for a strengthened, empowered and sustainably financed WHO at the centre of the global health architecture.
00:21:56
With 194 member states and 152 country offices WHO has a unique global mandate, unique global reach and unique global legitimacy. With the UN General Assembly in September, the G20 summit in October and the special session of the World Health Assembly in November the next three months will be a critical period for shaping the future of pandemic preparedness and response.
Whatever structures and mechanisms emerge, WHO believes they must be grounded in several core principles. They must have the engagement and ownership of all countries, they must be linked to and aligned with the constitutional mandate of WHO rather than creating parallel structures which would lead to further fragmentation of the global health architecture, as the Senior Minister said.
They must involve partners from across the one health spectrum including animal and environmental health, civil society and the private sector. They must ensure convergence with the International Health Regulations and other international instruments, and they must be accountable.
00:23:06
WHO is committed to working with all 194 of our member states to build a global system to better protect all people in all countries.
Finally although the world's attention is rightly focused on ending the COVID-19 pandemic there is another epidemic that will continue to kill millions of people every year. Cardiovascular diseases are the leading cause of death globally and hypertension is one of its main risk factors.
More than 1.2 billion people live with hypertension. I'm one of them but I am one of the lucky ones with good access to medicines, understanding my condition and making sure it's controlled. That's why I say that I'm the lucky one.
The same is not true for most others with hypertension. A new study led by Imperial College, London and WHO today estimates that almost half of all people with hypertension don't know they have it and only one in five have it under control.
We have the tools to prevent, diagnose and manage hypertension. Our challenge is to make sure everyone with hypertension has access to those tools.
00:24:38
Today WHO launched a new guideline for the pharmacological treatment of hypertension in adults which presents the most up-to-date, evidence-based recommendations on managing hypertension. This new guideline provides recommendations on the level of blood pressure at which it's appropriate to start medication, what types of medicine or combination of medicines to use, what level of blood pressure to target and how often follow-up checks are needed.
Pharmacological treatment should always be combined with healthier diets and regular physical activity. More strictly, controlling tobacco products and identifying and treating comorbidities such as diabetes and pre-existing heart disease.
Indeed Singapore is a good example of a country that has taken concerted action to reduce hypertension and heart disease with a bill that will ban the use of artificial trans-fats, a leading contributor to hypertension and heart disease, from its food supply by this year.
00:25:54
WHO's new guideline is another example of our commitment to our mission to promote health, keep the world safe and serve the vulnerable. Margaret, back to you.
MH I also should say, I did not mention another person who's in the room; that's Dr Jaoud Mahjour, who's our Assistant Director-General for Emergency Preparedness. Online we also have Dr Kate O'Brien, who's the Director for Immunisation, Vaccines and Biologicals; both of whom you already know very well.
Now I will start the questioning with Anias Pedrera from AFP. Anias, could you unmute yourself and please go ahead.
AN Good afternoon, everybody. Today more than ten experts who took part in the mission in Wuhan in January have lamented in the journal Nature that the search for the origins of COVID has stalled [?]. They say that it is at the critical juncture and that the window of opportunity to find answers is rapidly closing.
So do you agree with that and what can be done concretely now to speed up this process? I'm not talking about SAGO as you have talked already on that. Thank you.
00:27:39
MH Thank you. Dr Maria Van Kerkhove will take this.
MK Thanks very much for the question. As you know, we have been also encouraging the advancement of the studies into SARS-CoV-2's origins since the beginning of this pandemic and especially since the international team returned from their mission in February 2021 and since they published their report in March 2021.
The report outlined a number - dozens of recommended studies that need to take place to better understand the early cases, to better understand the animals that were sold in markets; numerous studies going forward and we have encouraged the urgency in which those studies can be conducted.
In fact there is no delay in how those studies can be conducted in China because there are many, many capable scientists there that can carry those out without delay.
00:28:35
So we are also in agreement about the urgency to continue those studies. I will mention the SAGO even though you said that you'd heard about that but the SAGO is the scientific advisory group which is to be established to establish a framework for the study of the origins of emerging and re-emerging pathogens.
We know that SARS-CoV-2 was disease X. The next disease X is out there. You heard from the Director-General; you heard from the Senior Minister how important preparedness is. This is in effect a step to that because we recognised a need to establish a standardised approach for studying where and when these pathogens emerge.
So part of the responsibility of the SAGO will be to look at where we stand with the global studies for SARS-CoV-2. There are many studies that have been going on in China and there are studies that are happening elsewhere as well.
Since the international team has returned many studies have been published looking at market sales, looking at animals that have been sold in Wuhan and in other locations, looking at the susceptibility of animals and so one of the responsibilities of the SAGO will be to urgently look to see, where do we stand and where do we prioritise what studies need to go forward.
00:29:48
But that should not delay and does not delay the advancements of studies that can be ongoing in China today. In fact we have heard from Chinese colleagues that studies are underway from some public statements that they have made recently.
So again we want the origins work to remain scientific, transparent, urgent and inclusive and we will continue to work with all member states to make sure that we better understand how this pandemic began so that we can be better prepared for future ones.
MH Thank you, Dr Van Kerkhove. The next question comes from Imogen Foulkes from the BBC. Imogen, could you unmute yourself and go ahead with your question.
IM Yes, a follow-up on AFP's question. You say there is no delay and that some of these studies are happening so actually Chinese scientists are doing the origin study on their own now or is the other team going to China as well and if so when? Because, as Anias said, they've warned today that the window is closing to complete this work.
00:31:05
MK I can come in and maybe Mike, who's online, if his connection is solid would want to come in on this as well. Imogen, yes, as I've said, we've heard statements from our Chinese colleagues that there are studies that are underway in China. We would have to ask them specifically what those studies are and we look forward to the results of those.
As has been outlined in the international report these include studies looking at serology, looking at sera that is stored from 2019, looking at tracing back of animals that are there. I don't have the specifics on these exact studies. We very much look forward to what those studies are but there should be no delay in carrying those out, as I said.
The international team; we had a meeting with them today. In fact we've had several meetings with them. Some of them are continuing to discuss with their colleagues in China. There are many bilateral research relationships that are happening with scientists around the world and these studies are starting to be published.
00:32:06
We need to gather all information that we have in China and elsewhere to be able to get to the bottom of this. From our point of view it's time to move on, get on with this and really keep it rooted in the science.
What we are hoping for is that any release of information on future studies goes from a political debate to a scientific one and again we encourage this work to continue.
MH Thank you, Dr Van Kerkhove. I think Dr Ryan is online and has something to add.
MR Hi, Margaret. I'm just checking if my connection is good enough. Can you hear me?
MH Very well. In fact Mark the magician has fixed all our technical problems.
MR Great. First of all, yes, Maria is correct; we have spoken with the international team again and when you actually looked at the report of the international mission they laid out studies that should be carried out by all parties including China and outside and there's been nothing to prevent those studies actually proceeding and there is no need as such for a new international team to go out in the field unless that is absolutely required.
00:33:22
These are important ecologic and clinical and other studies that rely on actually getting data and getting that data made available and a lot of the work is down to actually going out and collecting that data or releasing that data that already exists.
We do look forward to getting updates from our Chinese colleagues on the progress from those studies. All of that data from both China and from the other international studies will be considered by the scientific advisory group on origins and that is the point; to be able to bring all of that data into the open and look at that data in a transparent way and be able to determine how far our understanding has gone and where the gaps in the understanding remain.
There is no impediment right now to those studies going ahead. Chinese colleagues don't need WHO to hold their hands through this kind of a process. Those studies have been laid out, they've been agreed between the international team and Chinese colleagues so we look forward to getting the results of those studies and we are very willing to deploy a further international team as needed.
00:34:33
This may require smaller international teams, more specialised teams to focus on specific issues, on the ecologic side, on the clinical side, on the epidemiology side. The team that went the last time had a huge and broad series of issues that it needed to advance and it made great progress in advancing a broad range of scientific studies.
Further international teams or further support or co-operation to colleagues in China and in other countries may require much more specialised, smaller teams to advance that but there is no impediment right now to those studies going ahead. In fact many of our Chinese colleagues do report those studies are underway and we very much look forward to receiving data and reports from those studies and are getting reports.
MH Thank you very much, Dr Ryan. I think that concludes... Oh, sorry. Is that finished? Okay, so we can go on to the next question. Yes, okay. We're going from French to English; now we go to Spanish. Isabel Sacco from EFE. Isabel, could you unmute yourself and please ask your question.
00:35:52
IS Hello. Thank you very much. The permanent Chinese mission to the UN in Geneva has informed that its Ambassador has written to the Director-General, Dr Tedros, to say that the Wuhan lab leak hypothesis is very unlikely and has called for an investigation into labs in the US, military labs and a lab from the North Carolina University. I would like to hear your reaction to this call. Thank you.
MR Margaret, can I come in?
MH Yes, Dr Ryan will answer that question. Please go ahead, Dr Ryan.
MR From the perspective of the laboratory hypothesis or the hypothesis that a laboratory leak may have occurred, the team who went out to the field used a liquered [?] scale which is a scale of relative likelihood between different scenarios. It doesn't say as such that something could not have happened or that that is off the agenda.
But the team tried to determine on the basis of likelihood which scenarios were more likely than other scenarios based on the data they had at that time and the team were very, very clear. They said, based on the information they were given, based on the information provided these were the likelihoods according to that scale.
00:37:21
It's a qualitative mechanism; it's not a quantitative scale and that was what they were trying to do, was to prioritise work going forward and say where the most important work was to be carried out and clearly the international team had identified the ecologic side and the likelihood of the disease passing between an animal and a human to be more likely than a lab leak which was less likely in that case according to that scaled approach.
It's slightly contradictory if colleagues in China are saying that the lab leak hypothesis is unfounded in the context of China but we now need to go and do laboratory investigations in other countries for leaks there so that in itself is a contradiction in terms.
I am sure when we sit down to look at the issues of laboratory work - and there is work that needs to be done in general around the world on how we do laboratory research and how that's mandated [?] and how the biosecurity and biosafety aspects of all of this work are very, very important going forward into the future.
00:38:24
As technologies advance, as we do more and more work in labs it's extremely important that we have a framework to govern how this work is done around the world but the current situation is that all of the hypotheses regarding the origins of the virus are still on the table.
Some are more likely than others based on the current analysis but all of those hypotheses require further elucidation and further inquiry and we will go and look where all of those leads take WHO.
But from the perspective of our Chinese counterparts it is a contradiction if you're saying that the lab hypothesis is a non-starter from a Chinese perspective but we need to now go and look at labs in other countries. I find that difficult to understand but I'm very willing to engage with our Chinese colleagues to understand what exactly they mean by that statement.
MH Thank you, Dr Ryan. I'm looking around the room to see if there are additions but no so we will now go on to Jeremy Launch from Radio France International. Jeremy, please unmute yourself and go ahead with your question.
00:39:36
JE Thank you so much. As you may know, France is one of the countries that's opened up its vaccination campaign for a booster dose. People over 65 years old may now receive a third shot, I think, six months after they completed their vaccination courses.
So the question is, what do I say to my parents who are over 65 years old, who live in France and who may receive a booster? Should they listen to the legal authorities of their country or should they listen to the recommendation of this body and wait until the rest of the world is in better shape to get a booster dose?
In the end did any country respond positively to your recommendations and agree to postpone its booster vaccination programme? Thank you.
MH Thank you. I'll ask Dr Soumya Swaminathan to come in on that first of all. Dr Swaminathan, are you online and able to answer the question?
00:40:43
SS Yes, thank you. Thank you, Margaret, and thanks for that question. I think we also have Dr Kate O'Brien online and she would like to come in. What I would like to emphasise is that the WHO's position on boosters is based primarily on the scientific data that we're seeing.
Then of course there's also the moral and ethical argument which is clearly telling us that people around the world need a primary course of vaccination. Our urgent task today is to reduce and prevent mortality. We have the tools, we have the vaccines, we should not have 10,000 people dying every day due to COVID.
But on the science side what we're tracking very closely - and we recently had an expert group meeting with scientists from around the world; this included researchers, it included regulatory experts from different regulatory agencies. There was consensus that the data around the need for boosters is not conclusive.
It is true that we need to follow very carefully the vaccine efficacy and effectiveness over a period of time because it is possible that some groups, the elderly might need boosters at some point in time. It's possible that different vaccines may behave differently from each other in terms of the breadth and duration of protection and it's also possible that with the new variants you might need a booster strategy at some point.
00:42:22
But putting together all of the evidence from all of the countries around the world we are not at the point to recommend boosters so I think that's the first point.
The second point of course is that we have limited supplies of vaccines globally. We do not have unlimited supplies at this point in time and therefore those supplies need to go to the people who are desperately waiting for the vaccines, the front-line workers, the doctors and nurses who are still fighting this pandemic and who are losing their lives because they don't have access to the vaccine, and the elderly and the vulnerable.
So we need to prioritise that and, as the Director-General has said, we've called for a time-limited moratorium on the boosters so that we can get every country vaccinating at least 10% of their population by the end of September - so we have only a month - and 40% of populations by the end of the year.
00:43:16
That will reduce mortality significantly and then of course we can scale up vaccination and by then there will be data on boosters. We also don't know about the safety of boosters because when we talk about vaccines it's not just the efficacy. What happens when you give a third dose of an MRNA vaccine or any other kind of vaccine?
These need to be studied as well so before we launch into full-scale booster programmes for the whole population there are a number of questions that need to be answered and maybe Kate wants to add to that. Thanks.
KOB Thanks, Soumya. Just a couple of things I'd like to add to this. The first is that it is the responsibility of national governments to establish policies within their country and it's the responsibility of WHO to provide the best advice, the best WHO-based policies on the evidence for what our recommendations are regarding policies.
Just to emphasise a couple of additional points on top of those that Dr Swaminathan made, one of the concerns is about the emergence of variants and variants predominantly and will dominantly emerge among people who are non-immune and where transmission is occurring that is a high level of transmission. That's in unvaccinated populations.
00:44:51
We also have real clarity at this point that the vaccines are holding up very well against the severe end of the disease spectrum and that was the intention of the vaccines, to protect against severe disease, hospitalisation and death.
We see that the vaccines are holding up very well over time against those outcomes and so this is a broad context; in the context of constraints in supply what do you best do with that supply to end this pandemic?
The real point is that unless there is clear scientific evidence that would compel the need for additional doses perhaps in some risk strata, perhaps for some products so it's not an across-the-board yes or no, the data will tell us product-by-product and risk-stratum-by-risk-stratum.
Then the final point is that because these decisions are such important decisions not only for the here and now - and Soumya has described very aptly the equity issue her which is not only an equity issue, it's an ending the pandemic issue about where the doses go for their maximum effect - the other issue is that this does potentially set the stage for the future of how we manage COVID disease and the SARS-CoV-2 virus.
00:46:31
Unless we have clear evidence of what the vaccines are doing, the need for boosters or the lack of need for boosters and then the performance of those boosters over time we will be in a place in the future where we have a weak set of evidence on which to make recommendations for the future and for what people should do two years from now and three years from now and four years from now.
That's really the obligation that a scientific community has to individuals in every community, that we have the scientific evidence on which the recommendations that we're making to individuals for what they should do... and that's really a vaccine confidence issue.
So I think those are the additional elements of why this is such a critical issue and that we need to act only when we have clarity and the scientific evidence provides a clear picture of what needs to be done.
00:47:40
MH Thank you very much, Dr O'Brien and Dr Swaminathan. The next question, I think, is for our special guest, our Minister of Singapore. It's from Ji Han Wong from 21st Century Business Herald. Ji Han, could you please unmute yourself and go ahead?
JH Thank you so much. This question is, now vaccine equity is still a big problem as the pandemic still thrives [?] so what can the G20 to support vaccine delivery? Thank you so much.
TS The most urgent international priority is to overcome COVID-19 but the capacities we put in place to overcome COVID-19, in particular the scaled-up manufacturing and delivery capacity of vaccines both to produce vaccines on a global scale and to put them in people's arms all over the world; that capacity is also going to be useful in preparing for future pandemics.
So there is a task that we now face that combines both tackling today's pandemic and preparing for future pandemics that requires more resources. It requires more collective action and funding and the mechanisms required to mobilise such resources can be set up. They're not complex and they're basically affordable by the international community because we're going to be able to save much larger costs if we fail to do this right.
00:49:27
MH Thank you very much for that excellent answer. The next question goes to Carmen Powell from Politico but I'll say to all of you now, we've had most of the questions on the virus origins so if your question is about the virus origin I'm going to pass on to the next question. Anyway, Carmen, please unmute yourself and go ahead but expect a quick curtailment if it's virus origins.
CA Hi, Margaret. Thank you for allowing me to ask... Yes, I had questions about that too but I have others so I'll ask another question not related to the virus origin. I wanted to ask about the situation in Afghanistan. I know that there was medical aid stuck in Dubai that your colleagues in the region were trying to get into Afghanistan and one of your officials said that responses from the US and NATO countries, sending evacuation planes, were not encouraging. They said they couldn't get that aid into Kabul with the planes coming to evacuate people.
I was wondering if there's been any update on that and if there've been any countries that have offered so far to support that process, to get some medical aid into Kabul with some of the planes they're sending to evacuate people. Thank you.
00:50:49
MH Thank you for that great question. Dr Fall will answer it.
SF Thank you, Margaret. The situation in Afghanistan is still very challenging so we are working in the continent with our humanitarian partners. Clearly supply of medicine and other goods is a priority because of the constitution and on WHO's side we had some supplies in Kabul. We were able to distribute it to the priority health facilities but what we have in country right now can only cover up to one week.
We have supplies in Dubai; we have [unclear] from some countries to facilitate supplies like Spain and we are working with our partners to really facilitate an air bridge, not only in Kabul but also you need to use a helicopter bridge to be able to reach people outside the capital city.
So this is still a big challenge; we are working with our partners and we hope that by the end of this week we will be able to bring more supplies in country including to the most remote parts. Thank you.
MH Thank you very much, Dr Fall. We have another question for our special guest, the Minister. This one comes from Gunila van Hall from Svedska media. Sorry, Gunila, if I've got the media wrong. Please, Gunila, unmute yourself and go ahead.
00:52:27
GU Thanks. It's Svenska Dagbladet. I have a question on the waning of the vaccines and also a question for the Minister but I want to ask you, at what point when it comes to booster vaccines would you take a decision that it's needed, how much does protection against infection have to drop, 40 or 50% before boosters will be needed, what is your thinking around this?
Also the question to the Minister or Dr Tedros is, your call for financing for preventing future pandemics; what are your expectations that this will actually happen? As many countries now are under big economic strains after going through this pandemic and if you do not get this financing what are you going to do, what is the plan B? Thank you.
MH Thanks. I'll ask the Minister to answer the second question first and then we'll go on to the boosters.
TS Thank you. I think in the course of the last month-and-a-half since we released our recommendations there has been intensive discussion amongst G20 members as well as many others and further consultations with the global health community.
00:53:49
There is an emerging consensus that we do need to work with some urgency to strengthen the financing for the current pandemic as well as to prevent future pandemics. The case is not just a moral one - the case is very strong on moral grounds.
It's also a case of financial responsibility. To spend 1,000th of an annual government budget to avoid the costs that are going to be several hundred times larger is simple financial responsibility and nations have to be willing to commit these resources in fairness to their own people quite apart from being for the good of the global community.
It's just elementary financial responsibility. This is not about aid to countries far away from you. This is about what's in the global interests and the national interests at the same time and it is affordable. So there is an emerging consensus in favour of the need for significantly stronger financing in the first instance to tackle the ongoing pandemic and prevent it from being a very prolonged pandemic but at the same time to start preparing for the next pandemic, which could come any time.
00:55:23
MH Thank you so much for that answer. Dr Tedros is going to add.
TAG I can add to that. The Minister has said it very well. Just to add my voice, I think there is, as the Minister has said, an emerging consensus that health is central and the world has seen the consequences of this pandemic and losing freedoms. Now with this report what is being proposed is US$10 billion but that US$10 billion in a year will save trillions.
So in terms of the economic argument it makes full sense and, as the Minister said, it's clear. Not only is it economic consequences but the social and political upheaval also we are seeing globally. So I think the world has realised that.
And plan B; I don't think we need to have a plan B; I don't think we'll have any plan B. We need to get the funding which is a small amount of money compared to what the world is losing in trillions. Finance Ministers like the Minister actually see the US$10 billion as a rounding error in the budgets of many countries so it may seem big money but it's not compared to that it saves for the future and in terms of how it can help us also end this pandemic.
00:57:14
MH Thank you, Dr Tedros. Gunila, you got lucky; you've got two questions. Dr O'Brien will answer the first question second now.
KOB The question on when or what would be the criteria on which a recommendation for booster doses would be made is really a policy question and I think the things that we would point to are first of all looking carefully at the outcome which is of most relevance from a public health perspective and that is the severe disease, hospitalisation and death outcome.
That's really where the focus is because that was the intent; that's the whole reason around which the pandemic is what it is so very much focusing on that end of the disease spectrum. That is the end of the disease spectrum against which the vaccines are highly effective.
The second is the consistency of the findings. Acting on a single study is just not a sound policy basis so we also, as all policymakers do, include the entirety of the evidence.
00:58:29
Then the third is around the issue of the risk groups, that we do expect different performance of the vaccines in different risk groups. So recommendations around the use of booster doses would very much be tailored around which risk groups are those that may have some change in the performance of the vaccines over some period of time.
So really there's no on-or-off, yes-or-no answer to this question. This is the science and the art of formulating policies but what is really clear is that there is a global context around this and the global context is about ending the pandemic and ending the pandemic means that the priority must be around getting vaccinated those who are at most risk of disease and we are not there at this point.
So where we have constrained global supply, which will be relieved in the future, we still have to prioritise from a policy perspective, an allocation perspective and a delivery perspective immunising people who are at highest risk; healthcare workers, older adults, those with underlying medical conditions, to get them their first doses.
00:59:51
Then there will be a time when as a prioritisation the idea of enhancing potentially, if it's needed, the performance of the vaccines for those who have already received...
And we should remember that these vaccines, as all vaccines do, create some level of memory response in people's bodies so we don't expect at all that these vaccines will suddenly stop working in some way.
These are the issues when you ask, at what point would we make a recommendation around booster doses; these would be the primary considerations. First and foremost is getting first doses in to those who are most at risk so that the serious disease end of the spectrum can be protected against in all countries.
MH Thank you very much, Dr O'Brien. We're coming up to the hour so I will begin to finish this press conference and thank you all for your great points and questions. I would like to ask our special guest, His Excellency, the Senior Minister for Singapore, if he's got any final points he'd like to make.
01:01:11
TS I think the final point I'll make is - this is something which Dr Tedros and I have discussed over the months - that we've got to make sure that the reforms we make are adding to the system and not just rearranging the chairs. That means, as Dr Tedros has highlighted, the need to make sure we don't duplicate existing mechanisms, the need for funding or for governance.
That's what we've sought to do in this report; to have new funds and new governance to bring finance and to help, to strengthen the WHO and to strengthen global health security rather than to fragment the system.
That's the main way in which we've got to go forward; don't add complexity but actually add to the resources in the system.
MH Thank you so much, Your Excellency. Of course, any questions you didn't feel were answered, you may contact us at media enquiries and we'd be very happy to furnish you with all our replies as usual. The recordings of this, the video recordings, the audio with transcript will be available online soon.
To finish, of course, I will ask Dr Tedros to close.
TAG Thank you. Thank you so much. I fully concur with the Minister on the conclusion, the closing remarks he made so that makes my life easier so I concur. Thank you so much for your leadership and also for joining us today.
01:02:57
Then just one more thing I would like to add is on the boosters because there are many questions on that. On the boosters, first of all it's not conclusive in terms of its benefits and also we don't know if it's safe and it has already been said.
The second problem is when some countries can afford to have a booster and others are not even vaccinating the first and second rounds it's a moral issue and Mike said it some time ago; it's like saying, okay, you have a life jacket and you're adding another one while others don't have a single life jacket.
But it's not just a moral issue; with a big part of the population unvaccinated, especially in low and low/middle-income countries we're giving an opportunity to the virus to circulate. So it's good for the virus, meaning new variants will emerge and these new variants could be even more potent than the delta variant and could even evade the vaccines that we're using now; the vaccines we're using may not be effective for the emerging ones.
01:04:40
So it's technically wrong and morally wrong and that's why we have this two-month moratorium so that countries could refrain from using boosters so that other countries who don't have vaccines at hand, whose vaccination coverage is very low - let's take Africa; it's less than 2% - for those regions and countries to have access to vaccines.
So we're in the same boat and treating one part I don't think will help us to recover soon from this pandemic and it's in the interests of all of us to show real solidarity. With that, thank you so much again, Your Excellency, for joining us and thank you also to media colleagues for joining today. See you in our upcoming press conference. Thank you so much.
01:05:40