WHO press conference on coronavirus disease (COVID-19) - 8 December 2021

8 December 2021
 | video (press briefing)
Summary
WHO regular press briefing on COVID-19, 8 December 2021
WHO Team
Department of Communications (DCO)

Transcript

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00:00:37

CL          December 2021 and my name is Christian Lindmeier. We have simultaneous translation provided in the six official UN languages - Arabic, Chinese, French, English, Spanish and Russian - and we have Portuguese as well.

Now let me come to the participants. We have here in the room Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Soumya Swaminathan, Chief Scientist, and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. We also have online Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products.

With this, it's my pleasure to hand over to Dr Tedros for the opening remarks.

TAG        Thank you. Thank you, Christian. Good morning, good afternoon and good evening. The omicron variant has now been reported in 57 countries and we expect that number to continue growing. Certain features of omicron including its global spread and large number of mutations suggest it could have a major impact on the course of the pandemic. Exactly what that impact will be is still difficult to know.

00:02:13

We're now starting to see a consistent picture of rapid increase in transmission although for now the exact rate of increase relative to other variants remains difficult to quantify. In South Africa the number of omicron cases is increasing quickly. However omicron was detected when transmission of delta was very low so it had little competition.

It will therefore be important to monitor carefully what happens around the world to understand whether omicron can outcompete delta. For that reason we call on all countries to increase surveillance, testing and sequencing, our existing diagnostics work, both PCR and antigen-based rapid tests.

Emerging data from South Africa suggests increased risk of reinfection with omicron but more data are needed to draw firmer conclusions. There is also some evidence that omicron causes milder disease than delta but again it's still too early to be definitive.

Any complacency now will cost lives. Many of those who don't die could be left battling long COVID or post-COVID condition, a disease with debilitating, lingering symptoms that we're only beginning to understand.

00:03:58

To help us build a clearer picture of the severity and symptoms of disease caused by omicron we're calling for more countries to submit more data to our clinical data platform using an updated case reporting form available on our website.

New data are emerging every day but scientists need time to complete studies and interpret the results. We must be careful about drawing firm conclusions until we have a more complete picture.

Every day WHO is convening thousands of experts around the world to share and analyse data and drive research forward. For example the technical advisory group for virus evolution is assessing omicron's effect on transmission, disease severity, vaccines, therapeutics and diagnostics and the effectiveness of public health and social measures.

The joint advisory group on COVID-19 therapeutics prioritisation is analysing the possible effects of omicron on treatment of hospitalised patients. The research and development blueprint for epidemics is convening researchers to identify knowledge gaps and the studies needed urgently to answer the most pressing questions.

00:05:34

And the technical advisory group for COVID-19 vaccine composition is assessing impacts of omicron on current vaccines and determining whether changes to vaccines are needed.

Once again I thank the scientists in South Africa who have been working closely with WHO to help us learn more about omicron. Building capacity across Africa is a key priority for WHO, which is why next week I look forward to joining the International Conference on Public Health in Africa, hosted by the African Union and the Africa Centres for Disease Control and Prevention, which will bring together researchers from across the continent to discuss some of the most pressing scientific questions about COVID-19.

Even though we still need answers to some crucial questions we're not defenceless against omicron or delta. The steps countries take today and in the coming days and weeks will determine how omicron unfolds. If countries wait until their hospitals start to fill up it's too late. Don't wait. Act now.

00:07:00

We're running out of ways to say this but we will keep saying it. All of us, every government and every individual must use all the tools we have right now. All governments should reassess and revise their national plans based on the current situation and their national capacities.

Accelerate vaccine coverage in the most at-risk populations in all countries. Intensify efforts to drive transmission down and keep it down with a tailored mix of public health measures. Scale up surveillance, testing and sequencing and share samples with the international community. And avoid ineffective and discriminatory travel bans.

I'm also pleased that France and Switzerland have lifted their travel bans on southern African countries and I urge other countries to follow their lead. To France and Switzerland, merci beaucoup.

All individuals can reduce their risk by keeping a safe distance from others, avoiding crowds, wearing a mask, cleaning your hands and meeting outside if possible or in a well-ventilated space indoors. And please get vaccinated if you can.

00:08:35

We can save lives from delta right now, we can prevent omicron becoming a global crisis right now and we can prevent other variants emerging right now. This virus is changing but our collective resolve must not. Christian, back to you.

CL          Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask questions you need to raise your hand using the raise your hand icon and do not forget to unmute yourself when it's time. We'll see if we have the first online and I think I saw Priti Padnaik before from Geneva Health Files. Priti, please go ahead.

PR          Hi. Can you hear me?

CL          Yes. Go ahead.

PR          Thank you for taking my question. I have two related questions. One is, what's the latest on reaching vaccination targets, inoculating 40% of populations across countries? And do you already see indications of vaccine hoarding as a result of omicron?

We also see news today that some companies believe that the booster doses actually could potentially be effective against omicron. Are you already seeing instances of vaccine hoarding or do you expect this will get worse and affect donation programmes? Thanks so much.

00:10:17

CL          Thank you, Priti. We'll start with Dr Kate O'Brien, Director of Immunisation, Vaccines and Biologicals.

KOB       Thank you for those questions and our concern about the situation with omicron as well as really the fact that we're in a delta pandemic right now even as we're working and watching very carefully what's going on with the omicron variant.

You asked specifically about the 40% target by the end of the year and there are over 50 countries that are unlikely to meet the target of 40% coverage. This really is primarily about supply and it's not about supply in the past month or six weeks.

Obviously reaching targets like 40% requires a programme that rolls out over a period of weeks, months, over a significant duration of time so what we're seeing is the cumulative effects of the supply constraints that have been going on over many months in this past year, notwithstanding that at this point we are seeing significant increases in the supply through COVAX to countries that are reliant on COVAX for their doses and countries are ramping up their deployment of those doses very quickly.

00:11:34

On the issue of the information that was provided by Pfizer about the initial laboratory tests that they have results from on either two doses or three doses, we're aware of those results. We're very interested of course in the findings that they have. These are preliminary results and we will look forward very much to not only these but others, again some early reports out of South Africa also on the performance of the Pfizer MRNA vaccine.

So these are results that, if they prove to be replicable, will provide us with some information about existing vaccines and I think one of the most important things is that we are still very much in a delta pandemic and so assuring that we're getting to vaccinate all people, especially those at highest risk of disease, with our existing vaccines continues to be the top priority.

What they've also noted is that there is a sight-line perhaps from these early data that the difference in the performance of the vaccines may be much more sustained on the severe end of the disease spectrum and again this is speculation because we're really in early days still. Thank you.

00:13:07

CL          Thank you very much, Kate. Next question goes to Helen Branswell from Stat News. Helen, please unmute yourself.

HE          Thanks very much. I'd like to follow up on the issue of omicron's potential effect on vaccines. Given that there are little bits of data coming out already that the new variant seems to be able to escape the neutralising antibodies that have been generated by two doses of the Pfizer vaccine, is WHO rethinking its opposition to booster shots? Thank you.

CL          Thank you very much, Helen. We'll start with Soumya Swaminathan, the Chief Scientist.

SS          Yes, thank you, Helen. I can start and Dr Annamaria Henao is online and she can update us also on what the R&D blueprint expert groups are doing. As you know, there are some very preliminary reports, I think from three different groups, one from South Africa and two others, that have measured neutralising activity mainly against the Pfizer BioNTech vaccine from people who've been vaccinated but also people who've been infected in the past.

00:14:26

As was expected from the combination of mutations that had been seen on the sequences there is a reduction in the neutralising activity but I think first of all there's a wide variation in this reduction from four or fivefold to up to 40-fold across these different experiments.

Secondly the numbers are still very small. Some of these assays used live virus, some used a pseudovirus and so there's still a lot of work to be done. Then of course it's only looking at one element, just the neutralising antibodies and we really haven't got information on the effectiveness.

So I think it's premature to conclude that this reduction in neutralising activity would result in a significant reduction in vaccine effectiveness. We do not know that because, as you know, the immune system is much more complex. There are the T-cells, there are the memory B-cells and so what we really need now is a co-ordinated research effort and not jumping to conclusions study-by-study.

I think Dr Ryan said last time that we are going to see a couple of weeks of every day new information, new studies. One study is not going to really prove anything so it's important in fact now for this global co-ordinated research effort, which is exactly what the R&D blueprint is doing.

00:15:54

Perhaps Annamaria might want to add. We just had the consultation on December 6th as well which laid out some of the knowledge gaps and research priorities and encouraged researchers to really study these in depth. As you know, this takes a little bit of time so we'll have to be a bit patient.

CL          Thank you. We go to Annamaria Restrepo.

ARH       Thank you, Dr Soumya. Indeed, within our consultations with the experts we have been focused on three things, the transmissibility of the omicron variant, the potential virulence of this variant and the ability of this variant to evade immune responses induced by vaccines or by prior infection.

The three draft manuscripts that has been posted with neutralising data from the omicron variant are very interesting. They all describe early data and they are, as was mentioned, not yet peer-reviewed.

00:16:50

They all mentioned significant reductions in neutralisation against omicron but with a broad range and I want to emphasise and take this point to say that reduction in neutralisation of 40% doesn't mean 40% reduction in vaccine efficacy.

These studies include a small number of samples and need to be followed up. There is variability in the results. The studies also include only a few vaccinated and unvaccinated individuals, some with boosters, some without them.

Additional information from other studies - at least six we have counted - will be anticipated in the following days. We recognise, as Dr Soumya says, that neutralising antibodies are an important piece of information, they play an important role in control of the infection but they are only one part of the protection against severe disease.

Once the cells are infected protection against severe disease also comes from cell-mediated immunity. Soumya mentioned this and I just want to emphasise that this data together with clinical data is still critical so that we fully understand how a vaccine will protect against disease caused by omicron.

00:18:02

Early clinical data, as Dr Tedros mentioned, suggests that disease may not be severe but it is too early and more data is definitely needed. So overall our experts consider that this emerging data is important information but before we conclude what the omicron variant can do and cannot do against evading vaccine immunity we need more data. Thank you.

CL          Thank you very much, Annamaria Restrepo. We now go to the next and that's Laurent Siero from Swiss News. Laurent, please unmute yourself.

LA          Thank you, Christian. Thank you for taking my question. I'd like to come back to what DG Tedros said in the preliminary remarks on the rate of omicron cases. I understand that it's difficult for now to assess but in the epidemiological update you released yesterday evening there is that huge increase of 79% of cases in Africa for last week.

So if we only target last week do we have an idea on the ratio of what might be attributed to delta and what might be attributed to omicron? Thank you.

MK         Perhaps I'll start with that. It's a great question. As the DG pointed out, there's a lot that we're still learning about this, particularly on transmission and severity and impact of countermeasures.

00:19:34

We are definitely seeing increasing transmission in South Africa and we're seeing a number of increasing reports around the world of the omicron variant. There are some challenges in our understanding of how much this is circulating because we do need sequencing to determine if it's the omicron variant or we had this S-gene drop-out with one of the PCR assays that gives us a clue of if it may be omicron circulating.

One of the things that we're really looking at right now is how omicron will circulate in different populations. In South Africa for example they had just finished a wave of infection with delta and so transmission with delta was at a very low level. They worked incredibly hard to bring that transmission under control and should be congratulated for that.

With the emergence of omicron in a population where delta was low-circulating, where it was not circulating very much omicron rely took off and it really is increasing in transmission around the country.

00:20:32

What we have to look at is how omicron will unfold in other countries other populations that have delta circulating at a high level and what will actually happen as omicron, if you will, competes with delta and whether or not we will see the same increased growth rate, the same increasing number of cases over time in different populations.

We expect to have good estimates of the time-varying reproduction number as it compares with other variants in the coming days. There are some early estimates of this but the confidence intervals are very wide.

I think one of the things we need to stress right now - and the Director-General said this in his speech - how countries react right now, in the next days to weeks - I'm not talking about reacting in January or February but the way countries react now will determine how omicron unfolds no matter what we find out in terms of its transmission, its severity, its impact on our countermeasures.

So we can't stress enough how important it is to act fast, to act robustly and I don't mean lock-down. We mean using proven public health tools to drive transmission down in areas where transmission is high and to keep transmission low in areas where transmission is low because it still is quite a diverse situation around the world and delta is dominant still globally.

00:21:58

So the situation will unfold in the coming days and weeks and I think we all have to recognise, as was highlighted in the last question, it will take some time for us to get some answers but as the experts work and release this information to us we will update you as regularly as we can to give you information and update on what needs to be done.

But we cannot emphasise more that we're telling countries not to wait but to act and to accelerate vaccination because the vaccines work against delta and even if there is reduced efficacy against omicron it's still better to be vaccinated than not.

So those of you who are out there and who may be hearing all of this information, it may sound scary, it may be confusing but as the experts are working this out what's important is what you do and you keep yourself safe and you take measures to reduce your exposure to the virus no matter what variant is circulating where you are and you get vaccinated when it's your turn and we work very hard to increase vaccination coverage in those who are most at risk in all countries.

00:23:06

CL          Thank you very much, Dr Van Kerkhove. With this we'll move to the next question and it goes to Kai Kupferschmidt from Science. Kai, please unmute yourself.

KA          Thanks a lot for taking the question. Let me ask a short or small question and a big one. The small one is is if we can have any data on secondary attack rates at this point in terms of the transmissibility of omicron. I'd be curious what we're learning on that front.

Then the big question, I know we're in the middle of this and we all want to look forward and we're realising more and more we don't have the luxury of waiting until this is over to learn some lessons.

So I would really appreciate if you could take a quick look back and say, why are we in the situation again, what went wrong, why didn't governments for instance once again act earlier in this wave?

CL          Indeed a long and a short question. Let's start with maybe the easier one first from Dr Van Kerkhove.

00:24:04

MK         Neither one of those are easy questions, Kai. They're not quite short questions either and I think you know that but they're good ones nonetheless. We do expect to have some secondary attack rates coming from countries, I think, on Friday. The studies are unfolding right now in countries in South Africa but also in the UK and elsewhere and I believe some of that information will be released on Friday.

What those household secondary attack rates will look at are they'll compare the secondary attack rates for individuals who are infected by omicron and how many people in that household are infected from one infected individual compared to delta.

But you also have to recognise - and I'm sure you know this - that some of the early data may be a little bit messy in the sense that we won't be able to control for all of the factors and those early estimates of a secondary attack rate may change.

I can remind you that the first issuing of the secondary attack rates for delta were actually reduced over time as more data came online. So we expect to have some of that on Friday.

00:25:09

With regard to lessons, we could spend the whole of the rest of the conference talking about this, which of course we won't but I think this is one of the scenarios that is completely predictable. The virus has been evolving since the beginning and we have been working with partners, with experts around the world to study how the virus is changing, how the virus is mutating and looking at some of these mutations and if they will confer a better fitness and that the virus will become more transmissible.

But also the possibility of if the virus could develop properties of immune escape where we may have reduced efficacy of some of our countermeasures. Unfortunately this is entirely predictable because the comprehensive nature in which we need to respond...

Number one, we have to look at increasing vaccination coverage in people who are at risk so that we reduce hospitalisations, we reduce morbidity and mortality and deaths. But secondly we also have to reduce transmission. We cannot only focus on vaccination coverage.

00:26:16

You hear us say a lot, vaccines and, not vaccines only. There's a comprehensive nature in which we tackle this problem.

Secondly this is a global problem and global problems need global solutions. We can't only fight this virus in some countries while others are fighting with their hands tied behind their back and this is why all countries and why the Director-General and our partners are fighting so hard to have vaccine equity but also equity and access to life-saving tools like diagnostics, therapeutics, that PPE is available to our front-line workers and that we utilise all of the tools that we have.

So this pandemic will last as long as we allow it because we're not using the tools most effectively but it's never too late to turn it around so I think we have to also think that as well, that there is hope to turn this around and again as much as we can act and as strong as we can act against delta it will benefit omicron and any future variants that emerge.

CL          Dr Ryan, please.

MR         Good afternoon, Kai. Yes, I think the raw numbers or estimates of R0 or reproductive numbers, the secondary transmission data is all pointing to a virus that's efficiently transmitting and probably more efficiently transmitting than even the delta variant.

00:27:45

But that does not mean that the virus is unstoppable. It means the virus is more efficient at transmitting between human beings and therefore we have to redouble our efforts to break those chains of transmission, to protect ourselves, to protect others.

It doesn't mean the virus has become invincible. It's just become better fit, better adapted to exploiting the contacts and the connections between us and therefore we have to double down on those efforts and use the methods at our disposal that we already have, that will allow us to do that.

It means we have to get fitter and faster as the virus has got fitter and faster. The DG has spoken to that in his opening remarks.

As well as that more transmissible does not mean more virulent or more lethal. Yes, if we allow the virus to transmit unchecked it will generate more. We saw that with delta before and with other variants. If they're allowed to spread unchecked even though they're not individually more virulent or lethal they just generate more cases, they put pressure on the health system and more people die. That's what we can avoid.

00:28:58

We cannot do anything about maybe the inherent qualities of a virus but we can prevent our systems coming under pressure, we can maximise the chance that anyone with severe illness has for survival by ensuring we protect the health system, we protect the most vulnerable, we protect those most likely to suffer severe illness and death and that's what we're saying.

Protect yourself, protect each other, get vaccinated. The single big message, if you are offered a vaccine please get that vaccine. It doesn't matter what variant you're doing it for and if we can, gibe more vaccines to countries that need them because they have vulnerable populations that are unprotected.

We've been saying this, Kai, going back months now. Long before we had omicron we were concerned about the delta wave and what it was doing and what we weren't doing to stop that.

00:29:52

Omicron represents another level, it's another dimension, it's another scale of response that we may need and we weren't doing particularly well in the face of delta. So I think the DG's remarks today, everyone should read them again because I think he's put it very, very clearly as to what we need to do to get through this next wave of disease.

CL          Dr Kate O'Brien, please.

KOB       I'd just like to add a couple of things to what Mike and Maria have both said. When you ask what went wrong, if we're seeing variants that are more transmissible... Really what we initially started hearing people take about at the outset of vaccination was there was going to be some reliance on herd immunity or herd effects.

As a pathogen becomes more transmissible it's really about individuals becoming vaccinated to have protection against the disease. So what went wrong here, as they both said, we can point to many things but one of the most important things at this point is we should be focusing very much on the message that we continue to give, which is everybody getting vaccinated as soon as they're offered vaccine.

00:31:15

We have such great vaccines available and even with omicron I don't think anybody expects that the vaccine, even in a worst-case scenario, would have no effect on the variant. So I think it's really important for everybody to understand that as we're talking about omicron and the vaccines we're talking about what adjustments there are, what changes there might be but we're not talking about vaccines that would become ineffective entirely.

So I think this is a really critical point and as a virus becomes more transmissible it makes it ever more important that every individual who is offered vaccine actually gets the vaccine. We can't be relying on the concept, the idea that somehow other people being vaccinated is going to protect others in the community who are choosing not to become vaccinated. Thanks.

CL          Thank you. Next question goes to Christiana Ulrich from DPA. Christiana, please unmute yourself.

CR          Thank you, Christian, for taking my question. This goes back to studies coming out of South Africa that point to maybe a milder version of disease for the omicron variant. Scientists tell us that this must be taken with a measure of caution because the population in South Africa is a lot younger than the population in my own country, Germany, and has very high baseline immunity from previous infections.

00:32:56

So this might not translate into a similar mild disease case in northern European countries. Would this not be the time for you to adjust your advice against boosters? Would this not be the right time to tell countries with older populations that it might be a good idea to administer booster shots at this point? Thank you.

CL          Thank you very much, Christiana. The first part we touched upon but worth reiterating. Dr O'Brien.

KOB       What's really important about vaccine schedules and optimising vaccine schedules is to follow the data and SAGE has just met yesterday to do an intensive review of data on booster doses and we will be following through on their conclusions out of that review and the data continue to roll in.

What I think is really important is that no matter which way you look at it primary doses always outperform booster doses for people who are at risk. The primary attention here has to be on assuring that everybody who has not yet had a primary series of vaccination has access to that vaccine and gets vaccinated.

00:34:20

We're in a two-track pandemic largely with those who are getting disease being those who are unvaccinated for any dose. So that has to be the absolute, primary attention that the world is focused on including countries that have high access to vaccines to assure that that supply is getting to those places in the world that have still not had adequate supply over these many months.

Of course that supply is ramping up now but that has to be our firm attention. The evidence on booster doses shows that for the severe end of the disease spectrum the performance of the vaccines is holding up very well with some minor reductions in the performance of the vaccines and on the more mild end of the disease spectrum some further reductions in the performance.

But given that the focus here is firmly on the protection against hospitalisation, severe disease and death these primary doses to those who have not yet been vaccinated really have to be the priority.

00:35:29

We'll continue watching the evidence very closely and providing recommendations that optimise how vaccines can best be deployed to address the pandemic, to close it down. Thanks.

CL          Dr Swaminathan, please.

SS          Just to add because Kate mentioned the data that we follow very closely, the data from country after country after country is showing that the people who are in the ICUs, the people who are severely ill and the people who are dying are the unvaccinated.

So I think the message is loud and clear that it's a primary course of vaccination that is going to protect against severe disease and death. That has to be our goal, that has to be the first goal and we were hoping to have achieved that by vaccinating the priority populations across the world, in every country in the world by the end of 2021 so that we could have reduced the deaths.

Because if deaths are going to be in those vulnerable groups that are at high risk of getting ill from COVID - and unfortunately even in countries that have adequate or more than adequate supplies there is still a substantial proportion of people who have not been vaccinated, 30, 40, 50%, complete course of vaccination.

00:36:53

So the boosters unfortunately are probably not the solution to this. While we're going to look at the evidence at some point, additional dose, boosters so we're not ruling that out but what we're saying is that at this point the benefits we will get from reaching those people who have not received primary courses of vaccination are going to be higher than giving additional doses to those who have already completed a primary course.

Of course there are vulnerable groups and we've also put out recommendations on where additional doses may need to be given, the immunocompromised and groups like that. But wholesale boosting is not the solution right now, it's reaching everyone and then doing all the other things, as we've been emphasising, in addition to the vaccination.

CL          Dr Van Kerkhove.

MK         I wholeheartedly agree with what Kate and Soumya said and I won't repeat it to save time but I wanted to discuss the severity part of your question. We have some information on severity but we don't have the full picture yet. It will take some time for us to understand the true severity of omicron as it compares to other variants that are circulating.

00:38:05

We certainly have information from South Africa that many of the patients that are identified with omicron have a more mild course of disease but it does take time for people to go through the full course of their infection, the full course of their disease.

We do know that the variant, if it can reach vulnerable populations. If you have underlying conditions or are of older age and are not vaccinated you could develop severe disease or there's a much higher risk of developing severe disease so it's too early to tell.

So I only wanted to caution against any conclusions about severity of omicron yet because now we really have anecdotal information, we don't really have studies yet. There's some very good work that's happening in South Africa with patients and hospitalised patients.

They're using a standardised collection form which they've been using throughout this whole pandemic and we're working with them to look at a time series of the patients now compared with the patients previous in the pandemic to look at what differences we may see.

00:39:08

Certainly we have indications of more mild disease but it's too early to conclude on that so I think it's really important and again if we have more transmission, if we have more cases we will have more hospitalisations and if we have more hospitalisations in overburdened healthcare systems the chances of increasing death are much higher.

So we are working with experts around the world to understand, are there intrinsic properties of the variants that cause a change in the severity profile or are there other factors that may lead to more severe disease and death, meaning that people can't get the proper care that they need because the health system is overwhelmed.

So it's a little early but again we will update you as we get more information.

CL          Thank you, all. We have Dr...

00:39:53

MR         Sorry, there're a lot of us speaking on this but I think Maria's point is exceptionally, exceptionally important in terms of the overburdening of the health system and that severity profile. If we allow a mild disease to transmit unchecked it will generate huge pressure in the health system which will decrease the positive outcomes for people and that's what we've seen with many before.

It's also something, I think, we need to caution everyone on. There is an assumption out there that as a disease becomes more transmissible it will become milder. I would hope that most viruses would become less transmissible and milder, that would be the ideal outcome.

But I think there's a little bit of an urban legend around that process. That doesn't necessarily happen. There is pressure on the virus to adapt and become more transmissible because that's an evolutionary pressure.

The outcome of whether a virus is more or less severe is much more random. It can happen, it can not happen and in that sense that's why we don't know and I think we have to be very, very careful in making any absolute determinations.

00:41:04

Remember in this that much of the severe outcomes, much of the hospitalisation, much of the death is not mediated by the virus, it's mediated by our own immune systems and our response to the presence of the virus.

So in a sense some of the most negative outcomes here are more to do with underlying conditions - diabetes, hypertension - and other factors that make the course of the illness more severe for a certain group of individuals.

Therefore they're locked into the system in a sense so therefore I don't expect in general viruses to become milder. It can happen randomly but it's not a direction that as a disease becomes more transmissible it becomes milder. I think we should have hope and everyone should have hope and we should hope for the best outcome but in this particular case hope is not a strategy and we need to be very, very careful on making any final determinations on severity.

CL          Thank you all very much for very important points and we move to Denise Rowland from the Wall Street Journal. Denise, please unmute yourself.

00:42:11

DE          Hi. Thank you for taking my question. It's about vaccine equity. It's clear that a lot needs to be done to improve the situation. I wondered in particular what the vaccine manufacturers could be doing to help this. Are there things that they could be doing already that they're not doing yet to improve vaccine equity? Thank you.

CL          Thank you very much.

SS          Again I can start. I think that's a great question and this is something we've be talking about also for some time. Just to put some faces on the previous figures, we were talking about people still not being vaccinated around the world. Only one in four healthcare workers in Africa has been fully vaccinated and there are large numbers of older individuals and people with underlying illnesses have not.

So we need to remember that there are lots of people out there taking care of others who haven't received shots yet. So what can manufacturers do? The first thing they can do is to work with COVAX in providing some transparency and visibility in our supplies because one of the challenges has been for countries to not know how many vaccines they'll receive and when so that they can plan their vaccination campaigns.

00:43:29

Then everyone ends up blaming those countries for not absorbing those vaccines and using them fast enough.

The second is that they arrive with sometimes short expiry dates, one month, six weeks. Again it's very unrealistic to expect a country will be able to move a large volume of vaccines with short expiry dates.

Thirdly some of the companies have taken a long time to have the indemnification and liability negotiations with the countries despite COVAX really making all attempts to standardise a language and to facilitate this process.

Then of course they should be prioritising COVAX. COVAX is a global mechanism for supplying vaccines to all countries, both the AMC countries that get the donor-funded doses but also the self-paying, self-purchasing countries and we have not seen that happen.

We've seen manufacturers delayed their shipments to COVAX while we know that they're supplying other buyers, countries.

00:44:37

Then finally of course we would very much like manufacturers to enter into technology transfer arrangements, either bilateral voluntary technology transfer or work with the WHO, multilateral technology transfer hubs. Let's expand manufacturing capacity, let's build and strengthen that capacity in parts of the world that currently do not have it.

These are some of the things they can do and I don't know if anyone else wants to add to that.

CL          We also have Dr Simao online, who wants to come in, Assistant Director-General, Access to Medicines and Health Products. Dr Simao.

MS         Thank you, Christian. Just complementing what Dr Soumya was saying right own, it's not only the sharing. I think it's super-important right now because the situation we are seeing is not an equitable situation and we need to change it for 2022.

It's not only the sharing of technology and know-how but also the sharing of intellectual property and we do have mechanisms to do that on a voluntary basis, to have public health-oriented licences to the medicines patent pool, using the COVID Technology Access Pool which is the CTAP, which is a WHO initiative [unclear].

00:45:58

So we have a mechanism in place that can help the manufacturers to find the legal arrangements that are necessary to do that voluntary licence through the medicine patent pool and also to arrange the technology transfer so that we can speed up the process of local production in different regions of the world. Thank you.

CL          Thank you very much, Dr Simao. Dr Mike Ryan, please.

MR         There was a very specific question, what manufacturers, industry do now when we're in the face of omicron. This is, I think, a very important moment. For 70 years we've worked with industry and manufactures introducing a really careful, twice-a-year process with manufacturers to identify new vaccines twice a year for the northern and southern hemisphere.

We develop new vaccines, candidate vaccines against particular avian flu strains that emerge over time. This is a partnership that works extremely well when the public service, governments and multilateral institutions work with industry, where the public, the citizens of the world get to decide what's made on their behalf and what's manufactured on their behalf.

00:47:14

This has been a hugely important collaboration over many years where industry are our partners, not our masters and we need to reproduce that now. We need the discipline and he science to bring the data together, to engage with industry and we're doing that through the R&D blueprint for epidemics, we're doing that through the meetings we held today with the technical advisory group on COVID vaccines.

We want to see that partnership work but we want to see good decisions made based on good data, based on good science. We want that to happen quickly, we want that to happen fast but we need publicly-driven decision-making regarding any shifts or changes to vaccine development or production and we want, as I said, our partners in industry to move with us on that journey.

SARS-CoV-2 and COVID-19 is going to be around for a good while longer and other variants may emerge. We need a systematic process of working with industry so we don't have chaos, a circus of everyone doing what they think they should do and nothing being co-ordinated. This would be the worst possible outcome for the world so this is a real test.

00:48:31

Can we behave coherently, can the public and the private sector act together in unison in the service of the citizens that we all say we are here to serve?

CL          I'm looking around. Do we have more comments? Dr Kate O'Brien, please.

KOB       I just want to add, you asked a question about the vaccines and the manufacturers of the vaccines and I think we also need to make a specific point about the syringes to actually deliver vaccines. There is a syringe shortage and this is an absolutely critical part. A vaccine doesn't save anybody's life, only vaccination does and we can't deliver the vaccines into people's arms unless there are the syringes that are the right kind of syringes, syringes that are safe, syringes that are appropriate for a vaccine and syringes that can actually be deployed in countries when they're needed, when they're needed in the volume that they're needed.

00:49:23

So this is another critical component of actually manufacturers being able to contribute in an extremely important way to assure that the vaccines that are being produced are delivered to people, into their arms and actually save lives.

We have to have an intensive focus on this, which are we doing along with UNICEF to work directly with the manufacturers to syringes to assure that they are available in the time and the place and the numbers to make sure that the programme functions as it should. Thanks.

CL          Thank you very much. Annamaria, please go ahead.

AHR       Thank you very much. I just wanted to add to what has been said and additional perspective from the research point of view. The first one is that there are numerous vaccines still in the pipeline that need to be tested so to the developers of these vaccines we tell them, we need more vaccines, perhaps vaccines with attributes which make them better for deployment in low and middle-income countries, maybe not injections, maybe fewer doses, etc.

But in addition to emphasise what Dr Ryan says about if we need a modified, environment-specific vaccine we want the developers to work with us in a collaborative approach through our systems and our expert committees like the COVACTAG [?].

00:50:51

We also have worked and the colleagues in the regulatory team have worked with regulators all around the world to describe pathways that perhaps will accelerate while maintaining robust standards, the evaluation of variant-specific vaccines so we want to continue those dialogues.

Finally if we are going to test vaccines we should focus not on booster dose vaccines, variant-specific vaccines, just on booster doses but as many people on the planet as still remain without receiving one dose, we also have to test variant-specific vaccines among people who have received no doses. Thank you.

CL          Thank you very much, all, now. We'll go to a new visitor in our press conference and that's Kenneth Kendolf Hauk from the Norwegian broadcaster. Kenneth, please unmute yourself.

KE          Thank you. Can you hear me?

CL          Yes. Please.

00:51:48

KE          Okay. My question pertains to Norway, which currently has a rather significant omicron outbreak. How does the World Health Organization regard the outbreak of omicron in Norway and what is the World Health Organization's view on meeting outbreaks like this with strict regulations or lock-downs?

CL          Thank you very much, Kenneth. I'm sure we have individual expertise here on the country.

MK         I could start. I'm not going to comment specifically on Norway because I don't know the exact situation there. I can look up the data but what we can say to countries who are dealing with different types of outbreaks and intensity of activity is that this comprehensive approach of tacking both increasing vaccination coverage, particularly those who are most at risk, we are advising countries to look at which proportion of your population is actually covered and in particular if you have high coverage how much of your at-risk group are being missed and why and target your vaccination to those who are most at risk, that's the first thing.

Second thing is to work to drive transmission down and when we say that we don't mean lock-down. Many countries have had to use lock-down throughout this pandemic because they've been overwhelmed.

00:53:11

What we need to happen is that we need to see this layered approach of using these public health and social measures, which is a huge number of different individual-level measures, community-level measures but first and foremost wearing of masks, well-fitting masks over your nose and mouth with clean hands, reducing the number to contacts that people have, avoiding crowds, spending more time outdoors than indoors.

I know that's more difficult as we enter the winter months. There are many holidays that are coming up where people are increasing their number of contacts. This needs to be done as carefully and as safely as possible. Again we cannot stress enough, particularly as we enter into the holidays, that people need to be extra-careful.

Given the uncertainty of this new variant, given the certainty of delta in many parts of the world we need to take measures to reduce our exposure.

00:54:07

We also need governments to look at their plan, look at what they're doing, look at the data that's coming out from all of the systems that they've worked very hard to put into place, make sure that those are strengthened, check in with your workforce because we know many people in the workforce are leaving in droves because they are absolutely exhausted after two years of dealing with COVID and going into a third year.

And making sure that the public health systems in place are really strengthened, taking measures to improve ventilation in the places where we work, where we live, where we study. It's a combination of factors so it's a constant reassessment on the situation in the country, the capacities to be able to respond and to course-correct where it's necessary.

So it's two parts to the equation, increasing vaccination coverage in those most at risk and then making sure you take measures to drive transmission down as much as possible.

CL          Dr Ryan.

MR         Yes, I think the incidence of cases in Norway has increased about 22% in the last week but Norway's done a really good job in decoupling incidence from deaths and hospital admissions and I think the high vaccination coverage, the strength of the health system in Norway - the pay-off is that there's been a huge impact there.

00:55:31

Overall the attack rate in the population is, I think, about 420 per 100,000 per week, which is equivalent to many other western European countries like the UK and France so like many countries in Europe, incidence is poised at a high level. It has been increasing over the last number of weeks.

I think all countries are on that trajectory, that they've been increasing their incidence of delta. I know that we've had a verified report, a notification of the presence of the omicron variant but it's not determined yet whether there is local transmission in Norway.

So I would say Norway is very much in a typical position of a western or northern European country right now, high transmission or intense transmission of the delta variant in the context of a well-vaccinated population, low numbers of deaths but obviously the issues that will arise potentially with omicron will put potential pressure on the system in the coming weeks. It remains to be seen.

00:56:35

CL          Thank you both very much. Now we've come up to the hour and I thank you all for your participation. Just for those who haven't made it yet into the queue or to ask their questions, I just remind you we had 11 more questions pending so huge interest and I guess we could have continued for another hour here.

Thank you again. We will be sending the audio files and Dr Tedros' remarks right after the press conference and the full transcript will again be posted tomorrow on WHO's website. I thank you all very much and hand over to Dr Tedros for the closing.

TAG        Thank you. Thank you, Christian, and thank you to all colleagues from the media who have joined today and see you next time.

00:57:21


00:00:37

CL          December 2021 and my name is Christian Lindmeier. We have simultaneous translation provided in the six official UN languages - Arabic, Chinese, French, English, Spanish and Russian - and we have Portuguese as well.

Now let me come to the participants. We have here in the room Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Soumya Swaminathan, Chief Scientist, and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. We also have online Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products.

With this, it's my pleasure to hand over to Dr Tedros for the opening remarks.

TAG        Thank you. Thank you, Christian. Good morning, good afternoon and good evening. The omicron variant has now been reported in 57 countries and we expect that number to continue growing. Certain features of omicron including its global spread and large number of mutations suggest it could have a major impact on the course of the pandemic. Exactly what that impact will be is still difficult to know.

00:02:13

We're now starting to see a consistent picture of rapid increase in transmission although for now the exact rate of increase relative to other variants remains difficult to quantify. In South Africa the number of omicron cases is increasing quickly. However omicron was detected when transmission of delta was very low so it had little competition.

It will therefore be important to monitor carefully what happens around the world to understand whether omicron can outcompete delta. For that reason we call on all countries to increase surveillance, testing and sequencing, our existing diagnostics work, both PCR and antigen-based rapid tests.

Emerging data from South Africa suggests increased risk of reinfection with omicron but more data are needed to draw firmer conclusions. There is also some evidence that omicron causes milder disease than delta but again it's still too early to be definitive.

Any complacency now will cost lives. Many of those who don't die could be left battling long COVID or post-COVID condition, a disease with debilitating, lingering symptoms that we're only beginning to understand.

00:03:58

To help us build a clearer picture of the severity and symptoms of disease caused by omicron we're calling for more countries to submit more data to our clinical data platform using an updated case reporting form available on our website.

New data are emerging every day but scientists need time to complete studies and interpret the results. We must be careful about drawing firm conclusions until we have a more complete picture.

Every day WHO is convening thousands of experts around the world to share and analyse data and drive research forward. For example the technical advisory group for virus evolution is assessing omicron's effect on transmission, disease severity, vaccines, therapeutics and diagnostics and the effectiveness of public health and social measures.

The joint advisory group on COVID-19 therapeutics prioritisation is analysing the possible effects of omicron on treatment of hospitalised patients. The research and development blueprint for epidemics is convening researchers to identify knowledge gaps and the studies needed urgently to answer the most pressing questions.

00:05:34

And the technical advisory group for COVID-19 vaccine composition is assessing impacts of omicron on current vaccines and determining whether changes to vaccines are needed.

Once again I thank the scientists in South Africa who have been working closely with WHO to help us learn more about omicron. Building capacity across Africa is a key priority for WHO, which is why next week I look forward to joining the International Conference on Public Health in Africa, hosted by the African Union and the Africa Centres for Disease Control and Prevention, which will bring together researchers from across the continent to discuss some of the most pressing scientific questions about COVID-19.

Even though we still need answers to some crucial questions we're not defenceless against omicron or delta. The steps countries take today and in the coming days and weeks will determine how omicron unfolds. If countries wait until their hospitals start to fill up it's too late. Don't wait. Act now.

00:07:00

We're running out of ways to say this but we will keep saying it. All of us, every government and every individual must use all the tools we have right now. All governments should reassess and revise their national plans based on the current situation and their national capacities.

Accelerate vaccine coverage in the most at-risk populations in all countries. Intensify efforts to drive transmission down and keep it down with a tailored mix of public health measures. Scale up surveillance, testing and sequencing and share samples with the international community. And avoid ineffective and discriminatory travel bans.

I'm also pleased that France and Switzerland have lifted their travel bans on southern African countries and I urge other countries to follow their lead. To France and Switzerland, merci beaucoup.

All individuals can reduce their risk by keeping a safe distance from others, avoiding crowds, wearing a mask, cleaning your hands and meeting outside if possible or in a well-ventilated space indoors. And please get vaccinated if you can.

00:08:35

We can save lives from delta right now, we can prevent omicron becoming a global crisis right now and we can prevent other variants emerging right now. This virus is changing but our collective resolve must not. Christian, back to you.

CL          Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask questions you need to raise your hand using the raise your hand icon and do not forget to unmute yourself when it's time. We'll see if we have the first online and I think I saw Priti Padnaik before from Geneva Health Files. Priti, please go ahead.

PR          Hi. Can you hear me?

CL          Yes. Go ahead.

PR          Thank you for taking my question. I have two related questions. One is, what's the latest on reaching vaccination targets, inoculating 40% of populations across countries? And do you already see indications of vaccine hoarding as a result of omicron?

We also see news today that some companies believe that the booster doses actually could potentially be effective against omicron. Are you already seeing instances of vaccine hoarding or do you expect this will get worse and affect donation programmes? Thanks so much.

00:10:17

CL          Thank you, Priti. We'll start with Dr Kate O'Brien, Director of Immunisation, Vaccines and Biologicals.

KOB       Thank you for those questions and our concern about the situation with omicron as well as really the fact that we're in a delta pandemic right now even as we're working and watching very carefully what's going on with the omicron variant.

You asked specifically about the 40% target by the end of the year and there are over 50 countries that are unlikely to meet the target of 40% coverage. This really is primarily about supply and it's not about supply in the past month or six weeks.

Obviously reaching targets like 40% requires a programme that rolls out over a period of weeks, months, over a significant duration of time so what we're seeing is the cumulative effects of the supply constraints that have been going on over many months in this past year, notwithstanding that at this point we are seeing significant increases in the supply through COVAX to countries that are reliant on COVAX for their doses and countries are ramping up their deployment of those doses very quickly.

00:11:34

On the issue of the information that was provided by Pfizer about the initial laboratory tests that they have results from on either two doses or three doses, we're aware of those results. We're very interested of course in the findings that they have. These are preliminary results and we will look forward very much to not only these but others, again some early reports out of South Africa also on the performance of the Pfizer MRNA vaccine.

So these are results that, if they prove to be replicable, will provide us with some information about existing vaccines and I think one of the most important things is that we are still very much in a delta pandemic and so assuring that we're getting to vaccinate all people, especially those at highest risk of disease, with our existing vaccines continues to be the top priority.

What they've also noted is that there is a sight-line perhaps from these early data that the difference in the performance of the vaccines may be much more sustained on the severe end of the disease spectrum and again this is speculation because we're really in early days still. Thank you.

00:13:07

CL          Thank you very much, Kate. Next question goes to Helen Branswell from Stat News. Helen, please unmute yourself.

HE          Thanks very much. I'd like to follow up on the issue of omicron's potential effect on vaccines. Given that there are little bits of data coming out already that the new variant seems to be able to escape the neutralising antibodies that have been generated by two doses of the Pfizer vaccine, is WHO rethinking its opposition to booster shots? Thank you.

CL          Thank you very much, Helen. We'll start with Soumya Swaminathan, the Chief Scientist.

SS          Yes, thank you, Helen. I can start and Dr Annamaria Henao is online and she can update us also on what the R&D blueprint expert groups are doing. As you know, there are some very preliminary reports, I think from three different groups, one from South Africa and two others, that have measured neutralising activity mainly against the Pfizer BioNTech vaccine from people who've been vaccinated but also people who've been infected in the past.

00:14:26

As was expected from the combination of mutations that had been seen on the sequences there is a reduction in the neutralising activity but I think first of all there's a wide variation in this reduction from four or fivefold to up to 40-fold across these different experiments.

Secondly the numbers are still very small. Some of these assays used live virus, some used a pseudovirus and so there's still a lot of work to be done. Then of course it's only looking at one element, just the neutralising antibodies and we really haven't got information on the effectiveness.

So I think it's premature to conclude that this reduction in neutralising activity would result in a significant reduction in vaccine effectiveness. We do not know that because, as you know, the immune system is much more complex. There are the T-cells, there are the memory B-cells and so what we really need now is a co-ordinated research effort and not jumping to conclusions study-by-study.

I think Dr Ryan said last time that we are going to see a couple of weeks of every day new information, new studies. One study is not going to really prove anything so it's important in fact now for this global co-ordinated research effort, which is exactly what the R&D blueprint is doing.

00:15:54

Perhaps Annamaria might want to add. We just had the consultation on December 6th as well which laid out some of the knowledge gaps and research priorities and encouraged researchers to really study these in depth. As you know, this takes a little bit of time so we'll have to be a bit patient.

CL          Thank you. We go to Annamaria Restrepo.

ARH       Thank you, Dr Soumya. Indeed, within our consultations with the experts we have been focused on three things, the transmissibility of the omicron variant, the potential virulence of this variant and the ability of this variant to evade immune responses induced by vaccines or by prior infection.

The three draft manuscripts that has been posted with neutralising data from the omicron variant are very interesting. They all describe early data and they are, as was mentioned, not yet peer-reviewed.

00:16:50

They all mentioned significant reductions in neutralisation against omicron but with a broad range and I want to emphasise and take this point to say that reduction in neutralisation of 40% doesn't mean 40% reduction in vaccine efficacy.

These studies include a small number of samples and need to be followed up. There is variability in the results. The studies also include only a few vaccinated and unvaccinated individuals, some with boosters, some without them.

Additional information from other studies - at least six we have counted - will be anticipated in the following days. We recognise, as Dr Soumya says, that neutralising antibodies are an important piece of information, they play an important role in control of the infection but they are only one part of the protection against severe disease.

Once the cells are infected protection against severe disease also comes from cell-mediated immunity. Soumya mentioned this and I just want to emphasise that this data together with clinical data is still critical so that we fully understand how a vaccine will protect against disease caused by omicron.

00:18:02

Early clinical data, as Dr Tedros mentioned, suggests that disease may not be severe but it is too early and more data is definitely needed. So overall our experts consider that this emerging data is important information but before we conclude what the omicron variant can do and cannot do against evading vaccine immunity we need more data. Thank you.

CL          Thank you very much, Annamaria Restrepo. We now go to the next and that's Laurent Siero from Swiss News. Laurent, please unmute yourself.

LA          Thank you, Christian. Thank you for taking my question. I'd like to come back to what DG Tedros said in the preliminary remarks on the rate of omicron cases. I understand that it's difficult for now to assess but in the epidemiological update you released yesterday evening there is that huge increase of 79% of cases in Africa for last week.

So if we only target last week do we have an idea on the ratio of what might be attributed to delta and what might be attributed to omicron? Thank you.

MK         Perhaps I'll start with that. It's a great question. As the DG pointed out, there's a lot that we're still learning about this, particularly on transmission and severity and impact of countermeasures.

00:19:34

We are definitely seeing increasing transmission in South Africa and we're seeing a number of increasing reports around the world of the omicron variant. There are some challenges in our understanding of how much this is circulating because we do need sequencing to determine if it's the omicron variant or we had this S-gene drop-out with one of the PCR assays that gives us a clue of if it may be omicron circulating.

One of the things that we're really looking at right now is how omicron will circulate in different populations. In South Africa for example they had just finished a wave of infection with delta and so transmission with delta was at a very low level. They worked incredibly hard to bring that transmission under control and should be congratulated for that.

With the emergence of omicron in a population where delta was low-circulating, where it was not circulating very much omicron rely took off and it really is increasing in transmission around the country.

00:20:32

What we have to look at is how omicron will unfold in other countries other populations that have delta circulating at a high level and what will actually happen as omicron, if you will, competes with delta and whether or not we will see the same increased growth rate, the same increasing number of cases over time in different populations.

We expect to have good estimates of the time-varying reproduction number as it compares with other variants in the coming days. There are some early estimates of this but the confidence intervals are very wide.

I think one of the things we need to stress right now - and the Director-General said this in his speech - how countries react right now, in the next days to weeks - I'm not talking about reacting in January or February but the way countries react now will determine how omicron unfolds no matter what we find out in terms of its transmission, its severity, its impact on our countermeasures.

So we can't stress enough how important it is to act fast, to act robustly and I don't mean lock-down. We mean using proven public health tools to drive transmission down in areas where transmission is high and to keep transmission low in areas where transmission is low because it still is quite a diverse situation around the world and delta is dominant still globally.

00:21:58

So the situation will unfold in the coming days and weeks and I think we all have to recognise, as was highlighted in the last question, it will take some time for us to get some answers but as the experts work and release this information to us we will update you as regularly as we can to give you information and update on what needs to be done.

But we cannot emphasise more that we're telling countries not to wait but to act and to accelerate vaccination because the vaccines work against delta and even if there is reduced efficacy against omicron it's still better to be vaccinated than not.

So those of you who are out there and who may be hearing all of this information, it may sound scary, it may be confusing but as the experts are working this out what's important is what you do and you keep yourself safe and you take measures to reduce your exposure to the virus no matter what variant is circulating where you are and you get vaccinated when it's your turn and we work very hard to increase vaccination coverage in those who are most at risk in all countries.

00:23:06

CL          Thank you very much, Dr Van Kerkhove. With this we'll move to the next question and it goes to Kai Kupferschmidt from Science. Kai, please unmute yourself.

KA          Thanks a lot for taking the question. Let me ask a short or small question and a big one. The small one is is if we can have any data on secondary attack rates at this point in terms of the transmissibility of omicron. I'd be curious what we're learning on that front.

Then the big question, I know we're in the middle of this and we all want to look forward and we're realising more and more we don't have the luxury of waiting until this is over to learn some lessons.

So I would really appreciate if you could take a quick look back and say, why are we in the situation again, what went wrong, why didn't governments for instance once again act earlier in this wave?

CL          Indeed a long and a short question. Let's start with maybe the easier one first from Dr Van Kerkhove.

00:24:04

MK         Neither one of those are easy questions, Kai. They're not quite short questions either and I think you know that but they're good ones nonetheless. We do expect to have some secondary attack rates coming from countries, I think, on Friday. The studies are unfolding right now in countries in South Africa but also in the UK and elsewhere and I believe some of that information will be released on Friday.

What those household secondary attack rates will look at are they'll compare the secondary attack rates for individuals who are infected by omicron and how many people in that household are infected from one infected individual compared to delta.

But you also have to recognise - and I'm sure you know this - that some of the early data may be a little bit messy in the sense that we won't be able to control for all of the factors and those early estimates of a secondary attack rate may change.

I can remind you that the first issuing of the secondary attack rates for delta were actually reduced over time as more data came online. So we expect to have some of that on Friday.

00:25:09

With regard to lessons, we could spend the whole of the rest of the conference talking about this, which of course we won't but I think this is one of the scenarios that is completely predictable. The virus has been evolving since the beginning and we have been working with partners, with experts around the world to study how the virus is changing, how the virus is mutating and looking at some of these mutations and if they will confer a better fitness and that the virus will become more transmissible.

But also the possibility of if the virus could develop properties of immune escape where we may have reduced efficacy of some of our countermeasures. Unfortunately this is entirely predictable because the comprehensive nature in which we need to respond...

Number one, we have to look at increasing vaccination coverage in people who are at risk so that we reduce hospitalisations, we reduce morbidity and mortality and deaths. But secondly we also have to reduce transmission. We cannot only focus on vaccination coverage.

00:26:16

You hear us say a lot, vaccines and, not vaccines only. There's a comprehensive nature in which we tackle this problem.

Secondly this is a global problem and global problems need global solutions. We can't only fight this virus in some countries while others are fighting with their hands tied behind their back and this is why all countries and why the Director-General and our partners are fighting so hard to have vaccine equity but also equity and access to life-saving tools like diagnostics, therapeutics, that PPE is available to our front-line workers and that we utilise all of the tools that we have.

So this pandemic will last as long as we allow it because we're not using the tools most effectively but it's never too late to turn it around so I think we have to also think that as well, that there is hope to turn this around and again as much as we can act and as strong as we can act against delta it will benefit omicron and any future variants that emerge.

CL          Dr Ryan, please.

MR         Good afternoon, Kai. Yes, I think the raw numbers or estimates of R0 or reproductive numbers, the secondary transmission data is all pointing to a virus that's efficiently transmitting and probably more efficiently transmitting than even the delta variant.

00:27:45

But that does not mean that the virus is unstoppable. It means the virus is more efficient at transmitting between human beings and therefore we have to redouble our efforts to break those chains of transmission, to protect ourselves, to protect others.

It doesn't mean the virus has become invincible. It's just become better fit, better adapted to exploiting the contacts and the connections between us and therefore we have to double down on those efforts and use the methods at our disposal that we already have, that will allow us to do that.

It means we have to get fitter and faster as the virus has got fitter and faster. The DG has spoken to that in his opening remarks.

As well as that more transmissible does not mean more virulent or more lethal. Yes, if we allow the virus to transmit unchecked it will generate more. We saw that with delta before and with other variants. If they're allowed to spread unchecked even though they're not individually more virulent or lethal they just generate more cases, they put pressure on the health system and more people die. That's what we can avoid.

00:28:58

We cannot do anything about maybe the inherent qualities of a virus but we can prevent our systems coming under pressure, we can maximise the chance that anyone with severe illness has for survival by ensuring we protect the health system, we protect the most vulnerable, we protect those most likely to suffer severe illness and death and that's what we're saying.

Protect yourself, protect each other, get vaccinated. The single big message, if you are offered a vaccine please get that vaccine. It doesn't matter what variant you're doing it for and if we can, gibe more vaccines to countries that need them because they have vulnerable populations that are unprotected.

We've been saying this, Kai, going back months now. Long before we had omicron we were concerned about the delta wave and what it was doing and what we weren't doing to stop that.

00:29:52

Omicron represents another level, it's another dimension, it's another scale of response that we may need and we weren't doing particularly well in the face of delta. So I think the DG's remarks today, everyone should read them again because I think he's put it very, very clearly as to what we need to do to get through this next wave of disease.

CL          Dr Kate O'Brien, please.

KOB       I'd just like to add a couple of things to what Mike and Maria have both said. When you ask what went wrong, if we're seeing variants that are more transmissible... Really what we initially started hearing people take about at the outset of vaccination was there was going to be some reliance on herd immunity or herd effects.

As a pathogen becomes more transmissible it's really about individuals becoming vaccinated to have protection against the disease. So what went wrong here, as they both said, we can point to many things but one of the most important things at this point is we should be focusing very much on the message that we continue to give, which is everybody getting vaccinated as soon as they're offered vaccine.

00:31:15

We have such great vaccines available and even with omicron I don't think anybody expects that the vaccine, even in a worst-case scenario, would have no effect on the variant. So I think it's really important for everybody to understand that as we're talking about omicron and the vaccines we're talking about what adjustments there are, what changes there might be but we're not talking about vaccines that would become ineffective entirely.

So I think this is a really critical point and as a virus becomes more transmissible it makes it ever more important that every individual who is offered vaccine actually gets the vaccine. We can't be relying on the concept, the idea that somehow other people being vaccinated is going to protect others in the community who are choosing not to become vaccinated. Thanks.

CL          Thank you. Next question goes to Christiana Ulrich from DPA. Christiana, please unmute yourself.

CR          Thank you, Christian, for taking my question. This goes back to studies coming out of South Africa that point to maybe a milder version of disease for the omicron variant. Scientists tell us that this must be taken with a measure of caution because the population in South Africa is a lot younger than the population in my own country, Germany, and has very high baseline immunity from previous infections.

00:32:56

So this might not translate into a similar mild disease case in northern European countries. Would this not be the time for you to adjust your advice against boosters? Would this not be the right time to tell countries with older populations that it might be a good idea to administer booster shots at this point? Thank you.

CL          Thank you very much, Christiana. The first part we touched upon but worth reiterating. Dr O'Brien.

KOB       What's really important about vaccine schedules and optimising vaccine schedules is to follow the data and SAGE has just met yesterday to do an intensive review of data on booster doses and we will be following through on their conclusions out of that review and the data continue to roll in.

What I think is really important is that no matter which way you look at it primary doses always outperform booster doses for people who are at risk. The primary attention here has to be on assuring that everybody who has not yet had a primary series of vaccination has access to that vaccine and gets vaccinated.

00:34:20

We're in a two-track pandemic largely with those who are getting disease being those who are unvaccinated for any dose. So that has to be the absolute, primary attention that the world is focused on including countries that have high access to vaccines to assure that that supply is getting to those places in the world that have still not had adequate supply over these many months.

Of course that supply is ramping up now but that has to be our firm attention. The evidence on booster doses shows that for the severe end of the disease spectrum the performance of the vaccines is holding up very well with some minor reductions in the performance of the vaccines and on the more mild end of the disease spectrum some further reductions in the performance.

But given that the focus here is firmly on the protection against hospitalisation, severe disease and death these primary doses to those who have not yet been vaccinated really have to be the priority.

00:35:29

We'll continue watching the evidence very closely and providing recommendations that optimise how vaccines can best be deployed to address the pandemic, to close it down. Thanks.

CL          Dr Swaminathan, please.

SS          Just to add because Kate mentioned the data that we follow very closely, the data from country after country after country is showing that the people who are in the ICUs, the people who are severely ill and the people who are dying are the unvaccinated.

So I think the message is loud and clear that it's a primary course of vaccination that is going to protect against severe disease and death. That has to be our goal, that has to be the first goal and we were hoping to have achieved that by vaccinating the priority populations across the world, in every country in the world by the end of 2021 so that we could have reduced the deaths.

Because if deaths are going to be in those vulnerable groups that are at high risk of getting ill from COVID - and unfortunately even in countries that have adequate or more than adequate supplies there is still a substantial proportion of people who have not been vaccinated, 30, 40, 50%, complete course of vaccination.

00:36:53

So the boosters unfortunately are probably not the solution to this. While we're going to look at the evidence at some point, additional dose, boosters so we're not ruling that out but what we're saying is that at this point the benefits we will get from reaching those people who have not received primary courses of vaccination are going to be higher than giving additional doses to those who have already completed a primary course.

Of course there are vulnerable groups and we've also put out recommendations on where additional doses may need to be given, the immunocompromised and groups like that. But wholesale boosting is not the solution right now, it's reaching everyone and then doing all the other things, as we've been emphasising, in addition to the vaccination.

CL          Dr Van Kerkhove.

MK         I wholeheartedly agree with what Kate and Soumya said and I won't repeat it to save time but I wanted to discuss the severity part of your question. We have some information on severity but we don't have the full picture yet. It will take some time for us to understand the true severity of omicron as it compares to other variants that are circulating.

00:38:05

We certainly have information from South Africa that many of the patients that are identified with omicron have a more mild course of disease but it does take time for people to go through the full course of their infection, the full course of their disease.

We do know that the variant, if it can reach vulnerable populations. If you have underlying conditions or are of older age and are not vaccinated you could develop severe disease or there's a much higher risk of developing severe disease so it's too early to tell.

So I only wanted to caution against any conclusions about severity of omicron yet because now we really have anecdotal information, we don't really have studies yet. There's some very good work that's happening in South Africa with patients and hospitalised patients.

They're using a standardised collection form which they've been using throughout this whole pandemic and we're working with them to look at a time series of the patients now compared with the patients previous in the pandemic to look at what differences we may see.

00:39:08

Certainly we have indications of more mild disease but it's too early to conclude on that so I think it's really important and again if we have more transmission, if we have more cases we will have more hospitalisations and if we have more hospitalisations in overburdened healthcare systems the chances of increasing death are much higher.

So we are working with experts around the world to understand, are there intrinsic properties of the variants that cause a change in the severity profile or are there other factors that may lead to more severe disease and death, meaning that people can't get the proper care that they need because the health system is overwhelmed.

So it's a little early but again we will update you as we get more information.

CL          Thank you, all. We have Dr...

00:39:53

MR         Sorry, there're a lot of us speaking on this but I think Maria's point is exceptionally, exceptionally important in terms of the overburdening of the health system and that severity profile. If we allow a mild disease to transmit unchecked it will generate huge pressure in the health system which will decrease the positive outcomes for people and that's what we've seen with many before.

It's also something, I think, we need to caution everyone on. There is an assumption out there that as a disease becomes more transmissible it will become milder. I would hope that most viruses would become less transmissible and milder, that would be the ideal outcome.

But I think there's a little bit of an urban legend around that process. That doesn't necessarily happen. There is pressure on the virus to adapt and become more transmissible because that's an evolutionary pressure.

The outcome of whether a virus is more or less severe is much more random. It can happen, it can not happen and in that sense that's why we don't know and I think we have to be very, very careful in making any absolute determinations.

00:41:04

Remember in this that much of the severe outcomes, much of the hospitalisation, much of the death is not mediated by the virus, it's mediated by our own immune systems and our response to the presence of the virus.

So in a sense some of the most negative outcomes here are more to do with underlying conditions - diabetes, hypertension - and other factors that make the course of the illness more severe for a certain group of individuals.

Therefore they're locked into the system in a sense so therefore I don't expect in general viruses to become milder. It can happen randomly but it's not a direction that as a disease becomes more transmissible it becomes milder. I think we should have hope and everyone should have hope and we should hope for the best outcome but in this particular case hope is not a strategy and we need to be very, very careful on making any final determinations on severity.

CL          Thank you all very much for very important points and we move to Denise Rowland from the Wall Street Journal. Denise, please unmute yourself.

00:42:11

DE          Hi. Thank you for taking my question. It's about vaccine equity. It's clear that a lot needs to be done to improve the situation. I wondered in particular what the vaccine manufacturers could be doing to help this. Are there things that they could be doing already that they're not doing yet to improve vaccine equity? Thank you.

CL          Thank you very much.

SS          Again I can start. I think that's a great question and this is something we've be talking about also for some time. Just to put some faces on the previous figures, we were talking about people still not being vaccinated around the world. Only one in four healthcare workers in Africa has been fully vaccinated and there are large numbers of older individuals and people with underlying illnesses have not.

So we need to remember that there are lots of people out there taking care of others who haven't received shots yet. So what can manufacturers do? The first thing they can do is to work with COVAX in providing some transparency and visibility in our supplies because one of the challenges has been for countries to not know how many vaccines they'll receive and when so that they can plan their vaccination campaigns.

00:43:29

Then everyone ends up blaming those countries for not absorbing those vaccines and using them fast enough.

The second is that they arrive with sometimes short expiry dates, one month, six weeks. Again it's very unrealistic to expect a country will be able to move a large volume of vaccines with short expiry dates.

Thirdly some of the companies have taken a long time to have the indemnification and liability negotiations with the countries despite COVAX really making all attempts to standardise a language and to facilitate this process.

Then of course they should be prioritising COVAX. COVAX is a global mechanism for supplying vaccines to all countries, both the AMC countries that get the donor-funded doses but also the self-paying, self-purchasing countries and we have not seen that happen.

We've seen manufacturers delayed their shipments to COVAX while we know that they're supplying other buyers, countries.

00:44:37

Then finally of course we would very much like manufacturers to enter into technology transfer arrangements, either bilateral voluntary technology transfer or work with the WHO, multilateral technology transfer hubs. Let's expand manufacturing capacity, let's build and strengthen that capacity in parts of the world that currently do not have it.

These are some of the things they can do and I don't know if anyone else wants to add to that.

CL          We also have Dr Simao online, who wants to come in, Assistant Director-General, Access to Medicines and Health Products. Dr Simao.

MS         Thank you, Christian. Just complementing what Dr Soumya was saying right own, it's not only the sharing. I think it's super-important right now because the situation we are seeing is not an equitable situation and we need to change it for 2022.

It's not only the sharing of technology and know-how but also the sharing of intellectual property and we do have mechanisms to do that on a voluntary basis, to have public health-oriented licences to the medicines patent pool, using the COVID Technology Access Pool which is the CTAP, which is a WHO initiative [unclear].

00:45:58

So we have a mechanism in place that can help the manufacturers to find the legal arrangements that are necessary to do that voluntary licence through the medicine patent pool and also to arrange the technology transfer so that we can speed up the process of local production in different regions of the world. Thank you.

CL          Thank you very much, Dr Simao. Dr Mike Ryan, please.

MR         There was a very specific question, what manufacturers, industry do now when we're in the face of omicron. This is, I think, a very important moment. For 70 years we've worked with industry and manufactures introducing a really careful, twice-a-year process with manufacturers to identify new vaccines twice a year for the northern and southern hemisphere.

We develop new vaccines, candidate vaccines against particular avian flu strains that emerge over time. This is a partnership that works extremely well when the public service, governments and multilateral institutions work with industry, where the public, the citizens of the world get to decide what's made on their behalf and what's manufactured on their behalf.

00:47:14

This has been a hugely important collaboration over many years where industry are our partners, not our masters and we need to reproduce that now. We need the discipline and he science to bring the data together, to engage with industry and we're doing that through the R&D blueprint for epidemics, we're doing that through the meetings we held today with the technical advisory group on COVID vaccines.

We want to see that partnership work but we want to see good decisions made based on good data, based on good science. We want that to happen quickly, we want that to happen fast but we need publicly-driven decision-making regarding any shifts or changes to vaccine development or production and we want, as I said, our partners in industry to move with us on that journey.

SARS-CoV-2 and COVID-19 is going to be around for a good while longer and other variants may emerge. We need a systematic process of working with industry so we don't have chaos, a circus of everyone doing what they think they should do and nothing being co-ordinated. This would be the worst possible outcome for the world so this is a real test.

00:48:31

Can we behave coherently, can the public and the private sector act together in unison in the service of the citizens that we all say we are here to serve?

CL          I'm looking around. Do we have more comments? Dr Kate O'Brien, please.

KOB       I just want to add, you asked a question about the vaccines and the manufacturers of the vaccines and I think we also need to make a specific point about the syringes to actually deliver vaccines. There is a syringe shortage and this is an absolutely critical part. A vaccine doesn't save anybody's life, only vaccination does and we can't deliver the vaccines into people's arms unless there are the syringes that are the right kind of syringes, syringes that are safe, syringes that are appropriate for a vaccine and syringes that can actually be deployed in countries when they're needed, when they're needed in the volume that they're needed.

00:49:23

So this is another critical component of actually manufacturers being able to contribute in an extremely important way to assure that the vaccines that are being produced are delivered to people, into their arms and actually save lives.

We have to have an intensive focus on this, which are we doing along with UNICEF to work directly with the manufacturers to syringes to assure that they are available in the time and the place and the numbers to make sure that the programme functions as it should. Thanks.

CL          Thank you very much. Annamaria, please go ahead.

AHR       Thank you very much. I just wanted to add to what has been said and additional perspective from the research point of view. The first one is that there are numerous vaccines still in the pipeline that need to be tested so to the developers of these vaccines we tell them, we need more vaccines, perhaps vaccines with attributes which make them better for deployment in low and middle-income countries, maybe not injections, maybe fewer doses, etc.

But in addition to emphasise what Dr Ryan says about if we need a modified, environment-specific vaccine we want the developers to work with us in a collaborative approach through our systems and our expert committees like the COVACTAG [?].

00:50:51

We also have worked and the colleagues in the regulatory team have worked with regulators all around the world to describe pathways that perhaps will accelerate while maintaining robust standards, the evaluation of variant-specific vaccines so we want to continue those dialogues.

Finally if we are going to test vaccines we should focus not on booster dose vaccines, variant-specific vaccines, just on booster doses but as many people on the planet as still remain without receiving one dose, we also have to test variant-specific vaccines among people who have received no doses. Thank you.

CL          Thank you very much, all, now. We'll go to a new visitor in our press conference and that's Kenneth Kendolf Hauk from the Norwegian broadcaster. Kenneth, please unmute yourself.

KE          Thank you. Can you hear me?

CL          Yes. Please.

00:51:48

KE          Okay. My question pertains to Norway, which currently has a rather significant omicron outbreak. How does the World Health Organization regard the outbreak of omicron in Norway and what is the World Health Organization's view on meeting outbreaks like this with strict regulations or lock-downs?

CL          Thank you very much, Kenneth. I'm sure we have individual expertise here on the country.

MK         I could start. I'm not going to comment specifically on Norway because I don't know the exact situation there. I can look up the data but what we can say to countries who are dealing with different types of outbreaks and intensity of activity is that this comprehensive approach of tacking both increasing vaccination coverage, particularly those who are most at risk, we are advising countries to look at which proportion of your population is actually covered and in particular if you have high coverage how much of your at-risk group are being missed and why and target your vaccination to those who are most at risk, that's the first thing.

Second thing is to work to drive transmission down and when we say that we don't mean lock-down. Many countries have had to use lock-down throughout this pandemic because they've been overwhelmed.

00:53:11

What we need to happen is that we need to see this layered approach of using these public health and social measures, which is a huge number of different individual-level measures, community-level measures but first and foremost wearing of masks, well-fitting masks over your nose and mouth with clean hands, reducing the number to contacts that people have, avoiding crowds, spending more time outdoors than indoors.

I know that's more difficult as we enter the winter months. There are many holidays that are coming up where people are increasing their number of contacts. This needs to be done as carefully and as safely as possible. Again we cannot stress enough, particularly as we enter into the holidays, that people need to be extra-careful.

Given the uncertainty of this new variant, given the certainty of delta in many parts of the world we need to take measures to reduce our exposure.

00:54:07

We also need governments to look at their plan, look at what they're doing, look at the data that's coming out from all of the systems that they've worked very hard to put into place, make sure that those are strengthened, check in with your workforce because we know many people in the workforce are leaving in droves because they are absolutely exhausted after two years of dealing with COVID and going into a third year.

And making sure that the public health systems in place are really strengthened, taking measures to improve ventilation in the places where we work, where we live, where we study. It's a combination of factors so it's a constant reassessment on the situation in the country, the capacities to be able to respond and to course-correct where it's necessary.

So it's two parts to the equation, increasing vaccination coverage in those most at risk and then making sure you take measures to drive transmission down as much as possible.

CL          Dr Ryan.

MR         Yes, I think the incidence of cases in Norway has increased about 22% in the last week but Norway's done a really good job in decoupling incidence from deaths and hospital admissions and I think the high vaccination coverage, the strength of the health system in Norway - the pay-off is that there's been a huge impact there.

00:55:31

Overall the attack rate in the population is, I think, about 420 per 100,000 per week, which is equivalent to many other western European countries like the UK and France so like many countries in Europe, incidence is poised at a high level. It has been increasing over the last number of weeks.

I think all countries are on that trajectory, that they've been increasing their incidence of delta. I know that we've had a verified report, a notification of the presence of the omicron variant but it's not determined yet whether there is local transmission in Norway.

So I would say Norway is very much in a typical position of a western or northern European country right now, high transmission or intense transmission of the delta variant in the context of a well-vaccinated population, low numbers of deaths but obviously the issues that will arise potentially with omicron will put potential pressure on the system in the coming weeks. It remains to be seen.

00:56:35

CL          Thank you both very much. Now we've come up to the hour and I thank you all for your participation. Just for those who haven't made it yet into the queue or to ask their questions, I just remind you we had 11 more questions pending so huge interest and I guess we could have continued for another hour here.

Thank you again. We will be sending the audio files and Dr Tedros' remarks right after the press conference and the full transcript will again be posted tomorrow on WHO's website. I thank you all very much and hand over to Dr Tedros for the closing.

TAG        Thank you. Thank you, Christian, and thank you to all colleagues from the media who have joined today and see you next time.

00:57:21

Speaker key

CL Christian Lindmeier TAG Dr Tedros Adhanom Ghebreyesus PR Priti KOB Dr Kate O'Brien HE Helen SS Dr Soumya Swaminathan AHR Dr Annamaria Henao Restrepo LA Laurent MK Dr Maria Van Kerkhove KA Kai MR Dr Mike Ryan CR Christiana DE Denise MS Dr Mariangela Simao KE Kenneth

Audio
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