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

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MH         Hello, everybody. This is Margaret Harris in Geneva welcoming you today, Wednesday September 8th, to this week's WHO global press briefing on COVID and other health matters. We have with us today in the room the World Health Organization Director-General, Dr Tedros Adhanom Ghebreyesus and, as always, our WHO experts, Dr Mike Ryan, Executive Director, World Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead for COVID-19 and Dr Bruce Aylward, who is the Lead for the ACT Accelerator.

Joining us online we have Dr Soumya Swaminathan, our Chief Scientist, Dr Kate O'Brien, Director of our Immunisation, Vaccines and Biologicals department, and Dr Mariangela Simao, our Assistant Director-General for Access to Medicines and Health Products.

As usual our extraordinary interpreters will be providing simultaneous interoperation in the six official UN languages plus Hindi and Portuguese and I thank you all in advance for your extraordinary achievements.

Now without further ado I will hand you over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor.

TAG       Thank you. Thank you, Margaret. Good morning, good afternoon and good evening. Today the Democratic Republic of the Congo declared an outbreak of meningitis in the north-eastern Tshopo province with 261 suspected cases and 129 deaths reported.

Health authorities have deployed an initial emergency team and WHO is supporting the response. More than 100 patients are already receiving treatment at home and in health centres. WHO has provided medical supplies and plans to deploy more experts and resources.

Meningitis is a deadly and debilitating disease with serious health, economic and social consequences. Later this month WHO and our partners will launch the defeating meningitis roadmap, the first global initiative to address this devastating disease.

The roadmap has three key objectives; ending epidemics of bacterial meningitis like the one in DRC, reducing bacterial meningitis cases by 50% and deaths by 70% and supporting survivors to address disability and improve quality of life.

This outbreak in DRC is another reminder that although the COVID-19 pandemic continues to dominate headlines it's far from the only health threat to which WHO is responding around the world. So many of the situations are long-term challenges that don't seem to have obvious or immediate solutions.

But the COVID-19 pandemic does. People are dying who should not be. More than 50,000 people have died with COVID-19 every week since October last year and for the past month deaths have remained at almost 70,000 a week.

We have the solutions to stop transmission and save lives but those solutions are either not being used well or not being shared well. The inequitable distribution of life-saving tools including diagnostics, oxygen, PPE and vaccines is driving a two-track pandemic.

Some countries with the highest vaccine coverage are now seeing a decoupling of cases and deaths, which is allowing them to reopen their societies without their health systems being overwhelmed.

While cases in some of these countries are increasing among unvaccinated people hospitalisations and deaths have remained relatively low thanks to vaccines and earlier clinical care.

However premature relaxing of public health and social measures is putting unvaccinated and immunocompromised people at extreme risk. Meanwhile countries with low vaccine coverage continue to see high case fatality rates.

Additionally some countries are refusing entry to people who have been fully vaccinated with a vaccine that has WHO emergency use listing but which has not been approved by their own national regulators. This is creating more chaos, confusion and discrimination with some countries even refusing to use certain vaccines because of concern their citizens will be denied entry to other countries.

WHO emergency use listing follows a rigorous process based on internationally recognised standards. All vaccines that have received WHO emergency use listing are safe and effective in preventing severe disease and death, including against the delta variant.

We thank those countries that recognise all vaccines with WHO emergency use listing and we call on all countries to do the same. Globally 5.5 billion vaccine doses have now been administered but 80% have been administered in high and upper-middle-income countries.

WHO's global targets remain to support every country to vaccinate at least 10% of its population by the end of this month, at least 40% by the end of this year and 70% of the world's population by the middle of next year.

Almost 90% of high-income countries have now reached the 10% target and more than 70% have reached the 40% target. Not a single low-income country has reached either target. That's not their fault. We have heard excuses from manufacturers and some high-income countries about how low-income countries can't absorb vaccines.

Almost every low-income country is already rolling out the vaccines they have and they have extensive experience in large-scale vaccination campaigns for polio, measles, meningitis, yellow fever and more.

But because manufacturers have prioritised or been legally obliged to fulfil bilateral deals with rich countries willing to pay top dollar low-income countries have been deprived of the tools to protect their people.

There has been a lot of talk about vaccine equity but too little action. High-income countries have promised to donate more than a billion doses but less than 15% of those doses have materialised. Manufacturers have promised to prioritise COVAX and low-income countries.

We don't want any more promises. We just want the vaccines. A month ago I called for a global moratorium on booster doses at least until the end of September to prioritise vaccinating the most at risk people around the world, who are yet to receive their first dose.

There has been little change in the global situation since then so today I'm calling for an extension of the moratorium until at least the end of the year to enable every country to vaccinate at least 40% of its population.

Third doses may be necessary for the most at risk populations where there is evidence of waning immunity against severe disease and death such as the very small group of immunocompromised people who did not respond sufficiently to their initial dose or are no longer producing antibodies.

But for now we do not want to see widespread use of boosters for healthy people who're fully vaccinated. Yesterday the International Federation of Pharmaceutical Manufacturers association said that G7 countries now have enough vaccines for all their adults and teenagers and to offer booster doses to at risk groups and that manufacturing scale-up should now shift to delivering global vaccine equity, including dose sharing.

When I read this I was appalled. In reality manufacturers and high-income countries have long had the capacity to not only vaccinate their own priority groups but to simultaneously support the vaccination of those same groups in all countries.

We have been calling for vaccine equity from the beginning, not after the richest countries have been taken care of. Low and lower-middle-income countries are not the second or third priority; their health workers, older people and other at risk groups have the same right to be protected.

I will not stay silent when the companies and countries that control the global supply of vaccines think the world's poor should be satisfied with leftovers.

Earlier this week I had the opportunity to attend the G20 Health Ministers' meeting in Rome. I said that as the world's largest producers, consumers and donors of vaccines the world's G20 leading economies hold the key to vaccine equity and ending the pandemic.

I called on them to support the achievement of WHO's global vaccination targets by doing three things; first by swapping near-term vaccine deliveries with COVAX; second, by fulfilling their dose-sharing pledges by the end of this month at the latest; and third, by facilitating the sharing of technology, know-how and intellectual property to support regional vaccine manufacturing.

We have the tools. It's clear what needs to happen. Now is the time for true leadership, not empty promises. Margaret, back to you.

MH        Thank you, Dr Tedros. I'll now open the floor to questions from journalists and we have a long list today. You've all got your hands up already so I can see you're very interested in what Dr Tedros has been saying so please keep the questions short, keep to one question so we can get through as many as possible.

First up we have Sophie Mokoena from South African Broadcasting Corporation. Sophie, please unmute yourself and ask your question.

SO         Thank you so much. I just want to ask the Director-General; you spoke about the challenges we are facing in terms of the impact of COVID-19 in other areas where we are supposed to look at ensuring that the citizens of the world are able to access healthcare.

There's a concern around the issue of HIV and AIDS that is now taking a back seat and we see numbers rising, particularly in the sub-Sahara, and teenage pregnancy. What is the WHO's position on these issues and how can we deal with this issue? Because having young kids, young girls not being able to go to school will later be a problem for the world in terms of skills, development and building a better economy.

MH         Thank you, Sophie. I'm just looking around; that's quite a broad question so Dr Maria Van Kerkhove will start the answers.

MK         Thanks, Sophie, for the question. It's nice to hear your voice again. You did ask quite a broad question and quite a difficult one and I think there are many different elements to it but talking about the direct impact of the COVID-19 pandemic and all of the indirect effects of this, this obviously impacts us beyond the SARS-CoV-2 virus itself.

It impacts all of our ability to deal with other issues that our countries, our people have to deal with; HIV/AIDS, as you mentioned; teenage pregnancy; being able to go to school.

I think what we have been trying to do is to look at how we can tackle the pandemic, how we can bring transmission under control, drive transmission down to a low level so that we not only provide adequate care for those individuals with COVID-19 but that we can get these other services back online.

We do know that individuals with HIV/AIDS have a higher risk of developing severe disease. We know people with other types of underlying medical conditions have an increased risk of developing severe disease due to infection with the SARS-CoV-2 virus but we also know that people with underlying conditions need care for those conditions.

Other medical service has been severely impacted because of the shut-downs, the lock-downs, inability to treat those other conditions. That is improving over time. There have been some advances with different things like telemedicine but we are slowly starting to see countries bring these other essential services back online.

But we really need to continue to focus on driving this pandemic down and getting control over the SARS-CoV-2 virus with this comprehensive package. It includes vaccines, it includes vaccination but it also includes all of the other elements; individual-level measures, the distancing, the hand hygiene, the mask wearing, improving ventilation; surveillance, good testing.

We need to do that so that we can care for people, not only for COVID but for other factors.

With regard to schools, of course we have been advocating for opening-up of schools safely in areas where you can control transmission. Schools operate in communities so if you can drive transmission down there are many ways schools can be opened safely with provisions in place; making sure that there's a plan to be able to detect cases, that you have a good communication plan with the students, with the teachers, with the staff, with the parents of those students.

Looking at what you can do in the school to lower the risk of transmission including physical distancing, good ventilation, disinfection, the mask-wearing amongst staff and children of appropriate ages.

So there are many ways that countries have shown us that they can open schools, that school systems have shown us that they can open schools and keep those schools open safely. It is incredibly important. I don't have to tell you this but it's incredibly important to have children in school not only for their education but for their mental well-being, safety and security.

We work with UNICEF, we work with UNESCO, we work with many partners in trying to get schools safely open and showing the importance. This pandemic has had a tremendous detrimental effect on our kids.

It's a long-winded answer because it was quite a complicated question but others may want to come in and supplement here. We have to get control over this virus so that we can get on with our lives and make sure that we provide appropriate care not only for COVID-19 but for those who need it for all of the other problems that we face.

MR         I can maybe add; the Director-General, Dr Tedros, has already stated a number of times in the past that we were already falling behind on SDG3, the goal related to health and the COVID pandemic has amplified, accelerated the challenges to being able to reach those collective goals around the world regarding health.

HIV, TB and malaria have been three of the most important and it is to be noted that access to prevention services and testing services of HIV fell significantly and that has a major impact down the line in terms of people contracting HIV or getting into early therapeutic services.

But at the same time the number of people actually accessing antiretroviral therapy increased, which is a testament to the HIV treatment programmes that they've managed to keep going and accelerate their impact.

Equally in tuberculosis we've seen an increase in the number of people presenting or the number of people accessing treatment for multi-resistant tuberculosis has fallen. That's not necessarily because the rates have fallen but again it's an access issue.

Malaria, I think, has been more stable and with the movement and increasingly moving malaria diagnosis and treatment into the community with community health workers and an improvement in primary healthcare we've seen the resilience of primary healthcare-oriented services which have managed to continue within communities while at the same time we've seen huge challenges to tertiary healthcare provision as COVID overwhelmed the whole system.

So we would absolutely agree with you that COVID has had a negative - notwithstanding the presence of underlying conditions that worsen the outcome for individuals who get COVID, prevention services, diagnostic services and treatment services for these hugely important other diseases have come under severe pressure and they are struggling and they need to be protected and rebuilt.

But it's also a testament to the thousands of health workers around the world who have kept those services going despite the challenges. So it's both a silent hope that we can increase our support to communities through community-led, primary healthcare-led services but it also shows just how fragile those services are when we're struck with another emergency and how we have to work on resilience within our health system and the ability of the health system to cope during crisis.

But you are very correct in identifying that as a major threat to our collective healthy future on this planet.

BA           Sophie, thanks also for raising the issue. I just wanted to come at one other issue linked to the other points that the Director-General was making this morning. WHO has done a lot of work to try to understand what the drivers are and the specific issues leading to these declines in testing rates and other impacts that COVID's having on other services which are so crucial.

It's not just HIV and TB but also issues like - I think, Maria, you might have mentioned antenatal screening, routine immunisation services; everything got hit.

There are two issues; on the one side there were demand issues where people were concerned about going to healthcare centres because of COVID. But then there were also concerns on the part of healthcare workers to actually get vaccinated and if we look at the situation we're in today some of the countries with the highest burdens of HIV, the highest burdens of TB, some of the lowest immunisation rates in the world; they also have the lowest access to COVID vaccines.

This just comes back to the theme the Director-General's hammering today, that we have got to get sufficient vaccine into the low-income countries if we are going to get the health systems safe, protect the healthcare workers so that we can get movement.

All of these issues are interrelated and they hinge on equitable access to scarce products and making sure the people who really need them, people who deliver the services you're talking about, actually get them.

You'll remember the Director-General announced the 40% and 10% targets back in May and since May those high-income countries; you heard in the speech, there's been fantastic progress.

The low-income countries when the Director-General made his call had less than 1% coverage. Today they're at 1.4, 1.5, 1,7% coverage and it's just absolutely abhorrent what's happened and this gap is what needs to be tackled, not just for COVID but also for the delivery of other services, to run health services safely and to protect the people that are at the highest risk and who are at the coalface of this, the healthcare workers.

MH          Thank you so much to all our experts for unpacking this really difficult but really critical issue. Our next question goes to Laurent Sierra from Swiss TV. Laurent, please unmute yourself and ask your question.

LA           Can you hear me?

MH          Yes, we can. Please go ahead.

LA           Thanks, Margaret, for taking my question. I'd like to come back to Dr Tedros' preliminary remarks because you mentioned that you attended the G20 meeting last week and then you met also bilaterally a lot of health ministers. So what makes you think that now they're going to be committed to honouring their pledges and to materialising them in the next month? Thank you.

MH         Thank you, Laurent. I'm looking around the room. Dr Tedros will start.

TAG        Yes, thank you so much. As you know, the Ministers' meeting released its declaration at the end of the meeting and there was a clear statement in support of the 40% target that we have set for the end of this year.

During that meeting as a group and also during my meetings bilaterally they have assured me that they will do everything to contribute the vaccines required to achieve the 40% target by the end of this year.

As I said in my statement and several times in previous pressers, the G20 countries have the means to make it happen. They have the resources, they have the production capacity and they should make it happen.

I believe and I hope this time they will deliver on the 40% target because one thing that we should understand is this is in the interest of every country on Earth. I don't think the disparity we have, the inequity will help us to finish this pandemic. It's only through solidarity and equitable distribution that we can end this pandemic.

So I hope they will take action and that's why today I said, no more promises. I think the G20 countries all as a group have now promised to support and let's see the action and achieve the 40% by the end of this year. Thank you.

MH         Thank you very much, Dr Tedros. The next question will come from Gunila Von Hall from Svenska Media. Gunila, please unmute yourself and ask your question.

GU         Can you hear me?

MH         Very well. Please go ahead.

GU         Thank you for taking my question. You say with the moratorium on booster doses that you want to prolong it until the end of the year. It doesn't seem to have worked so far and more and more countries want to give booster doses in the richer countries and we have autumn coming with the fear of more virus waves.

So what makes you think it's going to work this time, that people will pause the booster doses? Thank you.

BA          Thank you very much, Gunila. The call for the moratorium on booster doses is being taken in an incredibly important bigger context. There're two press conferences today, you may have seen. There's the one that we're holding right now to talk about this issue and there was one earlier today at 2:00.

At that press conference the Leads on the COVAX facility released the most recent supply forecast for COVAX and what they reported was a 25% reduction in the number of doses that will go through COVAX without urgent action by the world's G20 countries, as the Director-General has said, and most importantly by the manufacturers themselves.

So here we are in a situation where there's an incredible outcry across the world about the huge equity gap on vaccines that's only got worse since May and the call for this 40%.

Then there's a call for a moratorium and yes, there were different perspectives on that but there was quite a lot of backing from the public and from others that indeed, I think, as Mike put it most famously, throwing another life jacket to people that already have one is not the most effective way to save lives and we need to get life jackets to people that don't.

In the face of that what we're seeing is the COVAX facility having to downgrade its forecast. So how can we have this commitment from the most powerful countries in the world, the producing countries in the world, the high-coverage countries of the world, the manufacturers of the world and then we have to downgrade the forecast?

So at this point we have to try and pull out every single stop to try and manage this situation. At the same time that this has happened in terms of vaccine supply we've seen incredibly compelling data from high-coverage countries, high-income countries, producing countries.

So where they're getting high coverage with these vaccines now, Gunila - you've seen it - they are still having COVID cases but their COVID deaths are plummeting. In the countries with the low coverage they are still having high rates of COVID deaths.

This is what we need to change and change as rapidly as possible. Should there be a moratorium on boosters? Absolutely. Should there be a moratorium on vaccinating people at low risk of severe disease or death? Absolutely.

So our job as the World Health Organization and the Director-General at the top of this is to make sure that we call for equity for these products in every single way possible.

The other thing that's happened in the last few weeks is that people have come out and said, well, it's only a few hundred million doses if we do boosters. We've just had to downgrade supply by a few hundred million doses. It makes a real difference in the face of scarcity.

We've had lots of countries come and discuss with us the moratorium and about whether booster policies can be delayed, etc. So it is making a difference, it is causing countries to pause, to think, have they got the right data, etc, to back that, let alone is this going to make the greatest possible impact.

So yes, some countries may be going ahead with decisions; others may not but our role is to make sure that we put forward the strongest possible arguments and way out of this pandemic and the way out of that is a moratorium and it's extended because since the last time we called for it the equity gap's got greater, the amount of vaccine available to low-income countries has gone down.

Sorry to go on on this a little bit, Margaret, but there's one other point I would make. To get all of the world to 40% coverage in every single country requires two billion doses of vaccine and we had the IFPMA come out yesterday and say, look, global production is at 1.5 billion doses a month now; 1.5 billion doses a month.

The absorptive capacity of the world is less than a billion right now because of what high-income and upper-middle-income countries can do so the volumes are there. This is a fixable problem but it's only going to get fixed if the political will and the will of the manufacturers comes together to solve it.

MH        Thank you, Bruce. Dr Kate O'Brien will add a few comments.

KOB      Yes, what I'd just like to add here is what we're really emphasising is the access issues but on top of the access issues on the booster dose question, this is not a matter of consensus scientifically or from the evidence. We're not asking to withhold something for which there is a strong set of evidence that this is needed in fact in order to give booster doses to individuals.

The vaccines are holding up very, very well against the severe end of the disease spectrum. The actual focus of the vaccine programme is to prevent severe disease, hospitalisations and deaths and we see in the evidence that in fact the vaccines are performing extremely well over time and against the variants against these outcomes.

So we'll continue to watch the evidence very carefully but our expert advisory committees continue to see that there is not a compelling case to move forward with a generalised recommendation for booster doses.

As Dr Tedros said in his opening speech, there are some very limited cases, very narrow cases, those few people who are immunocompromised, for which there is some evidence that is certainly growing to give a third does not as a booster dose but as a first priming dose to ensure that they have the same kind of protection as people who are not immunocompromised.

So I think we also have to contextualise this in terms of benefit, that it's hard to see how booster doses would provide any substantial impact that would be more than the impact that is achieved by people receiving their first doses.

So we will always be driven by the evidence and I want to emphasise that in this where we're certainly communicating very clearly about the access issues and the equity issues this is in the context where we don't have strong evidence that is a compelling reason to move forward with boosters even if there was the supply to provide for everybody.

Furthermore the vaccines are not authorised from a regulatory perspective. The regulators are also looking at these data along with the policymakers and I think you hear this in many places around the world. There is certainly not scientific consensus about the direction of travel on the issue of boosters.

MH        Thank you very much. Dr Ryan will add something.

MR        Just in reference to the DG's position on this, I can't remember who said this and who it's attributed to but giving up is the only sure way to fail and the Director-General will not give up in his responsibilities to speak for those who have no voice or to advocate for those who have no seat at the table.

That is his job. That is what he's here for and therefore there is no failure in that. There is just the continued pursuit and determined pursuit of solidarity and solutions that are based on scientific products that we have developed collectively around the world.

So I think the Director-General will continue to fight for the health justice that's required for us to get out of this pandemic and he'll continue to speak at every forum, I believe, and he will continue to develop strategies and policies that lead us in that direction.

In that sense, as I said before, in this sense giving up is the only sure way that we can fail in this endeavour.

MH        Thank you, Dr Ryan. On that critical point, at that critical moment we'll move to Priti Patnaik from Geneva Files. Priti, could you unmute yourself and ask your question.

PR         Hi. Can you hear me? Hello?

MH        Very well. We can hear you well.

PR        Thanks for taking my question. I was just wondering if you can share an update on the doses that have been withheld from the Serum Institute of India, whether there has been any kind of official communication from the Indian Government on when this restriction would potentially be lifted.

The second thing is, could you perhaps explain the logistical challenges of getting doses out of countries where vaccines are expiring for reasons that could be bureaucratic or otherwise? But clearly there are a number of doses that are getting wasted because they're not able to get to efficient countries in time. Thanks.

MH        Thank you, Priti. I think Dr Aylward will be able to answer that question.

BA         Sure, I'm happy to make a comment and Soumya or other may want to. With respect to the resumption of vaccines from India to supply COVAX I'd first like to just emphasise how important the issue is, Priti, and thank you for raising it because if we look at our supply projections out through the end of the year before we made the adjustments to them fully 30% of the products would have been coming from that supply so this is absolutely vital to the low, low-middle-income countries in particular that are served through the COVAX facility.

I just wanted to assure you as well that this is an area of constant conversation and dialogue between the leadership of the COVAX facility, Dr Tedros, Dr Berkley, who heads up the facility of course and GAVI and others with senior members of the Government of India as well as with, of course, SII itself.

So the conversation is ongoing, very much alive all the time and urging now as India has got its big delta wave under control, as it's now got vaccination coverage up, I think, as most of you will be aware. India is at nearly 40% coverage for single-dose and almost half of that with two doses.

So as these numbers get up there there is completely the expectation that they will be able to open up and supply other countries in need, low-middle-income, low-income countries through COVAX in the very near future so we continue to look for that.

Remember again just the incredibly important role that India has played in supplying the world vaccines and also of course the largest country, which is a member of the COVAX AMC group and that is India itself.

So ongoing conversation but definitely a really important part of the solution to reaching the global 40% target by the end of this year.

You raise the other important issue about the logistical challenges of getting vaccines moved from countries where they may nearly be expiring. It can be absolutely huge, Priti, and Kate may well want to speak to this as she deals with it day-to-day more than I do.

But it just reinforces again the reason to make sure that we use the vaccines that are available as efficiently as possible and we get them to countries that we know have the absorptive capacity to manage them and manage them in real time. This is the reason we set up COVAX.

COVAX is almost like a global clearing house; you can get the products in there, they have constant sight every single day on what status every country's in in terms of its ability to absorb product, use product and then it can redirect, direct product very, very quickly and does that in real time.

So the way that we can deal with this problem, Priti - because the one you raised, is a real one; it's very, very difficult to move vaccines if they get into countries that can't actually use them and this is what we're going to be seeing more and more in high-income and high-coverage countries in the coming months.

The way to control that is swap the deliveries so that they go to COVAX instead. COVAX can look across the world and solve that before we have to deal with those problems because that is very inefficient to have to deal with it that way. Kate may want to add to that but this is the kind of problem to try and solve before it becomes a problem.

KOB       Yes, just a couple of things to add here. I think the point that is really critical is that there is no country that can manage an immunisation programme and especially one that is as large as a COVID vaccine programme without planning.

One of the most difficult things that countries have been facing is the uncertainty about when the supply is going to come and what the expiration dates will be on those vaccines. We have seen vaccines coming through COVAX in a somewhat unexpected way because of the uncertainty of when the deliveries are going to happen.

Countries have done a phenomenal job of responding immediately to shipments that are coming and deploying them with absolute haste and speed in the face of sometimes only a couple of weeks of expiration time, which is an absolutely huge outlier in terms of how usual vaccine programmes operate and in terms of how COVID vaccine programmes in high-income countries operate.

High-income countries are not dealing with this. High-income countries have the clarity and the certainty of the supply for all the reasons that Dr Tedros has explained in his speech today. So I think in fact what is really needed at this point is this clarity on the supply distribution to low and low-middle-income countries though COVAX, much greater certainty on the supply, when it's going to come.

We're also seeing advances with the regulatory evidence with longer shelf-lives of the vaccine so all of these things together are going to improve the ability of countries to be operating in a surge mode and not just operating from emergency deployment to emergency deployment, which puts incredible stress on a programme no matter which kind of country we're talking about. Thanks.

MH         Thank you so much, Dr O'Brien and Dr Aylward for explaining how difficult this is. It's extraordinary what's been achieved. The next question goes to Simon Ateba from Today News Africa. Simon, please unmute yourself and go ahead.

SI           Thank you, Margaret. Thank you for taking my question. This is Simon Ateba with Today News Africa in Washington DC. In their joint statement today - and the DG just repeated it moments ago - COVAX said that only 20% of people in low and lower-middle-income countries have received the first dose of COVID-19 vaccine compared to 80% in high and upper-middle-income countries.

Here in the US at least 75% of all adults have received at least one shot. COVAX also said it has raised only $10 billion out of the tens of billions of dollars needed to crush COVID-19. WHO, please pardon my French. These almost seem like a curse. The delta variant for instance started in India and is now killing many people in the US daily, including today.

The mu variant started in Colombia and is now killing, is now affecting people here in the US. I guess my question is, do you need to adopt a new strategy for richer countries to understand that they will never know peace until everyone knows peace, until COVID-19 is really defeated everywhere, including in Africa, and that the illusion that defeating COVID-19 in their countries will protect them will not work? Thank you.

MK          Can I start here? Simon, I think you need to replace me in this seat up here because you have answered the question as you were asking the question. All of these questions are - rightly so - addressed to vaccines, vaccinations and boosters and we have to sort this out because frankly the world is not stepping up to get the vaccines where they need to go.

The DG's talked about this; Mike and Bruce, everyone's talked about this but it's about all of these other factors. There's all of this talk about planning, about the surge that's going to happen. It's happening right now. It happened in Brazil, it happened in India, it's happening right now in the United States, in my home country where they have high vaccination coverage.

The delta variant will not be the last variant to concern that you will hear us talking about. You mentioned the mu variant. There are others that are circulating. The surge of not only preparing for vaccination but improving our surveillance systems, getting tests out there so people know where the virus is circulating, making sure that we handle and appropriately manage mass gatherings or postpone them, making sure that we fix ventilation in our buildings, making sure that our workplaces have plans so that people who have to go to work can go to work and so on and so on.

Making sure that there's consistent, clear communication about how we need to use these tools; it doesn't exist right now. You asked for a new plan. The plan exists. The plan for controlling COVID-19 was issued on 4th February 2020, four days after the Director-General declared a public health emergency of international concern.

That plan has been adapted over time. It now includes vaccination. Don't say that that plan doesn't exist. I would like to see articles showing that that plan exists. The story is about how we implement them. The story is about how we use the tools that we have to prevent infections and to save people's lives.

Right now we have tools that can save people's lives. We have tools that can suppress transmission, which minimise, which reduce the opportunity for this virus to evolve, for variants to emerge.

You are right on with your question but we need people to step up, we need global leadership taking a stand and showing that we can take control over this virus. We haven't done that. There is a false sense of security that if your population reaches a certain percentage you will be safe.

The delta variant is showing us that and it's not the first variant of concern. Remember alpha variant across Europe; remember gamma, remember beta. Now delta is showing us that we cannot sit on our laurels, we have to remain vigilant and do what we can to not only get vaccine equity around the world but to ensure that we stop this virus from circulating as much as we possibly can.

We lost that opportunity to eliminate it at a global level very early on but we still have the power right now, all of us, to be able to drive that transmission down. So I think we need to - prove me wrong that we won't be able to do this but I think we can and I think countries have shown us over and over that we can. We just really need to step up.

MH         Thank you, Dr Van Kerkhove. Dr Aylward will come in and then Dr O'Brien will also have some comments to make.

BA          I think it's an important point you're making, Simon; what is the definition of insanity? Doing the same thing over and over again and expecting a different outcome. In this situation though the outcome we need is more doses of vaccine, more equitable sharing of what are really scarce resources to make sure they have the biggest impact possible and save the most lives possible.

The strategy is right; the strategy is absolutely sound. The work plan for trying to implement that strategy, potential solutions to addressing the equity problem through donation, through delivery swaps, etc; there're only so many ways you can skin a cat, so to speak, and those have been laid out very, very clearly by the Director-General week after week.

So it's not as much new strategies as new voices to help move the political agenda and the manufacturer agenda in the direction needed from the vaccine piece at least and one of the things the Director-General has established, as you'll be aware, is a multilateral leaders' taskforce.

Simon, you were asking that question; are people appreciating that we have to be in this together to solve this problem? So this multilateral leaders' taskforce now brings together Kristalina Georgieva, the head of the IMF; it brings David Malpas, the head of the World Bank Group, the Director-General along with Dr Ngozi at the World Trade Organization, a very powerful group of voices to make that economic argument as well as the health argument as well as the trade argument because all of these things add up and are crucial to getting out of this pandemic.

Just as we're bringing those voices together at the international level though politicians will react to a domestic agenda so we need the same voices, leadership out of the national agendas from the high-coverage countries, from the vaccine-producing nations to help those leaders make the decisions to prioritise COVAX because we need to change the colour of the map very, very rapidly if we're going to get out of this pandemic together, exactly as you said, Simon.

So what we need are more and more voices, more and more movement. As you can hear, we're all getting kind of hoarse but we need more help on this and that help has got to come from you, from the media telling the story, from the leaders at the country level because the international leaders are definitely doing their part.

MH         Dr O'Brien's got something to add.

KOB       Yes. I think you've obviously really hit the nail on the head here, as Maria has said and Bruce has said. Let me just add a couple of things here. We've been saying for over a year, nobody is safe until everybody is safe and the emergence of variants is really coming from where transmission is most happening. Transmission is most happening where people are unvaccinated.

So this is no surprise; saying that nobody is safe until everybody is safe. That's not a slogan; it's science; it's epidemiology; it's about the transmission of this virus. I think the world is starting to wake up to the fact that it's true and that we've been saying it because it's true.

So the calls to action, the policies that we have, the policies that the Director-General is describing and explaining and calling for action on are those things that are grounded in the evidence for what will stop this pandemic.

I think we want to really emphasise that on the vaccine side we need clear action. As the Director-General said, we've heard the promises, we appreciate the promises but those now need to turn into actions now, today, next week and in the months to come so that deployment of vaccines can actually go at an incredible pace to achieve the 40% target by the end of the year.

Those are the things that need to happen and we think that people are starting to really understand that this is not a slogan that we're repeating; it's actually based on what you can observe is actually happening, which we knew was going to be the case unless people acted.

So, as Maria said, there's still time to act but the longer there's a delay in doing that the longer this pandemic is going to persist and the more consequences there are from an economic, a social and a health perspective. That's what we want to short-circuit and get to the end of this. Thanks.

MH        Thank you very much, Dr O'Brien. I think on that very strong note we're coming up to the hour so we'll wrap up this press conference. I'll hand it over to Dr Tedros for some final remarks.

TAG      Thank you. Thank you, Margaret and thank you also to all media colleagues for joining us today. I look forward to seeing you in our upcoming presser so thank you.