Speaker key:
TJ Tarik Jasarevic
PA Preben Aavitsland
TG Tedros Ghebreyesus
JZ John Zaracostas
JA Jamey Keaten
ST Stephanie Nebehay
MR Michael Ryan
HB Helen Branswell
JL Jeremy Lance
CA Catherine Fiankan- Bokonga
LI Lisa Schnirring
KK Kai Kupferschmidt
JB Jason Beaubien
TJ Good evening, everyone, from WHO headquarters in Geneva. My name is Tarik Jasarevic and thank you for waiting. We are now ready to start with our press conference following the third meeting of the emergency committee on the Ebola outbreak in Democratic Republic of (the) Congo. Today with us we have Dr Preben Aavitsland, who is acting chair of the Emergency Committee, and we have Dr Michael Ryan, Executive Director of WHO Health Emergencies programme and we expect Dr Tedros, WHO Director-General, to call in from DR Congo where he is right now.
Before we give the floor to our speakers I would just like to remind everyone that journalists online can ask their questions by typing 0 1 on their keypad and they will be put in a queue for questions. We have journalists here in the room and also this is being webcast on WHO's Twitter account. Following this press briefing there will be an audio file available and we will also have a transcript later in the evening.
First of all I will give the floor to Dr Preben Aavitsland, who is acting chair of the emergency committee and who will present the findings.
PA Thank you and good evening. The emergency committee for Ebola virus disease in the Democratic Republic of (the) Congo met today here and by teleconference and I will read our statement.
The committee expressed its deep concern about the ongoing outbreak which, despite some positive epidemiological trends, especially in the epicentres of Butembo and Katwa in the Democratic Republic of (the) Congo, shows that the extension or the reintroduction of disease in other areas like Mabalako, presents once again challenges around community acceptance and security.
In addition, the response continues to be hampered by a lack of adequate funding and strained human resources. The cluster of cases in Uganda that was detected earlier this week is not unexpected. The rapid response and initial containment of that cluster is a testament to the importance of preparedness in the countries that neighbour the Democratic Republic of (the) Congo and the committee commends the communication and collaboration between DR Congo and Uganda.
At the same time, the exportation of cases into Uganda is a reminder that, as long as this outbreak continues in DR Congo there will be a risk of spread to neighbouring countries. The risk of spread to countries outside the region remains low. The committee wishes to commend the heroic work of all responders who continue to work under extremely challenging and stressful conditions.
The Committee extensively debated the impact of a declaration of a Public Health Emergency of International Concern on the response and the possible unintended consequences of such a declaration and how such consequences might be managed. Differing views were expressed as the committee acknowledged that recent cases in Uganda constitute international spread of disease.
Our conclusion and advice are as follows; it was the view of the committee that the outbreak is a health emergency in the Democratic Republic of (the) Congo and the region, but it does not meet all the three criteria for a public health emergency of international concern under the International Health Regulations.
While the outbreak is an extraordinary event and there's risk of international spread we believe that the ongoing response would not be enhanced by formal temporary recommendations from WHO under the International Health Regulations. The committee provided a range of advice to the WHO, to the member states and it strongly urges countries and partners to heed this advice.
At-risk countries should improve their preparedness for detecting and managing exported cases, as Uganda has done this week. Cross-border screening in the Democratic Republic of (the) Congo should continue and its quality be improved and sustained. WHO should closely monitor and publish progress on preparedness in the neighbouring countries to the DRC and WHO should continue to map population movements and sociological patterns that can predict risk of disease spread.
All the priority countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness. And optimal vaccine strategies that have maximum impact on curtailing the outbreak, as recommended by the WHO's own strategic advisory group of experts should be implemented rapidly.
Now perhaps our most important point; the committee is deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak. The international community must step up funding and support for the strengthening of preparedness and response in the Democratic Republic of (the) Congo and the neighbouring countries; step up funding.
The WHO and other partners and the Democratic Republic of (the) Congo should continue to strengthen community awareness, engagement and participation. There has been a great deal of progress in community engagement activities. However in border communities where mobility is especially likely, community engagement needs to be more sharply targeted to identify the populations most at risk.
The implementation by the United Nations and partners of more co-ordinated measures to reduce security threats, mitigate security risks and create an enabling environment for public health operations is welcomed and encouraged by the committee as an essential platform for accelerating disease control efforts.
The committee strongly emphasises its previous advice against the application of any international travel and trade restrictions and we do not consider entry screening at airports or other ports of entry to be necessary. We advise the WHO Director-General to continue to monitor the situation closely and reconvene our committee as needed.
For our meeting we heard from representatives of the government of the Democratic Republic of (the) Congo and the government of Uganda. We heard from the International Organisation on Migration, from the MONUSCO and from the WHO and we had an extensive and substantial debate to arrive at these conclusions. Thank you.
TJ Thank you very much, Dr Aavitsland. Now we will try to connect with Dr Tedros, WHO Director-General, who is currently in Kinshasa. Dr Tedros, can you hear us?
TG I can hear you but can you hear me?
TJ We can hear you very well, Dr Tedros. Please, you have the floor.
TG Thank you, Tarik. Thank you, chair; thank you, Dr Aavitsland and good evening to all of you from DRC. I would like to thank Dr Aavitsland for his leadership of the emergency committee and all the members of the committee as well as advisors and those who made presentations.
As you have heard, the emergency committee has decided for a third time and has agreed that the current Ebola outbreak in DRC does not constitute a public health emergency of international concern. Although the outbreak does not at this time cause a global health threat I want to emphasise that for the affected families and communities this outbreak is very much an emergency.
Today I have been in Kinshasa to discuss the current Ebola outbreak with the prime minister of DRC, the minister of health, opposition leaders, donors and others. Tomorrow I will travel to Goma and Butembo to meet with our incredible staff and partners who are on the front line of this outbreak. I will also be travelling to Uganda to assess the current situation.
Since the outbreak started last August there have been 2,108 cases of Ebola and 1,411 deaths. This is tragic. Although the spread of Ebola to Uganda is tragic it's not a surprise. We have said since the beginning of the outbreak that the risk of cross-border spread was very high and it still remains very high.
The fact that it has taken this long is a testament to the incredible work of all partners on both sides of the border. I particularly want to commend the government of Uganda for the way it has responded. So far investments they have made and the plans they have put in place to prepare for Ebola are paying off. The spread of Ebola to Uganda is a new development but the fundamental dynamics of the outbreak haven't changed.
We have the people, the tools, the knowledge and the determination to end this outbreak. We need the sustained political commitment of all parties so we can safely access and work with communities. We also need the international community to step up its financial commitment to ending the outbreak.
The WHO's current funding needs for the period from February to July are $98 million, of which $43.6 million has been received, leaving a gap of US$54 million. We call on all our partners to fill this gap as soon as possible and from our side we will continue to assess the Ebola situation closely and I will not hesitate to reconvene the emergency committee if needed. I thank you.
TJ Thank you very much, Dr Tedros. Before we open the floor for questions, just to remind those online, dial 01 on the keypad to be put in the queue. We will start with journalists here in the room. Please introduce yourself and also if you can switch on the small microphone that is in front of you if you want to ask a question.
JZ Yes, good afternoon, Dr Tedros; John Zaracostas for the Lancet. I was wondering, sir, coming to the issue of the shortfall in funding, last week you met with the secretary of state, Mr Mike Pompeo, and Ebola was the prime subject of your discussion in Bern. What is the impediment? Looking ahead you'll be going to the G20. Why are people not putting their hands deep in their pockets and coming out with the funds? Are they waiting for the emergencies to reach the rich countries before they react?
TG Thank you so much. Of course during our discussion with Secretary Pompeo one of the issues we discussed was Ebola and he assured me of the US's continued support and of course we need to fill the total gap but in the last week or two we have seen an increased flow of funding. But of course we need to have all the funding we need in order to strengthen our response but partners are already starting to support again based on the call that we have made. We hope this call will increase or mobilise the additional [inaudible].
TJ The line was just cut so we couldn't hear the end of the answer. I think the question was answered so any other questions from the room here? Jamey, could you come to the nearest microphone, please?
JA Hi, I'm Jamey from Associated Press. Sir, Dr Aavitsland, you mentioned that the funding is strained. Why would you not use a PHEIC - call it an international health emergency to help boost the funding? It would be a good way of boosting the funding.
My second question has to do with the countries involved, Congo and Uganda. You mentioned that you had spoken to officials in those countries. What kind of concerns did they express about announcing this as a public health emergency of international concern or not? Thank you.
PA Thank you. We considered that declaring a PHEIC should follow the criteria of the international health regulations and to declare it in an effort to try to raise funds would be a misuse of the instrument. There is an ongoing severe outbreak and emergency in the Democratic Republic of (the) Congo where children and adults and responders, healthcare personnel are dying from this disease and that emergency in itself is a reason for donors to fund the response so that WHO and the ministers of health and all the other partners could put a stop to this terrible outbreak.
I don't think it's right for me to go into details about the discussion that the committee had with government officials. They briefed us on the situation and on their concerns and on several issues. Thank you.
TJ Thank you very much, Dr Aavitsland. We will take one more question from the room, then we will go to journalists who are online and who should type 01 to ask a question. Stephanie, please. Also just to say that we have re-established the line with Dr Tedros in case he needs to answer. Stephanie.
ST Yes, Reuters, Stephanie Nebehay. A question, I think, for Mike Ryan, please. In terms of your contact-tracing, yesterday there were 27 known contacts. Has your list expanded at all, have you been able to locate everybody on your list? I understand there's a slight delay in the vaccination that was meant to begin today. Can you fill us in on whether that's going to be happening tomorrow and what the reasons might have been? Thank you.
MR Thanks, Stephanie. Currently 98 contacts have been identified under follow-up in Uganda but only ten of these are classified as high-risk so the Ugandan authorities have cast a wide net and are really having a very broad definition of what could represent a risky contact. Part of the reason; the vaccine is in country, the teams were listing those contacts over the last 24 hours plus also the contacts of those contacts.
So the process today has been to establish that exhaustive list of contacts and contacts of contacts and it was felt better to begin tomorrow with the full and comprehensive list of individuals to be vaccinated rather than doing it in a piecemeal fashion. That's the reason; there is no obstacle to actually getting the work done. It's making sure the process is as comprehensive as possible.
TJ Thank you very much. Let's go to journalists online. I will call first on Helen Branswell from STAT. Helen, can you hear us?
HB Yes, thanks very much. Just a question for Dr Aavitsland; I was wondering if you could give us a sense of how the committee came down on this issue; was this a unanimous decision, do you vote, do you record a vote and was there much opposition within the group to the final decision?
PA Thank you, Helen. The committee consists of members of different backgrounds, different expertise and in the group many views were represented and expressed and we had a long and substantial discussion after presentation of all the facts. In the end we do not take votes, we draft a statement and we agreed collectively on the statement that I read out earlier.
TJ Thank you very much. Hope this... Yes, Helen, go ahead.
HB So no-one was voting in favour at the end of declaring a PHEIC?
PA As I said, we don't do votes, we discuss and we agreed collectively on the statement at the end; that's how it's done in these emergency committees.
TJ Thank you very much. We will move forward with Jeremy Lance. Jeremy, can you hear us?
JL Yes, Tarik, I can hear you. Can you hear me? Thank you so much. Jeremy Lance for RFI, Radio France International. I just felt that you said it but I want to have a clear statement; do you actually blame the Uganda cases on the lack of funding?
PA Was that for me or for...? Okay.
JL Mr Ryan or Mr [unclear]; that doesn't really matter; just have a clear statement. Is the lack of funding responsible for the Uganda cases, according to you?
PA I wouldn't say that but I would say that the lack of funding makes the response in the Democratic Republic of (the) Congo and the preparedness work in the neighbouring countries more difficult and it may delay the actual stamping-out of this outbreak. The committee heard from WHO that they've had to scale back some of their preparedness work in neighbouring countries because of lack of funds.
So that's why the committee thinks that the first step now for every country around the world which is worried about the Ebola outbreak in the Democratic Republic of (the) Congo is to at least make sure that the funding is in place to respond to and prepare for the outbreak.
TJ Thank you very much. Next question comes from Catrine Finkan. Catrine, can you hear us?
CA Yes, Tarik, thank you. Catherine Finkan - Bokonga. I would like - in fact this is a follow up to Jeremy Lance's question about the lack of funding and the way it's affecting the preparedness in the nine neighbouring countries. Could you please be a little bit more clear about the amount of money that you should need, would need in order to be able to prepare the neighbouring countries on such an Ebola outbreak?
My follow-up on that is that Nigeria, which is not a neighbouring country of DRC, apparently is intensifying preparedness. Do you think that there's a kind of panic starting in Africa in countries that have big populations?
TJ Thank you, Catherine. Maybe Dr Ryan will take this one.
MR Yes, I think it's important to recognise first of all that the Ugandan authorities have really proven the value thus far of investments and preparedness; an ounce of preparedness is clearly worth more than a ton of response. Very modest amounts of funding have been used to support Uganda in achieving a very high level of preparedness both in terms of the border, the screening, the establishment of Ebola treatment units, enhanced community-based surveillance, community mobilisation, the establishment of laboratories and many other measures like safe and dignified burial teams.
In April the Ugandan authorities with partners ran a full-scale exercise in this very area to test all of these procedures and again the fact that these procedures worked, that the communication was in place, the lab samples got to where they needed to go, the patients were appropriately isolated and those that unfortunately died were appropriately buried again shows that it is possible for all countries to achieve adequate and very significant levels of preparedness.
However over the last three to four months very little funding has been available in the preparedness space. The budget for preparedness in the four most at-risk countries was over $60 million, nearly $70 but there's still a gap in that funding of $27 million as we speak and that's through to the end of June.
Currently the teams in the field are carrying out an operational review in collaboration with the ministry of health and World Bank and the Ebola response co-ordinator and a new strategic response plan for the further response is currently being costed. There will be a significant ask within that new response plan. That is in addition to the existing gap in the current response for both WHO and partners so there is a significant gap in funding for the response.
There is a significant gap in funding for preparedness. Both of these will need to be met, not just for WHO but for the countries, for the partners and again we must recognise the role, the CERF funding from Mark Lowcock's team in OCHA; it was the first time that advance funding was given for preparedness from surf funds in the four most at-risk countries and that $10 million did a tremendous amount of good in helping those countries get ready.
Again I think the return on that investment thus far is obvious so it is the belief of the secretariat that we need to continue to fund preparedness and do preparedness, support countries in doing it. It is a good investment in health security for those countries and health security for the world.
With regard to preparedness in countries more distant, there is never any harm in countries preparing. In fact Nigeria's been at a heightened level of preparedness for the last year to two years because of the threat of lassa fever, an ongoing endemic and epidemic on endemic Lassa Fever plus monkeypox. The capacities within Nigeria to scale up their own internal operations has actually become quite impressive and we're very pleased to see countries testing, exercising and developing higher capacities to be able to detect and respond to any infectious disease threat.
But we do advise against overreactions, we clearly advise against unjustified restrictions on travel and trade. We do encourage countries to invest in public health preparedness and hope that that trend continues, particularly in Africa.
TJ Thank you very much, Dr Ryan. We have a few more questions from journalists online. I'll call first on Lisa Schnirring. Lisa, can you hear us?
LI Yes, thanks for taking the questions. I just wanted to ask about vaccine supply and I saw a tweet from Dr Tedros earlier today that said there was some Ebola vaccine being made in the United States now so I'm wondering if that's going to help build up the supply. Just give your take on where things are at with that. Thank you so much.
TJ Thank you, Lisa. The line is not really good but we understood the question and Dr Ryan will answer.
MR Yes, Dr Tedros did communicate earlier, we're very, very pleased with the news that the Merck company will re-engage its research production plant at West Point in the US, which will effectively double the capacity of the company to produce vaccine over the coming year. This is very welcome news.
At the moment there are a quarter of a million doses ready to ship and we will have a further 100,000 doses before the end of the year. As you'll have listened to in the intervention by Dr Aavitsland, there're currently SAGE recommendations for the adjusted dose usage which have been approved for half the current dose of vaccine in Congo. They've been approved and that has been implemented so effectively we've doubled the availability of doses in the field.
Further deliberations will occur at the level of the SAGE working group on Ebola virus disease and the SAGE committee itself to look at any necessary further adjustment of those doses going forward. We're also working very hard with the consortium led by the Institute Nationale du Research Biologique in Kinshasa and a consortium of agencies like the London School of Hygiene and the UK rapid response teams for the potential introduction of a vaccine produced by J&J.
That protocol is currently under approval at the national regulatory and ethical authorities and we would hope to have that vaccine in country, which will also offer another alternative for boosting vaccination in the field. We're very pleased at the moment with the current announcement by Merck. We're cognisant and conscious of the fact that vaccine supply - this is a very precious commodity and a very precious resource. We have to use it extremely wisely and we will continue to do so.
We do believe that with current projections and with the planned adjustment of dose we should have enough vaccine to deal with the scenarios that we face but Ebola is a very unforgiving disease. We must constantly keep the epidemiology under review and we will certainly revert to the international community and to the manufacturers should we believe that the increased production that has been put on the table may not be adequate.
TJ Thank you very much. We have two more questions waiting; first Kai Kupferschmidt from Science. Kai, can you hear me?
KK Yes, Tarik. Can you hear me?
TJ Yes, Kai, please go ahead.
KK Perfect. Preben, I wanted to follow up a little bit on what Helen asked. I understand that you decided that basically this outbreak doesn't meet all the criteria for a PHEIC but I'm still curious what the debate was. You said that you had a debate about the pros and also unintended negative consequences that declaring a PHEIC could have. Could you explain that a little bit?
PA Thank you, Kai. Yes, I could. Declaring a PHEIC has really only two consequences; one is that WHO may share information about the disease spread even if the affected countries don't want WHO to do it. The second is that WHO may give temporary recommendations to the member states that the member states have to follow.
Both of those consequences are really not needed because the affected country and Uganda are extremely transparent and temporary recommendations are not needed because all the countries involved and the rest of the world are really already following the advice that WHO is giving. So for that reason there is no need for declaring a public health emergency of international concern.
On the other hand, there may be some risks in making such a declaration and this is connected to how such a declaration is perceived, namely as a global emergency but this is not a global emergency; it's an emergency in the Democratic Republic of (the) Congo, a severe emergency and it may affect neighbouring countries.
But if someone thought that it was a global emergency we risk seeing, as we have seen with previous public health emergencies of international concern, restrictions on travel and trade, we risk seeing airlines stopping their flights to the area and we also risk border closures or restrictive measures at borders which could severely harm the economy in the Democratic Republic of (the) Congo.
So it was the view of the committee that there is really nothing to be gained by declaring a PHEIC but there is potentially a lot to lose. Thank you.
TJ Thank you very much, Dr Aavitsland. Now we go to our final question for the evening and that's from Jason Beaubien from NPR. Jason, can you hear us?
JB Yes, I can hear you fine, thank you. My question also goes toward preparedness. With this family who went into Uganda, the surviving ones were sent back into the DRC because there weren't the same experimental drugs available in Uganda as there were in the DRC. In terms of preparedness should those drugs be part of that preparedness, what level of treatment should neighbouring countries be expected to provide to cases that turn up in their territory?
MR Thank you, Jason. Yes, you'll see in the recommendations of the committee itself that they do specifically recommend that all priority countries should put in place the necessary approvals for investigational medicines and vaccines as an immediate priority for preparedness. As we speak, the government authorities in Uganda are approving, are in the process of approving the MEURIE protocol, which is the protocol we use for introducing the investigational-use therapeutics and those drugs are on standby to be delivered.
Obviously the reason of moving a sick child before was to give that child the opportunity to be treated in a sophisticated isolation facility with the availability of therapeutics and an ongoing randomised control trial which is currently underway in Beni. It will be preferable that countries have in place the MEURIE protocol, have in place the drugs and those drugs are available and available free to those countries for their use.
But again we have to distribute those drugs in a very judicious way because we can't supply huge amounts of drugs to every country so we have to base that distribution of drugs to countries based on need but that doesn't prevent countries approving the protocol and getting ready to be able to use those drugs. We will ensure that any country that needs drugs will get them post-haste.
So that would be the current situation regarding that and we would expect that countries will continue to vaccinate health workers, will continue to do whatever is needed in terms of preparedness but it's not just the technologies for preparedness. The very simple measures of sensitising communities to the seriousness of Ebola, watching out for unusual symptoms, avoiding stigmatisation of people who may be having Ebola, especially health workers being vaccinated, being alert and knowing what to do if they see a suspect case, knowing who to call and knowing that if they call someone something will happen, someone will come to check, someone will come to investigate.
So there are much more simple public health measures that we need to take but certainly it is a great advance at the moment to be able to access these novel therapeutics, to be able to access effective vaccine and that is a real step forward in terms of global health security.
TJ Thank you very much, Dr Ryan. With this we will close this press conference. I thank all journalists here in the room, all journalists online, everyone who is watching us on our Twitter account and special thanks to Dr Aavitsland, Dr Ryan and Dr Tedros, who spoke to all of you today. The audio file will be available shortly and transcript later in the evening. Have a wonderful day, evening or morning. Thank you very much.