Speaker key:
CL Christian Lindmeier
RS Robert Steffen
TG Tedros Adhanom Ghebreyesus
TM Tom Miles
MR Michael Ryan
JK Jamey Keaten
JZ John Zarocostas
HB Helen Branswell
JA Jay
CF Caterine Fiankan
LG Laurie Garrett
DC Damien Coulomb
MM Megan Molteni
VI Vicky
CL Ladies and gentlemen, dear journalists, everybody please welcome to today's press briefing on the behalf of the fourth meeting of the International Health Regulations Emergency Committee on Ebola in the Democratic Republic of Congo. I'm very pleased to have with us today, the Chair of the Emergency Committee, Professor Robert Steffen. Also, of course, Director-General, Dr Tedros Adhanom Ghebreyesus. And at his side today, Dr Michael Ryan, Executive Director for the WHO Health Emergencies programme.
The Emergency Committee meeting started today at 12:00 Geneva time. We're now happy to announce the results of this meeting, and the recommendations to WHO by the chair of the committee. The statement and the recommendations will be sent out immediately after the announcement is being made. Then we'll go through the various announcements and declarations. And afterwards we're ready, of course, to take questions. Professor Steffen, please go ahead.
RS Thank you and good evening. The Ebola emergency meeting has, today, advised the Director-General to declare a Public Health Emergency of International Concern, a PHEIC. What does that mean? This is still a regional emergency, and by no way a global threat. And why this change of opinion? Despite the collective effort and particularly tremendous support by both the government of the Democratic Republic of (the) Congo and the commitment of the people fighting in the field against Ebola.
Also, despite significant improvement in many places, in a tremendously complex situation, now, first, there is concern about spread of Ebola from Goma, a gateway, even though so far no cases were newly infected in this city. Two, there is disappointment that there has been a recurrence of intense transmission in Beni so that the geographical expansion is now some 500 km. Four, the fight is ongoing for a full year now. And lastly, the assassination of two Ebola workers demonstrates the continued risk to responders due to (the) security situation.
Let me underline that the PHEIC is not declared as a reflection on a suboptimal performance of those active in the field, for instance the response teams, or the government of the DRC. The rationale is to better cope with the volatile characteristics of this outbreak. The strategy is not to be changed. We need to intensify the actions, also to become more proactive. In declaring a PHEIC, the committee put utmost emphasis that this should not interfere with travel and trade more than needed.
As per article two of the International Health Regulations, all actions must be commensurate. Explicitly, there should be no closure of borders by any of the neighbouring countries of the DRC or anywhere else, because that would have a terrible impact on the economy of the affected regions. Such impact would likely have negative consequences on the fight against the outbreak.
The committee reemphasised the recommendations issued during earlier Emergency Committee meetings and also during the 2014-16 outbreak in West Africa. Among the most important, preparedness must be enhanced in neighbouring countries. So far there is insufficient support for these actions. The list of all the recommendations, you will find in your handouts.
Finally, the committee is concerned that resources have become a limiting factor in technical assistance. Increasingly, there is lack of staff and of financial support. There must be more engagement by the global community to end this outbreak. Thank you.
CL Professor Steffen, thank you very much. Over to you, Director-General.
TG Thank you. Thank you, Professor Steffen, and good evening everyone in the room and everyone online. And thank you, Professor Steffen, once again, for your leadership of the Emergency Committee, as well as all members of the committee, and the advisors and those who made presentations during today's deliberations.
As you know, over the weekend a man from Butembo took a bus to Goma, a city of two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.
On his arrival in Goma, the man, a pastor, visited a health centre, where he was diagnosed with Ebola. He has since died.
Separately, last Thursday, a woman from Ebola symptoms from DRC crossed the border to buy fish at a market in Uganda. On Friday, she was diagnosed with Ebola and treated in DRC. She, too, has died.
Although there is no evidence yet of local transmission in either Goma or Uganda, these two events represent a concerning geographical expansion of the virus.
As a result of this concern for potential further spread, the committee recommended that I declare the outbreak a Public Health Emergency of International Concern, PHEIC, and I have accepted that advice.
Our risk assessment remains that the risk of spread in DRC and the region remains very high, and the risk of spread outside the region remains low.
I have also accepted the committee's recommendations for DRC, its neighbours and all countries, which you can read in the statement.
In particular, I emphasize that WHO does not recommend any restrictions on travel or trade which, rather than stopping Ebola, can actually hamper the fight.
Closing borders could have disastrous consequences for the lives and livelihoods of the people who cross the border every day for trade, education, or to visit relatives. Such restrictions force people to use informal and unmonitored border crossings, increasing the potential for the spread of disease. They will also serve no useful purpose - already there have been more than 75 million screenings for Ebola at border crossings and other checkpoints.
We call on all countries, companies, and individuals to support DRC by respecting those recommendations.
Now is the time for the international community to stand in solidarity with the people of the Democratic Republic of Congo, not to impose punitive and counter-productive restrictions that will only serve to isolate them.
The government of DRC is showing exceptional transparency in sharing information every single day. It was the DRC government which informed Uganda about the family with Ebola that crossed the border last month. It was the government of DRC that informed the international community immediately last week that there was a case in Goma.
The government of DRC is doing everything it can. They need the support of the international community. I stress this. The government of DRC is doing everything it can. They need the support of the international community.
That includes its financial support.
As we said very clearly after the last Emergency Committee meeting, a PHEIC is not for fundraising, it's for preventing the international spread of the disease.
WHO is not aware of any donor that has withheld funding because a PHEIC had not been declared.
But if that was the excuse, it can no longer be used.
We are now finalising the full Strategy Response Plan for this outbreak which will outline the resources needed for the next phase of the response. We don't have an exact sum yet, but it will run to the hundreds of millions. Unless the international community steps up and funds the response now, we will be paying for this outbreak for a long time to come.
Finally, I want to commend the government of the DRC for its commitment and cooperation, and to His Excellency, the President, who has visited the affected areas and has formed an inter-ministerial committee to ensure the whole government is focused on the response. I also want to honour the hundreds of responders from the government, partners, and our own staff who, as we speak, are putting themselves in harm's way to serve others. More than ever, they need our support. I thank you.
CL Dr Tedros, Professor Steffen, thank you very much for your elaborations. We will now take questions from the journalists. We will start with three questions from the room. And in the meantime, those who are online, if you type zero one on your touchpad, you can get into the queue for questions. We'll start from the room. Tom Miles, Reuters, please.
TO A question about vaccines, please. You mentioned at the end of the report or the recommendation that WHO should do all it can to help...
CL [Unclear] button, please. I think you're not on. No, on the bottom, the very front.
TM Right, I'll start again. Tom Miles from Reuters. A question about vaccines. You mentioned in the report that you want all WHO member states and manufacturers to do all they can to increase supplies of the Merck vaccine, including working with contract manufacturing organisations. If you could elaborate on what that means, please? And also, what about the other vaccines? Johnson & Johnson's vaccine seems to be, kind of, effectively blocked if a country will not allow research, a clinical trial. And meanwhile, I think China and Russia both have licensed vaccines. So why this problem with vaccines? What else can be done? Thank you.
MR The recommendation from the committee is encouraging WHO to work with the member states and manufacturers, as you said, to... Number one, it recognises the increased production from the Merck Company and doubling production for 2020, but also recognises that we have a gap in vaccine, and there is limitation of supply. We wouldn't have been involved in adjusted doses if we had adequate supplies of vaccine available right now. So accelerating the availability of vaccine is a priority.
And the Director-General has had discussions with senior representatives of the manufactures to discuss options for that, which could include increased production by the manufacturer or arrangements made with contracting manufacturers who could produce the vaccine on behalf of the company or through a licensed agreement with that company, and those discussions are underway.
With regard to the other vaccines, the SAGE has recommended the introduction of a second vaccine, and WHO still supports the introduction of a second vaccine, subject to the approvals of national regulatory and ethical committees. And we have worked very closely with J&J Consortium on planning for the introduction of that vaccine as that vaccine was considered through the dossier review by WHO to be the most likely candidate to be deployable in the field in an effective manner a real time, and at the scale and amount that will be needed.
Those discussions are underway with the Ministry of Health, and with the principal investor, INRB, in country. And yes, the ministry has expressed concerns about introducing a second vaccine, which are mainly around the issues of confusion in the local population. We're working through issues about where and when the vaccine could be used, and which protocol it will be used under. But just to state, for the record, WHO still supports the introduction of a second vaccine, in line with the SAGE recommendations, but subject to the appropriate national approvals.
CL Thank you very much. For those who cannot see it right now, this was Dr Mike Ryan, Executive Director for WHO Health Emergency Programme. Another question from AFP, here in the room, Jamey Keaten, please.
JK AP.
CL Sorry, AP.
JK Hello, Jamey from AP. The first question is, what exactly happens here? I mean, the UK, just the other day, announced £50 million that they're going to potentially contribute, up to £50 million. What happens now? Is this going to trigger now, automatically, more resources, more funding? And then, the second question is about the vaccination campaign. There has obviously been a couple of hundred thousand people who have been vaccinated. Why have we not seen more progress up until now? Thank you.
CL Who would like to take this?
TG And then maybe the vaccination for Mike? On the funding, first of all, we thank those who are contributing resources, but as we have been saying many times, we shouldn't link this Public Health Emergency of International Concern, the declaration, with intent to mobilise resources. Financing actually should be available to prevent outbreaks. Financing should be available to prevent a PHEIC from happening. Financing should be for preparedness. Financing should be to fix the roof before the rain comes.
So we don't want to associate the PHEIC or the emergency declaration with resource mobilisation. But it was a coincidence that even before this, there was renewed commitment to finance and we hope that will continue, whither it's PHEIC or not. So that will continue to be our position, thank you.
MR With regard to vaccine effectiveness, or the impact of vaccination, I think there are two separate issues here. One is the efficacy of the vaccine itself, which has been proven in the field. The vaccine protect individuals against disease. The other issue is what proportion of people who need the vaccine are getting the vaccine? Which is about are we detecting every case? Are we detecting those cases in time? Are we starting vaccination in the contacts and contacts in time?
So this response and all responses still rely on the core shoe leather surveillance, detection, community engagement, community acceptance, and many other factors. So vaccination can only be completely effective in the context of an effective surveillance operation within an accepting community. A huge amount of work is ongoing to improve our surveillance performance and, as you've seen, under the leadership of UNICEF, to improve and deepen community engagement and acceptance.
With the three together, I believe we are making progress, and in the last five to six weeks, we've seen the highest number of rings started in the shortest time since the beginning of the outbreak. So we're making significant operational progress, but notwithstanding the new risks that have been detailed by the Emergency Committee. Thank you.
CL Thank you very much. We'll take the third from the room, John Zarocostas, please.
JZ Good afternoon, John Zarocostas for The Lancet. My question is to Dr Ryan. Can you elaborate a little bit on the need for a second vaccine? And you suggested strongly Johnson & Johnson. Last week, the Ministry of Health of the DRC said due to a lack of sufficient scientific evidence on the efficacy and safety of other vaccines... So what has changed in the last five days?
MR Nothing has changed. I think the Ministry of Health in Congo have looked at the proposed protocols. They have concerns regarding the introduction of that vaccine into the epidemic zones. They still remain open to the design of studies that will allow the vaccine to be deployed in the field and used in areas not yet affected by the epidemic. We believe there's still the possibility to create that opportunity, and we're working very closely with both the government of DRC and the technical partners in the consortium to find a solution that will allow the vaccine to be deployed according the recommendations of SAGE.
CL Thank you very much, Dr Mike Ryan. Now we're ready to go into the lines, and thank you all for standing by for so long already. The first on my list is Helen Branswell from STAT, so please go ahead, Helen.
HB Thank you very much. This is a question for Dr Tedros. Dr Tedros, [unclear]...
CL No, can't hear her. Helen, we have very much trouble hearing you. The line is cutting. Can you try one more time slowly, and we'll give it another try, please?
HB Is this any better?
CL Yes.
HB Okay. My question is, in previous outbreaks, [?] even though WHO told countries not to close borders and not to refuse visas to residents of affected countries, countries did that nonetheless. Will WHO call out, publicly, any country that ignores its advice on this issue in this outbreak?
CL Dr Tedros, please.
TG Yes, thank you, Helen. You know, not only the recommendations of today, but since the outbreak started, we were advising neighbouring countries and others, because of the Ebola outbreak, to make no restrictions of trade or travel. And with this PHEIC, what we are telling the world is that it will actually have repercussions if there is restriction of trade and mobility. And it's actually through an open door policy we can control the outbreak better.
And I said it earlier, the government is actually leading and also cooperating. There is a daily report from the government of DRC on the Ebola outbreak situation. But not only that, it was the DRC government that had notified Uganda of the crossing of the cases, and Uganda was able to finish the cases as soon as... I mean, avoided the local transmission from establishing itself in Uganda, immediately. And not only that, Goma's case was reported by the government immediately.
So, when there is transparency, when there is cooperation, we have seen how helpful it actually is to follow open door policy. And not only that, on border points, checkpoints, more than 75 million people were screened, and this is helping. Some cases were detected during crossing. So when it's working well, we don't need to do anything different that affects the response negatively. But, having said this, if countries make restrictions, of course we will talk to the country in question, and try to help them to understand. But at the same time, we will make all our communications public. Thank you.
CL Thank you very much. Next, on the line is Jay from Radio France Internationale, RFI.
JA Jay [unclear], yes, for Radio France Internationale. Good evening. I had a question on Goma. I'm seeing, according to the Health Ministry in DRC that there are still 22 suspected cases in Goma. I understood that you said that there are no new cases in Goma for now, but I'm wondering about those 22 persons. Could it be worse in Goma than we actually think right now? I mean, how do you feel about the situation in Goma, exactly? Thank you.
CL Thank you, Jay. And to Dr Mike Ryan, please.
MR Yes, the first thing to say is that the teams in Goma... And there are over 650 responders on the ground in Goma as we speak, including 50 WHO staff specifically assigned to Ebola. We've been preparing in Goma, as the DG has referred to previously, for well over six months. As part of that process, we generate daily alerts of suspect cases. So suspect case definition is very broad, it's very sensitive, and therefore we're picking up suspect cases every day. And to date, none have been positive apart from the pastor.
We've also vaccinated 257 people as contacts and contacts of contacts in Goma. So we've taken a very broad approach to the contacts of contacts. We found the travellers who were on the bus with the pastor. So there's been extensive vaccination of contacts and contacts of contacts of the pastor. There are no other cases in association with that pastor. There are no other people meeting the case definition as part of that transmission chain. We will remain alert and vigilant.
So again it's important, there are many alerts every day in Goma, and there have been for many months. That shows the system is working. Some of those are considered suspect cases. They're taken to an ETU in a transit centre where they are tested. They have all tested negative so far over the last six months, apart from the pastor who tested positive after being transferred immediately from the first health centre he visited within one hour of presenting at that centre.
So what Goma has demonstrated, like Uganda has, is that preparedness works. And, as the DG said, these are the investments we need to see made now in preparedness and readiness in both surrounding provinces and countries.
CL Thank you very much, Dr Ryan. And we'll go now to number three, Caterine Fiankan Caterine, please go ahead.
CF Yes, thank you Christian. This is a question addressed to not only Dr Tedros but to the experts here. Dr Tedros has said that during the last meeting which took place in the Palais two days ago, that he wanted not only to contain the outbreak, but put an end to it, and reach zero case. So is this declaration of public emergency a way to alert the international community? And could he be, and you gentlemen be more precise about how many hundreds of millions you would need to do so? And also, do you have ideas about the quantity of vaccines that would be needed?
TG Want to go?
CL Thank you very much. There were a couple of questions in there. Dr Ryan, please? Do you want to start?
MR Okay, in terms of the costings for the response, as I said, the public health operations part of the costing, which is the core public health operation, has been costed in excess of $233 million, but those figures are being finalised and tweaked at the moment. So we're talking in that range. So that's the number on that. It was difficult to understand the first part of your question. I think we're struggling here to understand the precision on your question. I just wonder if you could just repeat the core part of your question.
KF Yes, I will repeat. Dr Tedros said that it was important not only to contain the outbreak, but to reach zero cases. So now that you less or more contained the outbreak for many months, is that appeal, declaration, a way to ask the international community to help you reach zero case?
TG Yes, the ultimate goal is zero case. Of course, it's confined now. The outbreak is confined in the two provinces of Ituri and North Kivu, but with a very high risk of spread to neighbouring provinces and also regionally. So our aim is to finish this outbreak, and our aim is actually zero.
CL Thank you very much. We move on to the next online. That's Laurie Garrett, please. Go ahead.
LG Thank you very much. If you already addressed this, I apologise. It's been extremely hard to hear what you're saying over a very loud electronic noise on the line. My question concerns exactly how much to date, have you received – not promised, but actually received – from the World Bank? And do you think that now that you're declaring a PHEIC, the World Bank will finally release its pandemic fund for your use? Thank you.
CL Thank you, Laurie. Dr Ryan?
MR WHO has, to date receive $6.5 million from the World Bank. But other agencies have received funds through the Pandemic Emergency Fund cash window. So far, to my knowledge, $20 million has been released by the Pandemic Emergency Fund cash window, of which, it's been divided, $6.5 million for WHO and $13.5 million for UNICEF. The World Bank, though, has been working with the government on reallocation of existing IDA funds at country level, but you'd have to follow up with them to get the exact numbers.
CL Thank you very much, Laurie, and apologies for a bad line. We're not sure where this would come from. It seems to be clear somewhere else. We go to the next question, and this might be the last for today, if we have no further. That's Damien Coulomb from Le Quotidien du Medecin.
DC Can you hear me?
CL Yes, all good.
DC Okay, thank you very much. So, my question will concern the violence that we observe in the region, the violence that is a big threat for your action against the epidemic. I was wondering, what do you think can be done to reduce the level of violence in this area? Do you think that the government of Republic Democratic of Congo have capacity to restore stability and security in this area? And, if not, do you personally think that you may, or the Goverment may ask help from other countries, like the African Union, for example?
CL Thank you. I guess this is another question for Dr Ryan.
MR I think it was more for Dr Tedros in terms of... I'm happy to take it.
TG The security problem in North Kivu has been there for many years now, more than 25 years, so it's not new. It's a war zone, and that's one of the reasons why, actually, we were not able to control the outbreak fully until now. It's almost a year. Because it's a war zone. And the other problem is the political tension, also, you see in that region. So these are the complicating factors that fuel the outbreak itself.
As you know, when there is a security problem the response is disrupted, and when the response is disrupted, the virus gets advantage and propagates. And whenever we make progress, when there is a security problem, we lose all the progress we made. So this was what you see in the curve of the epidemiology curve, actually, up and down, up and down. So the security problem is serious.
Of course, there was an incident a few days ago, and two community health workers, Congolese, were killed, but the last seven, six weeks has been relatively stable. And one of the reasons for this is the Congolese army and the MONUSCO UN troops are working in coordination. They have a coordinated command centre, and that's helping. And they're trying to prevent any attacks.
But in addition to that, I think the renewed community engagement is also helping. With community ownership, there could be more security and stability, because some of the attacks were coming, actually, from community members when they were angry because they were excluded from election, during last year's election. So the security problem has many reasons behind it, and addressing all of those will be important.
The UN Security Council, I think we have given a briefing twice, and the third one will be on July 31. And especially with regard to security, we will expect the support of the UN Security Council because this is a chronic problem that will need the attention of the international community. But led by the government, the government is doing its best, and the UN troops are also helping, and there is a relative stability in the last few weeks.
CL Thank you very much, Dr Tedros. We'll go back to the room for a question from Tom Miles, Reuters, and then I have two more online and that looks like with those we can close, unless we have a follow-up in the room still. So Tom Miles, please.
TM Yes, I wanted to ask a related question, but I'll follow up to the one that you just answered. Would you like to see the UN Security Council really raise its game, not just in this region of Congo, but in the region of Africa to try to sort out some of the endemic problems, not just health, but security, corruption, suspicion? People talk about, you know, political spoilers and manipulation, whatever that means.
And until these things are sorted out, long term, for the rest of our lives there will be outbreaks and problems that cannot be resolved. So do you not think that this is a moment when the world should look at this and say, we really need to sort out what's happening in this region? And is this not the job of the UN Security Council?
TG You know, addressing the root causes is the best solution, actually. It's a political problem or a security problem that's behind the Ebola. Ebola is a symptom. There is measles outbreak. There is chikungunya outbreak as we speak. There is cholera outbreak. As if it's not enough, then you have Ebola. And where there is, you know, a complicated root cause, that affects the whole system, the social, economic, and political situation, and then you will have such problems. So addressing the root cause, as you said, is obviously the most important solution.
But at the same time, while addressing the root cause of the problem, we have to also use, you know, whatever we have to fight the existing outbreak. But we made a call, a few weeks ago, as you may remember, and we have invited the international community to help DRC and other countries to address the root cause of the problem. Take Yemen, for instance. There is a cholera outbreak as we speak. A new generation in Yemen never had any knowledge of cholera. It was a forgotten thing. But with the war and destruction of the infrastructure, a cholera outbreak, which is the largest in modern history, has engulfed Yemen.
So addressing the root causes is key, and the world, as an international community, actually should help countries to address the root causes. And not only focusing on Ebola and on other humanitarian support, but linking the humanitarian support with development or focusing on humanitarian development nexus is very important.
CL Thank you very much, Dr Tedros. We'll go back to the line before we then go back to a round in the room. I have two or three more on the line here. The next is Megan from WIRED Magazine. Megan, can you hear us?
MM Yes, hi, thanks. Can you hear me?
CL All good.
MM Yes, I just wanted to find out a little bit more information about the plan for introducing adjusted doses. Is there going to be any kind of priority for who's going to be getting those kinds of doses, and when is that going to start?
CL Dr Ryan, I would assume.
MR Yes, the adjusted doses has already been introduced in Congo subjects and has been approved by the national regulatory authorities and the Ministry of Health. And that currently is, we've reduced the dose to the Guinea dose. In other words, it's half the original dose, which is the same dose that was used in the efficacy trials in Guinea, which proved efficacious. So based on the advice of our SAGE committee, we're confident in the use of that adjusted dose.
Any further reduction or adjustment of the dose would be carried out under the guidance of the same SAGE process, and we have a special Ebola Virus Disease Working Group of our SAGE committee which is keeping this under constant review. We would not make any further dose adjustments unless the epidemiologic situation indicated that we needed to expand the amount of available doses. Obviously the best solution for this problem is a ramp-up in production of Ebola vaccine.
CL Thank you Dr Ryan. And looking at the time, we have, actually, unfortunately, time for one last question now from Vicky from NPR before we need to close. So Vicky, please take the last question.
VI Hi, earlier this week, Rwanda's Ministry of Health advised people to avoid travelling to eastern Congo. Have the governments of Rwanda and Uganda given the WHO any assurance that going forward they won't advise any travel or trade restrictions?
CL Dr Tedros?
TG What I know is Rwanda and Uganda have been cooperating, actually, because both sides of the border, the same families. And that's their principle, to keep them, to stay together. It's actually the same family on both sides of the border, and that's what we know was in Rwanda and Uganda. And we hope that will continue.
CL Thank you very much, Dr Tedros. With this, we have to close. I thank everybody who has been waiting patiently online. Also, apologies again, for the delay of half an hour...