Speaker key:
TE Tarik Jasarevic
MR Michael Ryan
BE Ben
ST Stephanie
JE Jeremy
HB Helen Branswell
AG Ann Gulland
JA James
NM Nuala Moran
TE Thank you very much for joining this virtual press conference from WHO headquarters in Geneva. My name is Tarik Jasarevic and today we will speak about the Ebola outbreak in the Democratic Republic of the Congo. As you know, we try to provide you regular updates on the situation and on the response done by the ministry of health, WHO and other partners so today we are to provide you with an update as a part of our effort to inform you regularly on this topic.
Before I give the floor to our speakers, just to let you know that if you want to ask a question, those journalists who are online, please press 0 1 on your keypad and you will be put in line for questions. We also have journalists here in the room who will also be able to ask questions. We will have an audio file available from this press conference shortly after the briefing and we will also have a transcript that will be available later, in a day.
With us today is Dr Mike Ryan, WHO executive director for health emergencies. We also have Rob Holden, who is the incident manager for this outbreak so I will give the floor immediately to Dr Ryan to tell us more about where we are when it comes to Ebola in the DRC. Dr Ryan.
MR Thank you, Tarik, and good afternoon, everyone. Thank you for the opportunity to speak with you today. Since we last spoke the number of cases has surpassed 2,000; we're now on 2,025 cases including 1,357 dead, 552 survivors. Of note is that over the last two weeks we've had 88 new cases each week, meaning that in April the average was 126 per week. Numbers have stabilised and in fact, fallen in the last two weeks.
However, there is still substantial transmission in a number of health zones including Butembo and in Mabalako. However, we have noted a significant decrease in transmission in Katwa, which was the very hot epicentre of the outbreak not six weeks ago. So, on the one hand, we see improvements or decreases in transmission and on the other hand, we see areas in which we have seen sustained transmission.
The epidemic currently is affecting 75 health areas in 12 health zones of North Kivu and Ituri and to put that into context, North Kivu and Ituri have 664 health areas in 48 health zones. During this epidemic, 179 health areas have been affected overall and 22 health zones so you will see, with 75 health areas now affected in 12 health zones, it represents a much smaller geographic footprint than we've seen previously in the outbreak.
However, within that geographic zone, we've seen the dispersion of cases so we have to be very, very cautious in understanding that the disease is still heavily present. There is still a lot of transmission going on in communities and at any point, it can flare up again within an existing zone or spread, as you've seen in the past, to other unaffected areas so a note of caution there.
Surveillance has intensified; we are now detecting approximately, on average, 1,300 alerts per day, of which between two and 300 are validated and tested and again the average number of confirmed cases per week is now 88. The number of contacts; about a week ago we had peaked with over 20,000 contacts under follow-up, which is a huge number of people being traced on a daily basis.
Because of cases now finishing 21-day follow-up that number has dropped to 15,000. It's still an enormous number of people to be tracking every day; it represents a huge logistics and security challenge but we hope we continue to see that number fall but that depends effectively on us generating less cases and contacts per day than those that leave the list at the end. So in that sense reducing the number of incident cases at this point will be of huge benefit in that process.
With that and then looking at transmission dynamics, transmission in the zone continues to be complex. More than one-fifth of cases seek healthcare in another health zone entirely before they're detected, which means one-fifth of cases are moving not only out of a health area but moving out of an entire health zone and are very often presenting for the first time in a health facility that's very far away from where they actually live so it's quite difficult to make the connections between transmission chains when you have that sort of movement.
So population movement; health-seeking behaviour are still major drivers of the epidemic although we have seen a sustained falling in the rates of nosocomial or healthcare-related infections over the last number of weeks.
I think that's it from the perspective of general updates. The reproductive number, the number that we use to look at the transmission dynamics is now at 1.04 for up to 18th May, which essentially means that one case is generating on average one case more, which means the epidemic is very flat in terms of its dynamics. But that doesn't mean it's falling; it means it's flat and therefore can go in either direction; it can either continue to reduce or it could easily flare up again and we need to be very cautious.
There's still plenty virus; there are still a large number of cases but in trying to maybe establish a note of extreme vigilance at the moment, we are making progress with our operations. We're certainly seeing a huge benefit from the relative calm that's existed over the last six weeks and that period of calm is allowing our teams to get to the field more effectively.
We're seeing the fruits of enhanced community engagement and acceptance. A tremendous amount of work has been done in the field by our WHO and UNICEF teams and the ministry teams to try and improve that trust relationship but again the situation is extremely volatile. We need to continue with that investment and we welcome the arrival of NGOs and others to support that intervention in the field.
The reproductive number actually fell from previous numbers so we've seen a fall in that number but there are, when you break it down, areas within the outbreak that still have a higher reproductive number than one. If we take somewhere like Mabalako, for the last number of weeks everyone's been very concerned with Butembo and Katwa, understandably but if we look at the intensity of transmission, Mabalako has a higher intensity of transmission now than either Butembo or Katwa and that presents its own challenges.
Mabalako is not a city area, it's a rural area; population density is lower, which is a good thing from a transmission point of view but the downside is distances are longer, communities are in much more rural settings, cases are harder to find, people are harder - it's much more difficult to bring people to isolation centres and it's difficult to find everybody that needs to be vaccinated so there are trade-offs here at every stage.
At this point I would say we need to be exceptionally cautious but we also need to have hope that the measures that have been put in place over the last six weeks and before are beginning to bear some operational fruit but we need to remain exceptionally cautious, we need to work very, very hard over the coming weeks to ensure that any gains that we are making are sustained and we need to be very aware that this virus will exploit any opportunity that it gets to increase transmission. Most importantly in that is our continued fear of further violence that would disrupt the operations in the field. I'm happy to take any questions.
TE Thank you, Dr Ryan. I'll just remind journalists who are connected online to press 0 1 on their keypad if they wish to ask questions. We have already a couple waiting but we will start with questions here in the room, Ben.
BE Hi, Ben from AFP. I ask this understanding that it's difficult for WHO to comment on the analysis of this epidemic as articulated by its partners but maybe you can help me with this. When cases passed 2,000 this week the health ministry in DRC said things were moving in the right direction. That's a couple of days after the International Red Cross said we need a total reset, Oxfam said it's not working and Doctors Without Borders said there's no indication that this is getting better.
What I hear you saying is, we've made some changes, we've put in place some new things and if we stay on this track there is hope that this will turn the corner. Is that an accurate analysis of where things are, would you distance yourself from those calling for a reset, as the Red Cross has done?
MR Yes, it's a very good question and we could be here all day having the discussion and the argument. What I know is we have 700 people on the ground trying to make a difference. We've 700 people on the ground leading every day how to do this better. We've 700 people on the ground risking their lives to stop this epidemic with very brave colleagues from the ministry of health. They have every interest in stopping this outbreak and they have every right to hope in doing this.
This outbreak is not an iPhone, it doesn't have a reset button. This is a complex, volatile situation and it's very easy to say, let's hit the reset button, in this situation. Unfortunately, we don't get choices like that. We get to adapt, we get to learn, we get to scale up, we get to make the response the best we can make it but there is no alternative strategy to effective community engagement, rapid identification of cases, good surveillance, excellent contact tracing, quick isolation of patients in health facilities that respect their human rights and save their lives.
There's no alternative to doing that. The real issue about this is execution; can we execute these public health operations in as sensitive a manner that respects communities, in as aggressive a manner that gets rid of the virus and how do we balance sensitivity against the urgency of containing this virus? This has always been the dynamic and I've had multiple conversations with our very respected colleagues in the other agencies and there isn't that much distance between... It really depends on which side of this thing you're looking at.
Adapt, yes; learn, yes; change things, yes. Moving care closer to the community by bringing transit centres closer to communities that don't wish to go to large transit centres; absolutely. Creating better community dialogue in order that communities have more ownership of the response; yes. Hiring and training more local Nande-speaking workers who can engage more effectively with their own communities on surveillance; yes.
These are the things we need to do and I've been doing this for 25 years, I've been through a lot of Ebola and other outbreaks. There's no magic bullet, there're no unicorns. There's just hard work and there's learning from what we do and we're really pleased to work with our partners in the NGOs and the UN. I think the new arrangements with David Gressly and Ibrahima-Soce Fall our two ASGs in the field working with the UN system, with the government and with our NGOs will bring a little bit more coherence and coordination around how we look at the outbreak and how we plan and implement together.
I really welcome everyone's keen interest in this because everyone needs to be interested in this response, everyone needs to be concerned about the outcomes and when people are concerned about the outcomes of things we sometimes disagree because the urgency for action means that we will never have a completely coherent view because we look at different data over different periods. We're looking at data, very recent data from last night. We're able to look at that data in very great depth.
Others may be looking at that data from two weeks ago or three weeks ago and depending on what you look at, when you look at it you may come up with different views but certainly I agree; adapting, scaling up, executing better, changing when we do things badly; this is absolutely necessary.
TE Thank you very much. Any other questions here from the room? Stephanie and then Jeremy and then we will go to questions from the bridge. Stephanie, please.
ST Thank you. Reuters, Stephanie Nabahay. Can you tell us, Mike, what difference having this UN co-ordinator, Mr Gressly, in place is in terms of escorts for your teams, are there more armed escorts?
Then I know you gave figures about a month ago, early May for the number of attacks; it was over 119, I think, at the time. Can you give us an update on that and how you see the security situation in terms of access to some of the most warring hot spots and does that include Mabalako, the one that you're most concerned about now?
MR David hasn't arrived as such; David has been the deputy SOSG in the Kivus and in East Congo for a number of years now so no-one knows the area better but in putting on that vest of co-ordination for the UN and the broader response I think he brings a tremendous amount of experience both in terms of security management but in political engagement, in political dialogue and in managing the threat reduction part.
I think there're two elements here and David will obviously speak for himself. It's not just managing and mitigating the security risks; it's about reducing the threat of the incidents themselves and there're two dynamics. One is the dynamic that drives the incidents, which is very often political, it's very often groups that are manipulated, manipulated communities, it's factions, it's Mai-Mai, it's attacks, and you have to reduce the chances that those events will occur.
Some of that comes through disarmament, through integration, through dialogue with these groups to reduce the threat and that's a huge part of what David does and what he knows how to do and I believe is already happening.
The second part then is how you mitigate the security risks themselves and again there're two ways to mitigate or reduce the risk in terms of security to personnel. One is to make the whole area secure, in other words, increase the general level of security and sense of well-being and protection, and the other is to provide point security, which is to give individuals or groups security at the point of contact with the community.
You all know and you've all heard the stories; when that happens and you have too much point security it's very visible to communities so you want to avoid as much as you can point security because that creates a visible association between security services and the response so a lot of work is going into seeing how we can improve the area security.
Again David and the UN DSS people and others are working on how we improve arrangement so that for example in Butembo and Katwa and the surrounding zones our teams can move around more freely in general because the general level of security provision in the zone is better.
Security provision and escorts to teams are then done on a case-by-case basis. If you reduce the security threat, if you increase area security then you can reduce the number of teams that require specific escorts and you can then reduce the visibility of security within the response or associated with the response itself. I believe that's how David and his teams will be managing that.
We've definitely seen in the last three, four weeks a decrease in security incidents. Maybe Rob can speak to the ones in May but having been down there myself two weeks ago, as one member of staff put it to me, there was an eerie calm, there was a sense of calm but also a sense of trepidation and expectation. I'm sure you've all felt that in your lives; peace but a sense that anything can happen.
I think we had an ADF attack in Beni the day before yesterday or yesterday; ten civilians were killed. This was an attack on the community, it wasn't an attack on the response but a ville morte was declared in Beni yesterday and we had very limited operations there. Thankfully operations were at full 100% today, which is great because, remember, previously in September and October we had whole days and weeks when we couldn't operate because of ville morte in that situation.
At any moment things can happen like that so I would say we will try and minimise the amount of point security, try and minimise the visibility of security provisions to communities and certainly avoid any perception that we're securitising the response. What I mean by that; that we're using security forces to carry out public health operations because this has been a misunderstanding.
People are not being arrested in association with compliance or non-compliance; the police are not being used as an instrument of the public health operation. They are purely being used as a means of providing protection to teams in specific circumstances where we believe there's an elevated threat.
I drove around in Mabalako two weeks ago for a whole day-and-a-half without an escort because I was in an area that was deemed to have an appropriate, low level of security threat so we could do so and had no police protection whatsoever. There are other areas where that's not the case and we have to be guided by our colleagues in UN DSS when they determine that a trip to a given area is of high risk. It is they who decide that we need an escort and we have to comply with that.
TE Thank you. Jeremy.
JE Jeremy [unclear] from Radio France and RFE. I'm looking at the numbers here. Did I get this right? You mentioned more than 1,000 alerts per day. Is that correct? Then you said that there were up to 20,000 people who were traced and now it's around 15,000.
MR Mm-hmm.
JE This seems huge to me. You mentioned that you have 700 on the ground. Do you think you have the people on the ground, are those 700 enough to track down all those people? To me, it seems huge and I don't get exactly how you can manage this thing.
MR It is a very large demand and in that, I have to say that it is really again a testament to our colleagues in the ministry of health and the relais communautaire and the local communities themselves. Most of the surveillance officers who are now tracing cases every day are from their own communities, the recos, the relais communautaires. They've been trained and empowered to do that and in fact, we're providing supervision, support, transport and other things for the group so we're able to multiply the impact of our people on the ground by engaging and training local actors in the field.
So to claim - and WHO would never claim that our 700 are the ones who make the difference. Again if you go into the treatment facilities now it is Congolese doctors and nurses in the front line. There may be NGO or WHO badges on the tents but the doctors and nurses are Congolese; surveillance officers are Congolese; 80% of the vaccinators in this response are Congolese.
We seem to forget that as we engage in various assessments at global level around UN and NGOs and who's important and whose opinion is important. The people stopping this outbreak are Congolese and they deserve our unreserved support in doing that and the transfer of the technology and the capacities they need to be able to complete this task with our support. You're absolutely correct; it's a very high number; tracing 20,000 people on a daily basis in an area as volatile as North Kivu is enough to give anyone fear but to see that number drop - and it will drop slowly and I hope it continues to drop.
We need to move away from a vicious cycle where we have late detection of cases - and late detection of cases is still a problem; community deaths is still a problem but if someone dies in the community it's a disaster; it's a disaster for the community but it's a disaster for the response because that person has been in the community potentially affecting others.
So we must get earlier detection of cases, we must have more exhaustive identification of contacts, we need to convince all of those contacts to accept vaccination. 90% is great; 90% of people offered vaccine take the vaccine. It's not them that matter now; it's the 10% that don't because all of our cases are coming from that group.
We need to make sure when people are sick that we can get them to isolation quicker because, number one, they'll infect fewer people but more importantly, they stand a very good chance of survival if they reach an Ebola treatment unit in good condition. So all of these factors impact negatively on each other when they're bad; late detection leads to community deaths leads to more infection leads to fewer people vaccinated.
But if you can turn each of those numbers a little bit, if you can improve your case detection, improve your contact listing, decrease the time to isolation and treatment, if you can increase by even a few percentage points the number of people that accept vaccination, what were numbers that negatively impact each other become numbers that positively impact each other and you move from a vicious circle to a virtuous cycle of improvement.
To do that is very tough, it's very difficult, it's very easy for me to say, as it is very easy for people to say the word reset. It's really easy for us sitting here or people sitting anywhere to talk about these terms. Changing, turning, adapting, improving in a complex operation, in a very volatile and complex setting with thousands of workers involved is something that has to be done extremely carefully. It's got to be done with some idea of sustainability.
You can't just flip and flip and change; today let's run in this direction; tomorrow let's run in that direction; let's change what we do. I think we have to be very, very considered and we have to be very directed and very focused on what we're going to change, how we're going to change it, how is that change going to affect the outcome and how do we eke out the incremental gains in performance that we need.
I think that's going to be the challenge we all face but it is complex and I am sure some days the people in the field wake up and think, I don't know how we're going to do this again, 15,000 people today to see. It's a tough ask.
TE Thank you very much. We will now move to journalists who are online and queueing to ask their questions. Hopefully, we will be able to take as many as possible. We will start with Helen Branswell from Stat. Helen, can you hear us?
HB Hi, yes, thank you very much. I have a couple of questions so I'll ask the first one and then please come back to me so I can ask the second. Just the other day Robert Redfield, the CDC director, was testifying before a House committee in Washington about this outbreak and he said he thought that the world needs to be prepared to mount a response that could last another 12, 18, 24 months. Is that what you folks are seeing in terms of the trajectory of this?
TE Thank you, Helen.
MR Thanks, Helen. I think Bob was very clear in his statements there and his public statements are saying that the disease was definitely not under control; I do agree with him; it's not out of control but it's certainly not under control. When you say it's not under control then the trajectory can go anywhere you like. Yes, in a worst-case scenario, I can definitely develop a scenario for you in which this is going to take another year or two years.
I can also develop a scenario for you if we make the right improvements and we put the right effort into this and we put the resources into this and the funding into this and the people into this, that we have a much shorter scenario. So at this point, I think the outcome is effort-related; are we prepared to make the immediate, sustained, comprehensive effort to bring this disease under control?
If we are I believe the timelines can be much shorter than the ones stated but I don't disagree with Bob. I think Dr Redfield is really trying to wake the world up to the fact that this is a very complex situation and that if we keep operating at less than perfect efficiency we may end up being around dealing with this outbreak for a very long time. We've laid out the areas in which we think we can make improvements and we thank CDC for all they do to help us every day to make those improvements.
TE Thank you very much. Helen, did you have another question?
HB Yes. A few weeks ago I was talking to some people who [inaudible] and they were really concerned about the possibility that there was a lot of unspotted transmission, that there were chains of transmission that were completely under the radar. Is the response getting access on a daily basis to sequencing data and what is the sequencing data telling you about what percentage of the iceberg is being seen?
MR Thanks, Helen. Yes, we've been looking at those numbers and it's a rational concern. There's never been an outbreak in history where anyone can claim they've detected all the cases. There's always a potential to have missed cases and we've been looking at that over the last couple of days. We also have a special team working on that right now and our epidemiologic analysis cell in the field looking at the genetic data that you refer to but also looking at other parameters, going back in detail through each detailed case narrative and trying to link all of the existing cases to transmission chains.
We will be out in the next few days with a much more in-depth analysis of that but as an estimate the number of alerts we generate per day has doubled over the last number of weeks so the presence of surveillance teams on the ground, our field presence on the ground, the number of local staff trained and the basic daily efficiency of contact tracing and active case finding would indicate that we're not missing a massive sump of undetected cases.
However, we are definitely missing cases because when you have community deaths like that and probable cases then you are definitely missing transmission and the $1 billion question is how big is that number. We believe at this point - let me be very cautious here; we believe that we're probably detecting in excess of 75% of cases. We may be missing up to a quarter of cases. Again it's very difficult to determine that because there are a lot of cases with very delayed detection so the question is, are we missing the case or are we picking the cases up way too late.
When we look at this the biggest damage in the response is picking up the cases very late. The proportion of cases that we miss is very important and each of them is a tragedy in itself but we're also being affected by very late detection of some cases and we're trying to fix that as well. So do we believe that there's massive undetected transmission? No. Do we believe that there is undetected transmission? Yes.
The only way that we're really going to get to grips with that residual under-detected transmission is - we're all the way back to the strategy - community acceptance, better surveillance, better case investigation, better identification of contacts and a better understanding of the transmission dynamics.
We're also working very hard and we've just received significant funding from the Bill and Melinda Gates Foundation to fundamentally enhance genetic sequencing services in the field and add the kind of analytic tools to the sequencing that will allow us to do the stats, which is to make very accurate estimates of undetected transmission and the likely size of the epidemic outside the detected size.
We've offered that technology, we've offered those resources to the government and to the Institute Nationale du Research Biologique, who run the surveillance and the genetic sequencing services and we hope to conclude negotiations with them in the next week to fundamentally enhance the sophistication and sensitivity of the genetic sequencing approach in the field.
TE Thank you. We will move to Ann Gulland from the Daily Telegraph. Ann, can you hear us?
AG Hi, yes. Thanks very much for taking my question. You said, Dr Ryan, that you could shorten the trajectory of the outbreak if you get what you need so I just wonder what it is that you need that you've not got at the moment. Is it simply funding or is it staff or a mixture? If you could just let me know, thanks very much.
MR Thank you for the question. It's a mixture really and it's not a dependent issue; it's not, we can do better if... We will do better because we need to do better in each of these areas but certainly, we're now almost coming to the end of the SRP3 period. WHO has been directly funded, about one-third of our financial needs since February so we're operating on about one-third of the funds that we predicted we needed to operate on and in fact our operating costs are exceeding our estimation.
So we're definitely operating at a financial base way lower than we need to be able to do our work but that's not just affecting us. That's affecting the NGOs, that's affecting UNICEF, that's affecting [unclear]. That's not a problem unique to WHO so we call on all our funding and investment partners to scale up their investment in the response in general and to find the investments that best suit them and their mandates in order to support the response.
We also need the whole-of-government approach; we need an all-of-society approach in Congo; we need the government - now there's a new prime minister, there's a new cabinet, there's a multi-sectoral committee for Ebola control - we need that to function effectively. We need the government to reach out to opposition, we need an all-party approach, we need a single voice of leaders in Congo about this outbreak, about the importance of containing Ebola so we need political leadership and political engagement at all levels because we believe that will continue to decrease the threat of security incidents and increase the levels of community acceptance.
We very much welcome the recent allocation of funds from ACHE under the humanitarian pool funds at country level, which will provide, I think, $10 million for non-Ebola-based interventions, which will allow five NGOs to scale up investments in other services to communities in the area, which will help to boost community confidence.
Because one of the frustrations of the community quite frankly has been that the absence of humanitarian and development partners in the field over decades has meant that the arrival of the Ebola response has actually highlighted the absence of other investments and communities are saying, Ebola is important but it's your priority, not ours, our priority is different, we have other priorities here.
So we really welcome that approach and I think, yes, there's a financial investment part; there's a co-ordination and political engagement part that's needed to enhance the response so more of both of those would be great and, as I said, we very much welcome the efforts to provide enhanced coordination for those enabling activities by the UN Ebola response coordinator, David Gressly, and Ibrahima-Soce Fall, our assistant director-general.
Even at the end of this process of the SRP3 there's the SRP4 which will start in July, which is the fourth strategic response plan and again there's a tremendous amount of planning needed for that and the government and the World Bank will lead that process. So even beyond our immediate needs there are real needs that will exist and persist for a very long time so again we look forward to a very productive process of defining the needs for the next six months of the response and look forward to working with the government and the World Bank on establishing the operational strategy and the costings associated with that.
TE Thank you very much. Next question; Norit Eisenman from NPR. Norit, can you hear us? Hello, do we have Norit from NPR on the line? We can't hear. Let's see if we have any other questions. Is there a James from the BBC?
JA Hi, hello there. I have two questions if I can rattle them off quite quickly. The first one is, what would the numbers for this outbreak be like without the vaccine this time around? I'm also curious about why we've now seen the two world's largest outbreaks of Ebola in the past five years; is this something that in the long run we're going to be seeing a lot more of?
TE Thank you, James.
MR Getting all the easy questions today. Yes, one can speculate on the issues of how bad this would be without the vaccine. I can only offer you my considered opinion after having been through many, many Ebola outbreaks and looking at the data associated with this vaccine in terms of its efficacy in individuals who've been vaccinated. We'd be in a lot worse situation without this vaccine right now.
The difficulty we have is that we have a highly efficacious vaccine - in other words in an individual vaccinated at the appropriate time the vaccine is highly protective but the vaccine can't protect you if you're not vaccinated. So the overall effectiveness of vaccination as a strategy is less than it could be because we're not identifying everyone who needs to be vaccinated and everyone who needs to be vaccinated is not accepting vaccination.
We need to improve those two numbers; we need to improve the efficiency with which we detect and identify at-risk people and we need to improve the level at which they accept the vaccine. But, having said that, yes, we have some modelling data which suggests the number of cases we might have avoided but we are definitely avoiding a large bulk of cases using this vaccination strategy.
On the issue of two in a year and more to come, yes, we are entering a very new phase in terms of high-impact epidemics and this isn't just Ebola. We look at cholera, we look at yellow fever, we look at many other diseases; we're seeing both re-emergence and resurgence. It's important to note that about 80% of these high-impact epidemics are occurring in fragile, conflict-affected and vulnerable states so we're seeing a very worrying convergence of risks; areas of high biodiversity, high population density, high population mobility, weak governance, conflict and many other things layered on top of each other.
In some senses - we keep saying it here - we're tracking 160 events around the world today; we've 33 graded emergencies which are emergencies that require us to mount a structured response and we have nine grade-three emergencies; that's our highest level of operational response. I don't believe we've ever had a situation in the organisation where we've been responding to so many emergencies at one time. The vast majority of them are occurring in states that are already affected by protracted crisis, fragility, vulnerability and other things.
We look at climate [unclear] impacts and the associated epidemic events and direct impacts of those events; we look at emerging diseases; exploitation of rainforests; we look at antimicrobial resistance, population movement and mobility; the pressures that drive disease emergence, the pressures that drive disease amplification. Look at this outbreak; how much of this disease has been amplified within the health system, not outside, in the health system itself so to what extent we're amplifying disease through our own systems and then the potential that diseases can disseminate locally, regionally and around the world because of the mobility we have within our human species.
All of these things say that this is a new normal. I don't expect the frequency of these events to reduce and I do think we need to get better at prediction; I think we need to get better at risk reduction, at preparedness. It can't just be a cycle of response, response, response. We really do need to get to grips with readiness and building the resilience of systems at national level to be ready for these epidemics.
We will continue to respond but, interestingly, the director-general announced and we've just implemented - our programme now will have two divisions, a division of preparedness and a division of response, recognising that preparedness now has to be a major, major goal for the world because just responding from global level to these events one after the other is not a solution. It's salvation for some people but it's not a solution in the long run so, yes, a new normal.
TE Next question comes from Krista Larsson from Associated Press. Krista, can you hear us? Hello, Krista Larsson from AP, can you hear us? We've lost Krista. Do we have Miss Moore on the line? I'm sorry that we are getting names that are not always spelt correctly. Anyone online?
NM Yes, it's me, Nuala Moran speaking from Bioworld. Dr Ryan, I wondered if you could give us an update please on the progress of the clinical trial of the therapeutics. I know that the trial could run from one outbreak to another but I just wonder whether you're getting close to completing enrolment in the current epidemic.
MR I wish we were getting close to completing enrolment because it's a double-edged sword; we're not. The trial progresses extremely well. We're adding or have added in the last week a new site and there will be a further site added in Katu/Butembo in the coming weeks so we expect to enrol a higher number of patients in the coming weeks. But again the overall outcomes of the enhanced standard of care in the use of therapeutics are encouraging.
We don't have access to the precise data as to the individual impact of any of the therapeutics themselves obviously because it's a randomised control trial in which we're trying to actually establish definitively once and for all which of these therapies have the best performance in this situation. So no outcomes yet and, as you say, we will continue this into the next epidemic if necessary and certainly I'm sure you're probably in touch with Cliff Lane and Libby Haigs and others at NIH who are the sponsors of the trial to see how far...
I'm not quite sure what our target number is for number of patients enrolled to reach statistical significance but I'm very happy to go and find that out for you.
TE Thank you very much. That was Nuala Moran from Bioworld. Thank you very much for calling. Just to remind everyone, we will have an audio file and transcript available from this press conference. I'm just checking if there are any questions here in the room. Otherwise, we will probably ask Helen to ask her last question before we stop the press conference. Helen, can you hear us?
[Asides]
TE We lost Helen. We don't have any other questions that we can see right now so we will thank everyone for being with us today. Again, an audio file will follow shortly; the transcript will be available later in the evening. For any further questions on this or any other topic regarding WHO don't hesitate to contact the media team. I wish you a very nice rest of the day. Thank you.