COVID-19, Monkeypox & Other Global Health Issues Virtual Press conference transcript - 16 November 2022

Overview

00:00:24

MH         Hello everybody. This is Margaret Harris at WHO Headquarters, Geneva, welcoming you today, 16th November 2022, to our WHO press briefing on global health emergencies and other current health issues. As usual, we’ll start with opening remarks from our Director-General, Dr Tedros Adhanom Ghebreyesus, but not so usually he will be Nusa Dua, Bali. He’s joining us there, from where he’s participating the G20 Summit.

I will then open the floor to questions and our panel of technical experts, both in the room and online, will be available to answer your questions. In the room we have Dr Michael Ryan, our Executive Director of our World Health Emergencies Programme. And to Dr Ryan’s right we have Dr Ibrahima Socé Fall, our Assistant Director-General, Emergency Response. And next to Dr Fall is Dr Mariângela Simão, who is our Assistant Director-General for Access to Medicines and Health Products. And next to Dr Simão is Dr Gaudenz Silberschmidt, our Director for Health and Multilateral Partnerships. On Dr Ryan’s left we have Dr Ana Maria Henao-Restrepo, who is the Co-Lead for our Research and Development Blueprint for Epidemics.

00:01:46

We also have our usual panel of experts online and we have full simultaneous translation services. I thank the interpreters in advance for all that they’re doing. Now, without further ado, we’ve got Dr Tedros waiting in Bali, Indonesia, to make his remarks. So, Dr Tedros, you have the floor.

TAG        Thank you. Thank you, Margaret. As you said, greetings from Bali. Good morning, good afternoon, and good evening. Today, I’m joining you from Bali, Indonesia, where the G20 Summit has just concluded. Over the past two days I’ve had the opportunity to meet with several world leaders and to address the Summit itself. My message was that, as the COVID-19 pandemic has demonstrated, when health is at risk, everything is at risk.

Conflicts around the world, climate change, and global crises in food and energy security have now overshadowed the pandemic as the most pressing issues for world leaders but each of these crises has profound implications for health. The lack of food and energy, or their over-consumption, can have severe consequences for health and economies. Protecting health against the impacts of these crises is essential but it also helps to protect economies and societies.

I congratulate the G20 leaders on the adoption of their declaration, which includes strong support for health and health security. The G20 leaders said they remain committed to a healthy and sustainable recovery from the pandemic and building towards achieving and sustaining universal health coverage under the Sustainable Development Goals. They reaffirmed their commitment to strengthen global health governance, with the leading and coordinating role of WHO.

00:04:23

They expressed support for the work of the Intergovernmental Negotiating Body, which is negotiating the pandemic accord. They extended the mandate of the G20 Joint Finance and Health Task Force, which is critical for ensuring adequate financing for pandemic preparedness and response. They expressed support for the work of the WHO mRNA Technology Transfer Hub in South Africa. And they welcomed the establishment of the new Pandemic Fund, which was launched in Bali on Sunday.

Yesterday, WHO also signed an agreement with Indonesia’s ministries of health and defence to establish a new training hub for emergency medical teams to boost national, regional and global readiness for health emergencies. I thank Indonesia for its leadership as President of the G20 this year and we look forward to working closely with India next year.

Now, an update on the Ebola outbreak in Uganda. Since we briefed you last week, there have been six more confirmed cases and one probable case of Ebola in Uganda, bringing the total to 141 confirmed and 22 probable cases. There have also been two more confirmed Ebola deaths and one probable death, for a total of 55 confirmed and 22 probable deaths. 73 patients have now recovered.

00:06:09

The government’s efforts to respond to the outbreak have slowed transmission in most districts and two districts have not reported any cases for 42 days, indicating the virus is no longer present in those districts. However, in the past week the district of Jinja reported its first case, becoming the ninth district to be affected.

WHO and partners are supporting the government to intensify detailed case investigation, contact tracing, community engagement, and infection prevention and control measures. Since the outbreak began, the Government of Uganda, together with researchers, funders, companies, regulatory authorities and other experts, has been working under a global effort coordinated by WHO to accelerate the development and deployment of vaccines for use in trials.

Today, I’m pleased to announce that a WHO committee of external experts has evaluated three candidate vaccines and agreed that all three should be included in the planned trial in Uganda. WHO and Uganda’s Minster of Health have considered and accepted the committee’s recommendation. We expect the first doses of vaccine to be shipped to Uganda next week. A separate group of experts has selected two investigational therapeutics for a trial, as well as a trial design that is now being submitted for approval by WHO and authorities in Uganda.

Tomorrow, I will travel to Qatar to participate in the opening of the FFIA World Cup to highlight how major sporting events can contribute to improving health around the world and drive progress towards WHO’s goal of health for all. The World Cup is one of the greatest shows on earth, with an estimated audience of five billion people.

00:08:40

WHO is working with Qatar and FIFA to deliver a healthy World Cup, with a range of activities to promote physical and mental health for all people in Qatar and around the world. Together, we have designed measures to reduce the risk of diseases spreading at the World Cup, including COVID-19. We’re promoting healthy food options at stadia and fan zones and we’re conducting a study on ways to influence consumers to choose healthier food options. And tobacco use is banned in seating areas inside all stadia.

We’re also working with FIFA to promote physical activity, healthy diets and other elements of healthy living to the World Cup’s global audience, with pitchside advertising boards, videos in stadia and fan zones, extensive messaging on television and social media, and more. Lessons learned from the World Cup will also be shared with the International Olympic Committee to support preparations for the Paris Olympics in 2024, and the Milano Cortina Winter Olympics in 2026. WHO’s goodwill ambassadors Alisson Becker, Brazil’s goalkeeper, and former Côte d’Ivoire striker, Didier Drogba, will be supporting our work.

Finally, on Monday, WHO released an update of its Family Planning Handbook, which provides health workers and policy makers with the most current information on contraceptive options. This new edition details measures for health workers to protect access to family planning services during emergencies. During the initial phases of the COVID-19 pandemic in 2020, approximately 70% of countries reported disruptions to family planning services, increasing the risks of unintended pregnancies and sexually transmitted infections.

00:11:02

The updated handbook includes recommendations for wider access to self-administered contraceptives, including injectable contraceptives, which only need to be taken every two to three months. We urge all countries to adopt these recommendations. When all people have access to contraceptives, unintended pregnancies can be prevented, and people can plan their lives and families. Margaret, back to you

MH         Thank you very much, Dr Tedros. I’ll now open the floor for questions, and we have a lot of people online with many hands raised already. So, I’ll ask you to please try to keep your questions short, one question per journalist and please give your full name and your organisation, in case I get it wrong. And, indeed, indicate who your question is addressed to. We’ve got a lot of experts, so you may find some of them others jump in, but let us know who it is addressed to. The first question goes to Carmen Paun of Politico. Carmen, please unmute yourself and ask your question.

CP          Thank you, Margaret. I just wanted to ask, on the vaccines, on the three candidate Ebola vaccines that will be trialled in Uganda. How many doses does the WHO estimate will be needed of each for the trial and are there enough produced right now? Also, I know there were about two or three thousand contacts being followed. I was wondering if that’s enough to test three vaccines. Thank you.

00:12:58

MH         Thank you, Carmen. I think that question mostly goes to Dr Ana Maria Henao-Restrepo.

AH          Thanks for the question. As Dr Tedros says, the three vaccine developers and their funders have been working tirelessly to make the doses available for the trial, so we can confirm that we have received written confirmation from the developers that sufficient vaccines and a sufficient number of doses will be available for the clinical trial and beyond if necessary.

We have uncertainty, all of us, about the evolution of the outbreak and we don’t how many rings can be formed as part of the trial, but what we can say is that WHO, the partners and the developers are committed to randomise these vaccines so we can generate the robust evidence that will allow us to know if one or more of them has the efficacy we hope they have.

MH         Thank you very much, Dr Ana Maria. I’m looking around the room to see if we supplement but I think that more than adequately answers… Oh, Dr Ryan has got a supplement.

MR         Again, reflecting on Dr Tedros’ comments and, again, in previous questions we’ve had a perception this has been slow or delayed. This has been an incredibly fast collaboration between developers, countries who’ve sponsored the production of these doses, the academic institutes, like Makerere University in Uganda, who have been developing the protocols on the ground and bringing together our ability to both scale-up production, deploy these vaccines according to standardised protocols, with all the appropriate ethical and scientific oversight.

00:14:47

And to do that under the leadership of the Ugandan government I think represents a fantastic collaboration of all the players that you need to be able to deliver on something like this. As Ana Maria said, we hope, I dearly hope that this epidemic goes away and this epidemic is controllable without vaccines. It’s clear that we can get to containment without vaccines but it’s also clear from the Congo experience that you can get to control much quicker using effective vaccines. And they’re the answers we need to get.

We need to ensure that these vaccines are efficacious and do what they’re supposed to do. But, just to reassure people in Uganda, we can stop this outbreak based on the current efforts and I just want to remind those of you there, in Uganda, that understanding your own status, if you’ve had contact with a case, if you feel sick or febrile, you need to be able to present yourself to the health system so that we can have diagnosis, we have proper care for people and that we can end and break the chains of transmission.

Vaccines obviously will help in the longer run and we again thank the Government of Uganda, we thank the Minister of Health, we thank Makerere University for providing the world with an opportunity to be able to bring these vaccines into play and being able to gather the necessary data that we will need in order to prove their efficacy, and also the commitments being made by manufacturers and others to continue production of these vaccines.

00:16:12

To a great extent, we’ve really addressed the issue of Ebola Zaire through the work we did in the last number of years. The Sudan strain is a particular challenge and to have products ready to go on the ground is a huge victory, again for that collaboration from local to global that allows us to bring these products to bear. So, with huge gratitude to all those institutions out there, the UK Government, the US Government, SII in India, the Sabin Vaccine Institute, the Oxford Group, IAVI, Merck.

There’s so many different groups who have come together and when people put aside our individual objectives, be they public or private objectives, and we come together to solve a problem that communities are having in Uganda and we can bring to bear the innovation and the government support and the donor support to focus and bring that to bear in local communities, I think it’s a real good sign for the future.

I think we are making progress in this kind of collaboration and WHO’s role is to facilitate, to create platforms for that to happen, to convene, to bring partners together, to create a pathway, a transparent pathway, in which everyone can contribute to this kind of activity with our Member States, and like in this case with the Minister of Health and the Government of Uganda and the people of Uganda in the centre and driving this process. And I think we learn each time we do this. We are learning and that’s what we need to continue to do if we’re going to ever be able to face future epidemics and possible pandemics.

00:17:53

MH         Thank you very much Dr Henao-Restrepo and Dr Ryan. The next question goes to Helen Branswell of STAT. Helen, can you unmute yourself and ask your question.

HB         Hi. Thank you very much, Margaret. Well, it’s two-part. I think the first part goes to Ana Maria and maybe the second part to Mike. Has a decision been made about whether the Phase 1 trial for the IAVI-Merck vaccine can be done in Uganda or will it need to be done elsewhere?

And Mike, you mentioned that the outbreak could be brought under control using traditional measures. In some respects, one might wonder if that is already happening and whether, unfortunately, the window to test these vaccines might be closing. Obviously, ending the outbreak would be great news but do you folks think it’s realistic that you’re going to be able to get the trial up and running in time to get data? Thank you.

MH         Thank you. We’ll start with Dr Ana Maria.

AH          Thank you, Helen. Before the decision was issued by the independent expert committee we introduced in the protocol that has been conditionally approved in Uganda and by the WHO ERC, a provision to collect detailed information on the safety for certain vaccines if additional safety information is deemed necessary.

This is in the protocol, so the protocol is in a position to collect this information, like in a Phase 1 safety-like study. Whether or not the developers would like to conduct other studies elsewhere, that is their prerogative, but what we are proposing is to give the opportunity to collect the additional detailed safety data if our expert group does recommend.

00:19:55

In terms of whether or not we will have enough rings and cases during this outbreak, as you clearly point out, it is very difficult to predict the evolution of the outbreak, but we are working towards the idea that perhaps even if we have a small number of rings we could generate evidence that is important for this outbreak and beyond.

And I just want to say that everybody is asking us how many rings do you need to have an answer and what we are doing is we are randomising the rings. We will continue to randomise. We will have an independent data safety monitoring committee that will look at the data and will advise us and the and the PI, Dr Bruce Kirenga, at Makerere University, if we have sufficient information to decide whether or not one or more of the vaccines have the efficacy levels that we require or has demonstration that it doesn’t have the efficacy we were hoping for.

So, it is important to note that we have been there. You may remember, Helen, that when we did Ça Suffit in Guinea, it was at the tail end of the epidemic and the same conversations were on the table. The epidemic is finishing. Should we do a trial? Is it enough time? And since for the outbreaks where they are going to move forward, as Mike says, we hope it is controlled, it is better for us to work towards generating the evidence and put all our efforts on that rather than trying to second guess the evolution of the outbreak.

00:21:30

MR         I think that’s the dilemma. I hope and I believe we can get to the end of the outbreak with traditional measures but I also don’t hope that we have cases just because we want to test the vaccine. Nobody wants that, but we don’t know where the pandemic is going and as they once said about, I think, lotteries and raffles, if you’re not in, you can’t win.

What I don’t want to be doing in six weeks or eight weeks’ time is looking back, if there’s a deterioration in the situation, saying we should have, we could have and if only we had. And that’s what we’re doing. We don’t want if onlys. Emergency management doesn’t tolerate if onlys. You need to have no-regrets approach.

We’re making these investments and if we don’t get to the required numbers we’ve built the collaboration, we’ve built the platform to do this again. We’ve built the knowledge, we’ve built the collaboration. We’ve accelerated the development of these products.

And a bit like with Ça Suffit, it took another four or five years for the Ça Suffit trial to realise its benefits in the real world. So, if we have to do this in one or two steps we will but I don’t want to look back here and nobody wants to look back in six or eight weeks’ time and say if only we should have or we could have.

00:22:54

MH         Thank you very much for comprehensive answers. Now, we’ll move to India, to Priyanka Pulla. Priyanka, please unmute yourself and ask your question.

PP          Hi. My question has to do with the Indian inactivated vaccine Covaxin, which currently has an Emergency Use Listing from the WHO. As the panellists probably already know, the Indian media has raised multiple issues with the way the vaccine trials were conducted and then the WHO recently suspended procurement of Covaxin due to manufacturing issues.

Now, yesterday the American publication STAT put out a report which highlighted differences between the internal protocol for the Phase 1 trial of Covaxin and what the company eventual published in The Lancet for the Phase 1 trial. There were fairly major differences and the STAT article also had pointed out several other issues.

Now, coming as they do on the back of multiple issues raised in the Indian media, does the WHO plan to review the Emergency Use Listing for Covaxin? And, secondly, what is the status of the suspension because India continues to use the vaccine, the Indian regulator allows the use of this vaccine within India but the company has stopped exporting it elsewhere in the world, which is basically a major double-standard? So, is the WHO planning…?

MH         Priyanka, I think we need to shorten the question. I think your question is pretty clear and Dr Mariângela Simão will answer.

00:24:40

MS         Thank you, Priyanka. Let me say, first, that we are looking at the data that is coming out regarding the clinic trials, the allegations regarding the data on the clinical trials. Meanwhile, let me say that WHO issued an Emergency Use Listing, as you’re well aware, based on approval by the Indian drug controller before.

In March 2022, during an inspection on site that we did, we found a series of irregularities related to the good manufacturing practices in Bharat, which is the manufacturer. We are working with the manufacturer directly and we are expecting to receive what we call in regulatory terms a Corrective and Preventative Action plan, and we have not received it yet. So, going to your question whether we are planning to review, we are wating for the information, the additional information coming from the manufacturer regarding the correction of the irregularities we found before.

The WHO recommended that the suspension of the international procurement and this stays. The status of the EUL will depend on the assessment of the actions taken and the CAPA, what we call the CAPA, the corrective and preventive actions. And I think the question regarding the use in India should be directed to the Indian national regulatory authorities because that’s for them to authorise. It’s not WHO does the authorisation for national use. Thank you.

MH         Thank you very much for that answer, Dr Simão. We’ll now go Nina Larson of Agence France-Presse. Nina, unmute yourself and ask your question.

00:26:39

NL          Thank you very much for taking my question. I was hoping that you could say a little bit more about how you assess the COVID risk at the football World Cup coming up and if you are satisfied with Qatar’s preparations. Thank you.

GS          Thank you, Nina, for that question. We are working closely with the Qatar authority to FIFA and the Organising Committee, as we did already for the preparation of the Tokyo Olympics with the Japanese government and the International Olympic Committee, and the local committee and for the Beijing Olympics with the Chinese government. There, obviously, the COVID situation was much more tricky.

Here, the Qatari authorities are in a more comfortable situation from the global epidemic situation but they’re constantly monitoring and they have asked us to have two experts embedded with them for exactly that kind of monitoring. So, we are in constant contact with them.

MH         Thank you very much Dr Gaudenz Silberschmidt. The next question goes to Raghav Mahobe, from Reuters. Raghav, please unmute yourself and ask your question.

00:28:04

RM         Hi, good morning. I’m Raghav Mahobe, from Reuters. I would just like to ask could you please name the manufacturers of the Ebola vaccine candidates which are going to be in the trial and if you could also provide an update on the investigation of children’s deaths in Gambia?

MH         I’ll start with Dr Mariângela for any update on Gambia. And your other question, you were asking for the names of the manufacturers in the trial? We’ve got a lot of background materials on this that have been posted but I will also put you through to Dr Ana Maria to discuss that.

MS         Let me say that the investigations continue to be done in The Gambia regarding the causality between the deaths and acute kidney injury and the potential ingestion of contaminated products. However, let me reinforce that the fact that there were contaminants found in paediatric formulations is a real reason for concern and the measures that have been taken by the Gambian government and also by WHO with the Indian regulators in regards to the Gambian cases because, as you know, we do have some other cases being investigated in Indonesia, focusing on the same types of contaminants as found in The Gambia but by a different manufacturer.

So, we don’t have any new updates regarding this. It continues under investigation but the concern is that these types of contaminants should not be present in paediatric formulations or any adult formulations and we are doing our best to investigate and trace down the sources of where these excipients came in the first place. Thank you.

00:30:04

MH         And over to Dr Ana Maria.

AH          There are three vaccines that were considered by our independent committee and now will be proposed for the trial. The first one is a coli bivalent adenovirus vector vaccine that includes two antigens, one against the Zaire ebolavirus and another one against the Sudan ebolavirus that has been causing the outbreak in Uganda. This vaccine is called by the short name, called ChAdOx1, and this is being developed by the University of Oxford and the Jenner Institute in the United Kingdom, and the doses are being produced by the Serum Institute of India.

The second vaccine is a monovalent, again adenovirus vector vaccine, that includes also the Sudan ebolavirus that is causing the outbreak, the glycoprotein that is causing the outbreak in Uganda. This is called ChAd3 colloquially and is produced by the Sabin Vaccine Institute of the US and received the support from the US government through BARDA.

The third vaccine is called a monovalent vaccine that has the vesicular stomatitis virus to present the glycoprotein of the Sudan ebolavirus and this vaccine is very similar to the Ervebo, the vaccine that was produced and manufactured by Merck. This is now being produced under the leadership of the International AIDS Vaccine Initiative, IAVI, with support from Merck and with funding by the US government through BARDA. So, in short they are called ChAdOx, ChAd3 and VSV Sudan. Thank you.

00:31:56

MH         Thank you very much, Dr Ana Maria and Dr Simão. Now, we’ll go to Hong Kong, to Mary Ann Benitez, from the Hong Kong Standard. Mary Ann, please unmute yourself and ask your question.

MB         Hi. Thanks, Dr Harris. I would like to ask about this possibility tripledemic of seasonal flu…

IN           The interpreter’s apologies. The sound quality is too poor for interpretation.

MH         You’re breaking up.

MB         Yes. I am sorry about that.

MH         Ask your question again. That sounded better then.

MB         Is there any possibility of a triple pandemic of seasonal flu, RSV and COVID in Asia, as also is happing in the US apparently? And are there any updated guidelines on public health because there is no vaccine for RSV? So, the reason being to start that over the hospital season and how do you combine the promotion with seasonal flu and COVID? Thank you.

MH         We still struggled but my understanding is your question was about the three different respiratory viruses circulating and concerns about that. Dr Abdi Mahamud is online to answer that question. Dr Abdi, are you able to answer? Ah, there he is.

AM         Thank you so much. As the DG and Mike, and only yesterday Mike and Maria highlighted, we are seeing as we move to the winter season and with the restriction of public health measures we are seeing a resurgence of multiple respiratory pathogens. What we have been calling for is to do all preventative measures, taking your COVID vaccination, your flu vaccination and public health measures.

00:34:27

We have seen resurgence of influenza in the Southern Hemisphere during the winter season, an upsurge of cases of flu and also COVID. I think the preventive measures the public flu vaccination and COVID will be able to prevent this infection. We don’t have a triple pandemic. I think media would like to have that.

We had two endemic previously or we have infections that can happen, co-infection can happen by what we’ve been calling for again and again is protecting the vulnerable population, the high-risk populations, taking the masking when you’re in crowded facilities, your flu vaccinations and your COVID vaccination or boosters.

So, we haven’t seen the different viruses combining creating a new virus but we are seeing a resurgence of different viruses as countries are opening up. So, the basic public health measure still remain. Get your COVID vaccination, get your flu vaccination and follow the public health measures recommended in your country.

MH         Thank you very much, Dr Mahamud. Now, we’re approaching time and I can’t see further questions online, so we will now wrap-up and we’ll go back to the Director-General in Bali for final remarks.

00:36:05

TAG        Thank you. Thank you so much, Margaret, and thank you also to the members of the press for joining us today, and see you next time. Goodbye.

MH         Thank you Dr Tedros and I’ll just remind there is a lot of material online now about the vaccination trials and studies which we will provide with the final materials, the materials that we send out normally after a press conference, and thank you all.