COVID-19 Social media Q&A - 16 February 2022

Overview

00:00:53

AK          Hello, good afternoon, good evening and good morning to everyone joining us today, to our weekly COVID-19 #AskWHO session with Dr Mike Ryan and Dr Maria Van Kerkhove, who will provide an update on COVID-19 variants of concern including Omicron and its sub-lineage, BA.2.

So, please feel free to ask your questions, if you’re watching us on Twitter, using the hashtag #AskWHO. If you’re watching us on other platforms, please use the common section to send us your questions and I will gladly pass them to Mike and Maria.

Good afternoon, Mike, Maria. Thank you for your time today. Can we, maybe, start? While we’re waiting for questions, there is quite a lot of interest in Omicron and what is it doing around the world. Maybe we can start with the epidemiological update. Last week we had very shocking numbers in increase in cases but also deaths. So, are the trends still the same this week, Maria?

00:01:53

MK         Omicron is certainly dominating global circulation right now around the world. It has quickly replaced Delta, the last variant of concern that was circulating. We are still seeing a large number of cases. If you look at the overall epidemic curve, there are fewer cases that were reported in the last week than were in the previous week, but we need to look at this very carefully because testing rates have changed around the world and, although 16 million cases were reported to WHO, we know that that is an underestimate.

I think we need to be careful about interpreting too much this downward trend. Certainly, that’s in the right direction but it’s likely that there’s a large number of cases that we’re missing. The bigger concern right now, I think, is the still increasing number of deaths. It’s the sixth week in a row that we’re seeing increasing reports of deaths from COVID-19. In the last week alone, almost 75,000 people died, reported to us, and we know that that is an underestimate.

00:02:56

There is variation across the world in terms of increasing and decreasing cases and deaths but at this point in the pandemic, when we have tools that can save people’s lives, this is far, far too many and the big worry, really, is this increasing trend.

So, if we break it down, we published our weekly epidemiological report last night and, for those of you who are watching, you can go on our website and find that. We can certainly provide the link. This is really where we outline what’s happening at a global level and what’s happening across all of WHO regions. These are different geographic regions around the world.

And it’s quite dynamic. Almost 60% of cases are reported in Europe and this has been common in the last several weeks, millions of cases being reported in the Americas. We saw almost a 20% increase in cases in the Western Pacific region, so this in Asia, whereas in other regions we saw declines.

It’s quite dynamic but, again, testing rates have changed significantly in recent weeks. Part of this is because Omicron is transmitting so efficiently and there are just so many cases, but many countries have really dropped testing, reduced the amount of testing that they’ve done.

So, we are concerned that there still is too much circulation that’s happening at quite an intense level and if you have huge numbers of cases, like we are seeing, the opportunities for even more variants is higher. So, this is something that is quite concerning to us but, as I said, increasing deaths for six weeks in a row is not the situation we should be in right now.

00:04:35

AK          Thank you, Maria. Mike, what are your thoughts on the current situation?

MR         Well, I think the situation is very different depending on which part of the world you’re in and I think that’s very important because I think people are looking at their national situation and they’re looking at the global media and they’re saying, hang on, it’s different here to there and these people are opening up over there and we’ve still got tons of cases over here. And why are they opening and we’re not opening?

So, there is some confusion out there. Maybe this should be the same everywhere but it’s not. This whole pandemic, each country, each region has had a different experience and the point of impact of the pandemic has shifted between countries and between regions.

But, if you look at the overall global situation, and Maria is absolutely right, 74,000-75,000 deaths last week. At the peak of this pandemic, the highest week ever in this pandemic was around 110,000 deaths and that was considered to be the most awful week in the pandemic. We’re at 75,000. It’s not a whole long way from there. So, there are still many people dying from this disease.

00:05:42

I think another important observation is that in five of the six WHO regions the deaths increased in the last week and in two, in the Western Pacific and in the Eastern Mediterranean, there was a 27% increase and 38% increase in deaths respectively, and 14% in Africa. To me, that’s occurring at the same time that the number of reported positive cases has dropped.

So, we’re seeing the number of cases appearing to fall away and yet the number of deaths is increasing and when you see that trend epidemiologically, you then ask yourself the question, is that real? How could the deaths be going up and the number of cases is coming down?

Now, it could be that the deaths we’re seeing now are a lag from a few weeks ago and that’s one explanation. The explanation is that testing rates have dropped off remarkably in many countries. So, countries who are claiming now to say our transmission has dropped and we’ve got two to threefold less cases this week then we had six weeks ago, go and look at the testing rates and you see that the testing rates are much lower.

So, as society opens up and as people are able to go back to their normal lives, people are less instinctively going to go and get tested. It is now, in some cases, not even a requirement. So, I do think we have to be very careful in interpreting the data and I would say that, right now, we’re in a period of great uncertainty.

The pandemic is by no means over. Countries are having to make decisions to try and normalise and bring society and economies back online and there’s a tremendous political and social pressure to do that I completely understand that pressure.

00:07:34

But, we also have to be very careful. As Maria said, over 74,000 deaths in the last week and we’re seeing those death rates increasing and that’s not because there’s a brand new variant. That’s because Omicron has taken over and everyone said Omicron is much milder but the reality is, I think, even in the United States it’s historically the highest number of people dying.

So, I think we’re going to go through another number of weeks, months of uncertainty here and I think we need to be very careful about the potential emergence of new variants, while at the same time dealing with the reality that the number of cases and the transmissibility of Omicron and the potential higher transmissibility of the BA.2 variant, means that there will be potentially other surges of cases.

I think we’re seeing that Maria, in some countries, getting a surge of BA.2-related cases now in the aftermath as it takes over from the BA.1 lineage. They’re both Omicron. Again, you’re seeing that competition. You’re seeing the viruses. It’s the Olympics for the viruses right now in terms of each sub-lineage, each sub-variant, each variant trying to outdo the next one and that process will continue, and as long as transmission continues that selective pressure will be on the virus.

MK         Can I just say something? I know this is complicated for the viewers. We’re giving a lot of information at global level, a regional level about all these different things. What is really important for the viewer that is watching this, because we’re speaking to the general public and people across different social media platforms, is that this pandemic is not over and that we need everyone to be careful.

00:09:17

I think there are things that you can do, that your loved ones can do to reduce your exposure, to reduce your risk of hospitalisation and dying from infection and first and foremost is vaccination and getting the vaccine when it is your turn, receiving the full course of the doses that are recommended to you at your age and your condition where you live.

That is absolutely critical but, at the same time, we still need to be careful to behave in ways that reduce our opportunity to be around the virus. That will not be forever but right now it is really important that we remain cautious and that we be careful because the virus is circulating at such an intense level and given that testing rates have dropped, it’s not always clear how much of this virus is circulating where we live.

This is not meant to scare everybody but it’s to give people information to know what they need to do to keep themselves safe. We’ve always said know your risk, lower your risk. So, it’s about where you live, it’s about what you need to do every single day and to take measures to lower your opportunities to get infected in the first place, and there’s a lot that everybody can do.

MR         Right now, still, if you’re an older person or you’re a person with an underlying condition, the single best investment you can make right now, today, is to get vaccinated because the chance of being admitted to hospital, being admitted to ICU or dying are vastly greater in people who are unvaccinated, and the data is coming out from every country now and it’s absolutely consistent.

00:10:48

The most important thing you can do to save your own life or the life of somebody else is to get vaccinated and equally, as Maria said, we need to remain cautious because even though I may be vaccinated and I may not have a risk factor or I may not be under an age, I may have a loved one in my family who is and I don’t really want to bring that virus there.

So, avoiding infection as best we can and, at the same time, getting vaccinated. Again, it’s a big discussion right now and I see more and more articles about hesitancy and this issue of mandates. I’ve said that consistently, I hope, since the beginning. This is about continuing to engage with people to persuade, to convince, to show people the value of vaccination and not to harangue people, force people, push people.

I don’t want, and I’ve seen some stuff in the media, othering people who don’t want to be vaccinated, saying that they’re weird or there is something wrong with these people who don’t want to be vaccinated. I don’t believe that to be the case and I think it’s really important that we don’t have the vaccinated against the unvaccinated. And, I see with some of the demonstrations and stuff that’s on, it’s become political again, it’s become very nasty again, it’s become very ideologic again, and that’s not going to get us anywhere. It’s really not going to get us anywhere.

00:12:03

We have got to be able to demonstrate and continue to show people what the benefits of vaccination are and be prepared to have those long conversations and listen to the concerns that people have around getting vaccinated and understand that hesitancy doesn’t come from a bad place, hesitancy comes from an unsure place and, therefore, reassuring people and giving them the right information. If you’re someone who has been vaccinated and you have friend who hasn’t, talk to that friend.

Don’t turn this into, I’m the good person who got vaccinated and you’re the bad person who didn’t, because I don’t think that helps. I don’t think it advances us in our agenda to make sure that everyone in society is protected. Again, I’m seeing low uptake of vaccination in so many places and I think that’s our greatest barrier to actually getting out of this pandemic right now.

We’re still not making it in many countries. Even though vaccine availability is increasing and in many countries vaccine is available any time you want it in multiple paces, walk in, and yet people aren’t doing that. We need to continue the conversation, Aleks, and we need people out there in social media, we need influencers.

This is not going to be the job for the doctors telling everyone what to do or governments. This is about society deciding and internalising the benefit of vaccination for everyone and then having a proper, respectful conversation with our friends and families to give people the information they need and try and bring as many people possible with us to be vaccinated.

AK          Thank you, both. We have a lot of follow-up questions. Maybe I’ll start with this one. Mike, you mentioned that there is less testing happening around the world at the moment and that is why we are seeing a decrease in reporting cases.

00:13:50

Angelina Weir, watching us on Facebook is asking… Oh, sorry, this is not a question from Angelina. It’s a different question that I will pass later. There’s a lot coming here. However, the question is from Chelsea. Are self-tests at home impacting the numbers of cases being reported officially?

MR         I think it can. First of all, the ability to do self-testing can be extremely useful. It can be a really good addition to your attempt to keep yourself safe. For example, I’ve seen many colleagues self-testing themselves before they go to see an elderly relative and just trying to make sure that even though they’re double vaccinated and even though they’re not sick, they take an antigen test before they go to do that.

Being able to, if you just have a sniffle and you’re double vaccinated and think, I wonder do I have COVID? Doing an antigen test means you’re not going to walk into work and then get a PCR test and find that you now have ten contacts. So, that’s really useful and empowering people to be able to do that is very positive.

The challenge with antigen testing is that it needs to be more available everywhere and it’s relatively expensive and when countries in constrained economic environments, when they’re faced with a choice between making sure their hospitals have enough oxygen or handing out antigen tests, sometimes it becomes a trade-off between the different things you can do within a very limited budget. Therefore, there is an inequity in the distribution of these antigen tests at community level.

00:15:27

I really do support, certainly, in many countries beginning to use antigen tests within the clinical environment as a pre-screening, so that when someone sees someone they can do an antigen test and then refer them for a PCR test and that can make things very fast. It can also mean that the person knows they’re positive before the PCR test and, in that day that it takes to give a PCR test, may reduce exposure of other people.

So, I do think we need much more antigen testing in the health system as people access the system. Then, when you do have antigen tests coming before the PCR test, you may see the number of PCR tests dropping because you’re not testing as many people. But, what we’re seeing is that the number of positive cases is rising exponentially in some countries and that’s not necessarily linked to people doing more antigen testing.

There is a downside on antigen testing in that people could do an antigen test to avoid having a PCR test and don’t act on that information properly. It’s still very, very important and I see countries are considering over the next weeks and months lifting the requirement for isolation if you’re a case.

If you’re an antigen-positive person, if you do a test and you’re antigen-positive, you are very likely to be a positive case and the PCR test is really just a confirmation and the antigen actually more so. In fact, if you’re antigen-positive you’re very likely to be infectious and therefore you need to self-isolate.

00:17:05

I do think, when we talk about lifting restrictions and changing the public health measures, the one measure at this moment that I think we really should not be thinking of changing right now is the requirement to isolate if you are antigen or PCR-positive because that means you’re infectious, you are going to transmit to other people if you are not self-isolating. So, I do think that’s an important consideration.

But, I think an antigen test that costs a dollar a piece, that may sound very cheap and in the industrialised world that’s a small, little expense to buy a few antigen tests, but if you’re living in a developing country where you might spend five or ten dollars per person on health for the whole year, five antigen tests or ten antigen tests are massively expensive in the context of how much money people spend on health.

So, we have to be very careful when we talk about cheap antigen tests, who is cheap. Cheap in Europe is not the same as a cheap, available test in Africa and therefore we have to work harder on non-EU and the group working within the ACT-Accelerator are working to increase access to antigen tests.

MK         Can I add?

AK          Please.

00:18:23

MK         I think this is important. Because we are seeing such a shift in testing policies around the world, testing is a critical component to the COVID-19 strategy. You need to know where the virus is. You need to know how the virus is changing so that the interventions can be adapted and tailored to where they are needed most, especially given the third year of this pandemic and people are sick and tired of dealing with this.

We need to be smarter with the interventions that we use and testing is critical but testing needs to be used, it needs to be affordable, it needs to be reliable, it needs to be rapid and it needs to be cheap. It needs to be affordable for people to actually be able to use it.

We are working to make sure that there is better access to testing around the world because testing has many different functions. First and foremost, it tells an individual if they’re infected or not but not only that, what you need to do if you’re infected. We need national policies and sub-national policies that actually help people to know what to do.

As Mike has said, I wholeheartedly agree, dropping isolation requirements is really dangerous right now because we know that people who are infected and particularly with an antigen-based test which detects the virus in terms of in your body when you are most infectious, if you have a positive antigen test the likelihood that you are infectious is very high.

So, if you don’t isolate you will pass the virus to someone else and that just perpetuates the problem but also getting tested can get you into the clinical care pathway earlier and there are incredible therapeutics that are becoming available and, in particular, the antivirals.

00:20:03

These antivirals are not available over the counter, they still need to be administered by a medical professional but getting that test early means you get into the clinical care pathway early and the use of antigen-based tests are really exciting and they’ve been in use for more than a year and a half now because you can do antigen-based tests outside of medical facilities, outside of laboratories, into communities and in homes and this brings this closer to the individual.

So, it’s worth emphasising how important testing is and worth emphasising that dropping testing right now has a lot of negatives and not so many positives but also we need to really work harder to get antigen-based tests cheaper, reliable ones that are out there, and into the hands of the people that need them most. We are committed to doing that. We will continue to push this out and make sure that people have access to lifesaving tools, and tests are part of that lifesaving tool pathway.

AK          Thank you so much, Maria. We’ve received a few follow-up questions regarding evolution of new variants of concern. I know you both mentioned that it’s likely to have new variants given the current transmission, but maybe you can elaborate a bit on that.

00:21:20

MK         Yes. The virus is evolving and Omicron has several sub-lineages that we are tracking. We have the BA.1, BA.1.1, BA.2 and BA.3. It’s really quite incredible how quickly Omicron, the latest variant of concern, has overtaken Delta around the world.

Among the sequences that are available and, again, this is really great, that so many countries are doing testing and sequencing and sharing this information, we know that Omicron has quickly replaced Delta around the world.

Most of the sequences are this sub-lineage, BA.1, but we are also seeing an increasing proportion of sequences of BA.2. So, there are a lot of studies underway that are comparing these sub-lineages.

What do we know about transmission, severity, impacts of vaccines? Omicron is more transmissible than Delta, all of the sub-lineages but within the sub-lineages, Omicron BA.2 is more transmissible than BA.1. So, what we’re looking for in the epi curves, and I mentioned this last week, we’re looking at not only how quickly those peaks go up but how they come down, as Mike says, coming down the mountain.

As the decline in cases occur, part of it is we have to look at the testing as we’ve just talked about. We also need to look at is there a slowing of that decline or will be start to see an increase again? What we’re worried about is if we start to see an increase then we could, and I’m not saying we are saying this, but we could see some further infections of BA.2 after this big wave of BA.1.

00:22:57

I know a lot of people are concerned about this but this is something that we are looking at. Today, I sent Mike a text about this. I was so struck by a teleconference we had today where our teams here, and I just want to thank my own team working on this because they’re just incredible.

I definitely don’t thank them enough and certainly not publicly, but the amount of work that WHO staff are doing with scientists around the world to gather information on studies in labs, studies in populations, studies in hospitals to look at severity, about transmission, about severity, about vaccination and share that information in real time allows us, as WHO, to work with partners to give the best advice we can in real time.

It’s so dynamic. We’re in a position in which we can watch evolution occur in front of our eyes and track it through sequencing around the world and make assessments based on the data that’s available. So, BA.2 is certainly on the rise but this is also Omicron. We don’t see any difference in terms of severity between BA.2 compared to BA.1 and I think that’s important because we’re always worried about further virus evolution and whether or not we will see a change in severity, and we are not seeing a change in severity.

But, again, Omicron is not, quote/unquote, mild. It is less severe than Delta but we are still seeing significant numbers of hospitalisations of Omicron. We’re seeing significant numbers of deaths, as we’ve mentioned already. It is not the common cold, it is not influenza. We just have to be really careful right now.

00:24:43

I think, again, some of the narrative and the language that’s out there suggesting I might as well just get infected with Omicron is dangerous. Do what you can to avoid exposure. It doesn’t mean lock yourself away, it doesn’t mean lockdown in countries but do what you can to avoid exposure and infection.

We also get a lot of questions about post-COVID condition and long COVID, so I just wanted to mention this here. The risk of post-COVID condition, we’ve had 409 million cases reported of COVID-19 worldwide that we know about and there’s a significant number of people who are suffering from post-COVID condition.

We are working to better understand this every day but we get a lot of questions about will there be a difference in the proportion of people infected with Omicron getting long COVID? We don’t have an answer to that yet. There’s no reason to suggest that there would be a difference but we do know there was two studies that came out recently looking at vaccination and that vaccination reduces the risk of developing long COVID, and that’s really great. That’s really great news to see that come out.

Another reason. Number one, avoid infection in the first place but, number two, to really get vaccinated when it is your turn. So, I just wanted to mention that and we have a number of consultations that are coming up in a long series of consultations on post-COVID condition to specifically look at this even further.

00:26:07

But, post-COVID condition is real and we are working to make sure that it is recognised in countries, that patients get the care that they need for the long-term, and this is something that I think many have just started to recognise, more so than they did in the past, but it is something that needs significant amounts of attention because for any future scenario of this virus, any future variants post-COVID condition will be part of our future and it is something we really need to invest in right now.

AK          Thank you, Maria. I have just a follow-up question. Maybe if we have the data to put into context for people. When you said we know Omicron is more transmissible than Delta and now its sub-lineage BA.2 is even more transmissible, what do we mean by that? Do we have any average numbers?

MK         That is a good question. Why it is more transmissible has to do with a couple of different factors. One, we look at the actual mutations in the variant, itself. So, if we compare Omicron, the original. I shouldn’t say the original because it’s not like it is new and improved but if we look at when it was first detected, it was this BA.1.1.529, which is reclassified as BA.1.

If we look at those mutations compared to what are in Delta, some of the mutations that we see in Omicron suggest or confer easier entry into the human cells, the virus can get into the human cell easier and it can replicate easier. That’s an example. The other thing that we’ve seen with Omicron that’s very different from Delta is that we have what we call immune escape, which means that there’s less protection. It doesn’t mean that they don’t work but there’s less protection from vaccination or from past infection.

00:27:53

I should use this as an opportunity to say, which I didn’t say in my last answer, is that the vaccines, the COVID-19 vaccines remain incredibly effective at preventing hospitalisation and preventing deaths, including against Omicron BA.1 and BA.2. This is important because we do hear people say, well, why bother get vaccinated? Because it can save your life and I think that’s really, really important, which is why we’re still fighting so hard for vaccine equity around the world.

But, increased transmissibility has to do with the mutations, themselves, and also what we know as immune escape. So, this is something that we are looking for into the future variants and what may happen, if we will have more transmissible variants, which is likely, but we’re also worried about the potential for variants that will have further immune escape, which would mean that the risk of reinfection or the risk of breakthrough infection could be higher into the future.

AK          Thank you, Maria. There is a question, as well, from one of our viewers on Facebook. Is Delta still effectively circulating?

MK         Delta is still circulating in a number of countries but it is being quickly replaced by Omicron. So, it depends on where you live. There are beautiful maps that are in our weekly SITREP but also on platforms like GISAID. On the website of GISAID, the Nextstrain group has done these beautiful maps basically outlining which variants are circulating where.

00:29:19

Within our SITREP there is a map that actually shows where Delta is circulating or where it is being detected, I should say, compared to Omicron but what we can say is that Omicron is rapidly replacing Delta. So, wherever you live, your way of keeping safe, it doesn’t actually matter which variant is circulating. That’s the beauty of the layered approach to protection, the layered approach to preventing infection and preventing the onward spread.

Get vaccinated. Know your risk. Lower your risk in the area where you live. Wear a mask, a well-fitting mask over your nose and mouth with clean hands. Keep your distance. Improve the ventilation. Open the windows. Have good cross-ventilation when you’re indoors. Certainly, wear a mask when you’re indoors. Avoid crowed spaces. Be careful right now, and that shouldn’t matter if it is Delta or if it is Omicron.

MR         We talk about us, here, in WHO. We’re not wearing masks here because we’re suitably distanced but every other place in the building we’re still wearing masks. We still have a reduced number of people in the building and a requirement for vaccination to enter and work in the building.

We had to make special arrangements during the Executive Board a couple of weeks ago with extra testing for everyone, including ourselves, because we had guests coming to our house in a sense, to the WHO house.

00:30:41

This is about taking appropriate adequate measures, looking at each risk. The risk changes in this building from day-to-day because it changes depending on how many people are in the building.

We increase and decrease our level of vigilance depending on the risks that we perceive and that’s all you can do anywhere. It’s the same in a household, it’s the same in a workplace, it’s the same in a hospital. So, that ability to be able to continue to reduce the risk of transmission in these settings.

Even when everybody comes back to work and everyone goes back to social life we’re going to have to look at what might have to be, at least for the foreseeable future, some sustained personal behaviours. For example, as countries lift a requirement for something, they’re replacing that requirement with public health guidance. So, they’re saying it is no longer required to make a mask but our guidance would suggest that you should wear a mask on public transport.

Now, I would ask you, in that sense it is very contextual. The rules of the road say you should drive at 50 kilometres inside the city limits. That’s a general rule, that’s an important rule and if you exceed that, you break the rules. But, if there are people crossing over the street on some kind of a party or a march, you don’t say I’m not allowed to drive at 50 kilometres down the street. You reduce your speed because you can see the local risk has increased. The risk of something bad happening has increased.

00:32:12

I think it’s the same when it comes to these issues. I think for the foreseeable future, certainly in my own case, if I’m going to be in the workplace setting or whatever I’m very comfortable to continue wearing a mask in order to protect myself and protect others but I’m also recognising we have to have meetings and we have to do the things we have to do and we have to travel.

I’m travelling tomorrow. I’m going to a conference. That wouldn’t have happened six months but I just came back with my PCR test before I travel and be masked all the way and have your vaccination cert. So, that’s the idea, that each and every person needs to say, look, I really don’t want to get infected because I don’t want to be sick myself. I don’t want the risk of dying. I don’t want to infect somebody else. I don’t want to get long COVID.

So, how can I reduce those risks? Even if the government says it’s not mandatory anymore, how can I continue to, as Maria said, wear a mask in certain setting, ensure there’s good ventilation inside, avoid going into massively crowded environments where you know that local transmission is occurring? Managing ventilation inside in a way that allows you to disperse aerosols.

To me that’s just about being smart, in the same way you’re smart when you drive on the road. You’re not just driving by the rules, you’re driving by what you see and you adjust your behaviour on the road to be safe for yourself, your family that you’re carrying and other people on the road. It’s being courteous and being safe. That doesn’t require one to say, well, the rules say this, therefore I’m allowed to do everything up to the rules.

00:33:45

That’s not the way we live our lives. We live our lives by actually respecting the rules but then looking at our individual situation and then trying to adapt and reduce our risks to something we can manage ourselves and we feel comfortable with.

We do recognise this desire to open up, this desire to go back to normal but if that desire to go back to completely normal, in that sense, is going to sustain this pandemic going forward for much longer than it needs to be, then we really need to think about that.

I do think that some situations, the political pressure now to open up and remove all restrictions of all kinds is so high that we may overshoot the runway and we may end up in a situation. Again, I’m acknowledging uncertainty. I’m not sure that will happen and I’m not predicting that will happen but I’m a bit nervous right now that we’re just lifting everything.

If we get hit with another variant and we’ve already abandoned all measures, it’s going to be really hard to put anything back in place. So, I would just, as Maria has said, ask every individual just to look at your situation, reduce your risk of being infected, reduce your chance of infecting someone else, be smart, protect yourself, protect others, get vaccinated and just be safe and be careful.

If we all do that, if everyone does that a little bit then the overall risks decrease but this idea that we’re just going to abandon everything, I think is a very premature concept in many countries right now.

00:35:23

AK          Thank you, Mike. Actually, this was the next question I wanted to pass on to you because several of our viewers sent similar questions about lifting measures, sharing their anxiety about it given the epidemiological situation and some of them are asking what is WHO doing in this situation. We are seeing what’s the situation but we also see countries lifting measures. So, how are we doing to support them or to support people to do the right thing?

MR         It is kind of the way we came into it too. We have never, as WHO, ever advocated for these stringent measures and massive lockdowns. We’ve always talked about calibrated, adapted measures to the situation we’re in and using the minimum measures necessary to do the maximum suppression of the disease.

As we went into this pandemic and through this pandemic, we’ve always advised that those measures be adapted to the situation and we’ve seen countries do very well, particularly in the Western Pacific and in Asia, being able to raise the level of measures sequentially and then reduce them sequentially.

So, we’re not saying that countries don’t have right to begin reducing measures. What we’d like to see is a step by step approach, a calibrated approach that still looks at the data, looks at the epidemiology, looks at how the health system is doing and then slowly comes down the mountain, step by step.

00:36:44

I said this way back, I think a year and half ago. You’re much likelier to fall when you’re running down a mountain than when you’re trying to climb it and the problem is everyone is trying to run down the mountain. The danger with that is you can fall.

I would hate people to go away from this conversation or other conversations and say, oh, WHO, why are you saying this? You’re scaring everyone. This is just all about keeping the focus on the pandemic. Someone said to me the other day, oh, it’s because you people in health and the doctors and WHO just want to control the world. This is your big thing and you’re going to hang on to this.

I want this thing to go away so bad, and I mean so bad. I’ve seen my kids five times in two years. I don’t see my family because they live in another country. Many of us in the UN system, we live away from our home countries. We’ve been deeply affected by this. We’ve seen our friends sick. We’ve seen our friends die.

We’ve seen and experienced that with the world and we’ve watched those numbers every day and the horror of those numbers some days was almost too much to bear. So, we want this to go away and we want to go back to being normal but we have to be just careful, step-by-step.

It’s not to criticise counties who are trying to step away. There are many countries taking a very measured approach and they’re trying to do it step-by-step, balancing the risk of the disease against the economic and social damage that restrictions do.

00:38:14

Finding that balance is not easy. If was easy then it would be all done and we’d be fine. It’s not easy. It’s influenced by so many factors. So, I’m not here to criticise countries, I’m just here to say just ripping restrictions away without any other plan, to me seems, at the moment, in the current uncertainty we face, just to be ill-advised and we need to think it through. Even if governments do that, Maria has said it, individuals then need to take their own action to protect themselves, protect their families and ensure that they stay safe.

MK         Can I give an example?

AK          Please.

MK         As Mike has said, what we’ve tried to do is support governments in making the most tailored, agile response that they can based on the context that they’re in, the transmission, the capacities that they have, the trust of their people, their population level immunity, so many different factors, and that needs to be adjusted and calibrated regularly.

The problem is that we’ve seen too many countries lift all and then put it all back in and lift it all and put it back in, whereas other countries have really done this slow, step-wise approach and what we’re seeing right now, we hear in the news countries that are lifting everything. In some countries they’re in a better position to be able to do that because they have high levels of vaccination coverage, high levels of population level immunity and they have the ability to adjust but in many countries it is ill-advised to lift everything all at once.

00:39:48

But, what we’re also seeing in many countries, and this doesn’t receive as much attention, is that there are many countries that are doing this lifting slowly. For example, we’ve seen some countries that are lifting the requirement to wear a mask outside, at the same time saying continue to wear a mask indoors. That’s taking a bit of nuanced approach to not say all or nothing, wear a mask or not wear a mask.

We’re also seeing some countries that are changing their recommendations about requiring people to work at home versus coming in and, again, doing that in a step-wise manner. We’ve seen some countries that have actually made investments in ventilation, whereas others have said that but have actually taken no steps to improve ventilation.

So, there’s a lot of countries that are lifting and adjusting slowly but this is really important, this whole layered approach, this Swiss cheese approach, if you will. If you take everything away, this virus will take an opportunity to spread and, in particular, if you have populations that are not well-protected, it will thrive and this is what we have seen with all these variants.

Given the incredible intensity of spread of Omicron, it’s really astounding how many cases we are actually detecting versus how many we actually know that are out there.  We have some seroprevalence estimates that have come out that suggest that there are far more cases that have been unrecognised by current surveillance systems.

00:41:13

We just need to have countries do this all or nothing approach because it’s confusing and I don’t blame anyone that’s out there that is confused. I do want to also recognise, I do understand the frustration by individuals to say, well, I don’t have the backing of the government and you’re saying, well, it’s now my responsibility.

But, what is important for you to hear out there, which I hope is empowering, is that you have some control over this. There are masks that are readily available. They need to be worn, not on your ear, not under your chin but over your nose and mouth. And, there are different quality masks. Get your hands on the best quality mask that you can, wear it properly, wear it indoors, wear it when you’re around others with clean hands. Get vaccinated and just be careful.

AK          Thank you, Maria. Here’s a question from Julianne. Won’t there always be variants, so what’s the way forward?

MK         There will.

MR         There will always be variants and that’s the issue with coronavirus, in general. Coronavirus are a whole family and they exist in many different forms. This particular one, SARS-CoV-2, has many variations and it will continue to evolve. That’s the way of viruses. The microbes may be around for a lot longer than we are as a species. They’re extremely adapted to survive and they will continue to do that.

00:42:35

Again, both myself and Maria have said this for many, many months, more than a year now, that the virus won’t disappear. That opportunity is not there. What we’re trying to end here is the public health emergency associated with that virus and getting to a point where enough people are protected by full vaccination, where we have strong clinical management, as Maria said.

Point of care diagnostics where someone going to the family physician with a cough or a fever can be diagnosed on the spot for COVID-19 or flu because we’re developing a diagnostic test that can distinguish between the two. That that person, if they’re over 65 or if they have an underlying condition, could immediately, regardless of vaccination history, be placed on antivirals.

So, you can get to a point where this becomes a normal thing. Before the 1940s, if you got pneumonia or you got a bad wound infection you died and millions of people died. My great-grandfather died of blood poisoning from cutting himself shaving and he got a bacterial infection of his blood and he died. A young man. I think he was in his 30s. That would have been a quick trip to the GP and an oral antibiotic.

The bugs didn’t change in the 50 years, what changed was the intervention. We now have diseases that would have killed us 50-60 years ago but we have vaccines to prevent them, we have drugs to treat them, we have measures to prevent them. I think that’s where we need to think about, not let’s get rid of the virus. Let’s get to a place where we have the vaccines and we have the treatments and we have the means to normalise this, turn this into any other pathogen, turn this into just another bug that we can manage and we can deal with.

00:44:29

Within that, we have an opportunity and we had a huge meeting a couple of weeks ago, under the Research and Development Blueprint for Epidemics, looking at vaccines that would cover a broad range of coronaviruses and SARS viruses and beyond. So, we may get to a point where we can get vaccines that will cover a wide range of variants, a wide range of SARS-CoV viruses and a wider range of coronaviruses in general and we may get to a point where we get broad spectrum antivirals, antivirals that work against multiple viruses. That’s down the line but it’s something we need to be looking at for the future.

But, right now, we have the means to bring this disease to a position where we have it under control in terms of the damage it does in our society to our loved ones, to our economy and to our healthcare system and we have the means to deliver. This is the issue. We have the vaccines, we now have antivirals, we have diagnostics, when in the past it took years in HIV to develop the antivirals, to develop the diagnostic tests at point of care.

It’s a huge triumph. The HIV community are pathfinders in the world around integrating diagnostics and clinical care at the primary healthcare level and bringing justice and equity. It took years and it took a massive fight on behalf of that community to get that justice.

00:45:50

We’re still behind the curve with the equity but we’re faster than we were the last time. I’m not saying that’s success, it’s not, but we are getting to the point where we have those vaccines going out all over the world, we have that ability to bring diagnostics everywhere.

We have the ability, if we’re smart, to bring the antivirals everywhere but we have to use them smartly. We need to make sure the antivirals go to those who most need them. This is about putting a system in place in which we all feel safe again and I actually think we have the tools to do that.

MK         We do.

MR         We have. It’s just about implementing them in systematic way and not looking for that on/off button, as you said. Not saying it’s on, it’s off, it’s a pandemic, it’s not. These ideas, these false dichotomies have killed us in this pandemic, ideologic, dichotomous things.

We have more than we think we have and people should not lose heart. We’re not saying here just because the cases are high or we’re getting variants that it is terrible, it is just like it was a year and a half ago. It’s not. We have so much more. Science has triumphed, developed vaccines, antivirals, diagnostics.

We know this virus better probably than any virus in history. There’s been more research done on this virus than probably any virus in history. We’ve clearly demonstrated that the human intellect and human ingenuity can triumph but what we haven’t done is delivered those interventions properly, either though lack of equity in their development and distribution or through the hesitancy we see in people wanting to use those interventions. So, we still have a ways to go.

00:47:24

I do see us getting out of this. I do see variants will continue to emerge but we need to reach a point where ordinary people can get on with their lives and they need to then think, yes, scientists and the doctors and the health system, we’ve got this. We’ve got the drugs, we’ve got the vaccines and we can get back to our normal lives, but we may have to sustain a higher level of vigilance for longer than we expected.

So, we may have to wear masks in certain situations for longer than we expected. We may have to keep the windows open for longer than we expected and we may need to invest in the longer-term in looking to the future and say when the next pandemic occurs, are we going to be a in position to do these things quicker?

Are we going to make sure that our indoor spaces are better ventilated, as a rule? Are we going to have the ability to distribute masks in a respiratory virus event? Are we going to be able to deliver protective equipment to health workers more quickly? So, there’s an awful lot we can fix in advance of any further event and there’s a lot we can fix before this one ends.

00:48:28

AK          Thank you, Mike. I think I need to ask you three more questions before we close. One is a direct follow-up from Angela, watching us on LinkedIn. What are the ways that we can encourage people to take personal responsibility once governments lift mandates when there is so much misinformation that is circulating about the effectiveness of vaccines and masks?

MK         It’s a great question and I think she’s also almost answered that in her question. It’s about information and it’s about good information. Information is power, information saves lives, but it needs to be good information and unfortunately, as we all know, there’s huge amounts of disinformation, misinformation and critically disinformation on purpose circulating and misinformation circulates a lot faster than even these viruses do.

So, it’s about knowing how to keep yourself safe and passing good information to others. I think when we look at our social media, we tend to be in certain bubbles within that and people if they, unfortunately, are being fed a lot of misinformation. It’s very strong, it’s very powerful, it looks very reliable.

Go to good sources of information. You can always come to WHO for good information. We have a lot of information on our web, on our social media about how to keep yourself safe and that’s about advice to the public. We give advice to ministries but we also give advice to the public. But, also in your own home countries, there’s good sources of information from national governments or from medical institutions, from your doctor. So, it’s about getting that information.

00:50:09

We can say without question, and I think you hear the frustration in our voices, because we know there are so many tools that can save people’s lives, they’re just not being used most effectively. So, as an individual, we can say what will keep you safe is getting vaccinated.

COVID-19 vaccines are incredibly safe and effective at preventing you from getting very sick and preventing you from dying, so that’s first and foremost, and there are studies upon studies that evaluate these vaccines to make sure that they’re safe. It’s not just my opinion about the vaccines or Mike’s opinion about the vaccines.

These come from studies. These come from a really rigorous process to get this information to you, to get them developed and get them used. But, we also need to make sure that these vaccines are accessible to everybody around the world.

Masks work. We know that masks work, not just a piece of fabric, although that is better, that’s a barrier. But, what we would like to see is three-layer masks that are used, that have a certain amount of filtration, a certain amount of breathability. And, you can look at the quality of the mask where you purchase it and you can even make masks at home. We’ve outlined different ways those can be made, the best masks can be made.

00:51:22

Clean your hands. It’s one of the ways that is important to reduce the spread of pathogens, of bugs, one of which is SARS-CoV-2. You can keep your distance from others and avoid crowded spaces. You can make sure that you ventilate rooms that you are in. These are things that will reduce the amount of virus that is around you and that’s really, really critical.

So, it is hard to navigate the information that is out there but go to trusted sources. You can always come to WHO.int, you can go to our social media channels. We are working with all of the different platforms, you can answer this, Aleks, too, all of the Googles and Facebooks and the platforms that are out there to make sure that the right information is available to people because information is an additional tool.

Masks are a tool, vaccines are a tool, distancing, hand hygiene, all of that is a tool but information is one of the most critical pieces of power that you can have to keep you safe.

AK          Thank you, Maria. As we are running out of time, maybe Mike you can take it. Lee Kumar is asking or saying the first and the second or third vaccine composition or doses, I believe that’s the thinking, is the same. Does it truly help to repeat these types of vaccines? Also, there a few questions about any plans to change the composition of the vaccine. We having a Research and Development Forum next week, so I thought maybe you can answer this question.

MR         I will pass that second bit to Maria because she would have attended the TAG-CO-VAC meeting I think today or yesterday.

MK         Today.

00:52:58

MR         Today. We have a special advisory group that is looking at vaccine composition for the future, so Maria can speak to that. But, in terms of the value of vaccination, in terms of having a booster or a third primary shot, there is a lot of evidence to suggest and we’ve seen the same with people who have a natural infection followed by vaccination, that you go get a boost in your antibody levels after you get another shot but there’s probably a limited value to how many times you do that and get a benefit. Just the level of antibodies doesn’t necessarily indicate how much protection you have.

What often happens though and the benefit that may come from extending the course, for example, in an older person who may be immunocompromised with underlying conditions, they may not generate a fully mature immune response after one first and second dose.

It’s not that their immunity wanes, per se, it’s that their immunity never develops to the level it should have been in the first place. So, in a sense, when they get a third dose, it’s not like a booster, it’s almost like a third primary dose. They needed three doses to get the same level as a 22-year-old gets to with two doses.

What every often happens, too, within the immune system, I don’t want to go into all of the details here, we’ll bore people to death, but the immune response matures. It is like a good olive, a good wine or whatever it may be. But, there’s a process that over time and with restimulation, either by natural infection or by another vaccine, the immune system doesn’t just generate more antibodies, it actually matures in the response.

00:54:46

It’s like the difference between short-term memory and long-term memory. You start to generate longer-term memory and a more mature long-term memory for that virus in the system because what the system is essentially doing is thinking hang on because in some sense your immune system doesn’t know whether you’ve been infected by the virus or the vaccine. It’s reacting to the presence of that antigen in your body.

What the immune system is probably doing is there are hundreds of millions of pathogens out there but it tends to prioritise the ones that keep showing up. So, in effect, when you get your first dose and your second dose or maybe your third dose, your immune system starts to say, in a sense, hang on, this thing has come back a few times now. I need a more long-term mature ability to detect this type of virus every time and quickly, and you end up getting a much better cell-mediated T cell response that gives you a longer and broader protection against that virus and possibly a wider range of variants that may emerge as well. It’s a maturation thing.

So, there is a benefit but then there’s a point at which you get probably no benefit from that at all. At the moment, if you’re an otherwise healthy person and you’ve had two doses of an effective vaccine you are, as Maria said, very well-protected again severe disease, hospitalisation or death.

If you’re an older person or someone with an underlying condition, the data clearly shows that there is a benefit to having that third dose, if it is a two-dose vaccine, and that booster restores your immunity or boosts your immunity to a point where it is adequate, so there is a value in having that.

00:56:30

But, our main objective at WHO is to get everyone in the world, that 70%, to be two-dose fully vaccinated. We have the prospect and we have the work ongoing and we have a whole scientific group looking at the issue of broader spectrum, second and third generation vaccines that will provide broader protection and longer protection.

We’ve groups looking at nasal vaccines, vaccines that could actually give you immunity on the linings of the respiratory system, which would actually prevent the virus getting in in the first place, and that has certain advantages. Everyone out there has had an oral polio vaccine but everyone out there has probably had an injected vaccine as well.

And, you say, well, why do we have an oral vaccine and why do we have an injectable vaccine? Well, we have because those two vaccines do different things. When you take an oral polio vaccine, you get the immunity in your gut that prevents the virus coming in and being further excreted by you.

In the same way, if we had potential nasal vaccines, they may prevent us getting infected in the first place and then generating virus in our noses and our upper respiratory pathways or lower respiratory pathways and then coughing or sneezing or contaminating others.

00:57:39

So, there’s a huge prospect for us to take that to the next level but I think, going back to your point, Maria, there’s very clear evidence that getting that primary course, that two doses of vaccine and then, in certain cases, that third dose as a booster in certain individuals does give very high levels of protection. But, I’ll let you speak to the TAG-CO-VAC and the composition.

MK         I’m just listening to Mike talk and I think science is just so interesting. It was International Day of Women and Girls in Science recently and I hope that there are women and girls and young people around the world listening to this and getting inspired by science because science is pretty cool. It is complex and it takes a lot of study but there is so much opportunity and advancement in the development of vaccines, understanding the immune response.

But, to answer the question, we are closely, closely looking at vaccine performance and we are looking at that in the context of the evolving virus of Omicron or what the next one may be, and we’re looking at the individual mutations. In this context, we means experts around the world, thousands of experts around the world looking at these individual mutations in the spike protein and outside the spike protein and what that means.

And can we even be predictive in a way of saying if we saw this then maybe we want a vaccine to counter that. But, we’re looking at this and our Technical Advisory Group for Vaccine Composition is very carefully looking at the data that’s available on Omicron and, in particular, BA.1 and BA.2.

Data is coming in daily in terms of our understanding. Again, they’re holding up incredibly well against severe disease and death but what they’re looking at is if a change needs to be made in vaccine composition and this certainly may be the case because we’re entering the third year of pandemic. We’ve had hundreds of millions of infections, if not billions of infections so far, if we look at serology.

00:59:35

This will likely need to have an update in terms of vaccine composition but it needs to be done based on data and it needs to be done on a global level and that we don’t have individuals making decisions around this.

So, this group, this Technical Advisory Group on Vaccine Composition meets regularly and looks at what information they need and, should there need to be a change, they will make a recommendation on what that change needs to be and they will communicate that openly with all the manufacturers, and they’re working with manufacturers, they’re working with regulators, they’re working with…