COVID-19, Ukraine & Other Global Health Emergencies Virtual Press conference transcript - 16 March 2022

Overview

00:00:58

CL          Hello and welcome to WHO. It is Wednesday, 16 March 2022, and you’re joined for today’s virtual press conference on COVID-19, the war in Ukraine, and other global health emergencies. We have simultaneous interpretation available in six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, as well as Portuguese and Hindi.

Now, let me introduce the quite strong panel today. First and foremost, we have Dr Tedros Adhanom Ghebreyesus, WHO Director-General, and Dr Mike Ryan, Executive Director for WHO’s Health Emergencies Programme. On the more COVID side, we have Dr Maria Van Kerkhove, Technical Lead on COVID-19. Dr Bruce Aylward will join us shortly. He’s Senior Advisor to the Director-General and the Lead on the ACT Accelerator. We have Dr Kate O’Brien, Director of Immunisation, Vaccines and Biologicals.

00:01:56

On the health emergencies for Ukraine we have Dr Socé Fall, Assistant Director-General for the Emergencies Response, Dr Adelheid Marschang, Senior Emergency Officer at the Emergencies Programme, and Dr Flavio Salio, he’s the Network Lead for the Emergency Medical Teams, the EMT Network Leader at WHO. Last but not least, joining us remotely is Dr Mariângela Simão, Assistant Director-General for Access to Medicines and Health Products. With this, again welcome, and let me hand to the Director-General for the opening remarks.

TAG        Thank you. Thank you, Christian. Good morning, good afternoon and good evening. After several weeks of declines, reported cases of COVID-19 are once again increasing globally, especially in parts of Asia. These increases are occurring despite reductions in testing in some countries, which means the cases we are seeing are just the tip of the iceberg, and we know that when cases increase, so do deaths.

Continued local outbreaks and surges are to be expected, particularly in areas where measures to prevent transmission have been lifted. However, there are unacceptably high levels of mortality in many countries, especially where vaccination levels are low among susceptible populations. Each country is facing a different situation with different challenges but the pandemic is not over. I repeat, the pandemic is not over.

00:03:52

We call on all countries to remain vigilant, continue to vaccinate, test, sequence, provide early care for patients, and apply common-sense public health measures to protect health workers and the public.  We continue to call on everyone to be vaccinated, where vaccines are available, and we continue to work night and day to expand access to vaccines everywhere.

Now, to Ukraine. WHO’s priority remains to support health workers and the health system to continue to provide care to meet immediate health needs.  We have now established supply lines to many cities of Ukraine but challenges with access remain.

So far, we have sent about 100 metric tonnes of supplies, including oxygen, insulin, surgical supplies, anaesthetics, and blood transfusion kits.  Other equipment, including oxygen generators, electrical generators, defibrillators and more have also been delivered and we are preparing to send a further 108 metric tonnes.

We are coordinating the deployment of 20 Emergency Medical Teams of experts from many countries, pending a formal request for assistance from Ukraine’s Ministry of Health, and we have opened a field office in Poland to support our operations in Ukraine and to coordinate the response to the health needs of refugees.

00:05:35

But, we are facing financial constraints in our ability to deliver the support needed. So far, WHO has received just eight million US dollars of our appeal for $57.5 million. Huge amounts of money are being spent on weapons. We ask donors to invest in ensuring that civilians in Ukraine and refugees receive the care they need.

And we continue to call for attacks on healthcare to stop. More than 300 health facilities are along conflict lines or in areas that Russia now controls and a further 600 facilities are within ten kilometres of the conflict line. Since the beginning of the war in Ukraine, WHO has verified 43 attacks on healthcare. WHO condemns all attacks on healthcare, wherever they occur.

Tragically, Ukraine is not the only place where patients, health workers, facilities, infrastructure and supply are under attack.  2022 is only 75 days old but already WHO has verified 89 attacks on healthcare around the world, in Afghanistan, Burkina Faso, the Democratic Republic of the Congo, Libya, Nigeria, the occupied Palestinian territory, Sudan, the Syrian Arab Republic, and, of course, Ukraine.

Altogether, these attacks have injured 53 people and killed 35, including health workers. That includes eight polio health workers who were killed in Afghanistan last month. Attacks on healthcare not only endanger lives, they deprive people of urgently needed care and break already strained health systems.

Although Ukraine is the focus of the world’s attention, it is far from the only crisis to which WHO is responding.  In Yemen, roughly two-thirds of the population, more than 20 million people, are estimated to be in need of health assistance. In Afghanistan, more than half the population is in need, with widespread malnutrition and a surge in measles, among many other challenges.

00:08:20

And, in Ethiopia, 6 million people in Tigray have been under blockade by Ethiopian and Eritrean forces for almost 500 days, sealed off from the outside world. There is almost no fuel, no cash and no communications. No food aid has been delivered since the middle of December. 83% of the population is food insecure. Our partners are running out of what little food they have and the fuel to transport it.

About three-quarters of health facilities assessed by WHO have been damaged or destroyed. In February, WHO airlifted more than 33 metric tonnes of medicines and other supplies to Tigray, enough for 300,000 people, the first time we have been able to deliver supplies since July last year.

In the past two weeks, WHO and our partners have distributed supplies to 65 health facilities in Tigray, but much more is needed and we are now preparing to send an additional 95 metric tonnes of supplies, but no permission has been given yet.

We estimate that 2,200 metric tons of emergency health supplies are needed to respond to urgent health needs in Tigray. Only 117 metric tonnes have been delivered, less than 1% of what is needed, but with no fuel, even if we can get supplies in, getting them to where they need to go is very difficult, or impossible.

00:10:02

The humanitarian situation in the neighbouring Afar region also continues to deteriorate, with tens of thousands of people displaced and in need of food, shelter and health services. But, while the neighbouring regions of Afar and Amhara are also affected, we have had far better access to those two regions than we have in Tigray.

What’s the impact of all this? People are dying. There is no treatment for 46,000 people who need treatment for HIV and the programme has been abandoned. People with tuberculosis, hypertension, diabetes and cancer are also not being treated, and may have died.

As a result of the lack of fuel, some of our partners are having to scale back their operations. The situation in Tigray is catastrophic. The blockade on communications, including on journalists being able to report from Tigray, means it remains a forgotten crisis, out of sight and out of mind.

Yes, I am from Tigray, and this crisis affects me, my family and my friends very personally but, as the Director-General of WHO, I have a duty to protect and promote health wherever it is under threat and there is nowhere on earth where the health of millions of people is more under threat than in Tigray.

Just as we continue to call on Russia to make peace in Ukraine, so we continue to call on Ethiopia and Eritrea to end the blockade, the siege and allow safe access for humanitarian supplies and workers to save lives. Peace is the only solution in Ukraine, Yemen, Afghanistan, and Ethiopia. Christian, back to you.

00:12:21

CL          Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask questions, you need to raise your hand using the Raise your Hand icon on your screen, and do not forget to unmute yourself when called upon. We’ll start with Corinne Gretler, from Bloomberg. Corinne, please unmute yourself.

CG          Hi. Thank you. I’ve a question for Kate. I wanted to ask about Medicago’s COVID vaccine, Covifenz. I see that its EOI has not been accepted. Would you be able to help me understand what that means, exactly. Does that mean that Covifenz will not be considered for EUL evaluation at all?

Then, also why? Is that perhaps because of the tobacco link with Philip Morris, just because I know that there are some strict rules around tobacco cooperation with the FCTC or if there is another reason? I just want to understand what that means, basically, and whether Medicago can appeal that decision at all. And, sorry, just a super quick add-on. Has the war in Ukraine affected the WHO’s approval process of the Sputnik vaccine in any way? Thank you so much.

CL          Thank you very much, Corinne. I think we’ll first go to Dr Mariângela Simão, Assistant Director-General for Access to Medicines and Health Products. Mariângela, please go ahead.

00:14:00

MS         Thank you, Corinne, for the two questions, actually. First, on the Medicago. You know that Medicago has applied for an Emergency Use Listing by WHO but due to its connections, it is partially owned by Philip Morris International, the process is put on hold because it is well-known that WHO and UN have a very strict policy regarding engagement with the tobacco and arms industries. So, the process is put on hold. It is very likely that it won’t be accepted for Emergency Use Listing by WHO.

On the Sputnik, yes, we were supposed to go do inspections in Russia starting on 7 March and these inspections were postponed for a later date. So, the assessment and local inspections have been affected because of the situation and even the situation regarding flight options and also the financial issues related to support of credit cards and some more operational issues. This is being discussed with the Russian applicants and new dates will be set as soon as possible. Thank you.

CL          Thank you very much, Mariângela. The next question goes to Isabel Saco, from EFE. Isabel, please unmute yourself. Isabel, do you hear us? Please, unmute yourself. Yes, you’re good. Please, go ahead.

IS           Hello. Do you hear me?

CL          Yes, we do.

IS           Hello. Sorry.

CL          It seems like Isabel doesn’t hear us. We’ll give it a second to see if we can fix the connection. If not, then we’ll first go to Ashvin, from the Observer Times of India, and we’ll come to Isabel in a moment when you have fixed that. So, Ashvin, Observer Times, India. Please, unmute yourself.

00:16:36

AB          Thank you for considering my question. My question is, is cDNA microarray technology useful to get ideal vaccine characteristics for COVID-19 disease? Thank you.

CL          Ashvin, can you please repeat? We’re not sure we got the full question.

AB          Is cDNA microarray technology useful to get ideal vaccine characteristics for COVID-19 disease? Thank you.

CL          Thank you very much. I’ll go to Dr Kate O’Brien for a start, please.

KO         The question of the composition of vaccines and the technology to be able to determine that composition is still really an open matter for research and evaluation of vaccines. As you know, we have a number of different platforms of vaccines. Some of them are based on the virus itself, some of them are based on either RNA or DNA sequences of components of the virus. So, there’s no one technology that is the ideal technology or the critical way forward.

I think the important part of this is this is an area of science that has been evolving very, very quickly over the past year and importantly contributing not only to the development of very effective COVID vaccines but also deploying that technology towards other vaccines.

00:18:16

cDNA microarray technology is not something specific that we’re focused on as that particular technology. I really want to emphasise the range of options on vaccines. Those ones that have achieved WHO EUL have all delivered on the protection against especially the severe end of the disease spectrum. Thank you.

CL          Thank you very much, Dr O’Brien. We’ll try for a moment to come to Isabel Saco, from EFE. Isabel, let’s try again. Isabel, if you hear us, please unmute yourself.

IS           Yes. Shall I do it again?

CL          Yes, please go ahead. Sorry, we’ll have to cut that again and maybe try again later. In the meantime, we go to Manas Mishra, from Reuters. Manas, please unmute yourself.

MM        Thank you for taking my question. I’m just wondering what is causing the rise in infections again? Are we about to face a new wave?

CL          What is causing the rise in? We got it. Thank you very much. Dr Maria Van Kerkhove, please.

MK         Thanks for the question. It’s a combination of factors for which we’re seeing an increase in case detections again around the world. In the last week we saw an 8% increase in cases detected, with more than 11 million cases reported to WHO, and this is despite a significant reduction in testing that’s occurring worldwide.

00:20:01

So, it’s a combination of factors that is resulting in this increase. First, is we still have Omicron, which is transmitting at a very intense level around the world. We have sublineages of Omicron, BA.1 and BA.2. BA.2 is more transmissible than BA.1 even and this is the most transmissible variant we have seen of the SARS-CoV-2 virus to date.

In the context of lifting of public health and social measures, lifting of the use of masks, lifting of physical distancing, lifting of restrictions of limiting people’s movement, this will provide the virus an opportunity to spread. We have also incomplete vaccination coverage in many parts of the world and, in particular, among people who are at risk of developing severe disease.

And we have huge amounts of misinformation out there, the misinformation that Omicron is mild, misinformation that the pandemic is over, misinformation that this is the last variant that we will have to deal with. This is really causing a lot of confusion that’s out there.

So, we are seeing increases in case detection around the world for a number of reasons. These are the same factors that have been driving transmission of this virus since the beginning of the pandemic. We completely understand that the world needs to move on from COVID-19, wants to move on from COVID-19, but this virus spreads very efficiently between people and if we don’t have the right interventions on place, the virus will take opportunities to continue to spread, and the more the virus spreads, the more opportunities it has to change. So,  it’s a number of factors.

00:21:48

The good news is that we have the tools that can reduce the spread. We know that masking works. We know that physical distancing works. We know that vaccination saves lives. So, we need to continue, as the DG said in his speech just now and as the Director-General has been saying since the beginning of this pandemic, it’s about a layered approach and using these tools most effectively and making sure that we not only save lives with vaccination, earlier clinical care, good testing, but we also take measures to reduce the risk.

So, we are concerned that we’re starting to see an increase in case detection again and, again, it is within our control. We do have some power over being able to limit the spread and we really need to remain vigilant and do what we can, where we can, to reduce the spread.

MR         I will just maybe add to that point because I think when we look at these data and deep into them, when we look at the hospitalisations and deaths, again the overwhelming majority of people who are getting very sick and dying are vulnerable individuals, older individuals, people with underlying conditions who have not been vaccinated or have not received a full course of effective vaccines.

And we again need to restate the importance in every country. This is not just a North-South issue. Every single country needs to look again at vaccine levels in its most vulnerable, whether it’s using booster policies or not, and ensure at the very minimum that every individual who is vulnerable has two doses of effective vaccine and in situations where boosters are available and policy is in place, as well.

00:23:29

Because I think we’ll see this virus is still, as Maria said, very fit. It’s still moving around quite easily and, in the context of waning immunity and the fact that vaccines don’t work perfectly against infection, the likelihood is that this virus will echo around the world. It’ll be high in some parts and in sometimes it’ll move and be higher again. It’ll move to another area where immunity is waning.

The virus will pick up pockets of susceptibility and will survive in those pockets for months and months until another pocket of susceptibility opens up. This is how viruses work. They establish themselves within a community and they’ll move quickly to the next community if it is unprotected.

What can happen is if communities around a virus are well-protected, the virus can sustain itself even in small communities. It can stay there, it can rest there and then wait until susceptibility grows in other communities. We’ve seen this, I’m looking at Bruce, in polio, in other places.

So, I do think it’s very important that we recognise that the transmission of this disease will occur. It will wax and it will wane. It has not settled down into a purely seasonal or predictable pattern yet.

00:24:46

The idea that we’re through in the Northern Hemisphere now and we’ve got to wait till next winter, I think when we look at increasing rates, for example, of cases and deaths in the likes of the UK, I think we need to be very, very vigilant. We need to very cautious and we need to watch this very carefully and we need to focus on getting the most vulnerable appropriately vaccinated and we need to do that as quickly as possible in every country.

CL          Thank you very much, Dr Ryan. The next question goes to Lizzy Davies, from The Guardian. Lizzy, please unmute yourself.

LD          Hi. Thanks for taking my question. I’d like to know if you could give any more detail about the 43 attacks on healthcare in Ukraine, specifically what kind of establishments you’re talking about when you talk about healthcare? Where have most of the attacks taken place? Are you able to give any geographic information? And do you also have any information on how many healthcare workers in Ukraine have been injured or even killed in the same time period? Thank you.

CL          Thank you very much. We’ll start with Dr Socé Fall, Assistant Director-General for the Emergencies Programme, in response.

SF          Thank you very much, Christian. I believe that the attacks on the healthcare structures have been increasing day by day. It’s likely that by the end of today or by tomorrow there will be more and larger ones. The geographic distribution of them is varied. There are some of them occurring in zones that are under Russian control already and some that are not yet under Russian control.

00:26:43

The specific location matters less. The goal is to protect the population and to protect the health institutions, as well as the healthcare workers who must be protected. That is why we, without being able to say specifically who is behind these attacks, we feel that it is very important that all forces involved keep in mind the need to have working healthcare, particularly for the populations, for elderly, for example, who cannot travel or move about easily, and we must do everything we can to protect those vulnerable populations, those vulnerable groups. All parties must respect this international humanitarian law, which is to protect the healthcare workers and protect life. Thank you.

MR         Thank you, Socé. I think it’s imporant to reflect here and the DG referred to this, we’re only a very short part into this year and we have never seen globally, never seen this rate of attacks on healthcare. Health is becoming a target in these situaitons. It’s becoming part of the strategy and tactics of war. It is entirely, entirely unaccepable.

It is against international humanitarian law and, in fact, under international humanitarian law conflicting parties are actually instructed to specifically take measures to avoid attacking or inadvertently destroying or hurting health workers or health facilities.

They don’t bear a responsibiity to just not attack, they actually bear a responsibility to ensure that they don’t attack, to identify those facilities, to deconflict those facilities and to ensure that they do not, as part of their prosecution of war, attack those facilities. So, it is not only against international humanitarian law to carry out attacks like this, it is actually in the responsibility of all parties, and I might weigh all parties in conflict, to do so.

00:28:50

We are, as the DG again has said, working very hard with many partners to get emergency medical teams on the ground but how can we put emergency medical teams on the ground if the very facilities that they may want to go and support are going to be attacked and going to be bombed and going to suffer catastrophic damage?

This crisis is reaching a point where the health system in Ukraine is teetering on the brink. It is doing exceptionally well. It needs to be supported. It needs to be shored up. It needs to be given the basic tools to save lives. Part of that is deploying teams in to support that. But, how can you do that in all conscience if the very infrastructure that those people will go in to support is being under direct attack?

Flavio Salio is back from leading our EMT initiatives in Ukraine and maybe Flavio would like to comment on this but this issue is more imporant than bricks and mortar. This isn’t just about the destruction of buildings. This is about the destruction of hope. This is about taking away the very thing that gives people the reason to live, the fact that their families can be taken care of, that they can be cured if tehy’re sick, that they can be treated if they’re injured.

This is the most basic of human rights and it is being directly denied to people and we are then in a position where we can’t send assistance to those people becasue the very act of attacking those facilities or not taking care to avoid those facilities means we can’t sent the appropriate help when it’s needed. Flavio.

00:30:25

FS          Thanks, Dr Ryan. Yes, it becoming, for sure, a challenge to ensure the right level of support reaches facilities. We have been in touch with the hospitals requesting support, in particularly specialised care, where basically an external medical team can bring the added value and support the local sysem.

The challenge remains, obviously, safety of the staff, safety as well of the patients themselves. It has become, today, the most challenging point at this stage. There is, as well, a signficant component that includes evacuation of patients from the areas which are targeted, patients that obivously suffer from chronic conditions and do require support.

So, there is an ongoing evaluation of the system that can facilitate medical evacuation towards the borders and then, obviously, across facilities in Europe that will accommodate them. As a last point, I think maintaining the capacity through temporary facilities could be other options but is challenged by the element that Dr Ryan described in terms of the conflictions as well and ensuring that if you bring such kind of capacity, it is recognised by, obviously, the parties to the conflict. Thanks.

00:31:52

CL          Thanks very much, all, for these explanations. The next question goes to Sarah Newey, from The Telegraph. Sarah, please unmute yourself.

SN         Hi, there. Two quick questions, if that’s okay. Firstly, you’ve talked a lot about the risk of COVID spreading in Ukraine and other infectious diseases. Obviously, as Mike has just said, the health system is struggling but do you have any evidence of increasing COVID cases, or measles, or TB as people flee? Secondy, probably for Maria, could you just tell us a bit more about the global spread of BA.2 and is there any evidence that it is more severe or more likely to evade vaccines? Thank you.

CL          We’ll start with the emergencies question on Ukraine, on the diseases and the situation there. Dr Marschang, please.

AM         Thank you. We have stated prevoiusly that the COVID-19 surveillance system in Ukraine is holding, is strong, is detecting cases. We see at the same time that the testing has decreased. Still we have captured now, I think, something like more than 30,000 new cases and we’re trying to place that. If anything, it indicates an increase, this is something that we have suspected, but we also need to say there is a decreasing in access and capacity to deal with these cases.

We do understand that between 23 February to 8 March, there was a 22% decrease in the number of beds available with oxygen, for example, and a 20% decrease in the number of intensive beds when they are most needed for some of those health risks that we have pointed out previously, and that is trauma and injuries and an increase in acute conditions due to non-communicable diseases that we have already pointed out.

00:34:03

CL          Thank you very much, Dr Marschang. Dr Socé Fall, please.

SF          Thank you, Christian. Just to add one point on the risk of increased communicable diseases. It’s a real risk and there’s a risk of COVID-19 due to the movement of population and a low level of vaccination for two doses and the fact that people are gathering together, that increases the risk of COVID. The level of testing is very low currently and we will have to face that. If we combine that with the problem of providing oxygen for serious cases, it is really a recipe for disaster.

There’s also a risk for children, children who can’t receive their vaccinations for rubella or measles. There’s a risk of outbreaks. There’s a lack of access to potable water and then they face the risk of dysentery and other waterborne illnesses. There’s already a high number of patients being treated for HIV and tuberculosis. If their treatment is interrupted, it obviously worsens the risk of transmission and the antimicrobial resistence of diseases themselves. Thank you.

CL          Thank you very much, Dr Fall. We turn to the COVID part of the question from Dr Van Kerkhove.

MK         Thanks, Sarah, for the question about BA.2. In the last 30 days of the more than 400,000 sequences with sample dates, in the last 30 days, 99.9% of those have been Omicron and, among those, about 75% of those are BA.2 compared to BA.1. About 25% are BA.1. Let me say that again. Of the sequences that are available, about 75% are BA.2 and 25% of those are BA.1. All of these are Omicron and all of these are variants of concern.

00:36:20

We are seeing an increase in the proportion of BA.2 that is detected. However, the amount of testing that is happening worldwide, as we have mentioned previously, is dropping substantially. Our ability to track this virus, our ability to track BA.2 is compromised because testing is reduced and you can’t sequence those who you don’t test.

So, we need a very strong surveillance system around the world for COVID-19. Despite all of the challenges that we are facing, we still need to maintain testing, we still need to maintain robust sequencing and making sure that we have good geographic representation of the sequences that are shared so that we can really track this virus in real time.

We, as WHO, are working with literally thousands of public health professionals and scientists around the world to be able to track virus evolution and look at what these changes mean in terms of our ability to control the spread or reduce the spread, our ability to use tools effectively and, of course, to look at the use of vaccines.

We should say that COVID-19 vaccines remain incredibly effective at preventing severe disease and death, including against Omicron. You asked a question specifically about severity. We do know that Omicron is less severe compared to Delta. We do not see changes in severity of BA.2 compared to BA.1 at population levels.

00:37:51

However, with huge numbers of cases you will see an increase in hospitalisations and we’ve seen this in country after country. The sheer volume of cases that we have seen has really translated into increased hospitalisations and that, in turn, has translated into increased deaths.

What we can say when we look at deaths in countries around the world, as Mike pointed out earlier, as the DG has pointed out, the deaths are primarily occuring in people who are not vaccinated or people who have only had one dose of vaccine. So, it is absolutely critical that people receive vaccines around the world in all countries and, in particular, people who are at risk of developing severe disease.

If you look at some countries right now that are experiencing high amounts of mortality compared to previous waves, look at the proportion of those populations that have actually received the vaccines and look, in particular, how many above the age of 60, those who have underlying conditions, who have received vaccines, in fact in a lot of those countries that proportion is quite low.

So, it is really critical not just to vaccinate but to ensure that those who are at most risk receive the vaccines first because the vaccines are saving lives. We cannot stress this enough. It is really important that we keep up the systems that have been put in place for COVID for strong surveillance, strong testing, getting the patients into the clinical pathway early, increase vaccination.

00:39:25

It’s this layered approach that is really going to help us get a handle on COVID-19 and we have the power right now to take the death and devastation out of COVID, but we have to make sure that vaccines are received by all people and particularly those who are most at risk in all countries.

CL          Thank you very much, Dr Van Kerkhove. We managed to reach Isabel Saco, from EFE, in writing. As we’re already talking about BA.1 and BA.2, I’m going to read out the question she has on that. What do you know about the new supposed varient combining BA.1 and BA.2? Where has it been identified and is it a source of concern?

MK         I’ll take a stab at that question. I’m not aware of a combination of BA.1 and BA.2. You may be referring to the recombinant that we mentioned last week, which was a combination of AY.4, which is Delta, and BA.1, which is Omicron. That has been detected in three countries and it is a very low level of circulation, as we are aware, but not aware of a combination of BA.1 and BA.2. These are sublineages of Omicron. Again, BA.1 and BA.2 are Omicron and they are already classified as variants of concern.

MR         Can we we just add, so that is it not misunderstood, as well. Those sublineages can co-circulate. It’s not that there is a combined virus. What you have is multiple versions of the virus circulating at the same time and, depending on the situation, one can gain the upper hand over the other and it depends sometimes on just when it arrived.

00:41:06

So, for example, the predominance of BA.2 in many Asian countries, it may be that BA.2 emerged slightly later and has driven the ongoing  surge in Asia but there’s still BA.1, there’s still other variants and lineages causing disease. So, it’s not a combination of both, as in one virus, but a combined effect of both, when they’re both transmitting.

CL          Thank you very much. Both very important explanations. The next question goes to Bianca Rothier, from Globo, Brazil. Bianca, please unmute yourself.

BR         Hi, Christian. Thanks a lot for taking my question. In fact, it’s a follow-up on Isabel Saco’s question because Brazil said the country has now two cases of this Deltacron. They are calling it Deltacron. So, I’m not sure if I understood the answer because there they are saying that it is AY.4/BA.1. If you can explain better and if you have information about this. Thanks a lot.

CL          All right, let’s go and get an explanation from Dr Van Kerkhove.

MK         Thank you. This recombinant is a combination of AY.4, which is Delta, a sublineage of Delta, and BA.1, which is a sublineage of Omicron, and this redcombinant had been detected in a number of countries. I mentioned three countries and you’ve just mentioned Brazil.

Now, as we look more, as we do more sequencing, it is possible that his recombinant virus will be detected in other countries but is circulating, as we understand, at very low levels.

00:43:06

But, as I also mentioned, given our lack of testing and reduced testing around the world, we are at a disadvantage of being able to track this virus as effectively as we should, given the amount of testing that is possible at a global level, given the enhancements of sequencing that have occured in the last two years. So, it is really imporant that we maintain this.

We’ve mentioned prevoiusly that as this virus circulates, the more the virus circulates, the more opportunities it has to change. The possibility of recombinants has always been on the table and we are able to detect these recombinants now with good sequencing around the world. So, what I’ve mentioned and what you’ve mentioned is this recombinant of Delta and Omicron. We’re not calling this Deltacron, that is not terminology that we are using, but we have detected this variant.

MR         Maybe, just a way of explaining to people, what we very often see with viruses is a form of what is known as antigenic drift. In other words, a virus enters the human body and it effecively evolves. The virus that is transmitted on is slightly different because as the virus divides, as the virus reproduces itself, there are errors in reproducing its code. Most of those errors result in a virus that is either not competent or just dies away, and just occasionally that virus that’s passed on has an advantage in transmission or an advantage.

It’s just evolution in action. The same virus going into a body, coming out slightly different. That’s called drift and over time that can generate new variants over a long number of transmissions between hundreds and hundreds of different people.

00:44:52

Recombination occurs when two viruses infect the same person or the same animal and what you then have is not just errors in transcription, what you have is effectively two viruses can exchange large amounts of genetic information and you effectively get a new virus out the other end. Most of those viruses, because of the huge change in the code, are not viable, they’re not competent, they’re not very good at infecting the next human, but just occasionally they are.

That is how we generate pandemics of influenza, it’s through viral recombination. It’s called antigenic shift versus antigenic drift. Very often recombination is the way in which we get pandemics of influenza. So, we have to be very cautious, as Maria says.

We have to watch these recombinant events very, very closely and, again, we’re back to the argument. The best way to do that is to track the virus. The best way to do that is to ensure that people, number one, are vaccinated, that people who get the disease are treated and don’t have prolonged infections, and that we prevent and manage the reverse infection of large animal groups to allow that kind of recombination to happen. We can manage many of these risks but the risk will continue and there needs to be monitoring of that risk and it needs to go on for a very long time.

00:46:14

CL          Fantastic. I think there’s a clarification, maybe, on the question whether people can be infected with both variants at the same time.

MK         I think that was the clarification. It was not whether or not there was a recombinant of BA.1 and BA.2, it was whether or not people can be infected with two viruses at the same time. So, yes, thanks for that clarification and Mike clarified that, as well. Yes, there are viruses that are circulating, as we’ve said. We have BA.1 circulating, we have BA.2 circulating and, if you remember, even in Europe, when Omicron was first detected, we had huge amounts of Delta that were circulating. So, it is possible.

But, again, this is why we need to be able to test individuals. This is why we need to be able to continue to do this sequencing. We are still learning about this virus. We do not have all of the answers about this virus. What we do have answers to, we do have tools that can actually limit the spread and this is what people out there need to understand to be able to be empowered, to be able to do what they can to prevent yourself getting infected and to spread the virus to someone else, to get vaccinated when it is your turn and to fight for vaccine equity around the world.

CL          Thank you very much. Very important clarfications and explanations. Now, with this, we reached the end of our time today. I thank you all very much for your participation online and, of course, here in the room. We will be sending the audio file and Dr Tedros’ remarks right after the press conference, and the full transcript will again be posted on the WHO website tomorrow morning. For any follow-ups please write to Media Inquiries. Now, back to Dr Tedros for the closing remarks.

TAG        Thank you. Thank you, Christian, and thank you also to all members of the press who joined us today, and see you next time.

00:48:07

WHO Team
Department of Communications (DCO)