COVID-19, Ukraine & Other Global Health Emergencies Virtual Press conference transcript - 23 March 2022

Overview

00:01:02

CL          Hello and welcome to WHO and today’s virtual press conference on COVID-19, the war in Ukraine, and other global health emergencies. It is Wednesday, 23 March 2022. My name is Christian Lindmeier. We have simultaneous interpretation available today in the six official UN languages, plus Portuguese and Hindi.

Now, let me go to the panelists. First and foremost, Dr Tedros Adhanom Ghebreyesus, WHO Director-General. We have Dr Mike Ryan, Executive Director for the WHO Health Emergencies Programme. We have Dr Mariângela Simão, Assistant Director-General for Access to Medicines and Health Products. And online we’re joined for any other COVID topics by Dr Maria Van Kerkhove, Technical Lead on COVID-19, and Dr Kate O’Brien, Director for Immunisation, Vaccines and Biologicals.

00:02:00

For the emergency preparedness and for Ukraine, we do have Dr Socé Fall, Assistant Director-General for the Emergencies Response at WHO and we have Dr Dévora Kestel. She is Director for Mental Health and Substance Abuse in WHO. With this, over to Dr Tedros for the opening remarks.

TAG        Thank you. Thank you, Christian. Good morning, good afternoon and good evening. The global increase in COVID-19 cases continues, driven by large outbreaks in Asia and a fresh wave in Europe. Several countries are now seeing their highest death rates since the beginning of the pandemic. This reflects the speed with which Omicron spreads and the heightened risk of death for those who are not vaccinated, especially older people.

We all want to move on from the pandemic but, no matter how much we wish it away, this pandemic is not over. Until we reach high vaccination coverage in all countries, we will continue to face the risk of infections surging and new variants emerging that evade vaccines. Even as some high-income countries propose a second booster dose, one third of the world’s population remains unvaccinated.

But there are some promising signs of progress. In Nigeria, for example, vaccine uptake was dramatically increased when supply stabilised and planning was done on how to effectively distribute vaccines.

00:04:09

WHO’s target remains to vaccinate 70% of the population of every country by the middle of this year, with priority given to health workers, older people and other at-risk groups. Achieving that target is essential to save lives, prevent the risk of long COVID, protect health systems and increase population immunity.

Other tools, including testing, sequencing and contact tracing, also remain essential, and it’s vital that countries don’t abandon the capacities they have built over the past two years. WHO continues to support countries with the tools they need.

One of those tools is Go.Data, an application developed by WHO and partners for contact tracing and data management that helps responders track outbreaks in real-time. Go.Data is free, mobile-friendly, can be used offline and is easily adapted to different outbreaks and locations.

It was first used during outbreaks of Ebola in the Democratic Republic of the Congo and Uganda, and diphtheria in Bangladesh. When the pandemic struck, many countries realised that older contact tracing methods were not fit for purpose.

00:05:54

Today, 65 countries have used Go.Data. It's a good example of an aspect of the COVID response that will now strengthen health systems. For example, Brazil has used it for COVID and is now also using it to track measles.

Now, to Ukraine. It’s now one month since the Russian Federation invasion of Ukraine began. Almost ten million people, nearly a quarter of Ukraine’s population, have now been forcibly displaced. The humanitarian situation continues to deteriorate in many parts of the country and is critical in the Mariupol and Bucha districts.

The disruption to services and supplies throughout Ukraine is posing an extreme risk to people with cardiovascular disease, cancer, diabetes, HIV and TB, which are among the country’s leading causes of mortality. Displacement, poor shelter and overcrowded living conditions caused by the conflict are also increasing the risk of diseases such as measles, pneumonia and polio, as well as COVID-19.

So far, WHO has delivered about 150 metric tonnes of medical supplies. We have established supply lines from our warehouse in Lviv to many cities in Ukraine, but access to many parts of the country remains blocked. A humanitarian convoy to Mariupol was not able to be dispatched due to insecurity.

We continue facing serious cash-flow constraints in our ability to deliver life-saving support. So far, WHO has received just US$9.6 million against our appeal for $57.5 million over the next three months. We thank Norway, Switzerland and the UN Central Emergency Response Fund for their generosity, but we continue to face a huge funding gap that prevents us from delivering urgently needed medical supplies. We call on donors to quickly address these urgent needs.

00:08:47

WHO has now verified 64 attacks on healthcare since the start of the war, and we are in the process of verifying further attacks. Attacks on health must stop. Health systems, facilities and health workers are not, and should never be, a target. We also have concerns around the integrity and safe operation of nuclear and chemical facilities.

WHO is working with the International Atomic Energy Agency, IAEA, and we continue to call on all sides to minimise the risk of a nuclear or chemical accident which could have catastrophic consequences for human health. We continue to call on the Russian Federation to stop the war.

Although Ukraine is rightly the focus of the world’s attention, it’s important that we don’t lose sight of the many other crises in which people are suffering. Last week, I spoke about the humanitarian disaster in Tigray and that WHO was still waiting for permission to send an additional 95 metric tonnes of medical supplies.

Since then, permission has been granted. If we can deliver these supplies safely, they will help people in desperate need. But much more is needed. So far, only 4% of the needs for health supplies have been delivered to Tigray. That is insignificant.

00:10:41

The region has been under siege for almost 500 days, with dire shortages of fuel and food. People are starving to death. Actually, giving them food is more important than medicine. We continue to call on Ethiopia and Eritrea governments to end the blockade.

Earlier this week, I had the honour of attending the Guinea Worm Summit in Abu Dhabi. Although it’s largely unknown in high-income countries, Guinea worm has plagued people in Africa, the Middle East and Asia for millennia. But thanks to a partnership between WHO, the Carter Center and other partners, the eradication of this ancient disease is now within sight.

In the 1980s there were an estimated 3.5 million cases of Guinea worm disease globally. Last year, there were just 15 cases. Today, Guinea worm remains endemic in just five African countries. At the Guinea Worm Summit in Abu Dhabi this week, Ministers of Health from those countries came together to commit to taking the action needed to eradicate Guinea worm by 2030.

Finally, tomorrow is World TB Day. Tuberculosis kills more than 1.5 million people each year. Ending this debilitating disease remains a priority for WHO, and in recent years we have made encouraging progress. More than 66 million people received access to TB services since the year 2000.

However, the COVID-19 pandemic has led to disruptions that reversed years of progress and the war in Ukraine is also jeopardising progress in that country. For the first time in over a decade, WHO has reported an increase in TB deaths. This is a very dangerous trend that we must arrest. We call on all countries to invest in expanding access to effective tools against tuberculosis and in new tools to End TB. Christian, back to you.

00:13:49

CL          Thank you very much, Dr Tedros. Let me now open the floor to questions from the media and, as usual, to get into the queue to ask questions, you need to raise your hand by using the Raise Your Hand icon, and do not forget to unmute yourself when it is time. We’ll start with Simon Ateba, from Today News Africa. Simon, please go ahead and unmute yourself.

SA          Thank you for taking my question. This is Simon Ateba, with Today News Africa in Washington DC. Obviously, Ukraine is in a big mess right now. Ukrainians and foreigners are being bombed to death. The country is being destroyed by Russian troops and Africans there continue to face awful racism. I’m just wondering if, in trying to assist Ukraine, the WHO provide assistance to all people in Ukraine and in Poland regardless of the colour of their skin or where they come from. Thank you.

CL          I’ll start with Dr Mike Ryan, please.

MR         Hi, Simon. I think I can assure that that WHO looks to people’s needs, not to their ethnicity or to the colour of their skin. There has been a massive outpouring across many countries in Europe in receiving refugees and people fleeing this conflict and it is extremely important that we continue to remember that all persons on the move are fleeing violence and need to be treated equally and equitably in that process.

00:15:31

We’ve had, as an organisation, family members of our staff who had been trapped also in Ukraine and we’ve been looking out for them and ensuring that our staff members, their kids are students in Ukraine from both the Indian subcontinent and also from Africa, there were able to be dealt in a proper fashion.

So, it is very important that all countries remember that and their commitments under international humanitarian law, and I think that has been upheld. I don’t know, Dr Socé, if you want to speak to any specific measures on our side, but we will ensure that all persons in Ukraine and all persons and refugees who exit Ukraine are treated with absolute equality based on their need.

CL          Dr Socé Fall, please.

SF          Thank you, Simon. As the World Health Organization, we work across the globe to protect all the vulnerable populations in every continent. We have so many Africans working within this emergency programme and we never allow any discrimination of our actions.

We really work based on the needs of the population and, as Mike said, we have been working very closely with our regional offices, not only to assist the population of Ukraine but also a number of students from Africa and from other continents who have been stuck in Ukraine.

00:17:02

So, we will continue treating everybody as equal and we want all countries to do the same to make sure that we don’t have any discrimination when the refugees arrive in neighbouring countries. I think this is a basic and fundamental human right everybody needs to respect.

CL          Thank you very much, both. The next question goes to Belisa Godinho, from W Magazine in Portugal. Belisa, please unmute yourself. Belisa, do you hear us? If we can’t connect to Belisa for this moment, we’ll go to the next question. The next question goes to Giedre Peseckyte, and excuse me if I’m pronouncing this wrong, from Euractiv. Giedre, please unmute yourself.

GP          Hi. Thank you for taking my question. I have a question on COVID vaccinations for refugees fleeing Ukraine. As far as I know, there were seven vaccines that were authorised in Ukraine and five of them are used in the EU, they are authorised by EMA, but two of them, Covishield and CoronaVac, are not authorised.

I’m wondering if you know how many people are vaccinated in Ukraine with these two vaccines. And, for those who left Ukraine and are now in the EU or other neighbouring countries and they need a second dose or a booster, which vaccine should be used, as I assume it would be mix and match technology, so other vaccine platforms that it should be looked more.

CL          Thank you very much, Giedre. We’ll start with Dr Kate O’Brien, Director of Immunisation, Vaccines and Biologicals. She’s online now. Kate, please go ahead.

00:19:02

KO         Thanks so much for this question. First of all, the issue that you’ve raised is a really important one, which is that vulnerable people around the world and particularly those that are in particularly vulnerable circumstances, conflict settings, humanitarian emergencies, these are the highest priority groups to be fully vaccinated.

In Europe, we don’t have specific numbers on a product-by-product basis for individuals who have been vaccinated, but those immunisation records are available through the country systems and we’re working to assure that individuals can access those records. I think the important point is that the recommendations from WHO are allowing for and recommending, in fact, mix and match schedules as a perfectly acceptable means to assure full vaccination.

So, the availability of products across a number of different platforms allows for this real broad access for people to complete their vaccination schedules if they have already started and, if they haven’t started, the importance of getting started so they have protection, especially against severe disease and hospitalisation. And, of course, the countries in whom individuals are now taking refuge are providing access to those vaccines. Thank you.

CL          Thank you very much, Kate. It looks like Belisa has gone. We go to the next and that’s Ari Daniel, from NPR, National Public Radio. Ari, please unmute yourself.

00:20:51

AD          Hi, there. Thanks so much for taking my question and for this briefing, as always. I heard in the opening remarks that this the first time in over a decade that the WHO is reporting an increase in tuberculosis deaths. I’m curious to know was that tuberculosis or multidrug-resistant tuberculosis or a combination? I think that increase was attributed to COVID and the crisis in Ukraine, so I just wanted to confirm that. Then, also wondering just how much of an increase you’re seeing. Thank you so much.

CL          Thank you, Ari. Really good questions but I’m afraid we don’t have our TB experts with us today, so we have to take this offline and we’ll get back to you with our experts by email or another form afterwards. Sorry for that, Ari. And, Ari, in case you want to ask another question, please raise your hand again. But, for now, we go to Daniel Payne, from Politico. Daniel, please unmute yourself.

DP          Hi. Thank you so much for taking my question. A lot of countries, especially, and the United States, are worried about BA.2 as a new wave. I’m wondering if there’s any update there, whether this is going to a wave that sweeps the entire world, every country, or if it is going to be more on a case-by-case basis at this point.

CL          Thank you very much. We’ll got to Maria Van Kerkhove. She’s online. Maria, please go ahead.

MK         Hi. Can I just confirm you can hear me, Christian?

00:22:32

CL          Very well.

MK         Great. Thanks very much for the question. In fact, Omicron is sweeping the globe. It’s the latest variant of concern and the latest information that we have in terms of the sequences that are available, about 86% of the sequences that are available from the last four weeks are this BA.2 sublineage, the rest are BA.1.

We are seeing an increasing proportion of BA.2 being detected. However, we are seeing a lower number of sequences being reported to platforms like GISAID. So, it still remains absolutely critical that we have good surveillance worldwide, that we have strong testing, and that we have intelligent sequencing with good geographic representation around the world.

Your question about whether or not we will see BA.2 sweep the world, we’re seeing that happen right now. This is not a theoretical. Omicron is a highly transmissible variant of concern. BA.2 is more transmissible than BA.1 and what we are starting to see in some regions of the world, in some countries, is an uptick in cases again.

This is in the context of Omicron, which is highly transmissible, but also in the context of lifting of public health and social measures. So, whatever variant is circulating, if you lift all of the public health measures that we know can reduce the spread of this virus, the virus will take advantage of that.

00:24:05

I think all of the countries around the world need to learn from each other and really learn that it’s the combination of an approach that needs to be put in place and needs to be tailored to the local context. But, we are really asking all countries to have rational policies and use the tools that can reduce the spread, masking, physical distancing, improving ventilation, avoiding crowds, not lockdown. Also, increased vaccination coverage, particularly focusing on those who are most at risk first but really reaching high vaccination levels because vaccines are saving lives. So, it’s that dual approach that we are calling for. Thanks.

CL          Thank you very much. Dr Mike Ryan, please.

MR         In looking at that, certainly some detailed analysis in European countries, what we have seen in the last few weeks with the lifting of restrictions but also with, as Maria said, the BA.2 sublineage becoming more dominant is that the reproductive number has risen above one in many countries so, in effect, transmission has taken off again in many, many countries.

But, what we’ve seen in those countries that have high levels of vaccination, especially amongst vulnerable people, is that continued decoupling of that high incidence from pressure on the health system and high rates of hospital admission and high rates of death.

So, what we see is countries coping with that opening up and, as Maria said, when you open up as quickly as some countries have, you will get that bounce in transmission. If you add to that the increased transmissibility of BA.2, then you get a double impact, a double effect.

00:25:48

But, again, we’re seeing that in countries with high levels of vaccination, especially in those most vulnerable, we’re not seeing that translate into pressure on the health system, into high rates of hospitalisation and high rates of death.

We’ve seen some increase in hospitalisation. Some of that may be due to incidental diagnoses of COVID-19 amongst patients admitted for other reasons because the virus is so prevalent out there right now, especially in unvaccinated people.

We see that experience in Asia, as well. Countries that have high rates of vaccination amongst their vulnerable populations are weathering that transmission storm but in some countries where vaccination amongst those, particularly older, populations was lower or suboptimal, then we’ve seen higher rates of hospital admission and death.

The common factor here is, as Maria said, the virus is sweeping the world, other variants may emerge. With other effects, like season and temperature we may see incidence vary greatly around the world in the coming months but I think the message we can take from this is in all of those countries that have focused on vaccination, have focused on vaccinating their most vulnerable and protecting their most vulnerable population. It does not necessarily result in massive increases in pressure on the health system and it doesn’t result in increases in death rates.

So, I think, in that sense, it’s very important for us to remember and I think Maria has said this many times, the DG has as well, the future is in our choice. We have a choice about the future with this virus and with these variants. We may not absolutely control how the virus evolves and how it spreads.

00:27:38

We can certainly track it better so we know early if it is changing but, most importantly, what we’ve learned so far with each and every one of the variants that has come along, that good surveillance, good tracking linked to measures that reduce transmission but, importantly, measures that protect individuals, especially vaccination, lead to a situation where the health system can cope and populations can continue to live their lives as normally as possible.

CL          Thank you very much, both. We have a question which Florence Rosier, from Le Monde, wrote in because she doesn’t seem to be able to get to the microphone. It’s in connection with COVID-19 and Ukraine. In the refugee camps of those leaving Ukraine are vaccination campaigns either held or foreseen? Any details on the situation there? Dr Socé Fall, maybe.

SF          Thank you. This is a very important question. We already talked about the risk of increased transmission for COVID-19 with the refugee population and the way they are living together. We also know that the level of vaccination was already low, the level of vaccination in Ukraine, so the risk is really high.

We have clear policy guidance to countries receiving refugees in all humanitarian settings on the need to prioritise the vulnerable population for vaccination using the plan they have.

00:29:21

Clearly, the level of need, in terms of vaccine supply, will increase and we are working with partners to update that response plan in neighbouring countries to make sure that we can fill the gaps because of additional population, and this is really a priority in all neighbouring countries.

CL          Thank you very much, Dr Socé Fall, and maybe that’s a good moment to bring in Dr Dévora Kestel. She’s Director for Mental Health and Substance Abuse and WHO, and specifically now engaged with the situation of the refugees and the population in Ukraine. So, maybe that’s a good moment to elaborate on the situation here.

DK         Thank you. Thank you, Christian, for this opportunity. I think that what is important to highlight from our perspective is that the current situation for the population in Ukraine and those who have already left the country, is that they are affected by a number of stressors, from the violence itself but also from the concerns about their own life, the life of those that they have lost or they are not in contact with, the poor living conditions, the uncertainty, uncertainty about the future and lack of access to regular food, water, physical care, etc.

All these stressors are generating psychological distress and this is normal. Being exposed to these stressors is a situation that will generate these feelings of anxiety and stress, as mentioned. Now, for most of the people affected, many of those conditions will disappear over time. Some people will need help.

00:31:30

So, what we have been doing from right after the beginning of the crisis is make available tools on mental health and psychosocial support that are translated in Ukrainian and in Polish and in Hungarian, in the neighbouring countries as well, available for everybody to use that.

We have also been working from the global level and the regional level and the country level, supporting the country office to coordinate mental health and psychosocial support efforts at the country level in collaboration with more than 20 other local organisations that are trying to provide support to the population in the country.

We have also been able to surge support neighbouring counties with mental health and psychosocial support experts that could then provide coordination support and direct technical support to people in their migration movement, whether they are already settled down in those countries or already on the move.

Another component that is important, I think I want to use this opportunity to highlight, is people with severe mental health conditions and we are again in collaboration with colleagues in the country. We are monitoring the situation of people leaving local institutions there with challenges faced related to humanitarian response, basic needs in issues such as food, water, medicines and so on. We are also working closely with colleagues in that area. I will stop here if that is okay as a general picture.

00:33:30

CL          Thank you so much, Dr Kestel. Dr Fall wanted to add.

SF          Thank you, Christian. I just wanted to highlight that we are not only focusing on COVID-19. COVID-19 is a high risk but the DG highlighted the extreme risk of people with cardiovascular diseases, diabetes, HIV, TB and others. So, we need to use a comprehensive approach with host countries and our humanitarian partners to make sure that we are not only dealing with one disease and come tomorrow to try to deal with other diseases.

We know the lethal combination of non-communicable diseases with COVID, so it’s really critical to make sure that we use a multi-disease risk approach to provide the necessary support, including the ones one we have just talked about.

MR         Maybe, Christian, if I can just add. The plight of refugees who have had to leave Ukraine is terrible but remember that is 3.5 million. There are 6.5 million internally displaced people inside Ukraine and our colleagues at the international organisation of migration have looked at those individuals and looked at those households.

It makes stark reading when you look at the vulnerability of people who are internally displaced. 27% of those households, nearly a third, have an infant under five, 56% have a person over 60 years old, 32% of those households have a chronically ill person, 10% of those households have a pregnant woman, and 19.5% of those households have a disabled person, and not even getting to the issues of the mental health and the trauma that those people have suffered.

00:35:20

There’s an incredibly complex problem inside Ukraine and very, very complex needs and there are a further 12 million people estimated to be in the zones of conflict and unable to move right now. So, we are talking, when you look at that across a population of 44 million, where half the population of Ukraine has either left the country, has been displaced within the country or is in the direct conflict zone. That’s an incredible, shameful statistic four weeks into this invasion.

I don’t like to be a Cassandra, but the problems we’ve faced so far collectively, and with great credit to the surrounding countries, are really the tip of an iceberg of need and there’s going to have to be a further massive scaling-up of assistance within Ukraine in the coming weeks because I have never, myself, seen such complex needs so quickly in a crisis that has developed so fast.

While I have the floor, the Director-General spoke to other situations. When he spoke about the 95 metric tonnes of medical supplies that need to get into Tigray, that’s going to require six flight rotations just to get that in. We have experienced all kinds of bureaucratic restrictions in the past, cancellations.

This is not about struggling to get aid in. It is the responsibility of all parties to facilitate the process of giving access, not to take away piecemeal small bits of a blockade and allow some aid to trickle in. This is about opening up unfettered access to millions of people who are in desperate need.

00:37:16

Again, the words get played with but the reality is we need unfettered access, and it’s exactly the same situation in Ukraine with the figures I’ve just given you. So, it’s really important that all parties in conflict understand that it is their actual duty and responsibility to facilitate and provide access to populations in need.

It shouldn’t be upon the humanitarian community to have to constantly renegotiate and negotiate and then have bureaucratic blocks and stop-start, stop-start. This is not the way it is supposed to be and we are forgetting the basic principles of humanitarian law when we end up in these interminable discussions about getting the most simple and basic access to populations who desperately need it. Nowhere, right now, on this planet, has this situation been more precisely illustrated than in Ethiopia and in Tigray.

CL          Thank you so much for these elaborations. It looks like we have Belisa Godinho, from W magazine, Portugal, back on. Belisa, please unmute yourself.

BG         Thank you for taking my question. I would like to know what difficulties the WHO is currently experiencing in terms of ensuring the basic healthcare and COVID testing at the borders with Ukraine and how will it resolve the situation? Also, those who decided to stay in Ukraine, how do they have access if there are hospitals that have been bombed? Thank you.

CL          Thank you, Belisa. Part of this we already touched with the situation with the refugees but maybe we want to touch upon the situation of the health facilities inside Ukraine. Dr Fall, do we have that?

00:39:25

SF          Thank you. I think the first issue is around safety and access. We have a number of partners, including emergency medical teams, government partners, health crisis partners, who really want to scale up their support to people within Ukraine but also across the borders but, if we don’t have access and we don’t have security, it is very difficult to do that.

The Director-General just talked about 64 confirmed attacks on healthcare, including attacks on ambulances, so you can imagine how difficult it is to decide, even for very simple movement, to go where the population is.

Also, we talked about the supply we are providing, but making sure that the supply will reach the hospital where it is needed is another issue and making sure that the health workers also can go to work safely and the population can go to the hospital safety. These are a number of the issues we are facing.

With regard to COVID testing, it is very difficult when the population is in movement and we have reported already the high decrease of the number of people tested for COVID and the same will apply to other common diseases like TB, HIV and other diseases. This is why you need laboratory confirmation.

So, even having the right diagnostics to provide treatment is very difficult and when you go to non-communicable diseases the issue of triage, to see who needs to be evacuated and how we are going to evacuate those people, is another challenge. We are working with partners to find where to do that but, without a clear humanitarian corridor, it will be very difficult to save people from very common diseases.

00:41:22

CL          Thank you very much, Dr Fall. The next question goes to Mario Camilleri, from PMnews Malta. Mario, please unmute yourself.

MC         Hello. I’m Mario Camilleri, reporting from PMnews Malta. My colleague, Rita Bonnici, will ask our question. Thank you.

RB         Can you please give the details of the contracts, treaties and agreements recently signed between the WHO and the Government of Malta and submit a full copy to the media, as well as details of any other agreements currently being negotiated by WHO with the Government of Malta and/or European Union? Thank you.

CL          Thank you very much, Mario and colleague, for an interesting question. We cannot tackle this in this press conference here, so apologies. Please send this to mediainquiries@who.int and we will take this offline. Thank you very much. The next question goes to Priti Patnaik, from Geneva Health Files. Priti, please unmute yourself.

PP          Good afternoon. Thanks for taking my question. This is actually on the TRIPS waiver discussions at the WTO. A leaked text at this point suggests that the discussions are only limited to vaccines and not immediately on therapeutics and diagnostics. I was wondering if WHO can comment on the need for a waiver, even on therapeutics and diagnostics, given the stage of the disease. That would be really helpful. Thank you.

00:43:06

CL          Thank you very much, Priti. We will go to Dr Simão for this.

MS         Thank you, Priti, for the question. Just a quick update because the TRIPS waiver is being discussed at the TRIPS Council this week and we still need to see whether there is some negotiations ongoing on the final text between some countries. These actually focus on vaccines.

WHO is interested in the possible expansion to include therapeutics as well because we have seen that some of the therapeutics that WHO is recommending right now in its guidelines are not available in quantity enough and are also not affordable.

They are very expensive, especially the biologics, which is why WHO is moving with the biomanufacturing hub in terms of training other low and middle-income countries’ manufacturers to be able to produce these type of technologies in the future. So, this is the status. We are expecting to see some of the negotiations coming out by the end of this from the TRIPS Council. Thank you.

CL          Thank you very much, Dr Simão. I have one last question from Gabriela Sotomayor here, from Proceso, in Mexico. Then, we have a question, also again in writing, from Le Figaro, but this is something we have just tackled before with Dr Socé. So, I encourage the colleagues from Le Figaro to contact us and we will maybe be able to get Dr Socé for you to talk also in French about this very topic. So, next question, final question to Gabriela Sotomayor, Proceso, Mexico.

00:45:01

GS          Hi. Hola. Thank you for taking my question. I’m wondering if Dr Tedros can elaborate on his concerns about possible nuclear or biochemical accidents in Ukraine. It is unbelievable that we are talking about a nuclear danger in these times, but if he can elaborate on that.

Also, if I can ask about Mariupol, the health system there, if you have more details because I was reading, something very simple, like people do not have service on telephones so they can’t call an ambulance to take the injured, so they have to take their own injured to the hospitals. They don’t know where to go. The situation is really, really bad. So, if you can talk about this inside Mariupol. Thank you.

CL          Thank you very much, Gabriela. Two parts about the nuclear and biohazard and Mariupol. Dr Ryan, please.

MR         On the radionuclear and chemical risks, clearly you’ve all seen the footage of the nuclear plants and the Chernobyl plant, and also Ukraine obviously had a very large chemical industry. So, first and foremost, in any situation where you have an industry based on radionuclear or chemicals, you have to have very high levels of safety, very high levels of regulation, very well-qualified staff to manage those facilities so that you can keep them safe. That’s normal practice.

If you add a war into that and conflict and bombing and changing control of facilities, then you introduce a very high level risk and we’ve seen that occur, staff having to stay on rotation for days and days to maintain safety of facilities, firefights around facilities.

00:47:00

Can you imagine being a worker with responsibility for the safety of a nuclear plant with a firefight and bombs and flares going off outside? It’s tough enough work, it’s responsible enough without that pressure. So, there’s a huge issue here just on safety and maintaining that safety so that there is no inadvertent situation in which safety standards drop or where there is inadvertent damage to a facility that may lead to a chemical or radionuclear release.

We are very focused on working with our other UN agency colleagues and with the Ministry of Health. In general, we work on preparedness for all hazards, chemical, biologic, nuclear and others, and we have been working for years with our colleagues in Ukraine, as we do in many countries, on preparedness for such industrial accidents.

There is another obvious layer to this, which is the horrific potential that weapons could be used that are either chemical or nuclear in nature, and that’s a whole other consideration which is beyond the capacity of WHO to manage. This is a security issue.

We are ready and we will support our colleagues in the OPCW and in IAEA and we’re part of the UN system for response to such incidents if they occur and we’re ready to do so. But, again, it’s unconscionable even to think that would be the case.

00:48:31

Again, the use of such weapons in a situation like this it does not bear saying. It is against international law. But we are ready to deal with industrial accidents in support of the authorities in Ukraine and we will be ready to support the medical implications of any intentional use of such weapons in this situation.

But, again, remember we have a health system that’s under huge pressure already and maybe Dr Fall will speak about Mariupol. We’re seeing very similar situations that happened in Bosnia, that happened in other places. When civilians are in a situation like this, and you have to place yourself in the situation many civilians find themselves in somewhere like Mariupol, it doesn’t matter if the hospital is open or closed.

You’re in a basement. You cannot move. You are stuck. If you’re in trouble, if you’re having a difficult pregnancy or you’re having a crisis, a cardiac crisis or a stroke or if you’ve been injured, the risks that anyone will have to take to take you to healthcare, even if that healthcare is available and open and safe, the journey there can be deadly. And this is what we’ve seeing in Mariupol.

We’ve seen this again and again and again in urban warfare, particularly where the journey to the health facility, in itself, becomes a life-threatening experience. The pressure that people must be under, the horror to sit and watch loved ones potentially die because you cannot take them to healthcare.

It’s not just the attacks on healthcare. That, in itself, is an attack on healthcare, in denying access to facilities by terrifying people to the point where they cannot move to get water, they cannot move to get food, they cannot move to get healthcare.

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This is dehumanising at a level that is very hard to explain. It is very hard to understand. It is very hard to even imagine what people are going through in this situation. But, this has occurred in cities all over the world. This occurred in Aleppo. This occurred in many, many places around the world.

I’ve said this before, we have reached maybe, for once in my lifetime, an appropriate level of horror at what’s happening in Ukraine and particularly what’s happening in Mariupol. I hope that is the new level of horror we will express in all of these situations around the world from now on. Socé.

SF          Thank you very much, Mike. The situation in Mariupol is clearly catastrophic. I referred to problems in security and in movement previously and these are accentuated by the movement of population there. This is why we call for unlimited access for all humanitarian workers and we insist that there be access to hospitals and health facilities.

Now, we see the situation in a number of other places. We talked about Tigray just now, where there’s no fuel. So, is it possible for the population to bring those in need or medical attention to the hospital? And, the health workers cannot access medicines. We have seen that in Tigray, 9% of health facilities have been damaged by the conflict. This is why we launch an international appeal to consider access to essential needs such as food and elementary healthcare to be guaranteed in all of these places. Thank you.

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CL          Thank you very much, Dr Fall. We also have Dr Kestel.

DK         Thank you. Just to add a few more comments to the description that we just heard about the situation there and what I mentioned earlier about psychological distress being normal, how not to feel distress, anxiety, fear, problems sleeping, irritability, anger, hopelessness.

All those are mental health-related issues that are expected in most of the population facing these challenges. As said before, there are issues that can be done, there is support that can be offered and support that is not just to be given or provided by highly-trained professionals.

It is support that can be given by a number of people with basic training on psychological first aid and mental health and psychosocial support, basic issues that could alleviate partially some of these challenges that are being faced, and this is our concern as well right now. Thank you.

CL          Thank you so much for all and, with this, we come to the end of today’s briefing. Thank you for joining us and I hand over to Dr Tedros for the closing remarks.

TAG        Thank you. Thank you, Christian, and thank you to all members of the press for joining us today, and see you next time.

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