COVID-19 Virtual Press conference transcript - 12 January 2022

Overview

00:00:37

CL          Today's update on COVID-19 and other health emergencies here from Geneva. My name is Christian Lindmeier and I'm welcoming you today. Sorry for the little mishap of having sent the wrong codes to you but we hope that by now everybody has joined, which is why we started a bit later to give every one of you the opportunity to join with the right codes. Again thank you very much for joining and apologies for the mishap.

Simultaneous translation is again provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, and we have Portuguese and Hindi additionally. Now let me introduce the participants in the room. Of course first we have Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director of WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Senior Advisor to the Director-General and the Lead on the ACT Accelerator.

We also have Dr Kate O'Brien, Director for Immunisation, Vaccines and Biologicals. We have a number of colleagues online as well and we'll be joined by Dr Soumya Swaminathan, Chief Scientist, Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products, Dr Rogerio Gaspar, Director of Regulation and Pre-Publication, and last but not least Dr Sylvie Briand, Director for Global Infectious Hazard Preparedness.

00:02:12

With this we're ready to go and I'm handing to the Director-General for the opening remarks.

TAG        Thank you. Thank you, Christian. Good morning, good afternoon and good evening. Last week more than 15 million new cases of COVID-19 were reported to WHO from around the world, by far the most cases reported in a single week and we know this is an underestimate.

This huge spike in infections is being driven by the omicron variant, which is rapidly replacing delta in almost all countries. However the number of weekly reported deaths has remained stable since October last year at an average of 48,000 deaths a week.

While the number of patients being hospitalised is increasing in most countries it's not at the level seen in previous waves. This is possibly due to the reduced severity of omicron as well as widespread immunity from vaccination or previous infection.

00:03:31

But let's be clear. While omicron causes less severe disease than delta it remains a dangerous virus, particularly for those who are unvaccinated. Almost 50,000 deaths a week is 50,000 deaths too many. Learning to live with this virus does not mean we can or should accept this number of deaths.

We must not allow this virus a free ride or wave the white flag, especially when so many people around the world remain unvaccinated. In Africa more than 85% of people are yet to receive a single dose of vaccine. We cannot end the acute phase of the pandemic unless we close this gap.

We're making progress. In December COVAX shipped more than double the number of doses it shipped in November and in the coming days we expect COVAX to ship its one billionth vaccine dose.

Some of the supply constraints we faced last year are now starting to ease but we still have a long way to go to reach our target of vaccinating 70% of the population of every country by the middle of this year.

90 countries have still not reached the 40% target and 36 of those countries have vaccinated less than 10% of their populations. WHO and our partners are actively supporting these countries to overcome the bottlenecks they face in leadership and co-ordination, lack of supply visibility, short shelf life of donated vaccines, limited cold chain capacity, vaccine confidence, health worker shortages and competing priorities.

00:05:41

WHO is also paying careful attention to the impact of omicron on vaccines. In September last year WHO established the technical advisory group on COVID-19 vaccine composition or TAGCOVAC, a group of experts to review the implications of variants of concern on the composition of vaccines.

Yesterday TAGCOVAC emphasised the urgent need for broader access to the vaccines we have and that further vaccines are needed that have a greater impact on preventing infection and transmission.

Until such vaccines are developed the composition of current COVID-19 vaccines may need to be updated to ensure they continue to provide WHO-recommended levels of protection against infection and disease.

00:06:40

TAGCOVAC also said that a vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be sustainable. The group also emphasised that while some countries recommend boosters the immediate priority for the world is accelerating access to primary vaccination, particularly for groups at greater risk of developing severe disease.

The overwhelming majority of people admitted to hospitals around the world are unvaccinated. While vaccines remain very effective at preventing severe disease and death they do not fully prevent transmission.

More transmission means more hospitalisations, more deaths, more people off work including teachers and health workers and more risk of another variant emerging that's even more transmissible and more deadly than omicron.

The sheer number of cases also means more pressure on already overburdened and exhausted health workers. Protecting those most at risk also helps to protect health systems and health workers, which are once again under increased strain because of the burden of omicron.

00:08:13

A study published last year showed that more than one in four health workers globally have experienced mental health issues during the pandemic and data from several countries show that many health workers have considered leaving or have left their jobs because of poor working conditions, insufficient staffing and the distress of making life-and-death decisions every day under intense pressure.

Health workers have done their best to protect us for two years. We must all do our part to protect them by getting vaccinated and by taking precautions to prevent becoming infected or infecting someone else.

And we must remember that COVID-19 is only one challenge that health workers face every day. Taking the pressure off health systems will enable them to deal with the many other challenges they face including providing care for pregnant women.

Yesterday WHO hosted a global webinar attended by clinicians from around the world on the clinical management of COVID-19 during pregnancy, childbirth and the early postnatal period. Pregnant women are not at higher risk of contracting COVID-19 but if they're infected they're at higher risk for severe disease.

00:09:58

That's why it's vital that pregnant women in all countries have access to vaccines to protect their own lives and those of their babies. We also call for pregnant women to be included in clinical trials for new treatments and vaccines.

Fortunately mother-to-baby transmission in utero or during birth is very rare and no active virus has been identified in breast milk. We're also concerned by reports from some countries about women who have been separated from their newborn babies, which is unnecessary and can be harmful to the health and well-being of newborns during the critical first days after birth.

All women have the right to a safe and positive pregnancy and childbirth experience and need high-quality, respectful maternity care. Christian, back to you.

CL          Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. First on my list is Jason Beaubian from NPR. Jason, please unmute yourself.

JA           Thanks a lot for taking my question. Dr Tedros just mentioned there are 36 countries in the world that have less than 10% of their population vaccinated.

00:11:31

CL          Jason, can I ask you to speak up a bit because it's really hard to understand.

JA           Yes. Okay, I'll talk louder. I hope this is better.

CL          That's good.

JA           As Dr Tedros just mentioned, there are 36 countries that have less than 10% of their populations fully vaccinated. We have heard a lot about access to vaccine as a barrier but I'm wondering if you can talk a bit more about particularly those countries that have really struggled to get above 10% vaccinated and what are some of the other issues that are leading to some of these low vaccination rates.

CL          Thank you very much. I think we'll start with Dr Mike Ryan. No. Kate O'Brien, of course, the Director, Immunisation, Vaccines and Biologicals.

00:12:22

KOB       Thanks so much for this question. This is such a critical issue because countries that are struggling to get even above 10%, what this really means is that healthcare workers are not fully vaccinated yet. It means that those who are in older age populations, those who have underlying medical conditions - these are the people at highest risk - are not fully protected yet.

The reasons for countries which are below 10% are actually quite a wide range of reasons. First and foremost the reason is around supply that has been constrained, as you well know, over this past year. Any vaccine programme is going to struggle to stand up a programme if it doesn't know when it's getting doses, how many doses of which product so that is the underpinning, the foundational issue that many countries are struggling with.

But beyond that there are a number of issues and these are in no particular order but are a range of things that countries struggle with. The first is on financing. A campaign like a COVID vaccine campaign does require funding to deploy to new health workers to assure that the clinics have the resources that they need, the campaigns have the resources and securing the funding in a timely and in a predictable way is really important.

The second is that many of these countries have weak health systems to start with or are in conflict settings or in fragile settings. There may be humanitarian emergencies, there may be other issues that the country is struggling with.

00:14:02

So to add on to the deployment of all health services these other things, healthcare workers who are the ones who need to actually deploy vaccines, countries are also facing concerns from populations about the vaccines that are being received and deployed into countries. We've seen a lot of different countries making choices around vaccines and these are issues of concern to people in the country as well.

The other thing is the really strong commitment from leadership of countries around what their targets are and having decisions in countries about exactly what the targets will be in what time frame and that's what I think is so helpful about the targets that have been set by WHO to help guide countries around what the trajectory might be.

Then a couple of other things that I would mention are certainly the cold chain capacity where there have been a lot of investments to help countries increase that cold chain capacity to be able to secure not only what is needed for these vaccines but for other commodities that are coming through in the country.

00:15:14

So these are a range of issues. There's no one specific problem that is across all of the countries. It really is a country-by-country tailoring of understanding exactly what the country needs to be able to help the country accelerate vaccination.

We have seen that acceleration, especially when supply is secured and is in a predictable way. Many of the other pieces fall into place.

CL          Thank you very much. Dr Bruce Aylward, please.

BA          Thank you very much, Christian, and, Jason, thanks for this really important question because there's a dangerous narrative emerging in many high-income and high-coverage countries about the low vaccination rates in some lower-income countries or countries with weak immunisation or health systems and that narrative you're hearing more and more is countries can't use these vaccines or countries don't want these vaccines, as you mentioned.

00:16:22

So there're two points just to emphasise, further to what Kate said, Jason. The first is if you look at those maps and then look at a map of polio around the world or measles then you'll see that the same countries that have got very low coverage for COVID-19 have eliminated or eradicated polio or eliminated measles or achieved very high routine immunisation from other diseases.

So then, Jason, we've got to stand back and say, okay, why is that? A big part of the problem is we've made it twice as hard or three times as hard for low-income countries, many of them, to be able to achieve high coverage.

We have to be really clear on that. While we did not share vaccines for six months, seven months, eight months what we did share was a lot of misinformation, a lot of bad practice, a lot of problems so now as we are starting to get vaccines - and huge recognition here of the work of COVAX.

As the Director-General mentioned, the organisations working together will have shipped nearly a billion doses, 980 million doses as of today so watch that number. But that demonstrates COVAX can deliver and deliver at scale and get vaccines to these countries.

00:17:43

But the challenge we have now is it's very late and these countries have a much more difficult problem because they're dealing with the challenges around information. They've not had the investments always in the financing side, as Kate said, and then they've also had the problems associated with some of the donated products.

Some countries are sending vaccines that they don't want and low-income countries know that and then they have to work with their own populations. They're getting vaccines that have got short expiry dates, which makes them very, very difficult to use in complex environments, and expiry dates that are shorter than the countries donating them will actually accept themselves often.

So I just want to be very frank, Jason, that these are countries - many of them that are red on the map have achieved very high coverage for immunisation against other diseases and eradicated and eliminated diseases. They know how to run vaccination at scale.

It's a really tough environment they're operating in right now. How do we fix that? Number one, we have to provide full support, the financing for the delivery, the information support, the right products, the right time frames.

00:18:48

There's so much we can do because these countries know how to get to their populations, they know how to turn on the machinery, they know how to get people vaccinated. They have a fantastic track record, most of them.

CL          Thank you very much, both. The next question goes to Jamil Chade from O Estado, Sao Paolo. Jamil, please unmute yourself.

JA           Hello to everyone. My question, if you allow, Christian, will be in Portuguese because I have to read a statement by President Bolsonaro on omicron. Is that okay, if I do it in Portuguese?

CL          Let us try if that works. Yes, please. We should have Portuguese translation.

JA           Very good. The statement is by President Bolsonaro, made today.

00:19:45

TR          Omicron has already gone around the whole world and those who have had it said that it is very fast-spreading but it doesn't have major complications. According to some people who are serious and not linked to the pharmaceutical companies, they say that omicron is welcome and could be the end of the pandemic.

JA           The fact that President Bolsonaro claims that omicron has not killed anyone and that it could be a vaccine [?] virus and is welcome, is this a statement that tranquillises you all? Thank you.

CL          Jamil, can I ask you to repeat your question as such please because we're not quite clear what you're asking.

JA           My question is, is omicron welcome, as said by President Bolsonaro today, and is it true that it has not killed anyone?

CL          Thank you very much. I'm asking Dr Mike Ryan to start.

MR         Thank you. I'm not aware of any such statements but I think the Director-General was clear in his remarks that while omicron may be less severe as an individual virus infection in an individual this does not mean this is a mild disease and there are many, many people around the world as we speak in hospital, in ICUs, on ventilators gasping for their breath, on oxygen who would obviously be very clear that this is not a mild disease.

00:21:47

It is a vaccine-preventable disease, it is a disease that can be prevented to a great extent by taking strong personal precautions to avoid infection, getting vaccinated and there are things we can do about it and I think it's very, very important that we remember that it's still in our hands.

We have said this a lot, the Director-General says this a lot. There's much we can do and this is not the time to give up, this is not the time to give in, this is not the time to declare that this is a welcome virus. No virus is welcome that kills people and especially when to a great extent that mortality and that suffering is preventable through the appropriate use of vaccination.

So I'm not aware of the specific comments made by any individual on this but I would point you to the comments made by the Director-General in his speech.

CL          Thank you very much, Dr Ryan. We'll move to the next and that's Bayram Altug from Anadolu News Agency. Bayram, please unmute yourself.

00:22:57

BA          Thank you, Christian, for taking my question. Hans Kluge, WHO's Europe Director, said yesterday that more than 50% of Europe's population will be infected with the omicron variant in the next six to eight weeks. So does this scenario apply to the whole world? In other words, do you expect as WHO Geneva headquarters that more than half of the world's population will be infected with the omicron variant in the next two months if the current trends and waves continue?

If your answer is yes, are we able to see light at the end of the tunnel or is there a realistic hope that the pandemic will end soon because of the mass immunity issue? Thank you.

CL          Thank you very much, Bayram. Let's start with Dr Maria Van Kerkhove.

MK         Yes, thank you. You're referring to comments made via RD Euro, our Director on a model that was looking at future scenarios of COVID-19, in particular the omicron variant and circulation of the omicron variant. What we definitely see with this variant is that it transmits incredibly efficiently between people and you've seen that in the epidemic curve thaat we published last night online and the Director-General commented today, more than 15 million cases reported in a seven-day period.

00:24:20

We had to change the scale of the epidemic curve that we published last night because it's such an astounding number and certainly if we allow this virus to continue to spread as it is we will see higher numbers of cases in the coming weeks.

I think the point of us sitting up here and speaking every day and doing these press conferences, issuing guidance, issuing strategies is that we have tools at hand that can prevent something that's predicted in a model from actually happening.

We said this in the beginning of this pandemic. There were a lot of models that came out that gave very scary predictions about what would happen if we didn't act, if we didn't take this as seriously as it needed to be taken.

We're in that situation again. There is no inevitability about this virus and how it circulates. We have control, some measure of control in terms of limiting its spread with tools that we have access to - masks, distancing, ventilation, avoiding crowds, knowing what our risk is every day and taking measures to lower that risk.

00:25:25

At the present time we're not able to prevent all infections but we can limit the spread and we can reduce the sheer number of cases that are occurring right now. We can also reduce the severity of COVID-19 with vaccination, with earlier clinical care, with access to diagnosis to get patients into the clinical care pathway so they can receive earlier clinical care.

So I think we need to look at these models as ways to help us plan, as ways to look at scenarios going forward and we as WHO are looking at a number of different models, a number of different future scenarios in terms of case predictions, in terms of hospitalisations and deaths.

Also looking at potential scenarios of how much further this virus will evolve because the virus is spreading and it's continuing to evolve but these models are just that. They are tools that help us plan and take direction and take action so what we are asking is for everyone to help us reduce the spread because the sheer volume of cases is putting a burden on healthcare systems.

00:26:28

Because even though omicron is less severe than delta it still is putting people in hospital, it is still putting people into ICU and needing advanced clinical care, it is still killing people. So the more people that end up in hospital and fill up beds from COVID-19, they take beds away from other emergencies that need to be cared for as well.

Our healthcare systems around the world are significantly overburdened so we need everyone's help right now to, as Bruce says often, take the heat out of this epidemic that we're in right now, the latest wave of infections that we see and we don't have to actually have these models come to fruition.

CL          Dr Aylward, please.

BA          Thanks, Christian, and, Bayram, just to add to the point that Maria made, our Regional Director is ringing the alarm bell and if you go on the WHO website and have a look at the epidemic curve that Maria just referred to, it's absolutely staggering.

00:27:36

We in 30 years working on infectious diseases have not seen an epidemic curve like this before, certainly not with a pandemic-prone virus and in the face of a staggering upsurge of disease like that we're hearing two responses.

One group are saying, gosh, throw in the towel, let this thing immunise the world. Then we have another group - and this is led by Maria - that are saying, wear a mask, get vaccinated. If we make the wrong choice - and the first one is the wrong choice - people are going to pay the price.

They're going to be the healthcare workers trying to manage the system, they're going to be the older people who are going to die, as Michael said previously, due to the surging disease. They're going to be the other people who cannot access services that they need.

Have a look at that epidemic curve. In the face of something like that you want to do everything that you can to slow this thing down and take the heat out of it.

The other thing we have to remember is omicron is not going to be the last variant. We don't know everything where this virus is going yet and again, as Maria emphasises so many times, the more this thing can replicate the way it is now the more likely we are to be dealing with other, possibly even more challenging, ones as we go forward.

00:28:55

We need to make the right choice right now. As Tedros has said before, the way forward - you don't leave it up to chance. We have a choice here and the choice is wear a mask, get vaccinated, do everything you can to slow this thing down so others don't pay the price.

CL          Thank you very much, both. Next question goes to Latika Bourke from the Sydney Morning Herald. Latika, please unmute yourself.

LA          Thank you very much and Happy New Year, team. You will obviously have seen the controversy that Novak Djokovic has caused, trying to enter Australia not being vaccinated. I wanted to ask the WHO's view on vaccine mandates because we're going to run into this quite often in the future now where people will deliberately choose not to be vaccinated.

00:29:45

But in many countries there are mandates, they can lose their jobs or be excluded from things. Does the WHO back excluding people from their workplaces or indeed professional sportspeople from playing in competitions if they are not vaccinated?

CL          Thank you very much, Latika. We'll go to Dr Mike Ryan.

MR         Others may wish to add. In general - I'm speaking beyond COVID vaccines - WHO always asks governments to be cautious around the issue of mandatory vaccination because in most situations many people who are hesitant about taking vaccines have genuine questions that need to be answered, there's information they need to make a good decision.

So the issue of vaccine mandates becomes an issue when a government or when a public health authority has a clear public health goal for which vaccine is required to reach that goal. If that goal cannot be reached because of a high level of people not wishing to take the vaccine then sometimes governments are in a position where in order to benefit society through reduced suffering and death there is a need to bring in measures that incentivise people to take the vaccine or in some cases have some requirement that a vaccine is taken or given.

00:31:14

We have extensive guidance on that through our ethics group, it's very well laid-out and it really clearly states that all measures should have been taken in advance of a mandate to ensure that everyone is adequately informed, that everyone has the opportunity and time to be vaccinated and that clearly the public health outcome and the social outcome and the population outcome of a mandate greatly outweighs the disruption to any individual right or any individual freedom.

That has to be carefully balanced so yes, there are circumstances in which vaccine mandates are supported by WHO but it again is subject to the basic principle that the best way to get people vaccinated is to inform them, to educate, to have a dialogue and address people's genuine concerns when it comes to information and knowledge about vaccination, especially for them, their families, their children, their parents and community.

So WHO's position, I think, is pretty clear. We see mandates as a last resort in the face of... We've seen for example in the last number of months with delta and omicron, in the face of a large epidemic in which we know that vaccines will save lives and we know that vaccines are life-saving, that some countries, having done all they can to convince people to be vaccinated by any other means feel that in order for schools, in order for workplaces to function, in order for transport to function, in order for society to function and in order to save the maximum number of lives they bring in mandates.

00:32:46

We always ask that those mandates be clear, be explicit, be time-limited and at the same time to be accompanied by the appropriate risk communication and clarification and that governments continue to explain to people why they're doing things and continue to try and convince people of the benefits of vaccine rather than reverting to mandates as a single approach.

I'm sure Kate has something to say about this but that would be WHO's principal position on this matter.

KOB       Mike, I think you've summarised that extremely well. The one thing that I think is really important to add to the issue around vaccine mandates is of course there can be absolutely no situation of a mandate where access to a vaccine is not fully and freely available to those who would otherwise be subject to the conditions of the mandate.

00:33:41

I think this is one of the most important parts about our principles in WHO around this general issue of mandates. This has come up not only for COVID vaccines but for other vaccines as well and free and full access to safe and effective vaccines is the absolute precondition before any consideration of a mandate is made.

That is a grounding principle. It's also a grounding reason why - one of the reasons why there is not a requirement from WHO, a recommendation around any requirement for crossing international borders although somebody's vaccination status may be considered by countries with respect to other conditions that may be imposed on people through the course of their travel.

So I just really want to emphasise this issue about vaccine access as an absolute precondition for any consideration of mandate.

CL          Thank you very much. Next question goes to Simon Ateba from Today News Africa. Simon, please unmute yourself.

00:35:03

SI           Thank you for taking my question and Happy New Year. This is Simon Ateba with Today News Africa in Washington. Last week Dr Tedros talked about the catastrophic humanitarian situation in Tigray and elsewhere in Ethiopia. On Monday President Biden spoke by phone with Prime Minister Abiy Ahmed at the same time that the Government there was bombing women and children in Tigray.

I was just wondering if you could give us an update, especially since more bombs are dropping on Tigray. Does the WHO have access, is there any other way that you can reach the people suffering there, dying? Thank you.

CL          Thank you very much, Simon.

MR         I can begin and Dr Tedros may supplement. I think Dr Tedros' statement at the last press conference was very clear. The situation hasn't changed since then. If anything the situation has got worse so the simple answer to your question, Simon - and Happy New Year to you - is no.

Our access has not improved and quite frankly it's very upsetting here because we look at these numbers and we look at all of this but we've had contact from doctors working in Tigray, doctors working with patients with diabetes and other diseases and when you hear a personal report of the fact that we haven't been able to get basic insulin and diabetic treatments into Tigray since last summer, the end of last summer...

00:36:29

At one point insulin is almost entirely stocked out. The oral anti-diabetic drugs are almost unavailable. They're running out of IV fluids for managing diabetic ketoacidosis. The doctors and nurses in northern Ethiopia and Tigray can't even manage the most severe complications of a disease like diabetes which has catastrophic, immediate health consequences for people.

It's incredible as a physician, as someone who commits their lives to caring for others the politics of it are beyond me. The issue is that there are people, real people living in a situation, whatever the cause of that situation, who have no access to the very basic life-saving interventions that we in the West, that we sitting here in Geneva would expect immediately, instantly if we were to fall ill or sick.

From my perspective this is an insult to our humanity, to allow a situation like this to continue, to allow no access, zero access. Dr Tedros said at a speech at the last press conference that access is the lifeblood, the starting point for humanitarian intervention and we simply do not have that access, access for our staff, access to the field, getting basic medical supplies in there.

00:38:04

So it's truly important that all parties involved in this find a solution to allow humanitarian workers, doctors and nurses to do their job, which is to treat patients and save lives. And simply again, Simon, to be very clear, no, the situation is not getting any better since Dr Tedros spoke before, it's getting worse.

TAG        Thank you, Mike, and thank you also, Simon, for that very important question. As Mike said, the situation hasn't improved, it's actually getting more complicated and deteriorating. We just received, by the way, a letter from a physician who we don't know earlier today and maybe I'd like to read part of what he said in that message.

I am very sure that you have been following up the terrible and unimaginable stories of patients in Tigray that have been broadcast in the media. As to diabetes management we have not received any medication after June 2021. We have so far been using the stock we had before and starting from September we have started using expired anti-diabetic drugs - expired drugs.

00:39:38

And our treatment has recently focused on preventing acute complications. We have stopped being concerned about good glycaemic control and preventing chronic complications. We almost do not discuss about diet with patients as they have to eat whatever is available.

From the report we got from our pharmacy head we have learned that we are left with 150 vials of NPA and a few strips of glypanclamide and other drugs, of course, which he mentions.

He says, the sad part is, we have even run out of the expired drugs. The expired drugs are also finished. With a limited amount of drugs that we have we will be able to serve for only the next two to three days. These are the expired ones.

To make things worse we have run out of IV fluid so we're treating even moderate and severe DKA with free water - no IV fluid so free water. Anyway it goes on and on and on. I don't want to take your time reading all the message but you can see from this physician how desperate the situation is. Imagine because you don't have IV fluid you're using tap water.

00:41:12

I have said it before. Tigray, the region - which is a region, Tigray Regional State, in Ethiopia, with a population of seven million people. Its population is, by the way, almost equivalent to Norway and Estonia combined. This region has been under siege for more than a year.

Imagine a complete blockade of seven million people for more than a year and there is no food, there is no medication, no medicine, no electricity, no telecom, no media, nobody can report. And when there is no telephone I think accessing families is difficult.

No cash, no bank service and imagine the impact of all this on health. Lack of medicine has a direct impact and people are dying but lack of food also kills. And on top of that daily drone attacks are killing people. I think three days ago more than 50 civilians were killed, including children and yesterday more than 17 were killed. This is a daily event and people are living under constant fear and you can imagine how that impacts also the health of people, mental health.

00:42:49

When drugs are not available having all these wounded civilians - you can imagine where they can get the support or treatment - they can't. From our side we have been trying from WHO's side, trying to have access to some drugs to Tigray and the other areas affected by the conflict, Afar and Amhara regions.

We were permitted to send medicines to Afar region and Amhara region while we were not allowed to send to Tigray region. We have approached the Prime Minister's office, we have approached the Foreign Ministry, we have approached all relevant sectors but no permission.

So there is a blatant measure which has been taken - that's blockade - and siege for more than a year, seven million people and since especially July no medication was allowed from WHO, none whatsoever.

One thing we know is measles vaccines from UNICEF two weeks ago but I don't think measles vaccines would do anything. That's why I said last week in our presser, this has to stop. Humanitarian access even in conflict is the basis, the basics.

00:44:24

Even in Syria we had access, during the worst of conflicts in Syria. In Yemen the same, we have access, we deliver medicines. Here it's a complete blockade, especially since mid-July, nothing. This is six months without medical support, without food, without all the rest of the things I have said. It's impossible.

Of course I am from that region, I'm from Tigray, the northern part of Ethiopia but I am saying this without any bias. What I am saying is the truth. What I am saying is what's happening. What I am saying is, the situation is serious.

Nowhere in the world would you find a crisis like what you see in the northern part of Ethiopia, especially in Tigray, none. Nowhere in the world are we witnessing hell like in Tigray and the international committee has to do everything.

The basics is to have unfettered access whether it's food or medicine. Humanitarian access should be allowed at all times even during conflict. Even conflict cannot be an excuse because we're delivering medicine in conflict areas while the conflict is raging so that place cannot be different.

Then the other part, of course, this thing should be resolved politically, peacefully. If there is a commitment to resolve it peacefully there is a way. There is a way to resolve it peacefully and politically.

00:46:28

We know that just respecting the constitutional order, the constitution would bring this problem into a peaceful conclusion and the most courageous choose peace. So ultimately it's a political solution or peace which is the answer.

But as I speak now we're deeply concerned from WHO's side. We have tried all our best but we're blocked from sending medicines to Tigray, Ethiopia and that's so dreadful and unimaginable during this time, the 21^st century when a government is denying its own people for more than a year food and medicine and the rest to survive.

I thank you and, Christian, back to you.

CL          Thank you very much, Dr Tedros. With this we come to the next question and that goes to Stephane Bussard from Le Temps. Stephane, please unmute yourself.

ST          Hello, everybody. Thank you for taking my question. You've been talking about a situation which is not any better in terms of vaccine access, about the staggering infection rate but on the other hand there's a lot of talk about the mid-term and long-term impact of the omicron variant on the evolution of the pandemic.

00:48:13

Do you think there's a chance that we might move, maybe at the end of the spring, from the fake [?] to an endemic situation? Thank you very much.

CL          Thank you very much, Stephane. We'll start with Dr Van Kerkhove.

MK         Thank you for the question. As I said in a previous answer, we're looking at various scenarios going forward in terms of how this virus, how this pandemic will evolve in the coming weeks to the coming months.

We have a lot of information about how this virus behaves, how it spreads. We're learning every day more and more about omicron itself, how omicron is introduced into a population, what the population-level immunity is in that area, in that country, the vaccination coverage, etc, and we're seeing omicron outcompete delta in many populations where omicron is becoming more prominent compared to delta.

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To be able to predict what will happen in the spring depends on many different factors and again it is up to us how this pandemic unfolds. This virus is on its way to becoming endemic. There's no question about that but we are very much right now in the middle of this pandemic.

At transmission levels that we see right now, at the intensity of spread that we see, at the level of impact that these cases are having on our essential medical services, on essential services, on hospitalisation rates which are increasing in a number of countries and now certainly we see less rates of hospitalisation but the sheer volume of cases is really putting a heavy burden on our healthcare systems.

So the impact that we are seeing is really quite substantial. The big question is not necessarily how sharp and how quickly that peak will be in every country because we see a consistent vertical trajectory where omicron is.

If you remember with delta, when that emerged we had a similar trajectory but we didn't have this level of the top of that heap. This is off the charts. How we come down from that, how we turn that peak and the case numbers go down, I think, will depend on a number of things as it relates to vaccination coverage, as it relates to population-level immunity from past infection, as it relates to the interventions that are in play.

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So the virus is well on its way to becoming endemic but we're not there yet. The other factor that we have to consider is that this virus is still evolving so what will the next variant look like. As you've heard us say many times, this will likely not be the last variant that you hear us speak about.

So we have a little bit of an unpredictability. We don't have the same predictability we have with influenza where we have a typical seasonal pattern. We may get there with COVID-19 but we're not there yet so we're cautious about making very firm predictions about what may happen because each country is dealing with this pandemic differently in terms of their strategy, in terms of the implementation of their control measures, in terms of their adjustment of those control measures.

What we need is a collective renewal - the DG said this in, I think, also the last press conference - a renewal to this comprehensive approach to fighting this collective threat that we face. We cannot end the pandemic and have the virus become - quote, unquote - endemic in one country while the rest of the world deals with the pandemic. That's not how this is going to work.

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But how we come out of this - and we will come out of this because this pandemic will end. When it ends is really up to us collectively so we not only need to increase vaccination coverage among those who are most at risk in every single country, not just in some, we also need to take measures to reduce the spread and we have tools at hand. We're just not using them as effectively as we can.

So again it's up to us how this unfolds. We look at various scenarios going forward in terms of what we expect. We expect, number one, that the virus will continue to evolve and become more fit, more or less severe. We will have to see what happens as this virus evolves.

Second, we expect to see outbreaks among unvaccinated individuals, among people who are not well protected. We expect as population mixing increases and as other respiratory pathogens are circulating, like influenza for example, we expect that there will be concurrent outbreaks of other diseases because people are mixing.

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So we have to plan for that and ensure that our surveillance is integrated for respiratory disease surveillance and we expect that we can reduce severe disease and death by using vaccination but also by improving clinical care, getting people into that clinical care pathway.

How that actually unfolds depends on how we use the interventions at hand so there's a lot at play. It's very dynamic but it's up to us.

CL          Thank you very much, Dr Van Kerkhove. Looking at the time it looks as if we made it to the hour. Thank you again very much, everybody, for joining today. Apologies for the initial hiccup with the list of codes. We will be sending the audio files and Dr Tedros' remarks again right after the press briefing and a full transcript will be posted on the WHO website tomorrow morning.

With this, let me close and give it back to Dr Tedros for closing remarks.

TAG        Thank you. Thank you, Christian and thank you to all media colleagues who have joined today and see you next time.

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