COVID-19 Virtual Press conference transcript - 24 November 2021
Overview
00:01:28
TJ Good day and welcome everyone to today’s global COVID-19 press conference. It is Tuesday. No, it is Wednesday, 24 November 2021. My name is Christian Lindmeier and I’m welcoming you to today’s press conference on the COVID-19 updates. We have simultaneous translation provided, as usual, in the six official languages, Arabic, Chinese, French, English, Spanish and Russian, and we have Portuguese as well.
Now, for the participants in the room. As usual, we have Dr Tedros Adhanom Ghebreyesus, WHO Director-General; Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme; Dr Maria Van Kerkhove, the Technical Lead on COVID-19; Chief Scientist, Dr Soumya Swaminathan.
We also have Dr Mariângela Simão, Assistant Director-General for Access to Medicines and Health Products. I believe we also have Dr Bruce Aylward, who is Senior Advisor to the Director-General and Lead on ACT-Accelerator, and I think we have, online, the Principal Legal Officer, Steven Solomon. With this, very happy to lead over to what could possibly be the last briefing out of this room for COVID-19, but we’ll see. Over to you, Dr Tedros.
00:02:42
Thank you. Thank you, Christian. Good morning, good afternoon and good evening. Last week, more than 60% of all reported cases and deaths from COVID-19 globally were once again in Europe. The sheer number of cases is translating to unsustainable pressure on health systems and exhausted health workers. In many countries and communities, we are concerned about a false sense of security that vaccines have ended the pandemic and that people who are vaccinated do not need to take any other precautions.
Vaccines save lives but they do not fully prevent transmission. Data suggests that before the arrival of the Delta variant, vaccines reduced transmission by about 60%. With Delta, that has dropped to about 40%. If you’re vaccinated, you have a much lower risk of severe disease and death but you are still at risk of being infected and of infecting others.
We cannot say this clearly enough. Even if you are vaccinated, continue to take precautions to prevent becoming infected yourself and infecting someone else who could die. That means wearing a mask, maintaining distance, avoiding crowds and meeting others outside if you can or in a well-ventilated space inside.
And we continue to call on all governments to implement a comprehensive and tailored approach of public health and social measures to prevent transmission, take the pressure off health systems and save lives. And it’s vital that countries get patients that need care into the clinical care pathway earlier. That applies to all countries in all situations.
00:05:05
While Europe is again the epicentre of the pandemic, no country or region is out of the woods. It’s important for all countries to surge their capacities now to ensure the right measures are in place to avert the worst consequences of any future waves. And we must do better at sharing the fruits of science.
In my home continent of Africa, many countries are off-track to reach the 40% vaccination target by the end of the year. Many people who should have been vaccinated in low-income countries are missing out and are at greater risk of serious illness or dying. It’s not just about who we reach with vaccination, it’s about who we miss. Priority must be given to health workers, older people and vulnerable groups everywhere.
Through the ACT-Accelerator and COVAX, manufacturers and governments can easily prioritise sharing doses with those countries that have been starved of supply so that they can protect their most vulnerable. And it’s not just vaccines. It’s important for all countries to have access to the rapid tests and new treatment options so that we know where the virus is and can take measures to slow the spread and treat those that need help.
Through WHO’s COVID-19 Technology Access Pool or C-TAP, manufacturers can also easily pool technology and know-how, which would boost the overall supply that, again, is the major inhibitor to access. Yesterday, C-TAP and the Medicines Patent Pool finalised a licensing agreement with the Spanish National Research Council for a serological antibody test. This is the first transparent, global and non-exclusive license for a COVID-19 health tool. I would like to thank the government of Spain for its support for C-TAP and I also thank President Carlos Alvarado Quesada of Costa Rica for his leadership in initiating C-TAP last year. We hope this will be the first of many licenses to be shared through C-TAP.
00:07:48
WHO and our partners continue to explore every avenue for expanding access to life-saving tools. With the WTO Ministerial Conference next week and with the vast majority of countries now firmly supporting a waiver on intellectual property rights under the TRIPS agreement, I hope that consensus can be found and that we move forward.
The ongoing chaos of this pandemic only underlines why the world needs an ironclad global agreement to set the rules of the game for pandemic preparedness and response. This will be the subject of next week’s Special Session of the World Health Assembly.
The world has treaties to manage other threats. Surely countries can agree on the need for a binding pact on the threat of pandemics. The Special Session of the World Health Assembly is therefore a unique opportunity, an opportunity for a generational agreement that transcends media cycles and election cycles.
I’m encouraged that there is now a broad consensus for the need for such an instrument. We will not achieve everything at the Special Session but I hope it will serve as a launching pad for the development of an international agreement. And even while we respond to this pandemic, we cannot lose sight of the many other threats to health that people face around the world, including antimicrobial resistance.
00:09:37
Today marks the end of Antimicrobial Awareness Week. Antimicrobials, including antibiotics, antivirals, antifungals and antiparasitics, are the backbone of modern medicine but the overuse and misuse of antimicrobials are undermining the effectiveness of these essential medicines. By using antimicrobials responsibly and by following the advice of your health care provider, we can all play a part in preserving antimicrobials and preventing drug resistance. Christian, back to you.
CL Thank you very much, Dr Tedros. Before I open the floor to questions from the media, let me remind everyone to get into the queue to ask questions. You need to raise your hands, of course, using the Raise Your Hand icon and then, when it is your turn, please unmute yourself. Just a comment on what I just said before that this may be the last briefing out of this room. Not to misstate, this is definitely not our last COVID-19 briefing.
TAG Tell them we will do it from another room.
CL Exactly. We will do it possibly from a different room and this served us for many years here. So, with this, I go over to my first person on the list and that’s Nina Larson, from AFP, please. Nina, please unmute yourself.
00:11:08
NL Hi. Can you hear me?
CL All good.
NL Okay, good. Thanks. Thank you for taking my question. The German Health Minister yesterday warned that by the end of this winter just about everyone in Germany would probably be either vaccinated, recovered or dead. I’m wondering if you think that that is the case. Is it an exaggeration or the case and does that apply to the broader region, the world? Do you think it’s the same? Thank you.
CL Thank you very much, Nina. Dr Ryan, please.
MR I think Minister Spahn was really trying to just demonstrate the seriousness of the situation that Germany and the rest of Europe faces. Minister Spahn has provided excellent leadership throughout this pandemic and is obviously speaking directly to German citizens about how seriously he and the government take the current situation.
I think the German government is very committed to taking the necessary measures, both in terms of increasing vaccines, especially increasing vaccination in under-vaccinated older and vulnerable individuals and continuing to support measures where people can protect themselves through the targeted use of public health and social measures.
So, I believe the statement reflects Minister Spahn and the German government’s concern regarding the current situation and their commitment to adapt and change to the circumstances which they face, which is a situation faced by many countries.
00:12:43
And as the DG said in his speech, even countries that have achieved high levels of vaccination, even within that there is a patchiness to that vaccination. There are pockets of people who are under-vaccinated and many times those pockets contain people with high levels of vulnerability.
So, refocusing on ensuring that everybody gets access to an appropriate vaccination course and that we continue to sustain public health measures. Actually, I think the content of the DG’s speech spoke very much to the concerns that Minister Spahn expressed in his comments yesterday.
CL Thank you so much for that clarification. We move to the next. That’s Paulina Alcazar, from Encadena News in Cancun. Paulina, over to you. Please, unmute yourself.
PA Thank you very much. Can you hear me?
CL Yes.
PA Thank you for taking my question. Cancun is currently green but the holidays are coming up and, as for those who are unvaccinated, what about the airlines which require PCR tests if people come to Mexico. Nothing is requested if you leave Mexico, so there are no checks for people who are leaving Mexico. Thank you.
00:14:20
CL Thank you very much, Paulina. I’m not sure we understood exactly what the question is. Let’s maybe rephrase the question again Paulina because also translation wasn’t up immediately. So, please give us another hint at what your question is. Thank you.
PA Thank you very much. Yes, thank you for taking my question. So, right now Cancun is in the green zone, so we don’t have too many COVID cases or too many COVID infections but the holiday seasons is fast approaching. And my question relates to people who don’t want to get vaccinated who come to Mexico.
Right now, airlines ask for vaccine tests and PCRs but if you come to Mexico, if you’re entering Mexican territory, airlines aren’t asking for anything. So, if you go to Spain or Germany, you’re requested to have a PCR test. In other words, people are taking care of those who are coming into their country but they’re not thinking about those who are leaving their country. So, I’d like to see whether airlines could ask for PCR tests for anyone, regardless of whether they’re leaving or entering the country. Thank you.
CL Thank you very much, Paulina. I’m looking around, maybe to Dr Ryan.
MR I think the same issues sometimes arise with screening measures, exit screening versus entry screening. For most countries, bilaterally there are arrangements which side testing or certification is done and clearly it’s obviously better if someone is certified for travel before they leave because they don’t get on the aeroplane that they travel on or the conveyance that they travel on if they represent a risk.
00:16:32
And very often the airlines are asked by the governments on either side to take a part of that responsibility to certify or at least check. Each government has a different arrangement. Sometimes it’s the border control that do that checking, sometimes the airlines are expected to do the checking as well.
Certainly, a worst case scenario is if there is no checking on departure and no checking on arrival, then that represents a potential risk. But, my understanding is that in most cases, especially for the purposes of air travel, itself, airline companies are checking the status of vaccination, checking the testing status of people before they get on planes.
But, it’s important, if there is a gap that’s been created between any country bilaterally, it’s very important that countries work together bilaterally with the companies to close those gaps. So, I can’t speak to the specific issue in Mexico but if there is a potential hole in the system whereby testing or appropriate checking of certificates is not being done, then it will be up to both Mexico and the countries that they’re dealing with and the airlines involved to work out a system that doesn’t leave holes in the system.
CL Dr Van Kerkhove, please.
MK Maybe I can come in on the holidays that you mentioned coming up because in my own home country it’s Thanksgiving tomorrow, so I wish all of my family and friends in the US a Happy Thanksgiving. But, I do think it’s a nice opportunity to talk about how people are coming together.
00:18:02
One of the reasons we are seeing increasing transmission is increasing social mixing in the context of a highly transmissible variant, in the context of low vaccination coverage, in the context of lifting of simple measures like wearing of masking, improving ventilation, etc.
So, I think during these holiday periods, not just for Thanksgiving in the US, of course, but through the end of the year, it’s really important that all of us continue to take measures to keep us and our loved ones safe. Those of you who have access to vaccines, who are offered vaccination, please get vaccinated when it’s your turn.
As the DG has said, it’s not just about who is vaccinated, it’s who we miss. We need to make sure those who are most vulnerable, those who most at risk for developing severe disease get those vaccines first in all countries around the world, but we also have to continue to take other measures to drive transmission down.
So, this does mean wearing of a mask, a well-fitted mask over your nose and mouth when you’re with others, with clean hands, making sure that if you could spend more time outdoors, that’s better than indoors. If you are indoors, make sure you have your windows open or that the ventilation is improved as best you can and to just keep your distance where you can.
00:19:14
Now, of course, we understand during the holidays that’s very hard but there are ways that you can know what your risk is, depending on where you live in the world, and take steps to lower that risk. But, vaccination and getting a vaccine when it’s your turn remains absolutely critical, which is why we and our partners are working so hard to ensure vaccine equity around the world because we have to protect those who are most vulnerable to severe disease first because people are dying around the world unnecessarily and that can be stopped.
CL Thank you so much and we move to the next. That’s Jenny Lei Ravelo, from Devex. Jenny, please unmute yourself.
JL Hi. Thank you for taking my questions. WHO and COVAX partners have repeatedly made calls for vaccine manufacturers to prioritise COVAX and be transparent on vaccine production and delivery schedules. I just want to know, have there been any improvements or progress on this? How does this continue to affect vaccine deliveries? And just an additional question on booster shots. How big of a factor or challenge do these pose to reaching the 70% target of vaccination coverage by mid-2022? Thank you so much.
CL Two separate questions. I guess we start with Dr Bruce Aylward on the COVAX.
BA Jenny, thanks so much for the question. We have an ongoing and improving dialogue, let’s say, with manufacturers on the supply and the expected supply of vaccine through COVAX and to low and low-middle-income countries.
00:20:57
I think, as we’ve alluded to in a previous meeting, we’ve set up a working group across what we call our Multilateral Leaders Task Group. That’s ourselves, working with WTO, IMF, the World Bank, and then in association with other COVAX partners, have set up a working group to work with the manufacturers at a working level to really understand what their production is doing and where that production is actually going.
Just last week, we’ve put that on our website, about the status of those discussions, so if you go onto the Multilateral Leaders Task Force website, actually it’s on the IMF-WHO tracker, you can actually see the status of those discussions. So, they’re in different degree of, let’s say, certainty about supply but slowly starting to go the right direction.
We do not, I have to be clear, have enough clarity on supply yet to be able to say with certainty by what time will which countries be able to be assured of the security of their supply to get to 40%, our target for the end of this year, that they have sight on that and then 70%, as you highlight, for the middle of next year.
So, a lot of good faith, a lot of discussion ongoing but it isn’t going fast enough and we don’t have enough clarity of all of it but, Jenny, thanks for the question because, like we’ve said many times, you can’t have equity without transparency. If you don’t know what’s going where and when, you’re not able to try and address the gaps in the equitable distribution of what are still scarce products.
00:22:35
I think, as everybody on this call knows, we are still in a situation where, while we’ve got a global average of 40% coverage around the world, there’s huge discrepancies in that with low-income countries still at less than 3% fully vaccinated populations, which means they can’t cover their healthcare workers and their older populations at a time when much of the world is starting to vaccinate and deliver boosters, as you said in the second part of your question, Jenny.
And on how big a barrier that can be, boosters to our ability to get to 70%, the issue is really a timing issue. It’s increasingly clear that if you give an additional dose you’re going to be able to boost the immunity but, as Mike put so famously in an earlier press conference, your first priority has got to be giving one lifejacket to the people who have none before you give another lifejacket to those who have two, and that is still the case with respect to doses in that there is just so much of the world that have not gotten a first dose and that remains our focus.
So, the issue will eventually be less of a supply-side issue but really a prioritisation issue and making sure that we’re solving the problem of finding the people who have no doses before we prioritise those who already have two doses. And, remember, this is not a phenomena just of low-income countries. Also, in much of Europe where we’re seeing the current outbreak, much of that is being driven by the unvaccinated, of course, and many of the people ending up in ICUs who are dying are unvaccinated folk.
00:24:19
So, the first priority everywhere has got to be reaching the unvaccinated, most highly vulnerable populations. Eventually, we will need to get to boosters to sustain immunity, it looks more and more, but at this point there’s still an awful lot of unvaccinated people out there.
CL Thank you very much, Dr Aylward, and we move to BBC now. That’s Naomi Grimley, from the BBC. Unmute yourself, please.
NG Thank you very much. I’d like to ask Dr Ryan about the case of the UK, because he was very sceptical when I asked back in the summer about the release of restrictions in the UK almost entirely coming off, certainly in England, in July. But, now there’s another argument that it’s actually stood itself in good stead for winter with built-up immunity. What would his reaction be to that?
MR I think the numbers speak for themselves. We have intense transmission throughout Europe and, in fact, intense transmission throughout the United Kingdom and especially, I think, at the moment in Northern Ireland. The DG mentioned this in his speech.
The reality is that increased transmission and large rises in transmission and mixing that drives that transmission, even in the context of high levels of vaccination, is going to put pressure on the system. We’ve seen that. We’ve seen an uptick in hospitalisations and deaths throughout the United Kingdom.
00:26:00
What the United Kingdom have achieved, and it is to their great credit, is very high levels of vaccination, especially in vulnerable groups and that decoupling of the intense transmission leading to huge numbers of cases in hospital and huge numbers of deaths, which keeps the pressure off the NHS in the UK.
So, it depends what parameter you’re using here. If the objective is to vaccinate as many people as possible and reduce transmission as much as possible in order to protect the health system and keep deaths down, that’s fine. But, if the objective is to vaccinate some people and then let others just be exposed to the virus, and I don’t believe that’s the objective of the government of the United Kingdom, then there are long-term consequences of being infected with this virus, whatever your age.
Therefore, knowingly being exposed to a virus that you don’t need to be exposed to is not necessarily a prudent public health approach. We would prefer people to be protected by vaccination and by the avoidance of exposure to that virus.
And avoiding exposure to the virus is something that has reduced across the world and it has certainly reduced across Europe because of social mixing, because of both what governments have done in terms of reducing restrictions and reducing public health measures and communities, themselves, understandably trying to get back to normal life.
00:27:27
And we are back to pre-pandemic levels of social mixing. If you look at mobility patterns, if you look at the patterns, people are now in Europe, even in the midst of a very, very strong resurgence in cases and even in the midst of some of those countries under huge pressure in their health systems, we’re seeing pre-pandemic levels of social mixing, gathering and many other things, and the reality is the virus will continue to transmit intensely in that environment.
So, I would commend the United Kingdom for the success they’ve had in vaccination, for the success they’ve had in surveillance and their ability to track what’s happening with this virus almost at a micro level, for their success in genomic surveillance and would just caution that all countries remain vulnerable to high levels of disease transmission. And we should be continuing to do what we can to reduce exposure and not just rely on the virus to infect the uninfected as a means of achieving a public health outcome.
CL And Dr Van Kerkhove, please.
MK I’d like to add two more reasons why we need to drive transmission down as well as get vaccination coverage up, not specifically related to any country but in all countries. Number one is that the virus is evolving.
So, the more the virus circulates, the more opportunities it has to change. We have the Delta variant, which is the most transmissible SARS-CoV-2 virus we’ve seen to date and Delta is evolving as well. We have decent genomic sequencing around the world but we don’t have eyes and ears in all countries in terms of what is circulating and how these viruses are changing.
00:29:06
We’re making plans here looking through future scenarios about how much more this virus will change in terms of transmissibility or if there will be potential future immune escape, which will render some of our countermeasures less effective. We don’t want to be in that situation, so we need to drive transmission down to reduce the opportunity for the emergence of variants.
The second reason is long COVID, this post-COVID condition that we’re only beginning to learn about. The more people who are infected with this virus who develop disease, who develop COVID-19, have the possibility to develop this post-COVID condition.
We’re working with partners around the world to understand what in fact it is, how long there longer-lasting symptoms remain in some individuals, why they do. These symptoms affect all parts of the body. We don’t even have good estimates of how many people will suffer from long COVID.
So, until we know, it is prudent to drive transmission down as much as we can with simple measures that we know work. These proven public health and social measures that we mentioned don’t mean lockdown, they mean physical distancing, they mean wearing masks, they mean avoiding crowds, taking measures to lower your risk, investing in ventilation where we live, where we study, where we work. There are many reasons to have both sides of that equation have enough attention. Increase vaccination coverage, focusing on those who are most at risk as well as decreasing virus transmission.
00:30:35
CL Thank you, both. We move on with Rosie Birchard, of the Deutsche Welle. Rosie, please unmute yourself. We lost you so maybe we can come back to you later, if you come back in. Then, we move around the globe and go to Latika Bourke, from the Sydney Morning Herald. Latika, please unmute yourself.
LB Thank you very much for taking my question. Some really hopeful language from you there, Dr Tedros, in your opening. I’m just wondering, next week what’s the best case scenario for what you’d like to walk away from the end of the session next week seeing the global community agree to?
CL Yes, please, Dr Tedros or Dr Ryan.
MR I can be the warm-up act for Dr Tedros. Again, just to emphasise that the World Health Organization is made up of its member states. We are the Secretariat. We’re led by Dr Tedros, who has been elected by those member states to represent and implement the policy and will of the member states.
So, the process next week is led by the member states who will engage. Dr Tedros is bringing the member states together to have this really important conversation about where we’re going to go as a planet, as a global civilisation into the future.
We all recognise that we have struggled in this pandemic and we have struggled in this pandemic because we have not been able to put in place the measure that we need, the preparedness measures, the surveillance, the ability to share materials via both data and biologic materials, the ability to train and deploy health workers, the ability to manage and support resilient supply chains, the ability to do collective research and innovation that leads to the equitable distribution of countermeasures, all of the things, the ability to protect our frontline workers as they try to save the lives our friends and our families.
00:32:46
So, we have noticed and recognised all of these gaps and they’re complex and they require systematic, sustained, long-term solutions and, as the DG said in his speech, that go beyond media cycles, that go beyond election cycles. We need a generational commitment to the next generation and beyond, a promise to the future that this won’t happen this way again, that we will be better prepared, better prepared to react and better prepared to save lives, better prepared to share.
And that that needs to be on the basis of an agreement. This can’t be something that we just informally agree and then forget. This cannot be file and forget. This cannot be business as usual. This is business unusual and the Director-General feels and has led the way in working with and asking our member states to come together and create a new framework, to create a new platform for us all to work better together, to better prepare, to better react, to better respond to save lives and to create stability and resilience in the systems we most rely on in a crisis.
00:33:53
That has to be a goal. As he said, if we can make agreements on so many other things, we need to agree on this. The nature of that agreement, the depth of that agreement and the scale of that agreement is very much down to the member states. It is their process.
The Director-General is trying to drive and build a consensus for the best way forward to convene and to convince. I remember a previous Regional Director, Dr Ala Alwan, said to me once that the World Health Organization has two super powers, the power to convene and the power to convince, and I think we need to convene and then we need to convince ourselves and our member states that there is a way forward that we, as a collective group of nations, can deliver more for our citizens.
And the DG has led the way on that from the very first day of this pandemic and will continue to drive that message, that once this pandemic is done, we are not done. We need to not be done. We want to be done with the pandemic but we cannot be done with pandemic preparedness.
CL Chief?
TAG You want me to add but you have said it already nicely. Thank you, Helen. Thank you. Very nice to hear your voice and thank you for this very important question. Of course, this session will be a launching pad, as I said in my speech, for a negotiation between member states, but I hope it will be a launching pad for a successful outcome, for a better outcome.
We have all seen, going through this pandemic, what has really failed. One of the failures is many countries haven’t seen the obligation they have because there is no obligation on pandemic preparedness and response.
00:36:07
As you remember from the start, when the pandemic hit some countries were banning export of masks, export of raw materials and now export of vaccines because they don’t have any obligation and they don’t have any rule or law that would prevent them from doing that.
Of course, one example, as I said, is sharing of technology but there are many other challenges because we don’t have a law or rule of a game that countries, institutions or companies were not doing something that they should have done.
As you know, to govern a country you need law, you need rules and that actually brings the obligation. And to govern, also, the world, especially during pandemics, or to really manage shared problems like pandemics, you need laws and rules. That brings obligation by countries.
That’s what we miss and I hope countries will agree for a binding pact so that pandemics and epidemics can be managed better because it is only when there is a rule of law or pact that countries would behave in a certain way.
So, that’s what we expect. I hope they will agree to start a process for a binding pact that will address the problems that we have faced. I think they can really come up with a solution because everybody has seen to what extent we were really disorganised and all have seen the failures in the global system.
00:38:36
So, we expect that because I don’t think it’s a problem for anyone to see. Everybody has seen it. And I hope the outcome will be good, but still we don’t expect everything to be finished now. It’s a start of a journey but the outcome of that journey will be defined now based on what they agree during this session.
So, thanks so much for that question and I hope this generational agreement, this is going to be a generational agreement, will be realised from the process that the member states will agree at the end of this month. Thank you. Christian.
CL Thank you so much. The next question goes to Peter Kenny, Anadolu Press Agency. Peter, please unmute yourself.
PK Thanks for taking my question. I’d like to know about children and adolescents. WHO and the SAGE group say that they are reviewing vaccination and timing for children and adolescents. Can you comment on this and can you explain how children and adolescents are now affected by this disease because at the beginning they were seen as a lower risk group? Are they now being seen as a normally at risk group? Thank you.
CL Thank you, Peter, and we move to our Chief Scientist, Dr Swaminathan.
00:40:13
SS Thank you for that question and we know that many people are interested obviously in this, particularly parents. Let me try to review what we know about infection in children and also to say that the Strategic Advisory Group of Experts on Immunization is constantly reviewing the evidence as well and there’s likely to be a statement. In fact, there is a policy statement that has just been put out.
I think the first thing is just looking at the epidemiology of this disease, and from all of the data that has been reported to us, if you look at people under the age of 25, less than 0.5% of global deaths have occurred in that age group. And if you look at children less than five, it is 0.1%, and five to ten it’s also 0.1%.
So, the one thing that’s clear, and that’s been consistent from the beginning up till now, is that while children certainly get infected almost as commonly as adults do, the risk of severe illness and death has been consistently very, very low and we know that this progressively increases with older age and underlying comorbidities. The risk of severe disease keeps on increasing. So, this has been consistent.
However, there are children who get severely ill. There are children who develop long COVID and there are children who develop the multisystem inflammatory syndrome as well but, again, very, very small proportions if you look at overall. We’ve also many countries which have done seroprevalence surveys have actually shown that children, the level of infection is almost as high as that in adults, meaning that children were exposed, they got infected but remained, to the large extent, asymptomatic. So, that’s about the burden of disease.
00:42:15
Now, about vaccines, obviously all of the trials were first done in adults. They received emergency use listing and approval for adults. They were rolled out and many of the vaccine developers are looking at extending the vaccination to children, sometimes with a lower dose of the vaccine, sometimes with the same dose. So, as and when the manufacturers submit the data to WHO and to the regulatory agencies, of course we will look at that data and we provide emergency use listing.
So, there are a couple of vaccines that have received that. The Pfizer BioNTech has got an EUL above 12. We are looking a Moderna but we know that specific vaccines like Sinopharm and Sinovac, for example, in China are approved from the ages of three upwards, I believe. Similarly, Covaxin has also been studied in India for that age group, but none of them have emergency use listing in children.
So, looking at the vaccination policy, the roadmap that was developed by WHO, by SAGE, and that most countries have adopted, is starting with vaccinating priority groups, that’s people at the highest risk of death with the primary goal of reducing mortality first in the pandemic. So, that’s the older age groups, that’s the health workers, the frontline workers.
00:43:32
And we see now from data that, yes, two doses of vaccines, all of the approved vaccines, definitely saves lives. None of them are 100% effective but the majority of them are efficacy above 90% in preventing death and severe disease, so highly effective.
That’s why we need to start with those priority populations, make sure that they’re fully vaccinated with two doses and then the adolescents would be the next group because there are adolescents with underlying illnesses and we know in many countries that obesity is a risk factor for severe disease, obesity in adults but also obesity in adolescents.
There are also adolescents with other underlying illnesses that put them at high risk of getting severe illness so, again, that group should be prioritised with a vaccine that’s approved for use in adolescents and that should be the next group.
Finally, I think whether children get vaccinated or not will depend a lot on, firstly, how we’re able to cover these other priority groups first, what the epidemiology of the disease is. I think we need more seroprevalence data in children to understand how much natural infection has occurred and this will vary from country to country.
Then, when we get to the goal of reducing transmission really down to very low levels, at that point one might consider, of course, vaccinating children as well. What we do know is that education is very, very important and we have to do everything possible to keep schools open and, as we’ve said many times, schools should be the last to close and the first to open and it should be a high priority for every country.
00:45:18
We have a lot of guidance out there, WHO and UNICEF, on how to open schools safely. It does not require that children be vaccinated. Certainly, adults who work in schools should have received vaccines and I think the guidance on children will be very contextual and specific to local context, but we also need to then wait for more vaccines to have the data in children before we can make further recommendations. I don’t know if anyone else wants to add to that.
CL Thank you very much, Dr Swaminathan. We move over to China and I have Dong Yu, from the paper in China. Dong Yu, please unmute yourself.
DY Thank you very much for giving me this opportunity. My question is how can other countries avoid another COVID outbreak, and many of them are reopening their countries now? And, especially, what do you think of the European CDC’s latest suggestion that all adults should have a booster right now? Thank you very much.
CL Two very separate questions. May we start with Dr Van Kerkhove?
MK Yes, I can start. I’ll take the first part of that question about how to avoid future waves. The way that we issue our guidance, we understand that people need to get back to their lives and people want to go back to work and it’s really critically important, just as Soumya has said about opening up schools.
00:46:51
Our advice has been, since the beginning really, is to make sure that when you make adjustments to the measures that are put in place, that it’s done very carefully, that’s it is done in a slow and in a staggered way, and that the approach that is used in each country is based on the context, the situation there, the epidemiology and not just the numbers of cases and the numbers of deaths but also looking at which proportion of your population is getting vaccinated and what impact is that having. Who are you missing in your vaccination priorities and reaching those critical populations?
But, when you use the public health and social measures and, again, we’ve never meant lockdown when say public health and social measures. It’s a combination of interventions with physical distancing, some movement restriction in some situations, making sure that we have disinfection, we have good ventilation, we wear masks, we avoid crowded spaces.
All of those interventions provide an opportunity for a layered approach but when you add those layers on, when you start to lift them and you take those layers off, they need to be done carefully. If you take all of those layers off at once the virus will resurge and that’s what we are continuing to see. And in the context of the Delta variant, which is much more transmissible than the original strain, the ancestral strain, if you have that in the context of increase of people mixing, the virus will thrive.
So, our advice to countries continues to be to look at your local situation and make adjustments very carefully. Communicate with your public, communicate with people to say what needs to be done where and if changes are going to be made, make sure people understand how they can keep themselves safe.
00:48:35
It’s not just enough to put only the responsibility on individuals. We need policies that are in place that make sense, that are tailored, that are approached and that support people in actually carrying out these life-saving measures. So, whatever measures that are put into place, whenever they are lifted, they need to be lifted slowly, they need to be lifted carefully and, as the pandemic evolves and as time moves, reassess. Make an assessment of where you are and if course correction needs to be done, make that course correction.
For us, that’s a strength and what we see in many countries is they’re looking at what they’re doing and making some changes based on the local situation because it is dynamic. There is a lot that is happening right now and we need people to empowered, we need them to be engaged and we need to enable them to be able to carry out those life-saving acts.
CL And Dr Swaminathan for the second part, please.
SS To address the question of the European Centre for Disease Control recommendation on boosters, we’re aware that many European countries, many countries around the world are recommending boosters for certain specific population groups and, in fact, in some countries everyone over the age of 18.
00:50:00
The European Technical Advisory Group of Experts, the ETAGE on Immunization has also met to review the situation, taking into account the epidemiology, the rise in cases in many countries in Europe, the strain that it’s placing on the health system, and all of the things that were mentioned by Dr Tedros and Dr Ryan earlier.
The following recommendations have been made. The first and most important is we need to vaccinate those people who are not vaccinated. There are people in every country, even those who have lots of supply of vaccines, that have not been vaccinated. In fact, in many countries it’s stagnating. The vaccine coverage is stagnating at between 50-60% coverage.
So, we need to really make progress there because that’s the group that’s most at risk of getting infection, spreading infection and also falling sick and ending up in the hospital. So, we shouldn’t forget that there’s a lot of mileage to be covered there and especially if some of those people are in the vulnerable and high risk groups.
There are elderly people, there are disabled people, there are people in care homes, there are people who cannot access vaccines. We need to look at every possible means, engage the communities to make sure that everyone who needs a vaccine has access and gets the vaccine, and this involves a lot of communication and community engagement.
The second is that there are immunocompromised people. There are people who do not make a good immune response for one reason or another. There’s a whole list of conditions. Those people need a third dose, an additional dose, because the first two doses have not brought them to where they are.
00:51:43
Similarly, people who receive two doses of either Sinovac or Sinopharm, many European countries are using these vaccines, and are over the age of 60 should receive a third dose between one to six months after the course. So, those are additional or third doses for people we know have not made a good immune response.
Then, finally, there are countries that are giving booster shots to target populations. The ETAGE, the European Technical Advisory Group, has recommended that those countries that are offering boosters again prioritise giving it to those people whom we know are at the highest risk of getting very ill if they get infected. So, it’s the same groups that have been laid out already in the prioritisation roadmap.
And, finally, SAGE is constantly reviewing the evidence on boosters. The Director-General mentioned we know with the Delta variant, for example, that the protection against infection is not as high as it was with previous variants, so it was 60-70% against previous variants, it’s 40% against infection now but, however, the threshold for prevention of severe disease is still above 80% in the majority of cases.
The science keeps changing, coming in. We have more data. We’re tracking all the studies and so we will make recommendations by age group, by population group as more data comes in but, for now, I think this is the recommendation for Europe and, again, focus on the unvaccinated and then on the really high risk and vulnerable groups.
00:53:23
CL Thank you very much, Dr Swaminathan. We are slowly coming up to the hour and we have an extremely long list of journalists, so maybe we can take one last one and that’s Naomi Kresge, from Bloomberg. Naomi, please unmute yourself.
NK Hi. Good afternoon. Thanks for taking my question. Looking again at Europe, I was wondering if you think it’s possible for countries like Germany to break this wave of the pandemic without a broader lockdown? And returning to the UK question, as well, do you think the UK has anything to teach the rest of Europe in this regard as they’ve moved forward with few restrictions, even amid high case rates? Thanks.
MR I think Germany is a large country and it’s a federal state and I think the situation in different parts of Germany is different and will require different approaches, so I don’t think you can make one answer and, again, that’s the essence of it.
I think maybe one of the things Germany has done well, and particularly the UK has done well, is being able to have that microdata, knowing what’s happening locally at local county level within the nations that make up the United Kingdom and then having that overall view of the world.
I think Germany is looking at the problem in the same way, what’s driving transmission in each of the states and then what’s driving the hospitalisations and deaths. And, as the DG said in his speech, in some cases the hospitalisations and deaths are mainly being driven by the fact that vaccinations are low, as Dr Soumya said quite rightly, specifically in those highly vulnerable people, older people or immunocompromised people, and the priority is to get those individuals vaccinated as quickly as possible.
00:55:06
So, the question you’re asking, do we want to get transmission down? Yes, we do but, first and foremost, we need to get hospitalisations and deaths down and the best way to achieve that is to ensure that each and every individual who is likely to do not well with an infection is vaccinated as soon as possible, whether that means getting better at taking the vaccine to people or bringing people to the vaccine, whether it means informing people in a more proactive way and addressing their hesitancy and really going out there and knowing.
In many, many countries now we’re down to a smaller and smaller group of vulnerable people. Governments should know exactly who has not been vaccinated and move away from blunt percentages to missed individuals. Why did we miss this individual? Did we miss this individual because we didn’t know they were there or we didn’t have the logistics or that person couldn’t reach a vaccination centre? We couldn’t reach them? Or, that person has vaccine concerns?
And, one by one by one, to protect those individuals and move away from blunt statistics and move towards vaccinating those people the system has missed and vaccinating those people who still have individual concerns. That has to be a primary objective because that’s how we will save lives.
00:56:18
On top of that we can reduce the pressure on the system by reducing transmission. We can reduce the chance of the emergence of variants by reducing transmission. So, I think that’s where Germany and other countries need to go.
And, again, I think the United Kingdom and Germany, but UK has really led the world in how to look at data, how to do excellent analytics, how to give context and get insights for disease control. So, some great examples from the UK on how you should approach measurement around pandemics and epidemics.
CL Thank you very much, Dr Ryan, and I’m sorry to cut you off but Dr Tedros will have to leave and we are about to close. And before we close, we’ll send audio files and Dr Tedros’ remarks today after the briefing and, of course, you will find the full transcript tomorrow on the website. Over to you, Dr Tedros, for the closing remarks.
TAG Thank you. Thank you, Christian, and thank you to all media colleagues who have joined today and see you next time.