Media briefing on COVID-19 - 11/12/2020

ABSTRACT

000306 FC Hello, everybody. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Friday 11th December. Present in the room are the WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Ed Kelley, Director, Integrated Health Services, Dr Bruce Aylward, Special Advisor to the DG and who leads on the ACT Accelerator. Joining us remotely are Dr Soumya Swaminathan, our Chief Scientist, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals and Mr Joe Kutzin, who leads the WHO Health Financing team at WHO. Welcome, all. Simultaneous interpretation is provided in the six official UN languages plus Portuguese and Hindi. Now without further delay I would like to hand over to Dr Tedros for his opening remarks. Dr Tedros, the floor is yours. TAG Thank you. Thank you so much, Fadela. Good morning, good afternoon and good evening. This week vaccines against COVID-19 have started to be rolled out in the United Kingdom and we expect more countries to follow. To have safe and effective vaccines against a virus that was completely unknown to us only a year ago is an astounding scientific achievement. 000502 But an ever greater achievement would be to ensure all countries enjoy the benefits of science equitably. WHO and our partners are focusing on three priorities. First we face an immediate funding gap of US$4.3 billion to procure vaccines for the most needy countries. I urge donors to fill this gap quickly so that vaccines can be secured, lives can be saved and a truly global economic recovery is accelerated. Second we have worked hard to secure political commitment from world leaders for equitable access to vaccines but we would like to see that commitment being translated into action. Third we're preparing countries to deliver countries by assessing gaps in infrastructure. Already almost one billion doses of three vaccine candidates have been secured as part of the COVAX facility and 189 countries are now participating. Our COVAX partner, GAVI, is in discussions with several other manufacturers and further deals will be announced in the near future. 000625 Simultaneously WHO is working with GAVI and UNICEF to evaluate the first set of requests received from countries who are eligible for assistance through the COVAX facility. Addressing the financing gap is an urgent priority. On Monday WHO and the European Commission are reconvening the facilitation council for the ACT Accelerator with our co-chairs, Norway and South Africa. The council will scrutinise our strategic priorities and a draft financing framework to close the ACT Accelerator financing gap for 2021. This is crucial to ensuring all people everywhere are protected. We have all seen images of people being vaccinated against COVID-19. We want to see the same images all over the world and that will be a true sign of solidarity. Yesterday was Human Rights Day and tomorrow is Universal Health Coverage Day. These two days coming so close together at the end of this very difficult year are a reminder that as we rebuild from this crisis we must do so on the foundation of human rights including the rights to health. 000803 2020 has reminded us that health is the most precious commodity on Earth. In the face of the pandemic many countries have offered free testing and treatment for COVID-19 and promised free vaccination for their populations. They have recognised that the ability to pay should not be the difference between sickness and health, between life and death. This year Universal Health Coverage Day takes on even more importance than usual. Apart from the death and disease caused by the virus itself millions of people have suffered and died as a result of disruption to essential health services. This week WHO is launching two initiatives to support and rapidly accelerate countries' journey towards universal health coverage. The first is a global programme to strengthen primary healthcare, better equipping countries to prevent and respond to emergencies of all kinds from the personal crisis of a heart attack to an outbreak of a new and deadly virus. The second is a new UHC compendium designed to help countries develop the packages of services they need to meet their people's health needs. WHO is also launching a new report that provides the first analysis of how global health spending has changed during 2020 in response to the COVID-19 pandemic. 000946 Many governments have responded to the pandemic with exceptional budget allocations for their health systems and even larger allocations for economic stabilisation and social protection. At the same time COVID-19 has triggered a deep global economic crisis that could have a long-lasting impact on health financing. Public revenues are declining, forcing many countries to take on additional debt which will impact lower-income countries whose economies were vulnerable before COVID-19 struck. The report warns that higher debt servicing could make it more difficult to maintain public spending on health. But this is precisely the moment for investing in health. The pandemic has demonstrated that health is not a luxury. It is the foundation of social, economic and political stability. Indeed today's report highlights that the COVID-19 crisis provides an opportunity for a reset in countries with weak health financing systems. It makes six key recommendations for a new health financing compact. To draw more attention to universal health coverage we have also made it one of the main categories in the second WHO health for all film festival. 001122 We're inviting all film-makers, whether professional or amateur, to submit short films focusing on access to quality care for any health need by 30th January 2021. Several hundred films have already been submitted and the two other categories for the festival are health emergencies, in which we invite short films about COVID and other humanitarian crises, and better health and well-being, in which we invite films about climate change, pollution, sanitation, nutrition, gender issues and more. We know that although children are less at risk of severe disease and death from COVID-19 than older adults millions of children have suffered from the pandemic in other ways including disruption to their education. According to data collected by UNESCO classrooms for nearly one in five schoolchildren globally or 320 million were closed as of 1st December, an increase of nearly 90 million in just one month. 001241 In some places children have been out of school for nine months or more. Prolonged school closures are presenting an unprecedented challenge to children's education, health and well-being. Today WHO has released a new checklist to support schools in reopening and in preparing for resurgences of COVID-19 and similar public health crises. It lists 38 essential actions; a new checklist to support schools in reopening and in preparing for resurgence of COVID-19 and similar public health crises. It lists 38 essential actions to be considered by different stakeholders as they work to agree school reopening plans. More than 66 million cases of COVID-19 and 1.5 million deaths have now been reported to WHO. In the past six weeks the number of weekly deaths has increased by around 60%. Most cases and deaths are in Europe and the Americas. The festive season is a time to relax and to celebrate but we must not relax our guard. Celebration can very quickly turn to sadness if we fail to take the right precautions. As you prepare to celebrate over the coming weeks please, please consider your plans carefully. If you live in an area with high transmission please take every precaution to keep yourselves and others safe. That could be the best gift you could give; the gift of health, life, love, joy and hope. I repeat; the gift this season, the best gift this season you could give is the gift of health, life, love, joy and hope. I thank you. Happy holidays. 001515 FC Thank you, Dr Tedros. I will now open the floor to questions from members of the media. I remind you that you need to use the raise your hand icon in order to get in the queue to ask your question. I think we will start with Laurent Zero from ATS, Swiss news agency. Laurent, can you hear me? LA Yes, thank you, Fadela. Can you hear me? FC Very well. Go ahead, please, Laurent. LA Very good. We have observed in recent weeks a trend downwards in countries like Switzerland and some of its neighbouring countries but then more recently since one week ago there is a kind of plateau at a high number of cases despite strong measures that have been taken by the different governments. How do you explain that? Thank you. 001620 FC Thank you, Laurent. I'd like to invite Dr Van Kerkhove to take this question. MK Thank you for the question. Indeed across many countries in Europe we have started to see a decline in cases and I think that's a result of the measures that have been put in place and individuals who are adhering to those measures. But as you've said, it's starting to plateau in some locations and what this means is that we need to stay the course, we need to follow through, we need to continue to practise the physical distancing, staying home if asked, teleworking, following all the measures that are put in place to keep ourselves safe whether these are individual-level measures such as physical distancing, the wearing of masks, cleaning your hands, practising good respiratory etiquette, whether you are asked to stay at home; continue to stay at home. But we have to follow through. I think one of the lessons we can learn, especially across Europe, is over the summer Europe showed us that they brought transmission under control. In many countries cases were down to single digits and that can and that will be done again but we really must be vigilant and we really must stay the course. 001726 Given the holidays that are coming up, as the Director-General just said, it is a time when many people want to come together but we really need to make very careful decisions about how we celebrate this year. We will celebrate but maybe it means we celebrate with just our households and maybe we do another type of Zoom celebration, as we will do with my family this year. But we do need to stay strong and we do need to make sure that we keep ourselves separated from others for the time being while we have the good news of vaccines coming online. But again just to repeat, we need to stay the course. It's very easy for us to go up quickly in case incidence. It takes quite some time to actually come down the other side of the mountain, as you've heard Mike say, in the spring so we have to follow through but we will do it, Europe will do this again and they will show us how to bring it under control. 001824 MR I think, Maria, you're absolutely spot-on. I'll just repeat two of your words; follow through, make sure this time that we follow through on the measures. If we continue to build public health surveillance, we continue to work with communities to maintain those measures around physical distance, personal hygiene, avoiding crowds and then we add vaccines gradually in the coming year we can avoid the lock-downs. So this is about us all following through on our commitments as individuals, as communities and as governments in the coming months. FC Thank you. I would like now to call on Jason Bobia from NPR to ask the next question. Jason, are you with us? JA Yes, thank you very much. You mentioned, Dr Tedros, that the UK has now started vaccinating and the US appears to be on the verge of authorising the Pfizer vaccine and you talked about the need for equitable distribution but obviously that distribution can't start in many places until the WHO authorises a vaccine. Can you give us an update on when we can expect the WHO to authorise a vaccine that can start being distributed through COVAX? FC Thank you, Jason. We have with us remotely Dr O'Brien and Dr Soumya Swaminathan. Kate, do you want to start? Or Dr Swaminathan. 001957 SS I don't think Kate is connected. FC Okay. Dr Swaminathan, you have the floor. SS Thank you, Fadela. Yes, I can start. The WHO has put out our criteria for emergency use licensing and we are open to receiving submissions from all manufacturers who are interested. In fact we've received several and it's a rolling submission so as more data is accumulated from the different phases of trials it's provided to WHO so that we're up to date and we can stay as updated as possible. We are now going to be looking at the Pfizer dossier followed by a couple of others as they come in and we expect that... We work quite closely with the European Medicine Agency along with some of the other national regulatory agencies and so we expect that in the next couple of weeks our committees will be reviewing the Pfizer BioNTech dossier and coming out with an opinion. Thank you. 002111 FC Thank you. I think Dr Aylward would like to add something. BA Yes, thanks so much and, Jason, thanks for the question; super-important. When we established the COVAX facility to make sure that there would be absolutely no barriers to the most rapid access to vaccines possible for all countries in the world we're actually using a slightly different process and we are indeed looking at these products though the WHO emergency use listing procedure. At the same time we have an exceptional procedure in place where some products that are approved by what we call a stringent regulatory authority can also be considered by the COVAX facility so there will be no barrier to the speed with which these products could potentially be used globally. FC Thank you. I would like now to call on Isabel Sacco from EFE, the Spanish news agency. Isabel, you have the floor. IS Yes, good afternoon. I have more or less the same question as the previous one. I would like maybe to ask again if Dr Soumya can identify the vaccine candidates that WHO is reviewing and for the general public if she can explain the importance of this review by WHO, taking into account that we all know that there are many other national regulatory agencies that are doing the same procedure. Thank you. 002259 FC Thank you, Isabel. Dr Swaminathan. SS Yes, thank you for that question. Indeed it's a bit confusing because, as you rightly pointed out, national regulatory authorities do have the mandate and the jurisdiction to make these assessments and decisions for use within their own countries so every national regulatory authority has the authority and the mandate to do that but that's limited to their own countries. Several countries rely on WHO's pre-qualification service for vaccines and for drugs and that's a service that WHO provides also for global procurement agencies like UNICEF and GAVI because it's a stamp of quality, safety, efficacy and manufacturing quality. 002354 In the case of the emergency use licence of course we base this assessment on limited amounts of data and that's clearly laid out in the criteria so what should be the minimum efficacy, what's the minimum safety data that's needed as well as of course all the manufacturing details around the quality of the product. So, as I mentioned, we have opened the expressions of interest several weeks ago, I think it was about four to six weeks ago and we have been receiving both enquiries as well as submissions of dossiers from several companies, at least ten companies have either expressed an interest or submitted initial dossiers. The data will only be considered for an emergency use licence when there are some phase-three clinical trial results available and so there are only a couple of companies now that have those phase-three results and those are interim results. So we've started with the Pfizer dossier; we expect also to have the Moderna followed by the AstraZeneca dossiers examined in the next few weeks and we will be coming out with the decision, whether it is receiving an emergency use licence or not. The other thing that we're doing is of course working with the regulatory agencies, the International Coalition for Medical Regulatory Agencies, the ICMRA, with whom we have a letter of agreement now on how we would work together so that we can speed up things further. 002536 We have regulators from several countries actually who have stepped up and volunteered to help the assessments that WHO will be performing so these will be joint assessments done with national regulatory agencies. We have asked countries also to prepare for licensing of vaccines by either accepting the WHO EUL or PQ procedures or by accepting one of the stringent regulatory authorities, as Bruce was just mentioning, so that they are in a position to receive vaccine doses from the COVAX facility. They have to accept either of these. What we don't want is for every country to start an assessment process for every vaccine because that's just going to take far too long and so therefore it is important to rely on a few regulatory agencies globally plus the WHO process. Thank you. FC Thank you, Dr Swaminathan. Dr Ed Kelley would like to add something. 002635 EK Yes, thanks, Fadela. Just to complement the points made by Soumya on this, one of the pieces of work certainly is getting the vaccine through the regulatory process and getting it reviewed here at WHO but as we've always said, it's not the vaccines but vaccinations and vaccination programmes that will end up protecting people and there's tons of work going on right now; in fact the entire ACT Accelerator in many ways, as the person doing a lot of the work on the Health Systems Connector, has pivoted to support the assessment in countries. We were targeting 100 countries; we've now got 105 assessments already in and the picture of what is going on and how countries are preparing not just on the regulatory work, which does need some more work, but also on safety monitoring systems. We've got over 65% of countries that have already got safety monitoring systems in place so all of that work will be as important as the work that Soumya just mentioned. FC Thank you. I would like now to invite Jeremy Lunge from Radio France International, RFI, to ask the next question. Jeremy, do you hear me? JE Yes, I can hear you, Fadela. Thank you so much. A question about testing; a lot of people are thinking about getting tested ahead of Christmas. In France the Health Minister advised against it, saying that it might provide a false feeling of safety. I would like to know, do you have any comment on that, do you advise against or for testing before Christmas? Thank you. MR We certainly advise that all patients who are suspected of having COVID-19 are tested and that we expand testing through the use of rapid diagnostic tests in specific circumstances. Maria can go into details of how we see the strategic expansion of testing but we need more testing, not less. I think the Minister may have been relating to the specific issue of individual risk. Finding as many infected people in the community is very important but when you get a test and you test positive or negative on a certain day it doesn't mean you will test negative the next day or the next day. So doing more testing to find infected people; yes, good. Relying on a single test to guide your behaviour in the coming days or who you can meet or what you can do is problematic because knowing your status today does not guarantee your status tomorrow. 002917 So we must sustain the behaviours of physical distancing, wearing masks, avoiding crowded spaces, ensuring we're using appropriate ventilation and doing all those things to minimise risk in those environments. That does not mean that targeted, strategic testing is not a good idea. We want to see an expansion of testing but we want to see it done for public health purposes. Individuals who have the resources to have themselves tested; there is nothing wrong with getting a test. It's really how you interpret that result and how that affects your behaviour and how it should or shouldn't affect your behaviour. Maria. MK Yes, thanks. Just to supplement what Mike has said, we encourage, we advise, we recommend strategic testing. We have since the beginning and anyone who meets the suspected case definition should be tested. We work very hard through our regional offices and our country offices to build testing capacity. This has been a PCR-based testing capacity and now all countries are able to test for COVID-19, test for SARS-Co-V-2 infection, the virus that causes COVID-19 and that is really quite an incredible feat. We now have antigen-based rapid diagnostic tests that are coming online. These are cheaper, quicker, easier to use and we recommend these be used in areas where there's a lot of virus, where there's a lot of virus circulating, where there are outbreaks that are happening, in areas potentially screening individuals like health workers who are at a higher risk of exposure because they had direct contact with known patients. 003048 Those are really helpful to alleviate some of the pressure on the PCR-based system but testing for testing's sake must be linked to public health action, it must be linked to isolation of cases, clinical care of cases, contact tracing, supported quarantine of those contacts. As Mike has said, a test result gives you the result of that sample that was collected at the time of testing. You could become infected between the time that you took that test and the time you get that result back, which is why it's really important that we not only get tested with a high-quality either PCR or antigen-based test but that you get that result back quickly and you follow through with the public health actions that are there. 003132 So in some countries testing will be expanded and this is good and we have seen a global expansion of testing but again it needs to to be fit for purpose, it needs to be linked to cluster investigations and case finding and making sure that you're working towards your goal of reducing transmission and you're breaking chains of transmission. So there are good products that are coming online. These rapid antigen-based tests are a game-changer in many ways because they can be used in lots of different settings and take the pressure off the PCR systems. But again we still, all of us, need to adhere to all of the measures that keep ourselves safe, keep our loved ones safe so keep up that physical distancing, keep following all of the measures that are put in place in the local area where you live, which is based on the transmission that's happening around you. FC Thank you. Moving now to Cancun in Mexico I would like to invite Paulina Alcazar from Ancadena News to ask the next question. Paulina, do you hear me? TR Yes, Fadela. Can you hear me? Thank you. Good day to everyone from Cancun. What considerations should be taken into account with the high number of reinfections or is it considered as a long COVID, a persistent COVID when someone is positive again at a test several months later? What do we consider it as? 003307 MK Thanks for the question. There're two aspects to the question that you've asked. One is about reinfection and I think the other one is about long COVID so these are two separate things and let me just break them down very briefly. We do know that there are some individuals who may be reinfected with this virus and this has been detected in a number of countries that have good lab systems, that have been able to do a sequence of the first infection and a sequence of the subsequent, second infection and they can tell that there's a difference in that virus, a slight difference because the virus changes and that is indeed a subsequent infection. This is now starting to be picked up in a number of countries and we have more than 69 million cases that have been reported globally but the number of reinfections is a lot smaller than that. We're working with countries to help them better define what a reinfection is and to help them look to see how often this is happening. 003404 So it doesn't seem to be happening very often but we can't quantify that at the current moment. The question around long COVID is that there are individuals who've been infected with the SARS-CoV-2 virus, they have an acute disease where they're very unwell or they're mildly unwell and then they seem to recover but they're having longer-term effects. We are learning more and more about what long COVID is in terms of the effect on the body. It seems to affect many different organ systems. It's not just a respiratory illness of two weeks; it seems to persist for months. We're working with many different patient groups, we're working with many different researchers to better understand what is happening. We have met and the Director-General has met with patient groups and the patient groups have said to us what they need is recognition that this is real and this is real and there's now an ICD code for what's called post-COVID syndrome. We're working with them because we need better research to understand the extent of this in different populations, to understand what disease looks like in terms of the long-term effects and the different effects on the organ systems and also rehab. 003520 So we're working with clinicians to better design and work on rehabilitation for individuals who are suffering from this, to ensure that we give them the best care possible so we have a lot to learn in this area. There was a forum that was organised this week by ISARK [?] and partners which WHO participated in and we have seminars and working groups that have been established specifically to look at this so that we can provide adequate care. MR Let me just emphasise what Maria's been saying; it is best that we all try to avoid this infection and not to have to be concerned about your health going forward; also to reassure people, yes, the vast majority of people do have an infection that doesn't result in ongoing specific effects. But there's a significant minority of people who are suffering very, very long into a post-COVID period and our hearts go out to them as they approach this Christmas period because sometimes in life mortality and death is recognised and we all sympathise. It's very hard when you're carrying the after-effects of an illness; it can be a very lonely experience and people don't want to attract attention to themselves because people may think, I'm infected and I'm still coughing. 003640 So people are going through a lot of psychological trauma as well as having those lingering effects so I think we should all be very kind to each other and particularly kind to those who've had to fight through very difficult infections and have the continued concern of the long-term impacts on their family. To our journalist I would say, given the weather here in Geneva we would love to be with you in Cancun. FC True. Let's go to Georgia; I think it's cold in Georgia. I would like to invite a journalist from Georgian television, Imeda, Kitivan Kardava, to ask the next question. Kitivan, are you with us? KI Yes. Good evening. Can you hear me? FC Very well. Go ahead, please. KI Thank you very much for this opportunity, Mr Director-General. When you were talking about vaccine and about the news about vaccine you said recently that a beam appeared at the end of the tunnel. How bright is that ray today, can you tell us? 003748 As I represent Georgia I want to ask you about Georgia. Thousands of people are infected in my country every day. What would you say to the population of Georgia? They are watching your statements carefully every week. Also I have a question about information campaigns; how should information campaigns about vaccination be conducted so that the people have a confidence in the vaccine? We all know that vaccine will be effective in the case when people have confidence and trust in it. Thank you very much. FC Thank you. These are three questions. Maybe Dr Aylward would like to start. BA Sure, and Soumya may wish to come in on the issue around the confidence and everything that's being done to build that but in terms of the comment the Director-General made last week about the light at the end of the tunnel, I think was the phrase, and how bright that is, that light is getting brighter in fact. 003900 If you look week by week at the number of companies that are announcing positive results in terms of the efficacy of vaccines that number is increasing and what's important is it's increasing not just in terms of the number of products but also the different technology platforms that they are being built on. As we're seeing now, there're three different technology platforms, as we'd call them, that have reported very positive efficacy and safety data. We haven't seen and scrutinised all of the data behind that, as we've emphasised multiple times. Some of this is still in press reports but it's positive which means that beam is looking brighter, to the point that you asked. But at the same time there're other considerations and Mike emphasises this repeatedly and Maria. I think it's so important an that is that there are real challenges with volumes; these are still very, very scarce products and just as some companies are announcing successes there are others - and we've had two over the last few days - that have said they have challenges with their product either in terms of the volumes they can produce or in terms of some of the trial results. 004009 So this reminds us that while the beam, as you said, or light at the end of the tunnel is getting brighter over time it's still a long tunnel to get out of the battle against COVID and we still have a long winter in front of us. I think, to the points that Mike emphasises again and again, we have to do everything and we need to continue doing everything for the foreseeable future because with that light at the end of the tunnel we should have a new energy now to do the case finding right, do the contact tracing right, do the isolation right. So what this really should give us is the hope and the stamina to be managing this disease and implementing those measures that much more strongly in the near term. Perhaps Soumya'd like to comment to the broader agenda of work on confidence building. FC Thank you. Dr Ryan. 004101 MR No, with specific reference to Georgia itself, Georgia's had a tough time over the last number of weeks. It's had a very steep rise in cases and has reached pretty high cases per million population overall although that's stabilised in the last week; there's been a 9% increase in cases in the last week and, I think, an 8% increase in deaths. So Georgia's had - certainly in the first wave earlier in the year Georgia managed to avoid a good deal of the impact of the first elements of this pandemic but has been hit quite hard this time around. I think the positive answers or news are that the case fatality rate has been relatively low and again credit to front-line doctors and nurses who continue to maintain front-line services. But I think the story here too for Georgia - and I think it's something that every country needs to look at; past success or past avoidance of a given scenario does not mean that that scenario can be avoided the next time around. You may have dodged a bullet the last time; you may get hit hard this time and therefore it's really important that you understand in a given setting... You see situations like for example at the moment in Korea and in Japan; they've been dealing with a bounce in cases in the last couple of weeks. Korea's been an extremely high performer in the area of disease control but it's going to have to turn and fight that disease again and each and every time there may be different risk groups, it may be a different part of the country, it may be a different age group. 004235 Each time you fight this battle there are slightly different tactics required and that's why you need to be agile, you need to look at what's happening in your country, you need to not make assumptions about what's going to happen or things are going to go away or going to disappear or whatever all the other euphemisms are for this. You've got to fight what you see; knowledge and data drives that, understanding what's happening and then giving people the right information, intervening aggressively in the right places, adapting your control measures to the situation you see on the ground, expanding your testing and improving your capacity to understand clusters and amplification events and then supporting people in avoiding crowded settings and doing all of the other things we need to do. 004316 The DG keeps saying it again and again; do it all. But I would also say, do it smart, when you have limited resources do it smart as well and use those resources and drive your public health interventions with the intelligence that comes from using science and using data, a data-driven, science, driven approach. Again Georgia is turning that corner. It is not an easy time and we've seen in Europe that as the disease has come under control in many of the Western European countries, many Central European countries, in the Caucasus and even in central Asia have continued to have a difficult time and then that shows how this disease is in a different... We're not in an epidemiologically stable situation. The virus is still working its way through the human population. The vast majority of people remain susceptible so it has not settled down into a pattern that you can predict and say, oh, this is what's going to happen next week and the week after. That is not the case and there are potentially unique aspects of every country's culture and behaviour and set-up that can drive transmission one way or the other. Maria. MK I just want to say, it's moving around from your question a little bit but I just want to highlight some of the things Mike has just said there. 004431 It is about being in a state of readiness. We know so much more now, we're using data to drive our actions and if a country is having an increase in cases as we're seeing in Georgia you still have experience. There's a lot of experience and knowledge that is being used to help tailor the approach to what needs to be done, where it needs to be done and for the amount of time that it needs to be done. That's done at a political level, it's done at a community level, it's done at an individual level and with the example of Korea - and we could choose a number of countries that have seen a resurgence - it's about that state of readiness. If you use the system that you have in place - the world is not in the same place we were in a year ago. Many countries have built up this public health infrastructure, some at a faster rate than others but we still need to continue to invest in people in a workforce that can do active case finding, that can carry out those tests and that strategic testing so that lab results get back quicker, so that we carry out the contact tracing and the cluster investigations. 004532 This virus likes people, it needs people to transmit between. It's primarily transmitting between people in close contact with one another. If you put a lot of people together, you're in an enclosed space, you add poor ventilation you are providing an ample opportunity for this virus to spread. We can take actions that can prevent all of that from happening and I think that's what's really critical right now. As Bruce said, as the vaccines are coming online there's a lot of hope that we have but I think many people will also feel a little bit frustrated because we won't be able to get to that light at the end of the tunnel as fast as we want to. We have to remain vigilant and your question was what should we tell the people of Georgia. Hang in there, do everything that you can to protect yourself and to protect your loved ones. You have individual-level measures that you can have. You have knowledge about where this virus is, how it spreads and you have the power to take decisions. 004627 Each of these decisions that you take can minimise your risk. We are telling everyone, know your risk and take steps to lower that risk. We want people to feel empowered, that there's a lot you can do and again, especially as we're seeing in this holiday season, please make the right decisions to keep yourselves safe. While we are seeing in many countries across Europe a decline in cases, as the Director-General has said, the percent increase in deaths globally, as the Director-General said, has been a 60% increase in the last six weeks; a 60% increase in deaths in the last six weeks. That is not evenly distributed around the world where we've seen in EMRO a 10% increase, in AFRO a 50% increase, in EURO almost a 100% increase in deaths over the last six weeks, SIERO 7.5%, PAHO 54%, WPRO 15% so it isn't evenly distributed. This virus is still circulating. Most of the world remains at risk. We can take steps to protect ourselves. Please do everything you can to protect yourself and your loved ones. FC Thank you. Dr Tedros. 004740 TAG Thank you. This is a rare treat from Georgia so thank you and greetings to Georgia first of all. That question is very important. As Bruce said, the light at the end of the tunnel is getting brighter - I fully agree - with more vaccines now in the pipeline. At the same time we have to also focus on some of the challenges we're facing to make the light really completely bright. There are three major areas where we're focused and the challenges we're facing are associated with those. Number one, funding. There is a need for immediate funding of up to US$4 billion; that's one. Second, we have all followed what has been happening in the last few months. Many world leaders, our political leaders have pledged to make vaccines a global public good. That pledge has to be translated into action so that's second. We expect our leaders to really honour their pledge. We see some concerns but I hope we will have the vaccines on the ground based on the pledges that have been made. Third is infrastructure; the whole supply chain, especially of developing countries, has to be strengthened, has to be prepared; the supply chain, training of health workers and so on. We're doing that and that's the other area where we're focusing because when we do these three things - the funding, the political commitment translated into action and preparing the infrastructure - then the vaccines that are coming into the pipeline will lead into vaccination. 004949 At the end of the day the most important part of the whole process is when you see people vaccinated, when they have the inoculation and when that is done fairly and when that's done globally. When that's done then the world can recover faster and, as we said many times, sharing the vaccine and having the inoculation everywhere in all countries means faster recovery and it's in the interests of each and every country in the world. Lives and livelihoods will get back to the new normal and we believe that's what the world wants. Thank you. FC Thank you, Dr Tedros. Dr Swaminathan, you have the floor. SS Thank you, Fadela. Very quickly on building confidence in vaccines, which was the third question. It's really important that governments and public health officials start communicating with citizens in their countries to explain to them the process of the deployment of the vaccines because things are happening extremely fast and people are anxious for information, they have a lot of questions and very often it's genuine questions that people have that need to be answered. 005123 They may have some fears that need to be allayed but a lot of times it's questions and doubts which really need to be addressed and it's only a minority of people, I think, who are anti-vaccine. The surveys that have been done showed that the majority of the world's people actually want a vaccine, they're waiting for a vaccine, they can't get it soon enough. At the same time they may have questions so this is the time to explain to people who are the population groups who have been prioritised, why have they been prioritised, when are the doses likely to come. The fact is that we are going to have limited doses in the first half of 2021 all over the world. Dose supplies are going to be limited. We need to prioritise those who are at the highest risk of getting the infection or dying from the infection. These are our front-line workers, our healthcare workers and the very elderly who are the most susceptible. 005219 The rest of us have to be a little more patient. We have to continue with all the measures that we've talked about and these are the things that governments need to communicate so it's important to have a national vaccine deployment plan and a strategy. One of the key elements of that is the communication to the public and the more open and transparent we can be the more likely it is that people will have the trust and the confidence and will not only want to take the vaccine but will also be patient and wait for their turn. Thank you. MR Just very practically on that, we've been working very, very closely; the Immunisation Programme with Kate and the Emergencies Programme on our side have joined together with UNICEF and the International Federation of the Red Cross and Red Crescent Societies on a common service around risk communication and community engagement and specifically in the area of vaccination. 005315 So if countries require more integrated systems and services and support there is the planning part but then there's the implementation so we take this deadly seriously. This is a science and this is a moment of translating our knowledge and communications into behaviour and action and demand and it doesn't happen by itself. It requires a dedicated and committed investment in social engagement so we stand ready as three organisations and others to support member states and people and nongovernmental organisations in the field in doing that and we are specifically investing in a strand of activity to support the implementation of the ACT Accelerator and the preparation of countries for successful vaccination campaigns. Kate O'Brien, Sylvie Briand and others are leading on that internally here at WHO. We have many excellent colleagues in UNICEF and Red Cross working with us on this portfolio. FC Thank you so much to all of you. I would like now to invite Sophie from SABC South Africa to ask the next question. Sophie, are you with us? 005422 SO Yes, I'm here; Sophia Mkwena from the South African Broadcasting Corporation. The topic of vaccines on the African continent at times can be very controversial because there's a perception that the continent is being used for all the trials. There's a heated debate in South Africa currently. The Chief Justice of the Constitutional Court yesterday - a very religious person - when he was praying he prayed that there shouldn't be a vaccine that is being manufactured based on gammon [?]. Therefore that has generated a heated debate and it has instilled fear in some people, questioning, particularly after he also pointed out, why do you give people vaccine when they are not necessarily infected. I just want to check from Dr Ryan and Dr Tedros; this will demand a serious discussion and perhaps senior leaders to deal with the issue of perception. What is your advice to the African continent, particularly South Africa, at a time when the numbers are currently going up? We are in the second wave of the infection. FC Thank you, Sophie. Dr Ryan. 005559 TAG Dr Tedros and Dr Aylward or Soumya may wish to comment but if we take a step back and look at it from the perspective of Africa, Africa has used vaccines as one of the single most effective public health interventions over the last 30 years on the continent. Africa has just recently eradicated the wild polio virus; it has put the wild polio virus to death on the continent using vaccination. The way in which African nations, even with weaker health systems, have prioritised immunisation of children; this has been the single biggest life-saving intervention on the continent. Therefore I think Africa is to be commended for the way in which immunisation has been used, has been trusted by populations and has been instrumental in reducing mortality rates. When a new vaccine is introduced there are always concerns and there are always questions and increasingly there are people who will distribute disinformation and misinformation and anti-vaccination information. The dialogue is needed at community level in order to address those concerns and we were just speaking about that, how we can deal with that. But certainly we need leaders and others to be very consistent in their messaging to people. We need people not to be raising fears but we need people at the same time not to be, in a sense, ignoring fears. You have to address people's fears with knowledge and with information and allow people to make up their own minds. 005730 I have great faith in people in Africa in general. South Africa and other countries - and again in this African countries have actually shown the way in this response, in community engagement; they've led the way on community-led responses. African countries have - for example the laboratories in South Africa, in Senegal have been reference centres for diagnostics and even the development of diagnostic tests within Africa. Africa CDC and our African regional office have worked and the African Union have taken a big leadership role - the DG may wish to speak to that - on the continent. So Africa's doing well and Africans should be proud of what's being achieved. The next move of bringing in vaccines - and again South Africa, I believe, has participated in vaccine trials and has been at the leading edge of science and other types of trials for other diseases over many years. 005823 It is really important though that countries that do support vaccine trials and countries that do participate in advancing science and innovation have fair and equitable access to the products that come from that process. That's another issue; the DG speaks to that process of equity but in this I think African nations and particularly South Africa are partners in science, they're partners in the innovation but communities have genuine questions that need to be addressed. Bruce may wish to speak or Soumya or others but again I think we need to be very rational in how we approach this discussion. Vaccination, immunisation are life-saving interventions, they have saved hundreds of millions of lives on this planet. We need to maintain our standards, we need to be sure that everything is safe and efficacious but we also need to trust in vaccination as a potentially game-breaking and game-changing intervention in this pandemic. Bruce. BA Thanks, Mike, and thanks, Sophie. These are such important questions and hardly unique to South Africa; you highlighted a couple of times specifically in the context of South Africa but in fact it's not just a South Africa issue - Mike alluded to this a little bit - but in every country there are people who raise questions. 005942 But at the same time there's no question that vaccines are one of the most powerful public health tools that we have and certainly no population, no people would want to be disadvantaged in terms of being able to access them. That's what the entire COVAX facility, the ACT Accelerator is all about. At the same time we're got to make sure that when there are questions raised they get listened to and they get addressed and it's so important to create the fora for discussing these things, to listen to the concerns and then to use the science and the data available to be able to answer those. One of the striking things - Dr Tedros talked about in his opening remarks - was the speed with which science has created tools now and vaccines, it appears, to be able to tackle this disease. But at the same time as striking has been the amount of transparency and the amount of scrutiny that's been given to these products. It's extraordinary and I think one of the great advantages here - I'll come back to South Africa - is that in South Africa you have such experts in the area of vaccines and vaccination, really world leaders in fact, whose counsel we take. 010056 So I think the country's in a very, very strong position, like all countries, to create those fora for the discussion, to listen to the issues and to address them but this has got to be anchored in what is now decades and decades of experience with vaccines, the power of vaccine and the countless millions of lives that have been saved as a result of them and that will be saved from COVID-19 as a result of these vaccines as they're proven and as they come eventually to market and to use. But again, as Dr Tedros said in his last intervention, a vaccine only saves lives when it's actually in someone, not in a vial so the big key now is making sure these products get out, get scaled to people as rapidly as possible. FC Dr Tedros, you have the floor. TAG Thank you. Thank you, Sophie, for those questions and I fully agree with what my colleagues said, especially with regard to some wrong perceptions of the vaccine, that's not just in Africa but it's all over the world. 010201 Then when we come to the testing, especially the vaccines for COVID have been tested outside Africa more than in Africa. Having the testing, as long as the right protocols are followed, is very important and that's what has been done and the testing, I don't think, has been focused in Africa actually; it's more outside but the most important thing is whether it has followed the right protocols or not, whether it's done in Africa or other places but it's done in many places. Then when vaccines are introduced, whether they get emergency use least or finally pre-qualifications, the safety is central in addition to efficacy. So we follow that and other organisations, regulatory bodies also follow that and we will make sure that whatever vaccine is available the two important criteria are met; the safety first and then of course the efficacy. Then the issue you raised with religion; I remember when HIV reached its climax and some medicines started to appear and some people were saying, either you follow your religion or you follow the medicine, the two can't go together. 010348 But religion and science can go together and I remember during that time religious leaders themselves came out and told the public that taking the medicine and doing their religious practices actually don't contradict one another. Many accepted that and many took medicines and they saved their lives. So for our religious leaders it's very important to see from the right authorities whether the right safety and efficacy measures; based on those the medicine or the vaccine is being provided or not; that's what they should focus on. Actually I would like to use this opportunity; it's the role of leaders - religious leaders, community leaders, political leaders - to be models and examples, to convince their followers to do the right thing. I hope our religious leaders will do their best to fight the pandemic, to fight the virus using the tools we have at hand and when vaccines are provided to also help their followers to benefit from the vaccines. I thank you. Thank you, Sophie. MR The DG mentioned something there and I think it was important. I think there are vaccine trials ongoing of different types in more than 50 countries around the world and only three are in Africa right now. The vast majority of trials are occurring in South America, in Central America, in North America, in Europe, in East Asia, in the Western Pacific, in Southern Africa and also, I think, in Kenya as well. 010552 So the vaccine testing is distributed... In fact it's a wonderful example of the absolutely global collaboration. It's the most amazing thing to look at a world map and see the number of therapeutic trials, the number of vaccine trials that are going on and the way in which that data is being shared between the public and the private sector, the way that data is being shared between academics and WHO. So I think it's an actual sign of tremendous faith in the global system that such collaboration exists and Africa is part of that. FC Thank you so much. We will take a last question from China Daily. Chen from China Daily, you have the floor; last question. CH Hi, thank you very much for the opportunity. This year, 2020, looks quite bleak obviously. You mentioned about the light at the end of the tunnel. Could you give us a picture of what the coming year, 2021, will look like, how many miracles this vaccine will do? Are we still going to get our lives back or see new wave after wave of cases, lock-down after lock-down and travel restrictions still there? What's the picture in your mind? Thank you. 010717 FC Thank you, Mr Chen. Dr Ryan. MR I suppose it's one of these moments where you say to everyone, let me give this to you straight. The situation globally is still very epidemiologically unstable. The vast majority of the world's population remains susceptible to this infection. Some countries are on a very negative trajectory in terms of the incidence and death rates for this disease and most countries even at low levels are still at risk of a disease resurgence. It's clear though and what we have learned and the hope is that many countries have demonstrated that this disease can be suppressed and controlled and that control can be maintained at low levels. But some countries face the current challenge of intense community transmission in the context of a seasonal period when it's very difficult to separate people adequately. For those countries who are not in that situation and are achieving lower levels of transmission avoiding intense community transmission must be an absolute objective in the coming weeks and months; avoiding going back into situations that require a lock-down because if that can be avoided and when we have now a vaccine coming online it can give great hope. 010842 So our strategy is we must continue with a comprehensive approach to controlling this disease; control, containment, suppression and mitigation together while introducing vaccine in a stepwise way. Testing needs to continue to be expanded, we need more testing but strategic testing that tells us where the virus is. We still need more and better therapeutics. We tend to forget a little bit, we're all jumping on the vaccine story but actually dexamethasone and other drugs are saving lives so we need better and new therapeutics and that's another big piece of ACT at the moment. But vaccines will make a huge difference. I'll let Bruce speak to how that will and can happen. They're a massively valuable tool but vaccines by themselves will not equal zero COVID. They will have a major impact on morbidity and mortality, who gets sick and how sick people get and whether they die as we vaccinate those high-risk groups. 010942 But the impact on transmission will not come until a much higher proportion of the population of a country is vaccinated and, as I said, as the DG says, we have to continue to do it all, we have to continue to do it smart but vaccine represent a major light at the end of the tunnel but we have much work to do to make that a reality. I'll hand over to Bruce or others who wish to comment and then the DG may wish to wrap up on that. BA Yes, thanks, Mike. I like the way Mike started when he said, I'll give it to you straight, because we'll go into the coming year with more hope definitely. We're in a completely different position in terms of the knowledge of this disease, the knowledge of the enemy and also the tools with which we'll fight the enemy; there's no question as well. But we also know that there're going to be challenges to scale up those tools, to get them out, to get them applied and to see them make the difference we want so you use that metaphor as well; the light at the end of the tunnel. 011043 It's a long tunnel, to give it to you straight, it is a long tunnel and when we look at the epidemic curve - remember now, the world is used to looking at these curves and you'll remember, they don't go up like that and come straight down, do they? They go up and then they peak and then they come down slowly and they come down over time. Some of the tools will help us drive those curves down faster but it's not going to change, boom, like that overnight, which means again, to the point Mike, Maria and Dr Tedros make repeatedly, this should give us hope and with that hope we should have a new energy, a new stamina to apply the measures that can make a difference. There's no reason for us to see the same epidemic next year because we know how to beat this disease but we've got to apply the knowledge that we know in a way that we haven't to the degree possible in 2020. When you look at the places that have they had a very different epidemic. That's what we should be looking at. 011143 FC Thank you. I think Dr Kelley would like to add something. Dr Kelley, you have the floor. EK Yes, just a quick thing to add to those two good comments. Next year IMF and World Bank are predicting that 3% of the world economy will contract and that we will have millions, 30 million people who will be put into poverty so on the eve of universal health coverage day next year for WHO certainly and for a lot of countries will be the year of trying harder. We'll have to continue on this push for the response, just as Mike was saying, just as Bruce was saying but we will also have to be continuing to work and expand this idea of what is essential; expanding access to healthcare to ensure that people have access for COVID but also to ensure that when this is all over we're able to say that we were able to treat those people that needed essential services as well. That, I think, will be something that will be coming through in the next year. FC Thank you, Dr Kelley. Dr Van Kerkhove would like to add something. MK I'm sorry. I know we shouldn't all answer the same questions but it's a really great question and I just want to talk at the individual level. We see countries right now that have brought COVID under control, that are opening up, that have stadiums full of people who are at sporting events and I've been getting a lot of questions lately at the end of the year thinking at the year round-up of, what is this going to look like. 011309 You've heard us say before that it is completely in our hands. We have the tools now to bring this virus under control. Vaccine and vaccination is an additional tool that we will have but I think everyone needs to start to think about the patience that we will need in 2021 to get us through this, to see us through the end of this and what is our motivation to get there. I've seen a lot of really excellent interviews lately about people saying, I didn't think about this for me, I wasn't worried about me getting infected but I was worried about my most favourite person in the world, I was worried about the person that I love most in the world and I would do anything I could to keep them from getting infected. I think whatever it is that motivates you to protect yourself but even moreso to protect that person that you love most in the world, do that and do it now because that's what 2021 is going to look like. That is what is going to help us bring this under control and the vaccinations coming online is incredibly hopeful but we need the patience to get us to that endpoint and it will take some time. 011417 So we don't have that exact end date but if you think of some of the countries that have actually brought it under control they're almost there. They have to keep it up, they have to remain vigilant and keep it down so that it doesn't resurge because no-one - you've heard Dr Tedros say this so often - no-one is safe until everyone is safe. But find your motivation that will help keep you and your loved ones safe because that is what 2021 means to me. FC Dr Tedros, you have the floor for your final comments. TAG Thank you. Thank you, everyone for joining and see you next week in our next presser. Bon week-end; have a nice weekend. FC Thank you, DG. Just to remind journalists, we will be sending the opening remarks of Dr... 011507