TJ           Hello to everyone from WHO Headquarters here, in Geneva, on this Wednesday, August 17th. My name is Tarik and I wish you welcome to a regular WHO press conference on global health issues. I will start by introducing our speakers here, in the room, and those who are online.
Today, we have Dr Tedros, WHO Director-General. We have also Dr Socé Fall, who is Assistant Director-General for Emergencies Response. With us is also Dr Mariângela Simão, Assistant Director-General, Access to Medicines and Health Products. Dr Sylvie Briand is Director of Global Infectious Hazard Preparedness, Dr Rosamund Lewis is Technical Lead for monkeypox, and Dr Abdirahman Mahamud is Incident Manager for COVID-19.
Online, with us, is Dr Mike Ryan, Executive Director of Health Emergencies Programme, and we also Dr Rogério Gaspar, who is Director for Regulation and Prequalification. We may have some other WHO experts also joining and who may answer questions.
We have, as always, simultaneous interpretation in the six UN languages, and Hindi and Portuguese. Journalists who are online and would like to ask a question, please click the icon Raise Hand and you will be then put in queue to be able to ask your question after the opening remarks. And I give the floor immediately to Dr Tedros for his opening words. Dr Tedros.
TAG        Thank you. Thank you, Tarik. Good morning, good evening, and good afternoon. First, an update on the global monkeypox outbreak. More than 35,000 cases of monkeypox have now been reported to WHO from 92 countries and territories, with 12 deaths. Almost 7,500 cases were reported last week, a 20% increase over the previous week, which was also 20% more than the week before.
Almost all cases are being reported from Europe and the Americas, and almost all cases continue to be reported among men who have sex with men, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity.
The primary focus for all countries must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement, and risk reduction measures. Vaccines may also play an important part in controlling the outbreak and in many countries there is high demand for vaccines from the affected communities.
However, for the moment, supplies of vaccines and data about their effectiveness are limited, although we are starting to receive data from some countries. WHO has been in close contact with the manufacturers of vaccines and with countries and organisations who are willing to share doses. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated and that the poorest will continue to be left behind.
As we announced last week, a meeting of experts convened by WHO has agreed to rename the two known clades of monkeypox virus using Roman numerals. The clade formerly known as the Congo Basin or Central African clade will now be referred to as clade I, while the West African clade will be called clade II. Work on renaming the disease and the virus is ongoing.
Now, to the Greater Horn of Africa where millions of people are facing starvation and disease in Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda. Drought, conflict, climate change and increasing prices for food, fuel and fertiliser are all contributing to lack of access to sufficient food.
Hunger and malnutrition pose a direct threat to health but they also weaken the body’s defences and open the door to diseases including pneumonia, measles and cholera. Food insecurity also forces some people to choose between paying for food and healthcare. Many people are migrating in search of food, which can also put them at increased risk of disease and reduced access to health services.
While other partners are working to address the food crisis, WHO is addressing the resulting health crisis. We have already released more than US $16 million from the WHO Contingency Fund for Emergencies, but more is needed. The $123.7 million we are appealing for will be used to prevent and control outbreaks, to treat malnutrition, and to provide essential health services and medicines.
In the Ethiopian region of Tigray, the drought is compounding a man-made catastrophe for six million people who have been under siege from Ethiopian and Eritrean forces for 21 months, sealed off from the outside world with no telecommunications, no banking services and very limited electricity and fuel. As a result, the people of Tigray are facing multiple outbreaks of malaria, anthrax, cholera, diarrhoea and more. This unimaginable cruelty must end. The only solution is peace.
Earlier this month, a delegation from the US, European Union, United Kingdom, Germany, Italy and Canada visited Tigray in an effort to facilitate peace talks. Following their visit, the US and EU issued a joint statement saying that swift restoration of electricity, telecommunications, banking and other basic services in Tigray is essential for peace talks to go forward. So far, the government has refused.
Since the humanitarian truce was announced in late March, some humanitarian aid has been delivered to Tigray, although nowhere near enough. In addition, the shortage of fuel and cash continues to be a major impediment to the distribution of aid and to WHO’s efforts to respond to outbreaks, provide vaccination against COVID-19, and deliver other life-saving health services.
Finally, on COVID-19, over the past four weeks reported deaths globally have increased by 35%. Just in the past week, 15,000 people around the world lost their lives to COVID-19. 15,000 deaths a week is completely unacceptable when we have all the tools to prevent infections and save lives.
We’re all tired of this virus and tired of the pandemic but the virus is not tired of us. Omicron remains the dominant variant, with the BA.5 subvariant representing more than 90% of sequences shared in the last month. However, the number of sequences shared per week has fallen by 90% since the beginning of this year and the number of countries sharing sequences has dropped by 75%, making it so much harder to understand how the virus might be changing.
With colder weather approaching in the northern hemisphere and people spending more time indoors, the risks for more intense transmission and hospitalisation will only increase in the coming months, not only for COVID-19 but for other diseases, including influenza. But none of us is helpless. Please get vaccinated if you are not, and if you need a booster, get one. Wear a mask when you can’t distance and try to avoid crowds, especially indoors.
There is a lot of talk about learning to live with this virus but we cannot live with 15,000 deaths a week. We cannot live with mounting hospitalisations and deaths. We cannot live with inequitable access to vaccines and other tools. Learning to live with COVID-19 does not mean we pretend it’s not there. It means we use the tools we have to protect ourselves, and protect others. Tarik, back to you.
TJ           Thank you. Thank you, Dr Tedros. We will now open the floor to questions, and we will start with the Financial Times. Donato Mancini is with us. Donato, please unmute yourself.
DM         Hi. Good afternoon. Thank you very much for taking my question. I actually have two, I’m so sorry. I was wondering if you had seen reports today that Bavarian Nordic is unlikely to meet demand for monkeypox doses. I know you have expressed concern on this but I was wondering if you had anything else to say. Should the company explore partnerships with other companies? Should they do tech transfer? Should more manufacturers be called in?
Are there any other vaccines that we should be looking at to respond to the monkeypox outbreak and, more broadly, given this resurgence of, quote/unquote, all diseases such as polio or even monkeypox is there a broad theme why this is happening? Is this climate change? Is this global populations performing better surveillance? Is it a long tail effect of the pandemic on population immunity? I appreciate it’s a broad question but I’d be curious to hear your thoughts. Thank you.
TJ           Thank you, Donato. There are really two distinct questions here. Maybe we start with the first one on monkeypox vaccines. Maybe Dr Simão can start there and then, on the second question, Dr Briand may help.
MS         Thank you. Thank you, Tarik, and thank you, Donato, for this question. Actually, WHO is in touch with Bavarian Nordic specifically but also with the other manufacturers, first to understand supply and the hurdles to increase manufacturing capacity and availability of therapeutics and also of vaccines and, second, to discuss potential opportunities for technology transfer and voluntary licensing of these technologies.
We’re talking about this in the context of where we do need more data about both vaccines and the therapeutics. So, this is work ongoing and we are happy to update as we get more information and the negotiations with these manufacturers continue. Thank you.
TJ           Thank you, Dr Simão. Maybe Dr Briand can take the second question on re-emergence of pathogens.
SB          Thank you very much for this question. Indeed, we have seen in the recent past a lot of disease emerging and others re-emerging and I think it’s important to differentiate the two phenomena. Emergence is something that we know most of the emerging viruses are coming from animals, this the case for monkeypox, and they infect humans.
At the beginning it’s only sporadic cases but if the virus finds the right environment then it can evolve and become more fit for humans, and then you can see localised transmission and further amplification. Again, if the conditions are supportive for that, like high human density, very close contact, then you can have an outbreak and this is what we have seen with monkeypox.
Initially, it was in animals, then it went to some humans, and then we had localised outbreak, and now we have a multi-country outbreak. This is for the emergence and of course there are many factors driving the emergence. You mentioned some of them, the climate change, but also human density in certain populations, certain human behaviour can also foster this amplification.
Also, what is really important is the fact that we can stop those outbreaks at the source but for this we need a very good health system, very good collaboration, with a One Health approach. That’s why it’s so important to strengthen universal health coverage and primary healthcare because this is why and we can then stop those outbreaks at source with good surveillance, good healthcare system and stop the spread when outbreaks are still localised.
For the re-emergence, sometimes there are other factors playing out. In particular, for a disease for which we do have tools for the control, like polio, like measles, the fact is that it’s often because the vaccine coverage is too low that those diseases re-emerge. It’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against those diseases and it’s very important, therefore, to make sure that all children get access to these vaccines in due time so that we can make sure that there is no cohort of human beings that are unprotected. We have the tools but we need to use them and this is what is really important to prevent re-emergence. Thank you.
TJ           Thank you, Dr Simão and Dr Briand. Just to correct that title. Dr Sylvie Briand is Director of Epidemic and Pandemic Preparedness and Prevention Department. With that, we will go to the next question. We have Erin Prater, from Fortune, online. Erin, go ahead.
EP          Hi. Thank you for taking my question. Just curious if there were any updates as far as mutations in the monkeypox virus. I believe CDC officials had said a month or two ago that they had seen at least two different strains. Curious if there’s any update. Thank you.
TJ           Thank you, Erin. Dr Lewis.
RL          Thank you very much. We do continue to monitor the strains that are reported through genome sequencing. That is put in accessible websites where scientists, evolutionary biologists and pox virologists can look and review. So, we have seen mutations but at the moment we don’t have any information really on what that means in terms of the behaviour of the virus, itself, or how it interacts with the human immune response. We’ll continue to monitor that space.
TJ           Thank you, Dr Lewis. We will now go to Helen Branswell, from STAT. Helen, can you please ask your question?
HB         Thank you for taking my question, Tarik. In the Director-General’s opening remarks he mentioned that some countries are starting to provide WHO with some evidence about the efficacy of the monkeypox vaccines. Could somebody please elaborate on what is being seen? Thank you.
TJ           Thank you, Helen. Dr Lewis.
RL          Thank you, Helen. We don’t have any randomised control trials of these studies in the context of this particular outbreak, so we don’t have direct clinical efficacy studies, as I say, in the context of this monkeypox outbreak at the moment. What we are beginning to see is some observational studies reporting, for example, persons who may have had post-exposure prophylaxis. After being exposed to monkeypox they may have had the vaccine. Again, just a couple of reports are coming out.
We have known from the beginning that this vaccine would not be a silver bullet, that it would not meet all the expectations that are being put on it and that we don’t have firm efficacy data or effectiveness data in this context. What we are beginning to see is that some cases are being reported, perhaps as breakthrough cases, either following post-exposure prophylaxis, which is meant to reduce disease severity, or following preventive vaccination, which is meant to, of course, reduce infection.
We don’t yet have any, as I say, randomised control trials specifically on that but the fact that we’re beginning to see some breakthrough cases is also really important information because it tells us that the vaccine is not 100% effective in any given circumstance, whether preventive or post-exposure. We cannot expect 100% effectiveness at the moment based on this emerging information.
Again, this is not new. In the past, based on a very limited study from the 1980s, it was already suggested that the smallpox vaccines in use at that time, which were also powerful replicating vaccines, might offer about 85% protection against monkeypox and that was really one study in an area where some people were vaccinated and some people were not, so they could compare that.
However, that’s really all the information we had and the vaccines we have now are developed in order to be safer but they’re also non-replicating. So, we are not expecting 100% efficacy for these vaccines for the prevention of monkeypox. We don’t know the exact information.
What we’re seeing are breakthrough cases, which are not really surprises, but it reminds us that vaccine is not a silver bullet, that every person who feels that they are a risk, and appreciates their own level of risk, and wishes to lower their own level of risk have many interventions at their disposal, which includes vaccination where available but also protection from activities where they may be at risk, reducing the number of sex partners, avoiding group sex or casual sex and, specifically, when a vaccine is in fact administered, waiting until that vaccine has the time to produce a maximum immune response.
In the case of MVA vaccine, this is two weeks after the second dose. So, again, it’s not a magic bullet. People do need to wait until the vaccine can generate a maximum immune response but we don’t yet know what the effectiveness will be overall.
TJ           Thank you, Dr Lewis. The next question is for Bianca Rothier, from Globo, Brazil. Bianca, can you hear us?
BR         Yes. Can you hear me, Tarik? Yes. Thanks. Thanks a lot for taking my question. I believe it’s the first press conference in three weeks, so I hope you had great holidays and I take the opportunity to make two questions.
First, regarding Brazil, when we see the WHO dashboard for monkeypox confirmed cases, Brazil is already the fifth country in the world. So, it seems the disease is spreading much faster in Brazil. Am I wrong? How do you explain this quick spread of the virus in Brazil?
The second is if you could comment on the first possible case of human-to-dog transmission of monkeypox. Is it a surprise? What are the precautions to avoid this kind of transmission? And what are the risks for pets? Thanks a lot.
TJ           Thank you, Bianca. Dr Lewis again.
RL          Sure. Thank you very much, Bianca. Yes, a number of countries are showing concerning trends and Brazil is one of them. The number of cases does continue to rise and it’s really important for all public health interventions that are available in the country to be put in place and for individuals to be given the information they need to protect themselves.
WHO, both at headquarters, of course, and the regional office, with the Pan American Health Organization, are there to support the country and the country office is also there to support Brazil. It’s really important that Brazil have a strong response, in terms of information.
Remember, our strategic imperatives for this response are information, action and evidence. People who are at risk in Brazil, as everywhere else, need the information that they need to protect themselves by knowing what types of settings and which types of activities may put them at risk, action in terms of public health response. Engaging with communities is one very strong action, engaging with affected groups and, of course, collecting the evidence on what works and what works less well. So, this is what’s critical for Brazil right now as access to other countermeasures is, of course, being worked on and scaled up as soon as possible.
Regarding the incident of the dog. Yes, this is the first case reported of human-to-animal transmission. This has not been reported before and we believe it is the first instance of a canine being infected. However, this has been a theoretical risk. You may see that a number of public health agencies have advised those who contract monkeypox to make every effort to isolate from their pets or to isolate their pets from themselves because of this hypothetical risk, particularly both in the household for domestic pets, as well as in possible risks of contamination of animals outside the household, for example rodents accessing garbage and things like that. So, waste management is critical, isolation is important.
These are some of the lessons, some of the messages that have been given on a precautionary basis to avoid contamination, infection of pets, and to avoid possible spread of the virus into other animal populations in countries where this has not occurred before. So, while these have been hypothetical, theoretical risks all along, we believe that they’re important enough to have this as part of the response, that people should have information on how to protect their pets as well as how to manage their waste so that animals, in general, are not exposed to the monkeypox virus.
TJ           Thank you, Dr Lewis. We will go now to The Economist. We have Slavea Chankova with us. Could you please unmute yourself and ask the question?
SC          Thank you for taking my question. You mentioned that there are more than 75,000 cases reported to the WHO. Are those confirmed cases or do they include suspected cases, as well? And my second question is you said that the outbreak in non-endemic countries is still concentrated in men who have sex with men. Is there evidence in any of those countries that it is spilling over to the general population in significant numbers?
TJ           Dr Lewis.
RL          Thank you, Tarik. The report we have today is over 35,000 cases, not 75,000. Just for clarity, 35,000 cases in 92 countries reported to date. These are confirmed cases. WHO reports confirmed and probable cases. There are, of course, other situations where suspected cases are reported but may not have had access to testing or the ability for laboratory confirmation. So, 35,000 are confirmed cases.
Sorry. I’ve forgotten the second question. Oh, the spillover. Thank you. Regarding the outbreak in men who have sex men and whether it’s affecting other communities and other groups. Yes, we are seeing, of course, sporadic cases in men who are not self-reporting as gay or bisexual, who are otherwise also reporting as heterosexual where the information is available, in some women, in other groups of people who have a larger number of sexual partners and in some cases in children, some of whom are adolescents aged 15, 16, 17, who may also be engaged in sexual activities, and then a small number of cases in children under the age of ten or under the age of five.
At the moment, these remain sporadic cases. There does not appear to be extended transmission from those within their own peer groups. So, this is in a very important space that we watch very closely and important for everyone to realise that even though the outbreak is spreading in men who have sex with men and this is our primary group that we are concerned should receive the information they need to protect themselves, it is also important that, yes, anyone who is in contact, in close contact with someone who has monkeypox can also be exposed, whether in the household setting or the occupational setting.
We do have some new information there and also in other settings where people may have multiple sexual partners. So, thanks for the question. We are still monitoring that very closely.
TJ           Thank you, Dr Lewis. The next question, Vijay Shankar, who writes for Lancet. Vijay.
VS          Thank you very much, Tarik, for giving me the floor to ask the questions. I have two questions. FIND came up with a database of monkeypox diagnostics but mentioned that they are not testing the specificity or sensitivity of those. So, is WHO planning to commission any studies to examine the quality of these, especially rapid diagnostic kits or any novel diagnostics? That’s the first question.
The second one. How does WHO compare any sort of latest developments in monkeypox diagnostics between high-income and low-income countries, especially with respect to ensuring equitable access? Thank you.
TJ           Thank you, Vijay. Maybe Dr Lewis can start.
RL          I can start. For the diagnostics, our laboratory teams here, in headquarters, as well as in all the regions and countries around the world are working very hard to bring a diagnostic capacity to countries, particularly low and middle-income countries that need support in accessing diagnostics. This primarily, at the moment, remains PCR. There are some commercial entities that have been validated through a WHO process and therefore recommended for direct procurement and/or support to countries directly, so that they have the test kits necessary to do the PCR testing.
At the moment there is not yet, to my knowledge, a validated rapid test, which is also a space that we are monitoring on an ongoing basis, and WHO would certainly be engaged in validating rapid tests if they become available. We know that a number of entities, whether academic or commercial, are working in this area and so we will continue to monitor that and bring information to you when we have it. Regarding the latest developments in high and low-income countries, I believe that question was about access, so I will refer to Dr Mariângela.
MS         Thank you. Thank you for the question, Vijay. I think you covered most of it, Rosamund, but just to add that, of course, access in low and middle-income countries is a very reasonable concern for all of us and we’re working, as Rosamund just mentioned, with developers and organisations that work with manufacturers to develop new technologies, including most importantly for the rapid diagnostic test that you mentioned, to be developed and be available at affordable prices for the developing world. So, this is work in progress at the moment.
TJ           Thank you very much. Then, we will go now to Nina Larson, from AFP. Nina, please unmute yourself.
NL          Hi. Thanks for taking my question. I just wanted to go back to Bianca’s question on the case of the dog who is infected by a human. If you could say a little bit more about what the main concern would be about that, if it’s the fact that virus can spread further, if it’s spreading in animals and humans at the same time or if you’re concerned that we’ll see more dangerous mutations, perhaps if the virus is spreading in species. Thank you.
TJ           Dr Lewis again.
RL          Thank you, Nina. First of all, the concern is, of course, for the household where infection may be occurring. We’re not talking about this particular case, of course, we’re talking about households in general. There are other members of the household, adults, children and pets, and so obviously the concern is to prevent infection of any member of the household and, of course, prevent onward infection from any member of the household to any other member of the household, which we have seen happen in other outbreaks in the past.
So, protecting members of the household through isolation, through regular cleaning, these are all important strategies and tactics to help, for people to protect the ones that they are closest to, their loved ones in their homes, as well as in their communities.
Regarding movement of the virus into an animal population outside the household, certainly, as soon as a virus moves into a different setting in a different population, there is obviously possibility that it will develop differently and mutate differently. That’s a theoretical possibility.
Right now, we don’t have information on that because we don’t have any reports. We are working closely with the World Organisation for Animal Health. They also have Q&A on their website and we do work with them on these issues to bring attention for those who are working in this space. I think Dr Briand would like to add.
TJ           If we just go first to Dr Mike Ryan, who wants to add something on this, and then we may hear from Dr Briand, as well. Dr Ryan, go ahead.
MR         Thanks, and Sylvie may be making the same point that I’m about to make. Again, in terms of caution, clearly in this particular case, with the transmission through a dog in a closed, domestic setting, with having one animal infected is not unusual. It’s not unexpected that would happen.
What we don’t want to see happen is disease moving from one species to the next and then remaining in that species as a species, moving around within a new species, because that’s when a virus can adapt to that new species, and in adapting to that new species it is incentivised to evolve, as such.
We see this, and this a probably the more dangerous situation, we’ve seen in other situations where a virus can move into a small mammal population with a high density of animals and then it is through the transmission between one to the next to the other animal. And it’s through that process of one animal infecting the next and the next and the next that you see rapid evolution in the virus.
It’s usually amongst those smaller mammals were you see a virus being able to move quickly in a dense population and then the virus evolves very quickly. I don’t expect the virus to evolve any more quickly in one single dog than in one single human so, in that sense, in this particular situation, this particular animal is the member of a human family and is just an animal unfortunately exposed to the virus. In that sense, we want to make sure that anybody around a person, a case, that you don’t infect people in the household with you, you don’t infect animals in the household with you if that can be avoided.
So, having that normal precaution of not infecting humans or animals around you is very important but not to become overly concerned in general and for people out there, people are not at risk, in the same way, as most of the general population are not at risk of contracting monkeypox. We need to remain vigilant, we need to remain cautious but at the same time animals and pets do not represent a risk to people right now.
It is important and is to be commended when people who have animals either try to protect those animals or if those animals become sick or become infected themselves, that they seek care for those animals, as has happened in this case. So, those individuals are to be commended for the action they’ve taken. In that sense, I think it’s important that we don’t allow these viruses to establish themselves in other animal populations. Single exposures or single infections in particular animals is not unexpected, however. Thank you.
TJ           Dr Briand.
SB          Just to complement. Thank you, Tarik. To complement a bit, we have seen those infections in the past with other zoonotic viruses where they contaminate a new species but usually it’s a dead end. It stops there because the virus is not very fit for this species and so sometimes it only stops there and it’s just one case.
Here, what is interesting, as Rosamund mentioned, is that we never had those kind of reports, so it’s the first time. It means that a dog can be infected but it doesn’t mean that a dog can transmit the disease and infect other dogs, nor does it mean that the dog can re-infect humans if it is infected. I think what we try to really, here, give as a message is what we need is to be cautious, as Mike said, vigilant, and prevent further transmission because those viruses, the more they transmit, the more they can evolve. Every time they invest or infect a new species they can acquire different properties and then evolve. So, it’s very important just to monitor the situation and all together be vigilant and prevent further transmission. Thank you.
TJ           Thank you, all. We will now go to Bloomberg. We have Dong Lyu with us for the next question. Dong, can you please unmute yourself?
DL          Hi. Thank you. I just wanted to follow up with a question on the monkeypox vaccine. Earlier you were talking about rates of infections. I just wanted to see if you could elaborate a little bit on how many doses those people who had a breakthrough infection had before they had a breakthrough infection. Also, could you provide an early estimate on how often this has happened? Thank you. Sorry, this is the general vaccine.
TJ           Dong, I think the question was about breakthrough infections among the vaccinated people. Dr Lewis?
RL          Thank you. I didn’t hear the second part of the question very clearly. The first part of the question, I don’t think we’re going to discuss individual studies here today. As that information continues to come in, we are monitoring it extremely closely. What we would like to see is some randomised control trials, wherever that may still be feasible, and supporting countries to do that, and also some observational studies wherever vaccine is being rolled out.
There are different study designs that can also be attempted to support what information we can collect in the context of the rollout of the vaccines and we do expect to have this type of information coming out, which does not give us the whole answer because they’re not randomised control trials and over time we will need to triangulate all that information to see what are the best estimates we can come up with.
TJ           Thank you, Dr Lewis. We will now call Gabriela Sotomayor, from a Mexican outlet, Proceso. Gabriela.
GS          Hola. Thank you. Thank you very much, Tarik. Nice to see you. On monkeypox, in Mexico the cases have doubled in a week. They are not doing tests and on the website of the Health Secretary, of the Health Minister there is no clear information, nor are men warned that they have sex with men. There’s no warning at all for men that have sex with men. About vaccines, there are no vaccines. So, I would like to know your comments, to hear your comments on the situation and what could happen in Mexico if this continues like this.
Second, if you allow me another question on Ukraine. If you can comment on Russian attacks against the Zaporizhzhia, I don’t know how to pronounce it, the nuclear plant, the dangers to which the population are being exposed. There may be a catastrophe there. So, I would like to hear your comments, your concerns and if you communicated with the Russian government on this matter. Thank you.
TJ           Thank you, Gabriela. There are two separate questions. Let’s go to Dr Mike Ryan to see if we can address some of them. Dr Ryan.
MR         Great. Thank you. I think we will follow up directly on Mexico. This message is for all countries. Countries need to obviously take monkeypox seriously. I’m aware of the specific issues you refer to in Mexico but we will follow up through Pan American Health Organization, our American regional office in Washington, and engage with the government in Mexico. My understanding is the government of Mexico do take this epidemic seriously and are taking action but we will take up your concerns with them, and be assured of that.
I am glad to take your second question on Ukraine. I am glad somebody asked a question about somewhere else. I’m quite surprised. I know this is quite a specialist group but it’s interesting to be asked questions only about monkeypox even though we have 15,000 deaths from COVID and we have a massive drought and a massive famine emerging in the Horn of Africa. And yet all of the questions relate to monkeypox, which shows how much interest there is in monkeypox. But it also shows, quite frankly, how interest is declining in COVID and how, really, no one seems to give a damn about what’s happening the Horn of Africa.
With regard to Ukraine, we have been involved since the very beginning with the authorities in Ukraine, and though the IAEA and the rem plan initiative, in order to be ready to respond to any radionuclear incident that might occur. We have been, and the Director-General is on the record, stating his concerns regarding the possibility of any form or radionuclear accident in and around one of the existing nuclear plants.
We’re in constant communication with the IAEA and remain ready, as a member of the UN system, to react if there’s a need to react, as a nuclear accident obviously would be catastrophic in this situation to human life and to the environment. So, we do remain concerned about that but we are guided by our colleagues at the IAEA and will continue to offer medical response support to them and to the government of Ukraine. Thank you.
TJ           Thank you very much, Dr Ryan. The sound was not the best on this last question but we will have a transcript of this press briefing posted tomorrow morning in case there was an issue with the audio and understanding what Dr Ryan has said. I think we have time for one more question, and we have Simon Ateba from Today News Africa with us. Simon, please go ahead.
SA          Thank you, Tarik, for taking my question. This is Simon Ateba, with Today News Africa, in Washington DC. The US CDC is ending recommendations for social distancing and quarantine for COVID-19 control and no longer recommends tests to stay in schools. I was wondering if you could react.
As people get tired of these very strict public health measures and we learn to live with COVID-19, with vaccines and therapeutics, is this something that the WHO will also recommend soon?
And on Tigray, the US government said last week that things seem to have been going very smoothly since the humanitarian ceasefire in March but Dr Tedros just said that things seem to still be very difficult and help is not reaching people in need. Can you please talk a little bit more about the situation there and hunger in the Horn of Africa, in general? Thank you.
TJ           Thank you very much. Maybe we start with the question on COVID, and we have Dr Mahamud with us, who is Incident Manager for COVID-19. Dr Mahamud.
AM         Thank you. Thank you for raising it. I think the main question Mike alluded to and the DG said in his speech, that the idea that we can live a virus that just killed 15,000 last week, it’s something we can struggling wrapping around it. Yes, we are tired of it, the public is tired of it, even us, we are tired of it. But the virus is not tired of us and every day is bringing new tricks up its sleeve. Over 200 Omicron subvariants are recorded. Some of them are gaining more momentum. There a lot of things the population can withstand. I think the resilience of the communities, if risk is explained very well, can be done.
Every Member State has to do risk mitigation and look at their national level. We are aware about the US CDC guidelines and how they will be handled nationally. But on the other side, in the same US, we have last week alone almost 100,000 population hospitalised, 500 deaths a day. That’s 3,500 a week. It’s almost one of the leading causes of death in the US.
On the other side of the world, Japan, Pacific islands for the first time are struggling. Multiple countries are struggling. Sadly, we are still in the midst of the pandemic and every wave is kind of starting again. We need to come together to resolve. Pandemic is once in a lifetime and it’s not a switch on and off that someone can decide this is today what we require.
What we have been calling for is really simple, basic measures that are cost savings. We need to share them equally and even in the richest countries the people who are suffering will be the low and middle-income categories, the marginalised, the ethnic minorities who don’t have the luxury of getting some of the recommendations.
To sum it up, WHO has always called for a risk-based approach to use data to make the decision at the lowest level because a big country cannot make a decision for that. That’s our main recommendation. We just updated our guidance on quarantine, on isolation, on surveillance which are all leading to it, to find the balance whether it is to suppress the transmission or to control the transmission while also reducing the morbidity and the mortality, taking into consideration the socioeconomic and the fatigue of the communities.
So, our message has remained really the same. It’s we have the tools. We need to share them equally. We need to explain to the people that pandemics are once in a lifetime and not small epidemics that you can come out of it. Thank you.
TJ           Thank you, Dr Mahamud. Maybe Dr Socé Fall can speak on other questions that Simon has asked.
SF          Thank you, Tarik. Thank you, Simon, for the question on Tigray and Greater Horn of Africa. The situation in Tigray clearly is still very, very difficult. We are talking about a blockage for more than two years, and still access to fuel for humanitarian workers is a big challenge. Humanitarian actors need two million litres a month and since April, the first week, they have received less than two million litres.
And the supply of medicine is still very challenging for WHO and partners. We have big delays because of the permit or authorisation to supply in Tigray. If you look at the level of disruption and lack of access to the health services, where health workers were not paid, it will take months and months for the system to recover. In the meantime, we have already lost so many people. So, the recovery will take very, very long and we are not even yet filling all the needs even to talk about recovery. Making sure that we have full access and a steady supply is permitted without any restriction is vitally important.
If you look at functionality of health services in reporting, we have seen now around 50% of the health facilities reporting, meaning that even to be able to detect and respond to outbreaks is very limited. The situation has been exacerbated by the situation in the Horn of Africa. Today. we are talking about more than 20 million people in Ethiopia that need support for humanitarian needs.
If you look at the Horn of Africa, the total population is close to 200 million but we already have eight million in a very acute food and security situation. And when you talk about a food crisis, we are already in a health crisis because of the many reasons already explained by Dr Tedros in the opening. So, we are seeing so many outbreaks of cholera, measles, malaria, meningitis in so many countries. In addition to that, the lack of access to primary healthcare because of the number of internally displaced populations, we are talking about 11 million population now displaced and 4.2 million refugees.
WHO is looking for $124 million to cover the health needs. So far, we are only covering 12% of the needs and mainly from the WHO Contingency Fund for Emergencies. Thanks to our partners for their support but we need much more on a bigger scale and very rapidly if you don’t want to lose millions of children and millions of population. Thank you.
TJ           Thank you. We can go for one more last question. This time it will be the last one, and it’s Lauren Pelley, from CBC. Lauren, you have the last question of this briefing.
LP          There’s a significant amount of debate and questions online regarding how exactly it transmits. Is it airborne? Can you get it from a clothing store? And, amidst all that, there’s actually so much misinformation circulating as well. How concerned is the WHO regarding a level of misinformation around monkeypox, much as we’ve seen with other illness and diseases, and do you have any strategies to combat what is a rather rampant amount of information circulating these days?
TJ           Thank you, Lauren. So, that’s about misinformation, how much we are concerned. So, maybe Dr Sylvie Briand can try.
SB          Thanks a lot, Lauren, for this question. Indeed, I think we have seen that every epidemic or pandemic is accompanied by this misinformation. So, it’s not new. Just what makes it more difficult, probably, to combat is the fact that now a lot of the population of the world is connected and it’s spread through social media and so it spreads faster and further than what we had observed before.
WHO is concerned by this because this misinformation, first, can really hamper the response to the outbreak because people can maybe take some treatments that are presented as miraculous but in reality they are not treating them and could be poisoned or they can maybe refuse the vaccine that can save their lives.
So, the impact of misinformation on people’s behaviour is really concerning and that’s why WHO is really doing a lot of effort to combat it. What do we do exactly? First, we listen on social media, what are the concerns of the people, so that we can provide them with the right information at the right time in the right format. This social listening is extremely important to, first, understand what kind of information is needed.
The second thing we do, we also work very closely with the communities, in particular, for this particular outbreak of monkeypox as you know because men having sex with men seems to be the community that is currently the most affected. It’s very important to reach out to this community, and having direct discussion with them and trying to understand how we can support them in preventing them to be infected.
We have, here, a department for HIV and sexually transmitted disease and they have been extremely helpful to discuss with these communities and provide them with information that they could need to prevent the transmission.
Then, what we do, we also identify the places where people might be exposed and have specific information during those situations. For instance, there was at the beginning some amplifying events such big mass gatherings, so it’s important to work also with the people organising those mass gatherings and people attending those mass gatherings so that the right information can be discussed at these meetings.
And, of course, there is a lot of work done but this is not specific for monkeypox, it has been done also for COVID-19 with the social media platform to try to triage and select the information that is pertinent and accurate so that people can have access to this information more easily or have the tools to understand if information is accurate or not and support them in acquiring not only this health authority but also this digital authority where they can grow their capacities to differentiate misinformation from accurate information.
So, this is a whole programme of work because we think that this is one of the main challenges that we are facing in the 21st century. The science has made fantastic progress. We have access to vaccines, to therapeutics and it’s really concerning if people cannot have access to this progress of medicine because of misinformation.
And I think we have all a role to play. I think journalists, in particular, you are really important messengers and really important trusted sources of information for the population and it’s very important that we all see this as our collective responsibility to make sure that people have access to the right information, at the right time, in the right format. Thank you.
TJ           Thank you very much, Dr Briand. We all have a role to play. With this, we will conclude today’s press briefing. We will be sending audio and video material later this evening and the transcript, as I have said, will be available tomorrow morning on our website. With this, I give the floor back to Dr Tedros for his final remarks.
TAG        Thank you very much. Maybe I will join Mike. Although we have tried to present many issues, the questions were focused on monkeypox. So, we would like to urge our members of the press to be involved also in the other important issues.
If I raise one, maybe the drought condition in the Horn of Africa. The situation is very dire, especially for all the countries in that corner of the world. The Somalia situation is more worrisome. That’s one. And the other is, in addition to the natural disaster we see, as I said it earlier, especially in Tigray, the region in Ethiopia with more than six million population, there is also a man-made disaster that’s affecting more than six million people.
Thank you, Simon, for asking the question if there is improvement or if it is worse. Maybe, in terms of improvement, there is some food sent, which is not near enough, but still the basic services that any human being needs like telecommunication, power, even banking services, the hard-earned money of your own money blocked in the bank by your own government for 21 months is unbelievable.
So, except the food aid, which is trickling, and some medicines, which is trickling, no immunisation of kids by the way, no vaccination at all, the siege by both Eritrean and Ethiopian forces continues. That’s the status quo. The status quo continues except some food delivery.
Nowhere in the world you would see this level of cruelty, where a government punishes six million of its people for more than 21 months by denying them basic services. Imagine, Simon, if you would be denied to access your own money, and you’re one of six million people. Imagine you would denied to medicines, and you’re one of six million people. Imagine you would be denied to even travel or use telephone because telephone is blocked. Imagine you’re one of six million people and that goes on and one for 21 months.
Imagine you have not been paid your salary for 21 months. You’re a health worker but you’re serving your people and you’re a doctor, maybe getting some food aid to serve your people but no salary. Of course, there are some peace talks, negotiation, discussion. Even for the peace talks, in order to build confidence in the peace talks, at least the basic services should be resumed. How can peace talks happen when six million people are suffocated?
Of course, if you take Ukraine, we’re sleepwalking into a major disaster. It’s a serious global disaster, if you take Ukraine, especially when you imagine what could happen in the future. We hear about, now, the incidents in the nuclear reactor. My fear is that we’re sleepwalking into even a nuclear war. That’s dangerous and it’s the mother of all problems, I fully agree.
But in terms of humanitarian crisis, I can tell you that the humanitarian crisis in Tigray is more than Ukraine, without any exaggeration. And I said it many months ago, maybe the reason is the colour of the skin of the people in Tigray. I haven’t heard in the last few months, several months now, even a head of state talking about the Tigray condition anywhere, in the developed world especially.
Why? I think we know but the only thing we’re asking is can the world come back to its senses and uphold humanity? If it’s the worst humanitarian crisis, and I’m saying nowhere on Earth six million people are sealed off, nowhere, from basic services, from their own money, from telecoms, from food, from medicine. This is the worst disaster on Earth as we speak.
I am from Tigray. It’s not because I am from Tigray that I am saying this. That’s the truth. That’s the bare truth. It’s true and it pains me, actually, to say this because I thought that the world would react. You remember Secretary Blinken called it several months ago, it’s ethnic cleansing. It could even be more.
But why are people not telling the truth? Why are people not taking this seriously, especially those who can influence, especially in the developed world, who have the carrot and stick to make this happen? Why? Why are we keeping quiet when six million people are being punished? There is nowhere on Earth that kind of punishment you would witness. Nowhere.
It’s cruel and two governments are doing it, both Ethiopian and Eritrean governments doing it, and nobody even mentioning the name of the two governments of the siege. Punishing six million people, six millions lives doesn’t matter? It doesn’t matter?
I say it again, it’s the worst, Simon. It’s the worst and there is no significant change or progress. But I appeal to the Ethiopian government to resolve this peacefully. The ball is in its hand. And I also appeal to the Russian government, urge it to choose peace because both the Ethiopian government and Russian government, if they want peace they can make it happen. I urge them both to resolve this issue peacefully and it’s in their hands.
I cannot take the side of both to be on equal footing. They’re not. This thing can be addressed unilaterally by the Ethiopian government and unilaterally by the Russian government. Thank you and, Tarik, back to you.
TJ           Thank you, Dr Tedros. Thank you, Dr Tedros, for this powerful comment. We wish everyone a nice end of the week and see you next time for our next press briefing.

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