CL Hello and welcome to WHO and today’s virtual press conference on COVID-19 and other health emergencies. It’s Wednesday, 8 June 2022, and my name is Christian Lindmeier. Today, we have simultaneous interpretation available in four official UN languages, and that’s Chinese, French, English, and Spanish, and we have Hindi. Unfortunately, we could not provide the other three languages we usually have today.
Now, let me introduce the participants. Available in the room today, we have Dr Tedros Adhanom Ghebreyesus, WHO Director-General. We have Dr Socé Fall, Assistant Director-General for Emergencies Response. We have Dr Maria Van Kerkhove, Technical Lead on COVID-19, and Dr Sylvie Briand, Director for Global Infectious Hazard Preparedness, and Dr Rosamund Lewis, Technical Lead on Monkeypox.
We also have two colleagues online, and that’s Dr Mariângela Simão, Assistant Director-General for Access to Medicines and Health Products, as well as Dr Meg Doherty. She’s Director at the Global HIV, Hepatitis and STI Programmes. With this, let me hand over the floor to Dr Tedros for the opening remarks.
TAG Thank you. Thank you, Christian. Good morning, good afternoon, good evening. Globally, the number of reported COVID-19 cases and deaths continues to decline. This is clearly a very encouraging trend. Increasing vaccination rates are saving lives but WHO continues to urge caution.
Globally, there is not enough testing, and not enough vaccination. On average, about three-quarters of health workers and people aged over 60 globally have been vaccinated, but these rates are much lower in low-income countries.
Almost 18 months since the first vaccine was administered, 68 countries have still not achieved 40% coverage. Vaccine supply is now sufficient but demand in many countries with the lowest vaccination rates is lacking. WHO and our partners are working with countries to drive uptake by getting vaccines to where people are, through mobile units, door-to-door campaigns and by mobilising community leaders.
The perception that the pandemic is over is understandable but misguided. More than 7,000 people lost their lives to this virus last week. That’s 7,000 too many. A new and even more dangerous variant could emerge at any time, and vast numbers of people remain unprotected. The pandemic is not over, and we will keep saying it’s not over until it is.
WHO is also continuing to monitor reports of hepatitis of unknown cause in children. More than 700 probable cases have now been reported to WHO from 34 countries, and a further 112 cases are under investigation. At least 38 of these children have needed liver transplants and 10 have died.
WHO continues working with countries to investigate the cause of hepatitis in these children. So far, the five viruses that commonly cause hepatitis have not been detected in any of these cases. WHO receives reports of unexplained hepatitis in children every year but a few countries have indicated that the rates they are seeing are above what is expected.
Now to monkeypox. More than 1,000 confirmed cases of monkeypox have now been reported to WHO from 29 countries that are not endemic for the disease. So far, no deaths have been reported in these countries.
Cases have been reported mainly, but not only, among men who have sex with men. Some countries are now beginning to report cases of apparent community transmission, including some cases in women.
The sudden and unexpected appearance of monkeypox in several non-endemic countries suggests that there might have been undetected transmission for some time. How long, we don’t know.
The risk of monkeypox becoming established in non-endemic countries is real. WHO is particularly concerned about the risks of this virus for vulnerable groups, including children and pregnant women, but that scenario can be prevented.
WHO urges affected countries to make every effort to identify all cases and contacts to control this outbreak and prevent onward spread. To support countries, WHO has issued guidance on surveillance and contact tracing, and laboratory testing and diagnosis.
In the coming days, we will also issue guidance on clinical care, infection prevention and control, vaccination, and further guidance on community protection. Last week, WHO hosted a consultation with more than 500 researchers to review what we know and don’t know, and to identify research priorities.
We’re also working with UNAIDS, civil society organisations and communities of men who have sex with men to listen to their questions and provide information on what monkeypox is and how to avoid it. There are effective ways for people to protect themselves and others. People with symptoms should isolate at home and consult a health worker. Those who share a household with an infected person should avoid close contact.
There are antivirals and vaccines approved for monkeypox but these are in limited supply. WHO is developing a coordination mechanism for the distribution of supplies based on public health needs and fairness. WHO does not recommend mass vaccination against monkeypox.
In the few places where vaccines are available, they are being used to protect those who may be exposed, such as health workers and laboratory personnel. Post-exposure vaccination, ideally within four days of exposure, may be considered by some countries for higher-risk close contacts, such as sexual partners, family members in the same household, and health workers.
It’s clearly concerning that monkeypox is spreading in countries where it has not been seen before. At the same time, we must remember that so far this year there have been more than 1,400 suspected cases of monkeypox in Africa and 66 deaths.
This virus has been circulating and killing in Africa for decades. It’s an unfortunate reflection of the world we live in that the international community is only now paying attention to monkeypox because it has appeared in high-income countries. The communities that live with the threat of this virus every day deserve the same concern, the same care, and the same access to tools to protect themselves. Christian, back you to you.
CL Thank you very much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask questions, you need to please raise your hand using the Raise Your Hand icon on the screen, and do not forget to unmute yourself when it is time. We’ll start with Helen Branswell, from STAT news. Helen, welcome, and please unmute yourself.
HB Thank you, Christian. At one of the recent VPCs, I think it was Mike Ryan, but somebody at WHO was talking about the fact that there is a virtual stockpile of smallpox vaccines and that WHO would be reaching out to countries that pledged doses to that stockpile to find out both whether those pledges were still good and what the status of the vaccine was. Can you give us an update on that, please?
CL Thank you very much, Helen. I’ll give it to Dr Briand. Please.
SB Thank for this question. Indeed, the WHO has been working for many decades now on preventing a potential re-emergence of smallpox. So, the stockpile that he was referring to was a stockpile for smallpox response.
This time, we don’t have smallpox, it’s monkeypox, but it’s the same family of viruses and we know that the vaccine for smallpox can be used for monkeypox with a high level of efficacy. That’s why we are now looking at, first, how many doses of vaccine are available in the world in general, what type of vaccines are available because, as you may know, there are different generations of vaccine. So, the quantity for each generation may be very different.
And, third, we are also looking at, if those vaccines are available, have they been tested recently? Because you can conserve them for many years but you need regularly to check their potency. So, this is what we are currently doing, checking also the potency of vaccines that are available in different places in the world.
So, it’s information gathering and we have contacted already many countries through different mechanisms but, in particular, the countries who have pledged vaccine previously for smallpox. We are also contacting manufacturers to see what are their capacities for production and also capacities for deployment and access to different countries in the world.
What we are doing, as well, is trying also to assess the needs because currently we do have only a limited number of cases but they are spread across different geographies. What is important, as mentioned previously, we will not have mass vaccination but targeted vaccination to close contacts.
It’s not sending millions of vaccines to one place but rather sending a few hundreds of vaccine to many different places in the world. So, we are also looking at this logistics aspect and trying to assess the needs in different places and anticipate also when these needs will be important so that we can also prevent further transmission. This is where we stand currently with the stockpile. Thank you.
CL Thank you very much, Dr Briand. We’ll move on to the next question, which comes from Christiane Oelrich, from DPA. Christiane, please unmute yourself.
CO Thank you, Christian. The answer remains to be answered. Do we know how many at this point, how many are there in the stockpile? And I have a technical question. Do people who get infected with monkeypox gain lifelong immunity? And one more. Sorry about that. Do you see more people who do not come from the men having sex with men community being infected now? For the cases that you are hearing about, is it mainly within that community? Thank you.
CL Thank you, Christiane. We have a couple of questions here. I think we’ll start with the stockpile, with Dr Briand, and then hand over to Dr Lewis, I believe. Dr Briand?
SB In terms of quantity of vaccine, currently we don’t have specific numbers because, again, each country is currently looking at their own stocks and trying to assess how many of these vaccines are still potentially being used because, as I said earlier, we need to do potency testing on those vaccines.
So, we don’t have those numbers currently yet but from what we had for smallpox, it was more about enough, at least to cover the current need, but we still need to anticipate that we would need more vaccine in the future if this continues to spread.
That’s why, for us, what is really important currently is making sure that we prevent further amplification of cases, which means that we need to ensure safe gathering in the future so that we don’t have amplifying events. But also that we use a tool that we have already in hand, which is reducing the close contact so that there is no further spread to communities. In the meantime, we also work on trying to get as many vaccines as possible that we can. Thank you.
CL Thank you very much, Dr Briand, and maybe to Dr Rosamund Lewis now.
RL Thank you, Christian. Thank you. As has been said before, there’s information that we have from 50 years of studying monkeypox in the endemic setting, in countries of West and Central Africa. Many of those studies were done in the 70s and 80s, long ago. More information has become available recently but in fact there’s a great deal that we don’t know at this time yet, especially including in the new circumstances.
Regarding the lifelong immunity of monkeypox, by analogy to smallpox it may be that there is some immunity. However, we have seen cases in the African setting of health workers who have been exposed once and have a second event, have a second case of infection. Again, it’s not 100% and this is something that we need to work on as part of the research agenda going forward.
Regarding the question around cases that are being reported now, at the moment the cases that are being reported now are still primarily in the non-endemic setting among men and still primarily among men who have sex with men.
There are a few reports now of cases amongst women and not that many, and at the moment there is still a window of opportunity to prevent the onward spread of monkeypox in those who are at highest risk right now.
These include men who have sex with men, members of their immediate families or households who may be exposed, and health workers who also require protection in the clinical setting where they may be seeing patients with a rash of unknown origin, so perhaps, frontline care, sexual health clinics, emergency rooms, dermatology clinics. And the guidance that will be coming out will be addressing some of these issues.
CL Thank you very much to both and we move on to Sara Jerving, from Devex. Sara, please unmute yourself.
SJ Thank you so much for taking my question. The World Health Organization has said it is gathering evidence for possible war crimes into attacks on healthcare in Ukraine. Is WHO also gathering evidence for an investigation into attacks in Tigray and elsewhere, and if not, why not? And what are the current updates on gathering of evidence for an investigation in Ukraine? Thank you.
CL Thank you very much, Sara. We’ll go to Dr Socé Fall. He’s Assistant Director-General for WHO’s Emergencies Response.
SF Thank you for your question. I think this is a very important role for WHO, the monitoring of attacks on healthcare, to make sure that everywhere we have crises, the population has access to health services, and also making sure that the health workers are protected.
We are mandated by, first, the World Health Assembly resolution on attacks on healthcare and this has been strengthened by the Security Council Resolution 2286 for WHO to continue monitoring attacks on healthcare. So, we continue doing it in Ukraine, where we have already around 268 attacks on healthcare reported since the beginning of the conflict.
We do the same in all conflict-affected areas. Recently, we sent a mission to Ethiopia to start putting in place a system because we were not able to report on the attacks on healthcare for many times, but the system is being put in place now and we expect to be reporting in everywhere we have attacks on healthcare.
The number keeps increasing. As you know, we have now more than 300 million people exposed to humanitarian crises and in need of humanitarian assistance. So, making sure that they have access to healthcare will help to really implement the theme of the World Health Assembly when we talk about Health for Peace, and Peace for Health because when the population don’t have access to peace, don’t have access to health, they don’t have access to school, the risk of internal displacement and refugees is so high. So, everything needs to come together when we plan for preventing and responding to humanitarian crises. Thank you.
CL Thank you very much, Dr Fall. We move on to Naomi Grimley, from the BBC. Naomi, please unmute yourself.
NG Hello. Thank you. Dr Tedros rightly pointed out that monkeypox had been circulating for many years in West and Central Africa. Now, I know Mike Ryan has talked a bit about climate being a factor and pushing humans and animals closer together, but are there any other factors that may explain why cases have been rising there as well as us seeing cases in places like the UK?
CL Thank you, Naomi. We’ll go to Dr Lewis, the lead on monkeypox.
RL Thank you very much. As you rightly pointed out, the virus has been present in Africa for 50 years. It was first described in 1970 in a nine-month-old child. Prior to that, it was first discovered in a colony of research monkeys in Copenhagen, in Denmark, which is the origin of the name.
It is a virus that is present in forested regions of Central and West Africa and it’s known to be a zoonosis, of course, and so there are events where the virus moves from animals to people.
In addition to climate change there are activities encroaching on the forest, there’s deforestation, there is perhaps pressure of population and demographics. The other factors are the fact that there are two different strains or clades of the virus that are prevalent in different areas.
The one that we’re seeing that is spreading in non-endemic countries is a strain which has long been known to perhaps cause less severe disease, and when there is less severe disease then people don’t need to, of course, stay home. It’s easier to move out and about if you’re not feeling all that ill.
So, it’s possible that transmission is being increased through increased contact, through increased human contact, physical contact independent of the nature of the virus, itself.
CL Thank you. And we’ll have Dr Fall to add.
SF Thank you. Just to add on to what Rosamund just explained. We have a number of factors and determinants explaining the re-emergence of many diseases in Africa and around the world. Clearly, climate is an important factor and issue. Deforestation, agricultural practice and more contact between the human population and the forest is another factor. So, the issue of biodiversity also is extremely important.
You have seen not only an increase of monkeypox cases in endemic countries in Africa but also if you look at Ebola, Lassa fever, Crimean-Congo and others, we have had so many outbreaks we did not have in the past.
So, making sure that we work in a more preventative way, investing in preparedness to make sure that we can continue maintaining biodiversity, but also making sure that the communities who are at the frontline have the knowledge and understanding to be able to protect themselves and to protect also the disease from expanding to other countries, is extremely important.
Now, clearly, the issue of more frequent travel from endemic countries to other countries is an important issue we need to take into account, meaning that when we do risk analysis for epidemic and pandemic right now, we need to analyse data across sectors to make sure that we are not only focusing on the public health aspects.
We need to make sure that we take all the determinants and we use all available means for preparedness, prevention, and rapid control of these diseases. Most of the time, we don’t invest enough into early detection and rapid containment.
We don’t do that. And if you don’t control the diseases at the source, we can continue to rushing when developed countries are affected, but we will never end the problem. So, making sure that in our research and development, we invest into research in endemic countries, I think this is the most important intervention we have to implement. Thank you.
CL Thank you so much for these important clarifications here. We’ll move on to Gunilla von Hall, from the Svenska Dagbladet. Gunilla, please unmute yourself.
GH Hello. Thanks, Christian. My question concerns Ukraine and the cholera outbreak in Mariupol. What do you know about the situation? As you’re not there on the spot, have you to tried to find out what’s going on? How worried are you? Vaccine, I understand, is in the country but how are you going to get it to Mariupol.
Also, the Russian authorities are now planning to have a sort of imposed quarantine. How efficient is that? If I just may add, do you have any information that the Russian authorities will allow international experts to come and evaluate the situation? Thanks.
CL Thank you very much, Gunilla. We’ll go to Dr Socé Fall again.
SF Thank you for the question. Since the beginning of the attack on Ukraine we have been highlighting the risk of infectious disease outbreaks, including cholera, measles, typhoid fever and other waterborne diseases because of the living conditions.
We have done a public health risk analysis and need assessment, and we anticipated by prepositioning tests for cholera diagnosis and treatment but we are working with many partners including emergency medical teams deployed on the ground.
We haven’t received any report of cholera so far but this is something we expect and with the prepositioning of equipment and medicine and planning, we hope that the team should be able to react to quickly control any cholera outbreak. Thank you.
CL Thank you very much, Dr Fall. We’ll go now to Benjamin Ryan from the NBC. Benjamin, please unmute yourself.
BR Hi. I’d like to know what your theory is or your understanding of the primary drivers of transmission in this outbreak, if you feel that sexual contact between men is indeed the primary driver, and also address the question of airborne transmission. There’s been confusion with the CDC’s messaging with regard to that. Do you think there is at least a theoretical risk of airborne transmission and is it a very small risk? What is your general knowledge about this.
CL Thank you very much, Benjamin. We’ll go back to monkeypox, to Dr Rosamund Lewis.
RL Sure. Thanks very much. The primary drivers of onward spread of this virus at the moment in the non-endemic setting are face-to-face, skin-to-skin, interpersonal contact, physical contact. This is how the virus has always been described as transmitting and, at the moment, this is the primary mode of transmission that we are aware of at this time.
As we’ve said before, there’s a lot we still don’t know about this new outbreak. However, this classic mode of transmission is well-described in the past as having been due to personal physical contact.
In situations, such as through sexual contact, there is the possibility, of course, of physical skin-to-skin contact. So, this clearly is likely to be a driver of onward spread at this time and therefore the importance of sharing information for people who need to have it, to protect themselves and to protect others.
It is possible to control the further onward spread of this outbreak at this time with standard public health control measures and this includes contact tracing, surveillance, clinical care, isolation for people and remembering that folks should remain isolated for as long as they are infectious, which is as long as the rash is there and the lesions have not yet dried up and crusted and fallen off. So, being mindful and being aware and being knowledgeable about monkeypox is really important for preventing onward transmission.
With respect to other modes of transmission, there is again a lot we still don’t know and more research needs to be done in this area. In particular, it’s important to perhaps appreciate that this skin rash also occurs in the mouth and in mucus membranes. It can occur in the mouth, in the eyes, and other mucus membranes around the genital area, for example.
So, anyone who has virus in the mouth can also transmit that virus through, again, close face-to-face contact. For this reason, it is recommended that health workers who are looking after patients or receiving patients with a rash or looking after patients with monkeypox should wear a mask because there is the possibility of transmission through droplets and contact through close proximity.
The same applies for persons who actually have monkeypox to realise that especially if they have lesions in the mouth or on the face, that they are able to transmit them in that way.
As to whether there is aerosol transmission, this is still not really known. Clearly, if there are aerosol-generating procedures that are done in the clinical setting, then this will of course contribute to aerosol spread.
Another possibility is from what we call fomites, materials that may be contaminated. This includes sheets, bedding, towels and it has been known, it has been described that health workers who were cleaners have also been exposed and infected through this way by managing the environment, by looking after the bedding, for example, the laundry. It’s also possible that someone could inhale particles from looking after contaminated bedding.
These are all the things that we do know but there’s a lot that we don’t know, and so it’s sometimes useful to think about what precautions can be taken in order to avert any risk of onward spread. But this must be nuanced, of course, with what we already know, and the primary mode of transmission as we just mentioned earlier, as you’ve said before, is physical skin-to-skin contact.
CL Thank you very much and that thank you also for that important opportunity for clarification here. Now, we move on to Jennifer Rigby, from Reuters. Jennifer, please unmute yourself.
JR Hello. Thanks for taking the question. You talked a little bit about how the virus might have been spreading among humans and community transmission for years and that’s kind of gone unnoticed or we’ve not really paid attention because it hasn’t been in high-income countries. I just wondered what that says about surveillance globally and how it should be tackled going forward in the wake of talking about pandemic preparedness and coping with emerging diseases like this, which we’re expecting to see more of.
CL Thank you. And, yes, we go back to Dr Lewis.
RL Thanks, again. I think we do need to be clear when we’re talking about circulation of virus in the endemic setting. Most of the events in the endemic setting, for example in the Democratic Republic of the Congo, Central African Republic or Cameroon, remain events that are zoonotic events, zoonotic spillover events where a single individual may be in contact with a contaminated animal that may happen in a forest setting, hunting, preparing meat, bringing meat to market, sharing meat with family members, inadequately cooked meat.
These are the traditional modes, when I say tradition, the modes that we have seen in the history of monkeypox in the forested settings where these cases have occurred and then, from there, there has been transmission in the family setting, short chains of transmission, five, six at the most. Most recently there was a report of nine.
This is happening in the context where the world was using smallpox vaccine until 1980 and, as has already been mentioned, the use of smallpox vaccine may be protective against monkeypox but now four decades have gone by where smallpox vaccine is not used.
So, as a whole the population is less immune and more susceptible. In the African we still see short chains of transmission. There is not necessarily circulation of the virus in the human population. There is circulation of virus, definitely, in the animal population.
Coming back to the comments that were made earlier by Dr Socé about managing emergence of diseases going forward, when it comes to the virus that may be present in non-endemic countries we don’t have a lot of information on this yet.
It’s possible that some cases that were related to travel or unrelated to travel were not detected, were circulating somewhat undetected, but we don’t know how long this could be. It could be weeks possibly months. We don’t know that it’s been much longer than that. These are all things that need to be investigated through the research agenda going forward.
CL Thanks so much, Dr Lewis. We have Dr Van Kerkhove to add.
MK Thanks. I just want to come in on this because I think it’s an important question you asked related to surveillance for pandemic preparedness, for epidemic and pandemic preparedness. As has been pointed out by the previous answers, it’s really important that we continue to have surveillance for these types for pathogens that we know are circulating.
There are many pathogens, high threat pathogens that are circulating in animals that sometimes spill over into human populations. We have entire programmes here at WHO that are focused, that are dedicated on these types of pathogens. Monkeypox is one.
Dr Socé mentioned several others. We are looking at other high threat respiratory pathogens. We’re looking at bacterial diseases. So, there’s a lot of work that can be done and the link that I wanted to make was what the world has focused on in the last couple of years, where we have been going through the COVID-19 pandemic, and many countries around the world have significantly invested in surveillance, have significantly invested in laboratory systems, diagnostic systems, sequencing systems at national levels, at subnational levels, outside of the typical ways in which we’ve been able to detect these pathogens over the last several years.
I think we have another opportunity here to be able to support those systems that have been enhanced over the last 2.5 years, specifically for SARS-CoV-2 but are built upon giants of flu surveillance that has been place for 70-plus years, for surveillance activities for polio, for surveillance activities for other coronaviruses, RSV, Ebola, monkeypox, orthopox viruses. We have an opportunity to really strengthen those systems and continue invest in them.
While there may be a decline in the number of tests needed for SARS-CoV-2, although we still need to have strong surveillance for that, the mechanisms that are in place, the systems, the workforce, the structures that are there for diagnostic capacity should be utilised for circulating threats that are there and this includes orthopoxviruses.
We have better detection systems now and, again, we just want to emphasise that countries need to continue to invest in these so that we are better prepared for earlier detection, so we have opportunity to prevent either these spillover events or prevent these spillover events becoming amplified, becoming outbreaks, becoming epidemics and becoming bigger than they need to be.
Then, lastly, of course, we’re working very closely with our partners at FAO and OIE on the animal sector to include surveillance in animals, to include surveillance in wildlife and in domestic populations. This needs to continue to be improved as well because most of these pathogens are zoonotic.
There’s a lot of opportunities here and we really can’t miss this chance to recognise that the investment still needs to be there and that it not only benefits public health, it not only benefits people, but it benefits the livelihoods of people and it benefits our economies. So, prevention is much better than response if we can help it and surveillance is really, really critical for that.
CL Thank you, Maria. Dr Socé Fall, please.
SF Thanks, Christian. Just to add a little bit on the surveillance aspect. If you look at the African countries, they are already using what we call an Integrated Disease Surveillance and Response System, where monkeypox is one of the diseases under surveillance.
We are using community-based surveillance, event-based surveillance and also indicator-based surveillance from the health facilities. If you look at the number of countries reporting, there are only nine but, if you analyse the real ecological zone of monkeypox, you have at least 15 countries that should report on monkeypox.
So, we needed to continue investing in diagnostics because most of the cases are suspected cases but also investing into genomic sequencing to make sure that we can understand better the dynamics of the transmission, but also to use this opportunity to highlight the fact that we cannot only wait for vaccines.
We have other public health measures we need to use to make sure we can have strong surveillance, early detection, isolation of cases, contact tracing to be able to stop the chain of transmission but also highlight the need to protect healthcare workers with protective equipment, all we need to do in terms of infection prevention and control.
CL Thank you, Dr Fall. Dr Briand, please.
SB Thank you. I think on surveillance, what is very important to look at is really, when the disease affects humans, you can detect cases because people go to the healthcare system and are detected when there is diagnostics. But for the situation in animals, surveillance in animals, it’s very complicated because most of the time animals don’t get sick or if they get sick and if they die, it’s not detected that they have been sick because of this disease.
So, animal surveillance is very complex. That’s why we work with FAO and OIE on this and for humans detection is easier because when they are sick normally they go to get care and then we can detect them. But this requires also a very good healthcare system and in some places in the world people don’t have easily access to a healthcare system, so that’s why detection is even more complex.
Moreover, of course, Member States and countries need to invest in surveillance but they also need to invest in their healthcare system to make sure we can detect, rapidly, cases.
CL Thank you very much, Dr Briand and thanks to Dr Fall. Now, we move on to Priyanka Runwal, from National Geographic. Priyanka, please unmute yourself.
PR Hi. Thanks for taking my question. I have a question about vaccination strategies. At the moment people who are most at risk or immediately exposed are the ones that are being vaccinated, at least in some countries. I’m wondering if there’s discussion about broader vaccination, maybe among certain communities and, if not, at what point is that discussion relevant?
CL Thank you very, Priyanka. Back to Dr Lewis, please.
RL Thanks very much. Indeed, as you mentioned, the strategy right now is post-exposure prophylaxis for those who have already been exposed to a person who has monkeypox, ideally a confirmed case. If it is a suspected or probable case, this needs to be discussed in a healthcare setting.
The vaccines that are available in some locations, there are different types of vaccines, so this is a discussion that needs to take place between the person exposed and the health worker, the healthcare provider. There’s not like a one-size-fits-all for this.
Primarily exposed persons would be the ones that would be best placed to receive vaccine within four days of exposure. It could go up to 14 weeks, but really for the vaccine to be effective, as far as we know, again we don’t have a lot of information on the use of these vaccines for post-exposure prophylaxis for monkeypox, but what we do know already suggests that it may be effective primarily within the first four-day window.
So, that’s the most important action that can be taken where these vaccines are available and, as I’ve said previously, WHO and Member States are working hard to improve access to these products.
The second group would be pre-exposure prophylaxis or prevention in those who may already be at higher risk by virtue of potential occupational exposure or at risk for other reasons. This is something that must be decided through national policy, at the national level.
Anyone who is at risk through possibility of immediate exposure might benefit from the vaccine, but again there is a lot of research to be done and so the work that needs to be done around these vaccines is that they should be used in a research protocol so that standardised data can be collected under a common protocol that is shared across communities and Member States. In that way we’ll be able to collect the information that we need to really understand the better the effectiveness of the products that may be available in a community setting.
With respect to broader vaccination, this is at the moment not part of the recommended strategy. Mass vaccination is not recommended at the moment and this is because of the nature and the way in which this virus, this disease is transmitted and spread between persons.
You might recall that even at the end of smallpox eradication era, prior to the declaration of the eradication of smallpox by WHO in 1980, even those last bastions of smallpox were managed through surveillance-containment strategies accompanied by vaccination in a small circle of individuals around the last cases. There was mass vaccination against smallpox but there was also surveillance-containment with support of vaccination.
Now, we’re looking at surveillance-containment strategies that are very similar, vaccination of persons exposed, vaccination of contacts. Whether we can go further to vaccination of contact of contacts really does require more information and we really encourage those who are using these products, Member States who are using these products, to do it under research protocol so that we can learn as much as possible in as short as possible period of time.
CL Thank you very much, Dr Lewis. I understand we have Dr Kate O’Brien, Director for Immunisation, Vaccines and Biologicals online and she would like to come in. So, Dr O’Brien, please go ahead.
KO Just a couple of things. I think just one clarification. Perhaps some people either misheard or I’m not sure whether Ros misspoke, but it’s four to 14 days. I think somebody heard 14 weeks, so I just wanted to clarify that point.
Then, the second thing I wanted to clarify on this was, as Rosamund has said, there’s a lot that is not known about how best to use vaccines and what that approach would be outside of the areas that Rosamund just described, these constrained ways of using the vaccine.
What’s really, really important here is, as countries are deciding how they will use vaccines, that that data is collected in a way so that it can really inform the future use of vaccine in the best way possible for the supply that’s available.
We should acknowledge that the amount of vaccine that is available for deployment in a number of different settings is a constrained amount of vaccine and we’re working with vaccine suppliers to establish how much vaccine there is, where that vaccine is going, and how we can provide access to countries where the use of that vaccine is going to be most relevant.
Then, the final thing to say is that our Strategic Advisory Group of Experts on Immunization is looking at the evidence and looking at all of these issues. We will be coming out with interim guidelines, as was mentioned earlier in the press conference and, in addition to those interim guidelines coming out from WHO, our external experts will continue looking at all of the evidence that’s coming out, both with respect to this outbreak, the use of the vaccines, as countries are starting to use them, and establishing a basis for a more broad-ranging policy about how best to use vaccines. So, thanks very much.
CL The next question comes from Donato Mancini, from the DT. Donato, please unmute yourself.
DM Hi. Thanks so much for taking my question. Has a significant mutation in the monkeypox virus been ruled out and, if so, could the rise of monkeypox and other diseases such as the hepatitis in children be explained by a change in our immune systems rather than a change in viruses? The broad question I’m trying to ask you is, if viruses haven’t changed, have we changed a lot in the past two years?
Then, just a couple of clarifications. Have any fatalities been reported to you from non-endemic countries in this monkeypox outbreak? On the sharing mechanism for tools to counter monkeypox, what does that look like? Will it procure drugs and vaccines on its own? Will it use a COVAX-like model? Could you give us a bit more detail there? Thank you.
CL Thank you very much, Donato. A big question here. Let’s start with Dr Lewis.
RL Thanks. We can start with the question on the virus. Nothing has been ruled out. There is not a lot that’s yet known. Countries are beginning to post genomic sequences of the viruses that they have for which they’ve done genomic sequences and virologists are actively looking at this information and beginning to assess whether this virus, these strains that are perhaps circulating now, how closely linked they are to previously identified strains and whether there is significant change at the moment.
But there is not enough information now. There are few sequences yet available and so again, as in so many areas, more needs to be done and more research is being done and we are looking to our colleagues and virologists to support that work, which is ongoing at the moment.
For the question have we changed a lot, I will pass to my colleagues but, before I do that, just to say that in one sense we have changed a lot. As mentioned earlier, that smallpox vaccine has not been used for 40 years and poxviruses, orthopoxviruses, have not been widely circulating for 40 years.
From that perspective, most people under the age of 40 or 50, depending on which country they have been when they were children, would not have immunity to orthopoxviruses. So, from that perspective, we have changed compared to 40 years ago but I’ll leave the other question to my colleagues. Thanks.
CL Thank you. Dr Van Kerkhove, please.
MK Just briefly to come in on that. Certainly, we’ve changed. Certainly, the way the world in which we live, we’ve changed. The way that we live in our homes, the way that we travel, the exposures that we have. So, there’s quite a bit of change, obviously, over the past several decades, urbanisation, climate change, all of these are factors associated with why and how we’re seeing the emergence and re-emergence of these pathogens.
But the one thing I wanted to comment on in regards to how you asked your question, we don’t work with speculation. What we work on is a scientific process in the sense of saying what might be happening here? What are the hypotheses? What are the potential drivers to explain what we are seeing?
Then, what we are fortunate to do. As WHO, we are very fortunate to work with scientists all over the world, experts all over the work, in countries all over the world that help us to address those different types of hypotheses.
Basically, the R&D meeting that was held last week for monkeypox, we’ve had many meetings of R&D meetings that are outlining what are the priority studies for all of these types of pathogens. Then, we work with people in countries to help us address those questions through scientific study.
We’re trying to democratise the use of scientific investigation all over the world, not just in a handful of high-income countries but being able to actually do the research on the ground, building that research capacity and then using the information that comes from those studies to drive our understanding, add more questions, try to answer more of those questions.
So, it’s an opportunity here for us to thank our partners around the world, the scientific organisations, the academic organisations, the public health institutes in every single country that are helping us to address those.
We don’t have all the answers. We don’t claim to. But what we do, when we sit up here, is we try to answer what we know, what we don’t know, and what importantly we’re doing to find out and what we, as WHO with our partners, are doing to address some of those questions.
And science is a process. Sometimes I get questions like when will you just know? When can we stop of asking the questions? Will you just know? And that’s not how science works. It’s a constant iterative process and the more information that becomes available, the more questions we have.
So, again, it’s a good opportunity for us to thank our partners to drive the research agenda forward so that we can get some of these answers and really understand drivers and understand what we can do to try to mitigate the potential impacts on them on our lives, on the health of people and on the livelihoods of people.
CL Thank you very much, Dr Van Kerkhove. The next question goes to Shoko Koyama, from NHK. Shoko, please unmute yourself.
SK Hello, Christian. Thank you for taking my question. On monkeypox, it’s mentioned that mass vaccination is not recommended. Could you let us know what the general public should care the most for not to be infected with monkeypox? How could we prevent from infecting with it? Thank you.
CL Thank you, Shoko. Yes, it’s a good one. Dr Lewis, please.
RL Thank you. Probably the most important tool that we have is information and awareness, so being aware that this is a new phenomenon, being aware of how its manifesting, being aware of how it’s spreading.
For the general public, just having that knowledge is already important to be able to appropriately assess the risk and adjust the risk. We’re not saying that there’s risk for everyone and we’re not saying there’s risk for no one. Each individual will know how to assess their own risk if they understand how the disease is spreading as far as we know today.
What we know today is that this is a disease that spreads primarily through person-to-person contact, face-to-face contact, skin-to-skin contact, mouth-to-skin contact from a person who has the infection to a person who is exposed, who is a close contact, whether that be through sexual contact, sexual activities, especially if there are more than one partner and especially if there are multiple partners in a short period of time. That is one form or risk that should be understood and information shared with the groups of people that need to have it.
Other potential persons at risk may be people who live in the household with someone who may have been diagnosed with monkeypox or who may have an unexplained rash for which they may wish to seek support and care from a healthcare provider to identify the rash.
There are many rashes that may be confusing in this regard. The blisters of monkeypox can look like chickenpox. Chickenpox is a relatively common disease that is not caused by an orthopox virus despite the similar sounding name. It’s caused by varicella-zoster. The varicella virus is causing chickenpox. So, it’s not chickenpox but the blisters can look similar.
There are other conditions that may masquerade in different ways, that may manifest in different ways and that would include even just the red rash of measles or, for example, other sexually transmitted infections such as herpes or syphilis. These are all things that people can perhaps be tested for if they seek medical care or look for the advice of a healthcare provider.
So, the most important thing is to know what to look for to educate oneself on how monkeypox manifests classically and also how it’s manifesting differently in this new outbreak that is occurring in adults, primarily in non-endemic countries.
In adults in non-endemic countries, the way it’s manifesting now is less severe disease in most but not all people, and so the rash may be a less aggressive rash and it may be localised to a part of the body that is covered most of the time, but it still is infectious and it still can cause spread and it still needs to be taken care of and looked after properly.
These are all things that are available and many of the information we already have as WHO is online. There is a monkeypox health topic page. There is a fact sheet. There are questions and answers. There are training courses that are available on the OpenWHO platform and there are many other resources that are being made available, especially through our work with stakeholders and organisers of large events, for example.
So, Pride parades, summer festivals, people who are attending these festivals may just need to be aware that it’s the close contact and the physical contact that may put them at risk and it’s good to be aware of this. WHO is working very closely through the regional offices as well, including the European regional office, with organisers of events, to make sure that the right information reaches the right people at the right time, so that people can have the information to protect themselves and to protect each other.
CL Thank you so much, Dr Lewis. I believe we also have Dr Meg Doherty, the Director, Global HIV, Hepatitis and STI Programmes, especially to comment on the work with communities. Meg, please go ahead.
MD Thank you very much. I think Rosamund covered much of it but I just wanted to add that it’s really important to use the communities and skills that have been learned over years of how to ensure that there is no stigma around a new disease or a new infection, but that we’re also communicating and having good messages so that communities, themselves, can share that information.
So, what our department is doing in helping this is working with the local Pride organisations, with community organisations, as well as other agencies and stakeholders who are working mainly men who have sex with men or their partners and ensuring that those messages and protection of oneself, protection of onward transmission is really well-articulated in infographics, on the web, on Twitter feeds, so that we can reach, through social media and other methods, as many people as possible.
And also to help organisers really think about how to hold these usually very family-friendly Pride events in a safe way. So, I think as we go through the summer months, we’ll be learning more and coming back to you with more information, but we’ve been engaging with several groups and we encourage others to reach out to WHO should they want to have more information or go to the website. Thank you very much.
CL Thank you very much Dr Doherty, and also Dr Lewis, for these important words on the community outreach. With this, we come to the end. I understand we still have a few questions outstanding and a few follow-ups, so I would like to ask you to just send this to Media Inquiries.
Other than that, thank you all for your participation. We will be sending the audio file and Dr Tedros’ remarks right after the press conference, and the full transcript will be posted on the WHO website tomorrow morning. With this, Dr Tedros, please, for closing.
TAG Thank you. Thank you, Christian, and thank you to all members of the press who have joined today. All the best. See you next time.
‘This too shall pass away’ this famous Persian adage seems to be defeating us again and again in the case of COVID-19. Despite every effort