FC Hello and welcome to WHO’s virtual press conference on COVID-19, Ukraine and other global health issues, and a special focus today on ACT Accelerator. We have several special guests that Dr Tedros will introduce shortly but let me introduce to you our experts who are in the room.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Senior Advisor to the Director-General and the Lead on ACT Accelerator, Dr Kate O’Brien, Director Immunisation, Vaccines and Biologicals, Dr Socé Fall, Assistant Director-General, Emergencies Response, and Dr Rogério Gaspar, Director Regulation and Prequalification.
As you know, this press conference is in different languages, the six UN languages plus Portuguese and Hindi. Now, without further delay, I would like to hand over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor.
TAG Thank you. Thank you, very much. Good morning, good afternoon and good evening. I will start by introducing our guests. Dr Seth Berkley, CEO of Gavi, Dr Philippe Duneton, who is in the room with us, Executive Director of Unitaid, and Dr Bill Rodriguez, CEO of FIND, and also Dr Juan Pablo Uribe, the Global Director for Health, Nutrition and Population at the World Bank. So, welcome to our guests and thank you so much for joining.
Over the weekend, WHO released an update about cases of acute hepatitis of unknown origin among children. So far, at least 169 cases of acute hepatitis have been reported from 11 countries in Europe, and in the United States, in children aged from one month to 16 years. Seventeen children, about 10% of the reported cases have required liver transplants and one death has been reported.
The symptoms include abdominal pain, diarrhoea, vomiting, jaundice, severe acute hepatitis, and increased levels of liver enzymes. The viruses that commonly cause acute viral hepatitis have not been detected in any of these cases.
Adenovirus has been detected in at least 74 cases, and this and other hypotheses are being explored. WHO is working closely with the European Centre for Disease Prevention and Control, and the affected countries, to support ongoing investigations, including additional lab testing.
Also, over the weekend, health authorities in the Democratic Republic of the Congo declared an outbreak of Ebola after a case was confirmed in Mbandaka, a city in the north-western Équateur Province of DRC.
A second case was confirmed today in a relative of the first patient. Unfortunately, both patients have died. WHO is supporting the government to scale up testing, contact tracing and public health measures.
Stockpiles of Ebola vaccines in Goma and Kinshasa are now being transported to Mbandaka, so that vaccination can start. The government and people of the DRC have a great deal of experience stopping Ebola outbreaks and WHO will support them to do whatever is needed.
Now to COVID-19. Globally, reported cases and deaths continue to decline, which is very encouraging and good news. Last week, just over 15,000 deaths were reported to WHO, the lowest weekly total since March 2020.
This is a very welcome trend but it’s one that we must welcome with some caution. As many countries reduce testing, WHO is receiving less and less information about transmission and sequencing. This makes us increasingly blind to patterns of transmission and evolution.
But this virus won’t go away just because countries stop looking for it. It’s still spreading, it’s still changing, and it’s still killing. The threat of a dangerous new variant remains very real and, although deaths are declining, we still don’t understand the long-term consequences of infection in those who survive.
When it comes to a deadly virus, ignorance is not bliss. WHO continues to call on all countries to maintain surveillance. Last week, I had the honour to visit Nepal, and to discuss the impact of the pandemic with Prime Minister Sher Bahadur Deuba and President Bhandari.
I saw how, with WHO support, Nepal has established genome sequencing in its National Public Health Lab, which will be key to identifying potential variants of SARS-CoV-2, as well as future pathogens.
I also had the honour of witnessing Nepal’s first typhoid vaccination campaign. Nepal’s constitution says that basic healthcare is a fundamental right of every citizen, and it was a privilege to see that right in action, to meet the children who were vaccinated, their families and the amazing health workers. And my appreciation also to Gavi and partners.
It was a great reminder of the power of vaccines to save lives, from COVID-19 and many other deadly diseases, including measles, meningitis, Ebola, polio and more. This week is World Immunization Week, an opportunity to highlight the incredible power of vaccines, not just to save lives, but in the words of this year’s theme, to offer the opportunity of a long life for all.
But around the world, the pandemic has caused severe disruptions to routine immunisation programmes, putting millions of children’s lives at risk, and opening the door to fresh outbreaks of measles and polio. One of WHO’s priorities is supporting countries to conduct catch-up campaigns to protect as many children as possible, as fast as possible in partnership with Gavi.
Last week, I also had the honour of visiting India, where I met with Prime Minister Narendra Modi. I also inaugurated the WHO Global Centre for Traditional Medicine with Prime Minister Modi, which will help to harness the power of science to strengthen the evidence base for traditional medicine.
Both Nepal and India are getting closer to vaccinating 70% of their populations against COVID-19 by the middle of the year and they’re also rolling out boosters to the most vulnerable. As a result, both countries are now seeing a decoupling between cases and deaths.
This is the level of vaccination we need to see in all countries. Almost 60% of the world’s population has now completed a primary course of vaccination, but only 11% of the population of low-income countries. Closing this gap remains essential to ending the pandemic as a global health emergency.
And it’s not just vaccines. On Friday, WHO recommended the antiviral combination nirmatrelvir and ritonavir, also known as Paxlovid, for patients with mild or moderate COVID-19 that are at high-risk of hospitalisation. This treatment helps prevent hospitalisations and is easy to administer.
However, several challenges are limiting its impact. It is largely not available in the vast majority of low and middle-income countries, and requires prompt and accurate testing before administration, within five days of symptom onset. This is compounded by a lack of price transparency in bilateral deals made by the producer.
The persistent global gaps in access to tests, vaccines and treatments highlight why the ACT Accelerator remains crucial to the global response to COVID-19. This week marks the second anniversary of the ACT Accelerator. This unique partnership of governments, global health agencies, civil society and industry has many achievements to be proud of, as outlined in the ACT Accelerator two-year impact report, which was published today.
Together, we have enabled 40 countries to begin their COVID-19 vaccination campaigns, we have helped to build the sequencing capacity in Southern Africa that first detected the Omicron variant, and we have negotiated unprecedented deals with the world’s largest oxygen suppliers to increase access in more than 120 low and middle-income countries.
In October last year, the ACT Accelerator launched a new strategic plan and budget and yet halfway through its current budget cycle, just over 10% has been funded. The pandemic is not over, and neither is the work of the ACT Accelerator.
We recognise that we live in a world with multiple overlapping crises and multiple demands for funding. Governments can find plenty of money for tools that take lives. We call on all countries to invest in tools that save lives.
I’m pleased that next month, United States President Joe Biden will hold a Global COVID-19 Summit with world leaders to maintain the high-level attention that this ongoing pandemic deserves. It will take all countries, regardless of income level, to commit to steps that can bring the pandemic to an end, end inequities, save lives, prevent suffering, and help get economies back on track.
Today, we’re honoured to be joined by leaders from four key partners in the ACT Accelerator, representing each pillar whom I introduced earlier. I will repeat again. Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, who will speak on behalf of COVAX, the vaccines pillar, Dr Philippe Duneton, Executive Director of Unitaid, on behalf of the therapeutics pillar, Dr Bill Rodriguez, CEO of FIND, on behalf of the diagnostics pillar, and Dr Juan Pablo Uribe, the Global Director for Health, Nutrition and Population at the World Bank, on behalf of the Health Systems and Response Connector.
Thank you all for joining us, and thank you all for your partnership and leadership over the past two years. Seth, let’s start with you. You have the floor.
SB Thank you, Dr Tedros, for inviting me here today. I remember two years ago when COVAX and the ACT Accelerator were formally established. At the time we knew the world was entering a pandemic, which turned out to be the like of which had not been seen for 100 years. We also knew that there were no known vaccines and likely would not be for some time.
Most importantly, we knew if we didn’t come up with a plan fast, that as soon as those vaccines were developed, they would only go to rich countries with others waiting at the back of the line. That is the challenge that COVAX was set up to solve in the ACT Accelerator, to accelerate vaccine development and ensure that vulnerable people everywhere would be able to access life-saving vaccines. Today, with over 1.9 billion doses allocated and 1.4 billion doses delivered to date, it’s the largest and most complex global vaccine rollout in history.
But where does that leave us today? The short answer is we have plenty to do. The science has been breathtaking and we have more than a dozen vaccines with many more coming. Currently, 44% of people in lower-income countries have now been vaccinated with at least two doses.
Given that the global coverage is 59%, the global vaccine equity gap is narrowing but it is still too wide. There are billions of people who have not been vaccinated. What’s more, there remain some low-income countries which you mentioned, 18 at last count, that still have protected 10% or less of their populations.
The good news is that today we have access to as much supply as countries need to meet their national targets. That means that countries, in turn, can plan large-scale rollouts with confidence that the doses they have requested will arrive on time including usually with their product of choice.
But we cannot ignore the fact that many country’s health systems lack the capacity to simply switch on massive vaccination programmes alongside the other vital routine immunisation services. To address this, Gavi has already made $600 million in COVID delivery support available to lower-income countries, money that can be used to help cover the cost of infrastructure, hire new vaccinators or work with communities.
We’ve also stood up and enhanced COVID vaccine delivery partnership to enhance delivery support for the 34 lowest coverage countries, and we’re grateful to our donors, thanks to whom we raised a further $600 million earlier this month.
The pandemic is far from over. Until now, we’ve seen a new variant emerge every four to five months. This means that while we may have enough doses today, we need to be able to move swiftly should the need arise to buy more or different vaccines in the future.
Again, here I’d like to thank our donors who, on April 8, at the AMC Summit, stepped up and helped us launch, but haven’t yet fully funded, our Pandemic Vaccine Pool, a contingent financing facility that will help us ensure that when the need arises, COVAX can step up and order new doses immediately.
This is in stark contrast to 2020, when we first had to raise cash before we could place any orders and it’s a sign of how far we have come as a multilateral solution, not just in helping address the challenges of this pandemic but leaving us better prepared for the next one. Working together is the only way to go. Dr Tedros, back to you.
TAG Thank you. Thank you, Seth. Philippe, over to you.
PD Thank you, Dr Tedros, and good afternoon for everybody on the call. I’m talking from the therapeutics pillar, which means it’s Unitaid, Wellcome, WHO, Global Fund, UNICEF, and some other organisations, including civil society. I will make three points. What we have achieved so far over two years, the progress we’ve made, and the challenge we see.
On the first point, I think that it has been a long journey over the last two years to find the right medicine that works and the first one was, if you remember, access to oxygen. I think, Dr Tedros, you made the point that it’s quite important, it’s life-saving combined with corticoids. I think that a lot of work has been put to review all clinical trials in particular with WHO and Wellcome, to make sure that we have the evidence to know what is working.
Secondly, where we are as an outcome, and Dr Tedros made the point that we have now the drugs and the evidence that WHO has recommended, in particular the product, Paxlovid, from Pfizer. We have for outpatient oral therapeutics, five drugs. In fact, two drugs oral and three IV, but the Paxlovid is the one which has the most efficient impact with a decrease of 85% of the hospitalisation and mortality for people at risk.
I think it’s quite important to flag that because it’s not recommended for all people with COVID but really for the people at risk. It means, in terms of age, in terms of comorbidity, diabetes in particular, but also immunocompromised patients, including people living with HIV.
I think now the challenge we see, one point is the unpredictability of the pandemic and I think it’s fair to say that, even if the good news is that we have a reduced number of cases, we need to be very cautious and be ready to deploy for the people in need.
The second issue, and I think Bill will come back on that, is the level of testing because we need to have a test before putting people under treatment and this is a challenge because if countries don’t test, it will be difficult to have access to these therapeutics for the people at risk.
We also need to have good term agreements with the manufacturers. Pfizer, based on the volume and the countries that also will benefit from a generic version of this compound at full year, at the end of the year, beginning of next year. So, it’s a big challenge.
The company has agreed already to grant a voluntary licence to the Medicine Patent Pool with 35 manufacturers that can do a generic version in the coming month but we need also to have funding. Initially, the Global Fund will support access in countries but we need to have an additional 2.3 billion, 1.3 for access to therapeutics and focusing on procurement and also preparing the ground for the generic manufacturers.
Second, to increase access to oxygen because it’s still important for all the people in counties to have access to oxygen, not only for COVID by the way, but also for other priorities. Thank you.
TAG Thank you. Thank you so much, Philippe. Bill, over to you.
BR Thank you, Dr Tedros and good afternoon and good evening everyone. When I was in medical training some years ago our programme director had a set of sayings that he used to help us understand the challenges of providing high-quality healthcare and two of his favourite sayings were our motto should be constant improvement without change and number two was we never make the same mistake eight times.
We would laugh when he would say this but over time, as you work in global health and you engage in the hard work or changing health systems, you come to realise quite painfully the wisdom in those sayings and how hard it is to sustain change and to keep doing the right thing. I’ve thought about those things quite a bit recently as I reflect on the trajectory of the pandemic and the two-year anniversary of ACT-A.
Certainly, as Dr Tedros and Seth and Philippe have discussed about vaccines and about treatment, we have seen tremendous advances in the way testing has been used throughout this pandemic to diagnose COVID, to strengthen testing systems, to strengthen surveillance systems and to link testing to public health and medical interventions.
Through ACT-A there have been a number of headline accomplishments with which everyone is familiar. Prices for PCR and rapid tests have dropped dramatically through the ACT-A diagnostics consortium and the Global Fund’s C19RM by 70-80%.
WHO has endorsed the use of self-tests for COVID on a global basis and that puts the power of testing into people’s hands everywhere, and not just in wealthy countries, and those tests are available globally at prices of $1.00-1.50 per test.
The global capacity for genomic sequencing and the systems to track new variants has advanced by leaps and bounds to the point where we now routinely see new variants identified first in Botswana and South Africa before similar laboratories can identify them in Europe, the US, and in Asia.
After a slow start, global manufacturing capacity for diagnostic tests now exceeds demand and, belatedly but critically, we’ve made major investments in local diagnostics manufacturing facilities in Brazil, in Senegal, in South Africa, in India, similar to what we’ve seen for local production of vaccines. And these manufacturing resources in the global south will be even more essential in a post-COVID world.
The tragic irony is here today on the second anniversary of ACT-A, we have never been in a stronger position as far as diagnostic testing progress. We’ve never been more capable of responding to the need for the low cost, accurate, rapid tests required to manage a global threat than we are with COVID, not for HIV, not for TB, not even for malaria, and certainly not for diabetes or cervical cancer or neglected diseases.
We’ve never had the degree of cooperation, the commitment, the policies, the tests, the manufacturing capacity, the integrated systems, procurement mechanisms, the trained workforce, the variety of community and hospital and laboratory-based tools and strategies to have unprecedented daily monitoring of a disease and its spread.
Yes, in the last four months, in the midst of Omicron, as cities in East Asia go on lockdown, as vaccination rates stall, testing rates have plummeted by 70-90% worldwide. So, we have an unprecedented ability to know what is happening and yet today because testing has been the first casualty of a global decision to let down our guard, we’re becoming blind to what is happening with virus.
As Philippe noted, that undermines our ability to treat COVID with new therapeutics and, as Dr Tedros said, this virus will not go away just because we stop looking for it. So, let me end with one thought. I see three paths ahead. One is the acute phase of the pandemic is over and we can mourn our losses and we can congratulate ourselves on what we were able to protect. But that path seems pretty unlikely to me.
Two is the pandemic continues to spread in waves across the world and rather than learn again the lesson that shutting down testing programmes prematurely is always a mistake, it always costs more money in the end, it always costs more lives, we make that same mistake that we’ve made so many times in the course of the pandemic and we have a strategy that’s based on hope rather than a strategy based on data.
A third, and this is my hope, is we learn from the past and through the ACT Accelerator we continue to invest in testing. We track the spread of COVID until all needless deaths are averted and we have fully contained this virus. Otherwise, we may come together in six months and at another press conference, I might open my remarks again with a story about a saying that I once used to laugh about, that we never make the same mistake eight times.
So, on behalf of the ACT-A diagnostics pillar, I have faith that we can still learn and respond and test, and I certainly hope that will be the future. Thank you very much and I’ll hand it back over to you, Dr Tedros.
TAG Thank you. Thank you, Bill. Thank you so much. And last but not least, Juan, over to you.
JU Dr Tedros, thanks so much and good morning, good evening to everybody. I’m very happy to be part of this press conference. The World Bank is an engaged partner of the Access to COVID-19 Tools Accelerator, ACT-A. We’re very happy to see its second year birthday, with all that has been done thanks to its efforts.
Together, with the Global Fund and with WHO, we co-convened the ACT Accelerator Health Systems and Response Connector, what we call the fourth pillar, which aims to give countries the necessary technical, operational and financial resources to translate COVID-19 tools into national response interventions to stop the transmission of the virus and to save lives.
The Global Financing Facility for Women, Adolescents and Children, GFF, and UNICEF also support the work of the Health Systems and Response Connector. The focus of the Health Systems and Response Connector is in supporting countries strengthen their health systems so that these COVID-19 tools, as we’ve heard from the prior colleagues, can be deployed and reach those who need them within the health systems.
Health systems are the foundation for the deployment of vaccines, as well as other countermeasures. At the same time, health systems have been disrupted by the pandemic and we can see how today, even two years after the pandemic, more than two thirds of the health systems in countries are still reporting disruptions to essential health services, in particular affecting the most vulnerable, women and children among them.
The Health Systems and Response Connector, in addition to addressing these challenges, also covers the personal protective equipment, that we call PPE, needs in countries, fundamental to protect essential health workers. This means providing protective equipment to more than 2.7 million healthcare workers including the community health workers who play such a vital role in our countries’ systems.
The World Bank’s COVID and vaccine financing, which is now reaching over $12 billion, is complementary to this work of the Health Systems and Response Connector and to the whole effort done by ACT-A. We are financing support to purchase and deploy vaccines, to strengthen health systems, to train health workers, to reach out to communities with proper communication, to develop tracking systems and to strengthen the cold chain, just to mention some of them.
We’re also working with COVAX in an innovative financial mechanism that allows countries to purchase vaccines as needed, as well. We will continue this engagement in ACT-A and the complementarity of our efforts with our funding, working with other colleagues in the Health Systems and Response Connector to ensure that these countermeasures reach the countries that still need them and that, as a consequence, we not only save lives but also strengthen health systems for future responses and for addressing future health needs. Thank so much, Dr Tedros. Over to you.
TAG Thank you. Thank you so much, Juan, and my thanks once again to all of you, and to all our ACT partners. I assure you of WHO’s continued commitment to working with you to expand access to all the tools needed to bring this pandemic under control. Again, thank you so much for joining us Thank you for your leadership. Thank you and, Fadéla, back to you.
FC Thank you, Dr Tedros. Let me now open the floor to questions from members of the media. To get into the queue to ask a question, you need to raise your hand using the Raise Your Hand icon, and do not forget, please, to unmute yourself when it is time. Let’s start with Nina Larson, from Agence France-Presse. Nina, can you hear me?
NL Yes. Thank you very much for taking my question. I’m sorry, I’m going to ask a question about something other than the ACT Accelerator. I wanted to ask you about the announcement that Elon Musk is buying Twitter because I’m wondering if you are concerned that Twitter being run by self-declared free speech absolutist could possibly run counter to your efforts to battle the so-called epidemic and could possibly allow more misinformation about vaccines, etc, to spread. Thank you.
FC Thank you, Nina. I would like to invite Dr Ryan to take this question.
MR I don’t think there’s much to say. I think the point made at the end of your question is always an issue for WHO, and that is to try and ensure that we and our partner agencies, including all our ACT partners, get the best possible information to people. People do well and people make good decisions when they get good information. That’s our experience.
There is misinformation and disinformation out there all across whatever platform you wish to go to. Good stewardship of those platforms is extremely important. It’s not the business of WHO who owns or who manages those platforms.
Many of the platforms that exist today have worked very, very closely with WHO. I don’t know if Gavi or anyone wants to make a comment on that but I know many of the social media platforms have really engaged with WHO and partners to try and improve the quality of information out there.
We really have created a new science of infodemiology. We work extremely closely with our communities to try and pass the best possible information but certainly when anybody takes on a new task, when anyone reaches a position in life where they have so much potential influence over the way information is shared with communities, they take on a huge responsibility and we wish Mr Musk luck with his endeavours to improve the quality of information that we all receive.
In cases like this pandemic, good information is life-saving. It’s even as life-saving, and in some cases more life-saving than having a vaccine in the sense that bad information sends you to some very, very bad places.
FC Dr O’Brien?
KO Let me just amplify a couple of things that Mike said. I agree with everything he said. I think the issue that really is just so central is that people’s lives are lost as a result of misinformation or intentional incorrect information.
It’s just incredibly critical on vaccines and on other health issues, that people are seeking credible information, they’re getting their information from credible sources and that people are only passing on information that is accurate and reflects the truth about, first of all, the diseases and the life-saving interventions that are available.
This is not just a matter of chatter on social media channels. It really has an impact on what people do, what they chose to do, what they chose to do for themselves, for their children, for their families. So, it’s something we take really seriously.
I think we also have to recognise that for the vast majority of people, they understand the value of vaccines. In particular, they understand the frankly life-threatening risks of the diseases against which we have life-saving vaccines and are seeking vaccines and getting vaccinated.
So, it really is a small group of people, a minority of people who are engaging in certainly any deliberate misinformation but it cycles out to many people who are having difficulty distinguishing between what’s accurate information and what’s not accurate information. Thanks.
FC Thank you. Next journalist is Sara Jerving, from Devex. Sara, can you hear me?
SJ Yes. Thank you so much. I’m wondering how concerned you are that the Ebola outbreak is in an urban area. Thank you.
FC Sara, can you just repeat the question? Your voice was very soft. Dr Socé?
SF Thank you, Fadéla. Ebola is always a concern for WHO Member States, although we have made progress over the last years in terms of the capacity to detect the disease like in Congo where, after less than 24 hours of confirmation the sequencing was done.
We have also built capacities for vaccination and treatment but knowing how deadly the disease can be, we are always concerned when it happens. It is always concerning when it happens in an urban area like Mbandaka, with the density of the population but also with the risk of spreading across the river to countries like Central African Republic and Republic of Congo-Brazzaville.
So, that’s why we are working very closely with the national authorities in Congo and also our partners to mobilise the community for active measures in the community but also some retrospective analysis of the health information data in the health facilities to be sure that we are not missing any channel of transmission.
This is concerning but, taking into account the capacity build-up and the experience in Congo, we believe it can be contained but every outbreak is unique. You cannot just assume that because we have dealt with an Ebola outbreak in the same area before you can do the same thing.
We need to make sure that the initial investigation is well done, identifying all possible sources of transmission and all possible scenes of transmission to contain it soon as possible. Thank you.
MR If I could just supplement because I think Bill mentioned this before in his intervention, how much we’re moving on and what the prospects are for even greater control of diseases like Ebola or COVID. The fact that this virus was sequenced literally within 24-48 hours, that we understood this virus wasn’t coming from a relapsed case but a new origin of the virus.
The fact that vaccines have been pre-positioned. This virus was reported on 23 April. Ring vaccination operations will begin I think today, Socé. So, again, the speed at which we’re able to detect, the speed at which we’re able to react, the pre-positioning of supplies.
The ability to have Ebola vaccine where Ebola happens and where Ebola is likely to do most damage and not to have these vaccines stored under a mountain somewhere in an industrialised country but actually have vaccines in the countries where these viruses strike, I think we are making progress and this demonstrates this.
But, as Socé so correctly says, there is also the risk and, certainly, Mbandaka is right there on the Congo River. It is very connected to Kinshasa. So, being alert and being vigilant in the face of this virus while at the same time using and exploiting the new technologies and the greater level of surveillance.
Again, to our colleagues at the Ministry of Health, and also to Dr Muyembe and others, they deserve huge credit for sustaining the surveillance of Ebola, for expanding the use of sequencing and for having diagnostics again on site and available now for making those diagnoses.
What is concerning about this outbreak, is again we have two health workers I believe, Socé. One of the workers is a health worker and again we see the tragedy of health workers being, in a sense, the sentinel event. Someone is coming to a hospital is sick, not diagnosed at the hospital level and it’s the death or illness in a health worker.
So, while we are making progress on some of the bigger issues, we are definitely struggling with the very straightforward issue of infection, prevention and control and staff protection and in managing infections within the hospital environment and still potentially allowing these diseases to amplify, even though there were very, very simple, straightforward health systems approaches to be able to deal with that.
Again, protecting our frontline workers, once more an area where we tend to fall down, and at some point we have got to take the issue of infection prevention and control within the healthcare system much more seriously or we always risk amplifications occurring like this.
FC Thank you. Next question is for Emma Farge, Reuters. Emma.
EF Good afternoon. Reuters just published an exclusive saying that the EU has decided to move away from the emergency phase of the COVID pandemic. Would you be able to react to that, please? Since Mr Uribe is here, I would love just a few details on the size of the Pandemic Preparedness Fund and how you see WHO’s role in it. Thanks.
MR We haven’t seen that, I don’t believe, as of yet but I think the DG’s speech said it all and I think also Bill alluded to that. This is not the time for us to lose focus on this virus nor on its potential to continue to evolve, nor on the fact that it is still killing people all over the world, nor on the fact that we’re losing sight of the virus because we’re reducing the amount of testing that we’re doing.
We will look and await the report that you refer to and we will read it with great interest. The European Union, in general, takes a very measured approach to these collective threats and I’m sure that any decision they made is going to be based on good science and good data.
Everyone is aware and anxious to move on from the pandemic, nobody more than us, I can assure you, would like to see the back end of this pandemic but the reality is that everyone has a right to their own opinion as to whether this pandemic is over or not but what you don’t have is a right to the fact and the fact is that this pandemic is still raging. You can have an opinion as to how we should react and respond to that but the fact is that we’re not out of this yet. Bruce, do want to speak?
MK I was just going to jump in and add on that. I agree with what Mike has said there and if we actually look at the information that we received, as the DG has said, we are seeing some positive trends and certainly we are seeing positive trends in the reduction in deaths around the world.
I have confidence in that, in terms of the reports of hospitalisation, the reports of deaths around the world but I have little confidence in the numbers of cases being reported around the world. The sheer fact that we have had massive changes in testing strategies, huge reductions in the numbers of tests being used around the world, we have very little confidence in what we are actually seeing in the trends, in terms of cases.
On the positive side, we do see a change. We’re in a different phase of this pandemic, certainly, but we are still very much in the middle of this pandemic, and this is still a global problem, when we have huge numbers of people who are dying that are dying unnecessarily and the lack of our ability to track this virus, to better understand the trends, to monitor the variants of concern that we are aware of.
As you know, Omicron is dominant worldwide. We are tracking sublineages of Omicron, sister lineages of Omicron, BA.4, BA.5, BA.2.12.1. This will continue and the uncertainty that we have about what the next variant will be remains a significant cause of concern for us because we need to plan for many different types of scenarios.
Again, on the positive side, we have tools that save people’s lives but we need to use those tools strategically and appropriately. Vaccines are saving lives but they are only saving lives in the people that they reach. Consistently, across high-income, low-income, middle-income countries, those who are dying are individuals who do not have access or have refused vaccines, who have refused to be vaccinated, do not have access to diagnostics, do not have access to clinical care.
We can change that. We can change the course of this pandemic and we must. It is our responsibility to continue to be vigilant on this. We also recognise the sheer fatigue that everybody feels in wanting to not talk about this anymore in the face of so many other challenges that exist. But, again, this is our responsibility to ensure that there is vigilance for this particular virus because of the threat of variants, because of the threat for post-COVID-19 condition or long COVID, which we are just learning about, really starting to understand.
We really need to use the systems that have been put in place and enhanced for COVID-19 for this current threat, as well as the threats we just talked about with Ebola and with other infectious diseases that are circulating. Now, is not the time to retreat. Now, is the time to really strengthen what we have put in place and ensure that we keep people alive and we get our economies back on track and we save people’s livelihoods.
MR Fadéla, can I just come back? I’ve just read the headers on this story. This is entirely consistent with WHO’s position on what the European Union are actually publishing. They’re speaking to a sustainable mode of control of the virus. They’re talking about sentinel surveillance, which WHO has already had multiple meetings on, and how do we shift to a sustainable, sentinel-based surveillance system with comprehensive collection of data.
The European Union also states that moving back to more emergency measures is also a contingency that they have in place. So, I believe this is very consistent with WHO’s Strategic Preparedness Response Plan and this is a matter of words but the reality is there is nothing that I’m seeing here that is inconsistent with any of the positions that WHO has.
FC Thank you. I believe there was a question for Dr Uribe. Do you want to take it, Dr Uribe?
JU Yes, of course. Thanks so much for the question and for the space to answer it. We’ve all learned throughout these three years that there is some urgent needed capacity at the global, regional and local levels to better respond to pandemic preparedness in the future.
We need to strengthen this capacity of preventing and responding to future health emergency challenges. Many independent reviews have highlighted the need to further invest in such capacities. So, together with WHO and with the support of the G7 and G20, among others, we’re all advancing and looking for these additional resources that may in the future again have all of us better prepared to confront new challenges.
We don’t know the size of such additional financing. It will depend on the consensus and the effort of donor countries coming around this very important public health need. We do need those additional resources and they should be additional, not just a redistribution of existing resources, as this is an unfunded area to a great extent.
We also know that those resources are needed sustained through time. It’s not a quick investment or a one-time investment. It has to be a sustained investment in the core functions of pandemic preparedness and response, again at those levels, local, national, regional and global, in order to really be prepared.
We also want those resources to work around a strong global architecture and not fragmented, as many have pointed out. I think those are guiding principles where we are all in agreement. So, hopefully, again there is going to be a consensus building around these guiding principles and, more important, the purpose of strengthening in the future our capacity to respond to health emergencies.
FC Thank you, Dr Uribe. Let’s go now to the next reporter, Shoko Koyama, from NHK. Shoko, can you hear me?
SK Hello, Fadéla. Can you hear me?
FC Yes. Go ahead, please.
SK Thank you for taking my question. Regard the reports of acute hepatitis of unknown origin, which Dr Tedros just briefly mentioned earlier, could you provide an update on what we actually know so far and what the general public should worry about? Thank you.
FC Thank you, Shoko. I would like to invite one of our experts, Dr Philippa Easterbrook, who is joining us online, to take this question. Philippa, can you hear me?
PE Yes, I can. Thank you and thank you for the question. I think it’s important to emphasise that the causes of the cases remains very much under active investigation. We’re looking at a range of possible underlying factors, both infectious and non-infectious that may be causing the cases. These investigations are continuing in both the existing cases, as well as new cases from the countries that have already reported, as well as new countries that are beginning to report.
But it is helpful to, I think, summarise what we’ve learnt so far. First, that it does appear that none of the common viruses that cause acute hepatitis, that is hepatitis A, hepatitis B, hepatitis C and hepatitis E have been detected in any of the cases. Similarly, none of the common bacteria or bugs that cause stomach upsets and gastroenteritis in children have also been detected.
Then, from the questionnaires that have been administered across the countries, there doesn’t appear to be any clear link to a particular food or a common exposure such as to a drug or to travel and importantly there is nothing to suggest a link to the COVID vaccine, as the vast majority of the children did not receive the COVID vaccine.
I think you’ll be aware of the reports of a possible link to adenovirus, which is a common infection in children, as one of the possible hypotheses of an underlying cause. Adenoviruses are a group of very common viruses that are spread from person to person and can cause respiratory infections and gastrointestinal infections, particularly in children.
It’s been detected in around 74 of those cases that have actually been tested for this but it is very unusual. It’s unusual for an adenovirus to cause these type of severe symptoms. So, this is what is being actively investigated at the moment and the importance of systematically testing, the whole range of continuing to text both infectious and non-infectious causes and doing this systematically in all the countries and in all the cases. But that is what we know so far, based on the 169 cases reported from 12 countries. Thank you.
FC Thank you so much. I would like now to invite the next reporter, Naomi Grimley, from the BBC. Naomi, can you hear me?
NG Yes. Hello. Thanks for taking this. It’s a follow-up question on hepatitis. Is the leading hypothesis that we’re just seeing the cases that we perhaps would have seen previously in years when there were lockdowns emerging, or is there more of a worry that it’s something that has emerged dramatically in the last couple of months?
PE Thank you. It’s important to be aware that reports of unexplained hepatitis of unknown etiology in children, they occur every year and there are few reports each year. I think you’re right to ask the question of whether we, because we’re doing more testing and because alerts have been sent out, we are flushing out and recognising more cases that have always existed.
I think we’re getting some information from countries that also do routine surveillance on adenovirus, since I think your question particularly relates to that. In some of the countries that do regular surveillance, there has been an uptick in the reports of community transmission of adenovirus.
In other countries that’s not the case and in some there is no routine monitoring, so it is simply a signal at the moment and trying to understand through the planned additional studies which are looking, in other settings, what the community rates of adenovirus across all the countries are, how we can compare the patients who have been evaluated with liver disease and adenovirus, compare them to other hospitalised children, whether we’re going to see the same rates.
Also, some more genomic and sequencing studies to understand whether they are of a common strain with adenovirus. But bearing in mind that less than three quarters of those that have been tested have reported adeno, so it is difficult to explain as the factor in all cases if, indeed, it is going to remain as important hypothesis and co-factor.
FC Thank you. Journalists are asking about the title of Philippa. Just let me give you the full title. Philippa Easterbrook is Medical Expert in the programme Global HIV, Hepatitis and STI programme at WHO. STI, sexually transmitted infections. So, here you go. Now, I would like to invite Sarah Neville, from FT, to ask the next question. Sarah, can you hear me?
SN Yes. Can you hear me?
FC Yes. Please, go ahead.
SN It was actually again on hepatitis. There’s been quite a lot of speculation that this level of disease has emerged because it may have been supressed during the lockdowns, that it really is linked to the lockdowns. I wondered what you thought about that hypothesis.
PE Well, that has certainly been one explanation and interpretation of why adenovirus, which normally only causes mild infection, should have resulted in more severe disease and that as a result of lockdown and suppression or lower levels of transmission of adeno and perhaps other viruses also and that following release of the mask controls and other measures, that susceptible children are now being exposed.
I think this is very much a hypothesis and I think we need to systematically work through this with the planned investigations in a number of countries, looking at this in much more detail. I think it is an interesting assessment of the data but it really needs to be followed up with more investigations.
FC Thank you, Dr Easterbrook. I would like to now give the floor to our special guests for any closing remarks because we are coming to an end to our press conference. Let’s start maybe with Dr Seth Berkley for any closing remark.
SB Thank you, Dr Tedros, for having us here and on behalf of CEPI, Gavi, UNICEF and WHO, who are the co-sponsors of the vaccine pillar of the ACT Accelerator. I think the critical issue here is a little bit what we heard in this press conference, Maria talked about this, is how we have to make sure that there is continued political leadership and paying attention to this as a global problem while there are many others going on.
What we have to do is make sure that we do get very, very high vaccine coverage in those at highest risk and that includes not just coverage but those that require boosters if necessary, so that we are prepared for potential new variants, new waves as they come and, of course, as the science changes, we need to be prepared to move with new vaccines, if those are necessary, or some type of routine boosters, if those are required going forward.
Once again, it has been an incredible honour to work with everybody else in the ACT-A Working Group on trying to make sure that we have tools available for everybody but it’s not over yet and I worry that we’re going to lose that political steam. Thank you.
FC Thank you, Dr Berkley. Now, I invite Dr Philippe Duneton for any closing remarks.
PD Thank you and thank you, Dr Tedros, for having us this afternoon. I think the point is that we need to recognise that we may face a new wave and we need to be prepared. Access to medicine will be a key element of the response. We are talking about thousands of millions of people to treat, it’s not billions. It is the difference between the vaccine because you need to cover a lot of population. Here, we are talking about people at risk.
So, we have the tool now and we need to push to make this available, to implement test-to-treat in countries and I think that political leadership is absolutely key in that from countries but also from donors. Thank you.
FC Thank you, Dr Duneton. Now, I would like to invite Dr Rodriguez for any closing remarks.
BR Thank you. My internet is a bit unstable. I hope you can hear me. I just want to reflect on what we heard during this press conference, first about the sequencing capacity in Nepal and how they’re able to now track variants in Nepal, about how critically important testing and surveillance has been for rapid identification of Ebola in Western DRC and how important it has been to rapidly respond to a new outbreak of hepatitis, to be able to track, quickly, cases.
I think the lesson there is how critically dependent we are on good testing programmes and good surveillance and what we need to acknowledge is the biggest global threat right now is COVID, and we should apply those same tools and those same lessons from COVID.
This press conference has reinforced how critical testing is and we shouldn’t walk away from COVID prematurely while continuing to focus on every other threat that we need to monitor, as well. I just want to make sure that message comes through loud and clear and, like Seth and Philippe, I appreciate the opportunity to reflect on the two years of ACT-A and, on behalf of the Global Fund and the WHO and all of our colleagues on the diagnostics pillar, I appreciate the opportunity to speak with everyone today.
FC Thank you, Dr Rodriguez. I would like to invite Dr Uribe for any final comments. Dr Uribe, you have the floor.
JU Thank so much and thanks so much again to Dr Tedros and all the team in Geneva. Very briefly, insisting on the importance of this further effort in reaching those who have not yet received vaccines, especially the at-risk groups.
And, in doing so, also starting to look ahead at the health system strengthening agenda that we have with universal health coverage as an end to it, where we will all come together again, hopefully using all these lessons learned to improve health systems and the wellbeing, especially of the most vulnerable in the low-income countries. Thank you, again.
FC Thank you, Dr Uribe. I would like now to hand over to Dr Tedros for any closing remarks. You have the floor.
TAG Thank you. Thank you, Fadéla. I agree with my colleagues. Thank you to Seth, Philippe, Bill and Juan for joining us today and for our partnership. I’m very honoured, actually, to work with you. We have a special partnership through ACT-A.
This is actually something that will be a gamechanger, to be honest, because for the last two years we have met every week at principal level, this level of commitment by all principal heads, those who have joined today and other colleagues, heads of other agencies who haven’t joined today.
This is a very good model, to be honest, to serve the world and I would like to use this opportunity for your commitment and also leadership. ACT-A has shown us how we can really partner and work together. So, that’s what I would like to highlight. Then, I would like to thank the press also for joining us and see you next time. Thank you.