World Health Organization Coronavirus Press Conference Transcript April 22

Dr. Tedros: (00:00) No, it's complacency. People in countries with stay at home orders are, understandably, frustrated with being confined to their homes for weeks on end. People understandably want to get on with their lives because their lives and livelihoods are at stake. That's what WHO wants, too. And that's what we're working for all day every day. But the world will not and cannot go back to the way things were. There must be a new normal: a world that's healthier, safer and better prepared. Public health measures we have been advocating since the beginning of the pandemic must remain the backbone of the response in all countries. Dr. Tedros: (00:52) Find every case, isolate every case, test every case, care for every case, trace and quarantine every contact and educate, engage and empower your people. This fight cannot be effective without empowering our people and without full participation of our people. Countries that do not do these six central things and do them consistently will see more cases and more lives will be lost. To be clear, WHO's advice is to find and test every suspected case, not every person in a population. WHO's committed to supporting all countries to save lives and we're also committed to human rights and to fighting stigma and discrimination wherever we see it. There are disturbing reports in many countries, in all regions, about discrimination related to COVID-19. Stigma and discrimination never acceptable anywhere at any time and must [crosstalk 00:02:18] in all countries. Dr. Tedros: (02:21) As I have said in many times, this is a time for solidarity not stigma. WHO is also working actively to address the impact of the pandemic on mental health. Working with mental health experts around the world, WHO has produced technical guidance for individuals and health workers, recognizing the enormous strain they are under. Dr. Tedros: (02:50) In addition, we have also developed a free children's book about COVID-19 with partners from UNICEF, [crosstalk 00:02:59], FRC, UNESCO among others. In less that two weeks, we received requests to translate the book into more than 100 languages, and the book is now being used among [crosstalk 00:03:14] children in [crosstalk 00:03:15] and children in Syria, Yemen, Iraq, Greece and Nigeria. One of WHO's core functions to provide evidence based technical advice to countries. This is not something we do alone. Every day, we work with thousands of experts all over the world to collect, analyze and synthesize the best science and turn it into guidance that we give back to countries. Dr. Tedros: (03:44) Through thousands of hours of discussion, we have exchanged first hand experience and debated the science to generate the advice that we make available to all countries. We then work with countries to turn that guidance into action. WHO has staff in 150 countries all over the world working directly with governments, scientists and partners to coordinate national preparedness and response plans and to implement them. I would like to use this opportunity to thank all my colleagues all over the world in all our 150 offices for their hard work and commitment. Dr. Tedros: (04:30) In addition, WHO has sent more than 70 teams to countries [crosstalk 00:04:32] to provide advice on infection prevention, how to treat patients, risk communication, lab capacity, data management and much, much more. We have also brought in external support through our global outbreak alert and response network and specialized emergency medical, what we call GOAR, or emergency medical teams, EMTs. And I would like to thank [crosstalk 00:05:06]. Dr. Tedros: (05:08) In addition to supporting countries, we also track progress globally among countries that have reported data to WHO. 78% have a preparedness and response plan in place. 76% have surveillance systems in place to detect cases and 91% have lab testing capacity for COVID-19 but we still see many gaps around the world. Only 66% of countries have a clinical referral system in place to care for COVID-19 patients. Only 48% have a community engagement plan and only 48% have an infection prevention and control program and standards for water, sanitation and hygiene in health facilities. Dr. Tedros: (06:03) In other words, there are still many gaps in the world's defenses and no single country has everything in place. WHO will continue working with countries and the international community to close these gaps and build sustainable capacities for now and the future. But we are not alone. We work with partners all over the world to harness their expertise and networks. Dr. Tedros: (06:33) Earlier this week, WHO and the international telecommunications union announced that we are partnering with telecommunications companies to reach people directly on their mobile phones with text messages about COVID-19. This will help reach half of the world's population that doesn't have internet access, starting in the Asia Pacific region and then rolling out globally. We are calling on all telecommunications companies globally to join this initiative to help unleash the power of communication technology to save lives. Dr. Tedros: (07:14) We also issued a call with the World Trade Organization calling on countries to ensure the normal cross-border flow of vital medical supplies and other goods and services and to resolve unnecessary disruptions to global supply chains. We need to ensure these products reach those in need quickly and we emphasize the importance of regulatory cooperation and international standards. Dr. Tedros: (07:47) Finally, with the holy month of Ramadan starting tomorrow, I would like to wish all Muslims around the world Ramadan Kareem. This is a season of reflection and community and opportunity for kindness and solidarity. Earlier today I spoke to health ministers from across Eastern Mediterranean region. I assured them that we will stand in solidarity with them as we will stand with all countries. We're all in this together and we will only get through it together again. Again, Ramadan Kareem. [ foreign language 00:00:08:30] Speaker 1: (08:31) Thank you very much, Dr. Tedros, for these opening remarks. So we will start with questions. I will remind journalist that they can, if they are joining us online, that they can select the language on the interpretation tab and that obviously you can ask question in any of six UN languages and many more to come. So maybe we will start now with the Dakar, with Senegal. Dakar [inaudible 00:09:07]. Can you hear us, please? Speaker 2: (09:08) [foreign language 00:09:25] Speaker 1: (09:22) Sorry. I think there was a little issue. Let's go to maybe... Do We have Jeremy? Let's go to Jeremy from [inaudible 00:09:34]. Jeremy, can you hear us? Jeremy: (09:34) Yeah, can you hear me? Speaker 1: (09:36) Yes, please go ahead. Jeremy: (09:37) Thanks. Thanks for taking my questions. Good evening to everyone. The questions about your position on easing of maintaining the lockdown for people at risk and people over 60 years old. Considering what Dr. Tedros said, that we won't see basically the end of this until we have a safe vaccine. It means next year, probably. So does it mean that we have to refrain ourselves from seeing our parents, our grandparents, until then? Is it what WHO mean in the end? Thank you. Dr. Maria Van Kerkhove: (10:16) So thank you for the question. I'll, I'll, I will start. So there are a lot of considerations that need to be taken into account when countries and decision makers are deciding to lift some of these public health and social measures. It's not a one size fits all. And what countries need to do and what decision makers need to do is to evaluate the situation in their countries at the lowest administrative level as they can to determine what can be lifted, where and when. Dr. Maria Van Kerkhove: (10:47) So we have outlined a number of factors that need to be taken into consideration. First and foremost, is to really understand where this virus is, how far it's being transmitted and if it is controlled. There are measures in which you can look to see if that's actually being achieved. How many of the cases are actually being detected? Speaker 3: (11:09) 33,495 have tested positive, and of those who have contracted the virus, 18,100 have very sadly died and we express our deepest condolences to the families and friends of these victims and my heart goes out to every single one of those who have lost a loved one throughout this crisis. As a government, we continue to take the steps necessary to slow the spread of this virus. The social distancing measures that people have overwhelmingly adhered to have meant that fewer people have needed hospital treatment. That has protected our NHS capacity as we continue through the peak of this virus and it is undoubtedly helped to save lives. Speaker 3: (11:53) At every point in this crisis, we've considered the scientific and the medical evidence that we've received. Dr. Michael J. Ryan: (16:07) [inaudible 00:16:07] families and they're continuing to do so and families are doing their best to protect them. What we've seen in the context of Europe and North America though are very intense series of individual outbreaks inside longterm care facilities, which have been quite devastating. And the risk of such events occurring into the future, as long as the virus is here, there's always an opportunity for that to happen. But at the same time it is very difficult to reduce that risk to zero. So I think each country is going to have to look at, "How can we minimize the risk of bringing disease into such a setting?" And there are lots of measures that can be done to minimize that risk. And even more importantly, "How are we going to pick up a signal that something has gone wrong, that there may be a case in that situation and how do we rapidly shut that down and deal with that very effectively?" Dr. Michael J. Ryan: (16:07) And that's going to be that sort of both the risk reduction and the risk response to an event if it occurs. I'm sure there are many, many, many older people living in longterm care facilities who, at the best of times, are lonely. And for the last number of weeks has been a terrible ordeal for them, both to be further isolated, but also with the constant threat of potentially becoming sick with this disease. As the disease dies down or comes under control at community level, then the risks obviously reduce for those longterm care facilities. But the consequence of disease getting into those facilities I think is clear and stark. So how do we protect and shield our older, oldest and wisest and most precious members of our society while at the same time not entirely cutting them off from the very things that makes us human? Dr. Michael J. Ryan: (16:07) And that's our ability to be part of a community. And these are trade offs that are very difficult to manage. My own view is that the risks can be managed. They need to be recognized then managed. And if in a situation where we do see disease occur in a longterm care facility, we must be ready to react very quickly to stamp out that disease. It's also important that carers in these facilities have adequate training, that there's an adequate design in facilities, there's adequate staffing in facilities and that we look again at the support, design and environment that we offer for our older citizens. Dr. Michael J. Ryan: (16:07) That those environments are made, not only more comfortable and more human, but also safer. And I believe that can be achieved. And I believe there are lots of ideas on how that can be done. I think we need to maybe also look at the model of the way in which we're providing care and support for our older citizens. There's a lot to be done, but I do think it's a major issue. I think if you look around Europe now and in North America and Canada, a large proportion of the intense disease transmission is actually concentrated in longterm care facilities, which is in itself a tragedy. And it's also a challenge. Speaker 1: (16:07) Thank you very much. Next question is from our friend at Geneva Bays, the reporter Musa [inaudible 00:16:08]. Musa, can you hear us, please? Musa: (16:28) [foreign language 00:16:32]. Speaker 1: (16:42) Thank you very much, Musa. The question is about repatriation of nationals that is taking place. Dr. Michael J. Ryan: (16:56) I think there are a number of countries around the world who've been repatriating students and other citizens from different countries around the world. And again we commend the efforts countries are making to protect their citizens, it's the first duty of government. At the same time we have to now look to the future. When we talk about opening up and reducing lock downs, there's also the question of how people begin to move internationally. A lot of the discussion up to now is, "how do we create the possibility of movement within countries?" Obviously the need to move between countries is going to become more and more an issue and more and more of a challenge. So I think the issue of moving citizens home or just getting back into international travel is going to have to be approached carefully and it's going to have to be done, I would suspect first at sub-regional level. I think already countries with borders with each other are beginning to come to arrangements of how people can move between countries. I think we're seeing that already in the likes of the European Union. I think we're seeing that between ASEAN countries and others and countries are looking at how we can reestablish links and movement between our countries. Some of that will be based on, I think risk equalization and response equalization where countries have a similar control of the disease and where countries have confidence in the measures being implemented in the other country. Then affect the risks are equalized and the movement of people between those areas in a sense doesn't add risk to the other country. Where there's a differential in transmission and where their disease is under control in one country and maybe out of control in another, then countries will have to look at how they're managed travel from those countries and that would include their own citizens. So I think a lot of the initial work that's going on is at sub-regional or regional level. And then opening up global travel, again, is going to require a careful risk management adjustments by everyone. We've said it, I think everyone is saying it's the new normal. Society until we have longer term solutions for this and until we understand this virus better in its transmission and whether it will come back in a more damaging way even, we have to be very prudent. But I believe, again, these risks are manageable because if, as the director general has said many times, countries have in place the six elements of detection, testing, isolation, quarantine, care and educated communities, then I believe those ingredients can bring... And if every country is implementing a similar strategy and if every country gets to a point where the disease is under control, then the risks between countries become more equalized and the movement of people then can be easier. Dr. Michael J. Ryan: (20:08) And I think there's a lot of discussion on that and WHO will be very pleased to bring countries together. We're already convening countries at regional level to discuss these matters. I know the director general spoke with ministers in the Eastern Mediterranean region today. There've been a whole series of different engagements from our regional directors and others over the last couple of weeks, so we will continue to work with countries to support them in trying to find ways to create and sustain movement both within and between countries in the coming weeks and months. Speaker 1: (20:46) Thank you very much, Dr. Ryan. Next question comes from Christoff from Miranda. Christoff, can you hear us? Speaker 1: (20:55) I think we lost Christoff. Then we will go to Salvia Rodriguez from Gua Chronicle from India. Salvia, can you hear us? Speaker 4: (21:06) Yes I can hear you. Can you hear me? Speaker 1: (21:07) Yes, please go ahead. Speaker 4: (21:09) Okay. My question is to Dr. Tedros and it's a very simple question. The question is: If he had an opportunity to rewind back the last couple of weeks where we've been going through the Coronavirus pandemic and certain decisions that were taken by the World Health Organization, would he have called the Coronavirus a pandemic earlier? Is my question. If he had the opportunity to rewind and go back would WHO have called the pandemic earlier than it did much later? Dr. Michael J. Ryan: (21:44) Dr. Tedros may speak to this but let me clarify to you technically. WHO raised its highest level of alert under international law on the 30th of January this year and declared a global public health emergency. That is under the international health regulations 2005 which is an international legal agreement between all of our member states, which asks that WHO declare such an emergency where the director general has received advice from an emergency committee and makes that determination based on that advice in the situation. Dr. Michael J. Ryan: (22:33) The characterization of the disease as a pandemic in itself has no basis other than a description of the event at that time as regards how many countries were affected. The global public health emergency was declared on the 30th of January, and that is the highest level of alert that WHO can declare. Dr. Maria Van Kerkhove: (22:59) If I may add, I think there'll be plenty of time to look backwards. Dr. Maria Van Kerkhove: (23:03) If I may add, I think there'll be plenty of time to look backwards. And one of the things we've been trying to do is look at what countries are doing. We go into these deep dives, uncertain countries, to evaluate how measures have been put in place. And we've seen some really good ones recently. You've heard us talk a lot about China, you've heard us talk a lot about Korea and Singapore and Germany, and we have now more and more countries in different regions that have highlighted what they're doing. For example, in Africa, we're seeing a number of countries who are still seeing imported cases. So, they haven't reached a point in time where the disease has really taken off and they reached that exponential growth where it's growing very, very rapidly. And in many countries what they've done is they've implemented some of these public health measures and social measures they've put in place when they've had less than 100 cases in each country. Dr. Maria Van Kerkhove: (23:56) And in doing so, they've been able to slow it down. They've been able to slow down that transmission. And importantly, once those measures were in place, which are difficult, which have societal impacts, which have economic impacts, which have personal impacts, it's slowed down transmission of the virus, and that time has been used very, very wisely. What we're seeing is in a number of countries they are doing everything that they can to ramp up testing. So, building on existing systems that they have, whether it's national influenza centers that exist. And we're working very hard through our regional offices to ensure that countries have those tests in hand to be able to detect cases. Dr. Maria Van Kerkhove: (24:37) We've seen a lot of efforts across the globe, and in the countries I'm talking about in particular, to sensitize the communities, to empower the communities to say this is what we can expect, this is what we need to do. This is what you need to do as an individual and in your families and this is what we need to do as a government. We've seen improved efforts to strengthen surveillance. So, whether this is making sure that there is a workforce in place, so actual individuals who can go out and find cases, whether these are people who could do contact tracing, and whether it improves the workforce within healthcare facilities. Dr. Tedros: (25:17) [inaudible 00:25:17] We have someone online that we can't identify and who... I think it's okay now. Sorry for this. Dr. Maria Van Kerkhove: (25:28) That's okay. It sounds like some people have kids at home. So just to say that this time is being used wisely to build up that workforce to identify where those cases are to find the contact tracers and also to ready the hospital systems. So not only building facilities or identifying locations, nontraditional places where mild patients may be treated, getting those beds ready, making sure those supplies take are purchased, are acquired, training healthcare professionals in infection prevention and control and clinical care. Dr. Maria Van Kerkhove: (26:05) I think what we're seeing is many countries are using this time to really build that infrastructure, that public health infrastructure and the hospital systems in place to get ready for when those cases do come. So, I think that message has reached many and that's been our message from the beginning, and we will keep saying that because this is what works. So, even in countries that are now seeing a resurgence in cases, they're coming back to this again. How do we find every case? How do we test all of the suspect cases? How do we care for all of them appropriately, and how do we trace and quarantine all of the contacts and keep our community engaged? Dr. Tedros: (26:47) Yeah. Thank you. I would like to add to that. I think my colleagues have already said based on the IHR 2005, what is expected from WHO is declaring the public health emergency of international concern as early as possible based on the factors. And as Mike said, the highest emergency as far as international health regulation is concerned was declared on January 30. And during that time, as Maria said, there were less than 100 cases, and to be specific, 82 confirmed cases on January 30 outside China. Of course in China we had more cases, but outside China we had only 82 cases, and most of these cases were actually in the neighborhood and most of them, [inaudible 00:28:17] as they are in the neighborhood, the rest of the world is still reporting no cases. We had few in Europe, and I can read that for you, what was reported from Europe. Dr. Tedros: (28:32) We had five from France, one from Finland, four from Germany. That makes it nine, 10 actually. 10 cases in Europe when we declared global emergency. In Africa, we didn't have any case. In the United Arab Emirates from the Middle East, United Arab Emirates had four cases. So you can see it for yourself. We triggered the highest level of emergency when the rest of the world had only 82 cases and no deaths. And then to add to that, global emergencies discussed among experts. It's not just one director general who just comes out and declares. We have experts representing all over the whole world coming together as experts and discussing, and they met on 23 January. They couldn't agree. They were divided. Then of course they continued for a second day. Still, they couldn't agree. Dr. Tedros: (29:57) Of course, they are agreed to meet in six, seven days, and then met for a second time on January 30 when based on the criteria we have, they were convinced that the criteria is met to declare this global emergency. So, I want to be clear again, the most important thing in which is expected as a declaration from WHO is the global emergency declaration on January 30. And that was declared based on experts opinion that was drawn from all over the world, who used the criteria to recommend to me that this is already a global emergency, and that consensus led to a declaration of global emergency from WHO, which I announced it myself. So looking back, I think we declared the emergency at the right time and when the world had enough time to respond when the rest of the world had enough time to respond. I repeat again, there were only 82 cases and no deaths. That was enough to cut it from the bud. Enough. That was January 30, and this is more than two months and 21 days ago, close to three months now. Thank you. Speaker 5: (31:38) Thank you very much. We will try now to go to Democratic Republic of Congo. We have Semi there from Congo Czech. Semi, can you hear us? Semi: (31:50) [foreign language 00:08: 54] Dr. Michael J. Ryan: (32:09) If I can begin... We really welcome all of the innovation we've seen around the world in both re-purposing older drugs or drugs that are used for other indications and putting them into trials to see what an impact they will have on COVID-19. We are also very grateful for all the investment and work going on for developing new molecules that may prove ultimately to be effective in the treatment. And we maintain a global database of all of those drugs and all of those trials. Dr. Michael J. Ryan: (33:16) And we're encouraging all innovators to work through their national regulators, [inaudible 00:00:33:21]their national institutes of health to ensure that any trials that are commenced are commenced with proper support and proper authority, proper ethical approval. And Africa has a strong track record in doing such work. I'd like to congratulate the institutions in DR Congo, especially [inaudible 00:33:44] and his staff because we have a monoclonal treatment, which is highly successful for Ebola now. And that was developed in Congo with collaboration with NIH in the United States. But it has been one of the first proven therapeutics against Ebola, a lifesaving intervention developed in DR Congo and has been used successfully to treat in the last outbreak. So again, there's tremendous amount of innovation going on in Africa in general. Dr. Michael J. Ryan: (34:21) Maria mentioned South Africa, and again it is interesting the way in which South Africa is bringing the disease under control and how African countries are actually in some ways showing the way. This strategy in South Africa was based on preparation, primary prevention, lockdown and enhanced surveillance. 67 mobile lab units around the country, 28,000 community health workers trained in case detection, and I think over 120,000 tests completed with a 2.7% positivity rate, which is incredible, that much testing for that return. So, we're seeing performance levels there. Again, congratulating the government and institutions of DR Congo for the superb way in which Ebola has been brought under control. We still have some way to go. So, I think in general we need to leverage the capacities that exist in Africa, the innovation, the science. We need to connect those scientists. Dr. Michael J. Ryan: (35:33) We need to connect those laboratories, those clinicians across Africa. Again, the director general working with our regional director [inaudible 00:35:40] and the African Union have been heavily engaged in trying to drive innovation, both in the public and the private sector across Africa. And it will be very important that studies in Africa are led by principal investigators from African institutions, and obviously reaching out to collaborators in other parts of the world. And I trust that those capacities exist, and again to point to the rapid evolution of capacity. At the beginning of this epidemic, and I will point to the fact that WHO began distributing validated testing kits in Africa on the 24 of January, which was seven days, eight days, a week before the declaration of the global public health emergency. But it was the laboratories that institute [inaudible 00:36:35] and ICD in South Africa that trained all of the laboratory technicians from all over Africa, who then met up with their new reagents when they returned home. Dr. Michael J. Ryan: (36:44) We're also seeing the use of high throughput diagnostic systems in places like Kenya where superb technology that's been provided by the global fund and others has been repurposed to use for high throughput diagnostics in many African countries. We're working very closely with the global fund, with UNICEF, with UNITAID to accelerate the availability of reagents for those high-throughput systems. So, I think we're seeing very, very good things happen, but we're very cognizant of the challenges. Dr. Michael J. Ryan: (37:15) We've seen almost 250% increase in cases in Sudan in the last week and Somalia, nearly 300%. And in many other countries, Tanzania, Mali, Congo, Gabon, Equatorial Guinea, Kapil Verde and Eritrea increases of more than 100% percent in the last week, but many other countries in Africa case increases somewhere between 30 and 90%. So, we are at the beginning in Africa. I believe that with a focus on preparation, on surveillance and community mobilization and on the undoubted capacity for innovation and science in Africa that we can avoid the worst of this pandemic. But we are also cognizant, as the DG said, that there are lives and there are livelihoods and the impacts of longterm lockdowns are having a severe impact. So, we have to find a way forward in Africa that can balance the risk of the virus against the risk to people's livelihoods and people's lives at the same time. Dr. Tedros: (38:25) Thank you very much Dr. Ryan. Now from DRC, we'll go to Greece where we have Costa from ERT. Can you hear us Costa, please? Costa: (38:36) Yes, I can hear you. Can you hear me? Dr. Tedros: (38:42) Yes. Please go ahead. Costa: (38:42) Yes, thank you very much for taking my question. My question is about COVID-19 and [inaudible 00:38:50]. Can you please confirm that there was in the last days teleconference between [inaudible 00:38:56] and UEFA and the proposal to suspend the football championships until the end of 2020? Dr. Maria Van Kerkhove: (39:08) I can start and perhaps Mike would like to... I'm not aware of the call, but it could have taken place, but I'm just not aware of it. What WHO does is we provide recommendations on how people can take decision about these types of sporting events and mass gathering events for that matter and what needs to be put into consideration whether to hold it or whether or not. The decisions are with them and we support them in taking those decisions. Dr. Michael J. Ryan: (39:38) Now we will follow up, as I'm not aware that there was any specific call, but we do, all the time, engage with the organizers of major events, and we've been doing so with the International Olympic Council, with FIFA, with many others. So, we've been engaged with the religious organizations and so many more. And those engagements are frequent and are happening at different levels of our organization. I think UEFA's a European institution, so we'll check with our European office. What's most important in this in terms of sporting events and others is sporting events, especially large sporting events representing themselves, mass gatherings. And bringing those types of events back online is going to require some very, very careful planning. We've got a lot of sports fans here in WHO and we miss our sports too, but we all want to be safe, and therefore I think sporting organizations and governments working both nationally and internationally are really going to have to look at how do we adapt. And this is one of the things we've been discussing internally is on the one hand we have the science and we have the evidence. Dr. Michael J. Ryan: (40:54) On the other hand, we have the practical reality of life. Now how do we adapt our evidential standards to what is the need to live and the need to manage risk at society level? If we all accept that there's no such thing as zero risk, the danger for governments at the moment are that the challenge they face is that if they do something and there's any risk and then there's a consequence, they're going to be blamed for the consequence. No one will remember that they did that on the balance of risks. They'll only remember something bad happened. Therefore, when you bring a mass of people together and something goes wrong, people won't be shouting afterwards, "Oh, we were the ones that wanted that to happen." It won't be that. People will say, "Why did you let that happen? Why did you let so many people come together? And it's your fault now because you've let all these people come together and now we have another outbreak." Dr. Michael J. Ryan: (41:49) So what we have to do is come to a new contract, a new social contract that allows governments and communities to engage, to co-manage the risks and say, "Okay, what risks are we prepared to accept, manage, reduce?" So can we look at the real risks? Can we work together to reduce those risks to a minimum that's acceptable? Can we have in place a means then to manage something if it does happen? And then can we do that on a no fault basis? Can we do that on the basis that we've all agreed that this is the best thing to do? Because you're never going to reach a point where there's absolute scientific evidence that it's safe to bring 10 people together or 20 or 30 or 40 or 60 or 200 or 2000 or 20,000 or 200,000. What we know is large numbers of people gathered together in close quarters in the presence of the virus will result in amplification of the disease. Dr. Michael J. Ryan: (42:47) Best evidence would suggest that the physical distancing of people is very effective in reducing the risk of that spread. Where you then compress that distance to almost nothing, then you have to accept that the risk increases because if the basis of risk reduction is to physically distance people, then pushing people back into very close contact by extension says the risk will increase. But at the same time, people want to get back to normal life. So, I think this needs to be a carefully discussed process. It will be driven by science, but it also has to have an element of practicality about it as well. I'm sorry to not be as precise as you may want me to be, but these are considerations that really have to be considered at a societal level, and it has to be based yes on evidence, but it also has to have a practical consideration as to how do you adapt science and evidence to the reality of living lives? Dr. Tedros: (43:51) Thank you very much. We will now go to Argentina. We have Valeria from radio, CNN Argentina. Valeria, can you hear us? Valeria: (44:02) Oh, hello. Are you listening to me? Dr. Tedros: (44:06) Please go ahead. Valeria: (44:07) Hello. I would like to know what do you think about the evolution of the pandemic in South America? Thank you. Dr. Maria Van Kerkhove: (44:23) So thank you for the question around the evolution of the pandemic in South America. So, what we are seeing is, I have to look at all of my numbers, is that there's increasing trends in terms of case numbers in a number of countries in Central and South America. And of course this is a worry because what we are seeing is that once the virus has an opportunity to take hold and to really transmit between people, if measures are not in place, then it can take off very, very quickly and you can see doubling times of three to four days, which is incredibly rapid. And so, what we need to see happen in South America and what we are seeing that is happening in South America is that all of these measures we've been talking about, so getting these laboratories to be able to identify cases, making sure that the surveillance systems are in place and the workforce is in place to be able to detect those cases. Dr. Maria Van Kerkhove: (45:18) We've seen in a number of countries that public health measures and social measures have been put in place with some stay at home orders, and that is buying some time. But again, as I said earlier, it's important that we use that time wisely. There is very strong commitment by governments to have an all of society, all of population approach to engage populations, to bring them along, to be able to inform them and to seek input back, and that's really important. We're seeing the trajectory of this pandemic, the trajectory of this outbreak in every country depends on how each country reacts, and that is consistent across all countries, regardless of high income- Dr. Maria Van Kerkhove: (46:03) And that is consistent across all countries regardless of high income, low income countries. And so, we are seeing an increasing trend in case numbers, but there still is opportunity. The window of opportunity, as a Dr. Tedros has said, still remains in many countries to be able to suppress that transmission and to ensure that we don't have massive outbreaks in some countries. Speaker 6: (46:26) Thank you very much, Dr. Van Kerkhove. Next question, we have a Priti Patnaik from The New Humanitarian. Priti, can you hear us? Priti Patnaik: (46:39) Yes. Can you hear me? Speaker 6: (46:41) Yes. Please go ahead. Priti Patnaik: (46:43) Yes. My question was for Dr. Tedros and Dr. Ryan. I wanted to find out all the concentrations that organizations like WHO and its partners take with respect to diverting funding or putting on hold activities that are meant for addressing other infectious diseases and having to take a call vis-a-vis the fight against COVID. What are some of the considerations that you could speak about the briefly? Dr. Michael J. Ryan: (47:11) Right, Priti. I think all countries face this same issue. A major emergency, number one, diverts attention, it diverts time, and it can divert resources as well, as you focus on what is most urgent and most dangerous. But director general may peak on this, but there are essential health services that are in place, core immunization services, services to refugees and to displace populations, TB, HIV services. As Maria said so many times, women are still giving birth all over the world and need safe antenatal and delivery services. Dr. Michael J. Ryan: (48:01) So, this is something that needs to be preserved, these core essential health services. And it's really important that countries try to do that. We have a whole team here and across the world that is dealing with sustaining essential health services led Ed Kelly and with regional counterparts. And we take that very seriously. Dr. Michael J. Ryan: (48:26) The U.N. Has been working very diligently over the last number of weeks, under the leadership of Robert Piper in New York, looking at this across the system and sustaining essential services across all of society with health services at the center. And I believe there'll be a major release of information and publication on that over the weekend or early next week. But we've been working very much with them on that. Dr. Michael J. Ryan: (48:55) Certainly in our area of emergencies, the conflict in Syria, the conflict in Iraq, the conflict in Yemen still exists. The fragilities in Somalia and South Sudan, in the [inaudible 00:49:08] still exist. And our teams on the ground continue to work with governments on them. They haven't gone away. And they won't go away, unfortunately. And therefore, we continue to be focused on dealing with COVID-19, as well as doing the other things that we do. And we have major programs in all of these areas. Dr. Michael J. Ryan: (49:29) The other concerns will be that we have a major yellow fever threat in parts of East Africa that it must be managed. We obviously have always the threat of cholera and other epidemic prone diseases. As you've seen, we've had the resurgence of Ebola in the R. Congo. So, we need to keep an eye. And one of the things we've done here in Geneva, we have a completely separated team who are doing nothing else but managing epidemic intelligence verification and response for other epidemic prone diseases and emergencies. And we've isolated that team to only work on that so that we don't miss things. And equally the same on the humanitarian front. Dr. Michael J. Ryan: (50:12) And Dr. Ibrahima Soce Fall, our assistant director general on the emergency response, is dedicating almost all of his time to leading on the humanitarian front and co-chairs the IASC committee on COVID-19 and sustaining humanitarian response with Mark Lowcock. So, we've done our best to try and preserve our services and our support to countries across all of these areas. But I have to admit that is not easy in the context of the resource constraints we face in continuing those programs. Speaker 6: (50:48) Thank you very much, Dr. Ryan. Now, we go to Jerry from Guyana Catholic Standard. Jerry, can you hear us? Jerry: (50:58) Yes. I can hear you. Can you hear me? Speaker 6: (51:00) Yes. Please go ahead. Jerry: (51:02) Hi. Good morning. My question is, there's a lot going on in my country especially and around the world. People are not really aware and serious about this stuff because, as you know, religious gatherings are going on, and secondly, some protests against lockdown. Is it the responsibility of the individual countries or are WHO can have some serious sanctions against some countries who are not following the rules? Thank you. Dr. Michael J. Ryan: (51:40) [inaudible 00:51:40] may wish to speak to this. We are a secretariat of 194 member states. We have no legal authority over any sovereign nation on this planet whatsoever. Under the IHR we have certain powers that are allowed to us by the member states to seek verification of outbreaks, to publish information regarding those events. We have no right to enter countries without permission or without discussion. And we have no rights of enforcement of any kind when it comes to health implementation. Dr. Michael J. Ryan: (52:21) However, we have science, evidence, and the normative role we play, the mandate we have to establish global standards and to give strong advice to countries regarding what are irrational public health measures. What we can do is lay out what we believe to be the rational strategies to respond to disease, as we did in January in the case of COVID. We talked about comprehensive strategies. We talked about case finding. We talked about testing. We talked about contact tracing. We talked about community empowerment. We talked about implementing both containment and mitigation strategies at the same time. We spoke about what was needed to suppress and control this disease. We spoke to that again, and again, and again. And, in doing that, many, many countries picked up and implemented those kinds of measures. Dr. Michael J. Ryan: (53:15) When it comes to what one individual country does, they will see our advice. They may see what other countries around are doing. And they may look internally very often, and correctly so, to their own public health and scientific communities and ask for advice as to the best way forward. And you'll see that many of the countries that have responded very well to this have relied heavily and work very closely with their scientific and public health communities and worked hand in hand, politicians working hand in hand, listening to and implementing science-based policy. And, in that sense, where we see situations where governments may be straying very far away from that sort of an approach, we engage with them. Absolutely. We don't engage in public debate. We don't engage in trial by media. We engage as we do, as a trusted partner. And we engage with those countries strongly and robustly, if we feel that their public health strategies are ineffective or not been implemented properly. And we do that time and time again. Dr. Michael J. Ryan: (54:24) We also engage when we believe they are. I've just spoken about South Africa and what they're doing. We've spoken about other countries here. We've spoken about Singapore. We've spoken about South Korea and many other countries that have implemented very rational policies. So, I think the power that we have is the power to persuade and persuade through science, persuade through evidence, persuade by demonstrating what other countries are doing and showcasing good examples of good practice. Beyond that, WHO has no power to enforce, no power to put any form of pressure on a country to change what is their sovereign will. Dr. Maria Van Kerkhove: (55:12) Can I just say that we have staff in more... we have thousands of staff. And we have WHO staff in 150 countries. And those staff are working directly with ministry of health officials, scientists, public health professionals to persuade, as Mike has said, to advise on what needs to be done and to sit across the table, to sit together, to train, to work hand in hand with our counterparts in countries to help them get through this, to help them plan, to ready their systems, to implement those systems. Dr. Maria Van Kerkhove: (55:51) And you mentioned Guyana. I'm looking at your case numbers. The case numbers are very low. I see 65 total cases so far and seven deaths. Every case is a tragedy, but you have in your power what can be done to contain this. And so, what we do with our staff is we help, we support, we empower. But it is up to everyone in countries to be able to implement these plans, and to ready their systems, and to actually activate them. Dr. Maria Van Kerkhove: (56:23) And what we have seen in countries, what we are working on for national strategies is to reinforce the action plans that are developed, to help ministries of health coordinate across different sectors so that there can be an all of society approach, to provide recommendations and trainings to engage communities, empower them so that everyone in the community is part of this fight along with government officials, to have the systems in place to find, and test, and isolate, and care for every case to ensure that we trace and quarantine every contact. When we say that, that means individuals, that means a dedicated workforce to be able to carry out all of those actions. Incredible frontline workers and healthcare workers who are caring for patients, who are away from their own family members to care for patients, to ensure that we provide clinical care and maintain other essential services that must continue. Dr. Maria Van Kerkhove: (57:18) And we support countries in adapting those strategies as the situation changes. So, when cases, before we've talked about the different transmission scenarios, countries that have no cases, that have their first cases, that have clusters of cases, and that have community transmission. So, as countries move through those different scenarios, as intensity increases, but in addition to that, as intensity decreases, how do we support countries in adapting those strategies so that they can make sure that they're continuing to suppress transmission and control these outbreaks? So, there's a lot that we're on a daily basis. But it's through that support and it's through that direct engagement that we have through our country offices and our regional offices to be able to do that. Speaker 6: (58:07) Thank you very much. Next question, we go to Kai Kupferschmidt from Science. Kai, can you hear us? Kai Kupferschmidt: (58:17) Yes. Sorry. Thanks a lot for taking my question. This follows on from one of the earlier questions. I'm curious, when you see protests like the ones in the U.S. against the measures, I mean, obviously WHO does have some experience in dealing with them, for instance, during the Ebola outbreaks in West Africa, also in DRC. I'm wondering whether, maybe Mike, you can talk a little bit about what you've learned from these experiences about how best to deal with this? Dr. Michael J. Ryan: (58:52) Yeah. Thanks, Kai. I think all situations are different and all societies are different. But I've said it many times in the past, one of the keys to epidemic control or emergency management in general is the level of trust between citizens and government. It's a hugely important investment in the bank of emergency response because, when you ask people to do something on trust and to end their social life, end physical contact, return to their homes, they have to fundamentally believe that somebody has a plan, there's a reason for this, and there's a reason for doing it, and there will be an end to this. So, and it's the same when you ask someone in the Democratic Republic of Congo to go into an Ebola isolation facility or ask the families to self-quarantine. Very similar situation. And there can be misunderstandings in real time if communities don't understand the purpose. But also, and we've seen this in Congo, where communities can be gamed and have been in many cases, in my experience. There are what are a genuine community concerns, if not properly addressed, can lead to tension, and lead to misunderstanding, and often to negative reactions which are counterproductive to the control of the epidemic. Dr. Michael J. Ryan: (01:00:20) But also, there are many situations in which those reactions and community sentiments are gamed and directed in a way that is counterproductive. And I've certainly seen that in many epidemic events in my time as well. So, it's really important that we listen to what communities are saying. It's really important that we understand community's frustrations. But it's also really important that we then re-engage with those communities to explain why the public health strategy is there, what is the purpose of that strategy, and how they are contributing to that. Dr. Michael J. Ryan: (01:01:01) And that's a process of dialogue. And sometimes, when we talk about communication, it seems that we talk about one way communication, what we tell people. So, we tell you to do something and then everyone magically goes and does it. That's not necessarily the way things work in all societies. Certainly my experience in Africa, and in Asia, and in the Middle East is very much about creating a dialogue where there's a two way communication, where communities can ask questions, communities can understand what's happening. And there's a transparency around what is happening and that people can actually understand, and there is no confusion between the different levels of the system. And there's a consistency in that communication. It's very easy to become confused if you're hearing one thing from one side, one thing from another side, someone else is telling you something else. You're in the middle suffering and you get frustrated. And it's very easy to manipulate that situation. Dr. Michael J. Ryan: (01:01:54) And it's really important that governments at all levels and in all countries really take on that role of communicating effectively with the communities in a two way dialogue. And then, we also engage civil society. We also engage nongovernmental organizations and others. And then, it's not purely governmental in nature. Dr. Michael J. Ryan: (01:02:16) So, yes. Communication, dialogue, understanding, persuasion, these are the words we need to be talking about, and empowerment. Many situations, in my experience, communities have felt disempowered by the process. And they want to take action. They want to be involved. And we need to be able to give communities things to do. I see many situations now around the world in COVID where like, for example, in South Africa where community health workers are being trained. They are the people on the streets. They're the ones who know the local families. They're the ones who know the local community. They're the ones who can educate and engage. You'll see the same going on in places like Massachusetts in the U.S. where you see that same kind of approach to driving community-based approaches. Dr. Michael J. Ryan: (01:03:03) So, I think there are good examples around the world where communities can be effectively engaged. And then, when communities understand and participate, there tends to be less tension. That's been my experience, Kai. But it's very hard to make comparisons between countries and between communities. Dr. Tedros Adhanom Ghebreyesus: (01:03:24) Yeah, just a bit. I fully agree with what Mike said. It's, at the end of the day, that trust between governments and citizens that will help. Even now, in the protests and gatherings in the middle of the pandemic will not help. It will only fuel the outbreak. So, we need to use several ways of communication with our citizens. We know how to communicate and help them understand. And I think it would be a good idea to mobilize community leaders here, civil society, religious leaders to speak to the citizens directly, not only just governments, but all public leaders, all community leaders, and religious leaders should be involved. And bring the different opinions actually into understanding, especially around this pandemic. Dr. Tedros Adhanom Ghebreyesus: (01:04:34) This virus is dangerous and it affects everybody. And there should be that understanding. And, whatever precautions we take, it is for all of us, for each of us and the whole public in general. The end of the day, people will understand and cooperate. But we need to use all the means we have to have clarity in our message and ask for cooperation using all means that's available. And, especially through the leaders they trust, including religious leaders, as I said earlier. Thank you. Speaker 6: (01:05:17) Thank you very much. Let's go to India Today. That's Gita, can you hear us, please, Gita? Gita: (01:05:28) Yes I can. Can you hear me? Speaker 6: (01:05:29) Yes. Please go ahead. Gita: (01:05:31) Thank you so much for taking my question. My question is to Dr. Tedros. Dr. Tedros, while the WHO is not an enforcing agency, it does do a lot of research and assesses and produces reports. So, in that, would the World Health Organization be looking at forming a team to investigate the origins of the virus? Look at maybe sending a team to China with independent stakeholders as part of that entire investigative team? And also, the United Nations has come out with a report saying that stringent lockdowns in developing countries could lead to economic catastrophe. What is your assessment on that particularly vis-a-vis India? Dr. Michael J. Ryan: (01:06:20) I think it's very, very important that we understand the animal origins of this disease, not least because it's clear the animal, human species barrier has been breached once. It can be reached again, and we need to understand where that has come from, what are the factors that have led to that, and how that can be prevented in the future. So, that's good public health, that's good science. Dr. Michael J. Ryan: (01:06:47) And we have certainly offered that assistance to the government of China, but also working very closely with our colleagues in FAO and OIE across a one health platform to do that. Peter [inaudible 01:07:03] is the scientist who leads our operations on that here. And we have a team working specifically on those issues very closely with OIE and FIO. And we'll be delighted to work with international partners and at the invitation of the Chinese government in order to carry out a really good investigation around the animal origins and really understand all of the factors associated with that. And we very much look forward to that opportunity. Dr. Michael J. Ryan: (01:07:33) With regard to lockdowns, absolutely. Lockdowns should and can be avoided in many circumstances. And many countries have implemented different versions of what you might call lockdown. And that's been, how do you get the maximum suppression of disease with the minimum amount of physical distancing, and restriction of movement, and stay at home orders? The way you do that is to really focus on case detection, on finding cases, on testing, on isolation and quarantine, and being very, very aggressive in investigating clusters of cases that emerge, particularly those that emerge in special circumstances, in high risk communities or in special environments. Dr. Michael J. Ryan: (01:08:23) And that is the challenge is the lockdowns may be providing a suppression on the disease, and we get to a point where the disease looks like it's under control. If you follow that up, as I said, South Africa have really followed up their lockdown with a very, very extensive campaign of training health workers, first surveillance, doing surveillance, 39 mobile labs. What they're doing is backing up the lockdown with a very strong public health response. And, as they put that in place, you can start to ease the lockdown, while helping people with their lives and their livelihoods. You can start to ease those lockdowns because you have something else to replace it with. The danger is easing these so-called lockdowns without- Dr. Michael J. Ryan: (01:09:03) ... danger is easing these so-called lockdowns without a replacement strategy. That's the real danger. There's always a danger even with the replacement strategy that there will be outbreaks, but they can be managed, I believe. But exiting lockdown without a strong public health strategy and a strong strategy to strengthen your health system is going to be difficult. Dr. Michael J. Ryan: (01:09:24) I believe India is making progress towards that. I've said it here before. India has a proud history of strong public health surveillance in smallpox, in polio and for TB and other diseases. I don't believe there's any reason why the public health capacities of India cannot be turned on to this respiratory syndrome, this respiratory disease, and why, as we move away from lockdown, that the government of India, the scientists of India, the public health authorities of India and the communities of India can put in place a solid, strong public health surveillance system that will continue to control this disease while we await the longer term solutions. Tarik Jasarevic: (01:10:10) Thank you very much. Let's take a few more questions. Our friend, Jamie Keaton from Associated Press. Jamie? Jamie Keaton: (01:10:21) Hi, Tarik. Thank you very much. I'd like to come back to the issue of funding from your biggest donor, the United States, especially given that Secretary of State Pompeo and other State Department officials, a short while ago, again criticized WHO and spoke about the halt to US funding for the agency. Yesterday, a WHO spokeswoman told us reporters here in Geneva that 81% of the WHO's $5.8 billion budget for this year and next is funded from donors already, including $1 billion for emergencies. If you are that well-funded, shouldn't WHO be able to easily get through this 60 to 90-day pause, as they call it, in any new funding from the United States that was announced by the Trump administration, and that the concrete impact of that contemporary halt to funding is simply exaggerated? Tarik Jasarevic: (01:11:28) Yeah, please, Jamie. Jamie Keaton: (01:11:31) Dr. Tedros, if I might, some US lawmakers say they want you to resign in order for the US to resume funding. Are you considering that? Thank you. Dr. Michael J. Ryan: (01:11:54) Hi, Jamie. I don't think you've seen me doing too much complaining. I'm way too busy getting on with putting teams all over the world quite frankly. The realities are, the organization with regard to call with COVID-19 is moving forward with all of our projects and at pace around the world. You've seen what we're doing in terms of lab supplies to 122 countries. You've seen what we're doing with our search teams in countries. You've seen what we're doing with the global supply chain mechanism and all of that. We're moving forward at pace on that. Dr. Michael J. Ryan: (01:12:35) The pause on funding is to WHO's core funding and other projects, the actual funding that WHO receives in the normal cycle. I believe about one-quarter of that funding is core and about four-fifths of that funding from the US is for specific areas, and the DG may wish to detail that, for immunizing children, for eradicating polio, and for some of the essential health services and trauma management in some of the most vulnerable populations in the world. Dr. Michael J. Ryan: (01:13:16) I've been on the phone in the last few days talking to colleagues in Syria, talking to colleagues in Iraq and other countries, not seeing how we deal with the impact of a loss of funding there on COVID, but how we actually deal with the fact that much of that funding that certainly comes to my program and it's very, very welcome when we were huge relationship operationally, technically and financially with the USA. We're very grateful for that relationship, but the reality is for my program, a lot of that funding is aimed at direct lifesaving services to people in the most destitute circumstances in the world. That's really what I regret. Like yourself, I very much hope that, as you say, that this is a 60-day stay on funding. That is my hope and that's why you don't see me complaining because we just got to get on with it. Dr. Michael J. Ryan: (01:14:10) We've a very, very difficult job to do, as many countries have around the world. I want to focus on that and I want to focus my teams on that and I don't want to focus them on where the next paycheck is coming from because, quite frankly, that's not what they're focused on. Our staff in the field, who we had one staff killed just two days ago and one of our other staff in a serious condition transporting COVID-19 samples in Myanmar. I don't think their families are that concerned about the overall funding situation in WHO. We're concerned about our friends and our colleagues in the front line who risk their lives every day, every single day to deliver life-saving interventions to people around the world. Dr. Tedros: (01:14:58) Yeah. Thank you. Thank you, Mike. Whatever funding is coming to WHO is to save lives. As Mike said, even WHO staff are risking their lives to serve, to save lives. The sad part this week is we have been remembering the death of Richard Musoko, its first anniversary on April 19. He was fighting Ebola in an area, as you know, in eastern DRC where we have security problem and he was killed. Richard was killed while fighting Ebola and bullets at the same time, facing bullets. Dr. Tedros: (01:15:53) As Mike said, we lost another colleague this week in Myanmar. His name is Wynn Mound. He was collecting samples for COVID-19 actually. They were collecting, they were traveling to collect COVID-19 samples when they were attacked and one of them wounded and the other one killed. Dr. Tedros: (01:16:21) Whatever penny comes to WHO is for a very, very important mission. One thing we would like to assure to the world is that we will work day and night and we will not be deterred by any attack. As our colleagues actually say, attacks like this, that even killed our colleagues, only strengthens our resolve. I'd like to assure that will that although we are mourning, that's a one year anniversary of a colleague we lost and another one yesterday. But that will only strengthen our resolve. Dr. Tedros: (01:17:13) In terms of resources, I think the world should be proud that it's providing funding to this cause to save lives and to do it through WHO. WHO staff prepared to risk even our lives to save others. Dr. Tedros: (01:17:40) When it comes to the US, US has been supporting WHO and it's number one donor and we value that. We appreciate that. As you know, I come from Ethiopia and I have seen firsthand at the country level the funding from the US making a big, big difference. Take PEPFAR not only saving lives but at the same time building the system, the health system. In Ethiopia, I was minister of health for eight years and the primary health care, the health extension program that's known globally, was built by enlarge from US funding. Not only I am a living witness to appreciate the US support at the country level, but as a director general, also a living witness to appreciate the support that the US gives and provides. Dr. Tedros: (01:18:46) I hope US believes that this is an important investment, not just to help others but for the US to stay safe also. For US to remain safe, the investment in other countries is very important. It's not just important for other countries. It is important for other countries that US supports, but at the same time it's important for the US itself. I hope the freezing of the funding will be reconsidered and the US will once again support WHO's work and continue to save lives. Dr. Tedros: (01:19:32) On the second issue, the resignation, I would like to ask you, Jamie, since you know the rules, I hope they will read the rules and you will help also in clarifying what the rules are. I don't have anything more to comment on that. Dr. Tedros: (01:19:52) But one thing I'm sure is we have been working very hard for the last three years, almost three years, reforming WHO. We've got many good ideas from WHO staff that is truly transforming our organization. We work day and night and we will continue to work day and night. I will continue to work day and night because this is a blessed work actually and responsibility, saving lives. I will focus on that, changing this organization for good. But not only that, especially now focusing on the pandemic and saving lives. That's my focus. There could be issues coming from left and right, but I would like to focus with my colleagues on saving lives because even one life is precious. I don't have any extra energy to respond to this or that, but focused on saving lives and continuing this blessed work. Those who need our support, that's what they want and that's what we will give. Tarik Jasarevic: (01:21:13) Thank you. I think we will have to finish here. Dr. Ryan has a conference call to go. He's already late, so we will apologize to all journalists online who were not able to ask questions. We will also thank all interpreters for their hard work today. Hopefully, we will have one more language on Friday as we said, but we will let you know on that. The audio file will be sent out very soon and transcript of this press briefing will be available sometimes tomorrow. Wish you a very nice evening, afternoon or morning. Thank you.