World Health Organization Coronavirus Press Conference Transcript April 27

Tariq: (01:55) Hello everyone, from WHO Headquarters here in Geneva. My name is [inaudible 00:01:56] and I welcome you to regular press conference on COVID-19. Today we have Dr. Tedros, WHO Director General. We also have Dr. Maria Van Kerkhove and Dr. Mike Ryan. Tariq: (02:16) For journalists who are following us on Zoom, we remind you that there is a simultaneous interpretation available. And as of today, we are proud to announce that we also have Portuguese, in addition to six UN languages. And that's Russian, English, French, Spanish, Arabic and Chinese. So if you're on Zoom, please look for interpretation and switch to channel you want. And you are welcome to ask question in one of those languages if it's more suitable for you. Tariq: (02:47) Also for the first time today we have captioning of the press briefing. That's not on Zoom, that's on a social media platform. So for people who have hearing impairment or otherwise would like to have captioning, this is now available. Tariq: (02:59) I will give the floor to Dr. Tedros for his opening remarks before we go to questions. Dr. Tedros : (02:59) Thank you. Thank you, [inaudible 00:03:16]. Thank you, [Tariq 00:03:17]. Good morning, good afternoon and good evening. First of all, we're pleased to have interpretation services available in Portuguese today. And I would like to welcome all Portuguese speaking journalists to join. The next will be Swahili and Hindi. And will continue, as WHO, to invest in multilingualism because our beauty is our diversity. WHO remains committed to providing access to as much information as possible, in as many languages as possible, and reach every corner of our world. Dr. Tedros : (04:11) I have said since the beginning that the most important resource in the fight against COVID-19 is solidarity. Solidarity, solidarity, solidarity. The launch of the access to COVID-19 Tools Accelerator on Friday was a powerful demonstration of that solidarity. WHO is deeply grateful to the many world leaders and partners who have come together to ensure no one misses out on lifesaving vaccines, diagnostics or therapeutics. Dr. Tedros : (04:51) We look forward to more countries and stakeholders supporting this global collaboration, this global movement. This initiative is a vital investment in the response, both for the short term and the long term. Diagnostics are helping us now to find cases and ensure people are isolated and get the right care. And we are hopeful that the Solidarity Trial will shortly help us to understand which therapeutics are the most safe and effective for treating patients. But ultimately we will need a vaccine to control this virus. The success in developing effective drugs and vaccines for Ebola reminds us of the enormous value of these tools, and the enormous power of nationals and international collaboration to develop them. WHO played a key role in the development of the Ebola vaccine and we're doing the same for COVID-19. Developing a COVID-19 vaccine has been accelerated because of previous work WHO and partners have done over several years on vaccines for other coronavirus, including SARS and MERS. Dr. Tedros : (06:21) Also, COVID-19 is taking a heavy toll. WHO is deeply concerned about the impact the pandemic will have on other health services, especially for children. Children may be at relatively low risk from severe disease and death from COVID-19, but can be at higher risk from other diseases that can be prevented with vaccines. This week is World Immunization Week. Immunization is one of the greatest success stories in the history of global health. More than 20 diseases can be prevented with vaccines. Dr. Tedros : (07:03) Every year, more than 116 million infants are vaccinated, or 86% of all children born globally. But there are still more than 13 million children around the world who miss out on vaccination. We know that the number will increase because of COVID-19. Already, polio vaccination campaigns have been put on hold. And in some countries, routine immunization services are being scaled back or shut down. With the start of the Southern Hemisphere flu season, it's vital that everyone gets their seasonal flu vaccine. Even when services are operating, some parents and caregivers are avoiding taking their children to be vaccinated because of concerns about COVID-19. And myth and the information about vaccines are adding fuel to the fire. putting vulnerable people at risk. Dr. Tedros : (08:13) When vaccination coverage goes down more outbreaks will occur, including of life-threatening diseases like measles and polio. Gavi, the Vaccine Alliance, has estimated that at least 21 low and middle income countries are already reporting vaccine shortages as a result of border closures and disruptions to travel. So far, 14 vaccination campaigns supported by the Gavi against polio, measles, cholera, human papillomavirus, yellow fever and meningitis, have been postponed. Which would have immunized more than 13 million people. The tragic reality is that children will die as a result. Dr. Tedros : (09:07) Since 2000, Gavi and partners including WHO, have helped vaccinate more than 760 million children in the world's poorest countries, preventing more than 13 million deaths. Gavi has set an ambitious goal to immunize 300 million more children with 18 vaccines by 2025. To reach this goal, Gavi will require 7.4 billion US dollars in its upcoming replenishment. We call on the global community to ensure Gavi is fully funded for this lifesaving work. This is not a cost. It's an investment that pays a rich dividend in lives saved, especially in our children. Dr. Tedros : (10:02) Just as immunization has been disrupted in some countries, so have services for many other diseases that afflict the poorest and most vulnerable people, including malaria. As you know, Saturday was World Malaria Day. And a new modeling analysis published last week estimates the potential disruption to malaria services from COVID-19 in 41 countries in Sub-Saharan Africa. In the worst case scenario, the number of malaria disease in Sub-Saharan Africa could double. But that doesn't have to happen. And we're working with countries and partners to support them, put measures in place to ensure that services for malaria continue even as COVID-19 spreads. Dr. Tedros : (10:58) As lockdowns in Europe is with declining numbers of new cases, we continue to urge countries to find, isolate, test and treat all cases and trace every contact to ensure these declining trends continue. But the pandemic is far from over. I repeat, the pandemic is far from over. WHO continues to be concerned about the increasing trends in Africa, Eastern Europe, Latin America, and some Asian countries. As in all regions, cases and diseases are under-reported in many countries in these regions because of low testing capacity. We are continuing to support these countries with technical assistance through our regional and country offices, and with supplies through Solidarity Flights. Dr. Tedros : (12:02) In the past week we have delivered supplies to more than 40 countries in Africa, and more are planned. Globally, WHO has shipped millions of items of personal protective equipment to 105 countries, and lab supplies to more than 127 countries. And we will ship many millions more in the weeks ahead. And we're preparing aggressively. Later this week, WHO will launch its second strategic preparedness and response plan, with an estimate of the resources needed for the next stage of the global response. Dr. Tedros : (12:48) I would like to time the People's Republic of China, Portugal and Vietnam for their recent contributions to WHO strategic preparedness and response plan. We are also grateful to the more than 280,000 individuals, corporations and foundations who have contributed to the solidarity response fund, which has now generated more than 200 million US dollars. And I thank Flu Lab specially, for its contribution of 10 million US dollars. Dr. Tedros : (13:23) We have a long road ahead of us and a lot of work to do. WHO is committed to doing everything we can to support all countries. But political leadership is also essential, including the vital role of parliaments. As a former parliamentarian, I fully recognize the big role that parliamentarians can play. Tomorrow I'll be participating in a webinar for parliamentarians hosted by WHO, the Inter-Parliamentary Union and the United Nations Office for Disaster Risk Reduction, to discuss the role parliaments can play to reduce risks [inaudible 00:14:12] emergency preparedness, and increase resilience. Dr. Tedros : (14:18) I continue to call for the world to come together in solidarity and national unity to confront this pandemic, but also to prevent the next one. And to build a healthier, safer, fairer world for everyone everywhere. But I repeat, national unity is the foundation for global solidarity. Solidarity, solidarity, solidarity, that's what we will say every single day. This virus will not be defeated if we are not united. If we are not united, the virus will exploit the cracks between us and continue to create havoc. Lives will be lost. And even every single life is very precious. We can only defeat this virus through unity at the national level and through solidarity, genuine solidarity, at the global level. I thank you. Tariq: (15:29) Thank you very much sir, Dr. Tedros, for his opening remarks. We are joined also by Dr. Soumya Swaminathan, WHO Chief Scientist, who may also answer some of the questions. I will remind journalists online that if you're on Zoom, you have a option of simultaneous interpretation in 61 languages and Portuguese. So welcome to ask question in your language. Please be short. And one question per journalist so we try to get as many as possible today. Tariq: (16:00) I would like also to thank all the interpreters who are here with us and making sure that our message goes out out in different languages. So if we may start, let's start with Jamil Chade, covering Brazilian Media and he's Geneva-based correspondent. Jamil, please. Do we have Jamil on the line? Jamil Chade: (16:32) Yes, I'm here. Tariq: (16:34) Yes, please go ahead, Jamil. Jamil Chade: (16:36) Yes, Dr. Tedros, I'm going to ask in Portuguese... Hi, before. But I'm going to ask in Portuguese so we can inaugurate the service. Dr. Tedros : (16:43) Please go ahead. Jamil Chade: (16:48) [Portuguese 00:16:44]- Speaker 2: (17:20) [foreign language 00:00:09]. Speaker 3: (17:32) Thank you very much, Jamil. The question is about easing lockdowns in Brazil. Dr. Michael J. Ryan: (17:43) Sorry, excuse me. I can't speak to the specific situation in Brazil. I know that over the last week, there's been an overall increase in reported cases, but I think about 50%, 60% increase in reported cases. But that situation may reflect different epidemiology in different states. Brazil is a very, very large country. I think we need to look at trajectory, at the direction of travel of the epi curve because the amount of testing is varying. Some countries, for example, brought on extra testing in the last number of weeks and their cases have gone up temporarily and now their cases are starting to drop. That's absolutely true. If countries reduce the intensity of testing, then clearly, the number of cases will go down. So when there is stable amount of testing or an increased amount of testing and the number of confirmed cases go down, I think you can be sure that that trajectory is downwards. And we would like to see that as a sustained downward trajectory of cases. We would also like to see the reproductive number, the number of people that one person may infect, to be one or less. And there are all kinds of other parameters that need to be looked at. Dr. Michael J. Ryan: (19:03) Each country has to look at its own context. I think we've said that a number of times. Each country has to balance lives against livelihoods. But at the same time, in doing that, be assured that in making that calculation, that if the calculation is made and then the restrictions are eased too early, you may be back in a situation where lockdowns have to be reimposed. And that again has an increased impact. And potentially an even greater impact on livelihoods. So I think they're the real difficult decisions that all governments are faced with right now. And there are no easy answers. And I think we have to recognize that each government is dealing with a very different context of epidemiology, of expectations of communities of the epidemiologic context. Dr. Michael J. Ryan: (19:56) What we want to see is countries taking a step by step data-driven approach that allows a country to move steadily towards a new normal, towards a new way of living that allows lives and livelihoods to return, but at the same time not doing it so quickly that there's a rebound in cases which results in further lockdowns which may be even more damaging to those lives and livelihoods that governments are trying to protect. Dr. Maria Van Kerkhove: (20:27) If I might supplement what Mike has said, so as he articulated, the lifting of any of these public health and social measures is not based on one factor alone, of course. It cannot only be based on the numbers of cases and deaths reported. And I think it's worth saying that at this point in the pandemic, I think all countries are struggling right now to identify cases and all countries are struggling to report the deaths associated with COVID-19. And that is to be expected because it is very challenging to identify all of them as you are dealing with a pandemic, as you are dealing with intense transmission in many countries. Dr. Maria Van Kerkhove: (21:05) But in addition to the transmission that may be happening in the country and the numbers of cases and deaths that are identified, there's a number of other factors that must be considered, which include the ability of the country to identify the virus. So whether it's a workforce of contact tracers to help find the virus, whether it's the workforce in your healthcare facilities, in your front line facilities to be able to deal with patients, looking at the numbers of beds available in hospitals for mild patients, for severe patients, what does that look like in terms of your ability to handle an increased burden if case numbers increase again? Making sure that if workplaces are opened, if schools are opened, that those places are ready, ready to receive students again, ready to receive people back at work where you can still manage physical distancing, where you can still manage the ability to keep people physically separated but let them work. Dr. Maria Van Kerkhove: (22:04) And it requires having the entire population engaged and informed to understand that this needs to happen in a slow, measured, and controlled way. And as the DG has said and has said repeatedly, this will take some time and this is nowhere near over. And we need everyone to be mentally prepared that we have some more to go. And that may require being more patient and having to deal with some of these measures that are difficult to deal with. So it isn't just case numbers and deaths alone, it's a combination of factors that need to be looked at so that a risk based approach is taken to lift some of these measures. Dr. Tedros : (22:48) Yeah. Thank you. So I'd like to say a few words. On countries following WHO's advice, we can only give advice to countries, but one thing should be clear. We don't have any mandate to force countries to implement what we advise them. It's up to the countries to take our advice or reject it, but we give out advice based on the best science and evidence. Dr. Tedros : (23:27) Maybe one example is, as you remember on January 30, we declared the highest level of emergency, global emergency on COVID-19. Based on the International Health Regulation, WHO can declare the highest level of global emergency. And we did that on January 30th. During that time, as you may remember, there were only 82 cases outside China, no cases in Latin America, actually. No cases in Africa, only 10 cases in Europe, not as is in the rest of the world, nothing. So the world should have listened to WHO then carefully because global emergency, the highest level of emergency was triggered on January 30 when we only had 82 cases and not as in the rest of the world. And every country could have triggered all it's public health measures possible. I think that suffices the importance of listening to WHO's advice. And then we advised the whole world to implement a comprehensive public health approach. And we said, "Find, test, isolate, and do contact tracing and so on." You can check for yourselves, countries who followed that are in a better position than others. This is fact. Dr. Tedros : (25:43) So again, I will come back, I can give you many examples but I don't want to take much off this time because the many people who want to ask additional questions. But one thing I would like to repeat is I assure you that WHO gives the best advice we can based on science and evidence. It's up to the countries to reject or accept. But from our experience so far, what we have seen is some countries accept, some may not. At the end of the day, each country takes its own responsibility. And I repeat, we don't have any power or force to enforce our advice except the willingness of the countries to accept or reject. So I hope that's very clear for any country, for any country. But one thing I would like to assure you is we will continue to give advice based on science and evidence and then it will be up to the countries whether to take it or not. Thank you. Speaker 3: (27:02) Thank you very much, sir. Next question is from Antonio from EFE News Agency. Antonio, can you hear us? Antonio, just to remind everyone, you need to unmute yourself to be heard here. So if you can unmute yourself and then ask the question. Antonio: (27:42) [ foreign language 00: 10:39]. Speaker 3: (28:22) Thank you very much, Antonio. The question is about a vaccine initiative and absence of some countries. Dr. Tedros : (28:28) Yes. No, thank you. The absence of some countries, we haven't invited all countries. We have invited countries who have some regional leadership. For instance, we have invited Saudi Arabia because it's the G20 Presidency. And we have invited Germany because it's going to take over, in June, the leadership of the EU Council. And we have invited Malaysia because it's the Chair of ASEAN. We have invited South Africa because it's the current Chair of the African Union and on and on. Of course, there are some exceptions like France and UK. It's because they were in the initial negotiation and this was the countries who have started the discussion at it's infancy and also the leadership they have given until the launching of the initiative. But if you take the countries I have just mentioned, they were invited based on their role in their respective regions because we cannot bring all countries. So China didn't participate or others because of the same reason. Thank you. Soumya Swaminathan: (30:09) If I can just add to what the DG has just said, WHO works with a number of through our expert networks and groups. And our expert networks have been working since the beginning of January on diagnostics, on therapeutics, on vaccines for COVID-19. And these experts come from all over the world. We have almost 1000 experts today coming from all of these countries that are working on things like animal models, standardization of assays, what are the ideal characteristics for a new vaccine? The design of clinical trials for both drugs and vaccines. And as you know, the solidarity trial is now in almost enrolling in 11 countries, but we have over 100 countries, actually, that have expressed an interest and are in some process of joining. And this shows that this is really a global trial. We have 1600 patients already enrolled and we hope to now recruit patients in many countries very, very rapidly. Soumya Swaminathan: (31:20) As new vaccine candidates are developed, we hope that the same global collaboration will continue in the development, in the testing, and most importantly, in the access to these vaccines. Doesn't matter where in the world it's developed, there are over 100 candidates currently, which are at some stages of preclinical development, seven candidates have gone into human testing. We hope that of these hundred, at least a few will prove to be safe and efficacious against COVID. And it's in the interest of all countries to collaborate today because we don't know which vaccine is going to be successful and we have to ensure that people everywhere in all countries have access to the vaccine. Thank you. Speaker 3: (32:09) Thank you very much, Dr. Tedros and Dr. Swaminathan. We will go to the next question. And again, I will ask when I call the journalist to unmute themselves. So it's Dawn Kopecki from NBC. Dawn, can you hear us? Dawn Kopecki: (32:23) Yes, thank you. Can you hear me? Speaker 3: (32:25) Yes, please go ahead. Dawn Kopecki: (32:26) Thank you for taking my question. Dr. Tedros, a few weeks ago, you had said that America was doing a great job in fighting the coronavirus. On Thursday, President Trump said that he asked whether or not injecting disinfectants into the body would help kill it. There are states that are reopening government, reopening services, even though there's no contract tracing in virtually any state in the United States and we're about to hit a million cases. Can you tell me if you still think the United States is doing a great job? And if so, what is it that the US is doing well? And what is it that we're not doing so well? Speaker 3: (33:07) Thank you very much for this question, Dawn. Dr. Michael J. Ryan: (33:11) Thank you. I think the United States is dealing, as it has been for awhile, with what is a complex situation. This is a very large country with 50 states, each one with different populations, with different levels of urbanization, and the epidemic at different levels of development and evolution in each of those. I believe the federal government and the system of governors are working together to move America and it's people through this very difficult situation with public health and other scientific leaders adding and inputting their advice into the system. And as such, as the DG just said, WHO advises our member states on what we believe to be rational policies, but governments themselves- Dr. Michael J. Ryan: (34:03) I believe to be irrational policies. But the governments themselves and especially in the United States with its superb public health, health, science and policy infrastructure is well-positioned to manage its own transition from the public health and social measures, and has to balance, as I've said before, the health issues associated with COVID, and the lives and livelihoods issues. Dr. Michael J. Ryan: (34:28) What we can say is that it's important that I think there is a national plan. I think that has been very clearly laid out, a phased plan for a stepwise reduction in public health and social measures. That plan is driven by certain parameters of data. Like I mentioned before, a downward trajectory of cases, the availability of capacity in the health system and many others. As Maria said, it's a multifaceted decision-making process. And that framework exists. And obviously, if that framework is being advised by top scientists at a federal level, then obviously it is a discussion with the state system as how best to introduce that. Dr. Michael J. Ryan: (35:16) But we believe that the overarching federal plan seems to be very much based on science and to the extent possible. And with all of the adaptations that are needed as we move forward, we hope that the US government and its people can move through that plan, work through day to day how to do that, and we'll find a successful solution that reduces the impact on people's lives and also on their livelihoods. Dr. Tedros : (35:46) Thank you very much, Dr. Ryan. We go now to Azerbaijan, to Cameron Casimo from Real TV? Cameron, unmute yourself, please, and ask the question. Do we have- Cameron Casimo: (36:03) Can you hear me? Can you hear me? Dr. Tedros : (36:05) Yes, please go. Cameron Casimo: (36:06) Okay. Greetings from Azerbaijan, from Real TV. Thank you Mr. Teddy. Exactly Azerbaijan following advices of WHO, and some of the special quarantine regime restriction have been lifted since the 27th of April in Azerbaijan today, I mean. And some of places, photo studios and other shopping are now open. But big malls and other places, I mean cinema, theaters, schools exactly are not open this time. Please, many experts face about the second wave of coronavirus in Azerbaijan. What do you think about that? If it is possible, Mr. Tedros, I want to your answer to my question. Dr. Tedros : (37:05) Thank you Cameron. I think it has been touched upon but Dr. Ryan will answer. Dr. Michael J. Ryan: (37:10) Yes. I know that the epidemiologic situation in Azerbaijan is reasonably stable. I think you have 1,600 or so cases, and I think 21 deaths reported at this point, and the increase from last week is about 18%. So the epidemiologic situation, at least from where we sit is stable. And as governments around the world in a stable situation are looking to see how they can open up. There is always the risk of as we move away from these public health and social measures, and remember as the Director General said, these measures had to be put in place in order to suppress what was a very, very rapidly developing and deteriorating situation in many countries. And it's to the credit of governments and their peoples that they've managed to successfully suppress the worst parts of the pandemic in their countries. Dr. Michael J. Ryan: (38:11) The challenge now is how to unlock, how to have an exit strategy that doesn't result in the disease bouncing back. And that bounce back can happen in another wave and that wave can happen now or it can happen in a month or it can happen in two months. We don't know what's going to happen in two, three, four or five months when we may see a reemergence of the disease. We don't know what's going to happen. Dr. Michael J. Ryan: (38:38) But what we do know is that if countries release those measures, if you release the pressure, and in a sense the public health and social majors, the lockdowns have created huge pressure on the virus. They're preventing the virus finding new victims. And in doing that you're putting that pressure on the virus's capacity to survive. And I think it's really logical that if you lift that pressure too quickly, the virus can jump back. And we don't know how quickly and we don't know for sure which are the measures that will result in a successful exit strategy. Dr. Michael J. Ryan: (39:13) We do know for example, and I think everyone agrees, that large scale mass gatherings are not a good thing. But what all governments are really grappling with now is can we open the schools or part of our school system at the moment? Can we open part of our economy, essential workers, construction, transport systems? And each country is having to look at the potential positive impact on the economy of doing certain opening, but also the potential negative impact in the disease bouncing back. And that to an extent, is determined by the context. What is the urban population versus the rural population? Where are the highly vulnerable populations within a given a society? Dr. Michael J. Ryan: (39:59) So we can't prescribe from Geneva or from WHO exactly what each country can do. What we need to see countries doing is taking a measured stepwise approach based on the data and replacing the public health and social measures. And I would like to emphasize this. Those measures need to be replaced by a new social contract with citizens around physical distancing, around personal hygiene, around community participation, with strong public health measures such as surveillance, case finding, contact tracing, quarantining, as the DG said, detect, isolate, treat and trace. And also with a strong investment in the healthcare system, so if the disease does come back, the healthcare system will not come under the same pressure it may have come under before. Dr. Michael J. Ryan: (40:49) So there are requirements that allow you to ease the lockdowns without having a tremendous danger of a negative outcome. But nothing is certain at this point. And that's why we're watching very closely each and every country to see what lessons are being learned. And we will ensure that those lessons are shared between countries. Dr. Michael J. Ryan: (41:09) Just a few days ago, the DG with all of our member states, we had six of our member states presenting on the lessons they've learned, very different context, very different countries doing sometimes very different things, listening to each other to see, well this is what we've done, here are the outcomes, this is what we've done, here are the outcomes. And it's that exchange of knowledge, it's that exchange of learning that I think is going to help us get through this successfully. Dr. Tedros : (41:35) Yeah. Thank you. Mike. Just would like to add a few words to that. A second wave, as Mike said, is in our hands. If we implement the right intervention, we can prevent it from happening, and focused on public health interventions of course, and the details that he had said. Dr. Tedros : (41:58) But when we do this, not just the national interventions, having the regional and also coherence in the global interventions and global solidarity is very important. And if we take Azerbaijan, I remember the recent regional gathering that Azerbaijan hosted and I had the opportunity to join, and when the countries in the region decided to work together to fight this virus. That's very important. And not only that, Azerbaijan also contributed 5 million US dollars to the global response. Dr. Tedros : (42:43) So I see strong commitments starting from the president, the national response, and the president also working with neighboring countries to have the regional response, a united regional response, and then contributing to the global response even financially and through other means. Dr. Tedros : (43:04) So I would like to use this opportunity actually to express my respect and appreciation to the leadership of His Excellency, the President, considering all the three levels that he's trying to be involved in and support. Dr. Tedros : (43:21) Today also, we got another commitment to global solidarity, and Latvia has contributed financially to the global response. And I would like to use this opportunity again to appreciate the commitment from Latvia. And also I would like to inform you that Latvia's response is also very, very strong to the COVID, and what's happening at the national level is something that really is bringing result in Latvia, but at the same time their contribution to global response is much appreciated, and thank you so much Latvia for that. Thank you. Dr. Maria Van Kerkhove: (44:11) One additional point I wanted to add to what Mike and DGs have said is about this question around the second wave. And as the Director General has just said, it's in our hands. But we are learning about this virus every day. And while one of the important things that we are starting to learn now is the extent of infection in countries, and some of this comes from the surveillance which is detected through the PCR testing, but there's an additional tool that we have which is gathering information about the extensive infection through seroepidemiology, which is measuring the extent of infection in people who may have been missed through surveillance. And we detect the antibody levels in those individuals. Dr. Maria Van Kerkhove: (44:51) And while I don't have specific details about Azerbaijan, we are learning from a number of countries that early results suggest that a large proportion of the population remains susceptible. And that's an important feature because that means that there still are people that this virus can infect. Dr. Maria Van Kerkhove: (45:08) And so in addition to how we intensify the measures to increase the so-called lockdown measures, as well as lifting those in a controlled and steadied way, it's really important that we remain vigilant, that we remain vigilant to identify cases very, very quickly through all of the systems that we have been describing. And that early action, again, even if countries have been successful in suppressing transmission, it's important that they remain vigilant to be able to detect those quickly and stamp it out right away. Dr. Maria Van Kerkhove: (45:42) So these seroepidemiology studies have been very important. Even though they're early, even though there are some limitations with these studies that have come out so far, it's important that we understand at this point in time, four months into a global pandemic, a large proportion of the population still remains susceptible. Dr. Tedros : (46:02) Thank you very much. So this was answered to Cameron Casimo from Azerbaijan. And now we will go to South Africa. It's Dennis from Network 20 40 V. Dennis, can you hear us? You would need to- Dennis: (46:18) [inaudible 00:46:19]. Dr. Tedros : (46:19) Please Dennis, go ahead. Dennis: (46:22) My question is for the Director of the WHO. Director, I would like to know what is the stance from the WHO on South Africa, and how South Africa is handling this pandemic. Thank you. Dr. Michael J. Ryan: (46:41) I can begin. I'm sure the DG will want to supplement. Actually, as it happens, we were discussing this earlier today. I think there are a number of things. I think one is South Africa has, I think, used its initial luck done very well, and put in place a four point plan for preparedness and response. I think the deployment of 39 mobile laboratories all over South Africa has been a huge innovation. I think the training of up to 30,000 community health workers for doing contact tracing testing and other things. Dr. Michael J. Ryan: (47:18) I also believe that South Africa is tracking closely the HIV positive population and actively looking to see if there's any differential impact on that population, which I think is very prudent and shows a very caring approach for a vulnerable population. Dr. Michael J. Ryan: (47:33) Obviously, like in any country, South Africa is a large country, extremely diverse, and the disease has not yet reached the whole population, and there are large numbers of vulnerable people in South Africa. So South Africa, like every country is not out of the woods. But South Africa was the first country in Africa to develop its own capacity to do laboratory testing, and also has given that gift to the rest of Africa through the training it has run with the Senegalese Institute [inaudible 00:48:07] Lab and others. So South Africa is a net contributor to capacity building in Africa. Dr. Michael J. Ryan: (48:13) And also, because South Africa is entering, or will enter into the influenza season fairly soon with countries like Argentina, like Chile, like Australia, it's really important that we support countries in the southern hemisphere who do experience yearly influenza cycles, to ensure that they have the capacity to both manage and monitor both influenza and COVID-19 at the same time. Because I believe the lessons that are learned in the experience those countries will have with potentially both diseases circulating at the same time will not only benefit their countries, but will greatly benefit countries in the northern hemisphere who may face the same situation in six months time. Dr. Michael J. Ryan: (48:58) So we have a huge benefit to gain from investing in the capacities, the scientific epidemiologic and other capacities in South Africa, which have been demonstrated already to be very strong. But I'm sure, as I said, that every country faces its own challenges. And I'm sure the lockdowns have not been easy for communities, particularly those in poor and vulnerable settings. Dr. Michael J. Ryan: (49:22) But I hope I can say this without fear of contradiction, I think South Africa has really shown the way in Africa, and it's showing the way globally for how a country that, facing its own economic and other difficulties, has clearly demonstrated a very strong public health led response to this pandemic. But still nobody is out of the woods yet. Dr. Tedros : (49:49) Thank you. I have been following developments in South Africa, and one thing that we need to underline is its community-based approach and the deployment of community health workers. That's one. And the other is, on the risk, I just did the strategy on COVID-19. I got the information that there are now 69,600 emails received from citizens, their comments, their inputs. I think this type of listening to communities, listening to their concerns, listening to their inputs, can really help. To defeat COVID-19, the solution is making it everybody's business. And that's why as WHO we have always been saying, please break the barrier across party lines. Come together, whether you're in the left, right, or in the middle. This is about saving the lives of your- Dr. Tedros : (51:03) The middle. This is about saving the lives of your people. So just unite as one. No party lines should really divide you and listen to your communities, listen to the citizens, get their inputs on how to fight this outbreak or this pandemic. That's the solution. And truly this kind of consultation with the community that South Africa is doing is very, very important. So please continue doing that, listening to your people, getting inputs from them, understanding their concerns and all political leaders joining hands, working together to defeat this virus. Dr. Tedros : (51:47) So it's not an easy thing. I'm not saying it will be easy for South Africa, but the community-based approach, listening to the community and getting input from the community will really help. Whether it's getting emails like the 69,000 emails or other ways of inputting, getting their advice from the communities is very important. Our communities know the problems, know the root causes of the problems. They also know the solutions. Let's listen to our citizens. Let's listen to our people. Let's make this fight truly community-based. Speaker 4: (52:36) Thank you very much. The next question is from Ankit Kumar from India Today. Ankit, can you hear us? Ankit Kumar: (52:44) Yes, I can hear you. Good evening. My name is Ankit Kumar. I presented yesterday. My question is in India, scientists from two institutions have claimed that high fatality rate in some of the cities could be possibly linked to a L type strain of the virus. Is there any evidence to show that the fatality rate is higher in this particular L type strain? If you could please talk about it. Thank you. Dr. Maria Van Kerkhove: (53:11) Thank you for that question. So there are a number, we're working with a global network of neurologists and laboratorians across the world that are looking specifically at the sequences of the viruses that are circulating around the world. And there are more than 10,000 full genome sequences available. I don't even have the last count, but at least 10,000 full genome sequences that are available. And we're looking at the changes in the virus to see if any of those changes mean that the virus has mutated and that it changes in terms of its transmissibility or its ability to infect people or its ability to cause severe disease. Dr. Maria Van Kerkhove: (53:50) And so far this virus is relatively stable. There are changes in the virus which are expected in RNA viruses, but these changes are within expected range and there aren't any differences in the viruses that have been found in different countries that suggest that it behaves differently in terms of its ability to transmit or its ability to cause severe disease in people. Speaker 4: (54:15) Thank you very much, Dr. Van Kerkhove. Now we go to Tania Valbuena, N+1, that's online science magazine for Latin America and Spain. Tania, can you hear us? Maybe you need to unmute yourself, Tania Valbuena. Tania Valbuena: (54:35) Hola. Speaker 4: (54:35) Hola. Please go ahead. Tania Valbuena: (54:53) [inaudible 00:03: 45]. Dr. Tedros : (55:03) Thank you very much, Tania. The question is about immunity passports. Dr. Maria Van Kerkhove: (55:20) So I'll start in and perhaps Micro DG would like to supplement. So yes, there are some countries that are considering the use of a passport or a certificate, which would indicate that somebody has been infected with COVID-19 and has developed some immunity. And so what we're doing is we're working with labs to understand how these serologic assays are being used in individuals and what an antibody response, which is what those tests measures, means in terms of immunity and in terms of protection. And so there are a number of studies that are underway to look at the tests themselves to see if they actually do what they say they do. Dr. Maria Van Kerkhove: (55:56) And what we're finding is that individuals who develop an antibody response is developed about a week or two after infection. And we're trying to better understand what that antibody's response means. Right now there are no studies that evaluate the antibody response as it relates to immunity. So we can't say that an antibody response means that someone is immune. Having said that, there are a number of studies underway and we expect this, this is a very active area of research. We expect people that are infected with COVID-19 to develop a response that has some level of protection. Dr. Maria Van Kerkhove: (56:32) What we don't know right now is how strong that protection is and if that's seen in everybody that is infected and for how long that lasts. And so right now, at the present time, four months into this pandemic, we're not able to say that an antibody response means someone is immune. Saying that there's no evidence in this area doesn't mean that there's no immunity. It just means that these studies haven't been done yet. And so we're working with scientists all over the world with our partners to really understand what this means for people who have mild disease, for people who have severe disease and what the antibody response means in terms of protection. Michael J. Ryan: (57:10) Yeah. So if I could just add to that, I mean, the serologic tests are the tests, the blood tests that test whether you've had the infection, to a greater or lesser extent of accuracy can say you've had this infection. It's a very different question to say, are you protected from another infection? So one tells you, yes, you've had the infection. The scientific question is to what extent does having had that infection offer you protection against another infection? And that is the question that still needs to be addressed. Michael J. Ryan: (57:45) Empirically, we assume some level of protection from having had an infection. If you are a healthy individual that fully clears the virus from your system, you recover, you develop antibodies. In most cases, you would expect those antibodies to provide you with protection for a period of time. The question is it is unknown what that period of time is and it is unknown what the extent of protection is and that needs to be studied. There are also, and just to be clear, there are countries that are considering different kinds of documentation. Michael J. Ryan: (58:19) One piece of documentation is a documentation for someone who's leaving hospital as they go back into their communities that allows that person to say, I've been in hospital and I've completed the treatment course and I've now tested negative. Those kinds of documentations can be very helpful for reintegrating people back into their communities because sometimes there can be distrust. We've seen this with other diseases. So when a hospital issues a discharge letter or a note to a person to say, you've completed the treatment, you are no longer sick and we've tested you negative for the virus, that can be a helpful document for anyone going home and reintegrating with their family and friends. Michael J. Ryan: (58:58) I think that's different to the concept of an immunity passport or a document that says you've been previously infected. And I think there needs to be, I think, a very detailed debate on all of this documentation, what it's for and what is the purpose of the documentation and then what is it going to be used for going forward. And I believe that debate is ongoing. It's a healthy debate. It needs to be had, but again, it must be driven by science. If this gets distorted, then it could be very misleading. Michael J. Ryan: (59:31) So we need to have a scientifically informed debate on what the use of such documentation and such testing will be. And I hope that that happens immediately, sooner rather than later and we can all get the answers that we need. Speaker 4: (59:47) All right. Thank you very much, Dr. Ryan. I think we have an issue with the links, but I will ask one final question that I received from email and that's from Monique El-Faizy from France 24 and then the question is about the importance of global solidarity in developing vaccine and possible impact of the US acting alone. I think we already touched upon the question, but maybe Dr. [inaudible 01:00:33] wants to add about the importance of global solidarity in developing vaccine. If the question has been answered and we have technical issues, then we will conclude this press briefing here. Speaker 4: (01:00:47) We will have an audio file available via apologized to all journalists who have not been able to ask the question, but we will see you again on Wednesday. Thanks to all interpreters who were with us today from six US languages plus Portuguese. Have a nice evening. Dr. Tedros : (01:01:05) Okay. Thank you. Thank you Tarik and see you on Wednesday. Thank you. Thank you for joining us.