World Health Organization (WHO) Coronavirus Press Conference July 1

Margaret: (00:00) Director general will be Dr. Al-Mandhari, the Regional Director for the WHO Eastern Mediterranean Region and Dr. Richard Brennan, Regional Emergency Director for the same region. They will be providing more information about the COVID situation, the context, the challenges and achievements in the region. Joining them will be our other regular speakers, Dr. Mike Ryan, Executive Director of the WHO Health Emergencies Program, and Dr. Maria Van Kerkhove, Technical Lead for COVID-19, who will as ever provide answers to all your questions. I will now give the floor to Dr. Tedros. Dr. Tedros: (00:43) Thank you. Thank you, Margaret. And I would actually like to use this opportunity to thank Tarik. He has been moderating, as you all know, for more than 70, I think, close to 74 times, actually. So I'd like to thank him and also thank you for joining on July 1. I would like to say to one of our colleagues here, have a happy Canada day, July 1. Dr. Tedros: (01:22) Good morning, good afternoon and good evening. More than 10.3 million cases of COVID-19 have now been reported to WHO. And more than 506,000 deaths. For the past week, the number of new cases has exceeded 160,000 on every single day. 60% of all cases so far have been reported just in the past month. We will never get tired of saying that the best way out of this pandemic is to take a comprehensive approach, find, isolate, test, and care for every case. Trace and quarantine every contact. Equip and train health workers and educate and empower communities to protect themselves and others. Dr. Tedros: (02:23) No testing alone, no physical distancing alone, no contact tracing alone, no masks alone, do it all. Countries that have adopted this comprehensive approach have suppressed transmission and saved lives. Flare ups are to be expected as countries start to lift restrictions, but countries that have the systems in place to apply a comprehensive approach should be able to contain these flare ups locally and avoid reintroducing widespread restrictions. However, we're concerned that some countries have not used all the tools at their disposal and have taken a fragmented approach. These countries face a long, hard road ahead. Dr. Tedros: (03:19) But one of the lessons of the pandemic is that no matter what situation a country is in, it can be turned around. It's never too late. As you know, in March, Italy and Spain, were the epicenters of the epidemic or the pandemic. At the peak of its epidemic, Spain had almost 10,000 cases a day and Italy had more than 6,500 cases. But both countries brought their epidemics under control with a combination of leadership, humility, active participation by every member of society and implementing a comprehensive approach. Both countries faced a daunting situation, but turned it around. Dr. Tedros: (04:20) The fastest way out of this pandemic is to follow the science and do what we know works, the comprehensive approach. Today and tomorrow, WHO is holding a second research and innovation forum, bringing together more than 1000 scientists from all over the world to take stock of the progress made so far. To discuss new research questions and knowledge gaps, and to define research priorities for the remainder of this year and beyond. Research and innovation have played a vital role since the beginning of the pandemic and even before. Dr. Tedros: (05:05) In January WHO published the first protocol for PCR testing for the new coronavirus. In February, we brought together hundreds of researchers from around the world to identify research priorities. In March, we launched the solidarity trial, a large international study to find answers about which therapeutics are the most effective. And in April, with the European commission and multiple other partners, we launched the access to COVID-19 tools accelerator to catalyze the development and equitable allocation of vaccines, diagnostics, and therapeutics. Dr. Tedros: (05:47) This pandemic is a scientific challenge, but it's also a test of character. We must act in the interests of global solidarity and our shared humanity. We have a shared responsibility to ensure that all people have access to the tools to protect themselves, especially those who are most at risk. Dr. Tedros: (06:14) Although the pandemic is global, there are differences in the experience and approach of each region and country. Over the next few weeks, we plan to feature a different region regularly to highlight the challenges in different parts of the world and the lessons we're learning. Today, we're starting with the Eastern Mediterranean region, comprising much of the Middle East and North Africa, which is the third most affected region globally after the Americas and Europe. Today, I'm delighted to be joined by Dr. Ahmed Al-Mandhari, WHO's Regional Director for the Eastern Mediterranean and Dr. Rick Brennan, the Director of the WHO's Emergencies Program of the region, to talk about their experience and challenges. Dr. Tedros: (07:07) Dr. Al-Mandhari and Dr. Brennan, welcome both of you and thank you for your time today. And Dr. Ahmed Al-Mandhari, you have the floor. Dr. Ahmed Al-Mandhari: (07:19) Thank you. Thank you very much, our dear brother Dr. Tedros, for giving us the chance to come and join you in this important platform and this important regular briefing that you have started at the beginning of this pandemic. And it is our great pleasure to participate as first region in this sort of a briefing. And if you all accept, I'm going to give my talk and briefing in Arabic. So I start reading the briefing. Thank you very much, Dr. Tedros [inaudible 00:08:02]. Dr. Ahmed Al-Mandhari: (12:57) [Foreign Language 00:08:04]. Dr. Ahmed Al-Mandhari: (13:14) Thank you. Thank you very much, Dr. Tedros. Thank you. Dr. Tedros: (13:38) [Foreign language 00:15: 35], my brother Ahmed. Now back to Margaret, please. Margaret: (15:54) Oh, sorry. Not working. My apologies. Thank you very much. I understand Dr. Al-Mandhari will not be able to stay for long, but Dr. Rick Brennan will be available to answer questions about the Eastern Mediterranean region. Margaret: (16:10) The first person I have with question is Corinne Gretler, from Bloomberg. Corrine Gretler: (16:21) Hi, everyone. [Inaudible 00:16:22] taking my question. Mine is about the new China mission. I was wondering if you could give some more information on it, such as when will the team go, exactly? And what will the mission do, exactly? Will you study the new swine flu as well? And maybe who is on the team? Thank you. Dr. Michael Ryan: (16:48) The plan mission is an advanced mission, much like the previous China mission where a small advanced team, went in advanced to make preparations with Chinese colleagues. Essentially, to set up the scope of the mission, the terms of reference, the areas of study, and then to Lay out a program of work to carry out all of that work. That's currently being, obviously, dealt with right now in terms of the formalities for that. And we expect initially two experts from headquarters here to join our country team. One will be an expert in animal health, and one will be an epidemiologic expert with a major background in field investigation of epidemics and epidemiologic methods for investigating such situations. Dr. Michael Ryan: (17:39) But as I said, that is a scoping mission. And we do expect then, in collaboration with colleagues in China, to define a larger international mission. Again, it's important to note that we welcome such collaboration. In many, many situations we work very closely with countries who generally will carry out their own investigations... Dr. Michael Ryan: (18:03) ... With countries who generally will carry out their own investigations, and provide those investigations to WHO, and therefore it is an extra step for any country to invite in international teams and collaborate openly with them. So we look forward very much to that collaboration. With regard to the issue of the ... You referred to the new virus. I think it's important for us to clarify that the, I believe the virus you're referring to is the Eurasian avian-like H1N1 swine influenza virus, which has been a virus that's been under surveillance by Chinese authorities, and by the global influenza surveillance network around the world, the WHO collaborating centers. Dr. Michael Ryan: (18:45) It's been under surveillance since 2011. And in fact, the publication, the most recent publication is a publication of all of that surveillance data over that time. And obviously reporting both on the evolution of that virus within the swine population, but also in terms of occupational exposures to workers over that time. It's very important work, and it's work that is again, carried out in collaboration with the WHO collaborating center at China CDC, the other collaborating centers around the world, including the WHO collaborating center for influenza. That's CDC in Atlanta, and again shows the vital importance of the Global Influenza Surveillance and Response System. Dr. Michael Ryan: (19:35) The WHO collaborating center network, who keep these viruses under constant, constant surveillance. There are many, many, many avian flu and influenza viruses out there that have pandemic potential. We learned that in 2009, where a pandemic emerged in the Americas and we constantly need to stay on the alert. We need to continue to carry a very, very good surveillance on this G4 genotype, and we expect that, that will continue in the coming months and years. But again, it's important I think, to reassure people that this is not a new virus, this is a virus that is under surveillance. We are concerned with any viruses that show potential to infect humans, and we will continue with our collaborating centers and the Global Influenza Surveillance and Response System, to keep this virus under close surveillance. Margaret: (20:33) Thank you, Dr. Ryan. The next question comes from Jim Roope, Westwood One Radio. Jim, can you unmute yourself? ... Jim Roope: (20:46) Yes, thank you very much and hello everyone. I apologize for not having a question about the Mediterranean thing, but I do have a question about, as I understand it, there is no vaccine for a coronavirus, and this is the first coronavirus pandemic. So my question is, if there is a vaccine that is developed successfully for this coronavirus, and I'm assuming there will be. Will that help in developing a universal vaccine for the coronavirus, or just a universal vaccine in general? Would this be a great step toward that? Dr. Michael Ryan: (21:34) Universal vaccines against respiratory pathogens are really the holy grail of our longterm hopes. We've spent many decades thinking and hoping for a universal vaccine against influenza, and that has not been achieved. Although, much work is currently underway to develop such a universal vaccine, and that work is funded by many agencies around the world, including the Bill and Melinda Gates Foundation. So, identifying the targets in viruses that are conserved over time, in other words, sequences or proteins that we can develop vaccines against, that allow us to give a universal protection, are very important. Dr. Michael Ryan: (22:16) It remains to be seen whether a vaccine against this coronavirus would provide any cross protection against other coronaviruses. Many of the vaccines being developed are being developed against the surface proteins of the virus. There is a constant variation in those proteins, and therefore we would hope that the vaccines that are developed will be effective against this strain of the virus. It remains to be seen whether that would provide any cross protection. And I would imagine, given the longterm threat presented by coronaviruses and what we see out there in nature, that the longterm pursuit of more universal vaccines against [Sarah's 00:23:00] coronaviruses should be a longterm objective in the vaccine development community. Dr. Michael Ryan: (23:06) But for now, we deal with SARS-CoV-2, and what we do need is a safe and effective vaccine against this virus. And as you know, many, many products are currently in the pipeline, many now in clinical trials. We hope that such vaccines will be number one, effective. Number two, safe, and number three, will be accepted by people around the world and be available for everyone who needs them. And those outcomes are not a given, and we have a lot of hard work to do in order to be able to achieve that. But yes, the pursuit of universal vaccines is a very positive idea, but as I said, it's easy to say, it's hard to do. We're many decades into influenza control, and we're still not close to having universal vaccines against that virus. Dr. Maria Van Kerkhove: (23:54) Thanks Mike. Just to add, to say that I think this is a very good question, and it's a good opportunity to say that the work on vaccines for SARS-CoV-2, the virus that causes COVID-19, began even before January, 2020 with the development of vaccines for SARS-CoV-1 and for MERS. And so, the work that began there was building the research capacity, building the techniques and the technologies that could be used to advance vaccine development as a whole. And so, in January, 2020, we didn't start from scratch. We had a new virus, we had a new pathogen, and being able to know what that is triggered our work into focusing on SARS-CoV-2, as Mike has just said. Dr. Maria Van Kerkhove: (24:38) But the collaborations that began with scientists all over the world, with manufacturers, with production companies. That started before, and now we've enhanced that, and now we've accelerated that. Working towards a vaccine that is safe, that is effective, and that is available for those who need it. But I think we should pay homage to the people who have been working on coronaviruses for decades. There are a number of coronaviruses that circulate. And so, those that did the hard work for SARS-CoV-1, those that are doing the work for MERS, because MERS is still circulating in the Eastern Mediterranean region, and other countries as well. Any advancement we could make for a coronavirus vaccine, will get us closer to a vaccine for any coronavirus that emerges. Hopefully this work will pay off in the long run. Margaret: (25:29) Thank you, Dr. Van Kerkhove and Dr. Ryan. So the next question we have is from [Emma Farge 00:07:36] from Reuters. Emma, can you unmute yourself and go ahead? Emma Farge: (25:40) Good afternoon. I wanted to ask a question ... Mediterranean region, please. The director referred to limited data, and I was just wondering if he could elaborate on what he meant by that. Did you mean that the region is not testing enough, or it's not providing enough data? [inaudible 00:26:03] ... Margaret: (26:02) I think this ... Would you kindly answer that question? Dr. Rick Brennan: (26:08) Thanks very much. Thank you for the question. I think it's actually a combination of issues. As Dr. Al-Mandhari said, we have [inaudible 00:26:29] 10 countries in the region with humanitarian emergencies, and they have very weak health systems ... Do still not have sufficient ... Capacity built, and we are working with them to strengthen that testing capacity. I think also there are some gaps, other gaps in the availability of data not being readily available, but we are working with each of the countries to do that. Dr. Rick Brennan: (26:56) I think what we have seen is across the region, of a very strong effort by most of the countries to expand their testing. And as we look at the patterns of increasing the number of cases, and increasing the number of deaths that has coincided with the increased, in testing. But we still, as the director general himself said, we all know what works. We need to be scaling up all those public health interventions that we know are effective, and testing is critical to that. So, we still need more testing at sub national level, and we are working very, very hard with each of our member states on that particular issue. Margaret: (27:43) Thank you, Dr. [Rick Brennan 00:09:44], and we have no further answers in the room. So the next question will come from Donato Mancini from the Financial Times. Donato, can you unmute yourself and go ahead? Donato Mancini: (27:58) Hello? Can you hear me? Margaret: (28:01) Very well. Please, go ahead. Donato Mancini: (28:03) Hi, good afternoon. WHO has spoken a lot about equitable access to medicines, especially during this pandemic. So, do you view US moves to hoard virtually all Remdesivir through September with concern? Dr. Michael Ryan: (28:23) Yeah, we're aware of the reports in the media around this purchase or procurement of Remdesivir stocks, and we're obviously working to our colleagues and our partners in the access to COVID-2's accelerator, to clarify and verify this report. Obviously, there are many people around the world who are very sick with this disease, and we want to ensure that everybody has access to the necessary life saving interventions. But as I said, we will reserve our commentary until we verify the exact nature of the contracts. But also, we're also aware of other arrangements being put in place for sub-licensing and manufacturing under the country. So, let us look at the issues. Let us look at the implications of this, but certainly yes, we can restate. We are fully committed as an organization, and with our partners, to equitable access to life saving interventions. Margaret: (29:24) Thank you very much, Dr. Ryan. The next question comes from Agnes Pedrero of AFP. Agnes, can you unmute yourself and go ahead? Agnes Pedrero: (29:35) Yes, hi. Hello. Do you hear me? Margaret: (29:38) Very well. Please, go ahead. Agnes Pedrero: (29:46) [foreign language 00:11: 41]. Dr. Michael Ryan: (30:15) Yes, the various vaccines are used in different situations, but certainly in terms of a population based utilization of vaccines, we would await the results of population based clinical trials in order to prove safety and efficacy of use. In the area of national defense and security militaries around the world, have their own methods in order to define what products are needed, are justifiable, are used in their troops. We would, again, also be reassured that such products when they're used in the military are again, subject to the proper safety and efficacy testing. And again, subject to the informed consent of the individuals who take those products. Margaret: (31:09) Thank you, Dr. Ryan. Just letting you know, we do have a lot of questions today. Really appreciate all the interest. We will take as many as we can, but we can't guarantee that we'll get all your questions. So please stick to one question, as everybody has, but just letting you know. The next question will be from Christian [Urrich 00:31:29] of Deutsche Press Association. Christian, please go ahead, unmute yourself. Christian Urrich: (31:36) Hello, this is [Cristiana 00:00:31:37]. Thank you for taking my question. It was also on Remdesivir. I was wondering, is your communication channel still open to Washington? Are you talking to the US Government on Remdesivir and other matters? Or is this on a wind down? What is the latest of the relationship between WHO and the US Government? Thank you. Dr. Michael Ryan: (32:08) All I can only speak to the technical collaboration, and certainly we are grateful for and continue to engage with our technical counterparts in the United States on all matters related to science and public health, and we are very grateful for their collaboration. Dr. Tedros: (32:27) So it's just the same as Mike said. We're in contact, and we're still discussing, and there are collaborations. It's not specific to one thing that you raised, but on many issues. Thank you. Margaret: (32:51) Thank you, Dr. Tedros and Dr. Ryan. So the next question we have is from China Daily, from [Chen Huie Hua 00:00:32:59]. Chen, could you kindly unmute yourself and please ask your question? Chen Huie Hua: (33:05) Hi, just a related one. Has the US actually made a pledge for vaccine to its vaccine as a global public good? I mean, since USA is the leader in the development of vaccine. Thank you. Dr. Michael Ryan: (33:23) I think you should refer that question to the United States Government. Margaret: (33:30) Thank you, Dr. Ryan. So we now have a question from Greece, from Costas [Davinas 00:33:35] from Hellenic Public TV. Costas, please unmute yourself and go ahead. Costas Davinas: (33:49) Yes, thank you. Do you hear me? Margaret: (33:52) Very well, Costas. Please go ahead. Costas Davinas: (33:55) Yes. Thank you for taking my question. I'm coming back to the G4 virus. Can you give us, please, some [inaudible 00:34:04] information's about this new virus and how dangerous can it be in connection with COVID-19? Thank you. Dr. Michael Ryan: (34:14) I will begin. I think I've given you, number one, this is a recent, a very recent publication. As I said, the viruses discussed in the paper that's just been published are not new. And in fact, these G4 genotype was previously reported in swine in China, with the Harvard Veterinary Research Institute in a 2016 publication. The G4 genotype have been the dominant genotype in swine populations in China since 2016. The interesting finding in the latest report, is the zero prevalence among swine workers, which needs to be looked into carefully with an elevated zero prevalence rate against the G4 virus being reported. But this needs to be reviewed and looked at, and we need to really understand the study design, and the context, and exactly how that process was carried out. Dr. Michael Ryan: (35:11) Sporadic zoonotic infections, infections that transfer from swine to humans with the G4 genotype, have been reported in the past. And as I said, the WHO collaborating centers, particularly the one that China CDC and the one, our collaborating center in the United States at CDC in Atlanta, have been working on this Eurasian avian-like H1N1 variant. And this has been, as I said, under surveillance now for many years. What is interesting in collaboration with our flu and the WHO Global Influenza Surveillance and Response System in monitoring this, different candidate vaccine viruses of closely related strains have been developed by WHO at the China CDC, and they're available for vaccine development and preparedness purposes. This has been a huge part of developing the ... Dr. Michael Ryan: (36:03) ... preparedness purposes. This has been a huge part of developing the pandemic influenza preparedness framework and ensuring that we are constantly checking on each and every one of these viruses and ensuring that candidate vaccine strands are available for rapid development should any one of these numerous strands ever show a likelihood of spreading successfully or efficiently in human populations. But again, I'd like just to restate that this is a finding from surveillance that's been carried out over many years. These are not new viruses. We always take any variant strains of swine flu viruses extremely seriously, and that is why we will work and continue to work with our collaborating centers around the world on the surveillance and the development of countermeasures. Maria? Dr. Maria Van Kerkhove: (36:48) Just to add that this paper highlights the importance of the work that WHO and partners do with our collaborating centers globally, looking at viruses that are circulating in animals. This one happens to be a swine influenza virus, but there are other coronaviruses that are circulating in animals. There are other known pathogens that are out there. Dr. Maria Van Kerkhove: (37:09) And what we are doing is we are working with partner agencies at FAO and OIE, with academic institutions across the globe, with national centers for disease control all over the world to conduct surveillance in wild animals, to conduct surveillance in domesticated animals and to conduct surveillance in those animal workers to ensure that if there is a virus that spills over, that we are able to detect it, and we are able to detect it rapidly. There's a whole body of work and scientists that are working globally on all continents that are looking at these viruses. And for those of you who are watching who may not know that, I think it's important to mention. Dr. Maria Van Kerkhove: (37:48) So as Mike has said, this is not a new virus. This is a paper that is reporting on surveillance activities that have taken place between 2011 and 2018 in China. We're grateful for all of our partners who are doing work in this area of looking at the epidemic potential. We always say essentially is a virus that is circulating in animals, it can spill over into humans. We call that a zoonotic transmission and the potential for that virus to continue to spread. But this is an important area of work and it highlights the need to remain focused on this. Even though COVID is happening globally, we still need to ensure that our surveillance programs for influenza are continuing and that we strengthen them so that we are able to detect these viruses spilling over rapidly. Dr. Michael Ryan: (38:35) If I could just add to that, that the global influenza surveillance and response system collaborate centers, national influenza centers around the world are constantly doing surveillance for seasonal influenza. And they are the basis of developing the yearly seasonal influenza vaccines for the northern and southern hemispheres. They carry out active and ongoing surveillance of avian flu strains around the world. All of that infrastructure has been turned and is now looking also at COVID-19 and doing sentinel surveillance for both COVID-19 and for other influenza viruses. Dr. Michael Ryan: (39:11) This is a hugely important global good. This is a massive piece of global health security. And I would remind our member states and our donors that this system is constantly underfunded and this system is in constant threat of being not funded. Our colleagues, Rick Brennan is online from the Eastern Mediterranean region. We spent the last five years investing and expanding the influenza surveillance and response capacities in the Eastern Mediterranean and on the African continent. And we now face a situation due to funding shortages that we may have to pull back on these investments. And these are the trade-offs and unfortunate trade-offs that we may have to make. Margaret: (39:57) Thank you, Dr. Ryan and Dr. Kerkhove. So the next question is from Laurent Sierro from the Swiss News Agency here in Switzerland. Please unmute yourself and go ahead, Laurent. Laurent Sierro: (40:11) Can you hear me, Margaret? Margaret: (40:12) Very well, Laurent. Please go ahead. Laurent Sierro: (40:15) Thank you, and thank you for the briefing. Now, you mentioned the flare-ups observed in certain countries that started to lift the lockdown. There has been an increase, a steady increase this week in Switzerland, and in most of the cases it's related to small clusters in nightclubs. So do you consider that it's possible in this kind of venue to harder the physical distancing or is it just impossible and should these venues be being closed for now? Thank you. Dr. Maria Van Kerkhove: (41:01) So thank you for the question. You highlight an important challenge that many countries are facing right now, where they have seen success in suppressing transmission or some success in suppressing transmission and are starting to open up. And many countries are doing that carefully. We live here in Switzerland, and we are seeing that careful lifting, that step wise approach of lifting these measures. And I think we need to be realistic that we will see some setbacks in the sense that there could be pockets of activity. There could be clusters of activity. Dr. Maria Van Kerkhove: (41:32) You mentioned a nightclub, and anyone who's been in a nightclub knows how close you could be in contact with one another. And if the virus is present, then it will take that opportunity to pass between people, which is why we mention all the time about this comprehensive approach of physical distancing. And its physical distancing at all times of people, at least one meter between people, using hand hygiene, using respiratory etiquette, staying home if you're unwell, staying home if you're asked to and other measures that governments have put in place. But the virus does like the opportunity to pass between people if you're in close contact with one another. Dr. Maria Van Kerkhove: (42:16) What is important is when we do see these pockets of activity, we do see some clusters emerging, that we use the system that is in place, that public health infrastructure, the ability to rapidly find cases, to test those cases, to isolate cases. Even if they're mild, those mild cases need to be isolated or cared for in a medical facility, and to conduct contact tracing. Make sure that the contacts are identified and that they're in quarantine. And by doing so, you are effectively breaking those chains of transmission because you don't allow the virus to pass anymore between people. But it's all of this together that needs to be put in place. Dr. Maria Van Kerkhove: (42:55) And so when these clusters begin, it's important that countries act aggressively to try to stamp it out so that the small clusters hopefully remain small and die out and that they don't become bigger. Dr. Michael Ryan: (43:14) The thing to remember, I think, with transmission is because we often end up in scientific arguments over asymptomatic, symptomatic transmission, but in effect we're talking about context. We're talking about behavior. And though we might argue on the types of transmission, the fact is that context and behavior also are major drivers of transmission. So our behaviors will facilitate disease transmission or mitigate against it. The context, as you mentioned, nightclubs, large gatherings where people's social inhibitions, where people, even if they're asymptomatic, may be shouting, singing and that produces its own droplets. Dr. Michael Ryan: (43:57) So I think these are really important contexts. And we've seen in cluster investigations in Southeast Asia again, how specific contexts can lead to higher levels of transmission, but that is when the virus is present. So it very much depends on the background intensity of transmission at the community level. And in situations where the virus continues to transmit and is in society, then there are particular contexts. We've seen that in long-term care facilities, we've seen it with dormitories, we've seen it with crowded places, mass gatherings. And then there are particular contexts that we've seen transmission intensified or amplified and generating those kinds of events. Dr. Michael Ryan: (44:32) So it is about proximity. It is around intensity. It is around duration. And every individual, in a sense, every person needs to look at your own risk. You need to be aware of what is the local transmission. You need to know what the transmission in my area is. You need to be able to take control of your own destiny also and not just rely on information from governments. I do think people can manage. We do this every day in our lives as human beings. We manage risk. We decide when we cross the road, we decide when we fly, we decide when we have an operation or not have an operation. Dr. Michael Ryan: (45:13) We make decisions every life. Sometimes we make life and death decisions about ourselves and about our children. We are, by nature, by evolution, we are risk managers as individuals. And I think we're intelligent, and we're able to do that. What we need is the information to make those risk-based decisions. We need to gain the knowledge to be able to make good decisions. Knowledge and information allow you to make good decisions. Dr. Michael Ryan: (45:40) We decide on our proximity to other individuals. We decide on the intensity of our social engagement. We decide how long we spend in that environment. We can be advised by government. We can be advised by science, but in the end, this comes down to personal motivation and personal choice. Governments and scientists have to support communities with the information. We have to facilitate, make it easier for people to make good choices, but in the end it comes down to individuals, and it comes down to communities. Dr. Michael Ryan: (46:09) If it doesn't feel safe, it isn't safe for you. And therefore inform yourself, understand the risks, manage those risks. Because otherwise, the question you're asking, should we shut this open that? When it comes down to these binary choices, open, closed, we're in a situation right now where, as I've said previously, we have to learn to live with this virus. Understanding how this virus is affecting your community, understanding how your behavior, your individual behavior, either increases the risk or decreases the risk of this virus transmitting is absolutely vital. Dr. Michael Ryan: (46:49) So there is an element of government responsibility here, and it is real, and it is very important, but there is also an issue of individual responsibility and taking control and managing our own risks. Margaret: (47:02) Thank you, Dr. Ryan. The next question comes from Bianca Rothier of Globo. Bianca, please unmute yourself and go ahead. Bianca Rothier: (47:14) Hi, Margaret, can you hear me? Margaret: (47:16) Very well, Bianca, please go ahead. Bianca Rothier: (47:19) Thanks a lot. Dr. Tedros said today that some countries have taken a fragmented approach and these countries face a long, hard road ahead. I would like to confirm, is this also the case of Brazil? Am I right? And how do you see the situation in Brazil at this point in time? Yesterday, Paco said that the peak in Brazil could be in August. Do you agree? Dr. Michael Ryan: (47:51) I think the Director-General was making a general reference to the techniques and to the strategies that have worked. He was not making a specific reference to any individual country. Again, as I have said on numerous occasions in the past, Brazil is a large diverse country with many different environments and situations that it has to deal with. Currently, it is a complex challenge for Brazil, both at federal and state level. And we encourage, again, Brazil to continue to take a comprehensive approach and to focus on reducing mortality, suppressing transmission, and ensuring that communities are fully empowered. And the government's approaches, all of government, bi-partisan, are focused on passing the best possible information to people at all times. Dr. Maria Van Kerkhove: (48:46) I'd just like to add something. So it's not about any one particular country. It's about what we are learning about how countries are responding in general. And in the beginning, in early January, when we're learning more and more about this, what we've seen in what we've learned from countries is countries that acted very fast and took this very, very seriously because of their experience with other similar pathogens like SARS back in 2003, like MERS in 2012, 2013, they had first-hand experience of how dangerous a pathogen like this could be. And that aggressive nature and approach and looking at this as an all of society, all of government approach and focusing on the fundamentals of public health really had a headstart in the sense that they were able to formulate a plan, get organized, take this very, very seriously and really, really act quickly. Dr. Maria Van Kerkhove: (49:39) But the other thing that the Director-General said today was that it's not too late to turn it around. So even countries that didn't do that, even countries that didn't have that first-hand experience with SARS have experienced now with COVID-19, and it isn't too late to turn it around. It isn't too late to get the infrastructure in place to work on that and to use it appropriately. Many countries are going through very difficult periods of time. Some countries who have had success in suppressing transmission who are opening up now may have a setback, may have to implement interventions again, may have to implement these so-called lockdowns again. We hope not. We hope that we won't have to go into widespread locked again. So it's not too late to act fast. It's not too late to use the tools that we have, and countries have tools. They have surveillance in place. They have testing that is in place. They have people who could do contact tracing. Even in situations that are overwhelmed, break down the problem, break down this seemingly overwhelming problem into smaller components that you can tackle. Dr. Maria Van Kerkhove: (50:47) And the reason we say this over and over again is because we have seen countries that have been in overwhelming situations who have turned this around. So it isn't too late. It isn't too late to use this comprehensive approach. We are here, WHO is here for all countries all over the world. Margaret: (51:14) Okay. We're running out of time, but we've got time for two more questions. I call now on Simon Ateba, our friend from Africa News Today. Simon, unmute yourself and please go ahead. Simon Ateba: (51:26) Can you hear me? Margaret: (51:32) Yes, Simon, please go ahead. Simon Ateba: (51:35) Thank you for taking my question. My name is Simon Ateba from Today News Africa in Washington, DC. As the number of cases in Africa continues to increase, we have like 400,000 people who have been effected so far and over 10,000 fatalities have been recorded. We are beginning to see many people claiming that they have a way of curing the disease using non-traditional methods. Simon Ateba: (52:03) For instance, on Monday a very popular pastor in Nigeria, T.B. Joshua, released a video of a medical doctor in Cameroon, who was said to have been cured of the virus through prayers. I was wondering, in the context of epidemics, how does WHO react to this influx of information coming from non-traditional sources and from pastors and from people who are not maybe in the medical field claiming that they have been curing the disease? Thank you. Dr. Michael Ryan: (52:43) Yeah, it's important that we make the distinction between claims of disease cure and good acts that support communities in terms of the suffering they go through. And certainly spiritual leadership at a time like this is very important in communities, whatever the faith, and therefore we respect and have worked very closely with faith-based organizations on the huge contribution they are and can make to managing anxiety at a community level, providing direct support to communities coping with this disease, dealing with bereaved families and individuals. So the role that faith-based organizations play is very important. Dr. Michael Ryan: (53:23) They also play a very important role in getting good information to people. Sometimes it's projected as a route of misinformation. In fact, we find the faith-based organizations are a very effective way of passing good information because faith-based organizations are very often trusted by communities. They are a different channel, and we're working very, very closely with those organizations around the world. In fact, this week at the pre-conference on the WHO epidemiology conference, I think we had more than 10,000 connections to that conference. In fact, I think today on the research side, we have 1000 connections into that. So you can see- Dr. Michael Ryan: (54:03) On the research side, we have 1000 connections into that. So you can see there's a massive hunger, and there's a massive commitment to the positive management of information around this pandemic. And we're working very hard with our partners in the tech industry, our partners in the communications and social sciences, and other UN organizations to do that. So faith-based organizations are a very important part of this response. Dr. Michael Ryan: (54:24) With regard to claims of traditional methods or healing, we've seen that traditional... In many different diseases, effective therapies have been found through the examination of traditional products and other things. There are products out there that can enhance health and wellbeing. And obviously we should... Healthy diet and supplementing our diet with appropriate products is a very important part of being healthy. Specifically though, when it comes to making claims around cures for products, we have to be very careful. We want to make sure that all products that show promise in the care or cure of individuals with COVID-19 go through and go into properly managed trails, so we can see what their impact and their effectiveness is. Dr. Michael Ryan: (55:16) It is impossible to determine the effectiveness of any drug or any traditional product, unless we put it through the rigors of a properly controlled trial. That is the same, whether it's a product developed by the pharmaceutical industry or a product developed by traditional methods. As I said, many drugs and many effective things have been found through traditional approaches. So traditional medicine is very important to communities around the world. And therefore, WHO has an initiative on traditional medicine. We look on traditional medicine in a very positive way. But it is also, as I said, extremely important that any promising therapy go through the proper testing for safety and efficacy, so we can all support such products if they're found to be effective. Maria. Dr. Maria Van Kerkhove: (56:10) Just quickly to add on the information. So as you've pointed out, there are huge amounts of information that's out there. Not only for COVID, but for different cures or for every element of this pandemic. And as Mike has said, we have a conference that's ongoing right now on this infodemiology of how do we manage all of this information. We're not set up to absorb this much information all the time. So how do we tease out the good information, from the misinformation, from the disinformation? Because there's information that's out there that's not quite right, and it needs to be corrected. And so we work very hard with different platforms. We put out these myth busters where we directly head-on say, "This one isn't quite right. This is wrong. Here's the right information." But there's also information that's out there that's willingly wrong. And that could be incredibly dangerous, and it could put people in harm's way. And so we're working also to ensure that the information that's out there that is not harmful. And that anything that's out there that is purposefully wrong, we address. Dr. Maria Van Kerkhove: (57:10) Faith-based leaders are incredibly important in this. And as Mike has said, we work with faith-based leaders across the globe. We work with different travel and tourism industries. We work with the civil sector. We work with scientists and public health professionals. We work with journalists. Journalists also have a role to play in getting good information out, having fair and balanced reports. And we're so grateful for these articles that come out that explain very complex topics, and put it into the context of how we can help people suppress transmission and save lives. So we welcome the partnership with journalists on that. Dr. Maria Van Kerkhove: (57:45) And we work with individuals, everyone on the planet is part of this response. Every single person. And everyone needs to know that they have a role to play in this, not only from protecting themselves from getting infected, but preventing the onward transmission to their loved ones, to someone who potentially is vulnerable, that could develop severe disease. So you have a role to play, and also not... Ensuring that you don't pass on poor information. Go to good sources. You can always come to WHO. But there are ministries of health, there are hotlines, there are reliable sources of information. So please choose your information carefully. And please be conscious about the information that you pass onwards. Dr. Tedros: (58:28) Maybe I would like to add on this issue. And I remember this is during the HIV/AIDS era at its peak. And we started using medicines. And some patients were using some medicines. And there was same situation like what we're seeing now, where people were forced to choose between the medicine and faith. And I remember religious leaders, we discussed with religious leaders. And religious leaders going to their followers saying the two can go together. Have your faith, continue to take your medicine. That's what we advise you. And that really resolved the situation. And we know, as what Mike said, many religious leaders who would really advise their followers to follow their faiths, but at the same time use science. The two do not contradict. They go together. So that's our advice. And we would call on all religious leaders to be in this in fight and save lives. Thank you. Margaret: (01:00:02) Thank you, Dr. Tedros. The very last question goes to Paulina Alcazar from Encadena News, Mexico. Paulina, can you unmute yourself and go ahead. Paulina Alcazar: (01:00:13) Yes. Thank you. Can you hear me? Margaret: (01:00:20) Very well. Please go ahead. Paulina Alcazar: (01:00:22) Okay. Thank you for taking my question. And greetings from Cancun, Mexico. As Dr. Tedros says, this virus is very quick. And thanks to the contact tracing, we know that more and more people are infected without symptoms, the so-called asymptomatics. Can this be due to taking more than four months in raising their immune system throughout foods, vitamins, care? Do you have new records of this condition? Margaret: (01:00:53) Can you repeat that? We couldn't quite understand. You mentioned a condition related to the immune system. Is that correct? Would you kindly repeat it? Paulina Alcazar: (01:01:03) Yes. Thank you to the contact tracing, we know that more and more people are infected without symptoms, the so-called asymptomatics. Can this be due to the people taking more than four months, they raise up their immune system by foods, taking care of their own? Margaret: (01:01:27) So you're asking whether people have improved their immune system by particular foods? Do I understand you correctly? Paulina Alcazar: (01:01:38) [foreign language 00:07:37]. Margaret: (01:01:39) Good idea. Yes. Please, go ahead. Paulina Alcazar: (01:01:42) Okay. [foreign language 00:07: 43] Dr. Maria Van Kerkhove: (01:02:27) So I can start it. Maybe Mike would like to... If I understand the question, it's more about why are we seeing more of these asymptomatic cases through the contact tracing, and are they doing something differently? We do know that through contact tracing, and people who are under medical observation, some of them are being tested and they're testing positive, and they don't have symptoms. And we've known this for quite some time. That you can have people that test positive that don't have symptoms. And we know that those individuals, if they're not in quarantine, they can pass the virus to someone else. Dr. Maria Van Kerkhove: (01:03:02) What we tend to see through surveillance activities is, normally surveillance is focused on people who show up in a health facility, especially in the beginning of an outbreak. Certainly in the beginning of the pandemic, we often found people who were symptomatic first. And then when we did our contact tracing, if we found that that individual passed to someone else, they tended to... The secondary transmission, those individuals tended to have more mild infection. Some of them being asymptomatic. We don't know why in terms of their immune system, or if they had anything to do with how they ate. What we know is that all people are susceptible to this virus, and people can get infected. Dr. Maria Van Kerkhove: (01:03:43) And we know that it's very important when we do our case finding in our contact tracing, that those initial cases are isolated, and they're cared for depending on the severity of their illness. And those people who are undergoing contact tracing are in quarantine. Because in essence, if they in fact are infected, then they are not able to pass that virus to someone else. Dr. Michael Ryan: (01:04:10) I think in general, we don't understand the factors that drive asymptomatic versus symptomatic transmission. We don't know whether that is related to dose, related to age, related to the health of the immune system. But I think regardless of that, I think it's important that as human beings, we're a very complex biologic system. And we need a healthy immune system. We go through many infectious diseases throughout our lifetimes. And therefore, a healthy immune system, a healthy microbiome, having general health is very important in fighting disease. Dr. Michael Ryan: (01:04:46) And therefore, while it doesn't specifically help for COVID-19, a healthy diet and being in generally healthy condition, and protecting and promoting immune health is very positive for any number of infectious diseases. So I think it is important. Good nutrition leads to better immune systems. We've seen that. We've seen children who are undernourished, children in refugee camps around the world, and how they succumb so quickly to acute respiratory infection, to the impact of measles and other diseases. So we do see the vulnerabilities that are created by poor nutrition and undernutrition around the world. Dr. Michael Ryan: (01:05:24) And we've seen the impacts of stress. You put a human being into a situation where they don't have access to adequate hydration, adequate diet over a prolonged period of time, where they're subject to psychological stress. And the arch type for that are the millions and millions of refugees around the world, and migrants who live in these sorts of conditions. Absolutely. People in that situation are more susceptible to infectious disease. And I think as a general principle, we all need to look to how we can create a healthier population. This is what Dr. Tedros speaks about in the three pillars of WHO strategy. We're not just talking about responding to epidemics. We're talking about protecting health, healthier lives, we're talking about healthier and stronger health systems to deliver health care. And we're talking about protecting the world against emergency. So a huge chunk of WHO's overall strategy in our program of work for the next five years is built around the principle of healthier lives. And the immune system is an extremely important component of that. And nutrition is linked to that in a very meaningful way. Margaret: (01:06:43) Thank you, Dr. Ryan, Dr. Van Kerkhove. And thank you to all the journalists who attended, and for these really good questions. We will send the audio files as always. And thank you, Dr. Brandon for being on the line and answering questions as well. I'll hand over to Dr. Tedros for final words. Dr. Tedros: (01:07:02) Yeah. Thank you. Thank you, Margaret. And a very good start. This is not your first time, actually. We had you before to moderate this. So thank you to all also for joining. And especially to our colleagues from EMRO, Ahmed and Rick. Nice to see you virtually, and thank you for joining. And thank you also to all journalists who have joined today, and others of course. And see you on Friday. Thank you.