World Health Organization (WHO) Coronavirus Press Conference June 12

Tarik: (00:00) Dr. Mike Ryan, who is a lead on Health Emergencies Program. We also have Dr.Anshu Banerje, who is our Director for the Department of Maternal, Newborn, Child, and Adolescent Health and Aging here at WHO. Dr. Tedros will introduce our guest speakers today. I will give the floor immediately to Dr. Tedros. Dr. Tedros: (00:27) Thank you. Thank you, Tarik. Good morning, good afternoon, and good evening. WHO is a global organization, but we are also proud and active members of the cities and communities we live in. Since the 20th of March, Geneva's famous Jet d'Eau fountain has been switched off while the city was in lockdown. Yesterday, I had the enormous honor of restarting the Jet d'Eau as a symbol of the city reopening now that the number of cases has declined. I'm deeply grateful to the city and canton of Geneva for their hospitality and support for WHO and for eliminating the Jet d'Eau in blue in honor of WHO and the United nations. Although new cases here in Geneva are now in the single digits, we're continuing to see an escalating pandemic globally. The pandemic accelerates in low and middle income countries. WHO is especially concerned about its impact on people who already struggle to access health services, often women, children, and adolescents. The indirect effects of COVID-19 on this groups may be greater than the number of deaths due to the virus itself. Because the pandemic has overwhelmed health systems in many places, women may have a heightened risk of dying from complications of pregnancy and childbirth. Dr. Tedros: (02:18) WHO has developed guidance for health facilities, and community activities, or maintaining essential services, including for women, newborns, children, and adolescents. This includes ensuring women and children can use services with appropriate infection prevention and control measures and respectful maternal and newborn care. WHO has also carefully investigated the risks of women transmitting COVID-19 to their babies during breastfeeding. We know that children are at relatively low risk of COVID-19, but are at high risk of numerous other diseases and conditions that breastfeeding prevents. Based on the available evidence, WHO's advice is that the benefits of breastfeeding outweigh any potential risks of transmission of COVID-19. Mothers with suspected or confirmed COVID-19 should be encouraged to initiate and continue breastfeeding and not be separated from their infants unless the mother is too unwell. WHO has detailed information in our clinical guidance about how to breastfeed safely. Dr. Tedros: (03:47) WHO is also concerned about the impact of the pandemic on adolescents and young people. Early evidence suggests people in their teens and 20s are at greater risk of depression, and anxiety, online harassment, physical and sexual violence, and unintended pregnancies while their ability to seek the services they need is reduced. The school and university closures can also have a dramatic impact on the ability of adolescents to access preventive services. In some countries, more than one-third of adolescents with mental health conditions receive their mental health services exclusively at school. Millions of children who are fed through school meal programs also have reduced access to food. Limited opportunities for physical activity and increased use of tobacco, alcohol, and drugs may have impacts on the long-term health of these young people. Dr. Tedros: (04:56) To address these challenges, WHO has developed guidelines on maintaining essential services, which we have discussed before. There are also many things people can do to take care of their own health, like staying active, eating a nutritious diet, and limiting their alcohol intake. New products, information, and technologies are changing how health services are delivered. Increasingly, some medicines and tests can be safely obtained over the counter at pharmacies, or can be prescribed by doctors online, and delivered to people's homes. WHO has developed guidance on self-care interventions for health, which can be rapidly introduced in countries to save and improve lives. Dr. Tedros: (05:52) For example, providing women and girls with self-injectable contraception can greatly reduce the burden of unintended pregnancies. Access to treatment for people living with HIV and medicines for other health conditions that people can self-manage can reduce the burden of overstretched health systems while meeting the health needs and rights of individuals. Self-care interventions enable more people to obtain the health services they need during the pandemic when and where they need them. Dr. Tedros: (06:33) It's our collective responsibility to ensure these interventions are available and accessible to all people who need them. To talk more about the impact of COVID-19 on women, children, and adolescents, today I'm honored to be joined by four distinguished guests: Natalia Kanem, Executive Director of the United Nations Population Fund, Gabriela Cuevas Barron, President of the Inter-Parliamentary Union, Jayathma Wickramanayake, the UN Secretary-General's Envoy on Youth, and Mary-Ann Etiebet, the Executive Director of Merck for Mothers. I would like now to give the floor to my sister, Natalia. Please, you have the floor. Natalia Kanem: (07:30) Thank you very much indeed, Dr. Tedros. Greetings to all colleagues. UNFPA is proud to host Every Woman Every Child. Now in its 10th year, EWEC has galvanized political momentum, its women leaders Roundtable, advisors on the immediate actions we need to protect hard-won gains on sexual, reproductive maternal, newborn, child, and adolescent health. Today I'm here as a doctor, leading and speaking for UNFPA in the interests of women and girls facing COVID-19. It is a very serious situation. Action is a must because the realities and the consequences of inaction have never been so stark wherever maternity and child health services are not functioning or only partially functioning. In over 150 locations around the world every day, UNFPA reaches out to women and girls with reproductive health and violence protection services, bringing to life the care, including in humanitarian settings, through the rapid response mechanism UNFPA leads. Natalia Kanem: (08:49) With COVID-19 affecting health systems, many pregnant women are being cut off from reproductive healthcare. Many thousands could die from preventable complications of pregnancy and childbirth. Women like [Zaynab 00:09:04]... She delivered a daughter at home with absolutely no help. There was no midwife, no doctor. The maternity facility closest to her is closed down. Sadly, Zaynab hemorrhaged to death after the birth. We must do better. Pregnancies don't stop for the pandemic. Sexual and reproductive health services are not just nice to have. They are essential. Even before the emergence of COVID-19 for millions of women, timely high-quality maternal healthcare was unavailable. It was an accessible or it was not affordable. Natalia Kanem: (09:44) Now with the pandemic, we're seeing exacerbation of already limited access to care, putting women's health and lives at risk. UNFPA has shown that for every six months of curfew, lockdown, disruptions, some 47 million women will lose access to contraception. This would result in an additional 7 million unintended pregnancies during that six-month period. Progress on children's health, by the year 2030, is equally threatened with an estimated 13 million more child marriages over the next decade and an additional 2 million incidents of female genital mutilation. What can we do? We can act and act swiftly, countries making sexual, reproductive, maternal adolescent and newborn health services universally available and declared essential during the pandemic. For UNFPA, the COVID response hinges on services and on data. Natalia Kanem: (10:51) First, uninterrupted sexual and reproductive health services, so midwives and other health personnel get the personal protective equipment, PPEs, that they need. Second, we are helping to keep the supply chain going for on-time delivery of contraceptives, maternity drugs. We're providing dignity kits with menstruation necessities and other reproductive health commodities. Third, and certainly not least, we are joining WHO and others in sounding a red alert to stop gender-based violence and to give timely assistance for women and girls who are now trapped in abusive situations because of COVID. Natalia Kanem: (11:32) It's truly an emergency, a pandemic within the pandemic. Everybody, men especially, has a special responsibility to stop gender-based violence in its tracks once and for all. UNFPA working with the World Health Organization and other partners to maintain supply chain continuity to leave no one behind using technology, telemedicine, hotlines, and certainly to provide mental health counseling. UNFPA is gathering disaggregated data to support governments, to identify, and reach those most in need during the pandemic, including elders and people with disabilities. Natalia Kanem: (12:12) During this first ever International Year of the Nurse and Midwife, UNFPA salutes the world's midwives. Dear midwives of the world, you are the unsung heroes on the front lines of this COVID crisis, and you're essential when it comes to maternal and community health services to ensure safe pregnancies and births for everyone everywhere, to provide contraceptive services and information to young people, to prevent unintended and teenage pregnancies, and to prevent unsafe abortion, all major causes of preventable maternal death. Every single day, midwives risk their lives to protect women and newborns. They urgently need and deserve protective equipment just like other frontline workers. Natalia Kanem: (13:02) COVID-19 is devastating. Yes, it's making the road to 2030 steeper. It's been the great revealer of deep-seated inequality, and yet I believe the pandemic's effects around the world is giving us a unique opportunity to recast how we do things, to reimagine health systems, to recalibrate people-centered care, and as Secretary-General António Guterres says, " Build back better." With political leadership at the highest levels, with earmarked resources, with disaggregated data, and with hard work, I believe we can. We must build back better with more resilience and inclusive health systems so that our mothers, our sisters, our daughters, so that women will not die. Natalia Kanem: (13:52) Let us work in unity with EWEC during this crisis to assure that maternal health is prioritized. There's nothing more tragic than a woman losing her life as she gives birth, tragic for her, for her helpless newborn, for her family, community, and society as a whole. Let us be the generation that defeated COVID-19 and put an end to preventable maternal mortality within our lifetimes for every woman and every child. Thank you. Thank you very much, Dr. Tedros. Dr. Tedros: (14:25) Thank you. Thank you, Natalia. That was really amazing. Thank you so much for your message. Now to Gabriela Cuevas Barron, President of the Inter-Parliamentary Union. Gabriela, the floor is yours, please. Gabriela Cuevas Barron: (14:47) Thank you. Thank you very much, Dr. Tedros. Thank you very much, Dr. Natalia, Jayathma, Mary-Ann. Thank you very much for this opportunity of working together for every woman and every child. The COVID-19 pandemic is not only having a direct impact on those infected, but also indirect consequences due to the disruption of routine health services and far-reaching socioeconomic impacts, further exacerbating inequality. Women are affected differently than men. 70% of health workers are women. Women make up the majority of careers at home, as well as workers in grocery stores or pharmacy, putting them at high risk of infection. Gabriela Cuevas Barron: (15:34) Projections from the United Nations Population Fund, just as Dr. Natalia was mentioning, estimates that disruptions in sexual and reproductive health services could limit access to modern contraceptives for 47 million women and leading to 7 million unintended pregnancies. Also, a very important issue is that violence against women has already reached epidemic proportions in all societies, with 137 women killed every day globally by a member of their own family. The level of domestic violence and sexual exploitation further increases as a result of confined living conditions and economic stress. Gabriela Cuevas Barron: (16:21) Children and young people are not put at the center of this pandemic, but there is becoming the greatest victims. They are severely impacted by socioeconomic measures with 42 to 66 million children who could fall into extreme poverty as a result of the crisis this year. Financial hardship for families and the closure of schools are expected to increase malnutrition with long-lasting effects on wellbeing of children and young people. Young people, in particular, the most vulnerable, such as the young migrants, young refugees. Young people with HIV also have limited access to information, education, and social support services. To ensure that the pandemic does not disproportionately affect women, children, and adolescents, but also that we take this opportunity to build a better and fairer societies, we need to ensure, first, that measures taken in response to COVID-19 protect and support the most vulnerable. Gabriela Cuevas Barron: (17:31) As a parliamentarian and as President of the Inter-Parliamentary Union, I know that parliaments have a great responsibility in this regard and that they must be at the heart of the national and global response to COVID-19. We need to prioritize the continuity of services, including sexual and reproductive health services, immunization, and nutrition programs, ensuring access for all women, children, and adolescents. Also, we need budgetary oversight so that an effective response can be assured as WHO has been mentioning: find, test, isolate to treat and trace. Gabriela Cuevas Barron: (18:14) It is also important that decision-making processes are inclusive. This means that we need equal representation of women in order for policies and strategies to be effective for those in greatest need, ensure that health workers have personal protective equipment. Healthcare workers and first responders must be protected. Of course, they must also be protected against the stigmatization and attacks. Address care work, paid and non-paid, that is largely performed by women, apply a gender lens in the design of all measures to address the socioeconomic impact of COVID-19 to ensure greater equality and social protection of women who are more likely to have lower pay and to have less secure jobs. Gabriela Cuevas Barron: (19:09) For this pandemic, we must not lose sight of the needs of pregnant women as a vulnerable group. We must care for them and for their babies. The IPU parliamentarians are committed to the implementation of the universal health coverage initiative. This initiative represents an opportunity to promote a comprehensive and coherent approach to health through health system strengthening. This initiative has its basis on the belief that all persons and all communities should have access to quality essential health services. Governments must ensure the safety and wellbeing of children. We have, here, a lot of numbers, but the reality is that we took children as a population that is already safe. That is not a 100% sure answer. We need to come with answers in terms of nutrition, in terms of health, in terms of schooling. It is also about their wellbeing. Gabriela Cuevas Barron: (20:12) As parliamentarians, our duty is to ensure that these problems are adequately addressing legislation, as well as provide the means to do so through approval of budgets that can fund efforts into that direction. We know that to ensure a comprehensive approach, that goes with joined immediate short-term response to the pandemic. Yes, it is very much needed. We need an answer and a solution for the pandemic, but also, we need a plan. We need measures to address the root causes of gender and social inequalities that must be at the center of efforts like parliaments, governments, and all other actors during and after COVID-19. This includes addressing financial, cultural, and legal barriers to access health, improving nutrition, and access to education and information, including on sexual and reproductive health and rights. Gabriela Cuevas Barron: (21:06) The time for action is now. We have a collective responsibility to protect and promote the health and rights of all women, children, and adolescents. In the face of this pandemic, we cannot continue business as usual. We must take this opportunity to finally drive the changes needed to transform our societies for women, children, and adolescents. From the Inter-Parliamentary Union, we're fully committed on having parliamentary responses to COVID-19 and to build better societies after this pandemic. Thank you very much for having us and working directly with the parliaments. Dr. Tedros: (21:46) [Spanish 00:21:50], Madam President. Now we proceed to the next speaker. I have Jayathma Wickramanayake who is the Secretary-General's Envoy on Youth. You have the floor, Jayathma. Please proceed. Jayathma Wickramanayake: (22:12) Thank you very much, Dr. Tedros. With time, you have gotten so much better at pronouncing my surname, so congratulations on that. As you said, Dr. Tedros, we are all impacted by the COVID-19 pandemic regardless of our age. The health and non-health impacts of the COVID-19 on adolescents and young people are proving to be significant and long-lasting. The pandemic has exacerbated, as we all know, the existing vulnerabilities and inequalities. We are also witnessing the fact that the impact of COVID-19 will continue to be felt most harshly by the adolescents and young people of this generation already, who are starting their lives in difficult or disadvantaged circumstances like young refugees, young migrants, young LGBTIQ people, young people in detention, young people living with disabilities, young people living with HIV. Young people living in poverty are disproportionately affected. Jayathma Wickramanayake: (23:17) I touch upon what are the impacts of health particularly the impacts of sexual and reproductive health on adolescents and young people. Research indicates that children and adolescents are just as likely to become infected as any other age group and can spread the disease. Evidence to date suggests that children, adolescents, and young people are less likely to get the severe disease, but severe cases can still happen in these age groups, in particular, for those with underlying chronic health conditions. They should follow the same guidance for physical distancing, hand washing, and maintaining overall good hygiene practices, self-quarantine, and self-isolate if there is a risk that they have been exposed or are showing symptoms. I would like to reiterate the message to all the young people. Jayathma Wickramanayake: (24:03) The COVID-19 response is already putting immense stress on health systems around the world. It's disrupting the delivery of routine health services and information to young people, sharply limiting access to sexual and reproductive health services, disrupting immunization schedules, and cutting off young people's access to health services delivered through schools and universities, which are now shot because of physical-distancing measures. As the pandemic spreads to low income and lower middle-income countries, which have disproportionately large numbers of young people and comparatively weaker health systems, direct and indirect health impacts on adolescents and young people will likely increase. With the observed disruption of health services, young people who need essential time-sensitive and life-saving medication and information services may be at risk of not being able to access them. For an example, adolescents and young people's access to sexual.. Jayathma Wickramanayake: (25:03) For an example, adolescence and young people's access to sexual and reproductive health services is disrupted, which puts them at risk of unintended pregnancies, STIs, HIV, sexual and gender based violence. Needless to say that young women and girls are particularly vulnerable as Dr. Natalia mentioned the staggering projections in her remarks. 1.2 billion children and youth are kept out of school by the pandemic and this means that they not only miss formal education, but also non-formal education, which they usually receive through community interventions, universities, school clubs, youth clubs, peer organizations, and networks and youth groups. So not having access to this information could seriously impact the choices they make about their lives and bodies today but also impacting seriously their futures. Jayathma Wickramanayake: (25:54) And the second point I'd like to touch is on mental health. Before the COVID-19 emerged, the statistics on mental health conditions for young people were already stark. Around half of all mental health conditions start by age 14 and suicide is the second largest leading cause of death among young people aged 15 to 29. Now because of the pandemic and the lockdown measures, adolescents and young people have limited access to positive coping mechanisms that they turn to otherwise in times of crisis. For an example, social initiatives, community service, voluntary service, formal and non formal education opportunities, sports, youth clubs or other types of physical activity. A study carried out with young people with a history of mental health needs living in the United Kingdom reported that 83 of the young people who participated, 83% of the young people who participated in the survey agreed that the pandemic had made their mental health worse. A study done in Ethiopia in April 2020 reported a threefold increase in the prevalence of symptoms of depression compared to the estimates from Ethiopia before the pandemic. Jayathma Wickramanayake: (27:07) Parents in Italy and Spain have also reported that their children have had difficulties in concentrating as well as irritability, restlessness, and nervousness. The stay at home measures have come with the heightened risk of children witnessing or suffering violence and abuse as well. In a webinars series called Coping with COVID conducted by my office in partnership with WHO and UNICEF, we heard some dreadful stories from LGBTIQ young people who were forced to lock down with parents, families, and friends who do not accept them for who they are. And this is quite worrying. And a study published in the Journal of the American Academy of Child and Adolescent Psychiatry argues that mental health impacts may persist after the end of the lockdown measures as well. Examples, social isolation and loneliness shown to increase the risk of depression and possible anxiety at the time of loneliness was measured in between 0.25 to nine years later. Therefore the need for adolescent and youth sensitive mental health and psychosocial services and counseling will increase and should increase as the pandemic progresses. Jayathma Wickramanayake: (28:23) So three solutions before I wrap up. First, the post-COVID response plans must be sensitive to adolescent and youth specific healthcare needs. This means developing and funding national plans that shift care away from institutions to community youth-led grassroots-led services, allow for outpatient services, mobile clinics, and peer groups, ensuring the coverage of all young people without discrimination. Second , governments and policymakers must ensure that within the context of universal health coverage, availability and accessibility of youth-friendly mental health services and youth-friendly rights based sexual and reproductive health services and comprehensive sexuality education. Thirdly, governments and institutions need to see young people as partners not as troublemakers. There are thousands of young people right now volunteering in the communities as frontline healthcare workers, they're running hand-washing campaigns, fighting misinformation online, they're innovating solutions. So make them your allies, and make them your partners, support their work, create safe spaces for them and invest in their work. Jayathma Wickramanayake: (29:34) So these solutions that we are proposing will last for generations to come. Thank you. Dr. Tedros: (29:42) Thank you, thank you. And thank you for your kind words. And I would maybe add one more language from Sinhala to you for joining us [foreign language 00:04:56]. I hope it's correct. [foreign language 00:05:07] That means- Jayathma Wickramanayake: (30:09) Yeah. It's okay. Dr. Tedros: (30:11) Thank you. Thank you so much. Thank you Jayathma, thank you for your message and thank you for your hard work and we're really proud of you. And then the next speaker will be Mary- Ann Etiebet, the Executive Director of Merck for Mothers. You have the floor, Mary-Ann. Mary-Ann Etiebet: (30:39) Thank you so much, Dr Tedros. I'd also like to extend my thanks to the UN Secretary General Every Woman's Every Child initiative for the opportunity to contribute today and add to the perspectives and insights already shared by the other champions for women, children, and adolescents in this briefing. MSD for Mothers was created back in 2011 when our company made a $500 million commitment to help create a world where no woman has to die giving life. And MSD for Mothers is also known as Merck from Mothers in the US and Canada. And I'd like to thank Dr. Kanem specifically for sharing so eloquently just what is that state care, when it comes to maternal mortality. The COVID-19 pandemic threatens our shared vision for helping end preventable maternal deaths. In the worst case scenario, a recent publication in The Lancet estimated that COVID-19 in the next six months alone could result in the deaths of over 1 million children and over 50,000 mothers. All due to the indirect the impact of COVID-19 and the reductions in utilizations of essential services. We are all living in that worst case scenario right now. And I want to share two examples from Nigeria and India since together they account for over a third of all the global maternal deaths we see. In May, the Nigerian Ministry of Health reported that antenatal care visits and child immunization visits had dropped by about 50%. Skilled birth attendance was also dropping by almost 40%. and data from the Indian Health Management System also suggests that in March, after a nationwide lockdown was enforced, institutional deliveries dropped by 43%. We have already learned from the affected West African countries how Ebola wiped out 28 years of progress towards maternal, child and adolescent health goals. We cannot afford to look back on the next 10 years as the decade of picking up the pieces and rebuilding trust in the ability of health systems to deliver on essential services for women and children. Mary-Ann Etiebet: (33:10) We need rather to look back on the next 10 years as the decade of accelerating action because we all came together to do this. We need to recognize that funding for essential services for women, children, and adolescents will continue to come under increasing pressure. But we can build on preexisting institutions, including those like the World Bank's Global Financing Facility, whose core mission is to ensure sustainable health financing for these goals. MSD for Mothers is proud to be part of the GFF, which is currently supporting 36 countries to scale up access to comprehensive primary healthcare services, which are critical for effective pandemic preparedness and response. COVID is also teaching us other hard truths. It has exposed societal fault lines around gender, racial and ethnic inequities, and our inability to deliver on essential services for the most vulnerable, marginalized, or disenfranchised is not just a reflection of the fragility of our health systems, it's also a reflection of our societal values. We need to ensure that in our responses to COVID, we do not exacerbate inequities in health outcomes, including those inequities we see in the US and around the world due to systemic racism. As the global community mobilizes action against the pandemic, we need to recognize that it is not just about making the right decision for the moment, but it is also how we make the right decision in the moment, for the future. We will need multi-sectoral partnerships, we will need to support an innovation ecosystem, and we will need to remember that health systems should not end at the facility, but they should end with the person wherever they may be. Mary-Ann Etiebet: (35:18) Regarding that first point of ensuring that we are leveraging the strengths of all sectors to augment [inaudible 00:35:25] government responses, one potential solution includes leaning into the capacity of local private sector, whether it be the local private providers, the physicians, the nurses, the midwives, the supply chain distributors, the lab techs who can help deliver healthcare. Or whether it's leaning into social innovators who are creating digital solutions so we can better communicate with patients. And even local industry who are helping to manufacture essential PPE that our healthcare workers need, 70% of whom are women. We are seeing this for example, in South Africa where the government is including local private sector in their strategic response plan. Partnership is critical in all we do. MSD for Mothers is a board member of the Partnership for the Maternal, Newborn and Child Health group, which is the world's largest multi-sectoral alliance for these issues, with more than a thousand members and led by board chair, Helen Clark, the former Prime Minister of New Zealand. Mary-Ann Etiebet: (36:33) We are all standing behind a new seven point call to action, to protect and improve women, children's and adolescent's health, not just during COVID, but also beyond. And all of these champions, and civil society, and governments, the private sector, the health professional associations, youth groups, donors, academia, the UN, and more, will all be gathering virtually at the PMNCH Summit in July to drive multisectoral action for women, children, and girls. Mary-Ann Etiebet: (37:05) Second, we need to support an innovation ecosystem so that we can accelerate the timeline to develop deploy and scale solutions. Solutions that are not only needed to control the pandemic, but solutions that can also help us deliver essential services efficiently, at a high level of quality and at scale. Private sector will be an essential partner in this. And last but not least, COVID is teaching us that we must reach people wherever they are. Health systems don't end at the facility. They need to end with the person. So whether it's through those mobile units that Jayathma mentioned, or through community health workers meeting patients in their homes, or through technology connecting with patients on their phones, we can learn from our responses during COVID to build back better patient-centered care. Together we can do this, building on the global solidarity that is already driving our COVID-19 responses, to build stronger, more resilient, more responsive, and more inclusive health systems, that we can continue to protect and improve the lives of women, children, and adolescents. Thank you. Dr. Tedros: (38:30) Yeah. Thank you. Thank you so much, Mary-Ann and thank you to all again. Please Tariq back to you now for the next session. Tarik: (38:39) Thank you. Thank you Dr. Tedros and big thanks to all of our guest speakers. I understand that they will stay with us for any possible questions. So I would really encourage journalists to take this opportunity to use the presence of our distinguished guests and ask questions on this particular topic. Journalists who are with us on Zoom can listen this press briefing in 61 languages plus Portuguese plus Hindi. And this is thanks to our interpreters who are here with us today and we would like to thank them. Journalists can also ask questions in 61 languages and Portuguese, not in Hindi for the moment. So we will start with the questions. We expect everyone to be short, concise, and have only one question. So if we are ready from the technical side, we will start with the Shanghai Media Group and we have Bin Chen online. Hello? Can you unmute yourself please? Bin Chen: (39:47) Yes. Hello? Can you hear me? Tarik: (39:49) Yes, now we can hear you, please go ahead. Bin Chen: (39:52) Okay. Thank you very much for the special guests speech, but my question's not related to this subject. Sorry for that. But thank you for taking my question. So today EU announced its plan to invest billions in purchasing vaccines from pharmaceutical companies [inaudible 00:00:40:07], to secure enough shots for European citizens. While Washington indicated before also that it wants US-make vaccines for itself. So my question is, how would WHO formulate guidelines on the allocation of vaccines in the future to ensure fair access to pandemic remedies worldwide, especially for under-developed countries? Thank you. Dr. Michael Ryan: (40:34) Tedros may wish to comment. In fact, Tedros leads a very important global group looking at these issues on a weekly basis and having very productive video telephone conference with many partners, including the European Union last night. There are a number of initiatives around the world to secure vaccine for either single countries or groups of countries. And we need to work closely with those initiatives. The ACT accelerator, the Access to COVID Tools accelerator, and the vaccine component of it led by CEPI, by Gavi, and WHO seeks to not only identify the appropriate vaccine products, but to accelerate their production, ensure that there are adequate stocks and work across the whole partnership, political, scientific, and manufacturing to ensure that there is fair and equitable access to those. There are many ways to achieve that. Not one, I don't believe one single mechanism right now can do that because a number of initiatives were already started. Dr. Michael Ryan: (41:44) I think we have to recognize that reality. And I believe it's in the interest of the world that WHO and other agencies now work together with those alliances to ensure that everybody is pushing in the same direction and that is the production of enough vaccine to meet the demands that we would have according to the strategy and to ensure that we have fair and equitable availability of that vaccine to those who most need it. And Dr. Tedros has been pushing very hard in this direction and convening all players to ensure that everyone is aware of their responsibilities to contribute to this global good. Dr. Tedros: (42:31) Thank you, thank you, Mike. This question is very, very important and I will just add a few things to what Mike had already said. As you know, WHO and its partners have launched an initiative which is the ACT accelerator on April 24. And you also remember that there was a Pledging Conference by European Commission on May four, which was very successful and raised around eight billion US dollars. And we are also working with, as Mike said, with all relevant stakeholders regularly, especially to address one of the two objectives outlined during the launching of the initiative, which is access to the product that we hope will be produced or the vaccine that we hope will be produced, access by all who need the vaccine. Dr. Tedros: (43:50) Of course, we have already discussed in that platform of the meeting of the relevant stakeholders a draft allocation framework. But that draft or the allocation criteria cannot be implemented unless there is a global consensus on making any vaccine that will be found or discovered as a global public good. And for that to happen, we need political commitment. So a global consensus that's based on political commitment of our leaders will be very important. The good news is, many leaders as you have heard them say it during the launching, during the Pledging Conference, during the World Health Assembly, many leaders promoted the idea of making any vaccine that would be found as a global public good. But that should really be continued to be promoted and more leaders should join the boat. And we need to have a truly global political commitment and global consensus before even we have the product. Dr. Tedros: (45:29) So that's what we're pushing, but of course it's not yet completed. But we hope the world will agree and we'll have a consensus to make a vaccine that will be found a global public good. So this will be the commitment of not only by the way, the political leaders, but I think it's everybody's business too. And the voice of every citizen globally will be very important to assure access to vaccines and other products by those who need it. Thank you. Tarik: (46:19) Next question comes from Spain. We have [inaudible 00:46:21] from El Mundo Online. [inaudible 00:46:25] can you hear us? Please unmute yourself. Speaker 1: (46:30) Yes. Tarik: (46:32) We can hear you. Please go ahead. Speaker 1: (46:33) Okay. I have to [inaudible 00:46:38] two questions. First. I wondered if you are considered making an universal recommendation for the return of the children and kids to school [inaudible 00:46:54] measures because the behavior of the transmission in this population is really unknown. There are different points of view. And the other questions, it's about if there should be a global unification of data accounting in order to make more comprehensive comparison of the situation between countries, both a consumer case [inaudible 00:22:24]. Thank you. Tarik: (47:31) I will the repeat the question. So first one is if WHO is considering making a universal recommendation for the return of children to schools. And the second one is should there be a global unification of data in order to make a more comprehensive comparison of situation between countries? So, [inaudible 00:47:51] thank you very much for joining us for the first time. Normally we take only one question per journalist but I'll let our speakers help. Dr. Michael Ryan: (48:00) I'll just begin. Maria will comment on this. Issued guidance and considerations for the reopening of schools and Anshu is actually with us here today. He's actively engaged with education around the world and others and we will be bringing further technical advisory groups together around the whole issue of school and risk management at school level. It is very difficult to give a universal recommendation around school opening or closing. Dr. Michael Ryan: (48:27) As you can imagine, the contexts are extremely different, the epidemics are very different, the vulnerability of children in different settings is very different. School is a very different concept in many parts of the world. The age stratification and what you do in young children versus older children, versus adolescents, versus university. So it's very difficult to make universal recommendations. We have issued considerations and very detailed considerations for the risk-based decision making that governments should make. But I'll maybe pass to, maybe Anshu may have a comment on this, and maybe Maria can take the question on the bringing together of global data. Dr. Anshu: (49:06) Thank you very much. And so I think it's very important to highlight that we've seen negative impacts of closures of schools and at the same time also, we've seen that it has an impact on transmission. So what's very important for us is to identify better, what the impact has been of closure of schools on transmission in the community. And that's something that we're looking at at the moment. We have also identified that closure of schools has contributed or will contribute to poor educational outcomes, to mental health issues, as already mentioned by a previous speaker, but also to poor nutrition. Many children actually depend on a meal at school for their nutritional status, as well as looking at the impact of violence against children also highlighted earlier. So I think we need to really look at the balance, what is the risk or what is the impact of closing schools on the impact on children? Dr. Anshu: (50:03) What is the impact of closing schools on the impact from children versus the transmission in community, and that's something that we're studying at the moment. Dr. Maria Van Kerkhove: (50:11) Thanks very much. If I could just briefly add on the first question around the considerations to reopen schools. As Mike has said, we have issued guidance around this because it is very context specific. And when taking that decision, there's a number of factors that need to be taken into consideration, including the current epidemiology and transmission, intensity of transmission of COVID-19 in the area where the schools are and where the children live that go to those educational institutions. Dr. Maria Van Kerkhove: (50:39) And also the setting that the school is in, or that institution is in, what is their ability to maintain the ability to prevent and control transmission of COVID-19? And so what we've done is we've tried to outline these considerations to help the decision makers take the decision of when and how to open those. Looking into the school policies, the resources, the infrastructure that the school has, the policies, not only for the school staff, but for the students themselves. Looking at the different behavioral aspects or the age considerations. Obviously for younger children, there are different considerations for those that are at university or even in a high school level. Looking at hygiene and environmental cleaning within the facility itself. Looking at the ability of the school system to be able to screen for cases, detect cases. Dr. Maria Van Kerkhove: (51:34) What is the plan if you do find a case through the school itself? Education and communication through the parents and the students themselves, so not only talking to students, but listening to students and feeding that back into the plan. And looking at the ability to put in physical distancing and other public health measures that also need to be taken into consideration. So as Mike has said, as Anshu has said, it's very context specific, and so to set one policy is very difficult. And so what we're trying to do is help the decision makers take those decisions to reopen school safely. Dr. Maria Van Kerkhove: (52:10) With regard to the second question around global data. So indeed we do have systems in place to capture data from countries around COVID-19 cases. We have the mechanism through the IHR where official cases are reported to us through the IHR mechanism. We have issued case definitions which helps to define who is a suspect case, who should be tested, because as you know, our recommendation is to test suspect cases, and there's definitions for who those suspect cases are. Dr. Maria Van Kerkhove: (52:49) And we have also issued guidance around surveillance systems. How would one find suspect cases? Looking specifically at different populations and looking for cases in the community. And so the mechanism by which we capture that information is through IHR. And we have teams that are working to analyze the data that comes in to help us better understand the transmission situation and the characteristics of the cases reported. Tarik: (53:15) And we'll just ask if any of our speakers would like to add something on this first question on reopening schools. I understand that Natalia would like to add something. Natalia Kanem: (53:33) Yes. I think the question on data is extremely important. And I just wanted to remind all that the global action plan on SDG3, which relates to data and digital health as an accelerator of universal health, is something that WHO and UNFPA have been co-leading. And here at the cooperation at the country level where we never take our eye off of 2030, and the sustainable development goals even with COVID. The cooperation of country governments is extremely important as we strive across the 12 global health organizations, which are signatories, to align and accelerate and account and engage with governments on comprehensive, modern and functional health information systems, really depends on all sectors working together at the national levels. Thank you. Tarik: (54:31) Thank you very much, Dr. Kanem. If any other speakers would like to add, you just let us know. Not at this stage, I understand, so we'll go to the next question. We will go to Agence France-Presse and Nina Larson. Nina. Nina Larson: (54:49) Yes. Hi. Thank you very much for taking my question. I wanted to ask Brazil's President, Jair Bolsonaro, yesterday called on people to go into hospitals in the country to shoot video to show that the hospitals aren't overwhelmed at a time when the numbers are soaring in Brazil. I was wondering if you could say something about your thoughts on leaders making these kinds of suggestions. In the U.S. you also have the President who's planning on having his rallies this month. So I was just hoping that you could say something on this. Thank you very much. Dr. Michael Ryan: (55:34) Yes. While the numbers in Brazil have been high and continue to be high, and the number of deaths continues to be high, the health system itself across, and our colleagues in our America's regional office in PAHO, the Pan American Health Organization, are tracking on a daily basis, a number of parameters in Brazil, including the ICU bed occupancy each day across the 27 different administrative areas in Brazil. Dr. Michael Ryan: (56:06) And while a few have exceeded 80% occupancy, most areas are below that. Some are at a critical stage in terms of above 90%, and it's clear that some areas of Brazil have quite a bit of pressure on the intensive care system. So [inaudible 00:56:31] as such from the data we see is not overwhelmed, but certainly in certain parts of Brazil, there's a significant pressure on the intensive care unit bed occupancy. And again, we commend the brave frontline health workers, and doctors, nurses, and others who continue to provide that service in so many different facilities across Brazil and across the world. Dr. Michael Ryan: (56:56) So from that perspective, yes, the situation in Brazil is of concern. All 27 areas are affected. We've seen different rates of infection. There are clear hotspots in heavily populated areas. There are clearly different impacts in different populations. We've seen the impact in Amazonas, but overall, the health system is still coping in Brazil. Though having said that, with the sustained number of severe cases, that remains to be seen. And clearly the health system in Brazil across the country needs significant support in order to sustain its effort in this regard. But the data we have at the moment supports a system under pressure, but a system still coping with the number of severe cases. Tarik: (57:47) Thank you very much. We have received interesting question on email that's from World Health Alert Crisis, Karen Wolfson, who's asking, "Do you think countries would benefit from testing more children for COVID-19 so that we can get a clearer picture on how it affects children and adolescents?" Dr. Maria Van Kerkhove: (58:13) I can start and perhaps others may want to supplement. I mean, I think one of the areas of our understanding of this pandemic that's really limited is our understanding of COVID-19 in children and adolescents. And we have a number of unknowns that we're really trying to better understand is how often are they infected? Do they play a role in transmission? And if so, how much are they playing in that role? What roles do schools potentially have? And these are a number of areas of unknowns. And certainly there are some surveillance, look in children is important. Surveillance in all different populations is important. And there are a number of other ways in which data that could be collected for children, particularly with schools reopening in some areas. And we should note that in some countries schools didn't close. There are also seroepidemiologic investigations that are underway that some of those include children, and that will also give us more information about the extent of infection in children. Tarik: (59:21) If anyone wants to add something on that from our guests, let us know. If not- Dr. Michael Ryan: (59:28) Tarik, just also to say that there are some studies underway, and I know the unity studies, the zero prevalence studies also have nested studies on the incidents and prevalence in children. And I know colleagues in the UK have launched an extensive zero prevalence study looking at the experience of children of infection, not just of severe infection. And understanding the mild pattern of disease and how children participate in the overall transmission of disease or not. And then looking at the more severe end of the spectrum and why some children, very few, end up with severe outcomes from the disease. Dr. Michael Ryan: (01:00:01) These are really all very important interlinked, but independently important measurements we need to make. And notwithstanding what Anshu said, there are other negative impacts of this COVID-19 pandemic on children which may not be measured in serology, and they may not be measured in hospital admissions, but may be measured in educational attainment and psychological stress. And then disruption two important developmental milestones that we all hope our children reach at the appropriate time. Tarik: (01:00:33) Many thanks. We'll get to the next question. It's Jim Roope- Natalia Kanem: (01:00:37) Actually, if I- Tarik: (01:00:38) Yes, please go ahead. Natalia Kanem: (01:00:38) If I could just interject very briefly. This is really a crucial question in terms of surveying the epidemiology of where we're going. But the bottom line is how will we pay for the additional testing once available? And Gabriela may wish to speak to the importance of parliamentarians as the budget setters on the ground where it counts. The guidance is there and the invitation to do things is there, but what really turns into action is what countries decide. So I'd like to be very clear in the role of parliaments in influencing the budget allocation if we need more testing among an adolescent or a child age group. And there are barriers to resource mobilization at a time when economies are struggling and worried. So I think not just the policy barrier, but also the financial barriers are part of that discussion of how do we practically get the job done. Thank you. Tarik: (01:01:39) Thank you very much, Dr. Kanem. Gabriela Cuevas Barron: (01:01:42) If I may- Tarik: (01:01:43) Yes, please. Gabriela Cuevas Barron: (01:01:44) Thank you. Thank you so much, and thank you, Natalia, for bringing parliaments and parliamentarians to this conversation. Indeed, we have a very important role here when it comes to a budget or location. And I would like to separate two issues. I think, and as a parliamentarian, [inaudible 01:02:07] to you, but as a parliamentarian, I think that we need to see if the budget that was designed for 2020, is this still working for parliaments? Honestly, I don't think so, because most budgets were designed in 2019 where no one was imagined what's going to happen in the world. I think we are not even imagining what's going to happen in two months. So I think that we need to take a look to budgets that are being applied for 2020, and to allocate more budget for these health systems and the huge demand that they are facing. Gabriela Cuevas Barron: (01:02:47) We have seen some examples of countries that are building hospitals in a very fast way, that are developing research studies tests, and it is clear that budget is not being enough for the huge demand that the population is needing. And not only related to the basic health services, but for example, we just mentioned violence against women. We need it to strengthen old systems that are going to help women during this pandemic. Women are being left behind. They are not protected at home. They are not protected at work, and they are 70% of the health workers. So we need to put women, adolescents, and children at the center because, allow me to speak as a politician, but not a medical doctor, we have been hearing news talking about how this virus affects more men than women and how children and adolescents are not contagious. So we need to take a look on the different ways that this pandemic is affecting each of the groups and women, children, and adolescents cannot be left behind. Gabriela Cuevas Barron: (01:03:58) At the other issue is what are we going to do with the next budget? Because this pandemic is going to have severe effects, not only now, but also, I think it was Marianne who was saying, we need to take decisions right now, but for also taking a future consideration. So I think that it goes also to budget. Which are the needs now and which are going to be the needs in 2021? Because it is clear, and I think almost all countries are going to face that reality, I think that was part of what Natalia was saying, the economy is also struggling and when that happens, also public budget is going to be affected. Gabriela Cuevas Barron: (01:04:42) So I think that we should take a look at which are the priorities for the humanity, what are we going to do especially with children and adolescents? They do not vote. They do not participate in politics, but that doesn't mean that they cannot be taken into account. So I think that we need to put women, children and adolescents also for our priorities and budgets for 2021. Tarik: (01:05:09) Many thanks, Dr. Kanem and also President [inaudible 00:01:05:13]. Anshu, would you like to add something? Dr. Anshu: (01:05:17) Yes, I just want us to pick up on that last point, because I think it's important if we know whether children are actually an important element in transmission in the community or not. If not, then we don't have to close schools, and then parents actually don't have to stay at home and can continue working. So that link with the economy, I think, is an important reason why it would be important to have better data on children. Tarik: (01:05:43) Many thanks. We have couple of questions on breastfeeding. I will read one and then we will call on Jim Roope from Los Angeles, from Westwood One Radio. But first the question comes from New York Times from David Waldstein, who is asking the recommendation on breastfeeding. "Have there been studies to show that the breastfeeding is not a cause for COVID-19 transmission, and what are the main diseases that breastfeeding tends to prevent?" Jim, you also want to ask something about breastfeeding. Please go ahead. Jim Roope: (01:06:19) Yes. It was pretty much along the same line. Just a little clarification on the guidance on breastfeeding, especially for women who test positive for the virus, please. Thank you, Tarik. Dr. Anshu: (01:06:33) Thank you very much for that question. So far, we have not been able to detect live virus in breast milk. So several cases have been identified where there have been RNA fragments, so fragments of the virus in breast milk, but we haven't actually identified live virus in breast milk. And so the risk of transmission from mother to child so far has not been established. Dr. Maria Van Kerkhove: (01:07:00) And if I may supplement with the guidance that we have, an updated guidance we've published on May 27th, where we recommend and we have been recommending, that women who are suspect or confirmed, continue to breastfeed. They're encouraged to initiate and continue breastfeeding, and within the guidance outline ways to do that safely. Dr. Michael Ryan: (01:07:25) And just again, in terms of breastfeeding, has a lot of benefits beyond direct nutritional ones that certainly has been associated with preventing a whole range of different diseases including acute infections such as diarrhea, pneumonia, and various range of infections, [inaudible 01:07:44] influenza and other things and children. Now I know Anshu could speak for hours around the longterm health benefits of breastfeeding in terms of other chronic conditions of later life. So there is absolutely no question that breastfeeding provides the best possible nutrition for a child at any given moment, but also has direct beneficial effects in protecting children from infectious diseases. Tarik: (01:08:10) Anyone from our guests speakers would like to add something? No. Okay. So I will read one question that that came from Peter Schelling, who works with European news agency ENA. What's WHO recommendation on the vitamin A supplementation for preschool aged children in the context of COVID-19? Dr. Anshu: (01:08:42) We should continue providing vitamin A. It's an important vitamin A deficiency that can be prevented by supplementing vitamin A, and there's no reason not to do so. Tarik: (01:08:56) Okay. Thank you very much. So I will try now to go to Next Edition newspaper in Nigeria, and we have Adesa [inaudible 01:09:06] with us. Adesa, please unmute yourself. Speaker 2: (01:09:15) Okay. Yeah. Thank you very much. My question is on [inaudible 01:09:23] lockdowns in African countries [inaudible 01:09:28] from business owners. My question is should African governments ease lockdown now because infection is still rising and this situation may affect [inaudible 01:09:45], the health systems in Africa, especially in Nigeria, are very, very poor, [inaudible 01:09:58] women play the burden for caring for the home. So how do African governments factor in the role of women into this COVID-19? [inaudible 01:10:11] Thank you for having me. Tarik: (01:10:16) Thank you, Adesa, for this question. We had a very bad sound, but if I understood the question, it's how African governments should deal with easing the lockdowns in the context of increasing number of infections and the consequences it has on women and children. Dr. Maria Van Kerkhove: (01:10:37) So thank you for this very important question of balancing the need to control, suppress and control the virus while trying to lift some of these lockdown measures and resume economic and activity, especially mothers and children and for all. So we have outlined different ways in which we can support governments in taking decisions on when and how to lift these public health and social measures, or these so-called lockdown measures. And primary to this is to really understand the transmission. Is the outbreak in that area, in the area that we're talking about, controlled? Do we have a system in place? Is there the public health infrastructure in place to be able to detect cases and test for cases, care for those cases, find contacts, quarantine those contacts, and making sure that not only the public health infrastructure is in place, but the health infrastructure is there as well to care for those who need care for COVID-19, as well as other medical conditions, including those for women and children and adolescents. Dr. Maria Van Kerkhove: (01:11:49) Making sure that in situations that the risks for high vulnerable settings are minimized so that we don't have any hotspots of activity where the virus can really resurge very, very quickly. When resuming work, making sure that the workplaces are ready to be able to receive people back to work safely where these public health measures can be in place within the workplace facilities. And that communities are fully engaged and understand how the resumption of, and the lifting of some of these lockdown measures can be put in place. Dr. Maria Van Kerkhove: (01:12:26) Balancing that with trying to get people back to work, but ensure that the virus does not having an opportunity to resurge. We are learning from a number of countries who are trying to do this. They're doing it in a very slow way. They're doing it in a controlled and a deliberate way where maybe the resumption is not happening all at once in a country, but it's happening in different parts of a country, perhaps where the virus is actually controlled. And we are looking to do more in depth work with countries to better understand how they've done this, not only how these measures were put in place, but how they were lifted and how they are done safely. Tarik: (01:13:13) Thank you very much, Dr. Van Kerkhove. Our guest speakers, if there was anything you would like to add, just please proceed right now. If not, we will go to next question. And next question comes from India, and we have India TV and we have [inaudible 01:13:33] with us. Please unmute yourself. Hello? Do we have India TV on line? It seems it not a case. So we will go to [inaudible 00:23:59], our Geneva based colleague from Anatolia News Agency. [inaudible 01:14:05] Speaker 3: (01:14:07) Thank you very much for taking my question. [inaudible 01:14:09] There is a danger. It's called a triggerous second wave of COVID-19 outbreak. And are you optimistic that the pandemic will be under control in Europe and the rest of the world by the end of 2020? Thank you so much. Dr. Michael Ryan: (01:14:35) Well first and foremost, most of the world right now is still very much in the throws of the first wave of this pandemic. Some countries in Europe, in Southeast Asia, North America, have been through the peak of a wave of infection, and are slowly, carefully making their way out of that situation. Some had to entirely shut down their- Dr. Michael Ryan: (01:15:02) ... some had to entirely shut down their societies and economies to achieve that. Some have managed to avoid that. Dr. Michael Ryan: (01:15:09) The current uptick in cases in some countries can be represented, yes, as a second wave or a second peak. In other words, that the disease has not reached a very low level, maintained a low level, and then come back sometime later in the year. This is possibly in some countries related to reopening of society. Remixing of people and being in a situation without adequate social distancing, without adequate measures in place and without adequate capacity to test and isolate suspect cases and quarantine contacts, the disease can return again. And we've certainly seen a number of countries where that phenomenon has happened, not necessarily at a national level but in terms of a sub-national level. And countries have been working hard in Southeast Asia and other places to identify new clusters of disease and to break the chains of transmission. Dr. Michael Ryan: (01:16:09) It's not surprising at all that any country coming out of a so-called lockdown can have clusters of disease, reemergence of disease in clusters. That's not necessarily a second wave. That is just a result of, and many of you as journalists have asked us, there is a careful balance to be struck between keeping everyone at home and continuing to completely suppress transmission of COVID-19 and the untoward effects of that on the economy and society. And that's not an easy balance. This is a public health dilemma, and it's one that has to be carefully managed and balanced by every government, every minute, of every day. There are no correct answers in that regard. There is no playbook that can be written at the local level for each and every country in that circumstance. Countries have to balance those things. Dr. Michael Ryan: (01:17:01) Yes, we are concerned that we are still very much on the upswing of this pandemic in many countries, particularly of the global South. We are concerned that some countries are having difficulties in exiting the so-called lockdowns as they're seeing increases of cases again. And the responses in that regard for countries are going to be, are there alternatives now to controlling that uptick in cases, short of implementing full lock downs? Can countries engage in a much more micro process? Can countries identify exactly where they're getting an increase in cases? Can they apply measures there and avoid the playing measures in areas where they're not seeing that? Dr. Michael Ryan: (01:17:46) And that comes down to the granularity of your data. Do you know where the virus is? Can you tell specifically where the virus is increasing or decreasing? Do you have that knowledge? And within that, can you make an intervention at a geographic level that allows you to take some times increase measures without affecting the whole population? And that really comes down to the sophistication of your public health surveillance, your ability to test track and trace, your knowledge of the virus as it's spreading through communities, and your ability to apply measures in a way that's not a blanket measure. That you can lift and adjust measures at a sub-national or a sub-state level that allow you to be much more sophisticated in doing that. But that is driven by having good data. And without good data, it's almost impossible to take that approach. Dr. Michael Ryan: (01:18:37) As we've said previously, a comprehensive approach, strong public health surveillance, know where the virus is. If you see a rise in virus in a given area, strong cluster investigation, understand the risks, try and break those chains of transmission. And in a sense, we've said this, there must be an alternative to lockdown. Because in the absence of lockdown, the virus will tend to spread again. Dr. Michael Ryan: (01:19:01) The question is, what have you got to replace lockdown with? And what we have now in the absence of a vaccine is good public health surveillance, a strong relationship with communities so they know how to protect themselves and they're empowered to protect themselves. They're given the resources, the education and the materials to be able to do that. And that we in the health sector support them by putting in place the necessary surveillance, and we apply measures in as much as possible, the minimum measures to control the disease at the lowest possible level geographically. Dr. Michael Ryan: (01:19:34) It's very easy for me to sit here and say that. That is difficult to achieve in any circumstance, but it is the only way to sustain the next number of months while we wait for other interventions. And again, we have to say that we really hope we have an effective vaccine in time, but there are no guarantees. I've said it here previously, we have to learn to live with this virus. We have to find a balance of controlling this virus against the damage economically and socially of controlling this virus. This is a difficult dilemma, but we must find that balance. And each society must find that balance, which is in accordance with its values and what citizens in that country wish to achieve as a collective. And that's not always so easy to achieve. Dr. Tedros: (01:20:26) Yeah. Thank you. Thank you, Mike. And there is another dimension I'd like to bring to this question. We are truly concerned actually, because the world is divided. The world has never seen anything like this since the flu in 1918, which is more than a hundred years ago. This is a very dangerous virus, and it's very hard to fight this kind of virus in a divided world. That's what we should understand. Dr. Tedros: (01:21:07) And that's why, from day one, we have been calling for national unity and global solidarity. And we need this too in order to have a better outcome, like you say, by the end of 2020, or any time soon can happen with unity and solidarity, but it will be difficult in a divided world. That's why, again and again, we call for national unity and global solidarity. Thank you. Tarik: (01:21:43) Thank you much, Dr. Tedros. We will take a last question for this session of questions. Last [inaudible 01:21:53] before Dr. Tedros makes another announcement. Do we have a Gabriela Sotomayor from Proceso Mexican outlet with us? Gabriela? Gabriela Sotomayor: (01:22:03) [Spanish 01:22:04]. Dr. Tedros: (01:23:19) I don't have this particular information, which you said, but I will answer the question in general terms and, of course, repeating what I said earlier. At the national level, we have been saying it, many times, that there should be a national unity and that countries should unite in their borders, across party lines, across phases, across ideologies, or whatever differences we have. This virus exploits the cracks between us. This virus exploits the division between us. It's only when we are United, that we can defeat it. Dr. Tedros: (01:24:10) Some months ago, I had a phone call with the prime minister of Finland, and she was telling me about their model. Which is exactly what I said, they have a committee of the ruling and the opposition party, and they work together in identifying the problems, proposing solutions and working together to respond to the pandemic. That's the sort of national unity, across all the differences which I have said, is important. And when there is national unity, that leads to a genuine global solidarity too. When there is no national unity, it affects the global solidarity. And that's why we're calling for both, as a package, national unity and global solidarity. You can go back to history also. When the world unites together to fight a common disease or a common virus or other health problems, it succeeded when it united across ideologies or other differences it had. We should learn from history. That's what we were saying. Dr. Tedros: (01:25:45) And this is a very dangerous virus and something that is causing serious damages to lives and livelihoods, and this has to stop. The different measures that countries have taken to control the virus have turned the lives of many citizens upside down. Normally, we see its impact on health or on lives, but its impact on livelihoods is even more serious. I know millions have lost their jobs and we know many have lost their livelihoods. And we said it many times, an invisible but a very small virus is causing havoc. Dr. Tedros: (01:26:59) And we said it many times that this should be a humbling moment. This is when we're asking and when we need to really reflect and see humility as the main way to get out of this problem. For any individual person or any nation, weak or strong, poor or rich, it's a humbling situation. That's why we're saying enough is enough. Dr. Tedros: (01:27:43) Our fear is, as we have said, also it's declining in Europe. It's increasing in other parts of the world. And even Europe cannot be safe because the virus can be reintroduced, even to Europe back. No one is safe until everybody's safe. And that's why the unity and solidarity is important. We cannot fight this virus in isolation by looking inside and taking care of our respective countries only. We should think globally too. That's why an addition to the national unity, we need global solidarity to deny the virus any cracks, any division. Dr. Tedros: (01:28:35) The question, Gabriela, you asked is very, very important, and the most important factor in this fight is national unity and solidarity. Otherwise, with the increasing number of cases that we see now, we can say that the virus is actually starting and it will continue to wreak even more havoc, not just lives but the livelihoods. That's why we need unity and solidarity, and fight it together. I thank you. Tarik: (01:29:25) Thank you, Dr. Tedros. Dr. Tedros- Dr. Michael Ryan: (01:29:28) Maybe I could just add some specific data on Mexico. There've been nearly 130,000 confirmed cases in Mexico, with over 15,000 deaths so far. Of the 10 countries reporting the highest number of cases in the last 24 hours, Mexico ranks seventh. And of the 10 countries reporting deaths in the last 24 hours, Mexico ranks third. The situation in Mexico is clearly difficult. It is challenging. And the overall positivity in tests is about 37%. And in that sense, the 37% of those tested are tested positive. Dr. Michael Ryan: (01:30:14) There clearly is that the epidemic, as it is across all of the Americas, four of the top 10 countries reporting cases in the world today are in the Americas, and similarly on deaths. The pandemic is most active in the Americas and highly active in Central and South America. Many, many, many countries are affected, and Mexico is but one. Dr. Michael Ryan: (01:30:38) From that perspective, and as the DG says, there needs to be consistent messages from government at national and sub-national level. I think what we've seen around the world is our citizens get very confused if they perceive that they're getting different messages from different parts of the system. And we really do need to align our messaging and ensure that we're all working together to ensure that our citizens are getting the best possible information to protect themselves and protect their loved ones and their communities. Tarik: (01:31:13) Thank you, Dr. Ryan, for this. Dr. Tedros will have another topic to mention, but we will conclude the press conference as it is. I would also like to thank our guests: Dr. Natalia Kanem, Executive Director UNFPA; Mr. Jayathma Wickramanayake, UN Envoy for Youth; President Gabriela Cuevas Barron of Inter-Parliamentary Union, and Mary-Ann Etiebet, a lead, Merck for Mothers. Tarik: (01:31:45) Audio file from this press briefing will be sent to journalists shortly and the transcript will also be posted. I will give a floor back to Dr. Tedros. Dr. Tedros: (01:32:00) Thank you. Thank you, Tarik. And before I say bon weekend, I would like to say a few worlds about the World Blood Donors Day this coming Sunday. As you know this Sunday is World Blood Donors Day, an occasion to thank and celebrate blood donors all over the world for their selfless contribution to saving and improving lives. Many countries still lack universal access to blood transfusions and blood-related medicines. The COVID-19 pandemic has further reduced the world's blood supply. Our message on World Blood Donor Day is keep donating blood and saving lives. Dr. Tedros: (01:32:52) Giving blood during COVID-19 is safe, provided physical distancing and hygiene measures are respected. Thank you and have a nice weekend, and look forward to seeing you on Monday. And thank you so much for joining us today. Thank you.