World Health Organization Press Conference Transcript April 15

Tarik Jasarevic: (00:00) The flight that's departed out of Addis Ababa, carrying vital COVID-19 medical supplies to African nations. We also shared with you strategic preparedness and response plan for COVID-19. We also had a document that states that alcohol does not protect against COVID-19, and some other documents as well. We will ask journalists, after the opening remarks, to really limit their questions to one per person. And we will try to be short today. Dr. Tedros, please. Dr. Tedros: (00:38) Thank you. Thank you, Tarik. Good morning, good afternoon, and good evening everywhere you are. When the nations of the world met to form the United Nations in 1945, one of the first things they discussed was establishing an organization to protect and promote the health of the world's people. They expressed that desire in the constitution of WHO, which says that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economy, or social condition. That creed remains our vision today. Dr. Tedros: (01:38) The United States of America has been a longstanding and generous friend to WHO, and we hope it will continue to be so. We regret the decision of the President of the United States, to order a hold in funding to the World Health Organization. With support from the people and government of the United States, WHO works to improve the health of many of the world's poorest and most vulnerable people. Dr. Tedros: (02:19) WHO is not only fighting COVID-19, we're also working to address polio, measles, malaria, Ebola, HIV, tuberculosis, malnutrition, cancer, diabetes, mental health, and many other diseases and conditions. We also work with countries to strengths health systems, and improve access to life saving health services. WHO is reviewing the impact of our work, of any withdrawal of US funding, and we work with our partners to fill any financial gaps we face, and to ensure our work continues uninterrupted. Dr. Tedros: (03:07) Our commitment to public health signs and to serving all the people of the world without fear or favor remains absolute. Our mission and mandate are to work with all nations equally without regard to size of their populations or economies. COVID- 19 does not discriminate between rich nations and poor, large nations and small. It does not discriminate between nationalities, ethnicities, or ideologies. Neither do we. This is a time for all of us to be united in our common struggle against a common threat, a dangerous enemy. When we are divided, the virus exploits the cracks between us. We're committed to serving the world as people, and to accountability for the resources with which we're entrusted. In due course, WHO's performance in tackling this pandemic will be reviewed by WHO member states, and the independent bodies that are in place to ensure transparency and accountability. For that matter involving all responders, this is part of the usual process put in place by our members states. No doubt areas for improvement will be identified, and there will be lessons for all of us to learn. But for now, our focus, my focus is on stopping this virus and saving lives. WHO is grateful to the many nations, organizations, and individuals who have expressed their support and commitment to WHO in recent days, including their financial commitment. We welcome this demonstration of global solidarity, because solidarity is the rule of the game do defeat COVID- 19. Dr. Tedros: (05:31) WHO is getting on with the job. We are continuing to study this virus every moment of every day. We're learning from many countries about what works, and we're sharing that information with the world. There are more than 1.5 million enrollments in chose online courses through open who.org. And we will continue to expand this platform to train many more millions so we can fight COVID effectively. Today, we launched a new course for health workers on how to put on and remove personal protective equipment. Every day we bring together thousands of clinicians, epidemiologists, educators, researchers, lab technicians, infection prevention specialists, and others to exchange knowledge on COVID-19. Our technical guidance brings together the most up to date evidence for health ministers, health workers, and individuals. Dr. Tedros: (06:42) Yesterday, I had the honor of speaking to heads of states and government from the ASEAN Plus Three nations, certain countries. It was inspiring to hear their experiences and their commitment to working together to secure a shared future. As a result of their experience with SARS, and avian influenza, these countries have put in place measures and systems that are now helping them to detect and respond to COVID-19. Dr. Tedros: (07:18) We're also continuing to work with partners all over the world to accelerate research and development. More than 90 countries have joined or have expressed interest in joining the solidarity trial. And more than 900 patients have now been enrolled to evaluate the safety and efficacy of four drugs and drug combinations. Three vaccines have already started clinical trials. More than 70 others are in development. And we're working with partners to accelerate the development, production, and distribution of vaccines. Dr. Tedros: (08:03) In addition to the solidarity trial, I'm glad to say that WHO has convened groups of clinicians to look at the impact of corticosteroids and other antiinflammatory drugs on treatment outcomes. Specifically, we're looking at oxygen use and ventilation strategies in patients. Any intervention that reduces the need for ventilation and improves outcomes for critically ill patients is important, especially in low resource settings, to save lives. Dr. Tedros: (08:43) Last week, I announced the United Nations supply chain task force to scale up the distribution of essential medical equipment. Yesterday, the first United Nations solidarity flight took off transporting personal protective equipment, ventilators, and lab supplies to many countries across Africa. The solidarity fly, it is part of a massive effort to ship life-saving medical supplies to 95 countries across the globe in conjunction with the World Food Program and other agencies, including UNICEF, the Global Fund, Garvey, the United Nations Department of Operational Support, Unitaid and others, and Africa CDC, and African Union. Whether it's by land, sea, or air WHO staff are working around the clock to deliver for health workers and communities everywhere. Dr. Tedros: (09:54) I would like to thank the Africa Union, the governments of United Arab Emirates, and Ethiopia, the Jack Ma Foundation, and all our partners for their solidarity with African countries at this critical moment in history. And I would like to thank President Ramaphosa, and the Chairperson of the Africa Commission, Moussa Faki, for their leadership. Dr. Tedros: (10:22) The Solidarity Response Fund has now generated almost 150 million US dollars from 240,000 individuals and organizations. This Saturday, some of the biggest names in music are coming together for the One World Together At Home concert, to generate further funds for The Solidarity Response Fund, but not just to raise funds to bring the world together, because we are one world, one humanity, and fighting a common enemy. And I thank Lady Gaga, the Global Citizen, and all that are participating in putting this concert together. Dr. Tedros: (11:15) We will continue to work with every country and every partner to serve the people of the world with a relentless commitment to science, solutions, and solidarity. I repeat, with a relentless commitment to science, solutions, and solidarity from WHO. Since the beginning, WHO has been fighting the pandemic with every ounce of our soul and spirit. We will continue to do that until the end. That's our commitment to the whole world. I thank you. Tarik Jasarevic: (12:06) Thank you very much, Dr. Tedros for these opening remarks. As you know, we do send these opening remarks with the audio file after the press briefing, but even before that these remarks are posted on our website under Section Speeches Of The Director General, if you wish to get them a little bit earlier. Tarik Jasarevic: (12:28) We will open the floor to questions, but please make sure that your questions are short. And we will take only one per person. So if we are ready, we will try to go first to Dawn Kopecki from NBC. Dawn, can you hear us? Dawn Kopecki: (12:47) Yes. Can you hear me? Tarik Jasarevic: (12:48) Yes, please go ahead. Dawn Kopecki: (12:49) Hello, can you hear me? Hi, thank you for taking my question. My question is about funding. How much exactly does the United States government, not including the Gates Foundation or private contributions, the government provides WHO a year? How much have they already sent you, and how much is at stake that Trump is withholding or threatening to withhold? How does that affect your program? Dr. Tedros: (13:22) So I have said it in my statement, we're assessing how our programs will be affected. And not only that, we will try to fill any gaps with partners, so we will get back to you after our assessment is completed. Thank you. Tarik Jasarevic: (13:45) Thank you very much, Dawn. Let me just see who do we have next in line? Yes, okay. So we will go now to our colleague from Geneva Press Corps, [Jon Zagga Costas 00:14:05], who works for The Lancet and France 24, if I'm not mistaken. Jon, can you hear us? Jon Zagga Costas: (14:12) Yes, I can hear you. Can you hit me Tarik? Tarik Jasarevic: (14:13) Yes, please go ahead. Jon Zagga Costas: (14:15) Yes, good afternoon Dr. Tedros. I was wondering, sir, you just mentioned you're looking at the assessment on the short fall in funding. Looking at your 2020/2021 budget, it looks like the short fall would be around $115 million from the United States for 2020. Can you get the money from partners? Or will you be forced, as you're allowed under WHO rules, to transfer funds from other programs, up to 5% of earmarked funds? Thank you sir. Dr. Tedros: (14:49) So I will repeat what I said again. We will do the assessment and then announce it officially. Thank you. Tarik Jasarevic: (15:02) Thank you. Thank you very much, Director General. Now we will go to also our friend who is often here in Geneva, [Shoko 00:15:11] from NHK. Shoko, please? Shoko: (15:15) Hi Tarik, can you hear me? Tarik Jasarevic: (15:17) Yes, we can hear you. Shoko: (15:19) Okay. Dr. Tedros, US Department of State says our information by Taiwan on isolated treatment in Wuhan was withheld from global community by WHO. And they also criticized WHO for choosing politics over global health. How do you respond to such criticism? Thank you. Tarik Jasarevic: (15:45) The best, but I think the question was about Taiwan and isolating Taiwan. Dr. Michael J. Ryan: (15:50) Maybe I could just start off on the technical, maybe [Steve 00:15:52], or will take up the issue around working with Taiwan. But with the specific issue of reports. There were multiple sources of reports on the 31st. Dr. Michael J. Ryan: (16:03) ... multiple sources of reports on the 31st of December regarding a cluster of cases of atypical pneumonia in Wuhan, China. In fact, they emanated from a press release or a publication on the website of the Wuhan Health Authority and it was from that publication that many agencies, including our own epidemic intelligence from open sources and I believe [inaudible 00:00:25], I believe others picked up on that. There was a flurry of communications between various agencies to verify that signal. It was WHO then who moved to formally verify that signal through our country office with the government authorities in China. Tarik Jasarevic: (16:49) Just maybe to introduce, we have our colleague Steve Solomon, principle legal officer, who will also add something on this topic. Steve Solomon: (16:59) Thank you. Thank you, Tarik. Let me, let me address this larger issue of the question that was just asked. I'd like to do so in two parts by addressing, on the one hand, WHO's technical health mandate and on the other hand WHO's status as an international organization composed of countries. Steve Solomon: (17:22) On the one hand there is WHO staff, the doctors, the scientists, the researchers among many others. They focus on technical and operational public health work. On the other hand there are the countries, that is the member states. The member states decide on the political issues like membership, like observer-ship. They, these 194 members states of the World Health Organization, they set the policies of the organization. In that connection, the policies within our organization, it's important to understand that WHO is very much part of the United Nations. In 1971, the countries of the United Nations decided to recognize the people's Republic of China as the only legitimate representative of China. One year later, in 1972, the member states of the World Health Organization decided in resolution 25.1 to do the same thing, and this has been the official position of the United Nations since 1971. Steve Solomon: (18:27) WHO is the specialized health agency of the United Nations and as such aligns with the United Nations and must do so coherently. We are in the hands of countries on these issues. WHO staff doesn't have the mandate or power to change that. Our mandate is to work to promote the health of all people everywhere. We do this, again, as described by DG, without distinction of race, religion, political belief, economic or social condition. This is part of the DNA of the organization. It is literally written into the opening paragraphs of the WHO constitution. This means we work with and for all people everywhere, whether they are in Taiwan, China or any other place. Steve Solomon: (19:24) I'd like to provide some examples of the well-established arrangements for Taiwan's health experts working with WHO. I'd like first to give five examples of activities in the context of the COVID-19 response and then five more examples of activities in a wider context, so 10 in all. But I will keep this concise. Steve Solomon: (19:47) In the context of the pandemic, first for the International Health Regulations, the IHR, Taiwan has a formal point of contact, a focal point. The IHR is the international treaty which guides and regulates the global health response. Taiwan's IHR point of contact receives communications and provides information directly to WHO headquarters. It also has full access to the IHR event information site system and, in a recent development, all IHR contact points have access through that system to the weekly information sessions from headquarters. Steve Solomon: (20:27) Second, their health experts participate in two key WHO network set up in January to support WHO's work in the global response. Three of their experts are part of WHO's IPC network, the Infection Prevention and Control network. Two of their experts are part of WHO's clinical management network. Every week they join a WHO, teleconference sometimes twice a week, with scores of other experts from around the globe working to advance our knowledge and our guidance in the response. Steve Solomon: (21:03) Third, two of Taiwan's health experts participated in the WHO global research and innovation forum that was organized in mid-February with scientists participating from around the world. Steve Solomon: (21:16) Forth, WHO has briefed and discussed their response with their health authorities in Taipei. Dr. Van Kerkhove and I spoke with them by phone in February and again earlier today and work is underway to do so again. Dr. Van Kerkhove may want to comment on that in a moment. Steve Solomon: (21:36) Fifth, WHO also interacts with their health authorities through the European centers for disease prevention and control. Steve Solomon: (21:44) Those are some examples related to the pandemic. There are five additional examples I'd like to share with you on a range of other health-related issues. Steve Solomon: (21:55) First, over the course of last year, 2019, Taiwan's experts attended eight WHO expert meetings, more than one every other month. The issues they worked on included immunization, drug-resistant TB, vaccine safety, noncommunicable diseases, and mental health. Work is underway for more of this kind of expert participation in 2020 as well. Steve Solomon: (22:22) Second, on influenza, a Taiwanese vaccine manufacturer at Altimmune Corporation contributes to the WHO Pandemic Influenza Preparedness framework. The PIP framework is a critical access and benefit sharing framework for pandemic flu. Steve Solomon: (22:39) Third, in the fight against cancer, their experts have contributed articles published in WHO's international agency for research on cancer publications. Specifically, their articles have appeared in the authoritative WHO IR blue book on classification of tumors. Steve Solomon: (22:59) Fourth, in support of the IHR mechanisms ongoing, one of their leading public health experts is included in the prestigious IHR experts roster. Steve Solomon: (23:12) Fifth, on issues from pharmaceutical manufacturing to malaria, we have exchanges on practical and technical issues. Steve Solomon: (23:21) Those are 10 examples that underscores the principle that WHO works with all people everywhere. I'd like to add that this work contributes to WHO, to the response, and to WHO's work in many areas of global public health. Steve Solomon: (23:37) I hope that this information clarifies how WHO works together with Taiwan's experts and health authorities, and I'd like to offer to Dr. Van Kerkhove any opportunity to continue comment on today's discussions. Thanks. Dr. Maria Van Kerkhove: (23:55) Thank you, Steve. Just briefly, yes, I had the opportunity to brief scientists and public health professionals from Taiwan and it's always a wonderful opportunity to exchange with any frontline workers, anyone who's involved with this pandemic, to learn from them, to exchange information and how all of this information adds to our understanding of this previously unknown virus. Dr. Maria Van Kerkhove: (24:19) There were two exchanges that I personally participated in, and I'm very grateful for that. They also participate in our clinical networks and our infection prevention and control networks. Again, having a direct exchange with peers from all over the world, and that is another example of how WHO brings together people all over the world to share experiences which is always very critical early on in an epidemic or pandemic when a lot is unknown. This is a great opportunity to be able to exchange and learn and feed that into our guidance. Dr. Maria Van Kerkhove: (24:54) That's what I like to add. Thank you. Tarik Jasarevic: (24:59) Thank you very much for this comprehensive answer. This was Steve Solomon, WHO principle legal officer. We apologize that we didn't have a name plate, but we will surely send the name when we send out the audio file. Tarik Jasarevic: (25:13) We will now continue with questions. We go to a Russian news agency, Interfax. We have Irina with us. Irina, can you hear us? Irina: (25:23) Yes. Can you hear me? Tarik Jasarevic: (25:24) Yes, please go ahead. Irina: (25:27) Are you planning to discuss the budget issue with other countries particularly with Russia? Tarik Jasarevic: (25:36) Irina, can you please repeat the question? We only understood, did we discuss with Russia, but what exactly? Dr. Michael J. Ryan: (25:45) The budget. Irina: (25:46) Yeah. Are you planning to discuss the budget issue with other countries including Russia? Tarik Jasarevic: (25:49) Thank you. Dr. Michael J. Ryan: (25:51) The WHO, part of its governing bodies, has a number of mechanisms for discussing budgets with our member states and our program budget committee, our executive board and the world health assembly itself. I'm sure in the coming weeks and months those opportunities will arise as those governing body meetings emerge. As the director general said, we are laser-focused on doing a very important job right now and that is suppressing this virus and saving lives. Tarik Jasarevic: (26:22) Thank you very much for this answer, question that came from Irina Interfax Agency. We will now go to Chile. Marcello from Chile, [Spanish 00:26:32] newspaper. Can you hear us, Marcello? Marcello: (26:39) Hi. Hello. How are you? Can you hear me? Tarik Jasarevic: (26:41) Yes, we are all very well. Please go ahead, Marcello. Marcello: (26:45) Thanks you so much and good morning, Doctor. In Chile there is several city in quarantine [inaudible 00:26:51] it will be 20 days old. My question is, is it recommendable to keep this measure thinking about the population mental health? Dr. Michael J. Ryan: (27:05) Thank you. If I understand your question, you said, is it okay to keep these measures while considering people's mental health? Dr. Michael J. Ryan: (27:12) That's an important consideration. There is no doubt that restrictive measures stay-at-home orders, restriction of movement has been quite isolating for people, and all the more isolating for people who are already isolated or vulnerable. Therefore, as we have always said, lockdowns in their own right are not a solution. But they have, those population-wide physical distancing measures, have proved quite effective in countries where there has been a rapid escalation of cases, sometimes as a result of not being as successful in containing the disease in the first place. Those measures have served to suppress some of the transmission. We have said in our strategy that was released yesterday, we'll be releasing further technical guidance later today, tomorrow, on the transition strategies that countries have. We do note that in Chile and in other countries in South America there's been an acceleration in infections and it did require measures such as that. But those measures need to be replaced with strong public health intervention case finding, testing, contact tracing, quarantine, community engagement and in some ways a new norm where communities, all of us, are going to have to adapt to new ways of behavior, new ways of interacting with each other while we continue to suppress the virus and while we search for a vaccine and and therapeutics that will help us to truly suppress both the number of cases and the mortality associated with this virus. Dr. Michael J. Ryan: (28:52) Mental health, we have issued guidance on mental health and how to manage mental health. It's been one of the big issues as you've seen in social media. There's a huge outpouring of support for people. I think communities are supporting each other. There's been an incredible outpouring of solidarity between people. While we may be physically isolated, I actually have seen amazing stories of us not being socially isolated. It is tough. It's not easy and it's something we must endure. We must endure until we have in place the other measures to suppress this disease. Dr. Michael J. Ryan: (29:31) We've said it very clearly to governments, we must work really hard now to accelerate the investments we need in public health infrastructure and in community engagement and education and having a hospital system capable of dealing with cases. If we do that, we will be able to make our way out of these more draconian lockdowns. This is something that the World Health Organization wants saw badly with the rest of the world. Dr. Maria Van Kerkhove: (29:59) Yes. Thank you. As you've heard us say, we've stopped saying social distance, we've been saying physical distancing because it's important to remain physically separate but socially connected. There's a lot of ways that you can look after your own mental health and the mental health of your family during these very difficult times. Whether you are adhering to a stay-at-home order or you are isolated yourself, there's a lot of things that you can do. There's no lockdown on laughter. There's no lockdown on talking to your family and finding ways to connect. And especially through different religious periods that are coming up, there's ways in which you can connect with family using technology that you may not have used previously. Dr. Maria Van Kerkhove: (30:40) Make sure you exercise any way that you can, whether it's at home and doing a class, whether it's doing yoga, something to keep yourself physically active. Make sure you, if you meditate, find ways to meditate or find ways to turn the news off and have some time for yourself, listen to some music, read a story, play with your kids. Just find ways in which you can remain socially connected with others while you're remaining physically apart. Tarik Jasarevic: (31:14) Thank you very much, Dr. Van Kerkhove and Dr. Ryan. From Chile, we go to Pakistan. We have from [Neeha Dagia 00:15:16] from Express Tribune. Tarik Jasarevic: (31:19) Can you hear us? Neeha? Neeha Dagia: (31:23) Hi, Chris. My question is, there's a looming threat of the virus spreading in the slums, but Pakistan's negative responsive ratio is quite high, what do you think the government can do to ensure that it is testing the right people? Do you think that [inaudible 00:31:40] the WHO influenza surveillance can help in detecting communities spread? Dr. Michael J. Ryan: (31:52) Certainly. Taking your second question first, there's no question that influenza surveillance systems not only can be used in detecting community spread, but are being used very much- Dr. Michael J. Ryan: (32:03) ... Community spread but are being used very much all over the world and are proving very effective at picking up signals that the disease is at community level. Maria can speak a little bit more on the numbers around that. But the ILI surveillance systems that have been developed over the years by the global influenza surveillance and response system, which has been in place for over 50 years and it's protected the world against pandemic influenza and certainly much progress has been made in retooling that system to keep a sentinel watch as the disease spreads in communities. That whole system is no capable of doing systematic testing. Not only is it testing all its samples for influenza, it's also testing those samples for SARS-CoV-2, which is the virus that COVID-19. Dr. Michael J. Ryan: (32:56) With regard to Pakistan itself, it is very, it is a challenge in a country like Pakistan. I spent two and a half, nearly three years in Pakistan working on polio eradication. I've been in Karachi, I've been in Lahore, I've been in Baluchistan, I've been in Peshawar, in working in some of the poorest communities on polio eradication. I personally know the challenge that Pakistan faces in delivering an effective public health intervention in those circumstances. The structure of the response in Pakistan is quite well laid out with the National Disaster Management Agency. I know that the polio program in Pakistan has been very much retooled to support the response there. But there are limitations in the slums in Karachi, it's very difficult for people to social distance, lockdowns do cause hardships. It's really important that government, NGOs, and others are working to support local communities when they are suffering, both the threat of COVID but also the consequence of restrictions of movement and other things. Dr. Michael J. Ryan: (34:08) Pakistan continues to carry out good surveillance and has had one of the most effective surveillance systems for polio in the world and not only a surveillance system for the virus but has been doing extremely good environmental surveillance and other surveillance for polio viruses over a large number of years. The national Institute for Health, and the Aga Khan University, and others are very competent research facility outfits, and they are great public health leaders in Pakistan, like Rana Safdar and many others who can offer their leadership to Pakistan needs on the science side. And we trust that the government is coming together both at national and provincial level to provide the kind of leadership needed. Thank you. Dr. Maria Van Kerkhove: (35:01) So to add to that, so yes, we initiated a pilot study a few months back or a month back, which was trying to utilize the existing respiratory disease surveillance systems in countries for COVID-19. So in countries all across the world there are national influenza centers, these are the laboratories that test for flu and for other respiratory pathogens to use that basis to test for COVID-19. So that was building on an existing network. Dr. Maria Van Kerkhove: (35:29) In addition to that, what we started a few weeks ago was about looking at these samples that were collected, that were being tested for influenza to check if they had COVID-19. And so now we have this up and running in a number of sites where we're looking to see what is the percent positive among those samples for COVID-19 versus influenza. This is helping us track the trends for influenza in the Northern Hemisphere where the winter season is ending and also in the Southern Hemisphere where their winter season is just beginning. That could help us distinguish between COVID-19 patients and influenza patients. Dr. Maria Van Kerkhove: (36:05) In addition, Pakistan in particular, we're working with our country office who are working with partners there to actually consider conducting a serologic survey, as well. So they're going one step beyond that to actually look for the extent of infection from individuals who may be missed by surveillance systems entirely using serologic assays. So there's a number of different ways that you can look for cases there, using our recommendations for testing all suspect cases for COVID-19 and contacts who have symptoms, utilizing the ILI or the influenza like illness surveillance system that exists in many countries, and also doing serologic studies. Speaker 1: (36:47) Thank you very much. From Pakistan, we go to Azerbaijan where we have [Kamaron 00:36:53] from [inaudible 00:36:54] TV, Kamaron can you hear us? Speaker 2: (36:57) Yes, yes. Hello. First of all, I know last week Mr. Director General, Mr. Tedros participate in the meeting of Turkish language countries and I want that, what do you appreciate in situation in Azerbaijan. Because for example today we have 56 new cases and 53 recovered. What do you think about that? What do you appreciate about situation in Azerbaijan, Director General? Speaker 1: (37:38) Thank you for Kamaron for your question. Dr. Michael J. Ryan: (37:40) I can speak to the situation in Azerbaijan. Maybe the Director General may want to comment on his meeting with the Turkish leadership in the last week. Dr. Michael J. Ryan: (37:51) The number of cases in Azerbaijan as of today is a 1,148 and that is a relatively low number giving the numbers you've seen around the world. There's been a total of 12 deaths. What is a concern is that the number of cases over the last week has increased by 80%. Now we've seen much bigger increases in other countries. It's not in the red zone for increase over 100% per week, but it's certainly not in the green zone either. So the trajectory of the epidemic in Azerbaijan, while it's stable is still on the upward side. Dr. Michael J. Ryan: (38:25) So Azerbaijan will have to be very careful in the coming weeks to ensure that it applies the best possible control measures, good case finding, contact tracing, isolation, quarantine, and focuses on very strong public education on hygiene, on physical distancing. If it does that, Azerbaijan has an opportunity to keep that curve flat. Not to flatten the curve, but to keep that curve flat. But at the moment Azerbaijan is between an exponential situation and a very, very stable situation. So more work to do, but if the right measures are applied we believe Azerbaijan can remain on a safe trajectory. Director General. Okay. Dr. Tedros: (39:09) Thank you very much, Dr. Ryan. Speaker 1: (39:10) [inaudible 00:39:11]. Dr. Tedros: (39:13) I would like to add to that is the regional cooperation we see in the Turkic speaking countries, Turkey council, is very important. We have seen the same thing in the ASEAN Plus Three I have attended the meeting of the heads of states this week. And the Africa Union, the Caribbean, Latin American countries, that kind of regional cooperation is very important. That could lead us into global cooperation, too. Dr. Tedros: (39:56) So you have unity at the national level, and then regional cooperation, then the global solidarity that can really help us to fight this virus more effectively and efficiently. Speaker 1: (40:13) Thank you very much. We will go now to Helen Braswell from STAT. Helen, can you hear us? Helen Braswell: (40:22) I was hoping maybe Maria or Mike could give us some information about serology testing. I know that a number of countries have been starting to do this work. Is there any picture yet of how good the serology tests are, how reliable they are, and what is being seen in the testing that has been done to date? Dr. Maria Van Kerkhove: (40:49) So, hi Helen. Yeah, I will start with this and perhaps Mike would like to add. So yes, we are working with a number of countries across the globe on looking at the use of serologic testing for COVID-19. So as you know there are a large number of rapid tests that are available now commercially to purchase and we're working with FIND and we're working with labs that have experienced with coronaviruses to look at validation of those with well-characterized Sera. It's important for us to be able to evaluate how these actually work with clinical samples. So, that is a process that is ongoing. Dr. Maria Van Kerkhove: (41:23) There are a number of countries right now that are conducting serologic studies, which are looking either at stored samples that were collected throughout this pandemic for other clinical reasons, blood bank, blood donations, or are doing these studies prospectively. Today we had a teleconference with 160 groups, 160 people, who are working with us on our early investigations, which we're calling the unity studies now. These are early epidemiologic investigations that focus on cases and contacts, that focus on healthcare workers, that's a separate protocol, a separate protocol for household transmission, and a fourth protocol looking at age, population based sera surveys. Dr. Maria Van Kerkhove: (42:07) We had a call with them today to see where they are. We have more than 40 countries who are utilizing these core protocols in their own countries, and we're starting to see some results from some of them from the molecular testing, not yet from the serology. And they're asking us what are the tests that we can use. So we're working very hard to validate those tests so that we can be able to say here are four or five serologic assays that could be used so that we can have a better readout on how they actually work. Dr. Maria Van Kerkhove: (42:33) In addition to that, we have another serologic solidarity study. It's called the solidarity two study, which is working to estimate global sera prevalence and the first thing that this study is doing, it's called solidarity two. It's working on pulling together a serum panel, a standardized serum panel, across the globe so that they could standardize assays and that they can use one protocol to estimate global sera prevalence. That is a process that is ongoing and we're hoping that we will get some results from that in the coming months. Dr. Maria Van Kerkhove: (43:05) Having said that, there are some serologic studies that we're now starting to see being published. Unfortunately, I haven't seen full papers of these using full methodology. I've seen a study from Denmark, I've seen a study from Germany suggesting around at 3.5 to 14% sera prevalence. We need to really understand the methods that were used, the assays that were used in terms of their sensitivity and specificity before we can have a good understanding of what this actually means. But of course these numbers are lower, the sera prevalence in these two studies which is not representative globally are lower than I think what many people were expecting. Certainly lower than what some of the models had predicted. Dr. Maria Van Kerkhove: (43:47) But we're working with our partners to understand what all of this means in terms of our understanding of the epidemic waves that may happen with this pandemic virus. Dr. Maria Van Kerkhove: (43:57) Mike? Dr. Michael J. Ryan: (43:59) And just to add Helen, and Maria is there really speaking where sera epidemiologic studies, where the testing is done and validated labs as well. Where the testing is benched on in labs. There is a whole other world of rapid diagnostic test or point of care diagnostics and people are talking very much about can we do the diagnosis at the bedside, either a PCR based or there are new diagnostic tests based on antigen detection. And what they do is they detect the proteins of the virus in the sample. Or rapid diagnostic test based on the antibody that's developed by the body in response to the virus. And there's a lot of very important innovation going on in that space, but there are real... Dr. Michael J. Ryan: (44:46) We need to be very, very careful antigen tests the sensitivity of those tests can be low. In other words, they may pick up anything from 30 to 80% of true infections. In other words, you can have people who get a negative test who actually have had the infection. The same with some of the antibody tests. Dr. Michael J. Ryan: (45:03) The important consideration with antibody tests is that many people take up to two weeks or more to develop the antibodies in response to having the infection, so they could actually turn out to be negative on the antibody test but actually have had the infection. Dr. Michael J. Ryan: (45:17) Now, none of those are barriers to introducing these products as part of a comprehensive strategy, but we do need to be careful to ensure that introducing rapid test is done as part of a comprehensive diagnostic strategy, a comprehensive testing strategy, and where governments can have validated tests that they introduce into the system in a way that adds to the control of the virus, that adds to surveillance, that adds to diagnosis and doesn't cause unnecessary confusion. And many governments around the world are doing that just now. Speaker 1: (45:51) Thank you very much for this. Next question is from FA News Agency, we have Antonio. Antonio, can you hear us? Antonio: (46:00) Good afternoon. Speaker 1: (46:01) Good afternoon. Antonio: (46:01) Yes. Thank you for taking my question. So the main accusations of the U.S. President to WHO are that the organization failed to confirm in the first weeks of January, that there was human to human transmission and also that it opposed flight restrictions from China to U.S. and other countries. What has WHO to say in its defense? Dr. Michael J. Ryan: (46:39) As the DG said, we will be examining all of the actions taken by everybody on this. So in that sense, the idea of having a defense at this point seems rather strange. In the first weeks of January WHO was very, very clear, we alerted the world in January the 5th. Systems around the world, including the U.S. began to activate their incident management systems on January the 6th. And through the next number of weeks, we've produced multiple updates to countries, including briefing multiple governments, multiple scientists around the world on the developing situation. And that is what it was, a developing situation. Dr. Michael J. Ryan: (47:21) The virus was identified on January the 7th. The sequence was shared, I think on the 12th with the world. We're dealing with a completely new virus. All potential respiratory pathogens in the initial reports in which there were no mention of human to human transmission, it was a cluster of atypical pneumonia or pneumonia with unknown origin. There are literally millions and millions of cases of atypical pneumonia around the world every year, and in the middle of an influenza season. Sometimes it's very difficult to pick out a signal of a cluster of cases. In fact, it's quite remarkable that- Dr. Michael J. Ryan: (48:03) To pick out a signal of a cluster of cases. In fact, it's quite remarkable that such a cluster was picked out. 41 confirmed cases, ultimately, in a cluster in Wuhan. There is always a risk with a respiratory pathogen that it can move from person to person. We've seen with MERS for example. It can spread from person to person, but in very particular environments, as we've seen. In an occupational environment, in healthcare environments. And when WHO issued it's first guidance to countries, it was extremely clear that respiratory precautions should be taken in dealing with patients with this disease, that labs needed to be careful in terms of their precautions in taking samples because there was a risk that the disease could spread from person to person in those environments. There is a difference between the potential for human to human transmission. For example, avian influenza, H5N1, can spread from person to person, but it doesn't spread efficiently in community settings. It can spread in specific settings like at family, occupational, or healthcare environment, but it doesn't tend to spread at community level. The determination was not whether or not human to human transmission was occurring, the determination was, was the virus spreading efficiently at community level outside those environments? And that is not an easy determination to make and one has to make that very carefully. Dr. Michael J. Ryan: (49:28) So from that perspective, we'll be very happy when the after action reviews come. In fact, I am very anxious for those after action reviews to come because we do them for every outbreak response and I'll be delighted with our teams and look forward to that engagement, to look and see where we can learn to do better, where we can improve our response. With regards to flight restrictions, and I've certainly been on the record on a number of occasions saying that the implication or the imposition of flight restrictions by countries is the sovereign right of any member state. WHO does not control the law on this. WHO only function under the IHR is to challenge member states who put in place restrictions to ensure that they have a public health justification for imposing those restrictions. And that we are bound, then, to share those justifications with other countries who may be affected by those flight restrictions. That is the role of WHO, to ensure that restrictions on flights are public health based, evidence-based, limited to controlling the disease, have a balanced impact on travel and trade, and are short lived and only of origination to control the public health events of concern. So that's the framework. The International Health Regulations is a framework negotiated by 194 countries. We simply implement that framework on behalf of our member states. Dr. Maria Van Kerkhove: (51:13) So just to add to that, so exactly as Mike said, in the beginning of an outbreak, I actually went back and listened to my press conference on the 14th of January because it was a significant event for me. It was my first press conference I've ever done. But in terms of the outbreak itself, I laid out what are the things we need to know? And at the time, there were 41 confirmed cases. And Terrick was with me at that press conference. And what I outlined were six things. Dr. Maria Van Kerkhove: (51:40) I outlined what is the pathogen? How do we identify what this is? And at the time, we had learned that it was a novel coronavirus and that sequence was shared that the pathogen was identified. It hadn't been shared yet. Or I'm sorry, it was shared on the 12th of January. We needed to know the source of the outbreak. How were people getting infected, including a possible animal source? Because all of our experience with other coronaviruses and emerging respiratory pathogens, most of those come from an animal source. We call those a zoonotic spillover event. We needed to know what disease it causes and how to care for people. We needed to know the modes of transmission, including if there is any human to human transmission, what is the extent of transmission? We needed to know how to limit exposure and what to do. What is the extensive infection? Dr. Maria Van Kerkhove: (52:26) And so all of our guidance that was out before we did that press conference was about limiting exposure to people and to prevent transmission, particularly in healthcare settings because all of our experience with SARS and with MERS showed that those viruses could have explosive transmission and amplification in healthcare facilities. And so we wanted to ensure that frontline workers were protected. And so our guidance that was put out was about respiratory droplets and contact protection. And so all of that was out on the 10th and the 11th of January. Tarik Jasarevic: (53:03) Thank you very much. I do remember that press conference and I was going through my emails too. We was talking and replying to some of you who asking questions as of January second. Next question is for Karen from World Health Alert Crisis. Karen, can you hear us? Karen Wilson: (53:23) Yes, I can. Can you hear me? Tarik Jasarevic: (53:25) Yes, please go ahead. Karen Wilson: (53:27) Good afternoon. My name is Karen Wilson from the World's Health Alert Crisis. I just want to say the World Health Organization is doing so much to support countries through the COVID-19 pandemic and other diseases. I want to know what individuals, companies, and organizations can do right now to help protect those who work for the WHO, who are doing such wonderful work and show, in my view, so much humanity? And I want Tedros, Dr. Ryan, and Dr. Kerkhove, and all of your colleagues to know how much gratitude so many people in the country, in the UK where I'm from, and all over the world have for all of you. Please remember that. Please. Karen Wilson: (54:27) I want to also just add quickly that, as Tedros says, unity seems more important than ever. And I've actually discovered looking, I normally write news and analysis, but I've also discovered a very big issue. After looking at a massive data from cities worst hit around the world by COVID-19, I've discover these cities all have exceptionally high humidity levels, rising temperatures, and carbon dioxide of very high levels during the outbreaks. And I am not a climate person, but I've actually alarmed and now believe this is to do with global warming. And I've uploaded, as a result, the study to YouTube for everyone to read and maybe add to because I've realized that perhaps there's a much longer term issue that the world needs to address to reduce humidity and pollution to help reduce the risk of triggering more disease. Because I understand, I'll just continue a little bit, that COVID-19 appears to be triggered or not the onset, but the outbreaks, by wet and humid conditions, very much like malaria. Karen Wilson: (55:51) But my question really is what can we do to help you? Because I would like to create a human shield around you, but that's not possible. And I want to know if there's anything the world can do for the organization that is guiding us. Thank you. Tarik Jasarevic: (56:10) Thank you very much, Karen, for these nice words. Dr. Michael J. Ryan: (56:13) Yes, thank you very much. I think what we need in WHO, like so many workers around the world, is the space, the support, and the solidarity to do our jobs. And there are so many thousands of brave frontline workers all over the world doing that today. Our solidarity is with them. We thank communities and others. Dr. Michael J. Ryan: (56:40) Some specifics, companies, organizations, everyone's spoken about this, everyone's involved. This is all hands on deck, all hands on deck. And today, this director general was in a meeting with World Economic Forum business leaders, talking with them about how they can contribute. We're talking with vaccine manufacturers, we're talking with supply chain managers, we're talking with companies in the pandemic supply chain network around stabilizing supply chains for supplies and everything else. We're talking to producers of medical oxygen. We're talking to people who make ventilators and who can adapt technology for use in low resource settings. This is a moment where the public and the private sector, there is no public, there is no private sector. There is a combined effort to get rid of this virus and everyone has something to bring to the table. Everybody has something to bring. We try to not control or direct that. What we try to do is create the forums, to create the convening power, to create the mechanisms by which others can innovate, others can be successful. And we try to direct that energy in the best possible way through good policymaking and using science to drive what we do. Science solutions and solidarity. With regard to climate, there is no question that the climate and climate variability is driving infectious disease risk around the world. There are many diseases that are climate sensitive. We've seen outbreaks of cholera all around the world that are either related to flooding or related to drought. They're either related to too much water, too little water. We have literally billions of people living in peri-urban poor environments. And in many ways, unfortunately those populations are almost like kindling for a fire. And not just a fire of COVID, but any other number of diseases of future. We can't afford to leave people in overcrowded, underserved conditions in such densely packed environments. This is a risk. It's not only a political and a social risk, it is clearly an infectious disease risk going into the future. Part of the reason that we can't eradicate polio so far is because that virus can become entrenched in those very environments that we're speaking about Pakistan earlier. Pakistan has had a real struggle in clearing infections from large urban environments. Dr. Michael J. Ryan: (59:14) The direct impacts of climate on coronavirus incidents are not known yet. We do simply do not know what the impacts of humidity, temperature, and other factors are on this particular virus. We do know that other viral pathogens are affected and often occur in seasonal epidemics. The extent to which climate and humidity and other cold affect that are in some cases well known, in other cases not so well known. But in this particular case, we don't know yet. And quite frankly, I'd much prefer, in some senses, never to know. I will prefer to get rid of this disease than have to wait around long enough to know. But we may have to learn how to live with this virus. And we will certainly have to learn how to control this virus in high density urban settings. It's all you. Dr. Maria Van Kerkhove: (01:00:07) Only to add to that. So Karen, thank you for your very kind words and for all of the kind words that we've received since the start of this. It's very nice to hear. With regards to humidity and temperature, and if you remember, this began in very cold temperature, very dry temperature, very dry, low level humidity. And we are seeing this virus have the capability to accelerate in a number of different climates. As Mike said, we don't know how this virus is impacted completely yet. It's still new. We're still in the early stages of this pandemic in our fourth month and we need to treat this virus everywhere it shows up as aggressively as we can so we don't give it a chance to take off. Tarik Jasarevic: (01:00:49) Thank you very much. So I think we may conclude here. We had a number of good questions and we hope that we will take all those who are still pending. And I apologize, really, to a number of journalists who were contacting me directly and my colleagues and who were in queue. But we will try to get opportunity to everyone to ask a question at one of the next briefings. We will send the audio file from this press conference in next hour together with the name of our principal legal officer, Steve Solomon. I wish you a very nice evening. And then I'm sure Dr. Tedros will tells us when do we see each other again? Dr. Tedros: (01:01:46) So I'll see you on Friday.